Relationship between functional connectivity and weight-gain risk of antipsychotics in schizophrenia

BACKGROUND

The mechanisms by which antipsychotic medications (APs) contribute to obesity in schizophrenia are not well understood. Because AP effects on functional brain connectivity may contribute to weight effects, the current study investigated how AP-associated weight-gain risk relates to functional connectivity in schizophrenia.

METHODS

Fifty-five individuals with schizophrenia (final N = 54) were divided into groups based on previously reported AP weight-gain risk (no APs/low risk [N = 19]; moderate risk [N = 17]; high risk [N = 18]). Resting-state functional magnetic resonance imaging (fMRI) was completed after an overnight fast ("fasted") and post-meal ("fed"). Correlations between AP weight-gain risk and functional connectivity were assessed at the whole-brain level and in reward- and eating-related brain regions (anterior insula, caudate, nucleus accumbens).

RESULTS

When fasted, greater AP weight-gain risk was associated with increased connectivity between thalamus and sensorimotor cortex (pFDR = 0.021). When fed, greater AP weight-gain risk was associated with increased connectivity between left caudate and left precentral/postcentral gyri (pFDR = 0.048) and between right caudate and multiple regions, including the left precentral/postcentral gyri (pFDR = 0.001), intracalcarine/precuneal/cuneal cortices (pFDR < 0.001), and fusiform gyrus (pFDR = 0.008). When fed, greater AP weight-gain risk was also associated with decreased connectivity between right anterior insula and ventromedial prefrontal cortex (pFDR = 0.002).

CONCLUSIONS

APs with higher weight-gain risk were associated with greater connectivity between reward-related regions and sensorimotor regions when fasted, perhaps relating to motor anticipation for consumption. Higher weight-gain risk APs were also associated with increased connectivity between reward, salience, and visual regions when fed, potentially reflecting greater desire for consumption following satiety.

Microglial Density Alters Measures of Axonal Integrity and Structural Connectivity

Diffusion tensor imaging (DTI) has fundamentally transformed how we interrogate diseases and disorders of the brain in neuropsychiatric illness. DTI and recently developed multicompartment diffusion-weighted imaging (MC-DWI) techniques, such as NODDI (neurite orientation dispersion and density imaging), measure diffusion anisotropy presuming a static neuroglial environment; however, microglial morphology and density are highly dynamic in psychiatric illness, and how alterations in microglial density might influence intracellular measures of diffusion anisotropy in DTI and MC-DWI brain microstructure is unknown. To address this question, DTI and MC-DWI studies of murine brains depleted of microglia were performed, revealing significant alterations in axonal integrity and fiber tractography in DTI and in commonly used MC-DWI models. With accumulating evidence of the role of microglia in neuropsychiatric illness, our findings uncover the unexpected contribution of microglia to measures of axonal integrity and structural connectivity and provide unanticipated insights into the potential influence of microglia in diffusion imaging studies of neuropsychiatric disease.

Alterations in brain white matter microstructural properties in patients with Crohn's disease in remission

Patients with inflammatory bowel disease have been shown to have abnormal brain morphometry or function, which are associated with psychological symptoms such as stress, depression or anxiety. The present work recruited 20 Crohn’s disease patients in remission (CDs) and 20 age-gender-handedness-education matched healthy controls (HCs) and compared their brain white matter microstructural properties using Diffusion Tensor Imaging (DTI). Additionally, we examined the correlations between the microstructural properties and cognition (verbal fluency language task, VF) and affect (anxiety) in both groups as well as disease duration in CDs. Results showed that CDs exhibited significant alterations in microstructural properties compared to HCs in various white matter tracts relevant to language function despite no significant difference in VF scores. Furthermore, CDs’ microstructural changes exhibited correlations with anxiety level and disease duration. These findings suggest that CD patients may experience changes in white matter microstructural properties which may be a biomarker of neuropsychiatric comorbidities of CD.

A Verbal Fluency Task-Based Brain Activation fMRI Study in Patients with Crohn's Disease in Remission

BACKGROUND AND PURPOSE

In this pilot study, we investigated functional brain activation changes in patients with Crohn's disease (CD) in remission compared to age and gender-matched healthy controls (HCs).

METHODS

Data from 20 patients with CD in remission (age range 19-63 years) and 20 HCs (matched in age and gender) were analyzed. Task functional MRI (fMRI) data were collected while participants performed a cognitive (phonemic verbal fluency) task in the scanner. All participants also performed the same task outside the scanner.

RESULTS

Task fMRI results showed greater bi-hemispheric activation in CD patients compared to controls. Because this pattern is commonly reported with normal aging, we performed further analyses to investigate fMRI responses in a subset of the younger CD patients (N = 12, age < = 35 years) compared to matched young HCs (age < = 35 years), and an older cohort of HCs (age > = 50 years). Results showed that task activation patterns were similar between young CD patients and older HCs, and that both groups differed significantly from younger HCs. Activation intensity in specific brain regions for patients was associated with disease duration.

CONCLUSIONS

These results suggest that CD patients in remission may show accelerated signs of aging in terms of brain responses to a typical cognitive task. Future work with larger sample size will need to replicate these results as well as investigate the influence of factors, such as chronicity of the disease and medication effects on task-associated brain activation patterns in this patient population.

Alterations in resting-state functional connectivity in patients with Crohn's disease in remission

Previous studies have found neural alterations in regions involved in cognitive and affective functions among Crohn's disease (CD) patients. The present work recruited 18 CD patients and 18 age-gender matched healthy controls (HC) and specifically compared differences in resting-state functional connectivity (RSFC) within the executive control network (ECN) which has been implicated in cognitive function and default mode network (DMN), which has been implicated in affective function. Additionally, we examined the correlations between RSFC in ECN and verbal fluency (VF) in both groups as well as RSFC in DMN and anxiety level in the CD group. Results showed significantly increased RSFC between the right middle frontal gyrus and right inferior parietal lobule in ECN, as well as increased RSFC between the right precuneus and right posterior cingulate cortex in DMN, among CD patients compared to HC. However, the correlations between ECN/DMN and behavioral scores in each group were not significant, which was possibility due to the limited sample size. These findings suggest that CD patients may experience changes in the connectivity patterns in ECN and DMN. Increased connectivity observed on these networks could be a potential biomarker of a neuropsychiatric manifestation of CD.

Ipsilesional Mu Rhythm Desynchronization and Changes in Motor Behavior Following Post Stroke BCI Intervention for Motor Rehabilitation

Loss of motor function is a common deficit following stroke insult and often manifests as persistent upper extremity (UE) disability which can affect a survivor's ability to participate in activities of daily living. Recent research suggests the use of brain-computer interface (BCI) devices might improve UE function in stroke survivors at various times since stroke. This randomized crossover-controlled trial examines whether intervention with this BCI device design attenuates the effects of hemiparesis, encourages reorganization of motor related brain signals (EEG measured sensorimotor rhythm desynchronization), and improves movement, as measured by the Action Research Arm Test (ARAT). A sample of 21 stroke survivors, presenting with varied times since stroke and levels of UE impairment, received a maximum of 18-30 h of intervention with a novel electroencephalogram-based BCI-driven functional electrical stimulator (EEG-BCI-FES) device. Driven by spectral power recordings from contralateral EEG electrodes during cued attempted grasping of the hand, the user's input to the EEG-BCI-FES device modulates horizontal movement of a virtual cursor and also facilitates concurrent stimulation of the impaired UE. Outcome measures of function and capacity were assessed at baseline, mid-therapy, and at completion of therapy while EEG was recorded only during intervention sessions. A significant increase in r-squared values [reflecting Mu rhythm (8-12 Hz) desynchronization as the result of attempted movements of the impaired hand] presented post-therapy compared to baseline. These findings suggest that intervention corresponds with greater desynchronization of Mu rhythm in the ipsilesional hemisphere during attempted movements of the impaired hand and this change is related to changes in behavior as a result of the intervention. BCI intervention may be an effective way of addressing the recovery of a stroke impaired UE and studying neuromechanical coupling with motor outputs. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT02098265.

Abstract WP190: Ipsilesional Mu Changes Track With Behavioral Changes in UE BCI Intervention in Stroke Survivors

Loss of motor function is a common deficit following stroke insult and often manifests as persistent upper extremity (UE) disability which can affect a survivor's ability to participate in activities of daily living. Recent research suggests the use of brain-computer interface (BCI) devices might improve UE function in stroke survivors at various times since stroke. This randomized crossover-controlled trial examines whether intervention with this BCI device design attenuates the effects of hemiparesis, encourages reorganization of functional connectivity, and improves movement, as measured by the Action Research Arm Test (ARAT). 21 stroke survivors, presenting with varied times since stroke and levels of UE impairment, received a maximum of 18 - 30 hours of intervention with a novel electroencephalogram based BCI driven functional electrical stimulator (EEG-BCI-FES) device. Driven by spectral power recordings from contralateral EEG electrodes during cued attempted grasping of the hand, the EEG-BCI-FES device modulates horizontal movement of a virtual cursor as well as facilitating concurrent FES stimulation of only the impaired upper extremity. Primary outcome measure of function, ARAT was assessed at baseline, mid-therapy, and at completion of therapy. The signed r-squared value (at the ipsilesional C4 or C3 sites) for the Mu (8-12Hz) rhythm significantly decreased in the post-therapy stage compared to the pre-therapy stage (one-tailed paired t-test: t(20)= 1.85; p = 0.039; meanPRE = -0.142; meanPOST = -0.161), while the subject attempted movements of the impaired hand. These findings suggests that as the result of the intervention sessions, the “desynchronization” of the Mu rhythm signals significantly increases post-therapy at the ipsilesional motor site and this change is related to changes in behavior as a result of intervention. BCI intervention may be an effective way of addressing the stroke recovery of a stroke impaired upper extremity.

Abstract TP95: Whole Brain Gray Matter Structural Changes Following Stroke

Background: Changes in cortical gray matter volume is associated with cognitive impairment after ischemic stroke. Here, we investigated the differences of whole brain gray matter volume and gray matter density between acute stroke patients (AS), patients with risk factors for stroke (RS), and healthy controls (HC).

Methods: Patients with acute stroke (N = 65, ischemic stroke within 8 days of stroke onset, mean age = 60.64 years, SD = 12.24, SEM = 1.71), patients with risk factors for stroke (N = 27, mean age = 64.12 years, SD = 11.96, SEM = 2.30) and age-matched healthy controls (N = 57, mean age = 58.05 years, SD = 6.06, SEM = 0.80) were scanned on a GE 3T MRI scanner. High-resolution 3D T1-weighted whole brain BRAVO FSPGR images were collected: repetition time = 8160 ms, echo time = 3.18 ms, flip angle = 12°, field-of-view = 100 х 100 mm, slice thickness = 1 mm. Gray matter volume and density changes were assessed using VBM8 toolbox and SPM8, with Gaussian Random Field as multiple comparison (voxel p < .001, cluster p < .05).

Results: Two sample t-test indicated that: (1) AS had significantly decreased gray matter volume compared to RS (only on the postcentral gyrus) and HC (in sub-regions of frontal, temporal, occipital lobes, sub-lobar, cerebellum); (2) AS also had significantly decreased gray matter density compared to RS (in sub-regions of frontal, temporal, parietal, occipital lobes, limbic lobe) and to HC (in sub-regions of frontal, temporal, occipital lobes, sub-lobar, limbic lobe, cerebellum) but except two regions with increased density compared to HC (anterior and posterior cingulum). (3) RS had both significantly decreased gray matter volume and density compared to HC (in sub-regions of frontal, temporal, occipital lobes, sub-lobar, cerebellum).

Conclusion: Compared to RS and HC, AS may induce changes in both gray matter volume and density, which result in subsequent cognitive impairments such as language or working memory. Significant changes in RS indicate that brain and associated behavioral changes in this population merits further investigation before progression to stroke.

Abstract WP201: Electroencephalogram Based Brain Computer Interface Therapy for the Restoration of Distal Upper Extremity Motor Function in Chronic Severely Impaired Individuals

Introduction: Many stroke survivors are often left with persistent upper extremity motor impairment that affect their overall quality of life. This study aims to evaluate the efficacy of using non-invasive electroencephalographic (EEG) based brain-computer interface (BCI) therapy to facilitate distal upper extremity motor function. Data was acquired from 18 participants ((mean age = 60 years, F = 9, M = 9, 5 = sub-chronic (over 1 year from stroke onset), 13 = chronic (less than 1 year)). Behavioral outcomes were measured using the Modified Ashworth Scale (MAS), a Motor Activity Log (MAL), and the Stroke Impact Scale (SIS). We investigated whether severely-impaired, chronic stroke survivors could use BCI treatment to recover from stroke at a rate similar to that of severely-impaired, sub-chronic stroke survivors after BCI intervention.

Methods: EEG data was acquired using BCI2000 software and 16 channel EEG cap with electrodes positioned according to the standard 10-20 system over the sensorimotor cortex at C3 & C4. Participants were cued to move either their left or right hand to control a cursor towards the right or left side of a monitor. Data acquired at baseline (no more than one week prior to BCI therapy) and post-therapy (no more than one week following BCI therapy) were used in this analyses.

Results: No significant decrease in improvement in the chronic group compared to the sub-chronic group (0.95 confidence interval) was observed. The chronic group showed significant improvement in their affected arm in: MAS elbow flexion (p = 0.03746), MAS finger extension (p = 0.01896), MAL arm use (p = 0.02065), MAL how well they could use their arm (p = 0.02065), SIS perceived strength (p = 0.04105), and SIS arm use for daily life tasks (p = 0.01741).

Conclusion: For chronic stroke survivors, BCI intervention for restoration of upper extremity motor function may promote recovery at a rate similar to that of sub-chronic survivors.

Behavioral Outcomes Following Brain-Computer Interface Intervention for Upper Extremity Rehabilitation in Stroke: A Randomized Controlled Trial

Stroke is a leading cause of persistent upper extremity (UE) motor disability in adults. Brain-computer interface (BCI) intervention has demonstrated potential as a motor rehabilitation strategy for stroke survivors. This sub-analysis of ongoing clinical trial (NCT02098265) examines rehabilitative efficacy of this BCI design and seeks to identify stroke participant characteristics associated with behavioral improvement. Stroke participants (n = 21) with UE impairment were assessed using Action Research Arm Test (ARAT) and measures of function. Nine participants completed three assessments during the experimental BCI intervention period and at 1-month follow-up. Twelve other participants first completed three assessments over a parallel time-matched control period and then crossed over into the BCI intervention condition 1-month later. Participants who realized positive change (≥1 point) in total ARAT performance of the stroke affected UE between the first and third assessments of the intervention period were dichotomized as "responders" (<1 = "non-responders") and similarly analyzed. Of the 14 participants with room for ARAT improvement, 64% (9/14) showed some positive change at completion and approximately 43% (6/14) of the participants had changes of minimal detectable change (MDC = 3 pts) or minimally clinical important difference (MCID = 5.7 points). Participants with room for improvement in the primary outcome measure made significant mean gains in ARATtotal score at completion (ΔARATtotal = 2, p = 0.028) and 1-month follow-up (ΔARATtotal = 3.4, p = 0.0010), controlling for severity, gender, chronicity, and concordance. Secondary outcome measures, SISmobility, SISadl, SISstrength, and 9HPTaffected, also showed significant improvement over time during intervention. Participants in intervention through follow-up showed a significantly increased improvement rate in SISstrength compared to controls (p = 0.0117), controlling for severity, chronicity, gender, as well as the individual effects of time and intervention type. Participants who best responded to BCI intervention, as evaluated by ARAT score improvement, showed significantly increased outcome values through completion and follow-up for SISmobility (p = 0.0002, p = 0.002) and SISstrength (p = 0.04995, p = 0.0483). These findings may suggest possible secondary outcome measure patterns indicative of increased improvement resulting from this BCI intervention regimen as well as demonstrating primary efficacy of this BCI design for treatment of UE impairment in stroke survivors. Clinical Trial Registration: ClinicalTrials.gov, NCT02098265.

The Development of Augmented Reality to Enhance Minimally Invasive Surgery

Minimally invasive surgery (MIS) reduces unnecessary tissue damage to the patient but obscures the natural surgical interface that is provided by open surgical procedures. Multiple feedback mechanisms, mainly visual and tactile, are greatly reduced in MIS. Microscopes, endoscopes, and image-guided navigation traditionally provide enough visual information for successful minimally invasive procedures, although the limited feedback makes these procedures more difficult to learn. Research has been performed to develop alternative solutions that regain additional feedback. Augmented reality (AR), a more recent guidance innovation that overlays digital visual data physically, has begun to be implemented in various applications to improve the safety and efficacy of minimally invasive procedures. This review focuses on the recent implementation of augmented display and direct visual overlay and discusses how these innovations address common feedback concerns associated with minimally invasive surgeries.

Parameters From the Complete Phonatory Range of an Excised Rabbit Larynx

OBJECTIVE

This study aims to collect data throughout the complete phonatory range using rabbit larynges.

STUDY DESIGN

This is a methodological excised rabbit larynx study.

METHODS

Seven rabbit larynges were dissected and mounted on a modified excised laryngeal apparatus. Phonation was initiated at phonation threshold pressure (PTP) and airflow was increased by consistent increments until phonation instability pressure (PIP) was reached. At each airflow level, aerodynamic measurements, acoustic recordings, and high-speed videos were recorded. This procedure was repeated at multiple elongation conditions to further explore the parameters. Data were then compared across subjects and elongation conditions.

RESULTS

At PTP, subglottal pressure, fundamental frequency, and sound pressure level were found to increase significantly as elongation was increased. As elongation was increased at PIP, airflow was found to significantly decrease, whereas fundamental frequency was found to significantly increase. Vibratory amplitude decreased at both PTP and PIP as elongation increased. Also, as elongation increased, the range of all parameters was found to decrease significantly.

CONCLUSIONS

The results obtained, combined with the similarities of the histologic structure of the vocal fold lamina propria between rabbits and humans, validate the rabbit larynx as an effective and reliable model for tissue inflammation studies.

An Objective Parameter for Quantifying the Turbulent Noise Portion of Voice Signals

OBJECTIVES

Currently, there are no objective measures capable of distinguishing between all four voice signal types proposed by Titze in 1995 and updated by Sprecher in 2010. We propose an objective metric that distinguishes between voice signal types based on the aperiodicity present in a signal.

STUDY DESIGN

One hundred fifty voice signal samples were randomly selected from the Disordered Voice Database and subjectively sorted into the appropriate voice signal category on the basis of the classification scheme presented in Sprecher 2010.

METHODS

Short-time Fourier transform was applied to each voice sample to produce a spectrum for each signal. The spectrum of each signal was divided into 250 time segments. Next, these segments were compared to each other and used to calculate an outcome named spectrum convergence ratio (SCR). Finally, the mean SCR was calculated for each of the four voice signal types.

RESULTS

SCR was capable of significantly differentiating between each of the four voice signal types (P < 0.001). Additionally, this new parameter proved equally as effective at distinguishing between voice signal types as currently available parameters.

CONCLUSION

SCR was capable of objectively distinguishing between all four voice signal types. This metric could be used by clinicians to quickly and efficiently diagnose voice disorders and monitor improvements in voice acoustical signals during treatment methods.

Genomic analysis of filoviruses associated with four viral hemorrhagic fever outbreaks in Uganda and the Democratic Republic of the Congo in 2012

In 2012, an unprecedented number of four distinct, partially overlapping filovirus-associated viral hemorrhagic fever outbreaks were detected in equatorial Africa. Analysis of complete virus genome sequences confirmed the reemergence of Sudan virus and Marburg virus in Uganda, and the first emergence of Bundibugyo virus in the Democratic Republic of the Congo.

Nodular lesions found in Irish poultry during veterinary inspection at poultry meat plants

This investigation was carried out on three categories of old birds including cage layers, game birds (ducks and pheasants) and free-range birds. During the study 137,918 carcasses were examined grossly at slaughterhouses and 2040 condemned carcasses underwent detailed post-mortem examination. A total of 419 of the condemned carcasses had nodular lesions. On histological examination of the nodular lesions, one case of bacterial granuloma in a free-range layer, two cases of parasitic granulomata in ducks, 337 cases of different types of tumours and 79 cases of miscellaneous lesions with a nodular appearance were diagnosed. Overall, there was a total condemnation rate of 1.5%. The prevalence of various types of nodular lesions was discussed.

Regenerate: assessing the feasibility of a strength-training program to enhance the physical and mental health of chronic post stroke patients with depression

OBJECTIVE

The Regenerate pilot study explored whether a 10-week, community-based progressive resistance training (PRT) program could reduce depressive symptoms in depressed chronic stroke survivors.

METHODS

Participants were screened for depressive status using the PHQ-9 and confirmed by psychiatric assessment. Eligible people (n = 45) were randomised to PRT or a waiting-list comparison group. The PRT program included two high intensity sessions/week for 10 weeks at a community-based gymnasium. Depressive status, physical and mental health and quality of life were measured at baseline, 10 weeks and 6 months. Muscle strength was assessed using 1 repetition maximum (1-RM) for upper and lower limbs.

RESULTS

The participants' median age was 69 years: 27 were male. The intervention group had lower depression scores than the comparison group at all time points. At 6-month follow-up, there was a trend for PRT participants to be more likely to be no longer depressed than the comparison group, but the difference was not significant after adjusting for baseline scores. There were modest improvements in health and wellbeing over time, but many scores were lower than reported in non-depressed people. Intervention participants demonstrated significant improvements in strength. Program adherence was good: on average 75% of the 10-week program was completed.

CONCLUSIONS

The intervention appeared to be feasible within a community-based setting. To optimize stroke recovery and improve the quality of life of stroke survivors, health professionals should continue to focus on helping survivors' mental health recovery as well their physical rehabilitation.

Guideline implementation in allied health professions: a systematic review of the literature

BACKGROUND

Clinical guidelines aim to improve the safety and quality of patient care by providing clinicians with graded recommendations based on evidence of best practice.

OBJECTIVE

To evaluate the effects of the introduction of clinical guidelines for allied health professionals, and to estimate the effectiveness of the guideline dissemination and implementation strategies used.

METHODS

A comprehensive search of six electronic databases to June 2006 and the Cochrane Effective Practice and Organisation of Care database was conducted. Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series studies were included if the intervention was aimed at implementing guidelines in the allied health professions. Articles were screened for eligibility and their methodological quality was assessed; data were extracted independently by two reviewers.

RESULTS

Fourteen studies met the inclusion criteria. The methodological quality varied greatly, with the proportion of quality criteria met ranging from 0 to 6 out of seven. In most studies, the effects reported for patient and process outcomes were small and in favour of the intervention group. Of the 14 included studies, 10 focused on educational interventions. Six of the 14 studies used a single intervention strategy and seven used a multi-faceted implementation strategy. One study compared both single and multi-faceted strategies. Multi-faceted interventions were no more effective than single intervention strategies and effects of the same strategy varied across trials.

CONCLUSIONS

There is no evidence to support a set guideline implementation strategy for allied health professionals. When implementing clinical guidelines it is important to first identify specific barriers to change using theoretical frameworks of behaviour change and then develop strategies that deal with these barriers. When measuring the effectiveness of these strategies, professionals should consider the use of both patient and process outcomes and choose outcomes that reflect their aims.

Changes in gait and fatigue from morning to afternoon in people with multiple sclerosis

OBJECTIVES

The aim was to measure changes in walking patterns and self rated fatigue in people with multiple sclerosis (MS) compared with age matched control subjects, from the morning to the afternoon within a single day.

METHODS

Fourteen patients with MS and the same number of matched control subjects performed four 10 m gait trials at their preferred walking speed at 10 00 am and then again at 3 00 pm on the same day. Gait speed, stride length, cadence, and the percentage of the gait cycle spent in double limb support were measured using a foot switch stride analyzer. Patients with MS also self rated their fatigue levels in the morning and afternoon using an 11 point scale.

RESULTS

Compared with control subjects, patients walked very slowly, with reduced stride length and around twice as much variability in gait performance. Although self rated fatigue significantly increased from the morning to the afternoon, walking patterns remained consistent in both groups over the course of the day.

CONCLUSIONS

These findings imply that mechanisms controlling locomotion are separate from those regulating perceived fatigue. Objective measures of performance, rather than self report, should be used to monitor change in patients with multiple sclerosis.

Association of awareness, intrapersonal and interpersonal factors, and stage of dietary change with fruit and vegetable consumption: a national survey

PURPOSE

To examine associations of awareness, intrapersonal and interpersonal factors, and stage of change with consumption of fruits and vegetables.

DESIGN

Nationally representative, random digit dial survey conducted in 1997 with a response rate of 44.5%. Psychosocial correlates of fruit and vegetable consumption were assessed using regression analyses.

SETTING

United States.

SUBJECTS

A total of 2605 adults who were 18 years and older.

MEASURES

Awareness of the "5 A Day for Better Health" program and its message, along with stage of change; taste preferences; self-efficacy; and perceived benefits, barriers, threats, social support, and norms related to fruit and vegetable consumption.

RESULTS

Awareness and intrapersonal and interpersonal factors explained 24% of the variance in fruit and vegetable consumption beyond the 9% explained by demographic characteristics. Knowledge of the 5 A Day message was associated with a 22% increase in fruit and vegetable consumption. Self-efficacy for eating fruits and vegetables and taste preferences (affect) were the factors most consistently and strongly associated with both higher consumption and higher likelihood of being in action or maintenance stages of change. Affect and perceived barriers were more strongly associated with increased vegetables and salad than fruit.

CONCLUSIONS

Dietary intervention programs to increase fruit and vegetable consumption should emphasize the 5 A Day message, increased self-efficacy, and ways to make vegetables more palatable and easily accessible. Understanding the factors that influence dietary choices should be used when designing dietary interventions.

The biomechanics and motor control of gait in Parkinson disease

Parkinson disease is a progressive neurological condition characterised by hypokinesia (reduced movement), akinesia (absent movement), tremor, rigidity and postural instability. These movement disorders are associated with a slow short-stepped, shuffling gait pattern. Analysis of the biomechanics of gait in response to medication, visual cues, attentional strategies and neurosurgery provides insight into the nature of the motor control deficit in Parkinson disease and the efficacy of current therapeutic interventions. In this article we supplement a critical evaluation of the Parkinson disease gait literature with two case examples. The first case describes the kinematic gait response of an individual with Parkinson disease to visual cues in the "off" phase of the levodopa medication cycle. The second case investigates the biomechanics and motor control of turning during walking in a patient with Parkinson disease compared with elderly and young control subjects. The results are interpreted in light of the need for gait analysis to investigate complex functional walking tasks rather than confining assessment to straight line walking, which has been the trend to date.

Supporting parents of children with communication difficulties: a model

The project focuses on 'shared listening' from a structured developmental framework of 'sound/no sound awareness' to basic 'phonological awareness' linking it to the Foundation Curriculum: Early Years Goals (Department for Education and Employment 2000) and National Literacy Framework (Department for Education and Employment 1998). The project is based around parents borrowing topic bags where their children have been identified by speech and language therapy/specialist language and communication support teachers as having listening/phonological difficulties. Following a simple screening assessment parents borrow the bags weekly for a potential 30 weeks. These have been shown to have an effect on both parental attitudes to helping listening (practically-based and focused) and their children's listening skills.

Variations in the low levels of cyclin D1/BCL1 have prognostic value in chronic lymphocytic leukemia

Cyclin D1 (CyD1)/BCL1 (PRAD1) is expressed at high levels in almost all cases of mantle cell leukemia/lymphoma (MCL) and in rare cases of chronic lymphocytic leukemia (CLL). The CyD1/BCL1 protein plays an important role in the progression of cells through the G1 phase of cell cycle. Most of the CyD1/BCL1 protein expression studies are performed using immunohistochemistry. We used a sensitive solid-phase radioimmunoassay (RIA) to quantify CyD1 protein expression in 199 patients with CLL. Of these 137 patients were previously untreated with the rest having had standard chemotherapeutic regimens including alkylating agents and fludarabine before being referred to our center. Median white cell count in these patients was 49x10(3) /microl (range 3.0-438.5x10(3)/microl), hemoglobin level 13.1 g/dl (range 5.2-17.3 g/dl), platelet count 157x10(3) /microl (range 10-377x10(3) /microl), age 58 (range 26-89), and beta2-microglobulin 2.75 mg/dl (range 1.1-14.3). The median radioactivity (CPM) of mononuclear cells obtained from 56 normal individuals was assigned a value of 1. There was no significant variation in CyD1 levels among normal individuals (SD=0. 12). While most CyD1 levels in MCL varied from 6.5 to 15.6, the median CyD1/BCL1 in CLL was 1.4 with 75th percentile under 2.12. Rare CLL cases (3.5%) showed levels between 4 and 8.83. When divided into two groups at the median level, patients with higher CyD1/BCL1 expression had shorter survival (P = 0.03). This remained true when applied only to the previously untreated patients (P=0.05). Despite the relatively low expression, the CyD1/BCL1 levels in univariate analysis were as good or better predictors of survival than Binet (P = 0.03) or Rai (P = 0.05) staging. Furthermore, CyD1/BCL1 levels correlated with serum beta2-microglobulin (P = 0.001), white blood cell count (P = 0.004) and hemoglobin levels at the time of collection (P = 0.0003) but not with lymphocyte count, platelet count or age. The data demonstrate that CyD1/BCL1 is likely to play a significant role in the biology of CLL and can be used as a prognostic indicator. Further studies to clarify the role of CyD1 in the biology of CLL and its value as a prognostic indicator at the time of diagnosis are encouraged.

The continuing fall in incidence of hypoxic-ischaemic encephalopathy in term infants

OBJECTIVE

To examine trends in incidence of hypoxic-ischaemic encephalopathy in term infants over a twenty-one year period.

DESIGN

A retrospective analysis of medical records of all term infants admitted to a neonatal unit with hypoxic-ischaemic encephalopathy during the years 1992-1996 (period C) and a comparison with data from the years 1976-1980 (period A) and 1984-1988 (period B) from the same unit (previously published).

SETTING

A District Health Authority in Central England serving a population of about 450,000.

SAMPLE

All term infants admitted with clinical features of hypoxic-ischaemic encephalopathy.

MAIN OUTCOME MEASURES

Incidence of three grades of hypoxic-ischaemic encephalopathy, disability and mortality.

RESULTS

In each five year period there were similar numbers of births. Over the time-span of this study the stillbirth rate and neonatal mortality rate has consistently fallen. The overall incidence of hypoxic-ischaemic encephalopathy in term infants was significantly lower (P < 0.001; OR 0.42 CI 0.29-0.59) in the present study period (C) compared with the earlier study period B (1.9 vs 4.6 per 1,000 total live births). The fall in moderately and severely affected infants between the present and the first study period was significant (1.2 vs 2.6 per 1,000 total live births, P < 0.001: OR 0.46 CI 0.29-0.72). The number of deaths and the incidence of cerebral palsy in survivors fell progressively over the 21 years spanned by this study.

CONCLUSION

This study shows that the incidence of hypoxic-ischaemic encephalopathy and its sequelae in term infants has fallen significantly. The use of cardiotocography and caesarean section rates have risen but the relative contributions of changes in clinical practice are uncertain.

Virulence for mice of Staphylococcus aureus strains from bovine mastitis related to colonial morphology and serological types in serum-soft agar

Six Staphylococcus aureus strains isolated from bovine mastitic milk representing the typical growth types in soft agar media were injected into mice via the intraperitoneal route. Strains showing diffuse colony morphology (DCM) in serum-soft agar (SSA) as a permanent characteristic which reacted against anti-capsular sera types A, B, and D were virulent for mice. A strain showing DCM in SSA that reacted only against anti-capsular serum D behaved as a compact-colony-morphology-type strain in the peritoneal cavity of the mouse. Diffuse-type colony morphology and presence of capsular antigens type A, B, and D correlated with increased virulence for mice, but a capsule could not be demonstrated.

Home care & managed care--prospective partners

Health care reform will soon be upon both home care and managed care. Can the two industries meet and accomplish their mutual goal of providing cost-effective, high-quality care?

Effect of partially purified Staphylococcus aureus beta-haemolysin on the mammary gland of the mouse

Partially purified Staphylococcus aureus Beta-haemolysin and a S. aureus strain (FGH28), isolated from a clinical case of bovine mastitis, known to produce in vitro Beta-, but neither Alpha- nor Delta-haemolysins were each injected separately into the mammary gland of mice. Relative purity and in vitro biological activities of this preparation were assessed. The effects of both the partially purified preparation and the S. aureus strain injected were assessed in terms of mortality, clinical appearance, macroscopic and microscopic changes, recovery of organisms from the inoculated glands and biological activity in supernatants from ground mammary glands. When injected alone, partially purified Beta-Haemolysin was not found to be an important virulence factor, being a diffuse infiltration of neutrophils into the alveoli the pathological effect observed following its inoculation. Vascular lesions were observed, in the most severe cases, following injection of S. aureus FGH28.

Typhoid fever, ciprofloxacin, and renal failure

An 11 year old boy from whom Salmonella typhi had been isolated was treated with ciprofloxacin. He developed non-oliguric acute renal failure that was treated successfully.

Associations between farmers' personal characteristics, management practices and farm performance

A survey was carried out in a random sample of 123 dairy farms from the east of Ireland. The monthly mean production per cow was 315 l of milk and 11.5 kg of fat. The mean log herd somatic cell count was 5.45 (arithmetic mean = 372,573 cells/ml), with almost 50% of the monthly counts over 300,000 cells/ml in a 12-month period. Bivariate and multivariate analysis was performed to assess the relative impact of the personal characteristics of the farmer and the management policies he applied on the amount and quality of the milk produced. In five out of six models the group of variables related to farmers' attitudes, values, and sociodemographic profile explained a similar or greater amount (between 14.44 and 34.35%) of the variation of farm performance than the group of management variables (between 14.33 and 25.99%) as measured by the R2. These results stress the importance of the human factors in explaining variation in farm performance.

Tuberculosis in free-living deer

Tissues from 130 wild deer shot by hunters in County Wicklow, Ireland in 1983-1984 were examined for evidence of tuberculosis. The tissues examined included the lymph nodes of the head, the lung substances and associated lymph nodes, the hepatic lymph nodes and kidneys. Gross lesions were found in five deer. Mycobacteria isolated from the tissues were classified as Mycobacterium bovis on the basis of cultural, biochemical and biological tests in guinea pigs and rabbits.