The prevalence of challenging behaviors: a total population study

A total population study was undertaken in two areas of England to identify the situation and characteristics of people reported to exhibit challenging behaviors. We found that: (1) challenging behaviors are shown by 10-15% of people with mental retardation who are in contact with educational, health or social care services for people with mental retardation; (2) the most common forms of challenging behaviors reported were 'other' behavior (shown by 9%-12% of all people screened), aggression (7%), destructive behavior (4%-5%) and self-injury (4%); (3) the majority of people identified showed two or more of these four general forms of challenging behavior; (4) approximately two-thirds of the people identified were boys/men; (5) close to two-thirds of the people identified were adolescents or young adults; (6) approximately 50% of the people identified as showing more demanding challenging behavior were living with their families; (7) people who showed more demanding challenging behavior were more likely to need greater levels of assistance in eating, dressing and washing, be incontinent and have more restricted expressive and receptive communication.

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance

Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale.

Objectives

To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis.

Design, Setting, and Participants

A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017.

Main Outcomes and Measures

Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis.

Results

The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]).

Conclusions and Relevance

This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

Chiari malformation presenting in adults: a surgical experience in 127 cases

We reviewed 127 patients who were operated upon for adult presentation Chiari malformation and made six conclusions: (a) The clinical examination remains crucial in the diagnosis. (b) The surgical anatomy is highly varied. (c) Syrinxes can be missed on preoperative contrast studies. (d) By a conservative grading system, we determined that 46% of the patients improved during long term follow-up. One-quarter deteriorated over the long run in spite of any treatment. (e) The overall results did not differ whether the treatment was plugging of the central canal plus decompression or decompression alone. (f) In patients with progression, plugging of the central canal obtained superior results. A review of the literature shows that the natural history of this complex disease process has not been established. This history is needed to identify the course of what may be several important factors that lead to the pathological condition in this disease.

Defining mechanisms of action of interleukin-11 on the progression of radiation-induced oral mucositis in hamsters

Oral ulcerative mucositis is a common toxicity associated with drug and radiation therapy for cancer. It impacts on quality of life and economic outcomes, as well as morbidity and mortality. Mucositis is often associated with dose limitations for chemotherapy or is a cause for dose interruption for radiation. The complexity of mucositis as a biological process has only been recently appreciated. It has been suggested that the condition represents a sequential interaction of oral mucosal cells and tissues, pro-inflammatory cytokines and local factors such as saliva and the oral microbiota. The recognition that the pathophysiology of mucositis is a multifactorial process was partially suggested by the observation that interleukin-11 (IL-11), a pleotropic cytokine, favorably altered the course of chemotherapy-induced mucositis in an animal model. In the current study, we evaluated a series of biologic and morphologic outcomes to determine their roles and sequence in the development of experimental radiation-induced mucositis and to evaluate the effects of IL-11 in attenuating them. Our results suggest that IL-11 favorably modulates acute radiation-induced mucositis by attenuating pro-inflammatory cytokine expression. Data are also presented which help define the pathobiological sequence of mucositis.

Breast cancer incidence in women with abnormal cytology in nipple aspirates of breast fluid

This is a prospective study of breast cancer risk in relation to nipple aspirate fluid cytology in 2,701 volunteer white women from the San Francisco Bay Area first enrolled between 1973 and 1980. The women were not pregnant or lactating and were free of breast cancer within 6 months of entry into the study. The breast cancer status of this cohort was determined between June 1988 and April 1991. Follow-up was complete for 87% (n = 2,343) of the cohort, representing 29,961 person-years and an average of 12.7 years of follow-up. The overall breast cancer incidence was 4.4% (104 of 2,343) and rose with fluid cytology findings as follows: no fluid obtained, 2.6% (9 of 352); unsatisfactory specimen, 4.8% (15 of 315); normal cytology, 4.3% (56 of 1,291); epithelial hyperplasia, 5.5% (18 of 327); and atypical hyperplasia, 10.3% (6 of 58). Relative risks for breast cancer and their 95% confidence intervals were estimated by Cox regression, adjusting for age and year of entry. Compared with the relative risk for women who yielded no fluid, relative risks were: unsatisfactory specimen, relative risk (RR) = 1.4 (95% confidence interval (CI) 0.6-3.3); normal cytology, RR = 1.8 (95% CI 0.9-3.6); epithelial hyperplasia, RR = 2.5 (95% CI 1.1-5.5); and atypical hyperplasia, RR = 4.9 (95% CI 1.7-13.9). These findings were strongest for and were mainly confined to women aged 25-54 years. Women with atypical hyperplasia and a first-degree family history of breast cancer were six times more likely to develop breast cancer than were women with atypical hyperplasia but without a family history of breast cancer (95% CI 1.0-30.2). These findings provide strong support for our hypothesis that hyperplasia and atypical hyperplasia diagnosed in nipple aspirates of breast fluid are associated with an increased risk of breast cancer.

The prevalence of stress incontinence during pregnancy and following delivery

OBJECTIVES

To examine the variation in findings from epidemiological studies which describe the prevalence of stress incontinence during and after pregnancy, and to undertake a prospective survey of the prevalence of stress incontinence during pregnancy and following childbirth in order to provide clarification of the findings presented in the literature.

DESIGN

A review of the literature was undertaken using the Medline and Popline CD Rom. A postal questionnaire was sent to a sample of women when they reached 34 weeks' gestation and repeated at 8 weeks postpartum.

PARTICIPANTS

1008 women were recruited to the study when they attended the antenatal clinic at two hospitals in the north west of England. Seven hundred and seventeen (71%) women responded to the first questionnaire and 572 (57%) completed the second questionnaire.

FINDINGS

The prevalence of stress incontinence during pregnancy reported in the literature ranges from 20 to 67%. Following delivery the reported prevalence is between 6 and 29%. In the present study 59% of women reported stress incontinence during pregnancy, and 31% following delivery. Ten per cent of the women had daily episodes of incontinence during their pregnancy, 2% of all women reported daily incontinence following delivery. An association was found between parity and stress incontinence, with women of higher parity being more likely to experience the condition. No difference in the prevalence of stress incontinence was found between women who had a normal delivery and those having an instrumental delivery. A caesarean section was found to be associated with a lower incidence of stress incontinence compared with a normal spontaneous delivery.

KEY CONCLUSION

A high proportion of women experienced stress incontinence during pregnancy and/or following delivery. Some women reported severe symptoms, with leakage on a daily basis. Women of higher parity were more likely to suffer from the condition. Whilst women who had a normal spontaneous delivery or an instrumental delivery reported a similar level of stress incontinence, women who had a caesarean section were less likely to have the condition.

Factors associated with staff stress and work satisfaction in services for people with intellectual disability

Staff stress and morale have been identified as major issues affecting the quality of services for people with intellectual disability. The present study investigates factors directly and indirectly associated with staff general distress, job strain and work satisfaction amongst staff in services for people with intellectual disability. As part of a large-scale survey of staff in services for people with intellectual disability, information was collected from 450 staff concerning general distress, job strain and work satisfaction, and a wide range of factors potentially associated with these outcomes. Path analyses revealed that three factors accounted for 28% of the variance in general distress scores: (I) wishful thinking, (2) stress linked to work-home conflict and (3) role ambiguity. Six factors accounted for 50% of the variance in job strain scores: (I) wishful thinking, (2) stress linked to a lack of staff support, (3) alienative commitment, (4) role ambiguity, (5) stressors linked to a low status job and (6) working longer contracted hours. Six factors accounted for 66% of the variance in work satisfaction scores: (I) stress linked to a low status job, (2) support from supervisors, (3) influence over work decisions, (4) alienative commitment, (5) support from colleagues and (6) older staff age. A range of factors indirectly associated with the three outcome measures was also identified. The models of general distress, job strain and work satisfaction empirically derived in the present study confirm and extend previous research in this area. The implications for organizations and future research are discussed.

Women's reluctance to seek help for stress incontinence during pregnancy and following childbirth

OBJECTIVE

to identify whether women were made aware of stress incontinence around the time of childbirth, whether symptomatic women sought help from professionals caring for them at this time, to look at what help they receive in the first instance and to understand why some of those experiencing it chose not to seek help.

DESIGN

a qualitative survey was conducted using semi-structured interviews.

SETTING

interviews were conducted in participants' own homes.

PARTICIPANTS

42 women who reported symptoms of stress incontinence at eight weeks postpartum, and 15 women who were symptomatic one year following the birth of their baby.

FINDINGS

women were reluctant to seek help, although they were often inconvenienced and troubled by the condition. This was predominantly due to the nature of the condition itself, although the relationship with their health care professionals was also a consideration in some cases. The majority of women were not provided with information on the condition but wanted health professionals to provide a warning that the condition could occur. They also wanted health professionals to seek out information about symptoms, rather than the women themselves having to broach the subject. The first line of treatment at this time was usually a recommendation to perform pelvic floor exercises.

IMPLICATIONS FOR PRACTICE

health professionals caring for women during pregnancy or following the birth of their baby need to raise awareness of the condition, the treatment available, and to be pro-active in seeking out those experiencing incontinence rather than expecting women to approach them for help.

Predicting the persistence of severe self-injurious behavior

Information was collected on 95 people with mental retardation who had been identified seven years previously as showing severe self-injurious behavior. At follow up 71% of participants were still showing self-injurious behavior of a severity which presented a management problem for care staff. The occurrence of specific topographies of self-injury was extremely stable among the group showing persistent self-injury. Finally, self-injury status at follow-up was predicted with 76% accuracy by a logistic regression model containing three variables: site of injury (higher persistence being shown by people exhibiting head directed self-injury); reported (greater) stability of self-injury when first identified; and (younger) age.

Social network factors associated with perceived quality of life. The San Luis Valley Health and Aging Study

Demographic and social network factors associations with perceived quality of life (PQOL) were examined in a sample of rural Hispanic and non-Hispanic White (NHW) elderly. A 20-item PQOL scale measured participants' satisfaction with multiple facets of their lives. Age, gender, marital status, and living alone were not associated with this outcome. Hispanic persons with higher incomes had consistently higher ratings of quality of life compared to NHWs. More education was associated with a higher PQOL rating only among NHWs. More close friends and relatives, visiting in homes, and participation in outside activities were all independently related to PQOL. Interaction tests showed that the impact of social networks was stronger in NHWs. These findings suggest that network size and contact are important social factors that can improve quality of life for both ethnic groups. However, differences may need to be examined when judging the magnitude of these associations and when planning interventions.

Histological assessment of the mouse uterus from birth to puberty for the appearance of LGL-1+ natural killer cells

The appearance of natural killer (NK) cells during growth and maturation of the murine uterus was studied by immunohistochemistry, using the monoclonal antibody LGL-1. To determine the contributions of microorganisms in the environment and of T-cell and B-cell regulation to the establishment of a uterine NK cell population, uteri from barrier-raised, flora-defined, random-bred CD-1 mice and from genetically T-cell- and B-cell-deficient SCID mice (genotype C.B-17 scid/scid) were compared to uteri from conventionally raised CD-1 mice. Uteri were studied from birth to the ages at which these mice are normally paired for mating (7-10 wk). Absolute uterine weight and the ratio of uterine weight to body weight increased remarkably between 3 and 5 wk of age in each group of animals. Growth continued beyond Week 5 of age, and in all groups the ratio of uterine weight to body weight was similar at puberty, although both the flora-defined CD-1 and SCID mice were significantly smaller than conventionally reared mice. LGL-1+ cells could not be detected in any of the neonatal uteri examined. LGL-1+ cells were first detected at 2 wk of age in uteri from the conventional and flora-defined CD-1 mice. A significant increase in the number of LGL-1+ NK cells occurred in the CD-1 uterus between Weeks 2 and 3 of age and again between Weeks 5 and 7 of age. Environmental conditions did not alter the frequency of LGL-1+ cells between the two groups of CD-1 mice at any age studied.(ABSTRACT TRUNCATED AT 250 WORDS)

The experience of stress incontinence after childbirth

BACKGROUND

Epidemiological studies have reported prevalence of stress incontinence ranging from 23 to 67 percent during pregnancy and 6 to 29 percent after childbirth, but little is known about how the condition affects women at this time. The purpose of this study was to examine the effects of stress incontinence on women in their childbearing years.

METHODS

Interviews were conducted with 42 women who experienced stress incontinence at 8 weeks postpartum and 15 women who reported symptoms one year after delivery. Analysis of the qualitative data involved exploring themes and patterns, relationships and connections, contradictions and contrasts, and the language used within individual accounts and across the spectrum of narratives.

RESULTS

The results are presented within a framework that the women themselves adopted: day-to-day activities, putting the condition in some form of perspective, and feelings and emotions. For some women, stress incontinence had a great impact on their lives in terms of both their daily routine and psychologically, but others described it as a minor inconvenience that rarely disturbed their routine. Major concerns comprised the restrictions placed on the women, the worry or continual awareness stemming from the condition, and feelings of embarrassment associated with it. Twelve months after childbirth the effects appeared to have lessened, but a few women were still significantly affected, both physically and psychologically.

CONCLUSIONS

Although many women experience physical and psychological symptoms of stress incontinence after delivery, this study demonstrated that few sought professional care or advice for their symptoms. Health professionals should be aware of the prevalence, and women's responses to, stress incontinence so that they can initiate appropriate support and care. Further research on stress incontinence on childbearing women is necessary.

Factors associated with intended staff turnover and job search behaviour in services for people with intellectual disability

Staff turnover is a major problem in services for people with intellectual disability (ID). Therefore, understanding the reasons for staff turnover is vital for organizations seeking to improve their performance. The present study investigates the factors directly and indirectly associated with an intention to leave an organization and actual job search behaviour amongst staff in services for people with ID. As part of a large-scale survey of staff in services for people with ID, information was collected from 450 staff concerning intended turnover, job search behaviour and a wide range of factors potentially associated with these outcomes. Path analyses revealed that work satisfaction, job strain, younger staff age and easier subjective labour conditions were directly associated with intended turnover. The same factors, with the exception of younger staff age, were also directly associated with job search behaviour. Factors indirectly associated with these outcomes included wishful thinking, alienative commitment to the organization, lack of staff support, role ambiguity, working longer contracted hours, having a low-status job, a lack of influence over decisions at work and less orientation to working in community settings with people with ID. The models of staff turnover empirically derived in the present study confirm and extend previous research in this area. The implications for organizations are discussed.

Lateral ankle and hindfoot instability: a new clinical based classification

Ankle sprains are one of the most common soft tissue injuries accounting for nearly 40% of sports injuries. There are large number of procedures for its treatment reported in the literature with largely good results. The ankle forms a functional unit with the subtalar joint. We present a new classification for peritalar lateral instability. There are two intents of this classification. Firstly, the classification demonstrates an assessment and treatment guideline for the many causes of peritalar lateral instability. The second use of the classification is for research purposes so that cohorts of patients can be accurately described and the efficacy of different operations in different groups can be properly assessed.

Ly-49 G2+ NK cells are responsible for mediating the rejection of H-2b bone marrow allografts in mice

NK cells can mediate the specific rejection of bone marrow but not solid tissue allografts in lethally irradiated mice. NK cells are also responsible for the phenomenon of "hybrid resistance' in which F1 hybrid H-2 heterozygous mice can reject parental H-2 homozygous bone marrow grafts. Ly-49C and Ly-49 G2 are markers identified on subsets of NK cells. While Ly-49C+ NK cells have been demonstrated to mediate the specific rejection of H-2d bone marrow allografts, the role of the Ly-49 G2+ NK subset is unclear because depletion of this subset in vivo did not affect splenic NK activity against tumor targets. Through bone marrow transplantation typing studies, we demonstrate that Ly-49 G2+ NK cells complement Ly-49C+ NK cells in that they specifically mediate the rejection of H-2b bone marrow allografts in lethally irradiated mice. In support of this, depletion of the Ly-49C+ NK subset in vivo also enhanced the ability of the mice to reject H-2b bone marrow cells suggesting that the depletion was augmenting the ability of the Ly-49 G2+ NK cells to reject the marrow allografts. Depletion of Ly-49 G2+ NK cells in F1 hybrid mice abrogated their ability to reject parental H-2b but not H-2d bone marrow grafts. Therefore, Ly-49 G2 denotes a subset of NK cells that appears to play a critical role in the recognition of H-2b bone marrow cells in allogeneic and F1 hybrid mice.

Single dose oral naproxen and naproxen sodium for acute postoperative pain

BACKGROUND

Postoperative pain is often poorly managed. Treatment options include a range of drug therapies such as non-steroidal anti-inflammatory drugs (NSAIDs) of which naproxen is one. Naproxen is used to treat a variety of painful conditions including acute postoperative pain, and is often combined with sodium to improve its solubility for oral administration. Naproxen sodium 550 mg (equivalent to 500 mg of naproxen) is considered to be an effective dose for treating postoperative pain but to date no systematic review of the effectiveness of naproxen/naproxen sodium at different doses has been published.

OBJECTIVES

To assess the efficacy, safety and duration of action of a single oral dose of naproxen or naproxen sodium for acute postoperative pain in adults.

SEARCH STRATEGY

We searched The Cochrane Library, MEDLINE, EMBASE and the Oxford Pain Relief Database for relevant studies. Additional studies were identified from the reference list of retrieved reports. The most recent search was undertaken in July 2004.

SELECTION CRITERIA

Included studies were randomised, double blind, placebo-controlled trials of a single dose of orally administered naproxen or naproxen sodium in adults with moderate to severe acute postoperative pain.

DATA COLLECTION AND ANALYSIS

Pain relief or pain intensity data were extracted and converted into dichotomous information to give the number of patients with at least 50% pain relief over four to six hours. Relative risk estimates (RR) and the number-needed-to-treat (NNT) for at least 50% pain relief were then calculated. Information was sought on the percentage of patients experiencing any adverse event, and the number-needed-to-harm was derived. Time to remedication was also estimated.

MAIN RESULTS

Ten trials (996 patients) met the inclusion criteria: nine assessed naproxen sodium; one combined the results from two small trials of naproxen alone. Included studies scored well for methodological quality. Meta-analysis of six trials (500 patients) that compared naproxen sodium 550 mg with placebo gave a RR for at least 50% pain relief over 4 to 6 hours of 4.2 (95% confidence interval (CI) 2.9 to 6.0) and an NNT of 2.6 (95% CI 2.2 to 3.2). Three trials (334 patients) assessed naproxen 400 mg and naproxen sodium 440 mg, giving a RR of 4.8 (95% CI 2.75 to 8.38). Two small studies indicated that naproxen 200 mg and naproxen sodium 220 mg may provide effective postoperative pain relief. There was no significant difference between the number of patients experiencing any adverse event on treatment compared with placebo. Weighted mean time to remedication for naproxen sodium 550 mg was 7.6 hours compared with 2.6 hours for placebo.

REVIEWERS' CONCLUSIONS

Naproxen sodium 550 mg, naproxen 400 mg and naproxen sodium 440 mg administered orally are effective analgesics for the treatment of acute postoperative pain in adults. A low incidence of adverse events was found but reporting was not consistent.

Eurosibs: Towards robust measurement of infant neurocognitive predictors of autism across Europe

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The Eurosibs consortium is a nine-site European neurocognitive study of infants with an older sibling with ASD.

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Data quality assessments show that that neurocognitive measures hold promise for cross-site consistency in diverse populations.

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We present robust data analysis pipelines and highlight challenges and opportunities for future multisite research efforts.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects social communication skills and flexible behaviour. Developing new treatment approaches for ASD requires early identification of the factors that influence later behavioural outcomes. One fruitful research paradigm has been the prospective study of infants with a first degree relative with ASD, who have around a 20% likelihood of developing ASD themselves. Early findings have identified a range of candidate neurocognitive markers for later ASD such as delayed attention shifting or neural responses to faces, but given the early stage of the field most sample sizes are small and replication attempts remain rare. The Eurosibs consortium is a European multisite neurocognitive study of infants with an older sibling with ASD conducted across nine sites in five European countries. In this manuscript, we describe the selection and standardization of our common neurocognitive testing protocol. We report data quality assessments across sites, showing that neurocognitive measures hold great promise for cross-site consistency in diverse populations. We discuss our approach to ensuring robust data analysis pipelines and boosting future reproducibility. Finally, we summarise challenges and opportunities for future multi-site research efforts.

Bilingual Advantages in Inhibition or Selective Attention: More Challenges

A large sample (N = 141) of college students participated in both a conjunctive visual search task and an ambiguous figures task that have been used as tests of selective attention. Tests for effects of bilingualism on attentional control were conducted by both partitioning the participants into bilinguals and monolinguals and by treating bilingualism as a continuous variable, but there were no effects of bilingualism in any of the tests. Bayes factor analyses confirmed that the evidence substantially favored the null hypothesis. These new findings mesh with failures to replicate language-group differences in congruency-sequence effects, inhibition-of-return, and working memory capacity. The evidence that bilinguals are better than monolinguals at attentional control is equivocal at best.

The instruction in pelvic floor exercises provided to women during pregnancy or following delivery

OBJECTIVES

to examine the instruction in pelvic floor exercises given to women during pregnancy or following delivery, to assess the quality of any instruction provided, and to consider these in light of the women's views about the service.

DESIGN

a postal questionnaire was sent to a sample of women when they reached 34 weeks of pregnancy and a second at 8 weeks postpartum. A sub-sample of women who reported symptoms of stress incontinence at 8 weeks postpartum were interviewed about the instruction in pelvic floor exercises that they received during their pregnancy, or in the puerperium.

PARTICIPANTS

of the 918 women who were sent the first questionnaire, 717 returned it completed (78%). Five-hundred-and-seventy-two of 894 women (64%) completed the second questionnaire. Forty-two of 179 symptomatic women (23%) took part in an interview.

FINDINGS

55% of women received some form of instruction in pelvic floor exercises by 34 weeks of pregnancy. Eighty-six percent received instruction following birth. The way the information was given varied, ranging from a brief reminder, to exercising in a class with an instructor. The information was provided by a range of health professionals, and no single profession appeared to undertake responsibility for the service. As a result, the views of the service varied. A few women reported that they had received good quality instruction, others were critical of it, and a small number reported that they had received no instruction at all. The widespread practice of leaving a leaflet by the women's beds during their stay in hospital, was criticised by a large proportion of the women.

KEY CONCLUSION

the instruction in pelvic floor exercises by health service professionals was provided on an ad hoc basis. In many instances, the programme of instruction did not meet recommendations made in the literature. It is likely that the success of randomised controlled trials reported in the literature would not be repeated in the 'real world' Implications for practice: there is a need for the service to be reorganised so that all women receive high-quality instruction during pregnancy, with a reminder to exercise following birth. This could help to prevent, or relieve, the symptoms of stress incontinence that frequently occur at these times.

The prognostic significance of histomorphometry and immunohistochemistry in giant cell tumors of bone

Eighty-two cases of giant cell tumor (GCT) were reviewed. Hematoxylin-eosin-and hematoxylin, phloxine, saffron, and alcian green-stained sections (82 cases) were examined for mitotic rate, the number of giant cells, and the pleomorphism of the stromal cells. In 29 cases, the tumor was stained for CD68, alpha 1-antichymotrypsin (AIACT), S100 protein, Muramidase, and von Willebrand factor (factor VIII). The staining properties of mononuclear and multinucleated giant cells were compared. Morphometric analysis was performed on 14 cases with a LECO 2001 computer-assisted image analyzer (LECO Instruments Ltd, Mississauga, Ontario, Canada) and included absolute cell count, nuclear area, perimeter, roughness, roundness, and aspect and nuclear versus cytoplasmic ratios, measured both in the stromal cells and giant cells. The cases were divided into four groups: (1) cases with metastasis, (2) cases with recurrence, (3) cases with both metastasis and recurrence, and (4) cases with neither metastasis nor recurrence. Immunohistochemistry revealed a stronger AIACT than muramidase positivity in general. The staining was stronger in stromal cells than in giant cells. Giant cells in all tumors were positive for CD68. Stromal cells showed weaker positivity for the same stain. The number of asymmetrical mitotic figures was significantly greater in group 3 than in group 4 (P < .05). Morphometric assessment has identified a statistically significant difference in the aspect ratio and the roundness of the nuclei between these two groups. The other parameters did not differ significantly. In this article, the significance of these findings in prognostication and the histogenesis of the giant cell tumor are discussed. Their clinical applicability is yet to be determined.

Characteristics of streptolysin S hemolysis

The characteristics of hemolysis produced by streptolysin S (SLS) were investigated in rabbit erythrocytes. Treatment of erythrocytes with SLS at various temperatures prior to incubation at 37 C revealed an initial temperature-dependent interaction between toxin and the cells. No subsequent hemolysis occurred when erythrocytes were exposed to SLS at 0 to 10 C; exposure to toxin at temperatures above 10 C gradually increased the amount of hemolysis that occurred at 37 C. Very little binding of toxin to erythrocytes or their ghosts, as detected by a decrease of hemolytic activity from toxin preparations, could be demonstrated at any temperature. The release of hemoglobin after the temperature-dependent process occur at virtually the same rate at 0, 22, or 37 C. The loss of intracellular rubidium-86 (Rb) and hemoglobin from SLS-treated erythrocytes was studied. Rb+ release significantly preceded the escape of hemoglobin, suggesting that colloid-osmotic processes play a role in SLS hemolysis.

Accumulation, distribution and redistribution of dry matter and mineral nutrients in fruits of canola (oilseed rape), and the effects of nitrogen fertilizer and windrowing

Field studies were made at Ariah Park and Cowra to investigate the accumulation and distribution of dry matter and 12 mineral nutrients in fruits (pods) of canola (oilseed rape), and to assess the significance of redistribution of nutrients from the pod walls to the seeds. Flowers 4-6 from the base of the primary inflorescence were tagged at anthesis, and pods which developed from these were harvested at weekly intervals until maturity. Pods reached maturity 82 days after anthesis of the parent flowers. N fertilizer increased seed yields at both sites, but had negligible effects on the dry matter per pod, pod length, 1000 seed wt, seed number per pod, seed oil concentration, and concentrations of mineral nutrients in the pod walls and seeds. Similarly, there were no differences in these parameters due to locality, with the exceptions that seed oil per cent and concentrations of S and Mn in the pod walls and IVln in seeds were higher at Cowra than at Ariah Park. Pods had attained their maximum length and fresh and dry weights by the end of the first half of their development, but seeds had accumulated only 35% of their mature dry weight at this stage. Seeds gained dry matter after dehydration of the fruit began, but the pod walls did not. Seeds had 61% of the pod's dry matter, >70% of its P, N, Zn, Fe and Mg, 30-55% of its K, S, Mn, Cu and Ca, but <20% of its Na and C1. Dry matter was redistributed from the pod walls with 20% efficiency, and nutrients with from 17% (Cu) to 88% (P) efficiency; however, there was negligible redistribution of K, S, Ca, Na, C1, Fe and Mn from the pod walls. Redistributed dry matter and nutrients from the pod walls could have provided from 11% (dry matter) to 25% (N) of the amount in mature seeds. Concentrations of N, P, Mg, Mn, Zn and Cu in the pod walls declined as they developed, whereas those of Ca and Cl increased. Concentrations of nutrients in developing seeds remained fairly static. Windrowing plants when 40% of the seeds had changed to their mature colour did not affect seed oil per cent or concentrations of nutrients, but reduced seed size and seed yields by 10%. Data from the pod study also support the current recommendation to windrow when 40-60% of seeds reach their mature colour.

Interference scores have inadequate concurrent and convergent validity: Should we stop using the flanker, Simon, and spatial Stroop tasks?

BACKGROUND

Two-hundred one college undergraduates completed four nonverbal interference tasks (Simon, spatial Stroop, vertical Stroop, and flanker) and trait scales of self-control and impulsivity. Regression analyses tested 11 predictors of the composite interference scores derived from three of the four tasks and each task separately. The purpose of the study was to examine the relationships between laboratory measures of self-control, self-report measures, and the degree to which control might be related to extensive experience in activities that logically require self-control.

RESULTS

Fluid intelligence and sex were significant predictors of the composite measure, but bilingualism, music training, video gaming, mindfulness/meditation, self-control, impulsivity, SES, and physical exercise were not.

CONCLUSIONS

Common laboratory measures of inhibitory control do not correlate with self-reported measures of self-control or impulsivity and consequently appear to be measuring different constructs. Bilingualism, mindfulness/meditation, playing action video games, and music training or performance provide weak and inconsistent improvements to laboratory measures of interference control. Flanker, Simon, and spatial Stroop effects should not be used or interpreted as measures of domain-general inhibitory control.