Online self-exclusion from multiple gambling venues: Stakeholder co-design of a usable and acceptable self-directed website

Gambling self-exclusion programs are under-utilised and barriers to entry include shame and embarrassment with face-to-face registration, and complex and effortful procedures. The current study aimed to facilitate self-exclusion from gambling venues via an online self-directed website. A co-design approach was used to elicit key stakeholders' perspectives on required website features, functionality, and to identify variables potentially impacting on development and implementation. Semi-structured focus groups and interviews were conducted across four stakeholders (N = 25): self-exclusion end users (consumers, n = 5), gambling counsellors (n = 7), venue staff (n = 6), and policy makers (n = 7). Overall, stakeholder perspectives were consistent with content analysis indicating the importance of website user-friendliness, flexibility, supportiveness, and trustworthiness. Importantly, these attributes were linked to target end users': perceived vulnerabilities, diverse backgrounds and individual expectations. Participants believed that the entire self-exclusion process should be conducted online, including identity verification, whilst expecting high-level data security measures to protect their personal privacy. A separate webpage was also suggested containing relevant information and links to additional help services, such as counselling. This study describes an adaptable co-design framework for developing a usable and acceptable self-exclusion website. Future studies should empirically test system usability and acceptability to refine and maximise system uptake upon implementation. Findings may have broader implications for digital health intervention design.

In a native pasture, landscape properties influence soil moisture more than grazing management

It has been proposed that changes to grazing systems, from continuous to rotational grazing, alter the pasture mass and composition, which are reflected in changes to stored soil water. Additionally, in highly variable landscapes, determining whether the variation in soil water is due to the inherent landscape properties rather than the imposed grazing management has long been a contentious argument. To address this question, soil moisture was measured across a highly variable landscape under three differing grazing treatments (1-, 4- and 20-paddock systems). From the soil-water measurements, plant-available water and plant-available water capacity were determined. Different production zones (high, medium and low) were identified in the landscape by visually estimating green herbage mass in late spring. There were no observed differences in the measured plant-available water capacity across the grazing treatments; however, significant differences occurred in plant-available water capacity across the three production zones (high-production zone, 114 mm; medium-production zone, 102 mm; low-production zone, 88 mm) within the study period. There appears to be a trend between the plant-available water capacity and near-surface gravel content as measured in production zones. The high production zones held more plant-available water than did the low production zones, enabling more biomass and longer pasture growth during spring and autumn. The plant-available water in the low production zones significantly decreased with time. In all, 22 of the 50 soil-moisture monitoring locations displayed high temporal stability and were identified as being catchment-average soil water-content monitoring locations. A majority of these locations occurred in the medium production zone, demonstrating that representative soil moisture can be measured in these landscapes.

Characteristics of pesticide pyrotechnic smoke devices

Pesticide smoke generating products are widely used by amateurs and professionals but there is little published information available about their burn and deposition characteristics to enable the risks associated with using these devices to be assessed. This paper investigates their burn characteristics, deposition patterns, pesticide air concentrations and potential exposure to operators. Thirteen firings were carried out in different spaces with different ventilation conditions. Three types of devices were investigated: dicloran, permethrin and red dye. Pesticide air concentrations increased after firing, reaching a maximum determined by the room volume in approximately 10 min and decreasing exponentially as a result of ventilation and deposition. Ejected pesticide was present in the aerosol phase but there were only occasional traces of vapour. Settlement of pesticide was affected by surface orientation, height, sampling material and the pesticide-to-space volume ratio. The manufacturer's recommended treatment period for dicloran of 4 h followed by half an hour of ventilation may be insufficient to reduce pesticide to safe levels for re-entry under very calm conditions.

Audit of local recurrence rates following ‘ultra’-conservative surgery for invasive breast cancer—a boost to the breast?

BACKGROUND

Conservative breast surgery with postoperative radiotherapy and appropriate systemic therapy is associated with similar outcomes when compared with mastectomy. The reported 5 year local recurrence rate varies between 3% and 15%. We prefer a more conservative 'complete' local excision rather than 'wide' local excision combined with post-operative radical radiotherapy and tumour bed boost with the aim of achieving optimal cosmesis.

AIMS

Our review was undertaken to assess whether or not this 'ultra' conservative approach was compromising long-term local control.

METHODS

Case notes and pathology reports of patients who underwent conservative surgery for breast cancer from January 1983 to February 2001 were accessed for this audit. Patient demographic data and tumour characteristics were noted. The primary outcome data were the number of local recurrences following invasive breast cancer at 5 and 10 years and the distance from the tumour to the closest margin of excision.

RESULTS

At 5 and 10 years there were 16/451 and 5/124 local recurrences, with a local recurrence rate of 3.5% (95% CI, 1.7-4.7%) and 4.1% (95% CI, 0.47-6.5%), respectively. Complete data with regards to the closest histological margin of excision were available in 423 patients. One hundred and sixty-five patients (39%) had their tumours excised with a distance of less than 1 mm to the closest margin. Nearly, all tumours (97.8%) were excised with the distance to the closest margin less than 1 cm and 81% with 5 mm or less.

CONCLUSION

It is possible to achieve low local recurrence rates after very conservative surgery for breast cancer when this is combined with radical radiotherapy and an additional tumour bed boost.

Fusion of the ALK gene to the clathrin heavy chain gene, CLTC, in inflammatory myofibroblastic tumor

Inflammatory myofibroblastic tumor (IMT) is a rare, but distinctive mesenchymal neoplasm composed of fascicles of bland myofibroblasts admixed with a prominent inflammatory component. Genetic studies of IMTs have demonstrated chromosomal abnormalities of 2p23 and rearrangement of the anaplastic lymphoma kinase (ALK) gene locus. In a subset of IMTs, the ALK C-terminal kinase domain is fused with a tropomyosin N-terminal coiled-coil domain. In the current study, fusion of ALK with the clathrin heavy chain (CTLC) gene localized to 17q23 was detected in two cases of IMT. One of these cases exhibited a 2;17 translocation in addition to other karyotypic anomalies [46,XX,t(2;17)(p23;q23),add(16)(q24)].

Translocation t(1;3)(p36.3;q25) is a nonrandom aberration in epithelioid hemangioendothelioma

The cytogenetic findings for two epithelioid hemangioendotheliomas are reported. An identical chromosomal translocation involving chromosomes 1 and 3 [t(1;3)(p36.3;q25)] was detected in both cases of epithelioid hemangioendothelioma, possibly representing a characteristic rearrangement for this histopathologic entity. The presence of clonal karyotypic abnormalities supports a neoplastic origin for the epithelioid variant of hemangioendothelioma. Identification of the 1;3 translocation may be useful diagnostically. Should additional studies confirm these data, this could lead to the identification of the gene(s) central to this neoplastic process.

Can peak expiratory flow be measured accurately during a forced vital capacity manoeuvre?

Spirometry and peak flow measurements traditionally depend on different forced expiratory manoeuvres and have usually been performed on separate, dedicated equipment. As spirometry becomes more widely used in primary care settings, the authors wished to determine whether there was a systematic difference between peak expiratory flow (PEF) derived from a short sharp exhalation (PEF manoeuvre) and from a full forced vital capacity (FVC) manoeuvre, using the same turbine spirometer (Microloop, Micro Medical, Kent, UK). Eighty children (38 with current asthma) aged 7-16 yrs were asked to perform 2 blocks of PEF and FVC manoeuvres, the order being randomly assigned. PEF obtained from a peak flow manoeuvre (PEFPF) was significantly greater than that from a forced vital capacity manoeuvre (PEFVC) in both healthy (group mean difference 20 L x min(-1); p<0.001) and asthmatic children (group mean difference 9 L.min(-1); p<0.004). For clinical purposes, a mean difference of about 3% for children with asthma is of no practical significance, and peak expiratory flow data can usefully be obtained during spirometric recordings.

Detection of the t(2;5)(p23;q35) and NPM-ALK fusion in non-Hodgkin's lymphoma by two-color fluorescence in situ hybridization

The non-Hodgkin's lymphoma (NHL) subset commonly referred to as large cell lymphoma (LCL) has historically been characterized by it's marked cytological, immunological, and clinical heterogeneity. One potential defining feature of these lymphomas, the t(2;5)(p23;q35), occurs in 25% to 30% of anaplastic LCLs and is also found in cases with diffuse large cell or immunoblastic morphology. We recently identified nucleophosmin (NPM) and anaplastic lymphoma kinase (ALK) as the genes on chromosomes 5 and 2, respectively, that are juxtaposed by this translocation. To provide a complementary approach to the use of classical cytogenetics or polymerase chain reaction-based methods for the detection of this abnormality, we have developed a two-color fluorescent in situ hybridization (FISH) assay for the t(2;5) that may be used for the analysis of both interphase nuclei and metaphase chromosomes. Three overlapping chromosome 5 cosmid clones located immediately centromeric to the NPM gene locus and an ALK P1 clone located telomeric to the chromosome 2 breakpoint were labeled with digoxigenin or biotin, respectively, and used to visualize the derivative chromosome 5 produced by the t(2;5), evident as juxtaposed or overlapping red and green fluorescent signals. This NPM-ALK FISH assay was initially validated by analysis of a series of cytogenetically characterized cell lines, with the presence of the der(5) chromosome showed specifically only in those lines known to contain the t(2;5). The assay was then applied in a blinded fashion to a series of eight cytogenetically t(2;5)-positive clinical specimens and seven known t(2;5)-negative cases, including three NHL and four Hodgkin's disease biopsy samples. Whereas the t(2;5)-negative cases were negative by FISH, all eight t(2;5)-positive cases were positive. One additional case, initially thought to be positive for the translocation by cytogenetics, was proven to not be a classic t(2;5) by interphase and metaphase FISH. These data indicate that the FISH assay described is a highly specific and rapid test that should prove to be a useful adjunct to the currently available methods for detection of the t(2;5).

Familial inverted duplication 7p

A 10-month-old female with developmental delay and failure to thrive was referred for genetic evaluation as part of an adoption assessment. Physical exam showed a mildly beaked nose and clinodactyly, but otherwise nothing remarkable. Chromosome analysis showed an inverted duplication of the p12.2-->p13 portion of chromosome 7[(46,XX, dup(7)(p13p12.2)]. The proposita's older brother, mother, and grandmother were cognitively delayed and had the same chromosome 7 duplication. A review of the literature showed no other cases involving this exact duplication.

Cytogenetic and molecular cytogenetic analysis of sacral chordoma

A specific or characteristic anomaly has not yet been identified in chordoma. Cytogenetic analysis of a sacral chordoma from a 70-year-old male revealed the following chromosomal complement: 42,XY,add(1)(p11), -3,der(4)t(4;?;?18;?)(q12;?;?;), -6, -9, -14,der(16) t(4;?;16)(q12;?;q11), der(17)add(17)(p12) t(17;18)(q11;p11),der(18)del(18)(p11)add(18)(q?)[6]/42, idem,der(9)t(6;9)(q11;p11)[4]/46,XY[10]. In situ hybridization with chromosome-specific paint probes assisted in identifying several of the rearrangements formerly designated as marker chromosomes. Although some of the anomalies observed appear unique to this case, others are similar to those previously reported in chordoma.

Involvement of multiple sulfhydryl groups in melatonin signal transduction in chick brain

To gain insight into the molecular mechanism underlying melatonin binding and signal transduction in the chick brain, we have investigated the role of -SH groups, using a sulfhydryl alkylating reagent N-ethylmaleimide (NEM). At least two -SH groups are involved in the formation of the receptor-G protein complex: one is sensitive to and the other relatively insensitive to NEM. Alkylation of the sensitive group selectively abolishes high affinity binding of 2-[125I]iodomelatonin ([125I]MEL), similar to the effect induced by GTP, thus leading to a complete loss of sensitivity to nucleotides. Modification of both groups causes a marked reduction in binding capacity. Agonists with high affinity, but not other compounds with low affinity for the melatonin receptor, protect against alkylation by NEM. GTP gamma s does not significantly alter the reactivity of -SH groups towards NEM, but agonist-protected receptors remain sensitive to this nucleotide. Moreover, NEM pretreatment blocks the inhibitory effect of melatonin on forskolin-stimulated adenylate cyclase activity in chick brain. These data suggest that the -SH group modulating agonist affinity may lie within the coupling domain between the receptor and G protein but outside of the GTP binding site. In addition, sulfhydryl groups are essential for melatonin binding and signal transduction in chick brain.

Genotype of Yupik Eskimos with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

An A-to-G transition in the second intron was the sole mutation detected in four Yupik Eskimo patients with salt-wasting congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency. Allele-specific hybridization should be an efficient means of performing prenatal diagnosis of the disease in this highly inbred population.

High dose chemotherapy with autologous bone marrow rescue in small cell lung cancer

Twenty five patients diagnosed as having small cell lung cancer (SCLC) were treated with etoposide and cisplatinum. After assessment for tumour response, autologous bone marrow (ABM) was collected from five patients in good clinical state who had shown a partial response (PR) and no bone marrow involvement with tumour. These patients were treated with high dose cisplatinum, etoposide and melphalan and then by ABM infusion. Although all patients (3 with extensive and 2 with limited disease) responded (4 CR and 1 PR), 3 patients with extensive disease relapsed and died of their disease. One patient with limited disease died of infection while pancytopaenic; one patient is alive but has relapsed at eighteen months. Although patient numbers are small, our data support the conclusion that high dose chemotherapy and autologous bone marrow rescue has a very small role or none at all in the management of patients with extensive or limited stage SCLC.

Parental ratings of treatments of self-injurious behavior

This study examined (a) how parents of autistic children, parents of other handicapped children, and parents of nonhandicapped children rate, as a whole, acceptability of time-out, differential reinforcement, overcorrection, and shock as treatments for self-injurious behavior, and (b) whether these parents show differences, as groups, in ratings of these treatments. On the Treatment Evaluation Inventory, all groups consistently rated differential reinforcement, time-out, and overcorrection as acceptable and shock as unacceptable. Differential reinforcement was consistently rated as the most acceptable, but the groups differed in ratings of acceptability of other treatments. On the Semantic Differential, ratings of differential reinforcement, overcorrection, and time-out did not differ. However, shock was consistently rated as the most potent and active of treatments as well as the most unacceptable. The implications of these findings for treatment of autistic and other handicapped children are discussed.

Abdominal lymphoscintigraphy: an effective substitute for lymphography?

Abdominal lymphoscintigraphy is a quick, easy, cheap and relatively non-invasive technique. In our study it appeared to be as accurate as lymphography, giving a positive correlation in 25 out of 32 patients (78%). In 11% of cases the lymphoscintigram detected an abnormality of lymph node function before macroscopic morphological change was seen in the lymphogram, indicating that in some instances lymphoscintigraphy is more sensitive than lymphography. The reason for this is unknown, although possible mechanisms are discussed and these are the subject of current further study. We believe this to be the first report of lymphoscintigraphy being more sensitive than lymphography for detecting lymph node disease.

Antibody guided irradiation of brain glioma by arterial infusion of radioactive monoclonal antibody against epidermal growth factor receptor and blood group A antigen

In a patient with recurrent grade IV glioma of the brain resistant to conventional treatment an antibody guided isotopic scan showed uptake by the tumour of a monoclonal antibody (9A) that was developed against epidermal growth factor receptor but cross reacted with blood group A antigen. As a therapeutic attempt antibody labelled with 1665 MBq (45.0 mCi) iodine-131 was delivered to the tumour area by infusion into the internal carotid artery. Computed tomography showed regression of the tumour after treatment, and an appreciable and sustained clinical improvement was noted without any toxicity. Delivery of irradiation guided by monoclonal antibody delivered by arterial infusion of the tumour area may be of clinical value in the treatment of brain gliomas resistant to conventional forms of treatment.

Cross sectional echocardiography in determining persistent patency of the ductus arteriosus in preterm infants

Thirty preterm infants (gestational age 26 to 30 weeks) were investigated by cross sectional echocardiography using a 5 or 7.5 MHz transducer positioned in the suprasternal notch or the left subclavicular position to enable visualisation of the aortic arch, main pulmonary artery, left pulmonary artery, and ductus arteriosus. Each infant was investigated on at least one occasion during both the first and second weeks of life and when possible between the ages of 26 and 31 days. There was prolonged patency of the ductus arteriosus during the first two weeks of life in all infants, and complete closure of the ductus arteriosus occurred only in four patients, all of whom had reached a postconceptional age of 32 to 34 weeks. Eighteen infants received intravenous indomethacin between the age of 5 and 10 days. In these patients ductal narrowing did not occur until a maximum postconceptional age of 29 weeks.

Electrocardiographic signs of pulmonary hypertension in children who snore

Two children presented with sleep disturbances due to enlarged tonsils and adenoids. One child died during induction of anaesthesia, and postmortem examination showed hypertrophy of the right ventricle and atrium. As a result a prospective survey was carried out of children undergoing tonsillectomy or adenoidectomy, or both. During a nine-month period an electrocardiogram was taken in 92 children. Three electrocardiograms (3.3%) showed evidence of right heart strain. The children with abnormal electrocardiograms had symptoms of sleep disturbance with apnoea, snoring, and daytime somnolence. These symptoms and the electrocardiographic changes were reserved by adenotonsillectomy. The prevalence of pulmonary hypertension in children with enlarged tonsils and adenoids is still underestimated. When signs and symptoms of sleep disturbance, particularly snoring, are present an electrocardiogram should be obtained and a cardiologist's opinion sought before embarking on routine surgery in view of the potentially fatal consequences.

Precordial catch syndrome

Seventeen cases of precordial "catch" are reported. The children varied in age from 8 to 16 years. The characteristics of this painful condition are discussed; in particular, the diagnostic indication of the site of the pain over an intercostal space, with the finger tip, is stressed. Anxiety in the child, or the parents, in relation to the complaint is discussed. Several methods of treatment are recommended.

An arteriovenous malformation of the liver giving rise to persistent transitional (fetal) circulation

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An evaluation of three litter control procedures--trash receptacles, paid workers, and the marked item technique

This study assessed the effectiveness of three litter control procedures on the grounds of a residential retardation facility. Fifty-seven areas were divided into five groups according to the amount of litter they contained. Daily litter counts were made in one randomly chosen area for four of the groups and weekly litter counts were made from one randomly chosen area from the fifth group. After the baseline period, trash receptacles were placed a high traffic areas on the grounds of the facility. This was followed by the payment of two resident workers for picking up trash. In the next phase, marked pieces of litter were placed on the grounds, and residents voluntarily collected litter and turned it in at a central location. When a marked piece was turned in, that resident received $1.00 and had his or her picture taken and posted. This phase was followed by a return to the trash receptacles phase and then a return to the marked item phase. The results indicated that the marked item procedure was effective in reducing the amount of litter on the campus grounds, but the use of trash receptacles and the payment of resident workers for picking up litter did not noticeably reduce the amount of litter. The results are discussed in terms of the cost effectiveness of the procedures.

Poor response to oral indomethacin therapy for persistent ductus arteriosus in very low birthweight infants

Administration of oral indomethacin to treat cardiorespiratory failure in 7 low birthweight infants, after failure of conventional therapy, produced an improvement in only 2 infants. These infants had a higher birthweight than the group as a whole. Surgical ligation, rather than oral indomethacin, may be the treatment of choice for persistent ductus arteriosus in very low birthweight infants.

Apical systolic click and murmur associated with neurofibromatosis

In this report we describe a child who had an apical systolic click and murmur, as well as widespread cutaneous neurofibromatosis. We were not able to show an anatomical basis for the click and murmur.

Ligation of patent ductus arteriosus in the very low birthweight newborn infant

Surgical closure of a patent ductus arteriosus was performed in 8 low birthweight infants suffering from cardiorespiratory failure secondary to a large left-to-right shunt. Mortality from the operation was nil, but only 4 (50%) ultimately survived. Earlier intervention may reduce mortality in these high-risk infants.

Astrovirus associated gastroenteritis in a children's ward

During an outbreak of gastroenteritis in a paediatric ward astroviruses were found in faeces from 17 to 27 symptomatic children and from four of 14 members of the staff with diarrhoea. No viruses were found in 10 asymptomatic children. Fourteen of the 21 astrovirus excretors were free of any recognised pathogens, but in the other seven, rotaviruses or pathogenic bacteria were also present. Serological evidence of astrovirus infection was obtained in five adults and two children.

Cardiac biopsy in childhood

Endomyocardial biopsy was attempted in 18 children aged 5 months to 15 years with 82% success. Biopsies obtained from 15 children were examined by light and electron microscope making positive morphological diagnoses in 3 cases. The biopsy findings were actively helpful in 7 other cases, which contrasts with experience in adult biopsy series. This is a low risk procedure which does not add to the hazards of cardiac catheterization in children.

Cystinotic rickets treated with vitamin D metabolites

A 22-month-old girl with cystinotic rickets was given 1 microgram 1,25-dihydroxycholecalciferol (1,25-DHCC) daily in addition to standard treatment. Her rickets healed and linear growth rate appeared to increase. It is suggested that the effect of 1,25-DHCC and its metabolically active analogues on cystinotic rickets should be further studied.

Persistent ductus arteriosus complicating the respiratory distress syndrome

Persistent ductus arteriosus (PDA) complicated the clinical course in 45 (15%) of 299 babies with the respiratory distress syndrome (RDS) presenting over a 3-year period. The incidence of PDA complicating RDS rose with decreasing birthweight and was highest in babies with severe RDS as judged by the use of assisted ventilation. In babies with a birthweight of less than 1500 g, PDA occurred as a complication of RDS in 25% of cases. In babies who recieved intermittent positive pressure ventilation (IPPV) for management of RDS, the incidence of PDA was 35%. Overall mortality for babies with RDS was 17%; when PDA occurred as a complication mortality was 31%. In survivors, spontaneous closure of the PDA occurred in all except one infant. The development of signs of PDA in 19 babies either necessitated a renewal of IPPV or prevented "weaning" from IPPV or from continuous positive airways pressure. 9 (47%) of these babies died, 8 of them after the first week of life. The frequency of PDA complicating RDS and the relatively high mortality in this conservatively-treated group of babies is emphasized. The incidence reported here is likely to increase with the increased survival of very low birthweight infants with severe RDS. The high incidence of late deaths in babies who develop signs of PDA associated with an inability to wean from assisted ventilation suggests that early surgical ligation of the PDA in these babies should be considered. The results of a conservative approach to management of these infants are presented.

Percutaneous angiocardiography for diagnosis of persistent ductus arteriosus in the preterm infant

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Cardiac biopsy in skeletal myopathy: report of a case with myocardial mitochondrial abnormalities

Transvenous right ventricular endomyocardial biopsy in an 11-yr-old boy with a proximal skeletal myopathy and a cardiomyopathy, has shown a major increase in mitochondrial size and numbers on electron-microscopic morphometry, with formation of unique ring-shaped mitochondria in cardiac muscle cells. The significance of this finding and the use of cardiac biopsy in children are discussed.

Pre- and postoperative growth in persistent ductus arteriosus

Children with a persistent ductus arteriosus requiring ligation under 6 months of age show evidence of intrauterine growth retardation. By the time of operation the weight centile of 17 (71%) of 24 such infants had fallen, but 20(84%) of the 24 gained weight postoperatively. Those who did not so were either large-for-dates infants growing towards the normal or small-for-dates infants who remained small postoperatively.