Adeno-associated virus 2 infection in children with non-A-E hepatitis

An outbreak of acute hepatitis of unknown aetiology in children was reported in Scotland1 in April 2022 and has now been identified in 35 countries2. Several recent studies have suggested an association with human adenovirus with this outbreak, a virus not commonly associated with hepatitis. Here we report a detailed case-control investigation and find an association between adeno-associated virus 2 (AAV2) infection and host genetics in disease susceptibility. Using next-generation sequencing, PCR with reverse transcription, serology and in situ hybridization, we detected recent infection with AAV2 in plasma and liver samples in 26 out of 32 (81%) cases of hepatitis compared with 5 out of 74 (7%) of samples from unaffected individuals. Furthermore, AAV2 was detected within ballooned hepatocytes alongside a prominent T cell infiltrate in liver biopsy samples. In keeping with a CD4+ T-cell-mediated immune pathology, the human leukocyte antigen (HLA) class II HLA-DRB1*04:01 allele was identified in 25 out of 27 cases (93%) compared with a background frequency of 10 out of 64 (16%; P = 5.49 × 10-12). In summary, we report an outbreak of acute paediatric hepatitis associated with AAV2 infection (most likely acquired as a co-infection with human adenovirus that is usually required as a 'helper virus' to support AAV2 replication) and disease susceptibility related to HLA class II status.

A novel approach to monitoring lithium blood levels and renal function in patients receiving lithium during the COVID-19 pandemic

Introduction

Lithium is commonly administered to patients in an outpatient department (OPD) setting. Regular monitoring of lithium levels and renal function in accordance with published guidelines is required. In our unit, this is usually performed at OPD review. During the COVID-19 pandemic, reviews were either postponed or done remotely.

Objectives

1. To devise a system to ensure that patients receiving lithium had appropriate blood test monitoring in the absence of traditional OPD appointments. 2. To assess the efficacy of this intervention by recording blood test dates and comparing with pre-COVID compliance.

Methods

All outpatients receiving lithium, identified from the hospital database, received (1) a letter summarising the monitoring guidelines and (2) prospectively dated blood request forms. Patients at higher risk of contracting COVID-19 were advised to attend their primary care setting. Others were encouraged to attend primary care or our phlebotomy department. Compliance was measured by accessing the hospital’s laboratory enquiry computer based system and compared with pre-COVID-19 figures. Information was anonymised, as per General Data Protection Regulations.

Results

57 patients receiving lithium were identified. Prior to the first Irish lockdown in March 2020, 16 (28%) were overdue testing. Three months into the pandemic, 15 patients (26%) were overdue testing.

Conclusions

In the absence of routine outpatient appointments during the COVID-19 pandemic, the provision of written guidelines and completed blood request forms for patients receiving lithium was effective in ensuring monitoring of lithium levels and renal function. This system can be utilised as an alternative/adjunct to OPD review benefitting patients and health service delivery.

Disclosure

No significant relationships.

Isolation and characterization of vibriophage vB_Vc_SrVc9: an effective agent in preventing Vibrio campbellii infections in brine shrimp nauplii (Artemia franciscana)

AIMS

This study describes the physicochemical and genomic characterization of phage vB_Vc_SrVc9 and its potential for phage therapy application against a pathogenic Vibrio campbellii strain.

METHODS AND RESULTS

A lytic phage vB_Vc_SrVc9 against V. campbellii was isolated from shrimp farm sediment, and characterized physicochemical and genomically. The use of vB_Vc_SrVc9 phage increased the survival in brine shrimp Artemia franciscana and reduced presumptive V. campbellii to nondetectable numbers. Genomic analysis showed a genome with a single contig of 43·15 kb, with 49 predicted genes and no tRNAs, capable of recognizing and generating complete inhibition zones of three Vibrio sp.

CONCLUSIONS

To our knowledge vB_Vc_SrVc9 is a lytic phage that could be used against Vibrio infections, reducing vibrio presence without any apparent impact over the natural microbiota at the family level in 28 libraries tested.

SIGNIFICANCE AND IMPACT OF THE STUDY

vB_Vc_SrVC9 is a novel phage and ecofriendly alternative for therapeutic applications and biotechnological purposes because is stable at different environmental conditions, has the potential to eliminate several strains, and has a short latent period with a good burst size. Therefore, the use of phages, which are natural killers of bacteria, represents a promising strategy to reduce the mortality of farmed organisms caused by pathogenic bacteria.

A device for the application of uniaxial strain to single crystal samples for use in synchrotron radiation experiments

We present the design, construction, and testing of a straining device compatible with many different synchrotron radiation techniques, in a wide range of experimental environments (including low temperature, high field and ultra-high vacuum). The device has been tested by X-ray diffraction on single crystal samples of quasi-one-dimensional Cs2Mo6Se6 and K2Mo6Se6, in which microscopic strains up to a Δc/c = 0.12% ± 0.01% change in the c lattice parameters have been achieved. We have also used the device in an inelastic X-ray scattering experiment, to probe the strain-dependent speed of sound ν along the c axis. A reduction Δν/ν of up to -3.8% was obtained at a strain of Δc/c = 0.25% in K2Mo6Se6.

Suppression of thermal conductivity by rattling modes in thermoelectric sodium cobaltate

The need for both high electrical conductivity and low thermal conductivity creates a design conflict for thermoelectric systems, leading to the consideration of materials with complicated crystal structures. Rattling of ions in cages results in low thermal conductivity, but understanding the mechanism through studies of the phonon dispersion using momentum-resolved spectroscopy is made difficult by the complexity of the unit cells. We have performed inelastic X-ray and neutron scattering experiments that are in remarkable agreement with our first-principles density-functional calculations of the phonon dispersion for thermoelectric Na(0.8)CoO2, which has a large-period superstructure. We have directly observed an Einstein-like rattling mode at low energy, involving large anharmonic displacements of the sodium ions inside multi-vacancy clusters. These rattling modes suppress the thermal conductivity by a factor of six compared with vacancy-free NaCoO2. Our results will guide the design of the next generation of materials for applications in solid-state refrigerators and power recovery.

Differences in bone density, body composition, physical activity, and diet between child gymnasts and untrained children 7-8 years of age

Strategies that enhance the acquisition of bone mass may be protective against osteoporosis. BMD was compared in 20 artistic gymnasts (10 boys; 10 girls) and 20 untrained children ages 7-8 years. Higher regional values of BMD were observed in female gymnasts than untrained girls. If retained to adulthood, this higher BMD may protect skeletal integrity in later life. Strategies that enhance the acquisition of bone mass in children may assist with the prevention of osteoporosis. This study explored the effects of regular high-impact and weight-bearing activity before the age of 7 years on total and regional bone mineral density (BMD). Twenty artistic gymnasts (10 boys and 10 girls) and 20 untrained children, 7-8 years of age, were recruited. The untrained children were matched to gymnasts by sex, height, weight, and age. Female gymnasts trained 8-10 h per week and had trained regularly for 3-4 years. Male gymnasts trained 4-6 h per week and had trained for 1-2 years. Measurements of bone mineral density were made using DXA for total body BMD (TBBMD); lumbar spine, both areal (aSBMD) and volumetric (vSBMD); total spine; pelvis; arms; and legs. Significant mean differences (8-10%) in aSBMD, vSBMD, arm BMD, and TBBMD were observed between female gymnasts and untrained girls (p < 0.05: aSBMD, vSBMD, and TBBMD body mass (BM); p < 0.01: arm BMD). A nonsignificant trend toward a higher TBBMD/BM and arm BMD was observed in male gymnasts compared with untrained boys. Trends toward a higher BMD within the pelvis, legs, and total spine were also observed in gymnasts. There were no differences in total and regional BMD between untrained boys and untrained girls. The results suggest that gymnastics training before the age of 7 years enhances the acquisition of bone mass at selected skeletal sites. The magnitude of this enhancement seems to be linked to the cumulative volume of such training. If retained during adolescence and young adulthood, a surfeit of bone acquired through high-impact and weight-bearing activity in early childhood may protect skeletal integrity in later life.

Beta1 integrin expression during normal and low score normal avian myogenesis

Skeletal muscle development is, in part, regulated by myoblast-extracellular matrix interactions mediated by the transmembrane integrin family of heterodimeric receptors. The avian genetic muscle weakness, low score normal (LSN), exhibits modified myotube and sarcomere structure that may be associated with altered integrin expression. Protein expression of the beta1 integrin subunit was measured during normal and LSN Pectoralis major muscle development at 14, 16, and 18 d of embryonic development, and 1 d and 1 and 6 wk posthatch. During embryonic development, integrin expression was downregulated. However, by 1 wk posthatch, integrin levels were upregulated and remained elevated through 6 wk posthatch. This pattern was observed in both normal and LSN muscle development. Overall, beta1 integrin levels were lower in the LSN P. major muscle. In normal and LSN satellite cell cultures, beta1 integrin expression was low during proliferation. In early differentiation, beta1 integrin expression increased and was then downregulated. As observed in the muscle extracts, LSN beta1 integrin expression was significantly lower during differentiation. These results suggest that the regulation of beta1 integrin expression is critical to the progression of myogenesis, and, during LSN myogenesis, decreased expression of beta1 integrin may be associated with modifications in muscle structure.

Critical care bug team: a multidisciplinary team approach to reducing ventilator-associated pneumonia

BACKGROUND

Ventilator-associated pneumonia rates in the medical-surgical intensive care unit first exceeded the 90th percentile in September 1997 and were significantly (P <.05) higher than National Nosocomial Infections Surveillance System pooled mean data. In January 1998, a multidisciplinary "Critical Care Bug Team" was developed by the Infection Control Committee to review 1997 National Nosocomial Infections Surveillance System data for four adult intensive care units in a 583-bed tertiary care hospital.

METHODS

Membership included clinical nurse specialists, a dietitian, a pharmacist, a respiratory therapist, an infection control professional, a research specialist, and a physician adviser. Having the team report directly to the hospital's Infection Control and Adult Critical Care Committees maximized support for recommendations and provided a direct link from patient care to hospital administration. By identifying issues, evaluating patient care processes, performing literature searches, and monitoring compliance, the team implemented numerous interventions, including policy and procedure changes, purchasing of equipment, and implementation of various education tools.

RESULTS

Each member of the Critical Care Bug Team contributed to a synergized effort that may have produced the desired outcome of decreasing ventilator-associated pneumonia rates. Except for August 1998, ventilator-associated pneumonia rates have been below the 75th percentile since May 1998.

CONCLUSION

This study illustrates the effectiveness of a multidisciplinary team approach devised to reduce and stabilize ventilator-associated pneumonia rates in a medical-surgical intensive care unit.

Psychopathy and depression: mutually exclusive constructs?

The present study was designed to evaluate the nature of the differences between psychopathy and depression. Based on previously articulated theoretical models, we hypothesized an inverse relationship between the two clinical constructs. Archival data were retrieved from 231 outpatient clients who had completed measures of depression and psychopathy. Correlational analyses and ANOVA's based on extreme groups supported the hypothesis. Implications for assessment, treatment, and research methodology are discussed.

Portraits of menopause in the mass media

This examination of menopause as presented by the popular print media was conducted in the context of furthering our understanding of the development of attitudes toward menopause. All articles indexed under "menopause" in the Reader's Guide in the years 1981, 1982, 1985, 1986, 1989, 1990, 1993, and 1994 were located and examined. The data revealed that, although there has been an increase in the frequency of articles on menopause in the last 15 years, the media's portrayal of menopause is problematic in several respects: (a) in spite of the increased attention, the information available on menopause through the popular media is minimal and insufficient; (b) there was little variability in terms of perspective, discipline, or focus; almost all were focused on menopause as a negative experience or disease and in need of medical treatment; (c) there was considerable contradiction and inconsistency among the articles with respect to descriptions of menopause and intervention advice for menopausal women; (d) aging, stress, life-style factors, race and ethnicity, exercise and diet were, with few exceptions, ignored or trivialized.

A content analysis of obstetrics and gynecology scholarship: implications for women's health

In the context of studying the medicalization of women, we sought insight into the reflexive and mutually influential relationships between the prevailing social agenda and the formal knowledge base by analyzing the content, purpose and funding source of the scholarly work published in the three major, English-language obstetrics and gynecology journals. Our analysis of the 6103 articles published in 1975, 1980, 1985, 1990, and 1993 led us to the conclusion that, rather than responding to changing social needs and life-styles, the obstetrics and gynecology specialty has continued to emphasize the reproductive nature of women rather than the health and well-being requirements of non-pregnant and non-fertile women. The social values and attitudes toward women inferred from the priorities evident in these data are ideologically consistent with the view that women's primary role is that of reproduction. The implied importance of certain themes and the consequent allocation of resources may serve to perpetuate the politically oppressive view of women as biologically motivated and determined.

Menopausal symptoms as consequences of dysrhythmia

A theoretical model is presented for understanding physical and psychological changes which frequently accompany the menopausal transition. According to this, as yet untested, model, as the menopausal transition progresses, hormonal patterns become unpredictable and previously learned homeostatic mechanisms can no longer provide a balanced internal milieu. The consequences of this dysrhythmia are the physical and psychological disruptions typical of jet travel and shift work. Internal attributions of illness and deficiency, promoted by the medical model and the popular media, have transformed these disruptions into a universal "deficiency disease." The model represents a theoretical integration and synthesis of diverse and, historically, unrelated areas; it is presented in order to promote empirical research on the causes, correlates, and interventions of menopausal symptoms.

Sex bias in psychological research. Progress or complacency?

A total of 4,952 articles published in 1970, 1975, 1980, 1985, and 1990 in the areas of developmental, clinical, physiological, and social psychology were reviewed for the purpose of assessing various indicators of sexism in human psychological research. Significant changes in sex of first author, sex of participants, sexist language, and inappropriate generalization indicated that sexism has clearly diminished in the past two decades. Despite these improvements, however, the data revealed continued evidence of discriminatory practices, suggesting that efforts to eliminate sexism must be strengthened if psychology is to be a nonsexist discipline.

Sex bias in psychological research: Progress or complacency?

A total of 4,952 articles published in 1970, 1975, 1980, 1985, and 1990 in the areas of developmental, clinical, physiological, and social psychology were reviewed for the purpose of assessing various indicators of sexism in human psychological research. Significant changes in sex of first author, sex of participants, sexist language, and inappropriate generalization indicated that sexism has clearly diminished in the past two decades. Despite these improvements, however, the data revealed continued evidence of discriminatory practices, suggesting that efforts to eliminate sexism must be strengthened if psychology is to be a nonsexist discipline.

The importance of chronicity and controllability of stress in the context of stress-illness relationships

The primary purpose of the present study was to increase our understanding of the roles of chronicity and controllability in the measurement of stress within the context of stress-illness relationships. Controllability and chronicity were assessed directly using a modified version of the Everyday Problems Scale. In addition to this scale, measures of depression, psychosomatic symptoms, and social support were administered to 128 women and 100 men. The results indicated that, for both men and women, the number of stressors was the best single predictor of symptoms. However, for women, chronicity and controllability of the stressors accounted for a significant amount of the variance in health outcomes over and above that accounted for by the number of stressors endorsed; for men, the addition of neither chronicity nor controllability consistently increased the strength of the association. While available social support was not found to influence the stress-illness relationships, greater willingness to utilize social support was associated with lower levels of depression.

Perimenstrual symptoms: relationships with chronic stress and selected lifestyle variables

Of primary interest in the present study was the assessment of the association between several contextual factors, including chronic stress, exercise, alcohol, nicotine, and caffeine intake, and the self-report of perimenstrual symptoms. Two hundred and eleven women completed questionnaires designed to assess chronic stress, perimenstrual symptoms, and physical health. The results indicated that stress accounted for a significant amount of the variance in perimenstrual symptoms. Stress, however, accounted for a substantially greater amount of variance in scores on a general health measure than in self-reports of perimenstrual symptoms. Of those lifestyle variables assessed, only duration of current level of strenuous exercise was associated with perimenstrual symptoms to a meaningful extent.

The mediating effects of psychophysiological reactivity and recovery on the relationship between environmental stress and illness

The present study investigated the association between psychophysiological reactivity and recovery and physical and psychological symptoms both directly and interactively with environmental stress. Symptoms, environmental stress, and psychophysiological reactivity to and recovery from a laboratory stressor were measured in 50 subjects. As in previous research, the results indicated a significant relationship between environmental stress and symptoms of illness. Although the data did not support a direct relationship between psychophysiological activity and illness, support for a buffering effect was found. Those individuals with greater physiological arousal to or slower recovery from a laboratory stressor exhibited a stronger relationship between environmental stress and symptoms than those who were less reactive or faster to recover. Implications of these results were discussed in the context of theoretical models relating stress and illness.

The potential role of exercise in the alleviation of menstrual disorders and menopausal symptoms: a theoretical synthesis of recent research

Research in the last decade has advanced our understanding of menstrual disorders and menopause. Paralleling this research has been both a popular and a scholarly interest in the correlates and consequences of aerobic exercise. The purpose of this paper is to integrate these two domains on a theoretical and, when possible, an empirical level, and to discuss the potential benefits of exercise in the treatment of menstrual disorders and menopausal symptoms - specifically, dysmenorrhea, premenstrual syndrome, hot flashes, and osteoporosis.

Correlates of menopausal hot flashes

The purpose of the present study was to examine the relationships of frequency, duration, and intensity of hot flashes with daily stress, ambient temperature, and caffeine, alcohol, and nicotine intake in menopausal women. Ten menopausal women suffering from hot flashes monitored these variables daily for 6 weeks. Intrasubject correlational analyses revealed significant relationships between hot-flash activity and stress for half of the sample; few women exhibited significant relationships between hot-flash activity and other variables. The results are discussed with respect to theoretical implications and treatment strategies.

Awareness of internal cues and concordance among verbal behavioral, and physiological systems in dysfunction

It is proposed that persons suffering from a particular dysfunction lack awareness of internal cues associated with physiological activity in the dysfunctional system. Further, this deficit in awareness results in a lack of concordance among verbal, behavioral, and physiological measures of the dysfunctional system; persons not suffering from the particular dysfunction have adequate perception of internal cues and exhibit concordance among these measures. To evaluate these hypotheses, relevant research is reviewed. Discussions of the potential relevance of the proposed theoretical orientation to treatment and methodological issues pertinent to empirical validation are included.

Evidence for a psychological etiology of menstrual disorders: a critical review

Past research which has been interpreted as support for a psychological etiology of menstrual distress is critically reviewed. This research is analyzed with respect to methodological issues such as the assessment of menstrual distress, the measurement of psychological parameters, and statistical procedures and with respect to experimenter bias apparent in the interpretation of results. It is concluded that the available empirical evidence is inadequate to support psychological causation of menstrual distress.

The Menstrual Symptom Questionnaire and spasmodic/congestive dysmenorrhea: measurement of an invalid construct

Chesney and Tasto's (1975a) Menstrual Symptom Questionnaire (MSQ) was developed on the basis of Dalton's theory of spasmodic and congestive dysmenorrhea, which states that the two types are caused by opposite hormonal imbalances and therefore should not be found in the same woman. Evidence is offered which suggests that the theory is incorrect. A multiple-group factor analysis failed to adequately support the two-component model. Subsequently, a factor analysis of 275 MSQs revealed seven factors rather than the two predicted by the theory. In addition, the incidence of both high premenstrual and menstrual symptoms in the same women was demonstrated. Finally, symptoms reported by women using oral contraceptives differed little from those reported by women not using oral contraceptives. It is concluded that scoring for the MSQ should be modified to include two subscales for premenstrual and menstrual symptoms, and that the labels "spasmodic" and "congestive" be discontinued until some evidence is found for their support.

The role of interoception in learned visceral control

Research concerned with the psychology and physiology of interoceptive processes is reviewed with the purpose of evaluating theoretical formulations of learned visceral control. Basic animal research in interoception provides relevant information; however, much research dealing directly with interoception and learned control is inadequate due either to inappropriate measurement of interoceptive ability or to poor experimental design. The two primary theoretical orientations linking interoception and learned visceral control differ according to the role ascribed to external feedback; the first views feedback as an enhancement of interoceptive cues, the second as an enhancement of exteroceptive cues. These theories are discussed with regard to recent investigations of learned visceral control.