Enhancing Eastern Equine Encephalitis Virus Surveillance in New Jersey: Optimized Collection of Culiseta Melanura

Eastern equine encephalitis virus (EEEV) causes the most clinically severe neuroinvasive arboviral disease in the United States. The virus is endemic in eastern and Gulf Coast states and the Great Lakes region, causing cases annually. To detect EEEV circulation in its enzootic cycle before the virus infects humans and other mammals, mosquito control agencies in New Jersey have conducted mosquito surveillance using a series of permanent wooden resting box sites since 1975. We conducted 2 field studies, 1 evaluating resting traps and 1 evaluating efficacy of CO2 lures, to optimize collection of Culiseta melanura, the primary enzootic vector of EEEV. Resulting mosquito samples were subjected to molecular analysis to determine EEEV infection rates. Corrugated plastic boxes trapped more bloodfed Cs. melanura than other resting trap types (resting boxes, Centers for Disease Control and Prevention [CDC] resting traps, or fiber pots) and were similar to resting boxes in total number of female Cs. melanura caught. Further, non-baited CDC light traps were more successful in trapping host-seeking Cs. melanura than those baited with dry ice, a CO2 lure. The EEEV RNA was identified in Cs. melanura, Aedes vexans, Anopheles quadrimaculatus, and Uranotaenia sapphirina. Our findings indicate that corrugated plastic boxes and non-CO2 baited traps could improve detection of Cs. melanura. Mosquito control agencies are encouraged to periodically assess their surveillance strategy for EEEV.

Field-Collected Ticks From Benton County, Arkansas, and Prevalence of Associated Pathogens

The recovery of a Haemaphysalis longicornis Neumann (Acari: Ixodidae) tick from a dog in Benton County, Arkansas, in 2018 triggered a significant environmental sampling effort in Hobbs State Park Conservation Area. The objective of the investigation was to assess the tick population density and diversity, as well as identify potential tick-borne pathogens that could pose a risk to public health. During a week-long sampling period in August of 2018, a total of 6,154 ticks were collected, with the majority identified as Amblyomma americanum (L), (Acari: Ixodidae) commonly known as the lone star tick. No H. longicornis ticks were found despite the initial detection of this species in the area. This discrepancy highlights the importance of continued monitoring efforts to understand the dynamics of tick populations and their movements. The investigation also focused on pathogen detection, with ticks being pooled by species, age, and sex before being processed with various bioassays. The results revealed the presence of several tick-borne pathogens, including agents associated with ehrlichiosis (n = 12), tularemia (n = 2), and Bourbon virus (BRBV) disease (n = 1), as well as nonpathogenic rickettsial and anaplasmosis organisms. These findings emphasize the importance of public health messaging to raise awareness of the risks associated with exposure to tick-borne pathogens. Prevention measures, such as wearing protective clothing, using insect repellent, and conducting regular tick checks, should be emphasized to reduce the risk of tick-borne diseases. Continued surveillance efforts and research are also essential to improve our understanding of tick-borne disease epidemiology and develop effective control strategies.

Do Aedes triseriatus Respect State Boundaries?: A Paucity of La Crosse Virus in the South Carolina Appalachian Mountains

Background: La Crosse virus is an important endemic public health concern in the North Carolina Appalachian Mountains; however, human incidence is not commonly noted in this region on the South Carolina side of the mountain range border. No relevant studies have been performed in South Carolina evaluating mosquito vector populations for La Crosse virus (LACV) infection; thus, a pilot mosquito surveillance study was executed in summer 2020. Material and Methods: Vector surveillance occurred at five South Carolina state parks bordering neighboring state endemic counties from May to August 2020. Collections were approved by the state park authority, as noted in Permit No. N-8-20. Results: All three competent mosquito vectors were collected during the study duration; however, these vectors were collected in low abundance: Aedes triseriatus (4.5% of all collected mosquitos); Aedes albopictus (2.0%); Aedes japonicus (1.4%). Principal mosquito vector specimens, Ae. triseriatus, were sent to Centers for Disease Control and Prevention for testing of LACV by real-time reverse transcription PCR-all were negative. Discussion: While entomologic evidence suggests low transmission risk for this arbovirus in the South Carolina Appalachian Mountain region, further eco-epidemiologic investigations are warranted to understand this endemicity variance within a relatively small geographic area.

Students' and staffs' views and experiences of asymptomatic testing on a university campus during the COVID-19 pandemic in Scotland: a mixed methods study

OBJECTIVES

To explore the acceptability of regular asymptomatic testing for SARS-CoV-2 on a university campus using saliva sampling for PCR analysis and the barriers and facilitators to participation.

DESIGN

Cross-sectional surveys and qualitative semistructured interviews.

SETTING

Edinburgh, Scotland.

PARTICIPANTS

University staff and students who had registered for the testing programme (TestEd) and provided at least one sample.

RESULTS

522 participants completed a pilot survey in April 2021 and 1750 completed the main survey (November 2021). 48 staff and students who consented to be contacted for interview took part in the qualitative research. Participants were positive about their experience with TestEd with 94% describing it as 'excellent' or 'good'. Facilitators to participation included multiple testing sites on campus, ease of providing saliva samples compared with nasopharyngeal swabs, perceived accuracy compared with lateral flow devices (LFDs) and reassurance of test availability while working or studying on campus. Barriers included concerns about privacy while testing, time to and methods of receiving results compared with LFDs and concerns about insufficient uptake in the university community. There was little evidence that the availability of testing on campus changed the behaviour of participants during a period when COVID-19 restrictions were in place.

CONCLUSIONS

The provision of free asymptomatic testing for COVID-19 on a university campus was welcomed by participants and the use of saliva-based PCR testing was regarded as more comfortable and accurate than LFDs. Convenience is a key facilitator of participation in regular asymptomatic testing programmes. Availability of testing did not appear to undermine engagement with public health guidelines.

Geographic information system protocol for mapping areas targeted for mosquito control in North Carolina

Geographic information systems (GIS) can be used to map mosquito larval and adult habitats and human populations at risk for mosquito exposure and possible arbovirus transmission. Along with traditional methods of surveillance-based targeted mosquito control, GIS can help simplify and target efforts during routine surveillance and post-disaster (e.g., hurricane-related flooding) to protect emergency workers and public health. A practical method for prioritizing areas for emergency mosquito control has been developed and is described here. North Carolina (NC) One Map was used to identify state-level data layers of interest based on human population distribution and mosquito habitat in Brunswick, Columbus, Onslow, and Robeson Counties in eastern NC. Relevant data layers were included to create mosquito control treatment areas for targeted control and an 18-step protocol for map development is discussed. This protocol is expected to help state, territorial, tribal, and/or local public health officials and associated mosquito control programs efficiently create treatment area maps to improve strategic planning in advance of a disaster. This protocol may be applied to any NC county and beyond, thereby increasing local disaster preparedness.

Childhood disability, social class and social mobility: A neglected relationship

Disability theorists have long highlighted the role of institutional, social, and environmental barriers in constructing disability, emphasizing its parallels with other socially constructed axes of stratification. However, despite theoretical developments toward sociological understandings of disability, social stratification and life-course research have largely neglected childhood disability as a social division. As a result, we still know little surrounding the socio-economic attainment of disabled children and young people. Drawing on Next Steps data, this research note highlights stark overlooked inequalities between disabled and non-disabled young people's activity status and social mobility in early adulthood. We specifically focus on the importance of social class for disabled young people's outcomes, emphasizing the need for intersectional analyses of disability inequalities. We also outline longitudinal survey data enhancements necessary for life-course research on childhood disability and its intersections.

Observing many researchers using the same data and hypothesis reveals a hidden universe of uncertainty

This study explores how researchers' analytical choices affect the reliability of scientific findings. Most discussions of reliability problems in science focus on systematic biases. We broaden the lens to emphasize the idiosyncrasy of conscious and unconscious decisions that researchers make during data analysis. We coordinated 161 researchers in 73 research teams and observed their research decisions as they used the same data to independently test the same prominent social science hypothesis: that greater immigration reduces support for social policies among the public. In this typical case of social science research, research teams reported both widely diverging numerical findings and substantive conclusions despite identical start conditions. Researchers' expertise, prior beliefs, and expectations barely predict the wide variation in research outcomes. More than 95% of the total variance in numerical results remains unexplained even after qualitative coding of all identifiable decisions in each team's workflow. This reveals a universe of uncertainty that remains hidden when considering a single study in isolation. The idiosyncratic nature of how researchers' results and conclusions varied is a previously underappreciated explanation for why many scientific hypotheses remain contested. These results call for greater epistemic humility and clarity in reporting scientific findings.

The Stark realities of reproducible statistically orientated sociological research: Some newer rules of the sociological method

There is increasing concern that research is not transparent and that empirical results are often impossible to reproduce. Guidelines for undertaking reproducible research have been proposed in a number of academic areas (e.g. computational economics, psychology and medical research), however currently there are no guidelines for sociological research. This methodological paper provides guidance for undertaking reproducible statistically orientated sociological research. We provide an extended demonstration of the issues associated with reproducing results and undertaking transparent analyses. We draw on suitable concepts and techniques from open research, e-research and computing. We propose a set of Newer Rules of the Sociological Method, for undertaking transparent statistically orientated sociological research that supports reproducibility.

Perceived Risk of Mosquito-Borne Arboviruses in the Continental United States

The United States experienced local transmission of West Nile Virus (WNV) for the first time in 1999, and Zika Virus (ZIKV) in 2016. These introductions captured the public's attention in varying degrees. The research presented here analyzes the disproportional perception of ZIKV risk compared to WNV transmission risk, by the public and vector control personnel. The risk perception of vector control was measured through purposive sampled interviews (24 interviews in 13 states; May 2020-June 2021), while the public's perception was estimated from news publications (January 2000-December 2020), and Google searches (January 2004-December 2020). Over time, we observed a decrease in the frequency of press reporting and Google searches of both viruses with decreasing annual peaks in the summer. The highest peak of ZIKV news, and searches, surpassed that of WNV. We observed clear differences in the contents of the headlines for both viruses. We propose that the main reason in risk perception differences between the viruses were psychological. Zika infections (mosquito-borne and sexually transmitted) can result in devastating symptoms in fetuses and newborns, observations that frequently appeared in ZIKV-related headlines. Our results highlight the likely influence the news media has on risk perception and the need for public health agencies to play active roles in the conversation, helping disseminate timely and accurate information. Understanding the factors that shape risk perceptions of vector-borne diseases will hopefully lead to better use of resources by providing better guidance.

Highlights of Medical Entomology 2018: The Importance of Sustainable Surveillance of Vectors and Vector-Borne Pathogens

The theme of the 2018 Entomological Society of America, Entomological Society of Canada, and Entomological Society of British Columbia Joint Annual Meeting was Crossing Borders: Entomology in a Changing World. Following the theme of the meeting, papers selected for the 2018 'Highlights of Medical Entomology' included reports of expanded ranges for Aedes albopictus (Skuse) (Diptera: Culicidae), Aedes japonicus japonicus (Theobald) (Diptera: Culicidae), Culex coronator Dyar and Knab (Diptera: Culicidae), Mansonia titillans (Walker) (Diptera: Culicidae), and Wyeomyia mitchellii (Theobald) (Diptera: Culicidae); a first report of mosquito feeding on earthworms and leeches; Cache Valley virus detection in Ae. j. japonicus; surveillance in high-risk areas of Canada for Lyme Disease; and increasing lone-star tick detections in Connecticut. The selection of papers served as a reminder of the increasingly difficult challenge of sustaining vector surveillance programs. Fluctuating funding and a decline in vector taxonomists and identification expertise contribute to the erosion of vector surveillance.

An investigation of social class inequalities in general cognitive ability in two British birth cohorts

The 'Flynn effect' describes the substantial and long-standing increase in average cognitive ability test scores, which has been observed in numerous psychological studies. Flynn makes an appeal for researchers to move beyond psychology's standard disciplinary boundaries and to consider sociological contexts, in order to develop a more comprehensive understanding of cognitive inequalities. In this article we respond to this appeal and investigate social class inequalities in general cognitive ability test scores over time. We analyse data from the National Child Development Study (1958) and the British Cohort Study (1970). These two British birth cohorts are suitable nationally representative large-scale data resources for studying inequalities in general cognitive ability. We observe a large parental social class effect, net of parental education and gender in both cohorts. The overall finding is that large social class divisions in cognitive ability can be observed when children are still at primary school, and similar patterns are observed in each cohort. Notably, pupils with fathers at the lower end of the class structure are at a distinct disadvantage. This is a disturbing finding and it is especially important because cognitive ability is known to influence individuals later in the lifecourse.

The role of administrative data in the big data revolution in social science research

The term big data is currently a buzzword in social science, however its precise meaning is ambiguous. In this paper we focus on administrative data which is a distinctive form of big data. Exciting new opportunities for social science research will be afforded by new administrative data resources, but these are currently under appreciated by the research community. The central aim of this paper is to discuss the challenges associated with administrative data. We emphasise that it is critical for researchers to carefully consider how administrative data has been produced. We conclude that administrative datasets have the potential to contribute to the development of high-quality and impactful social science research, and should not be overlooked in the emerging field of big data.

Quantifying alcohol-related emergency admissions in a UK tertiary referral hospital: a cross-sectional study of chronic alcohol dependency and acute alcohol intoxication

OBJECTIVES

Alcohol is responsible for a proportion of emergency admissions to hospital, with acute alcohol intoxication and chronic alcohol dependency (CAD) implicated. This study aims to quantify the proportion of hospital admissions through our emergency department (ED) which were thought by the admitting doctor to be (largely or partially) a result of alcohol consumption.

SETTING

ED of a UK tertiary referral hospital.

PARTICIPANTS

All ED admissions occurring over 14 weeks from 1 September to 8 December 2012. Data obtained for 5497 of 5746 admissions (95.67%).

PRIMARY OUTCOME MEASURES

Proportion of emergency admissions related to alcohol as defined by the admitting ED clinician.

SECONDARY OUTCOME MEASURES

Proportion of emergency admissions due to alcohol diagnosed with acute alcohol intoxication or CAD according to ICD-10 criteria.

RESULTS

1152 (21.0%, 95% CI 19.9% to 22.0%) of emergency admissions were thought to be due to alcohol. 74.6% of patients admitted due to alcohol had CAD, and significantly greater than the 26.4% with 'Severe' or 'Very Severe' acute alcohol intoxication (p<0.001). Admissions due to alcohol differed to admissions not due to alcohol being on average younger (45 vs 56 years, p<0.001) more often male (73.4% vs 45.1% males, p<0.001) and more likely to have a diagnosis synonymous with alcohol or related to recreational drug use, pancreatitis, deliberate self-harm, head injury, gastritis, suicidal ideation, upper gastrointestinal bleeds or seizures (p<0.001). An increase in admissions due to alcohol on Saturdays reflects a surge in admissions with acute alcohol intoxication above the weekly average (p=0.003).

CONCLUSIONS

Alcohol was thought to be implicated in 21% of emergency admissions in this cohort. CAD is responsible for a significantly greater proportion of admissions due to alcohol than acute intoxication. Interventions designed to reduce alcohol-related admissions must incorporate measures to tackle CAD.

Ethnicity and ethnic group measures in social survey research

This article is a review of issues associated with measuring ethnicity and using ethnicity measures in social science research. The review is oriented towards researchers who undertake secondary analyses of large-scale multipurpose social science datasets. The article begins with an outline of two main approaches used in social surveys to measure ethnicity, the ‘mutually exclusive category’ approach and the ‘multiple characteristics’ approach. We also describe approaches to the use of ethnicity measures in cross-national comparative research. We emphasise the value of sensitivity analyses. We also encourage researchers to carefully consider the possible relationships between ethnicity and other important variables in order to avoid spurious interpretations of the effects of ethnicity.

A review of educational attainment measures for social survey research

This article is a review of issues associated with measuring education and using educational measures in social science research. The review is orientated towards researchers who undertake secondary analyses of large-scale micro-level social science datasets. The article begins with an outline of important context, which impinges upon the measurement of education. The United Kingdom is the focus of this review, but similar issues apply to other nation states. We provide a critical introduction to the main approaches to measuring education in social survey research, which include measuring years of education, using categorical qualification based measures and scaling approaches. We advocate the use of established education measures to better facilitate comparability and replication. We conclude by making the recommendation that researchers place careful thought into which educational measure they select, and that researchers should routinely engage in appropriate sensitivity analyses.

A Review of occupation-based social classifications for social survey research

This article is a review of issues associated with measuring occupations and using occupation-based socio-economic classifications in social science research. The review is orientated towards researchers who undertake secondary analysis of large-scale micro-level social science datasets. This article begins with an outline of how to handle raw occupational information. This is followed by an introduction to the two main approaches to measuring occupations and a third lesser known but intellectually innovative approach. The three approaches are social class schemes, social stratification scales and the microclass approach. International comparisons are briefly described and a discussion of intersectionality with other key variables such as age and gender is provided. We are careful to emphasise that this article does not advocate the uncritical adoption of any one particular occupation-based socio-economic measure over and above other alternatives. Rather, we are advocating that researchers should choose from the portfolio of existing socio-economic measures in an informed and empirically defensible way, and we strongly advocate undertaking sensitivity analyses. We conclude that researchers should always use existing socio-economic measures that have agreed on and well-documented standards. We strongly advise researchers not to develop their own measures without strong justification nor to use existing measures in an un-prescribed or ad hoc manner.

Statistical modelling of key variables in social survey data analysis

The application of statistical modelling techniques has become a cornerstone of analyses of large-scale social survey data. Bringing this special section on key variables to a close, this final article discusses several important issues relating to the inclusion of key variables in statistical modelling analyses. We outline two, often neglected, issues that are relevant to a great many applications of statistical models based upon social survey data. The first is known as the reference category problem and is related to the interpretation of categorical explanatory variables. The second is the interpretation and comparison of the effects from models for non-linear outcomes. We then briefly discuss other common complexities in using statistical models for social science research; these include the non-linear transformation of variables, and considerations of intersectionality and interaction effects. We conclude by emphasising the importance of two, often overlooked, elements of the social survey data analysis process, sensitivity analysis and documentation for replication. We argue that more attention should routinely be devoted to these issues.

North American wetlands and mosquito control

Wetlands are valuable habitats that provide important social, economic, and ecological services such as flood control, water quality improvement, carbon sequestration, pollutant removal, and primary/secondary production export to terrestrial and aquatic food chains. There is disagreement about the need for mosquito control in wetlands and about the techniques utilized for mosquito abatement and their impacts upon wetlands ecosystems. Mosquito control in wetlands is a complex issue influenced by numerous factors, including many hard to quantify elements such as human perceptions, cultural predispositions, and political climate. In spite of considerable progress during the last decades, habitat protection and environmentally sound habitat management still remain inextricably tied to politics and economics. Furthermore, the connections are often complex, and occur at several levels, ranging from local businesses and politicians, to national governments and multinational institutions. Education is the key to lasting wetlands conservation. Integrated mosquito abatement strategies incorporate many approaches and practicable options, as described herein, and need to be well-defined, effective, and ecologically and economically sound for the wetland type and for the mosquito species of concern. The approach will certainly differ in response to disease outbreaks caused by mosquito-vectored pathogens versus quality of life issues caused by nuisance-biting mosquitoes. In this contribution, we provide an overview of the ecological setting and context for mosquito control in wetlands, present pertinent information on wetlands mosquitoes, review the mosquito abatement options available for current wetlands managers and mosquito control professionals, and outline some necessary considerations when devising mosquito control strategies. Although the emphasis is on North American wetlands, most of the material is applicable to wetlands everywhere.

Efficacy of aerial ultra-low volume applications of two novel water-based formulations of unsynergized pyrethroids against riceland mosquitoes in Greece

We assessed the efficacy of ultra-low volume aerial adulticiding with 2 new water-based, unsynergized formulations of Aqua-K-Othrin (2% deltamethrin) and Pesguard S102 (10% d-phenothrin) against the riceland mosquitoes of Greece. A helicopter with Global Positioning System (GPS) navigation, real-time weather recording, and spray dispersal modeling (AgDISP) was utilized to accurately treat the experimental blocks by adjusting spray line positions to changing meteorological conditions. Two application rates were applied per formulation that corresponded to 0.75 and 1.00 g AI/ha of deltamethrin and 7.50 and 10.00 g AI/ha of d-phenothrin. The mosquitoes used for the trials were the main nuisance species found in rice field areas of Thessaloniki, which were primarily Aedes caspius, followed by Culex modestus and Anopheles sacharovi. Overall mean mortality of caged mosquitoes was 69.2% and 64.8% for deltamethrin and d-phenothrin, respectively. Mean population decrease in wild mosquito populations within the treatment areas was 76.5% and 78% for deltamethrin and d-phenothrin, respectively. The AgDISP dispersal model, coupled with GPS navigation and real-time weather recording, enabled accurate placement of the spray cloud such that the majority of the treatment area received sufficiently high droplet densities to result in uniform caged-mosquito mortality across all sampling sites.

Prostate biopsy protocols: 3D visualization-based evaluation and clinical correlation

OBJECTIVES

Systematic needle core biopsy is commonly used for the diagnosis of prostate cancer by urologists worldwide. As accurate and early diagnosis will result in more and better options for treatment, it is critical that the best possible protocols for biopsy be used clinically. In this study, we develop three-dimensional (3D) modeling and simulation technologies to evaluate most of the biopsy protocols in current clinical use, and correlate the results with those from clinical cases.

MATERIALS AND METHODS

Using deformable modeling techniques, 3D computerized prostate surface models were reconstructed from step-sectioned, whole-mounted radical prostatectomy specimens with localized prostate cancer. A 3D computer simulation system was developed to accurately depict the anatomy of the prostate and all individual tumor foci. A user-friendly interface was developed in the system so that a physician can easily and interactively use it for prostate needle core biopsy. A total of 281 prostate models were reconstructed, and 18 biopsies were performed by a urologist on each model to determine the detection rates of seven different biopsy protocols. Clinical biopsies from 35 patient cases were also reviewed and correlated with the simulation results.

RESULTS

The most commonly used sextant biopsy had only a 71.5% detection rate, while rates for the 10-pattern and 12-pattern protocols were much higher (96.4% and 97.2%, respectively). Even the lateral 4-pattern protocol performed better than the sextant protocol, with a detection rate of 89.3%. The lateral sextant biopsy protocol (using sites similar to, but more lateral than, those in the sextant protocol) achieved a rate of 92.5%. Although the rate of the 14-pattern biopsy was a little higher (97.5%), it used four more biopsies to achieve this increase, which, according to McNemar's test, is not statistically significant when compared to results with the 10-pattern protocol. The 5-region protocol, which uses 12 biopsies, had a detection rate of 89.7%. Transition zone and seminal vesicle biopsies did not result in a significantly increased detection rate when added to the patterns above. The clinical correlation also confirmed that the 10-pattern protocol was significantly superior to the traditional sextant biopsy pattern.

CONCLUSIONS

The 10-pattern biopsy protocol was the most optimized among all the protocols evaluated. This protocol supplemented the sextant biopsy protocol with four more lateral biopsies in the mid and apical sites on both sides.

Allelic loss on chromosome 6Q in primary prostate cancer

Molecular genetic analyses of human prostate cancer (CaP) has revealed frequent loss of specific chromosome regions suggesting the presence of putative tumor suppressor gene(s) (TSG) on these chromosome loci whose inactivation may play a role in prostate tumorigenesis. To understand the role of 6q alterations in CaP, we have undertaken a comprehensive analysis of proximal 6q. Genomic DNA from tumor and normal prostate tissues from radical prostatectomy specimens of 38 patients were analyzed by polymerase chain reaction (PCR) for 13 polymorphic microsatellite loci on 6q. Allelic losses of 1 or more polymorphic loci were detected in 11 of 38 patients (29%). Six of 11 tumors showing any 6q deletion were found to have allelic losses at D6S1056 and D6S300 loci. Our results revealed a 1.5 megabase interval between D6S1056 and D6S300 at 6q16.3-21 as the minimal region of deletion, which may contain the putative TSG involved in prostate tumorigenesis. One of the tumor samples demonstrated homozygous deletion at a distal location D6S314 (6q23-24), suggesting another locus potentially associated with CaP. Although the relationship of 6q loss of heterozygosity (LOH) with various clinico-pathologic variables, i.e., cancer recurrence or pathologic stage, did not reveal a statistically significant association, the risk for 6q LOH to non-organ confined (pT3) disease was 5-fold higher than for organ confined disease.

Prostate-specific antigen-detected prostate cancer (stage T1c): an analysis of whole-mount prostatectomy specimens

BACKGROUND

Clinical and pathological staging of prostate cancer has been, and remains, problematic. Since prostate-specific antigen (PSA)-detected tumors are often discerned during "screening," what are their significance?

METHODS

We analyzed 67 consecutive patients with stage T1c prostate cancer undergoing radical prostatectomy at our institution from August 1, 1991-September 12, 1995, and who had whole-mount specimen processing. Diagnosis was determined in all cases by transrectal ultrasound-guided biopsy.

RESULTS

The mean age of our patients was 63 years, and the mean PSA at time of diagnosis was 8.6 ng/ml (median, 7.2 ng/ml). There was organ-confined cancer in 31/67 (46%) patients; 17/67 (25%) had periprostatic fat infiltration, and of these 5(7%) had seminal vesicle involvement. Thirty-one of 67 (46%) had positive surgical margins. Twenty-two (33%) had a Gleason sum of > or = 7 in the final pathological specimen. Insignificant tumors (dominant tumor volume < 0.20 cc) were found in only 4 cases. Smaller tumors were more likely to be found when the PSA was < 10 ng/ml. Multifocal disease was found in 64/67 (96%) prostate specimens.

CONCLUSIONS

This study adds impetus to the growing realization that nonpalpable prostate cancer, detected because of elevated PSA, is rarely insignificant. Our findings add further emphasis to the fact that patients diagnosed by PSA elevation have, for the most part, significant cancer that should be treated aggressively.

Geographic/ethnic differences in human herpesvirus-6 antibody patterns

Serum samples from healthy adults in four geographic/ethnic groups (Ghanaian Blacks, Malaysian Chinese, Malaysian Indians and United States Caucasians) were tested under code for antibodies to human herpesvirus-6 (HHV-6). The prevalence and titer of HHV-6 antibody in the healthy Ghanaians were significantly higher than in the Malaysian Chinese; United States Caucasians and Malaysian Indians had intermediate prevalence and titer of antibodies. Thus far, no specific differences in HHV-6-associated diseases have been noted between geographic/ethnic groups with these marked variations in antibody patterns.

Self-employment and providing child care

This paper considers self-employment and providing child care as occupational strategies that can lower the cost of child care. If the ability to care for one's own children while engaged in market work is important to mothers with young children, we predict that women with young children will be more likely to choose to be self-employed or to be a child care provider than women without young children. The analysis provides strong support for this hypothesis. The results show that the presence of young children is an important factor in choosing self-employment and in choosing to be a child care provider. Finally, simulations are presented which show that a woman's choice among these sectors is quite sensitive to the number and ages of her young children.

Characterization of the cytolytic activity of CD4+ and CD8+ tumor-infiltrating lymphocytes in human renal cell carcinoma

Previously we showed that IL2 expanded tumor-infiltrating lymphocytes (TILs) from renal cell carcinoma mediated non-major histocompatibility complex-restricted cytotoxicity. Phenotypic analysis showed that cultured TILs were composed mostly of T-lymphocytes with varying numbers of CD4+, CD8+, and CD56+ (Leu19+) populations. Here we compared the cytolytic activity of the two predominant TIL subsets, CD3+CD4+ and CD3+CD8+, to that of the CD56+ populations. Using magnetic beads coated with antibodies to either CD4 or CD8, CD3+CD4+, and CD3+CD8+ TILs were isolated in a highly enriched form (greater than 92%) and could be expanded for over 40 days in vitro with 1000 units/ml IL2. In a 4-h 51Cr release assay the CD4+ and CD8+ TILs showed minimal lytic activity, whereas unseparated cells exhibited significant levels of non-major histocompatibility complex-restricted cytotoxicity. The lytic activity seen in the 4-h assay with unseparated TILs appeared to be related to the presence of CD56+ populations. With one exception none of the purified CD4+ or CD8+ TILs expressed any significant levels of CD56, while the unseparated TILs contained varying numbers of CD3+CD56+ and CD3-CD56+ populations. Cell-sorting experiments verified that the CD56+ populations were responsible for most of the lytic activity in 4 h even though CD3+CD56- cells represented the predominant cell type. Although CD3+CD56- TILs were minimally lytic in 4 h, we show here that both CD3+CD4+ and CD3+CD8+ subsets displayed substantial cytotoxicity in long-term assays. In the 18-h 51Cr release assay 5 of 6 CD4+ and 2 of 3 CD8+ TILs were lytic for the autologous tumor. In two cases, restimulation with the autologous tumor induced augmented cytolytic activity of TIL subsets and in one case induced lytic activity in 4 h. The cytotoxic activity of TIL subsets was further examined using a 72-h assay in which TILs were cocultured with a confluent layer of tumor cells. The degree of cytotoxicity was quantitated by measuring the amount of crystal violet dye that was incorporated by tumor cells which remained after the incubation period. CD4+ and CD8+ TILs typically caused greater than a 50% reduction of tumor cells in 3 days and the level of reduction was increased when IL2 was added to the cultures. All the CD4+ and CD8+ subset preparations were cytotoxic in the 3-day assay even though some were not lytic for certain targets in the 18-h 51Cr release assay.(ABSTRACT TRUNCATED AT 400 WORDS)

TIL from renal-cell carcinoma: restimulation with tumor influences proliferation and cytolytic activity

TIL were cultured from human renal-cell carcinoma (RCC) in 1,000 U/ml rIL2 and restimulated with autologous tumor in efforts to establish which conditions would best expand the number of lymphocytes cytotoxic for autologous tumor. Greater cell yields resulted from multiple restimulations of TIL with autologous tumor. In most instances, these TIL lysed autologous tumor better than TIL grown in rIL2 alone. Enhanced proliferation was seen also after restimulation of TIL with allogeneic RCC as well as with tumor cells of non-renal origin. Although in some instances lysis of autologous tumor appeared to be specific, restimulation with autologous tumor did not consistently result in the generation of specific cytolytic T cells. Attempts to culture more specific cytolytic T cells by using 50 U/ml rIL2 were successful in expanding TIL with enhanced lytic activity; however, this activity was not specific for autologous tumor. The phenotype of the tumor-restimulated TIL generally did not change. In most of the TIL cultures, CD3+CD4+ cells were predominant with low numbers of CD3+Leu19+ cells and minimal numbers of CD3-Leu19+ cells. Thus, the cytotoxic response to tumor was mediated by T cells and not NK cells. Overall, our data indicate that restimulation of TIL with autologous tumor may be beneficial for growing larger numbers of cells which have increased lytic activity and for prolonging the presence of lytic activity among the expanded TIL.

Characterization of two cell lines with distinct phenotypes and genotypes established from a patient with renal cell carcinoma

Two human renal carcinoma cell lines have been established from the same patient. One cell line (CCF-RC1) was obtained from the primary tumor and the second (CCF-RC2) was established from cells of the renal vein effluent of the perfused tumorous kidney. Although they were established from the same patient, the cell lines differed in certain biological properties. They have been passaged up to 50 times in vitro for about two years. Each has an epithelial morphology and exhibits mutilayering. Cell cycle time of CCF-RC1 and CCF-RC2 was 34 and 36 h, respectively. They exhibited anchorage independent growth, and the plating efficiency of CCF-RC2 in soft agar was higher than that of CCF-RC1. Both lines induced tumors in nude mice at the site of s.c. injection closely resembling the original tumor in histological examination. Electron microscopic features of both tumors in nude mice were consistent with epithelial origin. Doubling time of CCF-RC1 and CCF-RC2 in nude mice was 11 and 12 days, respectively. CCF-RC1 and CCF-RC2 have hypotetraploid karyotype and modal numbers of 83 and 73, presenting two and three marker chromosomes, respectively. Immunocytology with commercial monoclonal antibodies against renal carcinoma (URO-3) and cytokeratin (Mac 6) showed positive reactions with both lines, suggesting that these cell lines derived from renal epithelium. A murine monoclonal antibody (2E11) was generated against CCF-RC2 by the hybridoma technique; 2E11 reacted with CCF-RC2, but not with CCF-RC1. These cell lines may provide a useful model for the study of tumor heterogeneity and its relationship to metastasis.

Is the ANA guilty of paternalism in its guidelines on withdrawing or withholding food and fluid?

The ANA Committee on Ethics's Guidelines on Withdrawing or Withholding Food and Fluid (1988) delineates those circumstances under which withholding is normally permissible. The Guidelines direct nurses to respect the wishes of competent adults. What of adults who are considered incompetent? Can they make decisions to refuse food and fluids? The Guidelines ask nurses to judge patient competence and the merit of the reasons behind the decisions. This suggests paternalism. A more appropriate role of the nurse might be to focus on helping the patient to make a decision, rather than on the merit of the decision itself.

An aging society: implications for health care needs and impacts on allied health practice

The first report of the National Task Force on Gerontology and Geriatric Care Education, excerpted herein, raises many more questions than it answers. Through its broad-brush articulation of the health care needs of older people, the report sets the environment for gauging the impact of these needs on allied health practice. Responses to a number of the implications for health care needs are now underway, yet much remains undone. In the coming year the task force will develop an action plan that addresses directly the many implications for allied health.

Immunotherapy of a murine renal cancer

A preliminary study of the response to various immunotherapy models in a spontaneous murine nal cell carcinoma model is reported. Tumor cells were implanted intrarenally and nephrectomy performed at a later time. Specific immunotherapy using irradiated whole tumor cells plus complete Freund's adjuvant and a crude membrane preparation plus the same adjuvant were compared to nonspecific immunotherapy with adjuvant alone. In the 1st of 2 response criteria examined, there was a statistically significant decrease in tumor growth following hind limb rechallenge in those animals immunized with the membrane preparation plus adjuvant (p less than 0.01). This form of therapy also produced a statistically significant (p = .024) increase in survival in a second experimental model in which locally recurrent tumor was induced. Whole irradiated cells plus adjuvant slightly enhanced tumor growth, while adjuvant alone had no effect. Treatment with adjuvant alone did, however, result in an increase in the incidence of pulmonary metastases in both groups of animals. The practical and theoretical applicability of a membrane preparation vaccine in human tumors is discussed.

Lack of positive results of a physiologically based treatment of amblyopia

Recent reports have described marked improvement of visual acuity in amblyopic eyes of young children following monocular exposure to square-wave gratings presented at a variety of spatial frequencies and orientations for as little as 7 minutes. We sought to confirm and expand on these investigations, with emphasis on single-session results. Sixteen juvenile and 11 adult amblyopes and 26 control subjects were used. Visual acuity was determined before and after a 7-minute stimulation period using an E-chart that controlled for contour interaction. The 50% visual acuity threshold corrected for guessing was computer calculated by probit analysis. Results show that frequency, range, and magnitude of changes (either increases or decreases) in visual acuity following stimulation were approximately the same (< +/- 10% Snell-Sterling) in both amblyopic and control groups. These findings suggest that brief exposure to the grating patterns had little if any beneficial effect on visual acuity in amblyopic eyes.

Comparative studies on immunity to EBV-associated antigens in NPC patients in North America, Tunisia, France and Hong Kong

This study compared the relative antibody titers to EBV-related antigens in patients with nasopharyngeal carcinoma (NPC) and controls from a high-incidence (Hong Kong), an intermediate incidence (Tunisia), and two low-incidence (France, North America) areas to determine which of several EBV antibodies best differentiated NPC patients from controls. Antibodies measured include anti-virus capsid antigen (VCA), anti-early antigen (EA), anti-soluble antigen by complement-fixation (CF) and antibody-dependent lymphocyte cytotoxicity (ADLC). A matched pair analysis showed that significantly more NPC patients had higher VCA and EA but not CF or ADLC antibody titers than their matched cancer controls. The comparison of geometric mean titers between NPC cases and controls was more than seven-fold (816 vs 11.5) for EA antibody and more than three-fold (359.7 vs 95.4) for VCA anti-body (p less than 0.01). A two-fold difference was seen for CF antibody to soluble antigens (27.3 vs 12.9, p less than 0.01) and a three-fold difference (2657.7 vs 870.9, p less than 0.05) was observed for ADLC. Our finding of significant differences between NPC patients from four countries and their matched controls suggest that if EBV is the etiological agent of NPC in Chinese, it is quite likely to cause the majority of NPC cases in other ethnic groups living in other countries as well.