Surgical Management of Ebstein Anomaly: The Australia and New Zealand Experience

BACKGROUND

Ebstein anomaly is a rare congenital anomaly of the tricuspid valve which presents challenges to cardiac surgeons due to the spectrum of the disease and the technical difficulty of valve repair. The natural history of the anomaly differs between patients presenting in the neonatal period to those presenting in adulthood.

METHODS

A retrospective review of all patients >15 years of age with Ebstein anomaly, undergoing surgery on the tricuspid valve at 6 centers across Australia and New Zealand was performed. Patients from 1985 to 2019 were included in the study.

RESULTS

A total of 125 patients were included in the study, 76 patients (60%) undergoing tricuspid valve repair, of which 23 patients underwent a Cone repair and 49 (40%) had a tricuspid valve replacement. The mean follow-up was 7.9 ± 7.3 years. Postoperatively, early mortality was 3 patients (2%) and 10-year survival was 91.5%. A postoperative pacemaker was required in 24 patients (19%). Reoperation was required in 21 patients (17%). There was no statistically significant difference in survival or reoperation between patients who underwent repair or replacement of the tricuspid valve; however, with a small number of patients in long-term follow-up.

CONCLUSION

Older children and adult patients undergoing surgery for Ebstein anomaly in Australia and New Zealand experience good medium-term postoperative survival. Repair of the valve is achieved in a significant proportion of patients with increasing use and success with the Cone repair technique.

The novel Mechanical Ventilator Milano for the COVID-19 pandemic

This paper presents the Mechanical Ventilator Milano (MVM), a novel intensive therapy mechanical ventilator designed for rapid, large-scale, low-cost production for the COVID-19 pandemic. Free of moving mechanical parts and requiring only a source of compressed oxygen and medical air to operate, the MVM is designed to support the long-term invasive ventilation often required for COVID-19 patients and operates in pressure-regulated ventilation modes, which minimize the risk of furthering lung trauma. The MVM was extensively tested against ISO standards in the laboratory using a breathing simulator, with good agreement between input and measured breathing parameters and performing correctly in response to fault conditions and stability tests. The MVM has obtained Emergency Use Authorization by U.S. Food and Drug Administration (FDA) for use in healthcare settings during the COVID-19 pandemic and Health Canada Medical Device Authorization for Importation or Sale, under Interim Order for Use in Relation to COVID-19. Following these certifications, mass production is ongoing and distribution is under way in several countries. The MVM was designed, tested, prepared for certification, and mass produced in the space of a few months by a unique collaboration of respiratory healthcare professionals and experimental physicists, working with industrial partners, and is an excellent ventilator candidate for this pandemic anywhere in the world.

Segmentation of epithelium in H&E stained odontogenic cysts

An algorithm for the automated segmentation of epithelial tissue in digital images of histologic tissue sections of odontogenic cysts (cysts originating from residual odontogenic epithelium) is presented. The algorithm features an image standardization process that greatly reduces variation in luminance and chrominance between images due to variations in sample preparation. Segmentation of the epithelial regions of images uses an algorithm based on binary graph cuts where graph weights depend on probabilities obtained from colour histogram models of epithelium and stroma image regions. Algorithm training used a data set of 38 images of four types of odontogenic cyst and was tested using a separate data set of 35 images of the same four cyst types. The best parameters for the segmentation algorithm were determined using a response-surface optimizer. The best parameter set resulted in an overall mean (± std. dev.) sensitivity of 91.5 ± 17% and overall mean specificity of 85.1 ± 18.6% on the training set. Particularly good results were obtained for dentigerous and odontogenic keratocysts for which the mean sensitivities/specificities were 91.9 ± 6.15%/97.4 ± 2.15% and 96.1 ± 1.98%/98.7 ± 3.16%, respectively. Our method is potentially applicable to many pathological conditions in similar tissues, such as skin and mucous membranes where there is a clear microscopic distinction between epithelium and connective tissues.

Insomnia and its relationship to health-care utilization, work absenteeism, productivity and accidents

BACKGROUND AND PURPOSE

To document and provide a micro analysis of the relationship between insomnia and health problems, health-care use, absenteeism, productivity and accidents.

PARTICIPANTS AND METHODS

A population-based sample of 953 French-speaking adults from Québec, Canada. Participants were categorized as having insomnia syndrome (SYND) or insomnia symptoms (SYMPT) or as good sleepers (GS). They completed questionnaires on sleep, health, use of health-care services and products, accidents, work absences and reduced work productivity. Data were also obtained from the Québec-government-administered health insurance board on selected variables (e.g., consultations with health-care professionals, diagnoses).

RESULTS

There were significantly more individuals in the SYND group relative to the GS group reporting at least one chronic health problem (83% vs. 53%; OR: 2.78) and who had consulted a health-care professional in the past year (81% vs. 60%; OR: 2.8). There were also higher proportions of individuals in the SYND group than in the GS group who had used prescription medications (57% vs. 30.7%; OR: 2.8), most notably to treat insomnia, mood and anxiety disorders, or who had used over-the-counter products (75.6% vs. 62.0%; OR: 1.8) and alcohol as a sleep aid (17.8% vs. 3.9%; OR: 4.6). In terms of daytime function, 25.0% of the SYND had been absent from work relative to 17.1% of GS (OR: 1.7), 40.6% reported having experienced reduced productivity compared to 12.3% of GS (OR: 4.8) and non-motor-vehicle accidents occurred at higher rates in the SYND group (12.5% vs. 6.4% for GS; OR: 2.4). No differences were found for hospitalisations or motor-vehicle accidents. Most of the associations remained significant even after controlling for psychiatric comorbidity. Rates for the SYMPT group were situated between SYND and GS on all major dependent variables. Furthermore, insomnia and fatigue were perceived as contributing significantly to accidents, absences and decreased work productivity, regardless of insomnia status.

CONCLUSIONS

This study indicates that insomnia is associated with significant morbidity in terms of health problems and health-care utilization, work absenteeism and reduced productivity, and risk of non-motor-vehicle accidents. Future studies should evaluate whether treating insomnia can reverse this morbidity.

Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors

BACKGROUND AND PURPOSE

To estimate the prevalence of insomnia symptoms and syndrome in the general population, describe the types of self-help treatments and consultations initiated for insomnia, and examine help-seeking determinants.

PATIENTS AND METHODS

A randomly selected sample of 2001 French-speaking adults from the province of Quebec (Canada) responded to a telephone survey about sleep, insomnia, and its treatments.

RESULTS

Of the total sample, 25.3% were dissatisfied with their sleep, 29.9% reported insomnia symptoms, and 9.5% met criteria for an insomnia syndrome. Thirteen percent of the respondents had consulted a healthcare provider specifically for insomnia in their lifetime, with general practitioners being the most frequently consulted. Daytime fatigue (48%), psychological distress (40%), and physical discomfort (22%) were the main determinants prompting individuals with insomnia to seek treatment. Of the total sample, 15% had used at least once herbal/dietary products to facilitate sleep and 11% had used prescribed sleep medications in the year preceding the survey. Other self-help strategies employed to facilitate sleep included reading, listening to music, and relaxation.

CONCLUSIONS

These findings confirm the high prevalence of insomnia in the general population. While few insomnia sufferers seek professional consultations, many individuals initiate self-help treatments, particularly when daytime impairments such as fatigue become more noticeable. Improved knowledge of the determinants of help-seeking behaviors could guide the development of effective public health prevention and intervention programs to promote healthy sleep.

An Alternative to Antibiotic-Based Drugs in Feed for Enhancing Performance of Broilers Grown on Eimeria Spp.-Infected Litter

Three trials were conducted to evaluate the effects of lasalocid, an anticoccidial feed additive (90.7 kg/ton); bacitracin, a growth-promoter (50 g/ton); and yeast culture residue (YCR) (1 kg/ton) on the performance of broiler chicks reared to 42 d of age on recycled litter. Recycled litter consisted of pine wood shavings containing droppings from chicks infected with 3 select strains of coccidia (Eimeria tenella, Eimeria maxima, and Eimeria acervulina). Response variables (BW, intestinal tract and litter coliform counts, cecal and liver relative weights, and litter moisture content) were recorded biweekly. Mean BW of chicks fed the diet supplemented with YCR was higher than that of the controls (P < 0.05) and comparable to that of the lasalocid-treated birds in all 3 trials. Mean BW of chicks in all treatment groups decreased uniformly as the litter aged and moisture content increased. The mean intestinal coliform population from YCR-treated chicks was lower (P < 0.05) than those of the control and lasalocid populations. The coliform count was consistently lower than that in chicks on a bacitracin-supplemented diet. Coliform counts from the control and lasalocid-treated birds did not differ. The litter coliform counts increased with increased use of the litter. Cecal and liver relative weights calculated from the chicks in trial 3 showed that only the liver was significantly affected by treatments. YCR appeared to be a viable alternative to bacitracin and lasalocid medication in enhancing growth of broiler chicks reared on recycled litter.

Effects of a statewide carve out on spending and access to substance abuse treatment in Massachusetts, 1992 to 1996

OBJECTIVE

We studied the first four years of the statewide carve out for Medicaid enrollees in Massachusetts to assess its effect on access and spending.

DATA SOURCES/STUDY DESIGN

Using administrative data, we compared the state's fiscal years 1992 (the last year before the carve out) through 1996 (the final year of the state's first carve-out vendor, MHMA). We evaluated the effect on spending by converting expenditures to constant (1996) prices using the medical services component of the Consumer Price Index for Boston and standardizing directly for the changing proportion of Medicaid enrollees who were disabled. We measured access through the penetration rate (proportion of enrollees using at least one substance abuse treatment service in a year .

PRINCIPAL FINDINGS

Overall this carve out reduced real adjusted spending per enrollee by 40 percent from 1992 to 1996. At the same time, access improved from 38 to 43 unduplicated users per 1,000 enrollees per year f rom 1992 to 1996, adjusted for changes in Medicaid eligibility. these savings were achieved by a shift in the type of 24-h our services (hospital, detox, and residential treatment ). In 1992, 87 percent of these services were provided in hospital compared to only 1 percent in 1996. the reductions were achieved within the first two years of the carve out and sustained, but not enhanced, in subsequent years.

CONCLUSIONS

By arranging Medicaid reimbursement for lower levels of care and limiting use of the most expensive settings, managed care achieved substantial cost reductions over the first four years in Massachusetts.

Assessment of the variation in cerebrovascular reactivity in head injured patients

Several indices have been reported which correlate with autoregulatory function [2, 3]. However, before critical thresholds for targeting therapy can be defined, a better understanding of the inherent variability of cerebrovascular reactivity as measured by these indices is required. In this study, patients had BP, ICP and bilateral MCA TCD velocity monitored before, during and after BP and CO2 challenges, applied in a random order, with measurements taken within 48 hours of injury. Four indices of reactivity were calculated: the PRx, the CORRx and the FVreact & ICPreact. At 48 hours post-injury inter-patient variation in cerebrovascular reactivity, as measured by these indices, is large and injury specific factors remain important determinants of the variance. Within patient analysis has identified instances where the combined monitoring of the PRx and the CORRx may provide information about the function of pressure autoregulation and further study of the combined use of these two indices of reactivity is warranted.

The impact of substance abuse treatment modality on birth weight and health care expenditures

During the 1990s, substance abuse treatment programs were developed for pregnant women to help improve infant birth outcomes, reduce maternal drug dependency and promote positive lifestyle changes. This study compared the relative impact of five treatment modalities--residential, outpatient, residential/outpatient, methadone and detoxification-only--on infant birth weight and perinatal health care expenditures for a sample of 445 Medicaid-eligible pregnant women who received treatment in Massachusetts between 1992 and 1997. Costs and outcomes were measured using the Addiction Severity Index and data from birth certificates, substance abuse treatment records and Medicaid claims. Multiple regression was used to control for intake differences between the groups. Results showed a near linear relationship between birth weight and amount of treatment received. Women who received the most treatment (the residential/outpatient group) delivered infants who were 190 grams heavier than those who received the least treatment (the detoxification-only group) for an additional cost of $17,211. Outpatient programs were the most cost-effective option, increasing birth weight by 139 grams over detoxification-only for an investment of only $1,788 in additional health care and treatment costs. A second regression using five intermediate treatment outcomes--prenatal care, weight gain, relapse, tobacco use and infection--suggested that increases in birth weight were due primarily to improved nutrition and reduced drug use, behaviors which are perhaps more easily influenced in residential settings.

The costs of crime and the benefits of substance abuse treatment for pregnant women

Although many pregnant, drug-dependent women report extensive criminal justice involvement, few studies have examined reductions in crime as an outcome of substance abuse treatment programs for pregnant women. This is unfortunate, because maternal criminal involvement can have serious health and cost implications for the unborn child, the mother and society. Using the Addiction Severity Index, differences in pre- and posttreatment criminal involvement were measured for a sample of 439 pregnant women who entered publicly funded treatment programs in Massachusetts between 1992 and 1997. Accepted cost of illness methods were supplemented with information from the Bureau of Justice Statistics to estimate the costs and benefits of five treatment modalities: detoxification only (used as a minimal treatment comparison group), methadone only, residential only, outpatient only, and residential/outpatient combined. Projected to a year, the net benefits (avoided costs of crime net of treatment costs) ranged from US$32,772 for residential only to US$3,072 for detoxification. Although all five modalities paid for themselves by reducing criminal activities, multivariate regressions controlling for baseline differences between the groups showed that reductions in crime and related costs were significantly greater for women in the two residential programs. The study provides economic justification for the continuation and possible expansion of residential substance abuse treatment programs for criminally involved pregnant women.

Sexuality and sexual activity in pregnancy

OBJECTIVES

To evaluate women's sexual experience in pregnancy, and to describe their sources of information regarding sexuality during this period.

DESIGN

Cross-sectional study.

SETTING

The offices of obstetricians providing obstetric care in a tertiary care university hospital in St. John's, Newfoundland, Canada.

POPULATION

One hundred and forty-one pregnant women.

METHODS

Pregnant women anonymously completed self-administered questionnaires regarding sexuality and sexual activity during pregnancy. Responses were summarised using descriptive statistics, and comparisons were made between the trimesters of pregnancy. Multiple logistic regression was performed to assess the influences of a variety of factors on sexual activity.

RESULTS

Vaginal intercourse and sexual activity overall decreased throughout pregnancy (P = 0.004 and 0.05, respectively) with the trimester of pregnancy being the only independent predictor. Most women reported a decrease in sexual desire (58%). Overall, 49% of women worried that sexual intercourse may harm the pregnancy. Concerns regarding sexual activity leading to preterm labour or premature rupture of membranes increased as the pregnancy progressed (P < 0-001 and P = 0-001, respectively). Only 29% of women discussed sexual activity in pregnancy with their doctor and 49% of these women raised the issue first, with 34% feeling uncomfortable in bringing up the topic themselves. Most women (76%) who had not discussed these issues with their doctor felt they should be discussed.

CONCLUSIONS

A reduction in sexual activity, vaginal intercourse and sexual desire occurs in many women as pregnancy progresses. Both the woman and her partner have concerns regarding complications in the pregnancy as a result of sexual intercourse. The majority of women wish to discuss these issues with their doctor, but are not always comfortable raising the topic themselves.

Alendronate and estrogen-progestin in the long-term prevention of bone loss: four-year results from the early postmenopausal intervention cohort study. A randomized, controlled trial

BACKGROUND

Up to 3 years of treatment with alendronate, 5 mg/d, prevents postmenopausal bone loss.

OBJECTIVE

To determine whether the effect of alendronate is sustained at 4 years of treatment and persists after treatment is discontinued.

DESIGN

Randomized, controlled trial.

SETTING

United States and Europe.

PARTICIPANTS

1609 postmenopausal women 45 to 59 years of age.

INTERVENTION

Participants were randomly assigned to receive oral alendronate, 5 mg/d or 2.5 mg/d; placebo; or open-label estrogen-progestin. Women in the alendronate groups received alendronate for the first 2 years of the study. Treatment was then continued without change or replaced with placebo for the last 2 years of the study.

MEASUREMENTS

Annual measurement of bone mineral density.

RESULTS

By year 4, the bone mineral density of participants in the placebo group had decreased by 1% to 6% (P < 0.001). Four years of treatment with 5 mg of alendronate per day increased bone mineral density at the spine (mean change [+/-SE], 3.8%+/-0.3%), hip (mean, 2.9%+/-0.2%), and total body (mean, 0.9%+/-0.2%) (P < 0.001 overall). By year 4, bone mineral density at most skeletal sites was greater in participants who switched from alendronate to placebo than in those who continuously received placebo. In years 3 and 4, bone loss in participants who switched from alendronate to placebo was similar to that seen during years 1 and 2 in those who continuously received placebo. Compared with 5 mg of alendronate per day, estrogen-medroxyprogesterone acetate produced similar increases in bone mineral density and estradiol-norethisterone acetate produced increases that were substantially greater.

CONCLUSIONS

Four years of treatment with alendronate or estrogen-progestin prevented postmenopausal bone loss. A residual effect was seen 2 years after alendronate therapy was stopped; however, continuous alendronate treatment was more effective in preventing postmenopausal bone loss than 2 years of alendronate followed by 2 years of placebo.

Seed-specific overexpression of phytoene synthase: increase in carotenoids and other metabolic effects

A bacterial phytoene synthase (crtB) gene was overexpressed in a seed-specific manner and the protein product targeted to the plastid in Brassica napus (canola). The resultant embryos from these transgenic plants were visibly orange and the mature seed contained up to a 50-fold increase in carotenoids. The predominant carotenoids accumulating in the seeds of the transgenic plants were alpha and beta-carotene. Other precursors such as phytoene were also detected. Lutein, the predominant carotenoid in control seeds, was not substantially increased in the transgenics. The total amount of carotenoids in these seeds is now equivalent to or greater than those seen in the mesocarp of oil palm. Other metabolites in the isoprenoid pathway were examined in these seeds. Sterol levels remained essentially the same, while tocopherol levels decreased significantly as compared to non-transgenic controls. Chlorophyll levels were also reduced in developing transgenic seed. Additionally, the fatty acyl composition was altered with the transgenic seeds having a relatively higher percentage of the 18 : 1 (oleic acid) component and a decreased percentage of the 18 : 2 (linoleic acid) and 18 : 3 (linolenic acid) components. This dramatic increase in flux through the carotenoid pathway and the other metabolic effects are discussed.

Low body mass index is an important risk factor for low bone mass and increased bone loss in early postmenopausal women. Early Postmenopausal Intervention Cohort (EPIC) study group

Thinness (low percentage of body fat, low body mass index [BMI], or low body weight) was evaluated as a risk factor for low bone mineral density (BMD) or increased bone loss in a randomized trial of alendronate for prevention of osteoporosis in recently postmenopausal women with normal bone mass (n = 1609). The 2-year data from the placebo group were used (n = 417). Percentage of body fat, BMI, and body weight were correlated with baseline BMD (r = -0. 13 to -0.43, p < 0.01) and 2-year bone loss (r = -0.14 to -0.19, p < 0.01). Women in the lowest tertiles of percentage of body fat or BMI had up to 12% lower BMD at baseline and a more than 2-fold higher 2-year bone loss as compared with women in the highest tertiles (p </= 0.004). Women with a lower percentage of body fat or BMI had higher baseline levels of urine N-telopeptide cross-links (r = -0.24 to -0.31, p < 0.0001) and serum osteocalcin (r = -0.12 to -0.15, p < 0.01). To determine if the magnitude of treatment effect of alendronate was dependent on these risk factors, the group treated with 5 mg of alendronate was included (n = 403). There were no associations between fat mass parameters and response to alendronate treatment, which indicated that risk of low bone mass and increased bone loss caused by thinness could be compensated by alendronate treatment. In conclusion, thinness is an important risk factor for low bone mass and increased bone loss in postmenopausal women. Because the response to alendronate treatment is independent of fat mass parameters, prevention of postmenopausal osteoporosis can be equally achieved in thinner and heavier women.

Evidence that increased calcium intake does not prevent early postmenopausal bone loss

Calcium's ability to prevent bone loss in early postmenopausal women is controversial. We used data on 394 women from the placebo group of the Early Postmenopausal Interventional Cohort study, a clinical trial of alendronate, to investigate the relation of calcium intake to bone loss. Calcium intake was recorded, and bone mineral density (BMD) (in the lumbar spine, total body, forearm, and hip) and biochemical markers of bone turnover (serum total alkaline phosphatase, serum osteocalcin, and urinary N-telopeptide crosslink levels) were measured at baseline and annually thereafter. Women whose baseline calcium intake was <500 mg/d were advised to increase their calcium intake. Mean (+/- SE) BMD decreased by 1.9% +/- 0.16% at the lumbar spine and 1.6% +/- 0.14% at the hip over the 24-month period. Despite wide variations in baseline calcium intake and changes in calcium intake, these measures were not significantly associated with changes in BMD or bone turnover. Even women whose total calcium intake was >1333 mg/d (the highest tertile of total calcium intake) showed a decline in BMD of almost 2%, similar to declines in the lower two tertiles of total calcium intake (<869 and 869-1333 mg/d, respectively). Increased calcium intake resulted in modest mean increases of approximately 200 mg/d. We were unable to demonstrate that increases of this magnitude or much greater (1 g/d) were protective against declines in BMD at any site, even in women who had the lowest calcium intake at baseline. In addition to adequate calcium intake, more effective therapy appears to be required when the therapeutic goal is to increase or maintain BMD.

Administration of a crystalloid fluid preload does not prevent the decrease in arterial blood pressure after induction of anaesthesia with propofol and fentanyl

Anaesthesia was induced in 58 women (ASA I or II) undergoing elective gynaecological procedures, using propofol 2.5 mg kg-1 and fentanyl 1.5 micrograms kg-1. Patients were allocated to receive 20 ml kg-1 of crystalloid fluid preload over 20 min or to receive no fluids before induction of anaesthesia. A significant decrease in systolic arterial pressure (< 75% of baseline value) occurred in both the fluid-loaded and the control groups, and was similar in both groups. Administration of a fluid preload did not attenuate the decrease in systolic arterial pressure after induction of anaesthesia with propofol and fentanyl.

Co-transformation with one Agrobacterium tumefaciens strain containing two binary plasmids as a method for producing marker-free transgenic plants

Co-transformation was investigated as a method that would allow the use of a selectable marker during plant regeneration followed by recovery of progeny which contain the desired gene(s) but lack a marker gene. Rapeseed (Brassica napus cv `212/86') and tobacco (Nicotiana tabacum cv `Xanthi NC') were co-cultivated with a single Agrobacterium tumefaciens strain containing two binary plasmids. Genes from both plasmids were expressed in approximately 50% of the primary transformants. Progeny expressing only one of the transgenes were observed in about 50% of the co-transformed lines, indicating that the genes were inserted at different loci. This single-strain co-transformation method allowed the use of a selectable marker during plant regeneration and subsequent recovery of marker-free progeny.

Substance abuse treatment for pregnant women: a window of opportunity?

The use of substance abuse treatment services by pregnant and nonpregnant women was compared to explore the effects of pregnancy on treatment utilization and outcomes. Treatment service records for 227 pregnant drug- and alcohol-dependent women and a matched comparison group of 277 nonpregnant women were retrieved from the Massachusetts Bureau of Substance Abuse Services Management Information System. Treatment services received by the two groups of women during a 6-month period following an index detoxification were tabulated and compared. Treatment services for pregnant women differed quantitatively and qualitatively from the services received by nonpregnant women over the 6-month time period. After controlling for background characteristics and substance abuse history, pregnant women were 1.7 times more likely to be readmitted to detoxification, 2.8 times more likely to enter residential facilities, and 5.4 times more likely to enter methadone programs. For both groups, the use of outpatient and/or residential treatment services following discharge from detoxification significantly reduced the risk of subsequent detoxification admissions. The increased likelihood of admission to detoxification, residential, and methadone services suggests that treatment programs have improved access to care for pregnant women. Multiple detoxification admissions suggest, however, that some pregnant women have difficulty entering stable recovery. Given the brevity of the gestational period and the detrimental effects of drug and alcohol use on fetal outcomes, the use of continuing treatment services for pregnant women is strongly recommended.

Prevention of bone loss with alendronate in postmenopausal women under 60 years of age. Early Postmenopausal Intervention Cohort Study Group

BACKGROUND

Estrogen-replacement therapy prevents osteoporosis in postmenopausal women by inhibiting bone resorption, but the balance between its long-term risks and benefits remains unclear. Whether other antiresorptive therapies can prevent osteoporosis in these women is also not clear.

METHODS

We studied the effect of 2.5 mg or 5 mg of alendronate per day or placebo on bone mineral density in 1174 postmenopausal women under 60 years of age. An additional 435 women who were prepared to receive a combination of estrogen and progestin were randomly assigned to one of the above treatments or open-label estrogen-progestin. The main outcome measure was the change in bone mineral density of the lumbar spine, hip, distal forearm, and total body measured annually for two years by dual-energy x-ray absorptiometry.

RESULTS

The women who received placebo lost bone mineral density at all measured sites, whereas the women treated with 5 mg of alendronate daily had a mean (+/-SE) increase in bone mineral density of 3.5+/-0.2 percent at the lumbar spine, 1.9+/-0.1 percent at the hip, and 0.7+/-0.1 percent for the total body (all P<0.001). Women treated with 2.5 mg of alendronate daily had smaller increases in bone mineral density. Alendronate did not increase bone mineral density of the forearm, but it slowed the loss. The responses to estrogen-progestin were 1 to 2 percentage points greater than those to the 5-mg dose of alendronate. Alendronate was well tolerated, with a safety profile similar to that of placebo or estrogen-progestin.

CONCLUSIONS

Alendronate prevents bone loss in postmenopausal women under 60 years of age to nearly the same extent as estrogen-progestin.

An examination of racial and ethnic differences within a sample of Hispanic, white (non-Hispanic), and African American Medicaid-eligible pregnant substance abusers. The MOTHERS Project

White (n = 213), African American (n = 210), and Hispanic (n = 104) Medicaid-eligible, chemically-dependent, pregnant women were interviewed during their stay in stay in publicly-funded detoxification centers in Massachusetts. Comparisons of demographic, psychosocial, and substance abuse variables revealed significant intergroup differences in almost all instances. There appears to be as much heterogeneity within the treatment population subgroup of pregnant women as there is across different treatment populations. Ramifications of the observed differences for treatment planning and service provision are discussed.

Characteristics and treatment needs of sexually abused pregnant women in drug rehabilitation. The Massachusetts MOTHERS Project

Four hundred forty-seven Medicaid-eligible pregnant chemically dependent women were interviewed during their stay in publicly funded detoxification centers in Massachusetts. One hundred eighty-four women (41%) reported sexual abuse during their lifetime. Sexually abused women differed significantly from women who had not been abused, on a variety of psychological, social, and medical problems indicators. Sexually abused women appear to constitute a specific subgroup of the larger population of substance abusing women, and have unique treatment needs.

Effect of recombinant bovine interleukin-1 beta on viral/bacterial pneumonia in cattle

Bovine herpesvirus-1 (BHV-1) is an important pathogen of respiratory infections in cattle. Its continuing importance lies in its ability to predispose infected hosts to bacterial infections (e.g., Pasteurella haemolytica). In this study we determined whether the immunoregulatory effects induced by recombinant bovine interleukin-1 (rbIL-1) could stimulate appropriate host defense mechanisms to influence the course of BHV-1 and P. haemolytica infection in cattle. We first evaluated the effect of multiple doses (5 doses of 300 ng/kg) of rbIL-1 in normal cattle. An increase in polymorphonuclear (PMN) cells, as well as monocytes, in peripheral blood was observed during the course of IL-1 administration. In addition, the phagocytic activity of monocytes was increased. Although the phagocytic and oxidative burst activities in PMN decreased during the course of rbIL-1 treatment, no changes were observed in the bactericidal capacity of these cells. Lymphocyte numbers in peripheral blood remained unchanged; however, the functional activity of these cells, as measured by IFN-gamma production upon in vitro stimulation, was decreased. In the bovine respiratory disease model, multiple administration of IL-1 did not influence significantly the progression of BHV-1/P. haemolytica infection in cattle. Thus, our results demonstrated that IL-1, although not therapeutically effective, could be administered safely as an adjuvant, even during the course of BHV-1/P. haemolytica infection.

Controlled expression of plastid transgenes in plants based on a nuclear DNA-encoded and plastid-targeted T7 RNA polymerase

Phage T7 RNA polymerase has been used extensively in Escherichia coli for high-level expression of selected genes placed under the control of the phage T7 gene 10 promoter. We have constructed an analogous system for use in plastids of higher plants. A T7 RNA polymerase chimeric gene containing a cauliflower mosaic virus 35S promoter and a tobacco ribulose-bisphosphate carboxylase/oxygenase small-subunit chloroplast transit-peptide sequence was introduced into tobacco by nuclear transformation. Stable plastid transformation of tobacco expressing the T7 RNA polymerase activity with a T7 promoter/beta-glucuronidase (GUS) reporter gene construct resulted in expression of GUS mRNA and enzyme activity in all tissues examined. Expression of GUS activity was extremely high in mature leaves, moderate in young leaves and petals, and low in stems, roots, and developing seeds. Plastid transformation of wild-type tobacco with the same chimeric GUS gene resulted in undetectable levels of GUS mRNA and enzyme activity. Genetic crosses demonstrated that a silent T7/GUS reporter gene could be activated in the F1 generation by transmission of an active nuclear T7 RNA polymerase gene from the male parent.

Use of the Addiction Severity Index with homeless substance abusers

The Addiction Severity Index (ASI) is a widely adopted assessment instrument that provides severity ratings of the multiple problems exhibited by alcohol and drug dependent persons and allows for quantitative assessment (composite scores) of client status in these problems areas over time. ASI change scores of homeless and near homeless substance abusers, generated by contrasting ASI composite scores at two points in time, show a high level of agreement to objective relapse data from the Massachusetts Bureau of Substance Abuse Services Management Information System. Clients readmitted to a publicly funded detoxification facility exhibited significantly lower mean change scores on five of the seven problems areas measured by the ASI. These data illustrate the applicability of the ASI to homeless men and women and the utility of the ASI in measuring client improvement.

Prevention and treatment of Staphylococcus aureus infections with recombinant cytokines

Antibiotic therapy is only moderately efficacious for bovine Staphylococcus aureus mastitis. We have used recombinant bovine cytokines to activate the natural host defenses, to prevent and treat bovine mastitis. Uninfected mammary glands infused with GM-CSF or IL-2 increased the percentage of phagocytic cells in the milk by 2-3 fold. IL-1 increased the number of polymorphonuclear cells in the milk, enhanced their inducible oxygen radical formation, and had no effect on phagocytosis. Treatment with IL-2 increased the number of polymorphonuclear cells in the milk, enhanced their inducible oxygen radical formation, and enhanced their phagocytosis. GM-CSF had no effect on the number polymorphonuclear cells in the milk but enhanced their inducible oxygen radical formation, and enhanced their phagocytosis. All cytokines were effective in preventing S. aureus infections (20-100%). 52% of all chronically infected mammary gland quarters treated with three doses of IL-2 responded to therapy and 32% of the treated quarters remained cured. 75% of all mammary glands treated with three doses of IL-1 beta responded to therapy by clearing the infection and 22% of the treated glands remained cured. These studies demonstrate that recombinant bovine cytokines can be used effectively to prevent infections as well as treat established chronic infection.

Physiologic effects of administration of interleukin 1 beta in cows

The immunomodulating polypeptide interleukin 1 beta (IL-1 beta) has been shown to be homologous to osteoclast-activating factor and is capable of stimulating increased osteoclastic bone resorption. This effect prompted an investigation into the potential use of IL-1 beta for prevention of parturient paresis, a disease of dairy cows characterized by hypocalcemia and poor osteoclastic resorption of bone. Six nonpregnant cows were treated with a high dosage of IL-1 beta (166 ng/kg of body weight) every 8 hours for 4 days. The IL-1 beta treatment significantly (P < 0.05) increased urinary hydroxyproline excretion, an index of osteoclast activity, indicating that bone calcium resorption might be stimulated by IL-1 beta treatment of cows. However, IL-1 beta treatment also caused transient fever, inappetence, increased pulse and respiratory rate, and diuresis. The acute, but transient, effect of IL-1 beta treatment was to cause a decrease in plasma calcium and phosphorus concentrations. The pleiotropic effects of IL-1 beta administration negated the positive effects on osteoclastic bone resorption, and indicates that this cytokine may be of minimal benefit for prevention of parturient paresis.

Soft drink consumption and urinary stone recurrence: a randomized prevention trial

The object of this study was to determine if a strong association between soft drink (soda) consumption and recurrence of urinary stone disease, found in an earlier case-control study of adult males, had a causal component. The study sample consisted of 1009 male subjects, who completed an episode of urinary stone disease, who were aged 18-75 at that time, and who reported consuming at least 160 ml per day of soft drinks. Half of the subjects were randomized to refrain from consuming soft drinks, while the remaining subjects served as controls. The intervention group had an observed 6.4% advantage in actuarial 3 yr freedom from recurrence (p = 0.023 one-sided) over the control group. One important secondary finding was that for those who reported at the time of the index stone that their most consumed drink was acidified by phosphoric acid but not citric acid, the experimental group had a 15% higher 3 yr recurrence-free rate than the controls, p = 0.002, while for those who reported at the time of the index stone that their most consumed drink was acidified by citric acid with or without phosphoric acid, the experimental group had a similar 3 yr recurrence-free rate to the controls, p = 0.55. This interaction was significant, p = 0.019.

Sex discrimination in social work careers

Although the social work profession has expressed a commitment to equal opportunity in employment for women, this study notes that inequities in salary and status still exist between male and female social workers. A major cause of these differences appears to be the process of promotion within public agencies, which introduces inequities early in the careers of social workers.

Recovery of bacteriophate from contaminated chilled and frozen samples of edible West Coast crabs

Edible West Coast crabs (Cancer magister and C. antennarius) were contaminated with bacteriophage and then held in a chilled or frozen state. Results indicated a significant survival of virus regardless of storage conditions.

Uptake of bacteriophage and their subsequent survival in edible West Coast crabs after processing

Edible West Coast crabs (Cancer magister and Cancer antennarius), when in seawater contaminated with coliphage T4, were found to accumulate high titers of this virus. To study the extent of the hazard presented by crabs contaminated with virus, samples of edible crabs were contaminated with coliphage T4 and then processed by boiling. Results indicated that virus in crabs withstood this method of processing. The survival rate varied from 2.5 to 20%, depending upon the processing time. Heat penetration studies showed that, although internal temperature in the crabs was sufficient to inactivate virus, the processing times normally used to cook crabs were not. These results suggest that processed crabs could serve as vectors for the dissemination of virus diseases if the crabs are harvested from a polluted area.

Preliminary observations on the uptake poliovirus by West Coast shore crabs

West Coast shore crabs (Pachygrapsus sp. and Hemigrapsus sp.), when in seawater contaminated with poliovirus or allowed to feed on virus-contaminated mussels (Mytilus californianus), were found to accumulate high titers of virus.