Chronic postsurgical pain (CPSP): an underestimated problem after incisional hernia treatment

BACKGROUND

Chronic postsurgical pain (CPSP) is a potential long-term problem following open incisional hernia repair which may affect the quality of life of patients despite successful anatomical repair of the hernia. The aim of this manuscript was to identify the incidence and outcome of patients following open incisional hernia repair in respect of risk factors to develop CPSP.

METHODS

A single-center retrospective analysis of patients who underwent open incisional hernia repair between 2015 and 2021 was performed. Pre-existing conditions (e.g., diabetes mellitus and malignancy), hernia complexity, postoperative complications, and postoperative pain medication were analyzed using the local database. Quality of life and CPSP were assessed using the EuraHS Quality of Life (QoL) questionnaire.

RESULTS

A total of 182 cases were retrospectively included in a detailed analysis based on the complete EuraHS (QoL) questionnaire. During the average follow-up period of 46 months, this long-term follow-up revealed a 54.4% incidence of CPSP and including a rate of 14.8% for severe CPSP (sCPSP) after open incisional hernia surgery. The complexity of the hernia and the demographic variables were not different between the group with and without CPSP. Patients with CPSP reported significantly reduced QoL. The analgesics score which includes the need of pain medication in the initial days after surgery was significantly higher in patients with CPSP than in those without (no CPSP: 2.86 vs. CPSP: 3.35; p = 0.047).

CONCLUSION

The presence of CPSP after open incisional hernia repair represents a frequent and underestimated long-term problem which has been not been recognized to this extent before. CPSP impairs QoL in these patients. Patients at risk to develop CPSP can be identified in the perioperative setting by the need of high doses of pain medication using the analgesics score. Possibly timely adjustment of pain medication, even in the domestic setting, could alleviate the chronicity or severity of CPSP.

Postoperative Analgesics Score as a Predictor of Chronic Postoperative Inguinal Pain After Inguinal Hernia Repair: Lessons Learned From a Retrospective Analysis

BACKGROUND

Chronic postoperative inguinal pain (CPIP) is a common complication after inguinal hernia surgery and occurs in up to 10-14% of cases. CPIP has a significant impact on daily life, work ability and thus compromises quality of life. The aim of this retrospective study was an in-depth analysis of patients undergoing inguinal hernia repair to further refine the prediction of the onset of CPIP reliably.

METHODS

A single center retrospective analysis of patients with who underwent open or minimally invasive inguinal hernia repair from 2016 to 2021 was carried out. Complication rates, detailed analysis of postoperative pain medication and quality of life using the EuraHS Quality of Life questionnaire were assessed.

RESULTS

Out of 596 consecutive procedures, 344 patients were included in detailed analyses. While patient cohorts were different in terms of age and co-morbidities, and the prevalence of CPIP was 12.2% without differences between the surgical procedures (Lichtenstein: 12.8%; TEP 10.9%; TAPP 13.5%). Postoperative pain was evaluated using a newly developed analgesic score. Patients who developed CPIP later had a significant higher consumption of analgesics at discharge (p = 0.016). As additional risk factors for CPIP younger patient age and postoperative complications were identified.

CONCLUSION

The prospective use of the analgesic score established here could be helpful to identify patients that are at risk to develop CPIP. These patients could benefit from a structured follow-up to allow early therapeutic intervention to prevent chronification and restore the quality of life.

The small non-coding RNA B11 regulates multiple facets of Mycobacterium abscessus virulence

Mycobacterium abscessus causes severe disease in patients with cystic fibrosis. Little is known in M. abscessus about the roles of small regulatory RNAs (sRNA) in gene regulation. We show that the sRNA B11 controls gene expression and virulence-associated phenotypes in this pathogen. B11 deletion from the smooth strain ATCC_19977 produced a rough strain, increased pro-inflammatory signaling and virulence in multiple infection models, and increased resistance to antibiotics. Examination of clinical isolate cohorts identified isolates with B11 mutations or reduced expression. We used RNAseq and proteomics to investigate the effects of B11 on gene expression and test the impact of mutations found in clinical isolates. Over 200 genes were differentially expressed in the deletion mutant. Strains with the clinical B11 mutations showed expression trends similar to the deletion mutant, suggesting partial loss of function. Among genes upregulated in the B11 mutant, there was a strong enrichment for genes with B11-complementary sequences in their predicted ribosome binding sites (RBS), consistent with B11 functioning as a negative regulator that represses translation via base-pairing to RBSs. Comparing the proteomes similarly revealed that upregulated proteins were strongly enriched for B11-complementary sequences. Intriguingly, genes upregulated in the absence of B11 included components of the ESX-4 secretion system, critical for M. abscessus virulence. Many of these genes had B11-complementary sequences at their RBSs, which we show is sufficient to mediate repression by B11 through direct binding. Altogether, our data show that B11 acts as a direct negative regulator and mediates (likely indirect) positive regulation with pleiotropic effects on gene expression and clinically important phenotypes in M. abscessus. The presence of hypomorphic B11 mutations in clinical strains is consistent with the idea that lower B11 activity may be advantageous for M. abscessus in some clinical contexts. This is the first report on an sRNA role in M. abscessus.

Glycopeptidolipid Defects Leading to Rough Morphotypes of Mycobacterium abscessus Do Not Confer Clinical Antibiotic Resistance

Mycobacterium abscessus is an emerging pathogen causing severe pulmonary infections. Within chronically infected patients, M. abscessus isolates undergo molecular changes leading to increased virulence and antibiotic resistance. Specifically, mutations in glycopeptidolipid (GPL) synthesis genes, leading to the rough phenotype, are associated with invasive, nonremitting infections and a severe clinical course. It has been unclear whether GPL defects confer antibiotic resistance independently of other molecular changes. We used transposon technology to isolate a rough (GPL-defective; Tn MABS_4099cZeoR) mutant and compare it to a fully isogenic parent strain (ATCC 19977) bearing wild-type zeocin resistance (WTZeoR). Antibiotic susceptibility profiles of Tn_4099cZeoR and WTZeoR were tested and compared using the Sensititre RAPMYCOI antimicrobial susceptibility test plate. MICs were evaluated within clinically relevant values according to the Clinical and Laboratory Standards Institute (CLSI) standards. We found that M. abscessus with rough colony morphotype (Tn_4009c) had comparable antibiotic susceptibility to its smooth isogenic WT counterpart. Small differences (a 1:2 dilution) in MICs were found for imipenem, cefoxitin, and tigecycline, yet those small differences did not change the clinical susceptibility report for these antibiotics, as they fell within the same CLSI cutoffs for resistance. While small alternations in susceptibility to imipenem, cefoxitin, and tigecycline were noted, we conclude that the GPL mutations in M. abscessus did not confer clinically significant antibiotic resistance. Increased antibiotic resistance in the clinical setting may occur in an unrelated and parallel manner to GPL mutations. IMPORTANCE Mycobacterium abscessus chronically infects patients with preexisting lung diseases, leading to progressive deterioration in pulmonary function. The common perception among clinicians is that the rough phenotype is associated with progressive disease and severe clinical course, manifested as a widespread inflammatory response and resistance to antibacterials. However, as clinical isolates accumulate hundreds of mutations over the prolonged course of infection, it is unclear whether the rough phenotype per se is responsible for the antibiotic resistance seen in late-stage infections, or whether the resistance is related to other genetic changes in the bacteria. Previous studies mostly compared rough and smooth clinical isolates. Here, for the first time, we compared WT smooth bacteria to a specific rough, GPL-associated, otherwise-isogenic mutant. We determined that the rough morphotype had essentially identical antibiotic susceptibilities as the parent strain. The mechanistic basis for the antibiotic resistance observed in rough clinical isolates is therefore most probably related to other genetic determinants.

Virulence-Associated Secretion in Mycobacterium abscessus

Non-tuberculous mycobacteria (NTM) are a heterogeneous group of originally environmental organi3sms, increasingly recognized as pathogens with rising prevalence worldwide. Knowledge of NTM’s mechanisms of virulence is lacking, as molecular research of these bacteria is challenging, sometimes more than that of M. tuberculosis (Mtb), and far less resources are allocated to their investigation. While some of the virulence mechanisms are common to several mycobacteria including Mtb, others NTM species-specific. Among NTMs, Mycobacterium abscessus (Mabs) causes some of the most severe and difficult to treat infections, especially chronic pulmonary infections. Mabs survives and proliferates intracellularly by circumventing host defenses, using multiple mechanisms, many of which remain poorly characterized. Some of these immune-evasion mechanisms are also found in Mtb, including phagosome pore formation, inhibition of phagosome maturation, cytokine response interference and apoptosis delay. While much is known of the role of Mtb-secreted effector molecules in mediating the manipulation of the host response, far less is known of the secreted effector molecules in Mabs. In this review, we briefly summarize the knowledge of secreted effectors in Mtb (such as ESX secretion, SecA2, TAT and others), and draw the parallel pathways in Mabs. We also describe pathways that are unique to Mabs, differentiating it from Mtb. This review will assist researchers interested in virulence-associated secretion in Mabs by providing the knowledge base and framework for their studies.

Comparison of Isogenic Strains Shows No Evidence of Altered Nosocomial Transmission-Competency of Rough, GPL-Negative Mycobacterium abscessus Strains

Mycobacterium abscessus is an emerging pathogen causing severe pulmonary infections. While environmental in origin, in the clinical setting M. abscessus often changes to a Rough phenotype associated with severe non-remitting infections. Clinical isolates baring mutations in glycopeptidolipid-synthesis genes, leading to the Rough phenotype, were suggested to have increase bacterial virulence while possibly showing reduced transmissibility on fomites. We set to determine whether an isolated glycopeptidolipid (GPL) defect affects transmissibility. We used transposon technology to create a fully isogenic Rough (GPL-defective) (Tn_4099c) and compare it to the isogenic parent strain (ATCC 19977). Survival on fomites was determined by spotting, drying, and retrieving the isolates at designated time points. This was repeated as a competition experiment using a mixture of differentially fluorescent M. abscessus 19977 (Smooth) and the Tn_4099c mutant (Rough). Survival ability in chlorhexidine solution (Septal Scrub Teva) was performed using a disinfectant killing-assay for mycobacteria. Despite significant bacterial killing in all assays, we found no survival advantage to either GPL-defected Rough or GPL-reserved Smooth morphotype-both on fomites and in chlorhexidine. Our findings suggest that while transmission fitness may be altered due to some within-host evolutionary changes, decreased transmissibility of clinical strains cannot be attributed to the GPL-synthesis defect alone. Further studies are needed to determine the effect of other mutations on the transmission potential of M. abscessus in the clinical setting. IMPORTANCE Mycobacterium abscessus is an emerging pathogen causing severe pulmonary infections. In the clinical setting, M. abscsssus undergoes molecular and genetic changes associated with increased virulence. Specifically, bacterial defects in glycopeptidolipid (GPL) synthesis, creating the "Rough" colony phenotype, have been associated with increased virulence, yet were also presumably observed to have decreased survival on fomites, leading to reduced transmissibility. We set to determine whether GPL-synthesis defects are indeed responsible for reduced transmissibility of clinical isolates. We compared fully isogenic GPL-disrupted versus GPL-preserved strains, and demonstrated no survival advantage for either strain on fomites. Additionally, neither isolate had a survival advantage in chlorhexidine, a widely used disinfectant in health care settings. Our findings suggest that reduced transmissibility of clinical isolates, should it be found, cannot be attributed to GPL-synthesis mutations. While clinical isolates may show changes in transmission potential, more studies are needed to investigate the mechanisms leading to these phenotypic changes.

Concomitant congenital CMV infection and inherited liver diseases

Inherited liver diseases may present in infancy as cholestatic jaundice progressing to severe hepatic dysfunction. Congenital cytomegalovirus (cCMV) infection may initially involve the liver, yet in otherwise healthy hosts rarely leads to long-term hepatic disease. We report a series of three patients, diagnosed with hereditary liver diseases: progressive familial intrahepatic cholestasis (PFIC) type IV, alpha 1 anti-trypsin deficiency (A1ATD) and Alagille syndrome (ALGS), who were also diagnosed with cCMV infection. All patients were treated with valgancilovir for symptomatic cCMV infection (6-12 months), followed by suppressive dosing in the 2 patients with PFIC and A1ATD. Following 15-24 months of follow-up - the patients with PFIC and A1ATD developed severe liver failure, and the third had ongoing cholestatic disease with stable synthetic function. We propose a significant contribution of cCMV infection to the course of the inherited primary disease, possibly leading to further compromise of the liver. We recommend screening patients with inherited liver disease for cCMV, and considering anti-viral treatment with valganciclovir to delay hepatic disease progression.

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

BACKGROUND

Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts.

METHODS

We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality.

FINDINGS

On July 1, 2019, 26% of infants (580/2,265; range, 0-100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received ≥1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were "rule-out" sepsis (32%) and "culture-negative" sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and "culture-negative" infections was 12 days (median; IQR, 8-14) and 7 days (median; IQR, 5-10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0·02).

INTERPRETATION

Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide.

FUNDING

Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship.

EttA is likely non-essential in Staphylococcus aureus persistence, fitness or resistance to antibiotics

Background

Tolerance to antibiotics and persistence are associated with antibiotic treatment failures, chronic-relapsing infections, and emerging antibiotic resistance in various bacteria, including Staphylococcus aureus. Mechanisms of persistence are largely unknown, yet have been linked to physiology under low-ATP conditions and the metabolic-inactive state. EttA is an ATP-binding cassette protein, linked in Eschrechia coli to ribosomal hibernation and fitness in stationary growth phase, yet its role in S. aureus physiology is unknown.

Results

Using whole genome sequencing (WGS) of serial clinical isolates, we identified an EttA-negative S. aureus mutant (ettA^stop), and its isogenic wild-type counterpart. We used these two isogenic clones to investigate the role of ettA in S. aureus physiology in starvation and antibiotic stress, and test its role in persistence and antibiotic tolerance. ettA^stop and its WT counterpart were similar in their antibiotic resistance profiles to multiple antibiotics. Population dynamics of ettA^stop and the WT were similar in low-nutrient setting, with similar recovery from stationary growth phase or starvation. Supra-bacteriocidal concentration of cefazolin had the same killing effect on ettA^stop and WT populations, with no difference in persister formation.

Conclusions

Lack of ettA does not affect S. aureus antibiotic resistance, beta-lactam tolerance, resilience to starvation or fitness following starvation. We conclude the role of ettA in S. aureus physiology is limited or redundant with another, unidentified gene. WGS of serial clinical isolates may enable investigation of other single genes involved in S. aureus virulence, and specifically persister cell formation.

Q Fever Osteoarticular Infection in Children

Studies of this condition, which is underestimated in children, will aid in its diagnosis and treatment.

Q fever osteoarticular infection in children is an underestimated disease. We report 3 cases of Q fever osteomyelitis in children and review all cases reported in the literature through March 2018. A high index of suspicion is encouraged in cases of an unusual manifestation, prolonged course, relapsing symptoms, nonresolving or slowly resolving osteomyelitis, culture-negative osteomyelitis, or bone histopathology demonstrating granulomatous changes. Urban residence or lack of direct exposure to animals does not rule out infection. Diagnosis usually requires use of newer diagnostic modalities. Optimal antimicrobial therapy has not been well established; some case-patients may improve spontaneously or during treatment with a β-lactam. The etiology of treatment failure and relapse is not well understood, and tools for follow-up are lacking. Clinicians should be aware of these infections in children to guide optimal treatment, including choice of antimicrobial drugs, duration of therapy, and methods of monitoring response to treatment..

Exposure to a Surrogate Measure of Contamination From Simulated Patients by Emergency Department Personnel Wearing Personal Protective Equipment

This study uses an atomizer and fluorescent markers to simulate contamination of uncovered skin and hair of health care workers wearing personal protective equipment after intubating patient manikins under emergency conditions.

Peptide Deformylase (def) is essential in Mycobacterium smegmatis, but the essentiality is compensated by inactivation of methionine formylation

Background

Co-translational processes in bacteria are attractive drug targets, but while some processes are essential, others are not. The essentiality of Peptide Deformylase (PDF, def) for vitality of mycobacteria was speculated, but never unequivocally proven.

Results

Here we show by targeted deletion experiments that def can only be deleted from M. smegmatis when an additional copy is present; that prior deletion of tRNA^fMet-Formyl Transferase (FMT, encoded by fmt) renders def completely dispensable; and that re-introduction of fmt into a Δdef mutant is not possible – constituting a definitive proof for the essentiality of def in mycobacteria.

Conclusions

Peptide deformylase is essential in M. smegmatis, but the fact that inactivation of fmt renders the gene completely dispensable, and thus any inhibitor of def useless, casts doubt on the usefulness of PDF as a drug-target in mycobacteria.

The addition of avibactam renders piperacillin an effective treatment for Mycobacterium abscessus infection in an in vivo model

Treating M. abscessus infection is challenging due to the potent β-lactamase Bla_Mab (Beta-lactamase of M. abscessus ₎. Avibactam is a non-β-lactam, β-lactamase inhibitor shown to inhibit Bla_Mab. We tested whether avibactem can render piperacillin effective against M. Abscessus. In-vitro, avibactam enhanced the activity of piperacillin by 16-32 fold, with no significant effect on meropenem. In an in-vivo Galleria mellonella model, meropenem and piperacillin/avibactam significantly decreased infection burden compared to untreated controls. Neither piperacillin nor avibactam alone had a significant effect.

787. The Addition of Avibactam Augments the Activity of Piperacillin Against Mycobacterium abscessus in vitro, and Is Effective in Treating M. abscessus Infection in a Galleria mellonella in vivo Model

Background

Mycobacterium abscessus is an emerging multi-drug-resistant pathogen, harboring the β-lactamse Bla_MAB. Avibactam is a non-β-lactam, β-lactamase inhibitor shown to inhibit Bla_MAB and improve the efficacy of ampicillin for M. abscessus infections in in vitro and in vivo models. Whether the addition of avibactam to piperacillin enables use of the latter against M. abscessus is unknown

Methods

We used a recombinant, luminescent M. abscessus to measure the reduction of MIC to meropenem, ampicillin, and piperacillin induced by avibactam. We then used our previously established G. mellonella infection model (Figure 1)¹ to evaluate the effect of antimicrobial treatments in vivo.

Results

Addition of avibactam (4 µg/mL) consistently decreased MIC of ampicillin and piperacillin by 16 and 16–32-fold, respectively, but as expected had no significant effect on meropenem MIC (Figure 2). We inoculated 60 G. mellonella larvae with luminescent M. abscessus on day 0, and treated larvae with meropenem, piperacillin, avibactam alone, or piperacillin combined with avibactam on days 2 and 3. Using IVIS^® imaging, we measured infection progression in live infected larvae on day 4. Larvae treated with meropenem and piperacillin–avibactam had significantly lower infection burden compared with untreated controls (P < 0.0001 and P = 0.004, respectively). Piperacillin and avibactam alone had no significant inhibitory effect (Figure 3).

Conclusion

Our findings suggest that the piperacillin–avibactam combination is effective against M. abscessus infections. This novel combination may hold a great promise for patients with cystic fibrosis suffering from M. abscessus, Pseudomonas aeruginosa, and/or Staphylococcus aureus co-infections. The G. mellonella infection model may be used in future studies to assess the efficacy of various antimicrobials and antimicrobial combinations on M. abscessus, P. aeruginosa, and S. aureus co-infections.

Reference

1. Meir M et al. Antimicrob Agents Chemother. 2018.

Disclosures

All authors: No reported disclosures.

Dormancy release and flowering time in Ziziphus jujuba Mill., a "direct flowering" fruit tree, has a facultative requirement for chilling

In deciduous fruit trees, the effect of chilling on flowering has mostly been investigated in the "indirect flowering" group, characterized by a period of rest between flower bud formation and blooming. In the present study, we explored the effects of chilling and chilling deprivation on the flowering of Ziziphus jujuba, a temperate deciduous fruit tree belonging to the "direct flowering" group, in which flower bud differentiation, blooming and fruit development occur after dormancy release, during a single growing season. Dormancy release, vegetative growth and flowering time in Z. jujuba cv. Ben-Li were assessed following several treatments of chilling. Chilling treatments quantitatively decreased the timing of vegetative bud dormancy release, thereby accelerating flowering, but had no effect on the time from dormancy release to flowering. Trees grown at a constant temperature of 25°C, without chilling, broke dormancy and flowered, indicating the facultative character of chilling in this species. We measured the expression of Z. jujuba LFY and AP1 homologues (ZjLFY and ZjAP1). Chilling decreased ZjLFY expression in dormant vegetative buds but had no effect on ZjAP1expression, which reached peak expression before dormancy release and at anthesis. In conclusion, chilling is not obligatory for dormancy release of Z. jujuba cv. Ben-Li vegetative buds. However, the exposure to chilling during dormancy does accelerate vegetative bud dormancy release and flowering.

The COP9 signalosome is vital for timely repair of DNA double-strand breaks

The DNA damage response is vigorously activated by DNA double-strand breaks (DSBs). The chief mobilizer of the DSB response is the ATM protein kinase. We discovered that the COP9 signalosome (CSN) is a crucial player in the DSB response and an ATM target. CSN is a protein complex that regulates the activity of cullin ring ubiquitin ligase (CRL) complexes by removing the ubiquitin-like protein, NEDD8, from their cullin scaffold. We find that the CSN is physically recruited to DSB sites in a neddylation-dependent manner, and is required for timely repair of DSBs, affecting the balance between the two major DSB repair pathways—nonhomologous end-joining and homologous recombination repair (HRR). The CSN is essential for the processivity of deep end-resection—the initial step in HRR. Cullin 4a (CUL4A) is recruited to DSB sites in a CSN- and neddylation-dependent manner, suggesting that CSN partners with CRL4 in this pathway. Furthermore, we found that ATM-mediated phosphorylation of CSN subunit 3 on S410 is critical for proper DSB repair, and that loss of this phosphorylation site alone is sufficient to cause a DDR deficiency phenotype in the mouse. This novel branch of the DSB response thus significantly affects genome stability.

Molecular Imaging of Membrane Transporters' Activity in Cancer: a Picture is Worth a Thousand Tubes

Molecular imaging allows the non-invasive assessment of membrane transporter expression and function in living subjects. Such technologies have the potential to become diagnostic and prognostic tools, allowing detection, localization, and prediction of response of tumors and their metastases to therapy. Beyond tumors, imaging can also help understand the role of transporters in adverse drug effects and drug clearance. Here, we review molecular imaging technologies that monitor transporter-mediated processes. We emphasize emerging probe substrates and potential clinical applications of imaging the function of membrane transporters in cancer.

Modular columns to study depth-dependence behavior of mosquito larvae and toxicity of Bacillus thuringiensis subsp. israelensis

Modular transparent column system was designed to study depth-dependence behavior of mosquito larvae. The system was used in preliminary experiments to evaluate the effect of water depth on the larvicidal activity of Bacillus thuringiensis subsp. israelensis de Barjac against bottom feeder larvae of Aedes aegypti (Linn.) (Diptera: Culicidae), and suggestions for increasing the efficiency of the device are discussed.

Changes in eggshell conductance, water loss and hatchability of layer hens with flock age and moulting

1. Changes in water loss, eggshell conductance and hatchability with flock age were monitored in layer hens in a commercial hatchery. 2. Optimal water loss for maximal hatchability of layer eggs was found to be 12 to 13% of initial egg mass at d 18 of incubation. 3. Mass specific water vapour conductance (GH(2)Osp) increased linearly with flock age from 0.31 mg/(d.g.Torr) at the beginning of the first breeding season to 0.40 mg/(d.g.Torr) at its end after 77 weeks (=4.21 and 5.44 mg/(d.100 g.kPa), respectively). 4. After forced moulting GH(2)Osp increased from 0.35 to 0.41 mg/(d.g.Torr) (=4.76 and 5.58 mg/(d.100 g.kPa), respectively). 5. The coefficients of variation of GH(2)Osp increased with flock age from 14% at the beginning of the breeding season to 31% at the end of the second breeding season. 6. In order to preserve normal incubation water loss for maximising hatchability, the humidity setting of an incubator should increase gradually, with flock age, from 53% RH to 66% RH in the first laying season and from 61% RH to 67% RH after forced moulting. 7. A 3.5-fold increase (from 2 to 7%) in the difference between mean and median GH(2)Osp of egg batches with flock age was found, indicating increasing frequency of microscopic cracks in eggshells with flock age. This has to be taken into account when setting the humidity regime in the incubator.

Effects of drilling holes into the air cell of incubated goose eggs on distribution of oxygen partial pressures under the shell

The purpose of this work was to measure changes in oxygen pressure in the air cell and under the eggshell (P(A)O2) of pre-pipping goose eggs before and after drilling holes into the air cell. Drilling a 0.6 mm (diameter of 0.9 mm) hole into the air cell caused an increase in air cell P(A)O2 of about 10 Torr. The rate of increase attenuated as hole area increased and reached about 21 Torr when the drilled area was 8.5 mm2. The P(A)O2 of intact eggs was not equally distributed under the shell. It was high in the air cell area (108 Torr) and decreased towards the pointed end (86 Torr). The increase in P(A)O2 after drilling a 4.9 mm2 hole was high in the air cell (18 Torr) and decreased with distance, becoming non-significant at the pointed end. The significant increase in P(A)O2 after drilling was limited to a distance of up to 38 mm along the shell from the edge of the air cell. This indicates that lateral diffusion in the shell membranes under the shell is limited. Drilling a hole of 3.5 to 4.9 mm2 was enough to increase air cell P(A)O2 in most of the eggs above the critical value of 100 Torr for hatching success. The increase in P(A)O2 was limited to about half the area of the shell and the average increase in P(A)O2 was 6.3 Torr (equivalent to a 0.9% increase in ambient O2). However, the blood perfusing chorioallantoic areas further away from the air cell edge may not be fully saturated with O2 and may not be sufficient to compensate fully for the low O2 availability caused by low eggshell conductance.

How automatic is manual gear shifting?

Manual gear shifting is often used as an example of an automated (vs. controlled) process in driving. The present study provided an empirical evaluation of this assumption by evaluating sign detection and recall performance of novice and experienced drivers driving manual shift and automatic transmission cars in a downtown area requiring frequent gear shifting. The results showed that manual gear shifting significantly impaired sign detection performance of novice drivers using manual gears compared with novice drivers using an automatic transmission, whereas no such differences existed between the two transmission types for experienced drivers. The results clearly demonstrate that manual gear shifting is a complex psychomotor skill that is not easily (or quickly) automated and that until it becomes automated, it is an attention-demanding task that may impair other monitoring aspects of driving performance. Actual or potential applications of this research include a reevaluation of the learning process in driving and the need for phased instruction in driving from automatic gears to manual gears.

Reported health concerns of Israeli high school students--differences by age and sex

Health concerns of high school students in the 10th grade and again in the 12th grade were studied. The students filled out an anonymous questionnaire that included a list of 73 concerns. At both ages their main concerns were reportedly related to school. Concerns relating to army service ranked high particularly in the 12th grade, among both sexes. Concerns relating to sexual relations were frequent among boys at both ages, whereas concerns about mood and loneliness were more frequent among girls. Reports on physical concerns were frequently related to height among the younger boys and weight and diet among girls of both ages. Concerns were grouped into 6 domains. In each of them, except for sexuality, girls had more concerns. A significant decline in the number of concerns was noted from the first to the second survey, indicating a partial resolution of the issues central to adolescent development. Knowledge about concerns of adolescents may help health care providers in counseling and health education program planning.

Artificial increase of eggshell conductance improves hatchability of early laid goose eggs

1. The purpose of this work was to test the possibility of increasing the hatchability of goose eggs with low mass specific eggshell gas conductance (Gsp), by drilling holes through the eggshell into the air cell, and thus solving both the low water loss rate and low oxygen availability problems. 2. A linear relationship was found between the area of a hole drilled and the apparent increase in eggshell gas conductance (G). Drilling more than one hole increased apparent G 3-6 times more than one hole only, of the same total area. 3. Hole-drilling did not increase egg contamination. The drilling of a 5 mm2 hole on day 17 of incubation increased hatchability both in laboratory tests and in commercial hatcheries (6.1% and 10.5% respectively). 4. Drilling holes on days 15 to 22 of incubation increased hatchability when the predicted mean water loss was lower than 14%. Drilling on day 25 did not have a significant effect, and drilling on day 11 of incubation was too early. 5. Drilling a hole into the aircell (during the second half of incubation) may increase hatchability of low conductance eggs, although oxygen pressure under the eggshell should then be checked in order to evaluate oxygen availability to the embryo.

Concerns and risk behaviors and the association between them among high-school students in Jerusalem

PURPOSE

To study the distribution, prevalence, determinants, and association between the health, social, and environmental concerns and risk behaviors of high school students in Jerusalem in order to provide a better basis for preventive and health promotion services.

METHODS

1078 tenth grade high school students, 15-16 years old answered an anonymous questionnaire including, perceived concerns and risk behaviors, (e.g., smoking, alcohol, drugs, and sexual activity). Concerns were grouped into six domains.

RESULTS

The most frequently reported concerns related to school, weight, coping with aggression, fatigue, war, enlistment into army, and relationships with peers. Girls had more concerns in the domains of self-image, anxiety, and relationships with peers (p < .05). Adolescents with mothers who had less education had significantly more concerns in the domains of anxiety and relationships with peers and adults (p < .05). Forty-seven percent engaged in at least one risk behavior (boys 63% and girls 34%). The Guttman scalogram indicated the following sequence of risk behaviors: alcohol, cigarettes, sex, and drugs. There were statistically significant associations between concerns and risk behaviors in the domains of anxiety, sex, and relationships with adults and peers.

CONCLUSION

Many adolescent concerns are universal, although the ranking and prevalence may vary based on different regional and population characteristics (e.g., in this population a high rate of concerns relating to aggression and war were identified). The results support the need to develop prevention and health promotion programs relating to the concerns and risk behaviors in the school and community, and individual counseling programs in primary care settings.

Improving turkey poult quality by correcting incubator humidity to match eggshell conductance

One of the most important factors determining hatchability of avian eggs is their proper water budget during incubation. We show here that water budget changes of turkey eggs effect not only hatchability but also poult quality. In addition to an increase in hatchability of 3.3%, poult quality was increased by 7.3%. This was achieved by sorting eggs into low (less than 18.5), medium (18.5 to 22.0) and high (greater than 22.0) eggshell mass-specific water vapour, conductance categories and incubating them in matching incubation humidities of 21.8, 26.6 and 31.4 Torr, corresponding to relative humidities of 45, 55 and 65% at 37.5 degrees C, respectively. A total diffusive water loss of 11.5% (range 10 to 14%) of the initial egg mass in 25 d of incubation yielded maximal hatchability and poult quality.

Increasing hatchability of turkey eggs by matching incubator humidity to shell conductance of individual eggs

One of the most important factors determining hatchability of avian eggs is the proper water balance of the eggs during incubation. In turkey eggs, a total diffusive water loss (F) of 12 +/- 1% SD initial egg mass in 28 days, yielded maximal hatchability irrespective of the combination of eggshell water vapor conductance (G) and incubator humidity (PI), which brought about this water loss. A good correlation was found between G as obtained at the beginning of incubation and the final F in a given PI. The G in a random sample of 1256 fresh turkey eggs was normally distributed around the mean of 18.70 +/- 2.87 SD milligrams (100 g X day X torr)-1 (Coefficient of variation = 15.3%). The distribution of G in eggs with dead in the shell embryos had, in addition, two more peaks of G values [around 22.5 and 13.0 mg (100 g X day X torr)-1]. When eggs were sorted into low (less than 17), medium (17 to 20), and high (greater than 20) G categories, and incubated at low (19.4), medium (26.6), and high (33.9) torr PI, respectively, hatchability increased by a factor of 1.08. Poor hatchabilities were obtained in mismatching humidities and conductances. It seems that hatchability success may be experimentally improved if a correct rate of water loss is fitted to sorted eggs during incubation.

A relationship between motor control and language development in an autistic child

Recent work in both experimental and clinical psychology indicates an important link exists between the development of motor control and language development. Diagnostic and therapeutic work with autistic children reveals a high incidence of gross motor dysfunction along with language deficits. A study to evaluate the effectiveness of behavior modification techniques in eliciting speech from nursery-age autistic children yielded new data to confirm the importance of the relationship. Results from a case study of one autistic child demonstrated that the child most frequently vocalized when motorically quiet, and engaged in motor activity when not speaking and especially prior to speech. Data from 30 half-hour behavior modification sessions and an intensive clinical interview indicated that limiting the child's gross motor activity was effective in increasing the frequency of vocalization. Several theoretical interpretations of this phenomenon as well as implications for treatment and further research are offered.