Successful rehabilitation and release of a powerful owl chick with suspected rodenticide poisoning

The successful rehabilitation and release of raptor chicks can be challenging, especially when the chicks are still in the post-fledging dependency period. Here, we report on a recently fledged powerful owl chick that was held in care for 33 days before being successfully reunited with its parents. We document the steps undertaken during the entire process from collection from the wild to post-release monitoring and recommend clinical procedures for treatment of raptors entering veterinary facilities. Success of this rehabilitation was facilitated by early care and treatment for potential rodenticide poisoning, as well as the integration of citizen scientists monitoring the family unit in the field while the chick was in care and during the post-release period. Given the emerging evidence of widespread rodenticide poisoning in raptors both in Australia and globally, it is critical to suspect all raptors may have been exposed to anticoagulant rodenticides and commence treatment with vitamin K immediately. Routine treatment for rodenticides early increases the probability of successful recovery post-trauma as well as reducing the time in treatment as much as possible.

Population-Weighted Seroprevalence From Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection, Vaccination, and Hybrid Immunity Among US Blood Donations From January to December 2021

BACKGROUND

Previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) vaccination, independently and combined ("hybrid immunity"), result in partial protection from subsequent infection and strong protection from severe disease. Proportions of the US population who have been infected, vaccinated, or have hybrid immunity remain unclear, posing a challenge for assessing effective pandemic mitigation strategies.

METHODS

In this serial cross-sectional study, nationwide blood donor specimens collected during January-December 2021 were tested for anti-spike and anti-nucleocapsid antibodies, and donor COVID-19 vaccination history of ≥1 dose was collected. Monthly seroprevalence induced from SARS-CoV-2 infection, COVID-19 vaccination, or both, were estimated. Estimates were weighted to account for demographic differences from the general population and were compared temporally and by demographic factors.

RESULTS

Overall, 1 123 855 blood samples were assayed. From January to December 2021, the weighted percentage of donations with seropositivity changed as follows: seropositivity due to vaccination without previous infection, increase from 3.5% (95% confidence interval, 3.4%-3.7%) to 64.0%, (63.5%-64.5%); seropositivity due to previous infection without vaccination, decrease from 15.6% (15.2%-16.0%) to 11.7% (11.4%-12.0%); and seropositivity due to hybrid immunity, increase from 0.7% (0.6%-0.7%) to 18.9% (18.5%-19.3%). Combined seroprevalence from infection, vaccination, or both increased from 19.8% (19.3%-20.2%) to 94.5% (93.5%-94.0%). Infection- and vaccination-induced antibody responses varied significantly by age, race-ethnicity, and region, but not by sex.

CONCLUSIONS

Our results indicate substantial increases in population humoral immunity from SARS-CoV-2 infection, COVID-19 vaccination, and hybrid immunity during 2021. These findings are important to consider in future COVID-19 studies and long-term pandemic mitigation efforts.

How do we…form and coordinate a national serosurvey of SARS-CoV-2 within the blood collection industry?

Background

A national serosurvey of U.S. blood donors conducted in partnership with the Centers for Disease Control and Prevention (CDC) was initiated to estimate the prevalence of SARS‐CoV‐2 infections and vaccinations.

Methods

Beginning in July 2020, the Nationwide Blood Donor Seroprevalence Study collaborated with multiple blood collection organizations, testing labs, and leadership from government partners to capture, test, and analyze approximately 150,000 blood donation specimens per month in a repeated, cross‐sectional seroprevalence survey.

Results

A CDC website (https://covid.cdc.gov/covid-data-tracker/#nationwide-blood-donor-seroprevalence) provided stratified, population‐level results to public health professionals and the general public.

Discussion

The study adapted operations as the pandemic evolved, changing specimen flow and testing algorithms, and collecting additional data elements in response to changing policies on universal blood donation screening and administration of SARS‐CoV‐2 spike‐based vaccines. The national serosurvey demonstrated the utility of serosurveillance testing of residual blood donations and highlighted the role of the blood collection industry in public–private partnerships during a public health emergency.

Genotype Distribution and Demographic Characteristics of Hepatitis C Virus NAT Yield Cases among US Blood Donors

BACKGROUND

HCV infection rates among U.S. blood donors have been well characterized; however, few studies evaluate HCV genotypes among blood donors. Monitoring trends in disease and demographic patterns contribute to understanding the safety of the blood supply. Here we examined the demographic characteristics and the distribution of HCV genotypes/subgenotypes for nearly a 16-year period among blood donors confirmed positive for HCV RNA but antibody negative (defined as NAT yield).

METHODS

A retrospective assessment of demographic characteristics and testing data was used to determine temporal trends and geographical distribution of HCV genotypes/subgenotypes among American Red Cross blood donors confirmed positive as HCV-NAT yield.

RESULTS

From 2003-2018, 343 donors (0.38 per 100,000 donations; 95% CI, 0.35-0.43) confirmed positive as HCV-NAT-yield cases. Temporal analysis revealed a significant increase in HCV-NAT-yield cases of 54.1% between 2009-2014 (p=0.014), followed by a significant decline of 31.4% between 2015-2018 (p=0.002). Significantly more HCV-NAT-yield cases were detected among first-time donors, non-Hispanic Whites, donors aged 20-29 years, equally likely to be males as females, with the highest frequency in the South (0.52/100,000 donations). Subgenotype 1a (49.6%) was most frequent, followed by 3a (18.7%), 2b (12.5%), 1b (8.5%) and 2a (1.7%).

CONCLUSION

Voluntary non-remunerated blood donors are at low risk for HCV infection. Since 2015, the frequency of HCV-NAT-yield cases decreased despite an increase of acute HCV infection in the general population. HCV subgenotypes 1a and 3a continue to remain predominant among U.S. blood donors with recent HCV infection.

Powassan Virus Infection Likely Acquired Through Blood Transfusion Presenting as Encephalitis in a Kidney Transplant Recipient

A kidney transplant patient without known tick exposure developed encephalitis 3 weeks after transplantation. During the transplant hospitalization, the patient had received a blood transfusion from an asymptomatic donor later discovered to have been infected with Powassan virus. Here, we describe a probable instance of transfusion-transmitted Powassan virus infection.

WED 241 Clinical relevance of regular blood monitoring in IG treatment

Background

ABN immunoglobulin (Ig) guidelines advise routine FBC and U and E monitoring with every treatment episode and screening for IgA deficiency.

Aims

We audited compliance in inflammatory neuropathy patients on longterm treatment in two UK Neurology departments. We looked for evidence of clinically relevant haematological or AKI Ig-related events.

Methods

Data was collected from Nov 2015 to Nov 2017. Accepted definitions for clinically and/or biochemically significant haemolysis, neutropenia, thrombocytopenia and AKI were used.

Results

1919 treatment episodes in 90 patients were analysed. Mean age (SD)=57.6 (14.4)years, 69.1% male, 74% CIDP (26% MMN), 94% IVIg (6% SCIg). Mean dose=1.57 (0.74) g/kg/month or 97.1 (37.3) g/infusion. No clinically significant episodes of haemolysis, neutropenia, thrombocytopenia or AKI occurred in relation to Ig treatment. An asymptomatic drop of >10 g/L Hb occurred in 68/1919 episodes in 38 individuals (3.5%); mean reduction 17.7 g/L, lowest Hb 99 g/L. Two patients with CRF (stage 3) received 28 (IV) and 104 (SC) infusions respectively without impact on eGFR. Two individuals with relative IgA deficiency (0.38 g/L, 0.4 g/L) received 16 infusions over 1.5 years without complications.

Conclusions

No clinically significant Ig-related events were identified in this representative cohort. We suggest annual screening or clinically indicated testing as safe and more appropriate in longterm IVIg use.

Reducing the risk of mouth-to-mouth transmission of pathogens via re-usable, machine-read parking tickets: an observational cohort study

The car parks at the study hospital are accessed using re-usable, machine-read tickets. In the initial phase of this study, 598 staff members were observed entering the car park, and 21.6% of them put their parking ticket in their mouth. Ultraviolet dye was used to demonstrate card-to-card cross-contamination. Swabs of the ticket machine yielded commensal bacteria: coagulase-negative staphylococci and a Bacillus sp. After placing a poster on the ticket-reading machine highlighting the potential risk of infection, a further 1366 observations demonstrated a significant and persistent decline in the proportion of staff who put their ticket in their mouth (P<0.001).

Bicycle weight and commuting time: randomised trial

OBJECTIVE

To determine whether the author's 20.9 lb (9.5 kg) carbon frame bicycle reduced commuting time compared with his 29.75 lb (13.5 kg) steel frame bicycle.

DESIGN

Randomised trial.

SETTING

Sheffield and Chesterfield, United Kingdom, between mid-January 2010 and mid-July 2010.

PARTICIPANTS

One consultant in anaesthesia and intensive care.

MAIN OUTCOME MEASURE

Total time to complete the 27 mile (43.5 kilometre) journey from Sheffield to Chesterfield Royal Hospital and back.

RESULTS

The total distance travelled on the steel frame bicycle during the study period was 809 miles (1302 km) and on the carbon frame bicycle was 711 miles (1144 km). The difference in the mean journey time between the steel and carbon bicycles was 00:00:32 (hr:min:sec; 95% CI -00:03:34 to 00:02:30; P=0.72).

CONCLUSIONS

A lighter bicycle did not lead to a detectable difference in commuting time. Cyclists may find it more cost effective to reduce their own weight rather than to purchase a lighter bicycle.

Predicting mortality for patients with exacerbations of COPD and Asthma in the COPD and Asthma Outcome Study (CAOS)

INTRODUCTION

Decisions about the intensity of treatment for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are influenced by predictions about survival and quality of life. Evidence suggests that these predictions are poorly calibrated and tend to be pessimistic.

AIM

The aim of this study was to develop an outcome prediction model for COPD patients to support treatment decisions.

METHODS

A prospective multi-centre cohort study in Intensive Care Units (ICU) and Respiratory High Dependency Units (RHDU) in the UK recruited patients aged 45 years and older admitted with an exacerbation of obstructive lung disease. Data were collected on patients' characteristics prior to ICU admission, and on their survival and quality of life after 180 days. An outcome prediction model was developed using multivariate logistic regression and bootstrapping.

RESULTS

Ninety-two ICUs (53% of those in the UK) and three RHDUs took part. A total of 832 patients were recruited. Cumulative 180-day mortality was 37.9%. Using data available at the time of admission to the units, a prognostic model was developed which had an estimated area under the receiver operating characteristic curve ('c') of 74.7% after bootstrapping that was more discriminating than the clinicians (P = 0.033) and was well calibrated.

DISCUSSION

This study has produced an outcome prediction model with slightly better discrimination and much better calibration than the participating clinicians. It has the potential to support risk adjustment and clinical decision making about admission to intensive care.

Survival and quality of life for patients with COPD or asthma admitted to intensive care in a UK multicentre cohort: the COPD and Asthma Outcome Study (CAOS)

BACKGROUND

Non-invasive ventilation is first-line treatment for patients with acutely decompensated chronic obstructive pulmonary disease (COPD), but endotracheal intubation, involving admission to an intensive care unit, may sometimes be required. Decisions to admit to an intensive care unit are commonly based on predicted survival and quality of life, but the information base for these decisions is limited and there is some evidence that clinicians tend to be pessimistic. This study examined the outcomes in patients with COPD admitted to the intensive care unit for decompensated type II respiratory failure.

METHODS

A prospective cohort study was carried out in 92 intensive care units and 3 respiratory high dependency units in the UK. Patients aged 45 years and older with breathlessness, respiratory failure or change in mental status due to an exacerbation of COPD, asthma or a combination of the two were recruited. Outcomes included survival and quality of life at 180 days.

RESULTS

Of the 832 patients recruited, 517 (62%) survived to 180 days. Of the survivors, 421 (81%) responded to a questionnaire. Of the respondents, 73% considered their quality of life to be the same as or better than it had been in the stable period before they were admitted, and 96% would choose similar treatment again. Function during the stable pre-admission period was a reasonable indicator of function reported by those who survived 180 days.

CONCLUSIONS

Most patients with COPD who survive to 180 days after treatment in an intensive care unit have a heavy burden of symptoms, but almost all of them-including those who have been intubated-would want similar intensive care again under similar circumstances.

Sex workers working within a legalised industry: their side of the story

OBJECTIVES

To examine the characteristics and work attitudes of female sex workers working in licensed brothels in Victoria, Australia.

METHODS

This was a cross-sectional study of sex workers working at 38 of the 92 licensed brothels operating in Victoria during 2006.

RESULTS

Of the 108 women approached, 97 (90%) completed the questionnaire. Women working in the legal sex industry in Victoria were generally aged between 23 and 35 years (51%), had completed high school (26%) and had worked in the industry for more than 5 years (43%). Half had dependent children and one third were in a relationship. Women's primary motivation for working in the sex industry was financial, whether this was the reason for their starting (56%), or the barrier to their leaving (61%). Although women valued the higher income and flexibility of this work, many were concerned about sexually transmitted infections (STI) (55%), community attitudes towards the industry (47%), their physical safety (38%) and maintaining their anonymity (37%). Over half of the women would like to leave the industry. The majority (95%) supported the monthly STI checks that are part of the Victorian regulations, with only one fifth reporting that the cost of these tests was prohibitive.

CONCLUSIONS

The findings of this study indicate that women working in licensed Victorian brothels come from a diverse range of backgrounds and circumstances and hold varying attitudes towards working in the sex industry. It is hoped that these findings go some way to redressing the assumptions commonly made about women working in the sex industry and reducing the stigma associated with this occupation.

Sensitivity of late-latency auditory and somatosensory evoked potentials to threat of electric shock and the sedative drugs diazepam and diphenhydramine in human volunteers

Late-latency auditory and somatosensory evoked potentials are sensitive to some centrally acting drugs and to certain psychological interventions. In this experiment we compared the effects of acute doses of a benzodiazepine, diazepam and an H(1) histamine receptor-blocking sedative, diphenhydramine, on auditory and somatosensory evoked potentials within the latency range 100-500 ms in a fear conditioning paradigm. Twelve healthy males (18-30 years) participated in three sessions at weekly intervals in which they received diazepam 10mg, diphenhydramine 75 mg and placebo in a balanced, double-blind, crossover protocol. One hundred and twenty min after diphenhydramine or 60 min after diazepam, they underwent an 8 min recording period in which auditory evoked potentials elicited by 40 ms, 95 dB[A], 1 kHz tones, and somatosensory evoked potentials elicited by a mildly painful electric shock (1.8 mA, 50 ms) were recorded at Cz (vertex). Each session consisted of four blocks of trials in which either the sound pulse or the shock was presented. Alternate blocks were designated SAFE or THREAT ('context' conditions); in THREAT blocks subjects were warned that shocks would be delivered via electrodes placed on the wrist (electrodes were removed during SAFE blocks). In one SAFE and one THREAT block, the sound stimuli and shocks (shocks were delivered only in the THREAT block) were preceded by a 2 s conditioned stimulus (CS: a red light) ('cue' condition). Diazepam, but not diphenhydramine, reduced the amplitude of the P2 auditory evoked potential. The THREAT context was associated with increased N1 and reduced N2 potential amplitudes. The CS had no effect on the amplitudes, but markedly reduced the latencies of the N1, P2 and N2 potentials under the THREAT condition. Diazepam reduced the amplitudes of the somatosensory potential evoked by the shock; the CS shortened the latencies of the later components of the response. Diazepam and diphenhydramine were approximately equi-sedative in the doses used in this experiment, as judged by visual analogue self-rating scales. The results indicate that the suppression of late-latency auditory and somatosensory evoked potentials by diazepam is not simply a reflection of sedation. Late-latency evoked potentials can be modified by an aversive CS, but the components that are sensitive to the CS are different from those that are sensitive to diazepam.

Long-term follow-up of patients from the 1989 Q fever outbreak: no evidence of excess cardiac disease in those with fatigue

BACKGROUND

In 1989, an outbreak of Q fever (C. burnetii infection) with 147 confirmed cases occurred in Solihull, West Midlands. Three patients developed cardiomyopathy in the subsequent 10 years. The cohort has been followed up with respect to the development of fatigue and, in this instance, cardiac effects after the original infection.

AIM

To determine whether persisting fatigue after Q fever represented sub-clinical cardiomyopathy.

DESIGN

Prospective follow-up study.

METHODS

All traceable subjects from the original outbreak, and community age-, sex- and smoking-matched controls, were studied. Questionnaires for idiopathic fatigue, 12-lead ECG, echocardiography, spirometry and shuttle walk distance were undertaken, and a subset with CDC-defined chronic fatigue syndrome had gated cardiac scans.

RESULTS

Of the original cohort, 19 had died, three had emigrated and 10 were untraceable. Of the remaining 115, 108 responded to a mailed questionnaire and 87 were investigated further, of whom 85 provided complete data. Two developed aortic valve vegetations, one of whom died. Chronic fatigue syndrome was found in 20% of cases and 5.3% of controls (including those with co-morbidities), falling to 8.2% and 0 when excluding those with co-morbidities. There were no significant differences in ECG and echocardiographic investigations or shuttle-walk distance between those with fatigue and those without. Six of the seven patients with CFS had gated cardiac scans: all were within normal limits.

CONCLUSIONS

These findings do not support the existence of a sub-clinical cardiomyopathy in the patients in this cohort who suffer from fatigue after acute Q fever, although endocarditis can occur after acute infection.

Chronic fatigue following infection by Coxiella burnetii (Q fever): ten-year follow-up of the 1989 UK outbreak cohort

BACKGROUND

Some patients exposed to Q fever (Coxiella burnetii infection) may develop chronic fatigue.

AIM

To determine whether subjects involved in the West Midlands Q fever outbreak of 1989 had increased fatigue, compared to non-exposed controls, 10 years after exposure.

DESIGN

Matched cohort study comparing cases to age-, sex- and smoking-history-matched controls not exposed to Q fever.

METHODS

A postal questionnaire was sent to subjects at home, followed by further assessment in hospital, including a physical examination and blood tests.

RESULTS

Of 108 Q-exposed subjects, 70 (64.8%) had fatigue, 37 idiopathic chronic fatigue (ICF) (34.3%), vs. 29/80 (36.3%) and 12 (15.0%), respectively, in controls. In 77 matched pairs, fatigue was commoner in Q-exposed subjects than in controls: 50 (64.9%) vs. 27 (35.1%), p<0.0001. ICF was found in 25 (32.5%) of Q-exposed patients and 11(14.3%) of controls (p=0.01). There were 36 (46.8%) GHQ cases in Q-exposed subjects, vs. 18 (23.4%) controls (p=0.004). A matched analysis of those more intensively studied showed fatigue in 48 (66.7%) Q-exposed patients and 25 (34.7%) controls, (p<0.0001), ICF in 25 (34.7%) Q-exposed and 10 (13.9%) controls (p=0.004), and chronic fatigue syndrome (CFS) in 14 (19.4%) Q-exposed patients and three (4.2%) controls (p=0.003). Thirty-four (47.2%) Q-exposed patients were GHQ cases compared to 17 (23.6%) controls (p=0.004).

DISCUSSION

Subjects who were exposed to Coxiella in 1989 had more fatigue than did controls, and some fulfilled the criteria for CFS. Whether this is due to ongoing antigen persistence or to the psychological effects of prolonged medical follow-up is uncertain.

A combined technique utilising regional anaesthesia and target-controlled sedation in a patient with myotonic dystrophy

Myotonic dystrophy presents several problems to the anaesthetist. We describe what we believe to be the first report of target-controlled sedation combined with regional anaesthesia in a patient with myotonic dystrophy. Precise control of propofol levels and titration to patient satisfaction avoided the problem of delayed recovery which has been described with propofol anaesthesia.

A survey of exposure to diesel engine exhaust emissions in the workplace

Forty sites were visited during a survey of exposures to diesel engine exhaust emissions. Personal and background exposure to gaseous components, respirable dust, elemental carbon, organic carbon and total carbon were measured and details of control systems were recorded. The results show a wide spread in exposure patterns reflecting the different work practices, job categories of employees and the control methods used. However, sites where fork-lift trucks were in use consistently produced the highest exposures. The survey results suggest that the measurement of elemental carbon could be used as an indicator of exposure to diesel engine exhaust emissions.

Perioperative myocardial ischaemia, heart rate and arrhythmia in patients undergoing thoracotomy: an observational study

We have studied myocardial ischaemia, heart rate and arrhythmia in 82 patients undergoing elective thoracotomy. Myocardial ischaemia was detected using a microprocessor-based surveillance system programmed to record leads V2 and V5. Patients were monitored on the day before and for up to 72 h after surgery. The total monitoring time was 5158 h. The incidence of silent myocardial ischaemia before operation was 11% (nine of 82). This increased to 24% (20 of 82) after operation. Postoperative myocardial ischaemia was associated with preoperative myocardial ischaemia in six patients. Before operation, the mean duration of myocardial ischaemia was 0.31 min per hour of monitoring. After operation, this increased to 1.36 min per hour of monitoring (P < 0.05). For the whole population, mean heart rate before operation was 74 beat min-1 and increased to 84 beat min-1 after operation (P < 0.01). Patients with ischaemia had a mean heart rate of 92.8 beat min-1 after operation compared with those with no ischaemia whose mean heart rate was unchanged at 81.8 beat min-1 (P < 0.05). The incidence of atrial tachyarrhythmia increased from one patient before operation to 12 patients after operation (P < 0.01). Atrial tachyarrhythmia was not associated with postoperative myocardial ischaemia. Nine patients had an adverse operative outcome; two had non-fatal myocardial infarction and seven died. Postoperative myocardial ischaemia was associated with adverse outcomes (P < 0.05).

The utility of exercise testing after cardiac transplantation in older patients

BACKGROUND

The criteria for cardiac transplantation recipient selection, including the appropriate recipient upper age limit, continue to expand with an increasing number of recipients greater than 60 years of age. While others have reported their transplant experience in older recipients in terms of quality of life assessment, we have examined the role of exercise cardiopulmonary testing post-transplantation in older cardiac transplant recipients.

METHODS

We reviewed inpatient and outpatient charts of 28 patients 60 years of age or older who underwent orthotopic heart transplantation at Vanderbilt University Medical Center.

RESULTS

In this population, perioperative mortality of 7.1% and Kaplan-Meier survival at 1 and 5 years of 89 and 77%, respectively, were similar to the institutional 1-year (89%) and 5-year (75%) survival among younger adult transplant recipients. Exercise cardiopulmonary testing results were available in 22/25 patients surviving greater than 1 year. Both peak oxygen consumption and percentage of maximum VO2 were significantly greater among patients reporting NYHA Class 1 or 2 functional status, in comparison with those NYHA Class 3 or greater.

CONCLUSION

Following cardiac transplantation, survival of patients greater than 60 years of age is equivalent to that of younger patients at our institution. Exercise testing provides an objective measure of performance and correlates with subjective status following heart transplantation. Most patients demonstrate good functional status, with minimal symptoms and good exercise capacity. These results, although retrospective, suggest that cardiac transplantation remains a reasonable therapeutic option for patients greater than 60 years of age with end-stage cardiomyopathy.

Workplace exposure to rosin-based solder flux fume during hand soldering

The patterns and extent of exposure to rosin based solder flux fume have been investigated in two surveys and a number of individual site visits carried out by the UK Health and Safety Executive (HSE). Determination of solder fume was by measurement of airborne resin acid particulate. Both static and personal sampling was carried out over time periods ranging from 15 minutes to several hours. Resin acid concentrations were found to vary from less than 1 microgram m-3 to 2289 micrograms m-3. The effects of various types of local exhaust ventilation on resin acid concentrations have been observed. On-tool tip extraction systems were generally found to be the best control measure available; however good design, positioning and system maintenance is essential for efficient capture of the fume. The resin acid concentrations detected at these twenty-six sites suggest that the proposed British long and short term occupational exposure limits are realistically attainable targets, particularly where good working practices and/or effective fume control measures are in place.

An investigation into the composition of products evolved during heating of hot melt adhesives

The major chemical components generated by a selection of fourteen hot melt adhesives during heating have been identified. This information is required so that the possible health consequences of occupational exposure can be assessed and advice on controls developed. Details are also given of the test apparatus and standard testing procedure devised for this investigation. Analysis of the evolved material indicates the presence of a wide range of chemical compounds, including resin acids, volatile terpenes, aliphatic aldehydes, aliphatic and aromatic hydrocarbons and isocyanates. Some components, including resin acids and formaldehyde, are common to several types of adhesive, whereas others, such as acrolein and isocyanates, are specific to just one. There is no component which is characteristic of fume from all fourteen adhesives. Concentrations of individual chemical components show significant variation, both between different types of adhesive, and between samples of the same adhesive heated to different temperatures or for different periods of time. For individual adhesives, concentrations of evolved material tend to increase as the temperature of the glue is raised, with the highest levels being observed in samples taken directly after commencement of heating.

Technology assessment--a survey of the clinical engineer's role within the hospital

Advancements in technology are vital to improve clinical outcomes within the medical community and, in particular, to healthcare systems. The need for a systematic approach to analyzing, assessing and selecting the best new technology for individual hospitals continues to increase in response to this technological growth. To determine the use of technology assessment, the effectiveness of different methods, and the role of clinical engineers and bioengineers in this process, a survey was conducted of clinical engineering departments throughout the United States. The results reveal that technology assessment programs are widely utilized as a team effort between hospital departments. Clinical engineers are playing a key role within these teams as technology managers.

Radioenhancement by cisplatin with accelerated fractionated radiotherapy in a human tumour xenograft

The aim of the present study was to investigate whether cisplatin would enhance the radioresponse of a human tumour xenograft when given in different schedules combined with accelerated fractionated radiation therapy. A human squamous carcinoma of the hypopharynx, FaDu, was grown in the thigh of athymic nude mice. Tumours were exposed to twice-daily 2-Gy fractions, applied 6 h apart over 2 weeks, 5 days a week, alone or combined with cisplatin given at maximally tolerated doses in three different schedules: (1) i.p. as a single bolus (SB) or (2) i.p. as a daily bolus at 30 min before the first daily radiation fraction or (3) s.c. as a continuous infusion through a mini-osmotic pump over 13 days, commencing 24 h prior to the first daily radiation fraction. The end point for the study was tumour growth delay (TGD), calculated as the difference between the delay in regrowth to 200% of the initial tumour size in treated versus control mice. SB cisplatin plus radiation showed only an additive effect on TGD, whereas daily-bolus and continuous-infusion cisplatin demonstrated a greater than additive effect when combined with accelerated fractionated radiation in this human tumour model. Cisplatin appears to be especially beneficial as a radiation enhancer when given throughout the course of radiation.

Enhancement of radiation-induced regrowth delay by gemcitabine in a human tumor xenograft model

Gemcitabine, a cytidine nucleoside analogue, has schedule-dependent antitumor activity in vitro and in vivo. Gemcitabine also has dose- and time-dependent radiosensitization properties in vitro. Thus it may have therapeutic application in combination with radiation. The aims of this study were to investigate whether gemcitabine could enhance radiation-induced tumor regrowth delay in a human squamous carcinoma (FaDu) xenograft in nude mice and to examine the effect of gemcitabine on radiation-induced apoptosis in in vivo tumors. Radiation was given locally to the tumors twice daily in 2 Gy fractions over 2 weeks for 5 days/week. Significant regrowth delay enhancement was observed which was dependent on gemcitabine schedule. Effective schedules using maximum tolerated gemcitabine doses were twice weekly and once weekly, but not daily. Significant toxicity occurred with radiation plus twice weekly gemcitabine, but enhancement was seen using gemcitabine doses well below the maximum tolerated dose. Both gemcitabine and radiation led to apoptotic cell death, but this was not increased when both treatments were combined. These results indicate that gemcitabine may be of therapeutic value as a radiation enhancer in the treatment of human cancers. Preliminary studies suggest that increased apoptotic cell death is not a mechanism leading to this enhancement.

Awake fibreoptic intubation in the semi-prone position following facial trauma

A fit 27-year-old man presented with severe facial trauma following an industrial accident. Initial assessment showed severe swelling around the lower jaw and haemorrhage from the mouth, nose, scalp and left ear. The patient was conscious with a Glasgow Coma Score of 13 but in respiratory distress. Following adoption of the prone position his airway improved. Relief of the patient's airway obstruction was a priority and the patient underwent awake fibreoptic intubation in the prone position prior to induction of anaesthesia. Computed tomography scans of his head and neck were unremarkable and after fixation of a bilateral mandibular fracture he made an uneventful recovery. Intubation in the semi-prone position may be a useful technique in injuries of this type.

Circulatory status and response to cardiac rehabilitation in patients with heart failure

BACKGROUND

We recently reported that some patients with heart failure and exercise intolerance exhibit severe hemodynamic dysfunction during exercise, whereas others have normal cardiac output responses to exercise. We postulated that patients with preserved cardiac output responses to exercise are limited by deconditioning and would respond to exercise training, whereas patients with reduced cardiac output responses are limited by skeletal muscle underperfusion and would not improve with exercise training. The present study was undertaken to test this hypothesis.

METHODS AND RESULTS

Thirty-two patients with heart failure were studied. Hemodynamic response to maximal treadmill exercise was measured; then patients were enrolled in a standard 3-month cardiac rehabilitation program. Peak exercise VO2, lactate threshold, and quality-of-life questionnaires were assessed at 1, 2, and 3 months. Twenty-one patients had normal cardiac output responses to exercise. All 21 patients participated in the rehabilitation program without difficulty, and 9 (43%) responded to rehabilitation, defined as a > 10% increase in both peak exercise VO2 and the anaerobic threshold. Of the 11 patients with reduced cardiac output responses to exercise, 3 discontinued rehabilitation because of severe exhaustion, and only 1 qualified as a responder (9%; P < .04 versus preserved cardiac output).

CONCLUSIONS

Patients with heart failure and normal cardiac output responses to exercise frequently improve with exercise training. Patients with severe hemodynamic dysfunction during exercise usually do not improve with training, which suggests that they are limited primarily by circulatory factors.

Risk of Parkinson's disease among first-degree relatives: A community-based study

OBJECTIVE

To determine the relative risk (RR) and cumulative incidence of idiopathic Parkinson's disease (PD) in first-degree relatives of PD patients compared with relatives of controls from the same geographic region.

DESIGN

A family history questionnaire was used to obtain information on all first-degree relatives of cases and controls. A subset of these first-degree relative was also examined. A Cox proportional hazards model with double-censoring techniques for missing information was used to model the RR for PD, adjusting for gender, ethnicity, and relationship to proband.

RESULTS

A total of 1,458 first-degree relatives of 233 PD patients were 2.3 times as likely (95% CI = 1.3 to 4.0) as 7,834 relatives of 1,172 controls to develop PD. The cumulative incidence of PD to age 75 among first-degree relatives of PD patients was 2% compared with 1% among first-degree relatives of controls. The risk in male first-degree relatives was higher than in female relatives (RR = 2.0, 95% CI = 1.1 to 3.4) and the risk in relatives of Caucasians was higher than in African-Americans and Hispanics (RR = 2.4, 95% CI = 1.4 to 4.1). Risk for siblings and parents of probands was similar.

CONCLUSIONS

Susceptibility to PD is increased in first-degree relatives of both sporadic and familial cases. The pattern of inheritance and the relationship between genetic and environmental risk factors warrant further study.

Difficult intubation following thoracic trauma

A previously fit 20-year-old man presented with a large haemothorax following a stab wound to the left chest. Pre-operative airway assessment indicated that tracheal intubation would be routine. On induction of anaesthesia, visualisation of the larynx proved impossible because of soft tissue swelling. Successful intubation was eventually achieved with the aid of a gum elastic bougie. At operation, the patient's common carotid artery was found to have been perforated close to its origin on the aorta. The patient made an uneventful recovery.

The use of a visual aid to check anaesthetic machines. Is performance improved?

We asked 20 anaesthetists and seven operating department assistants to check three anaesthetic machines 'doctored' to contain errors of varying seriousness, and recorded their performances. Two weeks later we asked the same group to repeat the test. On the second occasion they followed a visual aid and filled in a questionnaire about the test. Participants showed a significant improvement in the rate of fault detection when using the aid (p < 0.05). The visual aid was most useful at increasing the detection rate of machine leaks. Of the participants, 60% considered that the visual aid was helpful and 74% thought that such an aid should be available in our theatre complex. Sixty-six percent of those questioned felt that a formal check list would be of use.

Relationship of cardiac allograft size and pulmonary vascular resistance to long-term cardiopulmonary function

The purpose of this study was to evaluate the long-term cardiopulmonary function of heart transplant patients who received disproportionately sized allografts for varying levels of pulmonary vascular resistance. Resting hemodynamics and oxygen uptake during exercise were recorded at 1 year after transplantation in 52 patients. No differences in resting heart rate, cardiac output, stroke volume, peak oxygen uptake during exercise, and exercise duration were found in recipients of undersized hearts (donor:recipient weight ratio [D:R] < 0.75), sized-matched hearts (D:R = 0.75 to 1.25), and oversized (D:R > 1.25) hearts. In a further analysis according to preoperative pulmonary vascular resistance, resting cardiac output (5.8 +/- 1.3 L/min) was normal, and peak exercise oxygen uptake (22.7 +/- 8.0 ml/kg/min) was mildly decreased in recipients of size-matched allografts with a pulmonary vascular resistance of less than 3 Wood units (size-matched hearts, with mild or no pulmonary vascular resistance). Of patients with moderate pulmonary hypertension (pulmonary vascular resistance > or = 3 Wood units), resting cardiac output was normal (5.1 +/- 0.6 L/min) in recipients of oversized hearts and was reduced (4.7 +/- 1.0 L/min) in recipients of sized-matched hearts (p < 0.05 versus recipients of size-matched hearts with pulmonary vascular resistance less than 3 Wood units).(ABSTRACT TRUNCATED AT 250 WORDS)

Astroglial growth factors in normal human brain and brain tumors: comparison with embryonic brain

Aqueous extracts of 18-day embryonic chicken brains, 15-day embryonic and adult rat brains and human brain tumors, as well as control histologically-normal adult human brain taken from around brain tumors or around arteriovenous malformations each stimulated the growth of cultured chick astrocytes. Eight mitogenic fractions were separated reproducibly by Bio-Gel P-10 molecular seive chromatography. They had apparent molecular weights (M.W.) of 24, 17, 12, 9, 5, 2.8, 1.4 and 1.2 kD. The activity of each fraction was concentration dependent. The fractions did not appear to be artifactually derived by proteolysis from a larger mitogen since (i) protease inhibitors were added at the time of homogenization to prevent degradation, (ii) protease treatment did not produce large quantities of the lower molecular weight fractions, (iii) incubation of brain extracts for up to four hours at 30 degrees C did not alter the activity of the various mitogenic fractions and (iv) addition of albumin to inhibit protease activity similarly did not change the profile of the factors. In contrast, treatment with protease reduced the activity of all the factors although those with M.W. of 5 and 1.2 kD were inactivated more slowly than the others. The various fractions were stable when rechromatographed. This suggested they were not chance aggregates derived artifactually during extraction but rather might have physiological and pathological roles. The activities of each mitogenic fraction were significantly higher in brain extracts from embryonic rats than in those from adult rats. In brain extracts of rat and chicken embryos the fractions of lower M.W. 5 kD to 1.2 kD were relatively abundent. In contrast in brain extracts from adult rats the predominant mitogenic fractions had apparent M.W. of 24, 17 and 12 kD. In histologically normal adult human brain taken from around the tumors or around arteriovenous malformations the 5 kD fraction was present in small amounts and the fractions of lower molecular weight were present in very small amounts. In human glial brain tumors there was a preponderance of the 5 kD activity and more of the 2.8 and 1.4 kD activity fractions than in histologically normal adult human brain. But there was relatively less activity in the 24 and 17 kD fractions. The growth factor profile of human meningiomas was quite different from that of histologically normal human brain or human glial brain tumors. The fraction from meningiomas that was most mitogenic for astrocytes had a molecular weight of 12 kD.(ABSTRACT TRUNCATED AT 400 WORDS)

Interleukin 7 is a growth factor for mature human T cells

We have studied the capacity of interleukin (IL) 7 to support the growth and expansion of human T cell clones of different phenotype and function. All the clones studied (CD4+CD8+, CD4-CD8- Tcell receptor alpha/beta or gamma/delta) responded to IL 7. The proliferative response of all the T cell clones induced by IL 7 was routinely less than to IL2, but comparable to the IL4 response. IL 7 also induced the proliferation of resting, freshly prepared peripheral blood mononuclear cells (PBMC) or Tcell-enriched (E+) cells. The pattern of proliferation observed in the presence of IL 7 was similar, but lower in magnitude, to that induced by IL 2. In both these cells populations the response to lymphokines alone was always less than the response to lymphokines plus insolubilized anti-CD3 monoclonal antibody. In contrast IL4 produced a different pattern of responsiveness, as significant proliferation was observed only on PBMC costimulated with anti-CD3. The possibility that IL 7 mediates its growth stimulation by the IL2 pathway was excluded by the incapacity of anti-IL2 or anti-Tac monoclonal antibody, in concentrations which blocked IL2-dependent proliferation, to inhibit IL 7-dependent growth. We conclude that IL 7 is a major growth factor for human mature T cells, and its activity is not limited to lymphocyte progenitors.

Suppression of mitogenic lectin-induced blast transformation of human peripheral blood mononuclear cells by pyrimethamine

The anti-malarial drug pyrimethamine suppresses in vitro mitogenic lectin-induced blast transformation by human peripheral blood mononuclear cells (MNC) when the drug is added to cells (1 X 10(-5) M/culture). Sulphadoxine, a second widely used anti-malarial drug has no suppressive effect on the MNC. MNC responsiveness in the mixed leucocyte reaction and cellular viability are not altered by either pyrimethamine or sulphadoxine. In addition, no significant suppression is found when serum obtained from individuals on pyrimethamine-sulphadoxine chemoprophylaxis is added to MNC in the assays. The data, however, do not totally rule out any clinically significant suppressive effect by the anti-malarial drugs on human cellular immune responses.

Type 2 GM1 gangliosidosis with long survival and neuronal ceroid lipofuscinosis

Neurologic deterioration began in a girl before age 2 years. By 4 she was spastic and decerebrate. GM1 gangliosidosis was diagnosed by absence of beta-galactosidase activity in leukocytes and fibroblasts. She died at 17 years. Her small brain contained only 2.61 mumole glycolipid N-acetylneuraminic acid per gram, and was filled with autofluorescent material. GM1 gangliosidosis was confirmed by the presence of membranous cytoplasmic bodies, by the absence of beta-galactosidase, and by failure of complementation when the patient's fibroblasts were fused with cells from other forms of GM1 gangliosidosis. The autofluorescent material probably accumulated because of the long survival rather than the primary enzyme defect.