The effects of Hurricane Irma on seagrass meadows in previously eutrophic estuaries in Southwest Florida (USA)

In six contiguous estuaries in Southwest Florida (USA) focused management actions over the past several decades have reduced watershed nutrient loads, resulting in an additional 11,672 ha of seagrass meadows between 1999 and 2016, an improvement of 32%. However, in September of 2017, Hurricane Irma made landfall in the state of Florida, affecting the open water and watersheds of each of these six estuaries. In response, seagrass coverage declined by 1203 ha between 2016 and 2018, a system-wide decrease of 3%. The range of decreases associated with Hurricane Irma varied from less than a 1% loss of seagrass coverage in St. Joseph Sound to declines of 7 and 11% in Clearwater Harbor and Lemon Bay, respectively. Areas with the largest losses between 2016 and 2018 were those systems where seagrass coverage had declined in prior years, indicating the effects of Hurricane Irma might have been intensified by prior impacts.

Widespread recovery of seagrass coverage in Southwest Florida (USA): Temporal and spatial trends and management actions responsible for success

In Southwest Florida, a variety of human impacts had caused widespread losses of seagrass coverage from historical conditions. St. Joseph Sound and Clearwater Harbor lost approximately 24 and 51%, respectively, of their seagrass coverage between 1950 and 1999, while Tampa Bay and Sarasota Bay had lost 46% and 15%, respectively, of their seagrass coverage between 1950 and the 1980s. However, over the period of 1999 to 2016, the largest of the six estuaries, Tampa Bay, added 408 ha of seagrass per year, while the remaining five estuaries examined in this paper added approximately 269 ha per year. In total, seagrass coverage in these six estuaries increased 12,171 ha between the 1980s and 2016. Focused resource management plans have held the line on nitrogen loads from non-point sources, allowing seagrass resources to expand in response to reductions in point source loads that have been implemented over the past few decades.

Reactogenicity, safety and immunogenicity of a protein-based pneumococcal vaccine in Gambian children aged 2-4 years: A phase II randomized study

Pneumococcal conjugate vaccines (PCVs) have been successful in preventing invasive pneumococcal disease but effectiveness has been challenged by replacement of vaccine serotypes with non-vaccine serotypes. Vaccines targeting common pneumococcal protein(s) found in most/all pneumococci may overcome this limitation. This phase II study assessed safety and immunogenicity of a new protein-based pneumococcal vaccine containing polysaccharide conjugates of 10 pneumococcal serotypes combined with pneumolysin toxoid(dPly) and pneumococcal histidine triad protein D(PhtD) (PHiD-CV/dPly/PhtD-30) in African children. 120 Gambian children (2–4 years, not previously vaccinated against Streptococcus pneumoniae) randomized (1:1) received a single dose of PHiD-CV/dPly/PhtD-30 or PCV13. Adverse events occurring over 4 d post-vaccination were reported, and blood samples obtained pre- and 1-month post-vaccination. Serious adverse events were reported for 6 months post-vaccination. Solicited local and systemic adverse events were reported at similar frequency in each group. One child (PHiD-CV/dPly/PhtD-30 group) reported a grade 3 local reaction to vaccination. Haematological and biochemical parameters seemed similar pre- and 1-month post-vaccination in each group. High pre-vaccination Ply and PhtD antibody concentrations were observed in each group, but only increased in PHiD-CV/dPly/PhtD-30 vaccinees one month post-vaccination. One month post-vaccination, for each vaccine serotype ≥96.2% of PHiD-CV/dPly/PhtD-30 vaccinees had serotype-specific polysaccharide antibody concentrations ≥0.20µg/mL except serotypes 6B (80.8%) and 23F (65.4%), and ≥94.1% had OPA titres of ≥8 except serotypes 1 (51.9%), 5 (38.5%) and 6B (78.0%), within ranges seen in PCV13-vaccinated children. A single dose of PHiD-CV/dPly/PhtD-30 vaccine, administered to Gambian children aged 2–4 y not previously vaccinated with a pneumococcal vaccine, was well-tolerated and immunogenic.

The Alderson-McGall hand function questionnaire for patients with Carpal Tunnel syndrome: a pilot evaluation of a future outcome measure

The Alderson-McGall hand function questionnaire (AMHFQ) was developed to evaluate outcomes for patients with carpal tunnel syndrome (CTS). This pilot evaluation of 17 subjects with CTS involved the same battery completed twice prior to CTS release. The complete battery included evaluation of grip and pinch strength, static and dynamic two-point discrimination, dexterity using the Valpar Worksample for upper extremity range of motion, pain and hand function using visual analog scales (VASs), and the AMHFQ. The results indicated high internal consistency, with a Cronbach alpha value of 0.97. Intraclass correlation showed test-retest reliability in the 95th percentile for all items except one. Validity was demonstrated by AMHFQ correlations with all other battery items in the correct direction and significant correlations with dynamic two-point discrimination (r = -0.32), functional VAS (r = 0.3688), pain VAS (r = 0.36), and grip strength (r = 0.3867). These results suggest that the AMHFQ has clinical utility for patients with CTS. Further research to confirm these findings and determine sensitivity to change is required.

A comparative evaluation of a fibromyalgia rehabilitation program

OBJECTIVE

To compare an evidence-based clinical fibromyalgia program, referred to as Fibro-Fit, with results of controlled clinical trials.

METHODS

An interdisciplinary group education and exercise program with 36 sessions over 12 weeks was used. Demographic, clinical, and outcome variables were collected on 149 participants, of whom 71% completed the program. Outcomes included measures of self-efficacy, pain, physical fitness, function, and coping skills.

RESULTS

Results of the prospective before-after evaluation showed statistically significant (P < 0.005) improvements in all outcomes except for grip strength. These results were comparable with controlled clinical trials found in the literature. Data suggest that smoking, fibromyalgia support groups, and medications may be important modifiable factors.

CONCLUSIONS

Results suggest that Fibro-Fit was effective in improving physical impairments and function. Further investigation is required to refine the effective components of these programs and determine how modifiable factors can be used to improve outcomes.

The program for rheumatic independent self-management: a pilot evaluation

The 'Program for Rheumatic Independent Self-Management' (PRISM) is an interdisciplinary programme that integrates group education and individualised treatment using the principles of self-management, adult learning, case management and self-efficacy enhancement. This study is a before-after evaluation of 57 individuals who attended PRISM. Outcome measures were selected to measure self-efficacy, disability, pain and ability to cope. The mean self-efficacy score increased immediately following the programme and this improvement was maintained at 6-month follow-up. Disability decreased from baseline to 6-month follow-up. There was a decrease in the mean level of pain from post-class to 6-month follow-up. All of these changes were statistically significant. These preliminary findings suggest that PRISM may be effective in enhancing self-efficacy, and reducing disability and pain.

Activation-induced peripheral blood T cell apoptosis is Fas independent in HIV-infected individuals

T cell apoptosis has been proposed as an important contributor to the functional defects and depletion of T cells in HIV-infected individuals. However, the mechanisms involved in this apoptosis have not been elucidated. We recently showed that peripheral blood T cells from HIV-infected individuals are especially susceptible to Fas antigen-induced apoptosis. In this study we examine the role of Fas, CTLA-4, tumor necrosis factor (TNF) receptors (TNFR) and CD30, receptors known to be involved in T cell activation-induced cell death (AICD), in the spontaneous and activation (anti-CD3)-induced apoptosis of peripheral blood T cells from asymptomatic HIV-infected individuals. We report here that spontaneous and activation-induced T cell apoptosis cannot be inhibited by reagents that block interactions of Fas, CTLA-4, p55 and p75 TNFR and CD30 with their respective ligands. We also show that IL-12, IFN-gamma, IL-4 and IL-10 cannot modify spontaneous, activation- and anti-Fas-induced apoptosis. Anti-Fas preferentially induced CD4+ T cell apoptosis whereas AICD induced apoptosis equally in CD4+ and CD8+ T cells. We conclude that T cell AICD in HIV infection is not mediated by Fas, thus indicating that Fas-induced and activation-induced T cell apoptosis are independent mechanisms of apoptosis which may play different roles in the pathogenesis of HIV infection.

CD30-mediated signaling promotes the development of human T helper type 2-like T cells

We have recently shown that CD30, a member of the tumor necrosis factor/nerve growth factor receptor superfamily, is preferentially expressed by human T cell clones producing T helper (Th) type 2 cytokines. We report here that costimulation with an agonistic anti-CD30 monoclonal antibody enhanced antigen (Ag)-induced proliferation and cytokine secretion by established human Th2 and Th0 clones. Moreover, costimulation of peripheral blood mononuclear cells with the same anti-CD30 monoclonal antibody resulted in the preferential development of Ag-specific T cell lines and clones showing a Th2-like profile of cytokine secretion. In contrast, early blockade in bulk culture of CD30 ligand-CD30 interaction shifted the development of Ag-specific T cells towards the opposite (Th1-like) phenotype. Taken together, these data suggest that CD30 triggering of activated Th cells by CD30 ligand-expressing Ag-presenting cells may represent an important costimulatory signaling for the development of Th2-type responses.

Activation of HIV expression by CD30 triggering in CD4+ T cells from HIV-infected individuals

CD30 is a member of the tumor necrosis factor receptor superfamily, preferentially expressed by T cells producing type 2 helper (Th2) cytokines, whose ligand (CD30L) has been identified on B cells, activated macrophages, and a subset of activated T cells. We show here that cross-linking CD30 with an agonistic CD30-specific monoclonal antibody, as well as with CD30L+ CD8+ T cell clones or CD30L+ B cells, enhanced HIV replication in CD4+ T cells from HIV-infected individuals, and such a potentiating effect was inhibited by anti-CD30L antibody. The anti-CD30L antibody also exerted a suppressive effect on spontaneous HIV replication occurring in lymph node cells from an HIV-sero-positive patient, showing CD30L expression by both B and CD8+ T lymphocytes. Thus, CD30 triggering by CD30L-expressing cells may plan an important role in the activation of HIV expression from latently infected CD4+ T cells.

Protection against a lethal dose of endotoxin by an inhibitor of tumour necrosis factor processing

Tumour necrosis factor (tumour necrosis factor-alpha/cachectin) plays a critical role in certain physiological defensive responses but causes severe damage to the host organism when produced in excess. There are two forms of tumour necrosis factor, a type II membrane protein of relative molecular mass 26,000 (26K) and a soluble, 17K form generated from the cell-bound protein by proteolytic cleavage. The two forms of tumour necrosis factor and lymphotoxin-alpha (tumour necrosis factor-beta/lymphotoxin), a related protein, have similar but apparently not identical biological activities. A therapeutic agent which inhibited the release of tumour necrosis factor, but did not reduce the cell-associated activity or the level of lymphotoxin-alpha, might preserve the benefits of these cytokines while preventing tumour necrosis factor-induced damage. Here we describe a potent inhibitor of tumour necrosis factor processing and report that it protects mice from a lethal dose of endotoxin.

Ventricular function in snorers and patients with obstructive sleep apnea

We hypothesized that intermittent hypoxemia and increased ventricular afterload due to obstructive apnea during sleep (OSA) would cause chronic left ventricular dysfunction. Overnight polysomnography, M-mode and two-dimensional echo-Doppler studies while awake were performed on 51 consecutive snorers, 30 with OSA and 21 without apnea. Patients with previous myocardial infarction, awake hypoxemia or hypercapnia, or other causes of nocturnal hypoxemia were excluded. Echo-Doppler measurements included end-diastolic right and left ventricular dimensions and wall thickness, indices of left ventricular systolic performance (fractional shortening, ejection fraction and ejection time and diastolic performance, (isovolumic relaxation time, ratio of peak early [E] to late [A] diastolic transmitral flow and mitral pressure half-time). Both OSA patients and nonapneic snorers were of similar age. Although OSA patients were heavier, had a greater apnea-hypopnea index, and significant nocturnal hypoxemia, their echo-Doppler measurements were within normal limits and were not significantly different from nonapneic snorers. It is concluded that isolated obstructive sleep apnea does not cause chronic left ventricular dysfunction.

Increased risk of cataract in patients receiving radiotherapy to the eye: a pilot study

Of 507 persons in England and Wales identified as having had radiotherapy to the eye or eyes some years previously (after excluding those who had died and were not traced), information suitable for analysis could be obtained on 165. Of these, 23 had developed other eye disease so that the lens could not be examined. Of the other 142, 32 had certainly and one had probably developed cataract. A cataract operation had been performed on 19 persons, compared with an expected operation rate of four out of 142. The increased risk of cataract after radiotherapy to the eye is probably higher than the fivefold excess these figures for operations suggest.

Natural history of acute septic arthritis in an avian model

An experimental model of acute septic arthritis is described, utilizing the injection of S. aureus into chicken hock joints. The course of the infection was monitored over a 14-day period by measurement of chicken growth rate, histopathology of the joint, number of bacteria, and number and type of leukocytes in the synovial fluid. Bacterial numbers decreased initially then increased rapidly over the first 24 h. Leukocyte counts rose sharply, starting between 60 and 90 min after injection. Gross destruction of articular cartilage was observed at 4 days, and appeared to be initiated by the adherence of the staphylococci to the cartilage surface followed by their penetration and invasion of vascular tunnels in the epiphyseal cartilage. Extensive (but focal) erosion of the articular surface was evident by 14 days.

Transphyseal blood vessels exist in avian species

The distal femora and proximal and distal tibiae of 4 weeks old broiler chickens have three main types of blood vessels in the growth plate region-metaphyseal, epiphyseal and transphyseal. The transphyseal vessels extend across the entire thickness of the avian growth plate and provide a means of luminal communication between the metaphysis and epiphysis.

Acute haematogenous osteomyelitis and septic arthritis--a single disease. An hypothesis based upon the presence of transphyseal blood vessels

The acute childhood diseases haematogenous staphylococcal osteomyelitis and septic arthritis were studied concurrently using avian models which closely resemble the human diseases. Ultrastructural studies during the initial stages of bone and joint infection showed that adherence of bacteria to cartilage, bacterial proliferation, cartilage destruction and subsequent bacterial spread along the vascular channels within cartilage were common to both disease processes. Histological studies revealed that transphyseal blood vessels were present in the growing chickens and were a likely explanation for the frequency of the concurrence of acute osteomyelitis and adjacent joint infection following intravenous injection of bacteria. Transphyseal vessels provide a direct connection between the growth plate (physis) and epiphyseal cartilage supplying a route for bacteria to spread from an osteomyelitic focus in the metaphysis to the epiphysis and subsequently to the joint lumen.

Nonstress testing in a physician's office--a five-year experience

A study was undertaken to evaluate the use of nonstress testing in a physician's office in the management of high-risk pregnancies. A total of 1,485 office nonstress tests were done on 713 high-risk patients between 32 and 43 weeks' gestation. When indicated the contraction stress test was done in hospital. In all, 485 patients had a nonstress test within a week of their delivery, 97% of which were reactive and 2% were nonreactive. Those fetuses with a nonreactive test result had a significantly increased incidence of abnormal fetal heart rate patterns during labor and intrapartum fetal distress leading to cesarean delivery. With strict adherence to a protocol, nonstress testing in the physician's office can be successful in caring for fetuses thought to be at risk.

Mortality patterns in eight U. K. oil refineries

The patterns of mortality are described for 35,000 male employees, with a minimum of 1 year's continuous service, who worked at 8 refineries in the U. K. in the period 1 January 1950-31 December 1975. The trace rate of those involved was 99.8%. Overall the ratio of observed to expected deaths was 0.84 (O = 4406, E = 5259.9 P less than 0.00001). The numbers of deaths for many of the chronic degenerative diseases were lower than "expected." The number of observed deaths from all cancers were appreciably less than expected (O = 1147, E = 1286.4, O/E = 0.89, P = 0.00006). Lung cancer was particularly reduced (O = 416, E = 532.7, O/E = 0.78, P less than 0.00001); there was no excess of leukemia ( in workers including some exposed to benzene). Other comparable studies have suggested an excess of gastrointestinal cancer. In the present study deaths from esophageal, stomach, intestinal, and rectal cancer were slightly raised for all workers (O = 346, E = 328.6, O/E = 1.05, P less than 0.4); this was particularly true for those joining before 1950 with long service and increased latent interval. There were also excesses based on small numbers of deaths from nasal cancer (O = 7, E = 3.1, O/E = 2.24, P less than 0.05), and melanoma (O = 14, E = 6.5, O/E = 2.16, P less than 0.01). There was no evidence of an excess of brain tumors (O = 36, E =- 44.8, O/E = 0.80, P less than 0.2).

Parity and breast cancer

Data from the 1961 and 1971 Censuses in England and Wales were used to estimate the age distribution of women of various parities in 1976. Applying the age-specific incidences of breast cancer for women in England and Wales in 1975 gave the expected number of cases of that disease in 1976 and permitted an estimate of the mean age at diagnosis of breast cancer at each parity. This showed that the highest average age for breast cancer occurred in nulliparous women (65.9 years) and that the lowest age for the disease occurred in women who had borne two children (60.4 years). The figures obtained were similar to those reported in a separate study of women treated in Birmingham. The results of that study, however, may have been due to the age distribution in the population of women by parity, rather than any direct influence of parity on the speed of growth of breast cancer.

The influence of occupation on health--some results from a study in the UK oil industry

This study describes the patterns of mortality of 35,000 male employees, with a minimum of 1 year's continuous service, who worked at 8 refineries in the UK in the period 1.1.50-31.10.75. The trace rate of those involved was 99.8%. Overall the ratio of observed to expected deaths was 0.84 (O = 4406, E = 5259.9, P < 0.00001). The numbers of deaths for many of the chronic degenerative diseases were lower than 'expected'. The number of observed deaths from all cancers was appreciably less than expected (O = 1147, E = 1286.4, O/E = 0.89, P = 0.00006). Lung cancer was particularly reduced (O = 416, E = 532.7, O/E = 0.78, P < 0.00001); there was no excess of leukaemia (in workers including some exposed to benzene). Other comparable studies have suggested an excess of gastrointestinal cancer. In the present study deaths from oesophageal, stomach, intestinal and rectal cancer were slightly raised for all workers (O = 346, E = 328.6, O/E = 1.05, P < 0.4); this was particularly noticeable for those joining before 1950 with long service and with increased latent interval. There were also excesses based on small numbers of deaths from nasal cancer (O = 7, E = 3.1, O/E = 2.24, P < 0.05), and melanoma (O = 14, E = 6.5, O/E = 2.16, P 0.01).

Cancer mortality in male hairdressers

Although hair dyes have been shown to be highly mutagenic the literature on possible human cancer risk is confused. A variety of studies using different methods in different countries have provided a range of positive and negative findings. In the present study the observed and expected mortality among a sample of hairdressers identified in the 1961 census was examined and followed until 1978; attention was focused on five malignancies reported to have increased in male hairdressers in the other studies. The overall mortality and number of deaths from all neoplasms were lower than the 'expected' figures. No appreciable or significant excess was found for cancer of the oesophagus, larynx, lung, and bladder, or for leukaemia. The present report, based on the follow-up of nearly 2000 hairdressers for more than 15 years, provides no support for other work which has suggested that male hairdressers or barbers are at risk of certain cancers. These results provide only a limited probe into the influence of hair dyes; another part of the study involves follow-up of women hairdressers from the 1971 census, though it will be a number of years before enough deaths have accumulated to warrant analysis.

Hysterectomy rates and their influence upon mortality from carcinoma of the cervix

Cumulative hysterectomy rates for women in England and Wales have been estimated from data in the Hospital In-Patient Enquiry, and the effect of hysterectomy operations on mortality from cancer of the cervix has been calculated. About six to seven per cent of women born at about the turn of the century have had an hysterectomy by the age of 70, and this proportion could rise to about 19% for women born in the 1940s if present operation rates continue. The time trends in mortality from cancer of the cervix between generations of women are not at present distorted by correction for women without a cervix. Operation rates and their effect on cervical cancer mortality rates are much smaller in England and Wales than in the United States of America.

Mortality from respiratory disease at follow-up of patients with asthma

Over a 20-year period 765 men and 1127 women with asthma were followed up; 272 men and 282 women died compared with expected deaths of 165 men and 185 women. As anticipated there was an appreciable number of deaths attributed to asthma but an even higher absolute excess of deaths attributed to bronchitis when compared with the expected numbers. The relative excess from asthma and bronchitis was highest in the younger subjects. Mortality from all other causes was lower than expected.

A review of the National Health Service's computing policy in the 1970s

The health service computer policy is reviewed in this paper particularly the potential contribution of some systems to information gathering. The paper begins with a brief description of the computer applications thought suitable for the medical field in the late 1960s, and two views of the future that were published in 1968. Two reports on computing and information systems in Scotland are then described; the general philosophy and specific proposals on the use of population files are contrasted with the initial Department of Health and Social Services' (DHSS) experimental computer program. The subsequent changes in English policy are revealed in the reports of three reviews published by the DHSS. The present development of a master patient index in Tayside is noted and the potential applications in management and planning of information stemming from such systems are discussed. It is suggested that lack of work in this field is a major gap in the programme of activity in England.

Consecutive primary carcinomas of the breast

The incidence of consecutive primary carcinoma of the breast in 1489 women was 1 percent per year and remained constant for 20 years. The age of women with bilateral carcinomas was 6 years younger than those who had single tumors. Survival after the second tumor tended to be better in women less than 50 years. Patients who developed metastases had a shorter interval between the first and second tumors than those who remained free from the disease. Prognosis was the same in those with nonsynchronous carcinomas as in those with single tumors, and the incidence of positive nodes was the same in both groups. The prognosis was poorest in those who developed synchronous tumors. Prophylactic postoperative radiotherapy did not affect the incidence of consecutive breast carcinomas and did not alter prognosis. The results stress the importance of observing carefully the remaining breast, especially in younger women.