Management of recurrent localised bladder amyloid, has methotrexate helped?

Background

Amyloidosis of the bladder is a benign condition which can present with a multitude of symptoms including bladder mass, irritative voiding symptoms and haematuria.

Case presentation

We report on the investigation and management of a patient with recurrent localised amyloidosis of the bladder, which appears to have been managed fortuitously by concurrent methotrexate prescribed for another indication.

Conclusion

We provide further assessment and management with a focus on the possible benefit of methotrexate for management of localised bladder amyloidosis.

A Prospective, Observational, Multicenter Study Assessing Adherence to Interferon Beta-1b Therapy and Patient Satisfaction Using the BETACONNECT Auto-Injector

Introduction

It is important to achieve good persistence and adherence to disease-modifying therapies (DMTs) to achieve the best outcomes in chronic diseases such as multiple sclerosis (MS). The BETACONNECT device is an electronic auto-injector for the DMT interferon beta-1b (Betaseron), designed to improve patients’ injection experience and to monitor adherence. This observational study aimed to assess patient adherence to and persistence with interferon beta-1b therapy as well as patient-reported satisfaction in a US population.

Methods

A prospective, observational, multicenter study was conducted in 146 adult patients with relapsing–remitting MS or clinically isolated syndrome, newly prescribed or currently established on interferon beta-1b therapy and naïve to the BETACONNECT device, and followed up during a 6-month observation period.

Results

Among the 91 patients who completed the study, the overall mean adherence rate was 82.5%, with 65.9% of patients adherent for at least 80% for the duration of the 6-month period. At 6 months, 98.9% of patients had less than a 60-day gap in therapy. Of the 115 patients who provided satisfaction data, 90.5% of patients were either very satisfied or satisfied with the BETACONNECT device.

Conclusion

This study shows that the BETACONNECT device was associated with high adherence to interferon beta-1b therapy in patients with MS. Patients also reported high degrees of satisfaction with the device. Therefore, this may be a viable delivery option to help with adherence and persistence, potentially leading to improved clinical outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40120-022-00323-1.

World Small Animal Veterinary Association Global Dental Guidelines

Dental, oral, and maxillofacial diseases are some of the most common problems in small animal veterinary practice. These conditions create significant pain as well as localized and potentially systemic infection. As such, the World Small Animal Veterinary Association (WSAVA) believes that un- and under treated oral and dental diseases pose a significant animal welfare concern. Dentistry is an area of veterinary medicine which is still widely ignored and is subject to many myths and misconceptions. Effective teaching of veterinary dentistry in the veterinary school is the key to progression in this field of veterinary medicine, and to the improvement of welfare for all our patients globally. These guidelines were developed to provide veterinarians with the information required to understand best practices for dental therapy and create realistic minimum standards of care. Using the three-tiered continuing education system of WSAVA, the guidelines make global equipment and therapeutic recommendations and highlight the anaesthetic and welfare requirements for small animal patients. This document contains information on common oral and dental pathologies, diagnostic procedures (an easily implementable and repeatable scoring system for dental health, dental radiography and radiology) and treatments (periodontal therapy, extractions). Further, there are sections on anaesthesia and pain management for dental procedures, home dental care, nutritional information, and recommendations on the role of the universities in improving veterinary dentistry. A discussion of the deleterious effects of anaesthesia free dentistry (AFD) is included, as this procedure is ineffective at best and damaging at worst. Throughout the document the negative effects of undiagnosed and/or treated dental disease on the health and well-being of our patients, and how this equates to an animal welfare issue, is discussed.

Liquid Chromatographic Method for Determination of Diquat and Paraquat Herbicides in Potatoes: Collaborative Study

A liquid chromatographic (LC) method for the determination of diquat and paraquat herbicides/desiccants in potatoes was collaboratively studied in 6 laboratories. Analytes are extracted from 5 g sample with dilute acid by using a microreflux procedure; the hydrolysate is adjusted to pH 9–10 and passed through a disposable silica cartridge for rapid cleanup and preconcentration. Analytes are separated on a reversed-phase LC column and are measured as their heptanesulfonate ion pairs by UV detection. Each collaborator determined diquat and paraquat at 4 levels (0.05,0.1,0.5, and 1.0 ppm) in blind duplicate samples plus 2 blind negative control samples. Potatoes, obtained from each participant’s region, were spiked by the collaborators with unknown aqueous solutions containing no analyte or a mixture of diquat and paraquat standards. Repeatability and reproducibility relative standard deviations (RSDr and RSDR) averaged 17.1 and 29.0%, respectively, for determination of diquat and 10.8 and 29.5%, respectively, for paraquat. For analysis of standard solutions, RSDr and RSDR values were 6.3 and 12.0%, respectively, for diquat and 7.3 and 13.9%, respectively, for paraquat. Accuracy, measured by comparison with true spiking values (absolute recovery) averaged 77.6 and 76.2% for diquat and paraquat, respectively, and ranged from 71.8 to 88.0% for both compounds. The method was adopted first action by AOAC International.

Factors Shaping the Lived Experience of Resettlement for Former Refugees in Regional Australia

Refugees experience traumatic life events with impacts amplified in regional and rural areas due to barriers accessing services. This study examined the factors influencing the lived experience of resettlement for former refugees in regional Launceston, Australia, including environmental, social, and health-related factors. Qualitative interviews and focus groups were conducted with adult and youth community members from Burma, Bhutan, Sierra Leone, Afghanistan, Iran, and Sudan, and essential service providers (n = 31). Thematic analysis revealed four factors as primarily influencing resettlement: English language proficiency; employment, education and housing environments and opportunities; health status and service access; and broader social factors and experiences. Participants suggested strategies to overcome barriers associated with these factors and improve overall quality of life throughout resettlement. These included flexible English language program delivery and employment support, including industry-specific language courses; the provision of interpreters; community events fostering cultural sharing, inclusivity and promoting well-being; and routine inclusion of nondiscriminatory, culturally sensitive, trauma-informed practices throughout a former refugee’s environment, including within education, employment, housing and service settings.

How to use visual methods to promote health among adolescents: A qualitative study of school nursing

AIMS AND OBJECTIVES

Public health nurses attended a 3-day course to learn the use of visual methods in health dialogue with adolescents. The aim of this study was to explore how to use visual methods to promote health among adolescents in a school nursing context.

BACKGROUND

Photovoice is a visualising technique that enables adolescents to participate in health promotion projects in a school setting. Photovoice also enhances work of public health nurses and other health professionals.

DESIGN

This was a qualitative action research study. We developed and conducted a course in visual methods and used data from focus group discussions in combination with participant observations involving public health nurses working in school health services.

METHODS

We conducted focus group interviews (n = 40) using separate semi-structured discussion guides before and after a course in visual methods. The interviews were audio recorded and transcribed verbatim, and we documented the workshops (n = 8) through field notes. We collected the data from January-October 2016. Data were analysed and coded into themes and subthemes using systematic text condensation. We reported the study in accordance with the COREQ checklist.

FINDINGS

Public health nurses found photovoice useful in school nursing. The use of images offered pupils an active role in dialogues and more control in defining the topics and presenting their stories. When nurses allowed adolescents to bring images into conversations, they discovered new insights into public health promotion. The public health nurses pointed out the benefits and challenges of using new methods in practice.

CONCLUSION

Public health nurses considered photovoice to be useful in health promotion and other public health issues. Involving pupils in bringing images to conversations offered them an active role and voice in health promotion.

RELEVANCE TO CLINICAL PRACTICE

We recommend the use of photovoice and visual technologies (e.g., smartphones) in health promotion activities for adolescents.

Concerns and Treatment Satisfaction in Patients Being Treated With Azelaic Acid Foam for Rosacea

Objective: To describe patient characteristics, concerns, side effects, treatment satisfaction, and quality of life (QoL) of rosacea patients currently being treated with monotherapy azelaic acid foam based on patient-reported data. Methods: The study utilized a non-interventional, prospective, observational design. Patients were recruited in the United States and were eligible if the following criteria were met: diagnosed with rosacea by a medical professional, ≥18 years of age, currently receiving monotherapy with azelaic acid foam, and able to provide informed consent. Patients using other topical treatments for rosacea during enrollment were excluded. An online tool administered a survey of 3 questionnaires including the Rosacea Treatment Preference Questionnaire, Treatment Satisfaction with Medicines Questionnaire (SATMED-Q), and Dermatology Life Quality Index (DLQI). The survey collected demographics, clinical characteristics, treatment history, adverse events, and patient-reported outcomes related to treatment with azelaic acid foam and QoL with rosacea. Results: 54 patients met eligibility criteria. Participants were primarily female (90.7%), ranging from 26 to 63 years of age. The most common subtypes reported were erythematotelangiectatic and papulopustular (74.1% each) with 59.3% of participants reporting mild symptoms (16.7% “absent”; 24.1% “moderate”) in the 4 weeks before enrollment. The majority reported no concerns (74.1%) with their treatment. The biggest concern was cost (11.1%), with a mean importance score (IS) on a 10-point scale of 9.3. A majority (77.8%) of patients reported no side effects. Side effects reported included dryness (13%; IS: 5.3), stinging (7.4%, IS: 2.5), itching (5.6%; IS: 4.7), or burning (3.7%; IS: 7.0). Global satisfaction (SATMED-Q) mean score was 79.0 and treatment effectiveness mean score was 70.8. QoL impact of rosacea was minimal (mean DLQI score: 2.35). In regression models, increasing dryness was significantly associated with worsening outcomes in SATMED-Q and DLQI. Conclusions: Patient characteristics of the study population closely mirror the distribution of rosacea by gender and subtype as in previous estimates. Findings indicate minimal patient concerns with azelaic acid foam and primarily pertained to cost. Patient-reported side effects were rare. Minor patient-reported side effects and concerns do not appear to affect rosacea-related QoL and medication satisfaction. Compared to a previously conducted study of similar design with patients using metronidazole gel and metronidazole cream, more patients in the current study reported no concerns with their treatment, while the number of patients reporting no side effects, as well as mean SATMED-Q and DLQI scores, were similar. Further research is necessary to directly compare the results of these 2 studies. J Drugs Dermatol. 2019;18(4):381-386.

Six-Month Use of Droxidopa for Neurogenic Orthostatic Hypotension

Background

Droxidopa is approved for adult patients with symptomatic neurogenic orthostatic hypotension (nOH); there is limited information regarding effects on symptoms, outcomes, and quality of life (QOL) beyond two weeks of treatment.

Objective

Examine the real‐world experience of patients taking droxidopa after six months of treatment.

Methods

This non‐interventional, US‐based, prospective cohort study utilized a pharmacy hub, identifying patients who recently started droxidopa for nOH treatment. Questionnaires for fall frequency and other patient‐reported outcomes (PROs) were completed at baseline and one, three, and six months following droxidopa initiation.

Results

179 enrolled patients completed baseline surveys. Droxidopa continuation rates were high at months one, three, and six (87%, 79%, and 75%, respectively). From baseline to month one, there was significant reduction in the proportion of patients reporting falling at least once (54.1% vs. 43.0%; P = 0.0039), with similar observations at month three (52.9% vs. 44.5%; P = 0.0588) and month six (51.4% vs. 40.0%; P = 0.0339). Significant improvements from baseline to month one were observed and maintained at months three and six for most PROs, including the Orthostatic Hypotension Symptom Assessment Item 1, Short Falls Efficacy Scale‐International, Sheehan Disability Scale, Physical Component of the 8‐item Short‐Form Health Survey, and Patient Health Questionnaire‐9.

Conclusions

In this non‐interventional prospective study, fewer nOH patients reported falling after one, three, and six months of droxidopa treatment. Further, improvements reported in nOH symptoms, physical function, and QOL measures were maintained for six months following treatment initiation. Results from randomized clinical trials are required to validate the findings.

Ethical challenges experienced by public health nurses related to adolescents’ use of visual technologies

Background:

Visual technologies are central to youth culture and are often the preferred communication means of adolescents. Although these tools can be beneficial in fostering relations, adolescents’ use of visual technologies and social media also raises ethical concerns.

Aims:

We explored how school public health nurses identify and resolve the ethical challenges involved in the use of visual technologies in health dialogues with adolescents.

Research design:

This is a qualitative study utilizing data from focus group discussions.

Participants and research context:

We conducted focus group discussions using two semi-structured discussion guides with seven groups of public health nurses (n = 40) working in Norwegian school health services. The data were collected during January and October 2016. Discussions were audio recorded, transcribed, and coded into themes and subthemes using systematic text condensation.

Ethical considerations:

The leader of the public health nursing service who agreed to provide access for the study and the Norwegian Center for Research Data that reviewed and approved the study. All participants gave informed consent.

Findings:

In adolescents’ use of visual materials with public health nurses, ethical concerns were raised regarding suicide ideations, socially unacceptable content, violation of privacy, and presentations of possible child neglect. The nurses utilized their professional knowledge and experience when identifying and navigating these ethical dilemmas; they resolved ethical uncertainties through peer discussion and collaboration with fellow nurses and other professionals.

Discussion:

We discussed the findings in light of Annemarie Mol’s interpretation of the ethics of care. Mol expands the notion of ethical care to include the action of technologies.

Conclusion:

Although the increasing use of visual technologies offered benefits, school nurses faced ethical challenges in health dialogues with adolescents. To address and navigate these ethical issues, they relied on their experience and caring practices based on their professional ethics. Uncertainties were resolved through peer dialogue and guidance.

Remote Monitoring of Automated Peritoneal Dialysis Patients: Assessing Clinical and Economic Value

BACKGROUND

For chronic kidney disease patients who progress to end-stage renal disease, survival is dependent on renal replacement therapy in the form of kidney transplantation or chronic dialysis. Peritoneal dialysis (PD), which can be performed at home, is both more convenient and less costly than hemodialysis that requires three 4-h visits per week to the dialysis facility and complicated equipment. Remote therapy management (RTM), technologies that collect medical information and transmit it to healthcare providers for patient management, has the potential to improve the outcomes of patients receiving automated peritoneal dialysis (APD) at home.

OBJECTIVE

Estimate through a simulation study the potential impact of RTM on APD patients use of healthcare resources and costs in the United States, Germany, and Italy.

METHODS

Twelve APD patient profiles were developed to reflect potential clinical scenarios of APD therapy. Two versions of each profile were created to simulate healthcare resource use, one assuming use of RTM and one with no RTM. Eleven APD teams (one nephrologist, one nurse) estimated resources that would be used.

RESULTS

Results from U.S., German, and Italian clinicians found that RTM could avoid use of 59, 49, and 16 resources over the 12 profiles, respectively. Estimated reduced utilization across the three countries ranged from one to two hospitalizations, one to four home visits, two to five emergency room visits, and four to eight unplanned clinic visits. Total savings across all scenarios were $23,364 in the United States, $11,477 in Germany, and $7,088 in Italy.

CONCLUSION

In a simulated environment, early intervention enabled by RTM reduced healthcare resource utilization and associated costs.

Exploring the value of mental health nurses working in primary care in England: A qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Primary care and, in particular, general practice (GP) are often first point of access to health care. International evidence suggests that healthcare systems oriented towards primary care may produce better outcomes, at lower costs and with higher user satisfaction. Despite this, there are noted deficiencies and variations in the quality of care in primary care for patients with mental health problems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Emerging models of providing mental health services in primary care are poorly understood. This paper evaluates a mental health nurse-led Primary Care Liaison Service (PCLS), developed in 2011 in inner London. The findings suggest that this type of service can improve the quality of care for people presenting with mental health problems within primary care, specifically due to improved integration, clinical effectiveness, patient-centred care, access and efficiency. The study also highlighted challenges such as staff retention within this new role and setting appropriate referral criteria. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This is a relatively new service, and the cost-effectiveness is not yet fully understood; however, commissioners may want to consider the potential benefits of a similar service in their area. The extent to which the findings are transferable will depend on service configuration and local demographics which can vary. Further research within this area could give more detail on the impact of such teams on health outcomes, recovery rates, secondary care referrals and accident and emergency attendances, and its cost-effectiveness.

ABSTRACT

Aims/Question General practice is typically the first point of access to healthcare. This study explores what value a Primary Care Liaison Nurse (PCLN) service, established in 2011, can bring to people with mental health problems in primary care. Method Semi-structured interviews were used to elicit participants' experiences and perspectives on the value of a PCLN service. Participants included ten interviews with seven general practitioners and three senior practitioners working in primary care mental health services. Thematic analysis, based on a 6-phase approach, was used to describe and explore the data collected. Results Five main themes were derived from the thematic analysis of the interviews relating to: integration; clinical effectiveness; patient centred care; access; and efficiency. Discussion The study suggests that the PCLN service can improve the quality of care and is generally highly valued by its stakeholders. The study identifies particularly valued elements of the service, including having a duty worker, as well as aspects which could be improved, such as patient criteria. Implications for practice This is a relatively new service and the cost-effectiveness is not yet fully understood; however, commissioners may want to consider the potential benefits of a similar service in their area.

The economic burden of lung cancer and mesothelioma due to occupational and para-occupational asbestos exposure

OBJECTIVES

To estimate the economic burden of lung cancer and mesothelioma due to occupational and para-occupational asbestos exposure in Canada.

METHODS

We estimate the lifetime cost of newly diagnosed lung cancer and mesothelioma cases associated with occupational and para-occupational asbestos exposure for calendar year 2011 based on the societal perspective. The key cost components considered are healthcare costs, productivity and output costs, and quality of life costs.

RESULTS

There were 427 cases of newly diagnosed mesothelioma cases and 1904 lung cancer cases attributable to asbestos exposure in 2011 for a total of 2331 cases. Our estimate of the economic burden is $C831 million in direct and indirect costs for newly identified cases of mesothelioma and lung cancer and $C1.5 billion in quality of life costs based on a value of $C100 000 per quality-adjusted life year. This amounts to $C356 429 and $C652 369 per case, respectively.

CONCLUSIONS

The economic burden of lung cancer and mesothelioma associated with occupational and para-occupational asbestos exposure is substantial. The estimate identified is for 2331 newly diagnosed, occupational and para-occupational exposure cases in 2011, so it is only a portion of the burden of existing cases in that year. Our findings provide important information for policy decision makers for priority setting, in particular the merits of banning the mining of asbestos and use of products containing asbestos in countries where they are still allowed and also the merits of asbestos removal in older buildings with asbestos insulation.

“Simply providing information”: Negotiating the ethical dilemmas of obstetric ultrasound, prenatal testing and selective termination of pregnancy

Obstetric ultrasound is key to opposing ways of valuing foetuses, that is, both to the ascription of foetal personhood and to foetal selection and termination of pregnancy. Whilst ultrasound images are increasingly common within the public sphere there has been relatively little public discussion of its role in identifying actual or potential foetal anomaly and the consequences of this. This paper examines how professionals working with obstetric ultrasound encounter, navigate and make sense of the different uses of this technology. Professionals commonly delineate their work (as providing information) from women’s autonomous choices. Emphasising “women’s choice” can obscure consideration of different collective ways of valuing foetuses with anomalies. It can also deflect consideration of the fundamentally ambiguous information that ultrasound can produce. Distinguishing information from choice is underpinned by a questionable fact–value distinction. We describe alternate professional practices which involve questioning these binaries and foregrounding clinicians’ responsibilities for women’s current and future experience. Public discussion of ultrasound’s different roles in valuing foetuses would be enriched if the discourses and practices shaping professionals’ attempts to facilitate ethical decision-making were included for collective consideration.

The Missing Work of Collaboration: Using Assemblages to Rethink Antidepressant Action

How do antidepressants work? This often-asked question continues to attract debate. The depressed individual features in many debates about antidepressants' action. With this focus, discussion oscillates over whether antidepressants work to remedy chemical imbalances in the brains of depressed people, or produce inauthentic states of being. This article argues shifting the analytic focus away from the depressed individual and onto the collective body, or assemblage, moves debates about how antidepressants work into more productive terrain. This provides a new way of looking at how antidepressants work to facilitate recovery from depression through a series of collaborative connections or relationships. Drawing on the charts, photos, and narratives from research encounters with people who take antidepressants, the article illustrates how medication facilitates the creation of active associations in an assemblage of forces. The article concludes by discussing the new ways of thinking about depression, medication and recovery suggested by this understanding of antidepressant action.

Benchmarking framework for myocardial tracking and deformation algorithms: an open access database

In this paper we present a benchmarking framework for the validation of cardiac motion analysis algorithms. The reported methods are the response to an open challenge that was issued to the medical imaging community through a MICCAI workshop. The database included magnetic resonance (MR) and 3D ultrasound (3DUS) datasets from a dynamic phantom and 15 healthy volunteers. Participants processed 3D tagged MR datasets (3DTAG), cine steady state free precession MR datasets (SSFP) and 3DUS datasets, amounting to 1158 image volumes. Ground-truth for motion tracking was based on 12 landmarks (4 walls at 3 ventricular levels). They were manually tracked by two observers in the 3DTAG data over the whole cardiac cycle, using an in-house application with 4D visualization capabilities. The median of the inter-observer variability was computed for the phantom dataset (0.77 mm) and for the volunteer datasets (0.84 mm). The ground-truth was registered to 3DUS coordinates using a point based similarity transform. Four institutions responded to the challenge by providing motion estimates for the data: Fraunhofer MEVIS (MEVIS), Bremen, Germany; Imperial College London - University College London (IUCL), UK; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Inria-Asclepios project (INRIA), France. Details on the implementation and evaluation of the four methodologies are presented in this manuscript. The manually tracked landmarks were used to evaluate tracking accuracy of all methodologies. For 3DTAG, median values were computed over all time frames for the phantom dataset (MEVIS=1.20mm, IUCL=0.73 mm, UPF=1.10mm, INRIA=1.09 mm) and for the volunteer datasets (MEVIS=1.33 mm, IUCL=1.52 mm, UPF=1.09 mm, INRIA=1.32 mm). For 3DUS, median values were computed at end diastole and end systole for the phantom dataset (MEVIS=4.40 mm, UPF=3.48 mm, INRIA=4.78 mm) and for the volunteer datasets (MEVIS=3.51 mm, UPF=3.71 mm, INRIA=4.07 mm). For SSFP, median values were computed at end diastole and end systole for the phantom dataset(UPF=6.18 mm, INRIA=3.93 mm) and for the volunteer datasets (UPF=3.09 mm, INRIA=4.78 mm). Finally, strain curves were generated and qualitatively compared. Good agreement was found between the different modalities and methodologies, except for radial strain that showed a high variability in cases of lower image quality.

Making News: The Appearance of Tobacco Control Organizations in Newspaper Coverage of Tobacco Control Issues

Purpose.

To characterize the presence of advocacy groups in media coverage about tobacco issues.

Design.

A content analysis of tobacco-related newspaper articles.

Setting.

Australia.

Sample.

All 12 national and state capital daily newspapers published in Australia between 2004 and 2007.

Measures.

We coded each article for explicit mentions of any of 16 major national or state tobacco control advocacy groups; for the article type, prominence, and topic; for the tone of the event; and for the author's opinion.

Analysis.

A series of 2 × 2 χ2 analyses assessed the extent to which advocacy groups were more or less likely to be mentioned in articles of each type, prominence, topic, event impact, and opinion orientation.

Results.

Of the 4387 tobacco-related articles published over this period, 22% mentioned an advocacy group. There was a greater-than-expected proportion of advocacy groups mentioned in news articles with very high prominence (44%; χ2 [1, N = 3118] = 27.4, p < .001), high prominence (34%; χ2 [1, N = 3118] = 10.9, p < .001), and medium prominence (30%; χ2 [1, N = 3118] = 7.3, p = .007), and in articles covering events with mixed (30%; χ2 [1, N = 4387] = 10.0, p = .002) or positive (24%; χ2 [1, N = 4387] = 26.1, p < .001) implications for tobacco control.

Conclusions.

Australian tobacco control advocacy groups have a reasonable presence within the news discourse on tobacco control issues and so are likely to contribute to generating and shaping this discourse, particularly in relation to evolving and controversial issues.

Uniqueness of solutions of semilinear Poisson equations

Let R(n) denote n-dimensional Euclidean space, with n > 1. We study the uniqueness of positive solutions u(x), x in R(n), of the semilinear Poisson equation Deltau + f(u) = 0 under the assumption that u(x) --> 0 as x --> infinity. This type of problem arises in phase transition theory, in population genetics, and in the theory of nucleon cores, with various different forms of the driving term f(u). For the important model case f(u) = -u + u(p), where p is a constant greater than 1, our results show (i) that when the dimension n of the underlying space is 2, there is at most one solution (up to translation) for any given p and (ii) that when the dimension n is 3, there is at most one solution when 1 < p </= 3. In both cases, the solution is radially symmetric and monotonically decreasing as one moves outward from the center. For dimensions other than 2 or 3, and indeed for the analogous cases of a real dimensional parameter n > 1, we obtain corresponding results. We note finally, again for the model case, that existence holds for 1 < p < (n + 2)/(n - 2); thus, there remains an interesting difference between the parameter ranges for which existence and uniqueness are established.

Changes in the news representation of smokers and tobacco-related media advocacy from 1995 to 2005 in Australia

BACKGROUND

This study aims to show how smokers were represented in smoking-related news articles, editorials, letters and columns in a major Australian newspaper over an 11-year period from January 1995 to December 2005.

METHODS

Qualitative content analysis was conducted on a sample of 618 articles to identify 21 representational categories (RCs) of the smoker. Articles were also examined for statements that lent organisational support to either tobacco control or the promotion of tobacco.

RESULTS

The construction of the smoker as a "regulated citizen" due to being subjected to tobacco policy was the most prevalent RC, occurring in 43.4% of articles. Of the 13 most prevalent RCs, eight were constructions of the smoker that lent support to tobacco control outcomes, two were supportive of the promotion of tobacco, and three could be used by both parties. 30.6% of articles contained at least one statement from a tobacco control advocacy source, compared with only 13.6% of articles having a statement towards the promotion of tobacco.

CONCLUSION

These results indicate that constructions of the smoker that support tobacco control have dominated smoking-related discourse in this Australian newspaper and that representations favouring a tobacco industry viewpoint appeared less often. However, the pro-tobacco representations of smokers in reports relating to legal issues highlight an area of media discourse in which tobacco control advocates should remain vigilant.

Portrayal of tanning, clothing fashion and shade use in Australian women's magazines, 1987-2005

To examine modelling of outcomes relevant to sun protection in Australian women's magazines, content analysis was performed on 538 spring and summer issues of popular women's magazines from 1987 to 2005. A total of 4949 full-colour images of Caucasian females were coded for depth of tan, extent of clothing cover, use of shade and setting. Logistic regression using robust standard errors to adjust for clustering on magazine was used to assess the relationship between these outcomes and year, setting and model's physical characteristics. Most models portrayed outdoors did not wear hats (89%) and were not in shade (87%). Between 1987 and 2005, the proportion of models depicted wearing hats decreased and the proportion of models portrayed with moderate to dark tans declined and then later increased. Younger women were more likely to be portrayed with a darker tan and more of their body exposed. Models with more susceptible phenotypes (paler hair and eye colour) were less likely to be depicted with a darker tan. Darker tans and poor sun-protective behaviour were most common among models depicted at beaches/pools. Implicit messages about sun protection in popular Australian women's magazines contradict public health messages concerning skin cancer prevention.

The implantable loop recorder in children

OBJECTIVE

To evaluate use of the implantable loop recorder in children.

SETTING

Royal Hospital for Sick Children, Glasgow, UK.

METHOD

Retrospective study of children who had an implantable loop recorder between September 1998 and October 2005.

RESULTS

38 devices were implanted in 34 children. Median age at implantation 11.3 years (range 1.8-17.6); median follow-up period 15 months (range 2-58). The main presenting complaint was syncope in 26 (76.5%), seizures in 6 (17.6%) and palpitations in 2 (5.9%). After implantation, 19 (55.9%) patients had symptom recurrence. Of these, 11 were shown to have sinus rhythm during symptoms and 8 had an abnormal ECG. Four patients had asystole >3 seconds and were diagnosed with reflex asystolic syncope; 2 had polymorphic ventricular tachycardia. One patient who already had a diagnosis of long QT syndrome was shown to have ventricular ectopy during symptoms and beta-blockers were increased. One patient had transient complete heart block during symptoms but refused a pacemaker. In almost half the patients (44.1%), symptoms resolved after implantation. Complications requiring removal of the device occurred in 6 (15.8%) implants.

CONCLUSIONS

In children with syncope and palpitations, the implantable loop recorder appears to be an excellent method of effecting a "cure" in almost 50% of subjects. For those who remain symptomatic, it is successful in determining cardiac rhythm during symptoms, but the complication rate in children may be higher than that of adults.

"Stay away from them until you're old enough to make a decision": tobacco company testimony about youth smoking initiation

OBJECTIVE

To determine common themes used by US tobacco industry witnesses pertaining to youth smoking initiation during litigation in the United States.

METHODS

Qualitative thematic analysis of transcripts from 29 tobacco litigation cases dating from 1992 to 2002.

RESULTS

Youth smoking is portrayed by the tobacco industry as a source of great concern to them. Youth smoking prevention programmes developed by US tobacco companies are supposedly intended to delay decision-making about smoking until age 18, when individuals are then seen to be of an age where they are able to "choose to smoke". Tobacco industry media campaigns, youth access, community and school-based programmes are predicated on peer influence, parental factors, and commercial access being the primary influences on youth smoking uptake, rather than tobacco marketing, inaccurate risk appraisal, price and other factors known to influence youth smoking. Despite substantial financial investment in tobacco industry programmes, their witnesses were able to describe only weak evaluation methods, being preoccupied with measures of message comprehension, programme reach and uptake, and the associated costs of their efforts, rather than any evaluation designed to assess effects on youth smoking behaviour.

CONCLUSION

Stated concerns about youth smoking and youth smoking prevention programmes are put forward in litigation as evidence that the tobacco industry is "serious" about tackling youth smoking, and serve as a primary strategy to improve the tobacco industry's public image. The tobacco industry's evaluation of the effectiveness of their youth smoking prevention programmes is demonstrably insufficient under current public health evaluation standards. Public health and welfare agencies should avoid engagement with tobacco industry-sponsored programmes.

Long-term survival of surgically treated hip fracture in an Australian regional hospital

This study was undertaken to identify factors influencing outcome in elderly patients operated for hip fracture. In particular, this study examined factors related to mortality at least 30 months post-fracture. Hospital records and death registrations were analysed for 463 patients aged 60 or more years treated for hip fracture at a Queensland regional hospital between 1997 and 2001. The overall mortality for surgically treated patients was 13.7% at 100 days and 24.9% at one year Patient factors including age, gender, health status and place of residence were the predominant influences on mortality. Non-patient and process factors including delay to surgery, type of operation and type of anaesthetic had minimal impact on mortality. No major determinants of length of hospital stay were identified. Patient health status was the main determinant for surgical delay. Our results confirm the persistently high mortality in this group of patients, and suggest that the main determinants of outcome are patient- rather than process-related.

Inter- and intraobserver variability in LVH and RVH reporting in pediatric ECGs

BACKGROUND

Physicians' diagnoses are often used as the gold standard for evaluating computer electrocardiogram (ECG) interpretation programs. As part of a larger study to evaluate the Glasgow pediatric ECG analysis program, inter- and intraobserver variability in the ECG reporting of two pediatric cardiologists was examined.

METHODS

The ECGs of 984 children were sent for reporting independently by two cardiologists with all identifying information except age and sex removed. Three hundred twenty ECGs had no clinical indication available, and they were thus reported "blind." For 664 ECGs, the clinical indication was known and included with the ECG trace. All ECGs reported as right ventricular hypertrophy (RVH) or left ventricular hypertrophy (LVH) were returned to the cardiologists without their knowledge for reporting a second time "blind" as to the clinical indication.

RESULTS

When the cardiologists' reports were compared with each other, the provision of clinical information led to greater agreement between them for the diagnosis of LVH (kappa increased from 0.44 to 0.52) but did not substantially affect their agreement in diagnosing RVH (kappa fell from 0.66 to 0.63). Intraindividual comparisons in 166 ECGs revealed that one cardiologist was more consistent in diagnosing RVH and the other more consistent in diagnosing LVH.

CONCLUSIONS

This study has demonstrated the difficulties in using cardiologists' diagnoses as the gold standard with which to evaluate pediatric ECGs.

Australian letters to the editor on tobacco: triggers, rhetoric, and claims of legitimate voice

News coverage of tobacco issues influences both individual behavior change and policy progression. Thus, media advocacy is increasingly recognized as important for promoting public health. Letters to the editor (LTE) are a basic form of media advocacy, serving to demonstrate community sentiment on a given issue. Such letters are yet to receive systematic analytic consideration. The authors conducted an ethnographic content analysis of LTE on tobacco issues from a sample of 11 Australian daily newspapers over a 3-year period (2001 to 2003, N=361). They argue that letters are artifacts of active engagement in a public debate and note that various stakeholders adopt similar strategies to pursue their objectives. They illustrate how identifying personal and collective identities is crucial in the assertion of legitimacy of voice in LTEs. Better understanding is needed of both the particular issues that spark public engagement, and the salient rhetoric employed by advocates of disparate positions.

Impact of news of celebrity illness on breast cancer screening: Kylie Minogue's breast cancer diagnosis

OBJECTIVES

To describe the main media narratives in the reportage of singer Kylie Minogue's illness with breast cancer; and to assess the impact of this coverage on bookings for screening for breast cancer by mammography in four Australian states.

SETTING

Government sponsored BreastScreen programs in Queensland, Victoria, Tasmania and Western Australia.

MAIN OUTCOME MEASURES

Narratives on breast cancer in television news programs 17-27 May 2005; initial and re-screening bookings for mammograms.

PARTICIPANTS

Women aged > or = 40 years who booked for mammograms in BreastScreen programs in the 19 weeks before, the 2 weeks during, and the 6 weeks after the publicity.

RESULTS

There was a 20-fold increase in news coverage of breast cancer, which emphasised that young women do get breast cancer and that early detection was critical. Overall screening bookings rose 40% in the 2 weeks of the publicity, with a 101% increase in non-screened women in the eligible age-group 40-69 years. Six weeks after the publicity, bookings remained more than a third higher in non-screened women.

CONCLUSIONS

News coverage of Kylie Minogue's breast cancer diagnosis caused an unprecedented increase in bookings for mammography. Health advocates should develop anticipatory strategies for responding to news coverage of celebrity illness.

Evaluation of pediatric electrocardiogram diagnosis of ventricular hypertrophy by computer program compared with cardiologists

This study aimed to evaluate the diagnosis of pediatric left ventricular hypertrophy (LVH) and right ventricular hypertrophy (RVH) by the Glasgow electrocardiogram (ECG) interpretation program compared to interpretations provided by two pediatric cardiologists. ECGs had all identifying information removed and were sent to the cardiologists independently with the patient's age and sex and the clinical indication for the ECG, if known. A total of 984 ECGs were included in the study, of which 664 were reported "with clinical indication" and 320 were reported "blind." With respect to an averaged diagnosis of the two cardiologists, the sensitivity of the program for RVH was better when the cardiologists reported blind (73.3%) than with the clinical indication (53.5%), with the same trend for the program compared with individual cardiologists. The specificity of the program was at least 94.4% in all cases. For LVH, the program had high specificity (=95.8%) for "reported blind" and "with clinical indication" cases but low sensitivities throughout (the highest was 44.4% with respect to an averaged diagnosis of the two cardiologists reporting with the clinical indication). Subsequent discussion revealed that if the cardiologists had disagreed with one another initially, their consensus opinion was twice as likely to be in agreement with the program.

Individual versus corporate responsibility for smoking-related illness: Australian press coverage of the Rolah McCabe trial

This paper provides a thematic frame analysis of Australian newspaper reporting of the outcome and implications of the trial of Rolah McCabe versus British American Tobacco Australasia (BATA). In this trial, a Melbourne woman was awarded A$700,000 damages for smoking-attributable lung cancer when the defendant, BATA, had its case dismissed due to document destruction. In 60 commentaries from Australian national or capital city newspapers between 12 April and 9 May 2002, a total of 79 instances of eight tobacco-related frames were identified. Overall, 43% of the 79 instances were positive for tobacco control, 46% were negative for tobacco control and 11% were neutral. The most common frame that was negative for tobacco control (in 35% of articles) was the conception that smokers exert 'free will' in deciding to smoke and should therefore be personally responsible for their smoking and any disease that arises as a result of it. A related, but less commonly employed frame (in 18% of articles) was the expressed fear of a 'slippery slope' of litigation, which portrayed smoking as similar to eating fast food or other 'vices'. The most common frame that was positive for tobacco control (in 35% of articles) was the notion that the tobacco industry was 'evil' and, to a lesser extent, that the government should 'do more' to control smoking (15% of articles). These findings provide a sobering public health challenge to improve public communication efforts about the powerful forces that conspire to induce people to start smoking and keep them smoking for decades, despite a strong desire to quit. There is a need to fund public education programs and quit smoking services more adequately to address the complex education task of understanding the nature of addiction to tobacco and the enormity of the health risk.

Tobacco in the news: an analysis of newspaper coverage of tobacco issues in Australia, 2001

OBJECTIVE

To assess the extent and nature of newspaper coverage of tobacco related issues in Australia in 2001.

DESIGN

Content analysis of newspaper articles.

SUBJECTS

All articles (n=1188) at least seven lines long and containing at least one paragraph focused on tobacco in all major Australian national and State capital city newspapers (n=12) in 2001.

MAIN OUTCOME MEASURES

Number of articles, month of publication, State in which newspaper published, prominence of article, type of article, article theme, and slant of article relative to tobacco control objectives.

RESULTS

The number of tobacco articles varied considerably in different months over the course of the year, from a low of 51 in December to a peak of 180 in May. The most frequent theme was secondhand smoke issues (30% of articles), with the second most dominant theme related to education, prevention, and cessation programmes and services (20%). Events that were covered were predominantly positive for tobacco control: 62% of articles were related to events that were positive, compared with 21% that were negative for tobacco control objectives. Excluding news articles, the opinions expressed by the authors of articles were also mainly positive (61%) rather than negative (22%) for tobacco control objectives. The amount of coverage of and population exposure to tobacco focused articles showed considerable variation across different Australian States, with Victoria having the highest frequency and rate of articles and the most media impressions per capita throughout 2001.

CONCLUSIONS

: Coverage of events and opinions related to tobacco in Australian newspapers in 2001 was generally positive for tobacco control objectives. Given that over 2 million individuals (out of a population of 19 million) were potentially exposed to tobacco related newspaper articles per day in Australia, this represents good news for tobacco control advocates. The variation in news coverage in different States and at different times in the year, however, illustrates how a combination of local events and advocacy efforts may at times combine to make tobacco more newsworthy. Understanding which tobacco issues are most likely to be covered and the nature of the coverage about them provides valuable feedback for tobacco control advocates and is a useful gauge of actual events as well as the tobacco related agendas promoted by the press.

Use of an implantable loop recorder to investigate syncope in a cat

The Reveal is an implantable loop recorder. It is increasingly being used in humans for the diagnosis of unexplained syncope where it is believed that cardiac arrhythmias may play a role, and may have great potential for investigating syncope in veterinary patients. The purpose of this report is to describe the first use of the device in the diagnosis of unexplained syncope in a cat.

Mechanical strain, induced noninvasively in the high-frequency domain, is anabolic to cancellous bone, but not cortical bone

Departing from the premise that it is the large-amplitude signals inherent to intense functional activity that define bone morphology, we propose that it is the far lower magnitude, high-frequency mechanical signals that continually barrage the skeleton during longer term activities such as standing, which regulate skeletal architecture. To examine this hypothesis, we proposed that brief exposure to slight elevations in these endogenous mechanical signals would suffice to increase bone mass in those bones subject to the stimulus. This was tested by exposing the hind limbs of adult female sheep (n = 9) to 20 min/day of low-level (0.3g), high-frequency (30 Hz) mechanical signals, sufficient to induce a peak of approximately 5 microstrain (micro epsilon) in the tibia. Following euthanasia, peripheral quantitative computed tomography (pQCT) was used to segregate the cortical shell from the trabecular envelope of the proximal femur, revealing a 34.2% increase in bone density in the experimental animals as compared with controls (p = 0.01). Histomorphometric examination of the femur supported these density measurements, with bone volume per total volume increasing by 32% (p = 0.04). This density increase was achieved by two separate strategies: trabecular spacing decreased by 36.1% (p = 0.02), whereas trabecular number increased by 45.6% (p = 0.01), indicating the formation of cancellous bone de novo. There were no significant differences in the radii of animals subject to the stimulus, indicating that the adaptive response was local rather than systemic. The anabolic potential of the signal was evident only in trabecular bone, and there were no differences, as measured by any assay, in the cortical bone. These data suggest that subtle mechanical signals generated during predominant activities such as posture may be potent determinants of skeletal morphology. Given that these strain levels are three orders of magnitude below strains that can damage bone tissue, we believe that a noninvasive stimulus based on this sensitivity has potential for treating skeletal complications such as osteoporosis.

Anabolism. Low mechanical signals strengthen long bones

Although the skeleton's adaptability to load-bearing has been recognized for over a century, the specific mechanical components responsible for strengthening it have not been identified. Here we show that after mechanically stimulating the hindlimbs of adult sheep on a daily basis for a year with 20-minute bursts of very-low-magnitude, high-frequency vibration, the density of the spongy (trabecular) bone in the proximal femur is significantly increased (by 34.2%) compared to controls. As the strain levels generated by this treatment are three orders of magnitude below those that damage bone tissue, this anabolic, non-invasive stimulus may have potential for treating skeletal conditions such as osteoporosis.

Performance and carcass merit of growing beef steers with chlortetracycline-modified sensitivity to pituitary releasing hormones and fed two dietary protein levels

This paper reports the effects of reduced sensitivity to growth hormone-releasing hormone and thyrotropin-releasing hormone through feeding a subtherapeutic level of chlortetracycline (CTC; 350 mg CTC/d) and two levels of dietary CP (10% and 13% of diet DM) on growth performance and carcass merit characteristics. Thirty-two steers (initial average BW, 286 kg) were adapted to a common 13% CP diet consisting primarily of grass hay, corn, and soybean meal fed to gain 1.25 kg/d. The steers were assigned to four treatments (with or without CTC and 10% or 13% dietary CP in a factorial arrangement) and fed ad libitum amounts of diet for 91 d. Feed intake was determined daily and steers were weighed weekly. Steers were killed at the end of the feeding period for carcass merit determinations. Efficiency of BW gain was greater (P < .05) for steers fed the 13% CP diet than for the 10% CP diet and tended to be less for CTC-steers when the 10% CP diet was fed and greater for the CTC-steers when the 13% CP diet was fed (CTC x dietary CP interaction, P < .10). Feeding CTC increased (P < .01) fat over the longissimus muscle and marbling. This study is interpreted to indicate that the sustained effect of subtherapeutic feeding of CTC to cattle appears to increase fat deposition consistent with a reduced growth hormone and thyroid status reported earlier for these same steers. This would tend to increase energy utilization but may not necessarily produce a measurable increase in BW gain.

Globalization and international trade in the twenty-first century: opportunities for and threats to the health sector in the south

Globalization and international trade are important forces at the turn of the century. This article explores how freer international trade will affect developing countries that are net importers of health care goods and services. Four commodities are used as special cases for discussion: pharmaceuticals, health care technologies, pesticides, and tobacco and its related products. The authors discuss the role of international specialized agencies, such as the World Trade Organization, World Health Organization, and World Bank, that are concerned with international trade and its health and health care consequences, and argue that closer collaboration is required among these agencies if the negative effects of trade liberalization on developing countries are to be mitigated. The authors pose a number of research questions that could help in developing proactive policies for the South on the trade of goods and services with harmful effects on health as well as those with potential health and economic benefits.