Environment and shipping drive environmental DNA beta-diversity among commercial ports

The spread of nonindigenous species by shipping is a large and growing global problem that harms coastal ecosystems and economies and may blur coastal biogeographical patterns. This study coupled eukaryotic environmental DNA (eDNA) metabarcoding with dissimilarity regression to test the hypothesis that ship-borne species spread homogenizes port communities. We first collected and metabarcoded water samples from ports in Europe, Asia, Australia and the Americas. We then calculated community dissimilarities between port pairs and tested for effects of environmental dissimilarity, biogeographical region and four alternative measures of ship-borne species transport risk. We predicted that higher shipping between ports would decrease community dissimilarity, that the effect of shipping would be small compared to that of environment dissimilarity and shared biogeography, and that more complex shipping risk metrics (which account for ballast water and stepping-stone spread) would perform better. Consistent with our hypotheses, community dissimilarities increased significantly with environmental dissimilarity and, to a lesser extent, decreased with ship-borne species transport risks, particularly if the ports had similar environments and stepping-stone risks were considered. Unexpectedly, we found no clear effect of shared biogeography, and that risk metrics incorporating estimates of ballast discharge did not offer more explanatory power than simpler traffic-based risks. Overall, we found that shipping homogenizes eukaryotic communities between ports in predictable ways, which could inform improvements in invasive species policy and management. We demonstrated the usefulness of eDNA metabarcoding and dissimilarity regression for disentangling the drivers of large-scale biodiversity patterns. We conclude by outlining logistical considerations and recommendations for future studies using this approach.

33 PREVALENCE OF FALLS RISK-INCREASING DRUGS (FRIDS) DEFINED BY STOPPFALL CRITERIA AMONG MULTI-MORBID OLDER PATIENTS PRESENTING TO HOSPITAL WITH FALLS

Background

Several drug classes e.g. antidepressants, hypnotics significantly the risk of falls in older people. As an intervention in several studies, withdrawal of Falls Risk-Increasing Drugs (FRIDs) has led to a significantly decreased incidence of falls and injuries in older people. Recently, an explicit deprescribing tool focusing on FRIDs known as STOPPFall (Screening Tool of Older Persons Prescriptions with high Fall risk) has been validated. STOPPFall consists of 14 drug classes, most of which are psychotropics, known to increase falls risk in older people. There are no prospective studies of STOPPFall-defined prevalence of FRIDs in the literature.

Methods

We undertook a prospective study of 200 consecutively enrolled patients aged ≥65 years (mean age ± SD: 80.9±7.4 years) presenting with falls to the emergency department and Geriatric Medicine OPD clinics between August 2021 to February 2022. We screened for STOPPFall criteria FRIDs in this cohort with additional data collected to define age, sex and comorbidity status.

Results

STOPPFall FRIDs were detected in 59.5% of this cohort which was predominantly female (68%). Comparison of falls incidence between the youngest subgroup (65-74 years) and the oldest subgroup (>85 years) showed that patients aged >85 years fell repeatedly (i.e. ≥ 2 falls in the previous year) more than younger fallers (35.5% vs 21%). Of the 14 drug classes in STOPPFall criteria, antidepressants were the most prevalent FRID category (24%), followed by diuretics (17%). There was a significant positive correlation between the number of reported falls and the number of STOPPFall FRIDs prescribed (R=0.17; p=.016). Almost two-thirds of fallers were prescribed two or more STOPPFall drugs.

Conclusion

STOPPFall medications are highly prevalent among older people presenting to hospital with falls. STOPPFall represents an important tool for attending doctors to identify and deprescribe medications contributing to falls in older people.

SD^2: Slicing and Dicing Scholarly Data for Interactive Evaluation of Academic Performance

Comprehensively evaluating and comparing researchers' academic performance is complicated due to the intrinsic complexity of scholarly data. Different scholarly evaluation tasks often require the publication and citation data to be investigated in various manners. In this paper, we present an interactive visualization framework, SD^2, to enable flexible data partition and composition to support various analysis requirements within a single system. SD^2 features the hierarchical histogram, a novel visual representation for flexibly slicing and dicing the data, allowing different aspects of scholarly performance to be studied and compared. We also leverage the state-of-the-art set visualization technique to select individual researchers or combine multiple scholars for comprehensive visual comparison. We conduct multiple rounds of expert evaluation to study the effectiveness and usability of SD^2 and revise the design and system implementation accordingly. The effectiveness of SD^2 is demonstrated via multiple usage scenarios with each aiming to answer a specific, commonly raised question.

Predicting Participant Compliance With Fitness Tracker Wearing and Ecological Momentary Assessment Protocols in Information Workers: Observational Study

Background

Studies that use ecological momentary assessments (EMAs) or wearable sensors to track numerous attributes, such as physical activity, sleep, and heart rate, can benefit from reductions in missing data. Maximizing compliance is one method of reducing missing data to increase the return on the heavy investment of time and money into large-scale studies.

Objective

This paper aims to identify the extent to which compliance can be prospectively predicted from individual attributes and initial compliance.

Methods

We instrumented 757 information workers with fitness trackers for 1 year and conducted EMAs in the first 56 days of study participation as part of an observational study. Their compliance with the EMA and fitness tracker wearing protocols was analyzed. Overall, 31 individual characteristics (eg, demographics and personalities) and behavioral variables (eg, early compliance and study portal use) were considered, and 14 variables were selected to create beta regression models for predicting compliance with EMAs 56 days out and wearable compliance 1 year out. We surveyed study participation and correlated the results with compliance.

Results

Our modeling indicates that 16% and 25% of the variance in EMA compliance and wearable compliance, respectively, could be explained through a survey of demographics and personality in a held-out sample. The likelihood of higher EMA and wearable compliance was associated with being older (EMA: odds ratio [OR] 1.02, 95% CI 1.00-1.03; wearable: OR 1.02, 95% CI 1.01-1.04), speaking English as a first language (EMA: OR 1.38, 95% CI 1.05-1.80; wearable: OR 1.39, 95% CI 1.05-1.85), having had a wearable before joining the study (EMA: OR 1.25, 95% CI 1.04-1.51; wearable: OR 1.50, 95% CI 1.23-1.83), and exhibiting conscientiousness (EMA: OR 1.25, 95% CI 1.04-1.51; wearable: OR 1.34, 95% CI 1.14-1.58). Compliance was negatively associated with exhibiting extraversion (EMA: OR 0.74, 95% CI 0.64-0.85; wearable: OR 0.67, 95% CI 0.57-0.78) and having a supervisory role (EMA: OR 0.65, 95% CI 0.54-0.79; wearable: OR 0.66, 95% CI 0.54-0.81). Furthermore, higher wearable compliance was negatively associated with agreeableness (OR 0.68, 95% CI 0.56-0.83) and neuroticism (OR 0.85, 95% CI 0.73-0.98). Compliance in the second week of the study could help explain more variance; 62% and 66% of the variance in EMA compliance and wearable compliance, respectively, was explained. Finally, compliance correlated with participants’ self-reflection on the ease of participation, usefulness of our compliance portal, timely resolution of issues, and compensation adequacy, suggesting that these are avenues for improving compliance.

Conclusions

We recommend conducting an initial 2-week pilot to measure trait-like compliance and identify participants at risk of long-term noncompliance, performing oversampling based on participants’ individual characteristics to avoid introducing bias in the sample when excluding data based on noncompliance, using an issue tracking portal, and providing special care in troubleshooting to help participants maintain compliance.

Evaluation of Physico-Chemical Composition in Bulbs of Red, Yellow, and White Onion (Allium Cepa L.) Genotypes of Sub-Tropical India

In this study, thirty onion (Allium cepa L.) genotypes grown in sub-tropical region of India were analysed for different physico-chemical attributes. There were significant differences among genotypes, and the onion genotypes showed a tendency to be classified according to different colours. The cultivars of the same colour exhibited similar tendencies in terms of accumulating most of the analysed components. About 1.78 fold variation in dry matter (%) and 2 fold variation in fresh weight per bulb were recorded among coloured onions. Red genotype D-888-B possessed maximum contents of TS and NRS, while the yellow coloured genotype POH-5 accumulated highest RS and lowest NRS contents. Maximum values of fructans (3.68 g/100 g DW), AIS (6 g/100 g DW), protein (10.61 g/100 g DW), and FAA (4.24 g/100 g DW) were also found in red coloured genotypes D-715-B, D-97-B, PR-305, and D-PS-121-B, respectively. Proline content in different genotypes was found to vary about 6.9 fold. The correlation studies showed a positive relationship between most of the quality parameters. Our results suggested that red group genotypes were better than yellow and white groups for all the studied parameters except for RS, which makes red genotypes more suitable for processing purposes.

Predicting Cardiovascular Risk in Athletes: Resampling Improves Classification Performance

Cardiovascular diseases are the main cause of death worldwide. The aim of the present study is to verify the performances of a data mining methodology in the evaluation of cardiovascular risk in athletes, and whether the results may be used to support clinical decision making. Anthropometric (height and weight), demographic (age and sex) and biomedical (blood pressure and pulse rate) data of 26,002 athletes were collected in 2012 during routine sport medical examinations, which included electrocardiography at rest. Subjects were involved in competitive sport practice, for which medical clearance was needed. Outcomes were negative for the largest majority, as expected in an active population. Resampling was applied to balance positive/negative class ratio. A decision tree and logistic regression were used to classify individuals as either at risk or not. The receiver operating characteristic curve was used to assess classification performances. Data mining and resampling improved cardiovascular risk assessment in terms of increased area under the curve. The proposed methodology can be effectively applied to biomedical data in order to optimize clinical decision making, and-at the same time-minimize the amount of unnecessary examinations.

Graph Few-Shot Learning via Knowledge Transfer

Towards the challenging problem of semi-supervised node classification, there have been extensive studies. As a frontier, Graph Neural Networks (GNNs) have aroused great interest recently, which update the representation of each node by aggregating information of its neighbors. However, most GNNs have shallow layers with a limited receptive field and may not achieve satisfactory performance especially when the number of labeled nodes is quite small. To address this challenge, we innovatively propose a graph few-shot learning (GFL) algorithm that incorporates prior knowledge learned from auxiliary graphs to improve classification accuracy on the target graph. Specifically, a transferable metric space characterized by a node embedding and a graph-specific prototype embedding function is shared between auxiliary graphs and the target, facilitating the transfer of structural knowledge. Extensive experiments and ablation studies on four real-world graph datasets demonstrate the effectiveness of our proposed model and the contribution of each component.

Physical activity and sedentary behavior can modulate the effect of the PNPLA3 variant on childhood NAFLD: a case-control study in a Chinese population

Background

The patatin like phospholipase containing domain 3 gene (PNPLA3) rs738409 C > G polymorphism, one of the most important gene polymorphisms involved in hepatic steatosis, has been reported to interact with different nutrients and dietary patterns on Non-Alcoholic Fatty Liver Disease (NAFLD), but no studies have focused on its interaction with physical activity or sedentary behavior. Therefore, this study aims at determining whether physical activity or sedentary behavior could modulate the effect of the PNPLA3 variant on childhood NAFLD.

Methods

A case-control study was conducted including 1027 Chinese children aged 7–18 years old (162 children with NAFLD and 865 children without). The anthropometric measurements, liver ultrasound examination, questionnaires and genotyping of the PNPLA3 rs738409 polymorphism were performed.

Results

Stratified analyses showed that the proportions of NAFLD increased with the G-allele number only in children who did not have enough physical activity (physical activity < 1 h/d) (OR 3.05, 95% CI 1.82–5.12, P < 0.001), and in children with a sedentary lifestyle (sedentary behavior ≥ 2 h/d) (OR 3.41, 95% CI 1.88–6.18, P < 0.001). Significant interactions on childhood NAFLD were found between the G-allele number in the PNPLA3 rs738409 polymorphism and behaviors, including physical activity (P = 0.001), sedentary behavior (P = 0.010) and the combination of physical activity and sedentary behavior (P < 0.001).

Conclusion

This is the first study to report the interaction between the PNPLA3 rs738409 polymorphism and physical activity or sedentary behavior on NAFLD, providing new clues on the function of the PNPLA3 gene, which will also be useful for future risk assessment and personalized treatment of NAFLD.

Electronic supplementary material

The online version of this article (doi:10.1186/s12881-016-0352-9) contains supplementary material, which is available to authorized users.

Supra-aural gossypiboma: case report of a retained textile surgical sponge in an unusual location

Gossypiboma or retained surgical sponge is an infrequently encountered surgical complication, more so in the head and neck region. A literature search did not reveal a previously reported case of retained or concealed surgical sponge after microscopic ear surgery. We present a unique and previously unreported case of a 25-year-old male who presented with a cystic swelling in the right supra-aural region 5 months post-modified radical mastoidectomy of the right ear. Surgical excision of the swelling revealed a retained surgical sponge. We emphasise the importance of counting surgical sponges after every surgical step to minimise the incidence of such retained surgical items.

Prediction of fine-tuned promoter activity from DNA sequence

The quantitative prediction of transcriptional activity of genes using promoter sequence is fundamental to the engineering of biological systems for industrial purposes and understanding the natural variation in gene expression. To catalyze the development of new algorithms for this purpose, the Dialogue on Reverse Engineering Assessment and Methods (DREAM) organized a community challenge seeking predictive models of promoter activity given normalized promoter activity data for 90 ribosomal protein promoters driving expression of a fluorescent reporter gene. By developing an unbiased modeling approach that performs an iterative search for predictive DNA sequence features using the frequencies of various k-mers, inferred DNA mechanical properties and spatial positions of promoter sequences, we achieved the best performer status in this challenge. The specific predictive features used in the model included the frequency of the nucleotide G, the length of polymeric tracts of T and TA, the frequencies of 6 distinct trinucleotides and 12 tetranucleotides, and the predicted protein deformability of the DNA sequence. Our method accurately predicted the activity of 20 natural variants of ribosomal protein promoters (Spearman correlation r = 0.73) as compared to 33 laboratory-mutated variants of the promoters (r = 0.57) in a test set that was hidden from participants. Notably, our model differed substantially from the rest in 2 main ways: i) it did not explicitly utilize transcription factor binding information implying that subtle DNA sequence features are highly associated with gene expression, and ii) it was entirely based on features extracted exclusively from the 100 bp region upstream from the translational start site demonstrating that this region encodes much of the overall promoter activity. The findings from this study have important implications for the engineering of predictable gene expression systems and the evolution of gene expression in naturally occurring biological systems.

Atypical Presentations of Melioidosis in North India: Report of Two Cases

Melioidosis is an infection caused by Gram-negative bacterium, Burkholderia pseudomallei. This is a rare disease in India, more so in North India. We present two cases of melioidosis with unusual sites of infection. The first patient was a young diabetic male presenting to us with history of prolonged fever and upper abdominal discomfort, subsequently diagnosed as a case of pyogenic liver abscess. The second patient was a middle aged diabetic complaining of prolonged fever and headache and found to have right frontal lobe brain abscess.The pus cultured from the lesion in both cases showed growth of Burkholderia pseudomallei. These two cases are described to consider melioidosis as a differential diagnosis amongst pyrexia of unknown origin cases.

Prosthetic rehabilitation of a patient with an orbital defect: a simplified approach

Large oro-facial defects consequences in serious functional as well as cosmetic deformities. Acceptable cosmetic results usually can be obtained with a facial prosthesis. This article describes prosthetic rehabilitation of a 35 year-old female having a left orbital defect with HTV silicone material. A modified technique to fabricate an acrylic substructure in heat-polymerizing polymethyl-methacrylate to support silicone facial prosthesis was illustrated. The resultant facial prosthesis was structurally durable and esthetically acceptable with satisfactory retention. This technique is advantageous as there is no need to fabricate the whole prosthesis again in case of damage of the silicone layer because the outer silicone layer can be removed and repacked on the substructure if the gypsum-mold is preserved.

An in vitro comparison of detection methods for approximal carious lesions in primary molars

BACKGROUND/AIMS

This study aimed to compare and contrast in vitro six methods to determine the most accurate method for detecting approximal carious lesions in primary molars.

METHODS

Extracted primary molars (n = 140) were stored in 0.02% chlorhexidine solution and mounted in light-cured resin in pairs. The six carious lesion detection methods used by the three examiners to assess approximal carious lesions were visual inspection, digital radiography, two transillumination lights (SDI and NSK), and two laser fluorescence instruments (CDD and DDP). Five damaged teeth were discarded. The teeth (n = 135) were sectioned, serially ground, and examined under light microscopy using Downer's histological (HST) criteria as the gold standard. Intra- and inter-examiner reliability, agreement with HST, specificity, sensitivity, receiver operating characteristic (ROC) curves, and areas under the curve were calculated.

RESULTS

This study found visual inspection to be the most accurate method when validated by histology. Transillumination with NSK light had the highest specificity, and digital radiography had the highest sensitivity for detecting enamel and/or dentinal carious lesions. Combining specificity and sensitivity into the area under ROC curves, enamel plus dentinal lesions were detected most accurately by visual inspection followed by digital radiography; dentinal lesions were detected most accurately by digital radiography followed by visual inspection.

CONCLUSIONS

None of the four newly developed methods can be recommended as suitable replacements for visual inspection and digital radiography in detecting carious lesions on approximal surfaces of primary molars, and further developmental work is needed.

IMMUNOCHROMATOGRAPHIC TEST: A NEW DIMENSION IN DIAGNOSIS OF PLASMODIUM FALCIPARUM MALARIA

75 patients with clinical features suggestive of malaria were studied to evaluate the efficacy of immunochromatographic test (ICT), which detects histidine rich protein-2 antigen secreted by Plasmodium falciparum (Pfhrp-2), as against direct microscopy. There were 40 cases of P falciparum malaria, 14 cases of P vivax malaria and 21 cases of non-malarial fevers. Direct microscopy could detect 27(67.5%) P falciparum cases but failed to detect 13 cases (32.5%) whereas ICT could detect 35(87.5%) P falciparum cases out of 40 but failed to detect 5(12.5%) cases. All the P vivax cases and non-malarial fever cases were negative for ICT. The sensitivity and specificity of ICT is 87.5% and 100% respectively where as the positive predictive value and the negative predictive value of the test is 100% and 87.5% respectively. It is concluded that ICT test is a good adjunct to blood smear studies in fever cases with neurological and multiorgan dysfunction and in antenatal ladies.

Clinical studies on molar-incisor-hypomineralisation part 1: distribution and putative associations

AIM

This was to describe the distributions of affected first permanent molars (FPMs) in a sample of children with molarincisor- hypomineralisation (MIH) and molar hypomineralisation (MH), and to examine their perinatal and medical histories for putative associations with molar hypomineralisation.

STUDY DESIGN

A sample of 416 children aged 6-14 years with MIH or MH was identified from a specialist paediatric dental practice in Melbourne, Australia.

METHODS

A questionnaire regarding perinatal and medical histories was sent to their parents/guardians; 182 (44%) useable questionnaires were returned and the dental records of these children were reviewed.

RESULTS

The 182 dentitions were distributed as: MIH: 104; MH: 65; MIH* (permanent incisors unerupted): 13. These dentitions contained 720 FPMs; 429 FPMs were hypomineralised, distributed as: MIH: 282 FPMs; MH: 124 FPMs; MIH*: 23 FPMs. The 282 affected FPMs occurred in dentitions with MIH as: 1 FPM: 27%; 2 FPMs: 15%; 3 FPMs: 17%; 4 FPMs: 40% (mean 2.7 +/- 1.3 FPMs/dentition). The 124 affected FPMs occurred in dentitions with MH as: 1 FPM: 49%; 2 FPMs: 28%; 3 FPMs: 6%; 4 FPMs: 17% (mean 1.9 +/- 1.1 FPMs/dentition). The distribution of moderate to severe hypomineralisation in FPMs was: MIH: 89%; MH: 73%. Affected FPMs were similarly distributed between gender, quadrants and arches. At least one condition putatively associated with MIH/MH was seen in histories of 166 children (91%); ear infections, fevers, and perinatal conditions occurred in 53-66% of children. Frequent condition combinations were: ear infections + fevers (40% of children); antibiotics + ear infections (54%); antibiotics + other illnesses (56%).

CONCLUSIONS

All four FPMs in a given dentition were more likely to be affected and to differing extents in MIH than in MH. Putative associations appear to exist between MIH/MH and combinations of antibiotic use, ear infections, fevers, perinatal conditions, and other illnesses in the child's first 3 years. It is proposed that MIH is a more severe form of the hypomineralisation condition than MH, forming an MIH spectrum.

Countering imbalanced datasets to improve adverse drug event predictive models in labor and delivery

BACKGROUND

The IOM report, Preventing Medication Errors, emphasizes the overall lack of knowledge of the incidence of adverse drug events (ADE). Operating rooms, emergency departments and intensive care units are known to have a higher incidence of ADE. Labor and delivery (L&D) is an emergency care unit that could have an increased risk of ADE, where reported rates remain low and under-reporting is suspected. Risk factor identification with electronic pattern recognition techniques could improve ADE detection rates.

OBJECTIVE

The objective of the present study is to apply Synthetic Minority Over Sampling Technique (SMOTE) as an enhanced sampling method in a sparse dataset to generate prediction models to identify ADE in women admitted for labor and delivery based on patient risk factors and comorbidities.

RESULTS

By creating synthetic cases with the SMOTE algorithm and using a 10-fold cross-validation technique, we demonstrated improved performance of the Naïve Bayes and the decision tree algorithms. The true positive rate (TPR) of 0.32 in the raw dataset increased to 0.67 in the 800% over-sampled dataset.

CONCLUSION

Enhanced performance from classification algorithms can be attained with the use of synthetic minority class oversampling techniques in sparse clinical datasets. Predictive models created in this manner can be used to develop evidence based ADE monitoring systems.

Pleural and transdiaphragmatic retroperitoneal metastasis developing two and half years after resection of invasive thymoma

We report transdiaphragmatic pleural and retroperitoneal metastasis developing two and half years after resection of invasive thymoma (Masaoka stage III; WHO type B1, lymphocyte-rich) in a 34-year-old man. Post-surgery, he received radiotherapy and chemotherapy. Follow-up computed tomography (CT) one year post-surgery did not reveal any local recurrence or metastasis. He remained asymptomatic throughout. A follow-up CT done two and half years later revealed an enhancing retrocrural-retroperitoneal (posterior pararenal space) soft tissue mass measuring 12 cm x 10 cm x 6 cm. Another enhancing deposit was found in the left pleural space. This lesion was found infiltrating into the subjacent lung. Both these deposits were resected along with wedge resection of the affected subsegment of the lung. Histopathology confirmed these lesions to be metastases from the lymphocyte-rich thymoma.

PTSD symptoms, substance use, and vipassana meditation among incarcerated individuals

The present study evaluated whether Posttraumatic Stress Disorder (PTSD) symptom severity was associated with participation and treatment outcomes comparing a Vipassana meditation course to treatment as usual in an incarcerated sample. This study utilizes secondary data. The original study demonstrated that Vipassana meditation is associated with reductions in substance use. The present study found that PTSD symptom severity did not differ significantly between those who did and did not volunteer to take the course. Participation in the Vipassana course was associated with significantly greater reductions in substance use than treatment as usual, regardless of PTSD symptom severity levels. These results suggest that Vipassana meditation is worthy of further study for those with comorbid PTSD and substance use problems.

Microstructure and deformation behavior of biocompatible TiO2 nanotubes on titanium substrate

Titanium oxide coatings have been shown to exhibit desirable properties as biocompatible coatings. We report on the quantitative microstructure characterization and deformation behavior of TiO(2) nanotubes on Ti substrate. Nanotubes were processed using anodic oxidation of Ti in a NaF electrolyte solution. Characterization of the as-processed coatings was conducted using scanning electron microscopy and focused ion beam milling. Increases in anodization time had no significant effect on tube diameter or tube wall thickness. Coating thickness, however, increased with time up to 2h of anodization, at which point an equilibrium thickness was established. Nanoindentation was used to probe the mechanical response in terms of Young's modulus and hardness. Progressively higher values of elastic modulus were obtained for thinner films consistent with increasing effects of the Ti substrate. A possible deformation mechanism of densification of the porous oxide and wear of the dense surface is suggested and discussed.

Baby-friendly hospital initiative improves breastfeeding initiation rates in a US hospital setting

OBJECTIVE

Breastfeeding initiation rates were compared at Boston Medical Center before (1995), during (1998), and after (1999) Baby-Friendly policies were in place. Boston Medical Center, an inner-city teaching hospital that provides care primarily to poor, minority, and immigrant families, achieved Baby-Friendly status in 1999.

METHODS

Two hundred complete medical records, randomly selected by a computer, were reviewed from each of 3 years: 1995, 1998, and 1999. Infants were excluded for medical records missing feeding data, human immunodeficiency virus-positive parent, neonatal intensive care unit admission, maternal substance abuse, adoption, incarceration, or hepatitis C-positive mother. All infant feedings during the hospital postpartum stay were tallied, and each infant was categorized into 1 of 4 groups: exclusive breast milk, mostly breast milk, mostly formula, and exclusive formula.

RESULTS

Maternal and infant demographics for all 3 years were comparable. The breastfeeding initiation rate increased from 58% (1995) to 77.5% (1998) to 86.5% (1999). Infants exclusively breastfed increased from 5.5% (1995) to 28.5% (1998) to 33.5% (1999). Initiation rates increased among US-born black mothers in this population from 34% (1995) to 64% (1998) to 74% (1999).

CONCLUSIONS

Full implementation of the Ten Steps to Successful Breastfeeding leading to Baby-Friendly designation is an effective strategy to increase breastfeeding initiation rates in the US hospital setting.

Relationship between acute morphine and the course of PTSD in children with burns

OBJECTIVE

To investigate the relationship between the dose of morphine administered during a child's hospitalization for an acute burn and the course of posttraumatic stress disorder (PTSD) symptoms over the 6-month period following discharge from the hospital.

METHOD

Twenty-four children admitted to the hospital for an acute burn were assessed twice with the Child PTSD Reaction Index: while in the hospital and 6 months after discharge. The Colored Analogue Pain Scale was also administered during the hospitalization. All patients received morphine while in the hospital. The mean dose of morphine (mg/kg/day) was calculated for each subject through chart review.

RESULTS

The Pearson product moment correlation revealed a significant association between the dose of morphine received while in the hospital and a 6-month reduction in PTSD symptoms. Children receiving higher doses of morphine had a greater reduction in PTSD symptoms over 6 months.

CONCLUSIONS

This study suggests the possibility that acute treatment with morphine can secondarily prevent PTSD. This result is discussed in terms of the possible effect of morphine on fear conditioning and the consolidation of traumatic memory.

Non-Hodgkin's lymphoma of the ovaries and appendix: a case report

Involvement of the female genital tract by non-Hodgkin's lymphoma is extremely rare. Here is the report of a patient who presented as a bilateral malignant ovarian tumour and was diagnosed by laparotomy and subsequent histopathology to have non-Hodgkin's lymphoma of both ovaries and appendix. The patient had radical surgery followed by multiagent chemotherapy and is alive without disease at one year of follow-up.

Cholinergic mechanisms in central thermoregulation in pigeons

1. In unanaesthetized pigeons the effect on cloacal temperature was studied of acetylcholine (ACh), carbachol, atropine and (+)-tubocurarine injected into a cannulated lateral cerebral ventricle. The experiments were carried out at an ambient temperature of 19-25 degrees C. 2. ACh or carbachol injected intraventricularly produced hyperthermia, and in larger doses hyperthermia followed by hypothermia. These were central effects because they were not obtained when these drugs were injected in the same doses intravenously. 3. Atropine injected intraventricularly produced hypothermia which was greater and longer lasting than the hypothermia produced with the same dose of atropine injected intravenously. After the intraventricular injection of atropine the hyperthermic effects of ACh and of carbachol were abolished. 4. (+)-Tubocurarine injected intraventricularly produced a long-lasting hyperthermia in doses which had no effect on temperature when injected intravenously. After the intraventricular injection of tubocurarine the hypothermic effects of ACh and of carbachol were abolished. 5. It is concluded that the effects of ACh had carbachol imitate the effects of ACh released from cholinergic neurones in the central pathway involved in temperature regulation. The hypothermic effect of atropine is attributed to unmasking the activity of continuously released ACh acting on nicotinic receptors, and the hyperthermic effect of tubocurarine to unmasking the activity of continuously released ACh acting on muscarinic receptors.

Effects of catecholamines on thermoregulation in pigeons

1 In unanaesthetized pigeons, kept at room temperature (20-23 degrees C) the effects on cloacal temperature were examined of catecholamines, phenoxybenzamine and propranolol, injected into the cerebral ventricles.2 Noradrenaline, adrenaline, dopamine and isoprenaline caused a fall in cloacal temperature.3 Phenoxybenzamine produced a long-lasting small rise in cloacal temperature. This rise is attributed to removal of the hypothermic effect of noradrenaline released continuously from adrenergic neurones ending in the anterior hypothalamus. Propranolol produced a slight fall in cloacal temperature.4 The hypothermic effects of noradrenaline, adrenaline and dopamine were prevented by phenoxybenzamine but not by propranolol. They are therefore attributed to activation of alpha-adrenoceptors.5 The hypothermic effect of isoprenaline was not prevented by either phenoxybenzamine or propranolol. The effect can therefore not be attributed to activation of either alpha or beta-adrenoceptors. Propranolol actually accentuated the isoprenaline-induced hypothermia.