MR Imaging Characteristics of Intraocular Perfluoro-n-Octane

We describe the unique MR imaging characteristics of intraocular perfluoro-n-octane, a liquid used for intraoperative and postoperative tamponade in the context of complex retinal detachment repair, and contrast it with other intraocular pathologies. Because trace amounts of perfluoro-n-octane may be left in the globe postoperatively, it may be confused for other abnormalities, such as foreign bodies or tumors.

Microbiota of bovine milk, teat skin, and teat canal: Similarity and variation due to sampling technique and milk fraction

The aim of this study was to evaluate the effect of sampling technique and milk fraction on bovine milk microbiota data and to compare the microbiota in milk to microbiota on the teat end and in the teat canal. Representative milk samples are highly important for assessment of bacteriological findings and microbiota in milk. Samples were obtained from 5 healthy lactating dairy cows at udder quarter level during 1 milking. Swab samples from the teat end and teat canal, and milk samples collected using different techniques and in different milk fractions were included. Milk was collected by hand stripping and through a teat canal cannula before and after machine milking, through a trans-teat wall needle aspirate after milking, and from udder quarter composite milk. The microbiota of the samples was analyzed with sequencing of the V1-V3 region of the 16S rRNA gene. In addition, somatic cell counts and bacterial cultivability were analyzed in the milk samples. Microbiota data were analyzed using multivariate methods, and differences between samples were tested using analysis of similarity (ANOSIM). Differences between samples were further explored via individual studies of the 10 most abundant genera. The microbiota on the teat end, in the teat canal, and in udder quarter composite milk, collected using a milking machine, differed in composition from the microbiota in milk collected directly from the udder quarter. No differences in milk microbiota composition were detected between hand-stripped milk samples, milk samples taken through a teat canal cannula, or milk samples taken as a trans-teat wall needle aspirate before or after milking. We conclude that for aseptic milk samples collected directly from the lactating udder quarter, sampling technique or milk fraction has minor effect on the microbiota composition.

Development of ATLID Retrieval Algorithms

ATLID (“ATmospheric LIDar”) is the lidar to be flown on the multi-instrument Earth Clouds and Radiation Explorer (EarthCARE or ECARE) joint ESA/JAXA mission now scheduled for launch in 2022. ATID is a 3 channel linearly polarized High-Spectral Resolution (HSRL) system operating at 355nm. Cloud and aerosol optical properties are key ECARE products. This paper will provide an overview of the ATLID L2a (i.e. single instrument) retrieval algorithms being developed and implemented in order to derive cloud and aerosol optical properties.

Bioelectric impedance vector analysis (BIVA) in hospitalised children; predictors and associations with clinical outcomes

BACKGROUND

Clinical use of bioelectric impedance is limited by variability in hydration. Analysis of raw bioelectric impedance vectors (BIVA), resistance (R), reactance (Xc) and phase angle (PA) may be an alternative for monitoring disease progression/treatment. Clinical experience of BIVA in children is limited. We investigated predictors of BIVA and their ability to predict clinical outcomes in children with complex diagnoses.

METHODS

R, Xc and PA were measured (BODYSTAT Quadscan 4000) on admission in 108 patients (4.6-16.8 years, mean 10.0). R and Xc were indexed by height (H) and BIVA-SDS for age and sex calculated using data from healthy children. Potential predictors and clinical outcomes (greater-than-expected length-of-stay (LOS), complications) were recorded.

RESULTS

Mean R/H-SDS was significantly higher (0.99 (SD 1.32)) and PA-SDS lower (-1.22 (1.68))) than expected, with a wide range for all parameters. In multivariate models, the Strongkids risk category predicted R/H-SDS (adjusted mean for low, medium and high risk = 0.49, 1.28, 2.17, p = 0.009) and PA-SDS (adjusted mean -0.52, -1.53, -2.36, p = 0.01). BIVA-SDS were not significantly different in patients with or without adverse outcomes.

CONCLUSIONS

These complex patients had abnormal mean BIVA-SDS suggestive of reduced hydration and poor cellular health according to conventional interpretation. R/H-SDS was higher and PA-SDS lower in those classified as higher malnutrition risk by the StrongKids tool. Further investigation in specific patient groups, including those with acute fluid shifts and using disease-specific outcomes, may better define the clinical role of BIV.

Routine screening for pain combined with a pain treatment protocol in head and neck cancer: a randomised controlled trial

BACKGROUND

We compared the effectiveness and cost of a pain screening and treatment program, with usual care in head and neck cancer patients with significant pain.

METHODS

Patients were screened for the presence of pain and then randomly assigned to either an intervention group, consisting of a pain treatment protocol and an education program, or to usual care. Primary outcome was change in the Pain Severity Index (PSI) over three months.

RESULTS

We screened 1074 patients of whom 156 were randomized to either intervention or usual care. Mean PSI was reduced over three months in both groups, with no significant difference between the two groups. The Pain Management Index (PMI) at three months, was significantly improved in the intervention group compared with usual care (P<0.001), as was Patient Satisfaction (mean difference in scores was statistically significant: -0.30 [-0.60 to -0.15]). All subjects reported clinically significant levels of anxiety and depression throughout the study. Treatment costs were significantly higher for intervention (mean=£400) compared with usual care (£200), with a low likelihood of being cost-effective.

CONCLUSIONS

There was no difference in the Pain Severity Index between the two groups. However there were significant improvements in the intervention group in patient satisfaction and PMI. The pain screening process itself was effective. Sufficient benefit was demonstrated as a result of the intervention to allow continued development of pain treatment pathways, rather than allowing pain treatment to be left to nonformalised ad hoc arrangements.

The use of high-intensity focused ultrasound as a novel treatment for painful conditions-a description and narrative review of the literature

High-intensity focused ultrasound (HIFU) is a non-invasive technique that allows a small, well-circumscribed thermal lesion to be generated within a tissue target. Tissue destruction occurs due to direct heating within the lesion and the mechanical effects of acoustic cavitation. HIFU has been used in a broad range of clinical applications, including the treatment of malignancies, uterine fibroids and cardiac arrhythmias. Interest in the use of the technique to treat pain has recently increased. A number of painful conditions have been successfully treated, including musculoskeletal degeneration, bone metastases and neuropathic pain. The exact mechanism by which HIFU results in analgesia remains poorly understood, but it is thought to be due to localised denervation of tissue targets and/or neuromodulatory effects. The majority of studies conducted investigating the use of HIFU in pain are still at an early stage, although initial results are encouraging. Further research is indicated to improve our understanding of the mechanisms underlying this treatment and to fully establish its efficacy; however, it is likely that HIFU will play a role in pain management in the future. This narrative review provides a synthesis of the recent, salient clinical and basic science research related to this topic and gives a general introduction to the mechanisms by which HIFU exerts its effects.

Body composition in young female eating-disorder patients with severe weight loss and controls: evidence from the four-component model and evaluation of DXA

Background/Objectives:

Whether fat-free mass (FFM) and its components are depleted in eating-disorder (ED) patients is uncertain. Dual energy X-ray absorptiometry (DXA) is widely used to assess body composition in pediatric ED patients; however, its accuracy in underweight populations remains unknown. We aimed (1) to assess body composition of young females with ED involving substantial weight loss, relative to healthy controls using the four-component (4C) model, and (2) to explore the validity of DXA body composition assessment in ED patients.

Subjects/Methods:

Body composition of 13 females with ED and 117 controls, aged 10–18 years, was investigated using the 4C model. Accuracy of DXA for estimation of FFM and fat mass (FM) was tested using the approach of Bland and Altman.

Results:

Adjusting for age, height and pubertal stage, ED patients had significantly lower whole-body FM, FFM, protein mass (PM) and mineral mass (MM) compared with controls. Trunk and limb FM and limb lean soft tissue were significantly lower in ED patients. However, no significant difference in the hydration of FFM was detected. Compared with the 4C model, DXA overestimated FM by 5±36% and underestimated FFM by 1±9% in ED patients.

Conclusion:

Our study confirms that ED patients are depleted not only in FM but also in FFM, PM and MM. DXA has limitations for estimating body composition in individual young female ED patients.

Do thawing and warming affect the integrity of human milk?

OBJECTIVE

To evaluate the integrity of the human milk (pH, bacterial counts, host defense factors and nutrients) subjected to thawing, warming, refrigeration and maintenance at room temperature.

STUDY DESIGN

Mothers in the neonatal intensive care unit donated freshly expressed milk. A baseline sample was stored at -80 °C and the remainder of the milk was divided and stored for 7 days at -20 °C. The milk was then subjected to two methods of thawing and warming: tepid water and waterless warmer. Thawed milk also was refrigerated for 24 h prior to warming. Lastly, warmed milk was maintained at room temperature for 4 h to simulate a feeding session. Samples were analyzed for pH, bacterial colony counts, total fat and free fatty acids, and the content of protein, secretory IgA and lactoferrin. Data were analyzed by repeated-measures analysis of variance and paired t test.

RESULT

There were no differences between processing methods and no changes in fat, protein, lactoferrin and secretory immunoglobulin A with processing steps. Milk pH and bacterial colony counts declined while free fatty acids rose with processing. Refrigeration of thawed milk resulted in greater declines in pH and bacteria and increases in free fatty acids. Bacterial colony counts and free fatty acids increased with maintenance at room temperature.

CONCLUSION

The integrity of the milk was affected similarly by the two thawing and warming methods. Thawing and warming change the integrity of previously frozen human milk, but not adversely. Concerns about maintaining warmed milk at room temperature need to be explored.

Establishing sustainable performance-based incentive schemes: views of rural health workers from qualitative research in three sub-Saharan African countries

INTRODUCTION

Performance-based incentives (PBIs) are currently receiving attention as a strategy for improving the quality of care that health providers deliver. Experiences from several African countries have shown that PBIs can trigger improvements, particularly in the area of maternal and neonatal health. The involvement of health workers in deciding how their performance should be measured is recommended. Only limited information is available about how such schemes can be made sustainable. This study explored the types of PBIs that rural health workers suggested, their ideas regarding the management and sustainability of such schemes, and their views on which indicators best lend themselves to the monitoring of performance. In this article the authors reported the findings from a cross-country survey conducted in Burkina Faso, Ghana and Tanzania.

METHODS

The study was exploratory with qualitative methodology. In-depth interviews were conducted with 29 maternal and neonatal healthcare providers, four district health managers and two policy makers (total 35 respondents) from one district in each of the three countries. The respondents were purposively selected from six peripheral health facilities. Care was taken to include providers who had a management role. By also including respondents from district and policy level a comparison of perspectives from different levels of the health system was facilitated. The data that was collected was coded and analysed with support of NVivo v8 software.

RESULTS

The most frequently suggested PBIs amongst the respondents in Burkina Faso were training with per-diems, bonuses and recognition of work done. The respondents in Tanzania favoured training with per-diems, as well as payment of overtime, and timely promotion. The respondents in Ghana also called for training, including paid study leave, payment of overtime and recognition schemes for health workers or facilities. Respondents in the three countries supported the mobilisation of local resources to make incentive schemes more sustainable. There was a general view that it was easier to integrate the cost of non-financial incentives in local budgets. There were concerns about the fairness of such schemes from the provider level in all three countries. District managers were worried about the workload that would be required to manage the schemes. The providers themselves were less clear about which indicators best lent themselves to the purpose of performance monitoring. District managers and policy makers most commonly suggested indicators that were in line with national maternal and neonatal healthcare indicators.

CONCLUSIONS

The study showed that health workers have considerable interest in performance-based incentive schemes and are concerned about their sustainability. There is a need to further explore the use of non-financial incentives in PBI schemes, as such incentives were considered to stand a greater chance of being integrated into local budgets. Ensuring participation of healthcare providers in the design of such schemes is likely to achieve buy-in and endorsement from the health workers involved. However, input from managers and policy makers is essential to keep expectations realistic and to ensure the indicators selected fit the purpose and are part of routine reporting systems.

Dual energy x-ray absorptiometry and quantitative ultrasound are not interchangeable in diagnosing abnormal bones

OBJECTIVE

To evaluate whether dual energy x-ray absorptiometry (DXA) and quantitative ultrasound (QUS) classify the same children as 'abnormal' (SD (z) score (SDS) ≤-2).

METHODS

Speed of sound (SOS) was measured at the radius and tibia using QUS and lumbar spine bone mineral density (BMD) using DXA in 621 subjects aged 5-20 years; healthy 412, cystic fibrosis 117 and obese 92.

RESULTS

BMD SDS positively (p<0.001) and tibia SOS SDS negatively correlated with size (p<0.05). Disagreement between DXA and QUS for 'abnormal' scans occurred in 6-31%. Those with abnormal BMD and normal SOS SDS had lower mean BMI SDS than those with normal BMD and abnormal SOS SDS. SOS measurements were unobtainable in some children, especially in the obese group.

CONCLUSIONS

DXA and QUS identify different individuals as 'abnormal'. Agreement between BMD and tibia SOS is lower in obese subjects. Without a gold-standard, it is difficult to determine which technique is more 'correct'.

Mid-IR laser oscillation in Cr2+:ZnSe planar waveguide

We demonstrate 2.6 µm mid-infrared lasing at room temperature in a planar waveguide structure. Planar waveguides were fabricated using pulsed laser deposition (PLD) by depositing chromium doped zinc selenide thin films on sapphire substrate (Cr2+:ZnSe/sapphire). Highly doped Cr2+:ZnSe/Sapphire thin film sample was also used to demonstrate passive Q-switching of Er:YAG laser operating at 1.645 µm.

Variation in injury risk over the course of a two-day youth club soccer tournament

Athletic injury risk in youth is known to be greater in organised sport, higher levels of competition, games, and tournaments, yet young athletes are often expected to participate in tournaments that involve multiple matches per day on consecutive days. In 2006 and 2008 injury rates were observed during a club youth soccer tournament that involved athletes aged 9-18 years playing three to four matches over two consecutive days, to determine if injury risk varied over the course of the event. The injury rate for day 1 was 7.91/1000 hours with a mean severity of 3.5 days missed versus a day 2 rate of 6.75 and severity of 2.3. The rate and severity for the first game in a day were 7.13 and 3.5 respectively compared to 7.9 and 2.5 for game 2. Further research is needed to determine if a high density match schedule increases injury risk for youth soccer players.

INTERSTITIAL BRONCHOPNEUMONIA : II. PRODUCTION OF INTERSTITIAL MONONUCLEAR PNEUMONIA BY THE BORDET-GENGOU BACILLUS

Pure cultures of Bordet-Gengou bacilli produce in rabbits an interstitial mononuclear pneumonia which cannot be differentiated from that occurring in children dying of pertussis or from lhat caused in animals by the viruses of epidemic influenza and psittacosis. A similar pneumonia can be produced in rabbits by typhoid bacilli.

INTERSTITIAL BRONCHOPNEUMONIA : I. SIMILARITY OF A TOXIN PNEUMONIA TO THAT PRODUCED BY THE VIRUSES

Bacterial toxins can produce a pneumonia similar to that caused by viruses, and the presence of a toxin-producing bacterium in the lungs may account for some of the interstitial bronchopneumonias observed in diseases other than those caused by viruses.

The Assessment of Transactional Analysis Ego States Via the Adjective Checklist

Transactional Analysis (TA) conceptualizes personality in terms of five functional ego states: Critical Parent (CP), Nurturing Parent (NP), Adult (A), Free Child (FC), and Adapted Child (AC). The present investigation was designed to develop a procedure for the assessment of the relative strength of ego states from the responses of persons who are not familiar with TA theory. Fifteen TA experts assigned ego-state ratings to the 300 items of the Adjective Check List (ACL) with high interjudge agreement being found. Using the judges' mean raft rigs, a system was developed for obtaining ego-state scores for any selected set of ACL adjectives. The use of the system was illustrated by its application to the ACL self-descriptions of 100 university students which were analyzed in terms of "egograms" in which the five functional ego states were expressed relative to one another. A test-retest study involving an additional 154 students demonstrated stable individual differences in ego-state scores. Mean egograms of female and male students did not differ from one another but showed appreciable differences from the expert judges' ratings of the "psychologically healthy person." The potential Usefulness of the procedure in clinical practice and in testing TA theory is discussed.

Impacts of red meat production on biodiversity in Australia: a review and comparison with alternative protein production industries

All food production systems are under pressure to comply with societal expectations that the produce is not only of good nutritional value but is also sustainably produced. This review compares the performance of the red meat industry in Australia against white meat, plant-protein and other protein production systems across a range of biodiversity pressures through a review of over 500 peer-reviewed and other scientific sources. The review finds that taking into account the past legacy of red meat production systems, these industries make the largest relative potential contribution to the impact on terrestrial biodiversity in Australia, by both the area covered and the nature of the impacts. The review also finds that many initiatives of the beef and sheep industries have the potential to improve the management of biodiversity. To minimise the impact of beef and sheep meat systems on biodiversity, the conservation of natural resources needs to become a core and integral part of production systems, rather than it being perceived as an optional extra if times are good. To help address these challenges, stewardship payments for the ecosystem services (such as carbon, water and biodiversity) provided by the farming community to the wider society warrant further consideration.

Engaging recreational fishers in management and conservation: global case studies

Globally, the number of recreational fishers is sizeable and increasing in many countries. Associated with this trend is the potential for negative impacts on fish stocks through exploitation or management measures such as stocking and introduction of non-native fishes. Nevertheless, recreational fishers can be instrumental in successful fisheries conservation through active involvement in, or initiation of, conservation projects to reduce both direct and external stressors contributing to fishery declines. Understanding fishers' concerns for sustained access to the resource and developing methods for their meaningful participation can have positive impacts on conservation efforts. We examined a suite of case studies that demonstrate successful involvement of recreational fishers in conservation and management activities that span developed and developing countries, temperate and tropical regions, marine and freshwater systems, and open- and closed-access fisheries. To illustrate potential benefits and challenges of involving recreational fishers in fisheries management and conservation, we examined the socioeconomic and ecological contexts of each case study. We devised a conceptual framework for the engagement of recreational fishers that targets particular types of involvement (enforcement, advocacy, conservation, management design [type and location], research, and monitoring) on the basis of degree of stakeholder stewardship, scale of the fishery, and source of impacts (internal or external). These activities can be enhanced by incorporating local knowledge and traditions, taking advantage of leadership and regional networks, and creating collaborations among various stakeholder groups, scientists, and agencies to maximize the probability of recreational fisher involvement and project success.

Association among results of serum ELISA, faecal culture and nested PCR on milk, blood and faeces for the detection of paratuberculosis in dairy cows

Paratuberculosis is a chronic, infectious disease of ruminants that entails a serious concern for the cattle industry. One of the main issues relates to the efficiency of diagnosis of subclinically infected animals. The objective of this field study was to analyse the association among results of a serum enzyme-linked immunosorbent assays (ELISA), faecal culture and nested PCR tests on milk, blood and faeces for Mycobacterium avium subsp. paratuberculosis detection in dairy cows. Faeces, blood and milk samples were collected from 328 lactating dairy cows in four known infected herds. Results were analysed to determine associations and levels of agreement between pairs of tests. A total of 61 animals (18.6%) tested positive when all the tests were interpreted in parallel. The agreement between results in different pairs of tests was poor, slight and fair in two, five and three of the 10 possible combinations respectively. Faecal culture and faecal polymerase chain reaction (PCR) resulted in the highest kappa coefficient (0.39; fair agreement), with the lowest agreement being for ELISA and blood PCR (-0.036; poor agreement). Fisher's exact test resulted in statistically significant associations (P < or = 0.05) between the following test pairs: ELISA : faecal culture; ELISA : faecal PCR; milk PCR : faecal PCR, blood PCR : faecal PCR and faecal culture : faecal PCR. Enzyme-linked immunosorbent assays showed the highest complementary sensitivity values for all the possible two-test combinations, followed by faecal PCR. The combined use of ELISA and faecal PCR has the potential to increase the overall sensitivity for the diagnosis of paratuberculosis infection.

Reduction in bone mineral density in glycogenosis type III may be due to a mixed muscle and bone deficit

Glycogen storage disease type III (GSD III; OMIM 232400) is an autosomal recessive deficiency of the glycogen debrancher enzyme, amylo-1,6-glucosidase (EC 3.2.1.33). Patients with other hepatic glycogenoses are known to have reduced bone mineral content (BMC) and to be at consequent risk of fractures. They have key metabolic differences from GSD III patients, however. This study examines bone density and metabolism in 15 GSD III patients (6 female) from childhood to adulthood (aged 10-34 years). The results demonstrate that patients with GSD III have low bone mass at all skeletal sites compared with healthy individuals of the same age and sex, with a significant proportion (40-64%) having BMD > 2 standard deviations below the mean for whole body and lumbar spine. The deficiency seems to be attributable to a mixed muscle andbone deficit. Lower bone mass was found at all sites for GSD IIIa patients (combined liver and muscle defect) compared with GSD IIIb patients (liver only defect).

CONCLUSION

Patients with GSD III have significantly abnormal bone mass, placing them at increased risk of potential fracture. The underlying mechanism is probably multifactorial with contributions from abnormal muscle physiology, abnormal metabolic milieu and altered nutrition affecting micronutrient intake. Therapies need to address all these factors to be successful.

A simplified approach to analysing bio-electrical impedance data in epidemiological surveys

BACKGROUND

Bio-electrical impedance analysis (BIA) is widely used to estimate body composition. It is simple, quick and cheap, but less accurate than other methods. It has potential epidemiological value, but has conventionally required validation before application.

AIMS

To develop a simple method of expressing weight, height and impedance data that avoids the need for population-specific validation equations in order to facilitate epidemiological application.

METHODS

Body composition was measured using the four-component model in young adults (43 males, 90 females). Impedance (R) was measured hand-foot and foot-foot. Lean mass and fat mass were adjusted for height to give lean mass index (LMI) and fat mass index (FMI). Based on theoretical principles, we generated the index 1/R, which provides an index of body water adjusted for height. Sex-specific regression models were used to investigate the relationships between (a) 1/R and LMI, and (b) body mass index (BMI) adjusted for 1/R and FMI. The success of this approach was evaluated in relation to the conventional BIA approach, using correlation analysis.

RESULTS

1/R was a highly significant predictor of LMI. BMI adjusted for 1/R was a significant predictor of FMI. Our approach performed as well as the conventional approach for LMI, but not for FMI.

DISCUSSION

Direct use of BIA data, rather than their combination with population-specific equations for the prediction of total body water, proved successful at ranking individuals of both sexes in terms of LMI and FMI. The index 1/R may prove particularly valuable in epidemiological studies where ranking of LMI is required.

Body composition in normal weight, overweight and obese children: matched case–control analyses of total and regional tissue masses, and body composition trends in relation to relative weight

BACKGROUND

Childhood obesity is defined on the basis of weight and height, using body mass index (BMI). There is little detailed information on the body composition characteristic of overweight and obesity.

OBJECTIVE

To evaluate total and regional body composition in overweight, obese and control children aged 7-14 years.

DESIGN

Body composition was measured by the four-component model and dual X-ray absorptiometry in 38 age- and sex-matched pairs of obese and control children. Body composition trends were also evaluated by quintile of BMI standard deviation score (SDS) in these and 31 other children (n=107; BMI SDS range -1.0 to 4.3).

RESULTS

Obese children were taller than controls (Delta=0.6 SDS; P=0.01) and had greater hydration of fat-free mass (FFM) (Delta=1.8 %, P<0.0001). After adjusting for these variables, obese children had greater FFM, fat mass (FM) and mineral (P<0.0001). Regional analyses showed that these differences were apparent in the arm, leg and trunk, but the three tissues had different proportional distributions of the excess. Fat was primarily in the trunk, but mineral in the leg. FM, FFM, hydration and mineral mass all increased across BMI SDS quintiles (P<0.0001), but the trend for FM was much the steepest.

DISCUSSION

The greater weight of obese children is due to excess FFM including mineral as well as excess fatness. Increasing weight has a strong continuous relationship with increasing FM across the whole spectrum of weight.

The effect of L-alanine therapy in a patient with adult onset glycogen storage disease type II

Adult-onset glycogen storage disease type II (GSD II) (McKusick 232300) is a progressive disabling myopathy. At present there is no treatment of proven clinical efficacy. Enzyme replacement therapy may in the future provide benefit but it will be costly and is not yet freely available. L-Alanine, a simple and relatively cheap therapy, has been shown to reduce protein degradation in GSD II patients but has not previously been assessed for clinical benefit in a controlled study. In this study L-alanine was assessed in a double blind, placebo-controlled, crossover n = 1 study. Assessments consisted of spirometry, cardiopulmonary exercise testing, quality of life measurements, biochemical markers and assessment by the criterion 4-component model of body composition. Alanine therapy was associated with a 15% gain in total body protein. However, the patient showed no functional improvement and reported feeling worse after treatment. Further controlled studies in a small group may be warranted, but not widespread use of this therapy.

Prediction of total body water in infants and children

BACKGROUND

In paediatric clinical practice treatment is often adjusted in relation to body size, for example the calculation of pharmacological and dialysis dosages. In addition to use of body weight, for some purposes total body water (TBW) and surface area are estimated from anthropometry using equations developed several decades previously. Whether such equations remain valid in contemporary populations is not known.

METHODS

Total body water was measured using deuterium dilution in 672 subjects (265 infants aged <1 year; 407 children and adolescents aged 1-19 years) during the period 1990-2003. TBW was predicted (a) using published equations, and (b) directly from data on age, sex, weight, and height.

RESULTS

Previously published equations, based on data obtained before 1970, significantly overestimated TBW, with average biases ranging from 4% to 11%. For all equations, the overestimation of TBW was greatest in infancy. New equations were generated. The best equation, incorporating log weight, log height, age, and sex, had a standard error of the estimate of 7.8%.

CONCLUSIONS

Secular trends in the nutritional status of infants and children are altering the relation between age or weight and TBW. Equations developed in previous decades significantly overestimate TBW in all age groups, especially infancy; however, the relation between TBW and weight may continue to change. This scenario is predicted to apply more generally to many aspects of paediatric clinical practice in which dosages are calculated on the basis of anthropometric data collected in previous decades.

Composition of the fat-free mass in obese and nonobese children: matched case-control analyses

OBJECTIVE

Most body composition techniques assume constant properties of the fat-free mass (FFM), such as hydration, density and mineralisation. Previous studies suggested that FFM composition may change in childhood obesity; however, this issue has not been investigated in detail.

AIM

To compare FFM composition in obese and nonobese children.

DESIGN

Observational matched case-control analyses.

SUBJECTS

A total of 28 obese children (13 boys, 15 girls) and 22 nonobese children (10 boys, 12 girls) aged 7-14 y. Obesity was defined as body mass index centile >95.

METHODS

Measurements were made of weight, height, total body water, and body volume. Bone mineral content was estimated in a subsample. Body composition was calculated using three- and four-component models.

RESULTS

According to the three-component model (n=22 matched pairs), obese children had greater hydration (P<0.05), and reduced density (P=0.057) of FFM. According to the four component model (n=11 pairs), obese children had greater hydration (P<0.01) and reduced density (P<0.002) of FFM. The mineralisation of FFM was increased, but not significantly so.

CONCLUSION

The greater hydration and reduced density of FFM of obese children should be taken into account if body composition is to be measured with optimum accuracy during treatment programmes. These differences may be addressed by using multicomponent rather than two-component models of body composition. Although the greater mineralisation of FFM in obese children was not significant in the present study, the four-component model is best able to address the combined differences in hydration and mineralisation that occur in childhood obesity.

Assessing the acceptability and feasibility of the MEND Programme in a small group of obese 7-11-year-old children

BACKGROUND AND AIMS

An uncontrolled, pilot study to evaluate feasibility and acceptability of a new community based childhood obesity treatment programme.

METHODS

The mind, exercise, nutrition and diet (MEND) programme was held at a sports centre, twice-weekly, for 3 months. The programme consists of behaviour modification, physical activity and nutrition education. The primary outcome measure was waist circumference. Secondary outcomes were body mass index (BMI), cardiovascular fitness (heart rate, blood pressure and number of steps in 2 min), self-esteem and body composition. BMI of parents was also measured. See http://www.mendprogramme.org.

RESULTS

Eleven obese children (7-11 years) and their families were recruited. Mean attendance was 78% (range 63-88%) with one drop out. Waist circumference, cardiovascular fitness and self-esteem were all significantly improved at 3 months and continued to improve at 6 months. BMI was significantly improved at 3 months but lost significance by 6 months. Deuterium studies showed a beneficial trend but were not significant. Of the 17 parents measured, seven were obese (BMI >/= 30) and eight overweight (BMI >/= 25).

CONCLUSIONS

Although limited by the small number of participants and no control group, the MEND programme was acceptable to families and produced significant improvements in a range of risk factors associated with obesity that persisted over 3 months.

Nested PCR on blood and milk for the detection of Mycobacterium avium subsp paratuberculosis DNA in clinical and subclinical bovine paratuberculosis

OBJECTIVE

To determine the potential of PCR on blood and milk to detect cattle infected with Mycobacterium avium subsp paratuberculosis.

PROCEDURE

A nested PCR method probing for IS900 was developed and compared to ELISA serology in 11 clinically infected and 46 subclinically infected, lactating Holstein cows from a herd with confirmed paratuberculosis (Johne's disease).

RESULTS

When compared to serum ELISA the nested blood- and milk PCRs were equal in identifying DNA from clinically infected animals. The PCR procedures also gave positive DNA results with some subclinically infected animals when these only gave suspicious or negative results in the ELISA test. Most clinically and subclinically infected animals were detected with milk PCR.

CONCLUSION

Since there may well be a haematological phase in paratuberculosis, nested PCR testing of blood and milk samples shows potential to detect animals subclinically infected with M a paratuberculosis. More subclinically infected animals need to be tested and confirmed infected before estimates of sensitivity and specificity can be made.

Evaluating the performance of the Framingham risk equations in a population with diabetes

AIMS

The Framingham risk equations are widely used to estimate risk of coronary heart disease (CHD). The purpose of this study was to evaluate the reliability of these equations in predicting CHD risk in people with diabetes and the reliability of using imputed mean HDL-cholesterol values.

METHODS

Data describing the baseline characteristics of recognized CHD risk factors for 938 people aged 30-74 years were extracted from the Cardiff Diabetes Database. Data describing CHD events were available for up to 4 years following the baseline year (1996). Several mathematical techniques were used to assess the reliability of predictions provided by the Framingham equations in this population.

RESULTS

Thirty-four percent of males and 25% of females who experienced CHD events had a predicted 10-year CHD risk >/= 30%. Seventy-five percent of males and 58% of females had a predicted 10-year CHD risk >/= 20%. Using imputed HDL-cholesterol values, 26% of males and 6% of females who later developed CHD events had a 10-year CHD risk >/= 30%. Using imputed HDL-cholesterol values, the CHD risk predicted by the Framingham equations consistently underestimated the actual risk of CHD events. However, refitting the Framingham risk equations to the Cardiff data resulted in only marginal improvements in discriminatory capabilities.

CONCLUSIONS

The Framingham risk equations can be unreliable when applied to the diabetic population, tending to underestimate an individual's probability of progressing to CHD; the equations perform marginally better in women than in men. The use of imputed mean HDL-cholesterol values improved the reliability of the estimates of risk.

The role of connectivity in Australian conservation

The existing system of nature reserves in Australia is inadequate for the long-term conservation and restoration of native biological diversity because it fails to accommodate, among other elements, large scale and long-term ecological processes and change, including physical and biotic transport in the landscape. This paper is an overview of the connectivity elements that inform a scientific framework for significantly improving the prospects for the long-term conservation of Australia's biodiversity. The framework forms the basis for the WildCountry programme. This programme has identified connectivity at landscape, regional and continental scales as a critical component of an effective conservation system. Seven categories of ecological phenomena are reviewed that require landscape permeability and that must be considered when planning for the maintenance of biological diversity and ecological resilience in Australia: (1) trophic relations at regional scales; (2) animal migration, dispersal, and other large scale movements of individuals and propagules; (3) fire and other forms of disturbance at regional scales; (4) climate variability in space and time and human forced rapid climate change; (5) hydroecological relations and flows at all scales; (6) coastal zone fluxes of organisms, matter, and energy; and, (7) spatially-dependent evolutionary processes at all scales. Finally, we mention eight cross-cutting themes that further illuminate the interactions and implications of the seven connectivity-related phenomena for conservation assessment, planning, research, and management, and we suggest how the results might be applied by analysts, planners, scientists, and community conservationists.

Within- and between-laboratory precision in the measurement of body volume using air displacement plethysmography and its effect on body composition assessment

OBJECTIVE

To determine and compare the extent of within- and between-laboratory precision in body volume (BV) measurements using air displacement plethysmography (ADP), the BOD POD body composition system, and to interpret any such variability in terms of body composition estimates.

DESIGN

Repeated test procedures of BV assessment using the BOD POD ADP were reproduced at two laboratories for the estimation of precision, both within and between laboratories.

SUBJECTS

In total, 30 healthy adult volunteers, 14 men (age, 19-48 y; body mass index (BMI), 19.7-30.3 kg/m2) and 16 women (age, 19-40 y; BMI, 16.3-35.7 kg/m2), were each subjected to two test procedures at both laboratories. Two additional volunteers were independently subjected to 10 repeated test procedures at both laboratories.

MEASUREMENTS

Repeated measurements of BV, uncorrected for the effects of isothermal air in the lungs and the surface area artifact, were obtained using the BOD POD ADP, with the identical protocol being faithfully applied at both laboratories. Uncorrected BV measurements were adjusted to give estimates of actual BV that were used to calculate body density (body weight (BWt)/actual BV) from which estimates of body composition were derived. The differences between repeated BV measurements or body composition estimates were used to assess within-laboratory precision (repeatability), as standard deviation (SD) and coefficient of variation; the differences between measurements reproduced at each laboratory were used to determine between-laboratory precision (reproducibility), as bias and 95% limits of agreement (from SD of the differences between laboratories).

RESULTS

The extent of within-laboratory methodological precision for BV (uncorrected and actual) was variable according to subject, sample group and laboratory conditions (range of SD, 0.04-0.13 l), and was mostly due to within-individual biological variability (typically 78-99%) rather than to technical imprecision. There was a significant (P<0.05) bias between laboratories for the 10 repeats on the two independent subjects (up to 0.29 l). Although no significant bias (P=0.077) was evident for the sample group of 30 volunteers (-0.05 l), the 95% limits of agreement were considerable (-0.68 to 0.58 l). The effects of this variability in BV on body composition were relatively greater: for example, within-laboratory precision (SD) for body fat as % BWt was between 0.56 and 1.34% depending on the subject and laboratory; the bias (-0.59%) was not significant between laboratories, but there were large 95% limits of agreement (-3.67 to 2.50%).

CONCLUSION

Within-laboratory precision for each BOD POD instrument was reasonably good, but was variable according to the prevailing conditions. Although the bias between the two instruments was not significant for the BV measurements, implying that they can be used interchangeably for groups of similar subjects, the relatively large 95% limits of agreement indicate that greater consideration may be needed for assessing individuals with different ADP instruments. Therefore, use of a single ADP instrument is apparently preferable when assessing individuals on a longitudinal basis.

Trends in radiological anatomy teaching in the U.K. and Ireland

AIM

To determine the prevalence of radiological anatomy teaching in modern medical curricula.

MATERIALS AND METHODS

The present paper details a survey carried out amongst 21 medical schools in the U.K. and Ireland to determine the variability of the inclusion of radiological anatomy in their different curricula.

RESULTS

In all the institutions surveyed teaching of anatomy as revealed by radiological techniques was delivered by anatomy departments. There was considerable variation, however, in the way in which it was delivered, by whom and in the range of radiological material available. Most anatomy departments had links with radiology departments, though the precise arrangements of these also varied.

CONCLUSION

This study highlights the need for standardization between anatomy departments with regard to the content and level of radiological anatomy taught to ensure that an appropriate basis for clinical undergraduate training is provided.

Spatial resolution of spin waves in an ultracold gas

We present the first spatially resolved images of spin waves in a gas. The complete longitudinal and transverse spin field as a function of time and space is reconstructed. Frequencies and damping rates for a standing-wave mode are extracted and compared with theory.

Performance of steers grazing rhizomatous and nonrhizomatous birdsfoot trefoil in pure stands and in tall fescue mixtures

This study investigated the performance of steers grazing rhizomatous birdsfoot trefoil (Lotus corniculatus L.) (RBFT) compared to nonrhizomatous birdsfoot trefoil (BFT) in pure stands or when interseeded with endophyte-free tall fescue (Festuca arundinacea Schreb.; TF). Five forage treatments of RBFT, BFT, TF, RBFT+TF, and BFT+TF (four replicate paddocks per treatment) were continuously stocked in spring and fall of 1998 and spring of 1999. Grazing for individual treatments was terminated when pasture mass fell below 900 kg/ha. Average daily gain was greatest (P < 0.10) in pure stands of BFT and RBFT, but total forage production, and thus grazing days, for these treatments was low. Average daily gain for steers grazing BFT+TF and RBFT+TF treatments was not different from (spring and fall 1998) or greater (P < 0.10) (spring 1999) than that for TF. Total forage production of BFT+TF and RBFT+TF was greater (P < 0.10) than that of TF in spring 1998. In fall 1998, BFT+TF produced more (P < 0.10) total forage than either RBFT+TF or TF, and in spring 1999, RBFT+TF had less (P < 0.10) total forage than TF or BFT+TF. Total steer days on mixed pastures were greater (P < 0.10) than that for TF in spring and fall 1998 but not different from those for TF in spring 1999. In all three trials total weight gain/hectare was greater (P < 0.10) for RBFT+TF and BFT+TF than for TF. The RBFT+TF and BFT +TF had greater (P < 0.05) CP than TF in spring and fall 1998 and less (P < 0.05) NDF and ADF in fall 1998. We concluded that either RBFT or BFT could be interseeded with tall fescue to enhance ADG and total steer days.

Longitudinal spin waves in a dilute bose gas

We present a kinetic theory for a dilute noncondensed Bose gas of two-level atoms that predicts the transient spin segregation observed in a recent experiment. The underlying mechanism driving spin currents in the gas is due to a mean-field effect arising from the quantum interference between the direct and exchange scattering of atoms in different spin states. We numerically solve the spin Boltzmann equation, using a one-dimensional model, and find excellent agreement with experimental data.

Dynamical instability of a condensate induced by a rotating thermal gas

We study surface modes of the condensate in the presence of a rotating thermal cloud in an axisymmetric trap. By considering collisions that transfer atoms between the condensate and the noncondensate, we find that m>0 modes, which rotate in the same sense as the thermal cloud, damp less strongly than m<0 modes, where m is the polarity of the excitation. We show that above a critical angular rotation frequency, equivalent to the Landau stability criterion, m>0 modes become dynamically unstable, leading to the possibility of vortex nucleation. We also generalize our stability analysis to treat the case where the stationary state of the condensate already possesses a single vortex.

Development of a self-reported Chronic Respiratory Questionnaire (CRQ-SR)

BACKGROUND

The Chronic Respiratory Questionnaire (CRQ) is an established measure of health status for chronic obstructive pulmonary disease (COPD). It has been found to be reproducible and sensitive to change, but as an interviewer led questionnaire is very time consuming to administer. A study was undertaken to develop a self-reported version of the CRQ (CRQ-SR) and to compare the results of this questionnaire with the conventional interviewer led CRQ (CRQ-IL).

METHODS

Fifty two patients with moderate to severe COPD participated in the study. Subjects completed the CRQ-SR 1 week after completing the CRQ-IL, and a further CRQ-SR was administered 1 week later. For patients in group A (n=27) the dyspnoea provoking activities that they had previously selected were transcribed onto the second CRQ-SR, while patients in group B (n=25) were not informed of their previous dyspnoea provoking activities when they completed the second CRQ-SR. To assess the short term reproducibility and reliability of the CRQ-SR it was then administered twice at an interval of 7-10 days to a further group of 21 patients. The CRQ-IL was not administered. Longer term reproducibility was examined in 39 stable patients who completed the CRQ-SR at initial assessment and then again 7 weeks later.

RESULTS

Mean scores per dimension, mean differences, and limits of agreement are given for each dimension in the comparison of the two questionnaires. There were no statistically significant differences between the CRQ-IL and CRQ-SR in the mastery and fatigue dimensions (p>0.05). A statistically significant difference between the two scores was found in the dyspnoea dimension (p=0.006) and the emotional function dimension (p=0.04), but these differences were well within the minimum clinically important threshold. No statistically significant difference in the mean dyspnoea score was seen between groups A and B. The CRQ-SR was found to be reproducible both in the short term and after the longer period of 7 weeks, with no statistically or clinically significant differences in any dimension. Test-retest reliability was found to be high in each dimension, both in the short and longer term.

CONCLUSIONS

The CRQ-SR is a reproducible, reliable, and stable measure of health status. It compares well with the CRQ-IL but cannot be used interchangeably. The main advantage of the CRQ-SR over the CRQ-IL is that is quick to administer, reducing assessment time and hence cost.

Review of antiviral and immunomodulating properties of plants of the Peruvian rainforest with a particular emphasis on Una de Gato and Sangre de Grado

Viral diseases, including emerging and chronic viruses, are an increasing worldwide health concern. As a consequence, the discovery of new antiviral agents from plants has assumed more urgency than in the past. A number of native Amazonian medicines of plant origin are known to have antimicrobial and anti-inflammatory activity, although only a few have been studied for their antiviral properties and immunomodulating effects. Those most studied include: Sangre de Grado (drago) (Croton lechleri) in the Euphorbiaceae family and Una de Gato (Uncaria tomentosa) in the Rubiaceae family. This article reviews the chemical composition, pharmacological properties, state of current research, clinical use, and potential antiviral and immunomodulating activity of these and other plants from the Peruvian Amazon.

Establishing a cancer pain clinic in a developing country: effect of a collaborative link project with a UK cancer pain center

This paper describes a project for the establishment of a cancer pain clinic in a developing country. The project was conducted according to guidelines from the World Health Organization and utilized a link with an existing cancer pain clinic in the UK. The principal methods used for establishing the new pain clinic included: an assessment of barriers to effective cancer pain control, teaching programs for nurses and trainee doctors, educational links with a UK cancer pain clinic, and analgesic guidelines and introduction of a pain assessment tool. As a result of these interventions, a new cancer pain clinic was founded. The methods used serve as one possible model for establishing cancer pain treatment facilities in developing countries.

Effects of an angry temperament on coronary heart disease risk : The Atherosclerosis Risk in Communities Study

The objective of the study was to determine which component of an anger-prone personality more strongly predicts coronary heart disease (CHD) risk. Proneness to anger, as assessed by the Spielberger Trait Anger Scale, is composed of two distinct subcomponents-anger-temperament and anger-reaction. Participants were 12,990 middle-aged Black men and women and White men and women from the Atherosclerosis Risk in Communities Study who were followed for the occurrence of acute myocardial infarction (MI)/fatal CHD, silent MI, or cardiac revascularization procedures (average = 53 months; maximum = 72 months) through December 31, 1995. Among normotensive persons, a strong, angry temperament (tendency toward quick, minimally provoked, or unprovoked anger) was associated with combined CHD (acute MI/fatal CHD, silent MI, or cardiac revascularization procedures) (multivariate-adjusted hazard ratio = 2.10, 95% confidence interval: 1.34, 3.29) and with 'hard" events (acute MI/fatal CHD) (multivariate adjusted hazard ratio = 2.28, 95% confidence interval: 1.29, 4.02). CHD event-free survival among normotensives who had a strong, angry temperament was not significantly different from that of hypertensives at either level of anger. These data suggest that a strong, angry temperament rather than anger in reaction to criticism, frustration, or unfair treatment places normotensive, middle-aged persons at increased risk for cardiac events and may confer a CHD risk similar to that of hypertension.