How older adults manage misinformation and information overload - A qualitative study

BACKGROUND

The COVID-19 pandemic was characterized by an abundance of information, some of it reliable and some of it misinformation. Evidence-based data on the impact of misinformation on attitudes and behaviours remains limited. Studies indicate that older adults are more likely to embrace and disseminate misinformation than other population groups, making them vulnerable to misinformation. The purpose of this article is to explore the effects of misinformation and information overload on older adults, and to present the management strategies put in place to deal with such effects, in the context of COVID-19.

METHODS

A qualitative exploratory approach was adopted to conduct this research. A total of 36 semi-structured interviews were conducted with older adults living in Quebec, Canada. The interviews were fully transcribed and subjected to a thematic content analysis.

RESULTS

Participants said they could easily spot misinformation online. Despite this, misinformation and its treatment by the media could generate fear, stress and anxiety. Moreover, the polarization induced by misinformation resulted in tensions and even friendship breakdowns. Participants also denounced the information overload produced largely by the media. To this end, the participants set up information routines targeting the sources of information and the times at which they consulted the information.

CONCLUSIONS

This article questions the concept of vulnerability to misinformation by highlighting older adults' agency in managing misinformation and information overload. Furthermore, this study invites us to rethink communication strategies by distinguishing between information overload and misinformation.

Resting EEG correlates of neurodevelopment in a socioeconomically and linguistically diverse sample of toddlers: Wave 1 of the Kia Tīmata Pai best start New Zealand study

Development of communication and self-regulation skills is fundamental to psychosocial maturation in childhood. The Kia Tīmata Pai Best Start (KTP) longitudinal study aims to promote these skills through interventions delivered at early childcare centers across New Zealand. In addition to evaluating effects of the interventions on behavioral and cognitive outcomes, the study utilizes electroencephalography (EEG) to characterize cortical development in a subsample of participating children. Here, we present results of the baseline resting EEG assessment with 193 children aged 15 to 33 months. We identified EEG correlates of individual differences in demographics, communication abilities, and temperament. We obtained communication and behavior ratings from multiple informants, and we applied contemporary analytic methods to the EEG data. Periodic spectral power adjusted for aperiodic activity was most closely associated with demographic, language, and behavioral measures. As in previous studies, gamma power was positively associated with verbal language. Alpha power was positively associated with effortful control. Nonverbal and verbal language measures showed distinct associations with EEG indices, as did the three temperament domains. Our results identified a number of candidate EEG measurements for use as longitudinal markers of optimal cortical development and response to interventions in the KTP cohort.

The role of social signals in segmenting observed actions in 18-month-old children

Learning about actions requires children to identify the boundaries of an action and its units. Whereas some action units are easily identified, parents can support children's action learning by adjusting the presentation and using social signals. However, currently, little is understood regarding how children use these signals to learn actions. In the current study, we investigate the possibility that communicative signals are a particularly suitable cue for segmenting events. We investigated this hypothesis by presenting 18-month-old children (N = 60) with short action sequences consisting of toy animals either hopping or sliding across a board into a house, but interrupting this two-step sequence either (a) using an ostensive signal as a segmentation cue, (b) using a non-ostensive segmentation cue and (c) without additional segmentation information between the actions. Marking the boundary using communicative signals increased children's imitation of the less salient sliding action. Imitation of the hopping action remained unaffected. Crucially, marking the boundary of both actions using a non-communicative control condition did not increase imitation of either action. Communicative signals might be particularly suitable in segmenting non-salient actions that would otherwise be perceived as part of another action or as non-intentional. These results provide evidence of the importance of ostensive signals at event boundaries in scaffolding children's learning.

Infants' conceptual representations of meaningful verbal and nonverbal sounds

In adults, words are more effective than sounds at activating conceptual representations. We aimed to replicate these findings and extend them to infants. In a series of experiments using an eye tracker object recognition task, suitable for both adults and infants, participants heard either a word (e.g. cow) or an associated sound (e.g. mooing) followed by an image illustrating a target (e.g. cow) and a distracter (e.g. telephone). The results showed that adults reacted faster when the visual object matched the auditory stimulus and even faster in the word relative to the associated sound condition. Infants, however, did not show a similar pattern of eye-movements: only eighteen-month-olds, but not 9- or 12-month-olds, were equally fast at recognizing the target object in both conditions. Looking times, however, were longer for associated sounds, suggesting that processing sounds elicits greater allocation of attention. Our findings suggest that the advantage of words over associated sounds in activating conceptual representations emerges at a later stage during language development.

Oncolytic Herpes Simplex Virus Prevents Premalignant Lesions from Progressing to Cancer

Early detection and timely treatment of precancerous lesions are hallmarks of successful strategies to prevent deaths due to cancer. Oncolytic viruses are a group of promising anti-cancer agents with wide-ranging experimental and clinical efficacy against solid tumors. Previously, we have shown that NV1066, an oncolytic herpes simplex-1 virus encoding enhanced green fluorescent protein, selectively infects, replicates in, and kills various cancer types. In this study, we sought to determine whether this oncolytic agent can treat precancerous lesions to prevent cancer formation. Using an oral chemical carcinogenesis model in hamsters, we assessed the ability of NV1066 to infect precancerous and cancerous lesions. NV1066 consistently infected dysplastic cells, carcinoma in situ, and squamous cell carcinoma. Animals receiving an intramucosal injection of NV1066 for 7 weeks showed significantly fewer (3-fold) and smaller (4-fold) lesions compared to animals that did not receive viral treatment. Results indicate that infectivity might be dependent on the herpes simplex virus 1 receptor, nectin-1. This study demonstrates that not only can NV1066 treat oral squamous cell carcinoma, but it can also infect and treat premalignant lesions, thus delaying cancer progression. Overall, our study shows the potential of the oncolytic virus NV1066 as a cancer prevention tool.

Speech Intonation Induces Enhanced Face Perception in Infants

Infants' preference for faces with direct compared to averted eye gaze, and for infant-directed over adult-directed speech, reflects early sensitivity to social communication. Here, we studied whether infant-directed speech (IDS), could affect the processing of a face with direct gaze in 4-month-olds. In a new ERP paradigm, the word 'hello' was uttered either in IDS or adult-direct speech (ADS) followed by an upright or inverted face. We show that the face-specific N290 ERP component was larger when faces were preceded by IDS relative to ADS. Crucially, this effect is specific to upright faces, whereas inverted faces preceded by IDS elicited larger attention-related P1 and Nc. These results suggest that IDS generates communicative expectations in infants. When such expectations are met by a following social stimulus - an upright face - infants are already prepared to process it. When the stimulus is a non-social one -inverted face - IDS merely increases general attention.

Preoperative oral antibiotic bowel preparation in elective resectional colorectal surgery reduces rates of surgical site infections: a single-centre experience with a cost-effectiveness analysis

INTRODUCTION

Surgical site infections cause considerable postoperative morbidity and mortality. The aim of this study was to determine the effect on surgical site infection rates following introduction of a departmental oral antibiotic bowel preparation protocol.

METHODS

A prospective single-centre study was performed for elective colorectal resections between May 2016-April 2018; with a control group with mechanical bowel preparation and treatment group with oral antibiotic bowel preparation (neomycin and metronidazole) and mechanical bowel preparation. The primary outcome of surgical site infection and secondary outcomes of anastomotic leak, length of stay and mortality rate were analysed using Fisher's exact test and independent samples t-tests. A cost-effectiveness analysis was also performed.

RESULTS

A total of 311 patients were included; 156 in the mechanical bowel preparation group and 155 in the mechanical bowel preparation plus oral antibiotic bowel preparation group. The study included 180 (57.9%) men and 131 (42.1%) women with a mean age of 68 years. There was a significant reduction in surgical site infection rates (mechanical bowel preparation 16.0% vs mechanical bowel preparation plus oral antibiotic bowel preparation 4.5%; P = 0.001) and mean length of stay (mechanical bowel preparation 10.2 days vs mechanical bowel preparation plus oral antibiotic bowel preparation 8.2 days; P = 0.012). There was also a reduction in anastomotic leak and mortality rates. Subgroup analyses demonstrated significantly reduced surgical site infection rates in laparoscopic resections (P = 0.008). There was an estimated cost saving of £239.13 per patient and £37,065 for our institution over a one-year period.

CONCLUSION

Oral antibiotic bowel preparation is a feasible and cost-effective intervention shown to significantly reduce the rates of surgical site infection and length of stay in elective colorectal surgery.

Achieving clear margins. Directed shaving using MarginProbe, as compared to a full cavity shave approach

BACKGROUND

Following lumpectomy, full cavity shaving approach is used to reduce positive margin rates, among other issues previously studied by others, at an expense of increase in tissue volume removed. We present our experience after switching from full cavity shaving to a targeted shaving approach using MarginProbe, an intra-operative margin assessment device.

METHODS

Specimen excision was performed according to standard of care. Additional shavings were taken based on device readings on the lumpectomy specimen. Intra-operative imaging was used, as required.

RESULTS

We compared 137 MarginProbe cases to 199 full cavity shave cases. The re-excision rate was reduced by 57% (P = 0.026), from 15.1% to 6.6%. The overall tissue volume removed was reduced by 32% (P = 0.0023), from 115 cc to 78 cc.

CONCLUSIONS

MarginProbe enabled a change in the lumpectomy technique from full cavity shavings to directed shavings guided by the device. There was a significant reduction in re-excisions and in the overall tissue volume removed.The lower amount of shavings also contributed to a reduction in pathology work.

Thymic Nurse Cells Participate in Heterotypic Internalization and Repertoire Selection of Immature Thymocytes; Their Removal from the Thymus of Autoimmune Animals May be Important to Disease Etiology

Thymic nurse cells (TNCs) are specialized epithelial cells that reside in the thymic cortex. The initial report of their discovery in 1980 showed TNCs to contain up to 200 thymocytes within specialized vacuoles in their cytoplasm. Much has been reported since that time to determine the function of this heterotypic internalization event that exists between TNCs and developing thymocytes. In this review, we discuss the literature reported that describes the internalization event and the role TNCs play during T cell development in the thymus as well as why these multicellular complexes may be important in inhibiting the development of autoimmune diseases.

Do fetuses move their lips to the sound that they hear? An observational feasibility study on auditory stimulation in the womb

Background

We investigate in this feasibility study whether specific lip movements increase prenatally when hearing a particular sound. We hypothesised that fetuses would produce more mouth movements resembling those required to make the sound stimulus they heard (i.e. mouth stretch) compared with a no-sound control group who heard no specific auditory stimuli. Secondly, we predicted that fetuses hearing the sound would produce a similar number of mouth movements unrelated to the sound heard (i.e. lip pucker) as the no-sound group of fetuses.

Methods

In an observational feasibility study, 17 fetuses were scanned twice at 32 and 36 weeks of gestation, and two different types of mouth movements were recorded. Three fetuses received an auditory stimulus, and 14 did not. A generalised mixed effects log-linear model was used to determine statistical significance.

Results

Fetuses in the sound group performed one specific mouth movement (mouth stretch) significantly more frequently than fetuses in the no-sound group. A significant interaction between group and gestational age indicates that there was differential change in this specific movement as age increases (X² = 7.58 on 1 df, p = 0.006), with the no-sound group showing a decline of 76 % between 32 weeks and 36 weeks (p < 0.001), whereas the sound group showed no significant change over time (p = 0.41). There was no significant difference between the sound group and no-sound group in the frequency of lip puckering—the second, unrelated mouth movement (p = 0.35).

Conclusions

These results suggest that a sound stimulus is associated with an increase in specific, rather than general, mouth movements. The results are informative for the development of infant speech and potentially could also lead to a diagnostic test for deafness in utero. More research is needed to replicate this research with a randomised design and with a range of different auditory stimuli which would be produced with different mouth movements, such as “o” which would be seen as pursed lips.

Electronic supplementary material

The online version of this article (doi:10.1186/s40814-016-0053-3) contains supplementary material, which is available to authorized users.

Dissociating associative and motor aspects of action understanding: Processing of dual-ended tools by 16-month-old infants

When learning about the functions of novel tools, it is possible that infants may use associative and motoric processes. This study investigated the ability of 16-month-olds to associate the orientation in which an actor held a dual-function tool with the actor's prior demonstrated interest in one of two target objects, and their use of the tool on that target. The actors' hand posture did not differ between conditions. The infants were shown stimuli in which two actors acted upon novel objects with a novel tool, each actor employing a different function of the tool. Using an eye-tracker, infants' looking time at images depicting the actors holding the tool in an orientation congruent or incongruent with the actor's goal was measured. Infants preferred to look at the specific part of the tool that was incongruent with the actor's goal. Results show that the association formed involves the specific part of the tool, the actor, and the object the actor acted upon, but not the orientation of the tool. The capacity to form such associations is demonstrated in this study in the absence of motor information that would allow 16-month-olds to generate a specific representation of how the tool should be held for each action via mirroring processes.

The neuropsychology of infants' pro-social preferences

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Neural correlates of 6-month-old infants’ detection of pro-social agents.

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ERP component P400 over posterior temporal areas index social valence.

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First non-behavioral demonstration of pro-social preferences in young infants.

The current study is the first to investigate neural correlates of infants’ detection of pro- and antisocial agents. Differences in ERP component P400 over posterior temporal areas were found during 6-month-olds’ observation of helping and hindering agents (Experiment 1), but not during observation of identically moving agents that did not help or hinder (Experiment 2). The results demonstrate that the P400 component indexes activation of infants’ memories of previously perceived interactions between social agents. This leads to suggest that similar processes might be involved in infants’ processing of pro- and antisocial agents and other social perception processes (encoding gaze direction, goal directed grasping and pointing).

Novel antibody associations in immune-mediated necrotising myopathy without inflammation

INTRODUCTION

The patient presenting with proximal muscle weakness, elevated serum creatinine kinase and myopathic electromyography and biopsy findings has a wide differential diagnosis that includes toxic, autoimmune, paraneoplastic and congenital myopathies. Autoimmune myopathies are important to identify because they may respond to immunosuppressive therapies.

METHODS

We describe two cases of immune-mediated necrotizing myopathy each associated with a novel antibody.

RESULTS

Case 1 describes a progressive myopathy in a statin user. Antibodies to 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase were identified and the patient responded to steroid therapy. Case 2 describes an aggressive myopathy associated with antibodies to signal recognition particle. There was no response to steroids. Clinical improvement followed treatment with rituximab and cyclophosphamide.

CONCLUSION

The identification of myositis-specific antibodies is important because they are associated with distinct clinical phenotypes and may guide the physician in terms of treatment strategies.

Malignant mucosal melanoma of the paranasal sinuses: Two case presentations

Primary mucosal melanoma of the paranasal sinuses is a rare tumor of the head and neck which can be a devastating disease. Cancers arising in the sinonasal cavity are extremely rare, with a poor survival rate. There is inherent difficulty in diagnosing these lesions due to their complex anatomic locations and symptoms which are often confused with more common benign processes. The primary treatment of this rare disease process is resection, except in advanced stages where surgical resection is not an option. Diagnostic accuracy in consideration of size, location, and presence of metastatic disease of these malignant tumors tailors individual patients to different management in order to achieve the longest possible survival.

Anti-glycolipid GM2-positive Guillain-Barre syndrome due to hepatitis E infection

BACKGROUND

Hepatitis E infection is most prevalent in developing countries with poor sanitation, but can also occur apparently sporadically in more developed areas.

CASE

We here report a second European case of Guillain-Barre syndrome due to hepatitis E infection in association with anti-glycolipid GM2 antibody.

INTERPRETATION

This is likely to be a specific association involving molecular mimicry, and further European cases can therefore be expected.

The presence or absence of older siblings and variation in infant goal-directed motor development

This study investigates the relationship between having an older sibling and early goal-directed motor development. In a longitudinal study, infants were filmed playing with their mother and were observed at 5 and 12 months of age. After each observation, they were assessed with the Mental Bayley Scale. From the mother—child interaction, playing was coded in terms of the production of infant goal-directed actions. Results indicated that infants with siblings produced fewer goal-directed actions at 5 months than infants without older siblings, but at 12 months they produced relatively more goal-directed actions than infants without older siblings. There was no relationship with scores on the Mental Bayley Scale. In order to examine differences in adult behavior that may account for variation in infant motor performance, maternal level of motionese was scored with no differences found between the sibling—no sibling groups.

A high frequency of the MTHFR 677C>T polymorphism in Scottish women with epilepsy: Possible role in pathogenesis

The inheritance of most forms of epilepsy is usually considered to be multifactorial, although a number of single gene causes are known. Most previous studies of epilepsy genetics have implicated ion channel genes or ligand receptors. In a previous study of children with adverse effects of prenatal exposure to antiepileptic drugs, we noted an increased frequency of the methylene tetrahydrofolate reductase (MTHFR) 677C>T polymorphism in the mothers. To investigate this further, a new cohort of women with epilepsy has been identified from maternity hospital records and genotyped for polymorphisms in MTHFR, serine hydroxymethyl transferase (SHMT1), methionine synthase (MTR) and methionine synthase reductase (MTRR). Healthy blood donors were genotyped as controls. The frequency of the MTHFR 677TT genotype was significantly higher in women with idiopathic generalised epilepsy than in healthy controls (p=0.012, OR 2.26, 95%CI 1.13-4.51). No association was detected for the other polymorphisms tested. The MTHFR 677C>T polymorphism may be a susceptibility factor for epilepsy, and its higher frequency in women with epilepsy may contribute to the increased risk of malformation in children of women with epilepsy.

Fetal anticonvulsant syndromes and polymorphisms in MTHFR, MTR, and MTRR

The malformations found in fetal anticonvulsant syndromes (FACS) are associated with folic acid deficiency and methylene-tetrahydrofolate reductase (MTHFR) polymorphisms in the general population. To investigate a possible association between FACS and MTHFR genotype, we recruited 200 mothers who had taken anti-epileptic drugs in pregnancy, and delivered at Aberdeen Maternity Hospital over a 26-year period. Clinical findings in the mothers and their 337 children were documented. A clinical algorithm was devised to diagnose FACS objectively. Case-parent triads were genotyped for polymorphisms in MTHFR, serine hydroxymethyl transferase (SHMT1), methionine synthase (MTR), and methionine synthase reductase (MTRR), and analyzed by log-linear regression. No effect of the child's genotype on congenital malformation, neurodevelopmental disorder or FACS was detected using this method. The risk of having a child with congenital malformation or FACS was three to four times higher for mothers who were MTHFR 677TT homozygotes compared with MTHFR 677CC homozygotes. MTR 2756A > G and MTRR 66A > G genotype frequencies in children with FACS and neurodevelopmental disorder were different from those in healthy blood donor controls.

Herpes oncolytic therapy of salivary gland carcinomas

Oncolytic herpes simplex viruses (HSV) have demonstrated potent antitumoral effects against a variety of human malignancies in preclinical studies and are in early clinical trials. We explored the activity of an attenuated, replication-competent, oncolytic HSV (NV1023) for the treatment of human salivary gland carcinomas. NV1023 was able to successfully enter into 4 mucoepidermoid carcinoma (H292, H3118, HTB-41, UT-MUC-1) and 2 adenocarcinoma (HSY, HSG) cell lines, as measured by lacZ assays after exposure to 5 viral particles per cell (MOI 5). Viral plaque assays showed variation of viral replication within these cell lines, ranging from a 268-fold increase (H292) to a 3-fold increase (HSG) in viral titer. At MOI 5, all cell lines showed >95% cytotoxicity from NV1023 by Day 7, except for HSY (73%). At MOI 0.1, H3118 and UT-MUC-1 remained highly sensitive to NV1023, both showing >95% cytotoxicity by Day 7. The mucoepidermoid carcinomas were more sensitive to NV1023 at low viral concentrations compared with the adenocarcinomas. Flank tumors of H3118, HTB-41 and HSY in nude mice showed significant tumor volume reductions after a single intratumoral injection of NV1023 (2 x 10(7) plaque-forming units). These data suggest that oncolytic herpes viruses have significant efficacy entering, replicating within, and lysing human salivary gland carcinomas. These promising biologic agents should be further investigated as novel therapy for patients with salivary carcinomas failing conventional treatment.

Tumor hypoxia imaging in orthotopic liver tumors and peritoneal metastasis: a comparative study featuring dynamic 18F-MISO and 124I-IAZG PET in the same study cohort

PURPOSE

The purpose of this paper is to compare the uptake of two clinically promising positron emission tomography (PET) hypoxia targeting agents, (124)I-iodoazomycin galactopyranoside ((124)I-IAZG) and (18)F-fluoromisonidazole ((18)F-FMISO), by dynamic microPET imaging, in the same rats bearing liver tumors and peritoneal metastasis.

METHODS

Morris hepatoma (RH7777) fragments were surgically implanted into the livers of four nude rats. Tumors formed in the liver and disseminated into the peritoneal cavity. Each rat had a total of two to three liver tumors and peritoneal metastasis measuring 10-15 mm in size. Animals were injected with (18)F-FMISO, followed on the next day (upon complete (18)F decay) by (124)I-IAZG. The animals were imaged in list mode on the microPET system from the time of injection of each tracer for 3 h and then again at 6 h and 24 h for the long-lived (124)I-IAZG tracer (4.2-day half-life). Micro computed tomography (CT) scans of each rat were performed for co-registration with the microPET scans acquired with a liver contrast agent, allowing tumor identification. Regions of interest (ROIs) were drawn over the heart, liver, muscle, and the hottest areas of the tumors. Time-activity curves (TACs) were drawn for each tissue ROI.

RESULTS

The (18)F-FMISO signal increased in tumors over the 3-h time course of observation. In contrast, after the initial injection, the (124)I-IAZG signal slowly and continuously declined in the tumors. Nevertheless, the tumor-to-normal-tissue ratios of (124)I-IAZG increased, but more slowly than those of (18)F-FMISO and as a result of the differentially faster clearance from the surrounding normal tissues. These pharmacokinetic patterns were seen in all 11 tumors of the four animals.

CONCLUSIONS

(18)F-FMISO localizes in the same intra-tumor regions as (124)I-IAZG. The contrast ratios (tumor/background) reach similar values for the two hypoxia tracers, but at later times for (124)I-IAZG than for (18)F-FMISO and, therefore, with poorer count statistics. As a consequence, the (18)F-FMISO images are of superior diagnostic image quality to the (124)I-IAZG images in the Morris hepatoma McA-R-7777 tumor model.

Maternal personality and infants' neural and visual responsivity to facial expressions of emotion

BACKGROUND

Recent investigations suggest that experience plays an important role in the development of face processing. The aim of this study was to investigate the potential role of experience in the development of the ability to process facial expressions of emotion.

METHOD

We examined the potential role of experience indirectly by investigating the relationship between the emotional environment provided by mothers (as indexed by affective measures of their personality) and 7-month-olds' processing of emotional expressions (as indexed by visual attention and event-related potentials [ERPs]).

RESULTS

For positive emotion, infants with highly positive mothers looked longer at fearful than happy expressions, and a subset of these infants who themselves also scored highly on positive temperament showed a larger negative central (Nc) component in the ERP to fearful than happy faces. For negative emotion, there were no detectable influences of maternal personality, although very fearful infants showed a larger Nc to fearful than happy expressions over the right hemisphere.

CONCLUSION

To the extent that these variations in maternal disposition reflect variations in their expression of positive facial expressions, these results suggest that the emotional environment experienced by infants contributes to the development of their responses to facial expressions.

Information sessions for outpatients referred to a hospital Nutrition and Dietetic Service for cholesterol lowering advice

AIM

To assess the feasibility of recruiting outpatients referred for cholesterol lowering advice to attend a 1-h evening information session provided by a hospital dietitian and to evaluate the service.

METHOD

A Cholesterol Information Session was held on one evening each month between April and September 2000. Patients referred to the Nutrition and Dietetic Service for cholesterol lowering advice were sent appointments for these sessions by post instead of a one-to-one daytime appointment with the dietitian. At the session, the dietitian explained what cholesterol is and gave advice about the healthy eating and lifestyle changes needed to control it. Video material and literature were used to support verbal information. Questions were encouraged throughout the session.

RESULTS

Thirty-four patients were sent appointments. Twenty-seven (79%) attended, 10 of whom were accompanied by a spouse/partner/carer/family member. All patients who attended completed evaluation forms. There was a high level of satisfaction with the sessions. Twenty-six patients (96%) said they liked the way the session was run and found the advice and videos helpful. Twenty-five patients (93%) preferred the evening appointment to a day time one. Patients who attended with a spouse/partner/carer/family member indicated it was helpful to them and the accompanying person. Feedback through patient comments was positive. The seven patients (21%) who did not attend the sessions made contact with the dietetic service.

CONCLUSION

As a result of the positive outcome of the evaluation, the Cholesterol Information Session is continuing as a service to patients. It provides a facility outside the usual hours of outpatient services and can readily accommodate accompanying people. The information session uses the group format, which may be applicable to other specialist areas of the Nutrition and Dietetic service in the future, such as diabetes management.

Proximal sensory neuropathies of the Leg

This article addresses the proximal sensory neuropathies of the leg, concentrating on those nerves that are purely sensory or have a predominately sensory onset. These include the lateral femoral cutaneous nerve, the ilioinguinal nerve, the genitofemoral nerve, and the posterior femoral cutaneous nerve. The obturator and femoral nerves are also summarily mentioned with respect to their sensory symptoms.

Hydrostatic reduction of acute intussusception. A prospective study

Data were collected prospectively on 57 Jamaican children presenting with 62 episodes of acute intussusception over a two year period, for whom operative and hydrostatic methods of reduction were employed. 31 (54%) of 57 episodes were reduced successfully using barium (42), saline (11) and air (4) hydrostatically. Among the 31 other episodes, 15 had ileo-colic intussusception, seven caeco-colic, six ileo-ileo-colic and one ileo-ileal. Two patients had spontaneous reduction discovered at surgery. There were two episodes of barium hydrostatic perforation of the colon leading to death in one patient. Hydrostatic reduction is recommended as the first therapeutic option for acute intussusception because it spares the patient a major operative procedure when successful.

Positive selection by thymic nurse cells requires IL-1 beta and is associated with an increased Bcl-2 expression

A temperature-sensitive line of thymic nurse cells (tsTNC-1) that maintains the ability to selectively internalize immature alpha beta TCRloCD4+CD8+ thymocytes in vitro was used in long-term coincubation experiments to determine nurse cell function during the process of MHC restriction. The thymocyte subset released from its association with TNCs contained both viable and apoptotic cells. The cells that remained within intracytoplasmic vacuoles died through the process of programmed cell death. Surviving or rescued thymocytes in the released population displayed an increase in Bcl-2 protein expression. The rescue activity of TNCs was drastically reduced with the addition of antibodies against either class I or class II MHC antigens to cocultures. A subset of the TNC-rescued population matured from the alpha beta TCRloCD69- phenotype to alpha beta TCRhiCD(69+)-expressing cells only when IL-1 beta was added to cocultures. These results suggest that TNC rescue of early double-positive thymocytes from apoptosis is associated with an interaction between the TCR and the MHC and the onset of Bcl-2 expression. Maturation of thymocytes within the TNC-rescued population requires the costimulatory effects of IL-1 beta.

Control of Culex quinquefasciatus in pit latrines, using shredded, waste polystyrene

As an alternative to the use of commercially available, expanded-polystyrene beads, a study was made of the effectiveness of shredded, waste polystyrene (SWAP) for the control of Culex quinquefasciatus. The relevant physical properties of the SWAP were first investigated in the laboratory. Then, under field conditions in wet pit latrines, mosquito emergence rates were measured before and after application of the material. In the laboratory, when compared with the commercial product, the irregular shape of the SWAP particles greatly reduced their capacity to spread over the water surface and the interstitial air spaces also permitted respiration and development of mosquito larvae. Nevertheless, under field conditions, with careful application of the SWAP over the water surfaces in wet pit latrines, almost complete control of mosquito breeding was observed within a few days. This was sustained for 60 days, at which time observations were discontinued. SWAP appears to offer an effective, cheap and readily available alternative to the commercial product for the control of C. quinquefasciatus. The practicality of using it in community-based, mosquito-control programmes warrants further study.

Thymic nurse cells exclusively bind and internalize CD4+CD8+ thymocytes

Thymic nurse cells (TNC) contain 20-200 thymocytes within specialized vacuoles in their cytoplasm. The purpose of the uptake of thymocytes by TNCs is unknown. TNCs also have the capacity to present self-antigens, which implies that they may serve a function in the process of thymic education. We have recently reported the development of thymic nurse cell lines that have the ability to bind and internalize T cells. Here, we use one of these TNC lines to identify the thymocyte subpopulation(s) involved in this internalization process. TNCs exposed to freshly isolated thymocytes bind and internalize CD4 and CD8 expressing thymocytes (CD4+CD8+ or double positives) exclusively. More specifically, a subset of the double-positive thymocyte population displayed binding capacity. These double-positive cells express cell surface alpha beta type T cell antigen receptor (TCR), as well as CD3 epsilon. Binding was not inhibited in the presence of antibodies against CD3, CD4, CD8, Class I antigens, or Class II antigens. These results describe two significant events in T cell development. First, TNCs exclusively bind and internalize a subset of alpha beta TCR expressing double-positive T cells. Also, binding is facilitated through a mechanism other than TCR recognition of major histocompatibility complex antigens. This suggests that thymocyte internalization may be independent of the process used by TNCs to present self-antigen.

Nutrient intakes and dietary compliance in cardiac patients: 6-year follow-up

Changes in nutrient intakes which were recorded in the diets of cardiac patients at 1-year follow-up were maintained at 6-year follow-up, with the exception of fibre intake. Twenty-three patients, 60 per cent of the original study, were available for assessment at 6-year follow-up. The majority of these patients (74 per cent) had been classified as good compliers at 1-year follow-up. They had maintained the nutrient intakes observed at 1-year follow-up, except for fibre intake which had been reduced. Nutrient intakes of the small number of poor compliers (26 per cent) tended to deteriorate between 1- and 6-year follow-up. Body weight, which was reduced at 1-year follow-up, had increased to initial levels at 6-year follow-up for the total group. Poor compliers showed the greatest increase in weight. Serum cholesterol levels showed little change throughout the study for all patients. Compliance at 1-year follow-up appeared to determine compliance over the longer follow-up period for the study patients and especially for good compliers. More attention needs to be given to evaluating the factors which influence compliance, in particular dietary compliance.

The Rorschach Comprehensive System Egocentricity Index in psychiatric inpatients

This paper reports an exploratory study of potential correlates of Exner's Rorschach Egocentricity Index, a measure of self-focusing, in a sample of 70 psychiatric inpatients. We examined the relationship of the Index of the MMPI Ego Strength scale and to other MMPI and Exner Comprehensive System Rorschach variables, using Pearson Product-Moment correlations with partialling of the number of Rorschach responses. There were seven meaningful significant correlations between the Index and Rorschach variables: M, FM, X +%, F +%, Lambda, D, and A%. The Index-MMPI correlations were not significant. Sex differences and differences between these intercorrelations and some reported by Exner (1983) are discussed.

Factors affecting dietary compliance in coronary patients included in a secondary prevention programme

Nutrient intake was altered favourably in the diets of 38 cardiac patients who were followed up for 1 year as part of a rehabilitation programme. Total energy intake was reduced from 3540 kcal (14.9 MJ) to 2484 kcal (10.4 MJ). Fat intake was reduced from 41 to 37 per cent of energy intake with an accompanying increase in P : S ratio from 0.18 to 0.60. Cholesterol intake was reduced from 564 to 332 mg. Carbohydrate was increased from 38 to 41 per cent of energy intake with an increase in fibre intake from 18 to 24 g. The energy contributed by alcohol was reduced from 6 to 5 per cent. Patients varied in their compliance but all patients made some changes in their dietary intake. Changes in body weight, serum cholesterol levels, cigarette-smoking status and levels of physical activity tended to correspond with the recorded changes in nutrient intake. A low level of education, low socio-economic group, lack of understanding of the illness by the patient and inadequate communication were associated with reduced compliance. Initial motivation and anxiety levels in hospital had less effect on compliance.

Sequelae of mild closed head injuries

Thirty-nine minimal to mild closed head injuries without neurological signs were evaluated by a series of clinically available psychometric tests to determine the presence of identifiable intellectual deficits, rate of recovery, and personality or occupational changes. Even minimally head-injured patients suffer measurable cognitive deficits and occupational and behavioral changes.

Follow-up of sixty-one physicians after psychiatric treatment

Reported the results of a direct follow-up of 61 physicians who had been hospitalized for emotional impairment during 1969-1978. As of the fall-winter of 1979-1980, 35 physicians were in productive practice; 8 had died of purely medical causes; 5 had committed suicide; 2 were over age 65 and retired; 6 were not practicing for other reasons; 2 were physically disabled; and 3 could not be located. Recovery rate varied from 57% to 71% depending on the criteria used in calculating the ratio. Our outcome rate accords with those reported previously. Interviews with surviving physicians revealed that some important factors in recovery were rest and recuperation; spirituality, AA, and NA; modification in workload; support of colleagues; and constructive use of threat of loss of licensure.