Why were COVID-19 infections lower than expected amongst people who are homeless in London, UK in 2020? Exploring community perspectives and the multiple pathways of health inequalities in pandemics

High rates of COVID-19 infections and deaths amongst people who are homeless in London, UK were feared. Rates however stayed much lower than expected throughout 2020; an experience that compares to other settings globally. This study sought a community level perspective to explore this rate of infections, and through this explore relationships between COVID-19 and existing health inequalities. Analyses are reported from ongoing qualitative studies on COVID-19 and homeless health service evaluation in London, UK. Repeated in-depth telephone interviews were implemented with people experiencing homelessness in London (n=17; 32 interviews in total) as well as street outreach workers, nurses and hostel staff (n=10) from September 2020 to early 2021. Thematic analysis generated three themes to explore peoples' experiences of, and perspectives on, low infections: people experiencing homelessness following, creating and breaking social distancing and hygiene measures; social distancing in the form of social exclusion as a long-running feature of life; and a narrative of 'street immunity' resulting from harsh living conditions. Further study is needed to understand how these factors combine to prevent COVID-19 and how they relate to different experiences of homelessness. This community perspective can ensure that emerging narratives of COVID-19 prevention success don't ignore longer running causes of homelessness and reinforce stigmatising notions of people who are homeless as lacking agency. Our findings aid theorisation of how health inequalities shape pandemic progression: severe exclusion may substantially delay epidemics in some communities, although with considerable other non-COVID-19 impacts.

A participatory evaluation of legal support in the context of health-focused peer advocacy with people who are homeless in London, UK

Legal problems can be cause and consequence of ill-health and homelessness, necessitating efforts to integrate responses to these challenges. How to respond to legal issues within the context of health services for people who are homeless is though unclear. Groundswell piloted providing legal support to peer advocates (who have current or past experience of homelessness) and clients currently homeless in addition to their health-focused work. A participatory action-research design evaluated the emerging programme. Groundswell staff, both researchers and those involved in service delivery, co-led the research alongside an external researcher. Qualitative methods were used to understand the experiences of legal support. We interviewed peer advocates and volunteers (n = 8), Groundswell clients (n = 3) and sector stakeholders (n = 3). Interviews were linked to regular reflective recorded meetings (n = 7) where Groundswell staff and researchers discussed the programme and the evaluation. Data were analysed thematically. The findings focus on three themes. First, peer advocates' and clients' legal needs involve an experience of being overwhelmed by system complexity. Second, the legal support to peer advocates aided in brokering and signposting to other legal support, in the context of a supportive organisational culture. Third, support to clients can be effective, although the complexity of legal need undermines potential for sustainable responses. In conclusion, legal support for peer advocates should be developed by Groundswell and considered by other similar agencies. Legal support to people who are currently street homeless requires significant resources and so health-focused third-sector organisations maybe unable to offer effective support. Other modes of integration should be pursued. Findings also have implications for how the third sector relates to the government agencies implicated in the legal challenges facing people who are homeless.

A systematic review and meta-analysis of interventions to preserve insulin-secreting β-cell function in people newly diagnosed with type 1 diabetes: Results from intervention studies aimed at improving glucose control

AIMS

Type 1 diabetes is characterised by the destruction of pancreatic β-cells. Significant levels of β-cells remain at diagnosis. Preserving these cells improves glucose control and protects from long-term complications. We undertook a systematic review and meta-analyses of all randomised controlled trials (RCTs) of interventions to preserve β-cell function in people newly diagnosed with type 1 diabetes. This paper reports the results of interventions for improving glucose control to assess whether they preserve β-cell function.

METHODS

Searches for RCTs in MEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov and WHO International Clinical Trials Registry. Eligible studies included newly diagnosed patients with type 1 diabetes, any intervention to improve glucose control and at least 1 month of follow-up. Data were extracted using a pre-defined data-extraction sheet with 10% of extractions checked by a second reviewer.

RESULTS

Twenty-eight studies with 1662 participants were grouped by intervention into six subgroups (alternative insulins, subcutaneous and intravenous insulin delivery, intensive therapy, glucose sensing, adjuncts). Only three studies demonstrated an improvement in glucose control as well as β-cell function. These interventions included intensive insulin therapy and use of an alternative insulin.

CONCLUSIONS

This is the largest comprehensive review of RCTs in this area. It demonstrates a lack of robust evidence that interventions to improve glucose control preserve β-cell function in new onset type 1 diabetes, although analysis was hampered by low-quality evidence and inconsistent reporting of studies. Development of guidelines to support the design of trials in this field is a priority.

Jumping in lantern bugs (Hemiptera, Fulgoridae)

Lantern bugs are amongst the largest of the jumping hemipteran bugs, with body lengths reaching 44 mm and masses reaching 0.7 g. They are up to 600 times heavier than smaller hemipterans that jump powerfully using catapult mechanisms to store energy. Does a similar mechanism also propel jumping in these much larger insects? The jumping performance of two species of lantern bugs (Hemiptera, Auchenorrhyncha, family Fulgoridae) from India and Malaysia was therefore analysed from high-speed videos. The kinematics showed that jumps were propelled by rapid and synchronous movements of both hind legs, with their trochantera moving first. The hind legs were 20–40% longer than the front legs, which was attributable to longer tibiae. It took 5–6 ms to accelerate to take-off velocities reaching 4.65 m s⁻¹ in the best jumps by female Kalidasa lanata. During these jumps, adults experienced an acceleration of 77 g, required an energy expenditure of 4800 μJ and a power output of 900 mW, and exerted a force of 400 mN. The required power output of the thoracic jumping muscles was 21,000 W kg⁻¹, 40 times greater than the maximum active contractile limit of muscle. Such a jumping performance therefore required a power amplification mechanism with energy storage in advance of the movement, as in their smaller relatives. These large lantern bugs are near isometrically scaled-up versions of their smaller relatives, still achieve comparable, if not higher, take-off velocities, and outperform other large jumping insects such as grasshoppers.

Summary: Lantern bugs are large insects that jump at high-take-off velocities using a catapult mechanism that matches the performance of their much smaller planthopper relatives

Exploring Interventions to Improve the Oral Health and Related Health Behaviours of Adults Experiencing Severe and Multiple Disadvantage: Protocol for a Qualitative Study with Stakeholders

The number of individuals in England experiencing homelessness, substance use, and involvement with the criminal justice system is increasing. These issues, referred to as severe and multiple disadvantage (SMD), are often interlinked and co-occur. Health inequalities, particularly poor oral health, persist for those facing these inter-related issues and are closely linked with high levels of substance use, smoking, and poor diet. However, evidence for interventions that can improve these health outcomes for those experiencing these issues is limited. This paper outlines the design of a qualitative study which aims to explore the perspectives of stakeholders to understand what interventions can help to support SMD groups with their oral health and related health behaviours (i.e., substance use, smoking, diet). Interviews and focus groups will be undertaken with stakeholders comprising two groups: (1) individuals with experience of SMD, and (2) service providers (staff and volunteers), policy makers, and commissioners who support such individuals. Public involvement and engagement is central to the project. For example, stakeholders and research partners in policy and practice and people with lived experience of SMD will provide input at all stages of this study. Findings from the study will inform an ‘evidence for practice’ briefing outlining recommendations for policy. Dissemination will occur through presentations to a range of practice, policy and academic beneficiaries, and through peer-reviewed publications.

“It's been up and down”—perspectives on living through COVID-19 for individuals who experience homelessness: a qualitative study

Background

The UN describes the COVID-19 pandemic as the greatest public health crisis for the current generation. However, individuals who experienced austerity, adversity, and disadvantage prior to the pandemic have been disproportionately affected with every turn the pandemic has taken, from transmission risk to vaccination take-up. One such population is individuals who experience homelessness. As the UK begins to transition to a stage of post-pandemic recovery, it is imperative to understand the perceived impact COVID-19 has had on the day-to-day lives of individuals who experience homelessness, to ensure they are not left behind and recovery planning can be better targeted to their specific needs.

Methods

Between February and May, 2021, 26 individuals (10 women and 16 men) who self-identified as experiencing homelessness within the Newcastle Gateshead area took part in telephone interviews of 20–80 min in length. Participants provided written or verbal informed consent prior to participating. Recruitment took place through existing networks, housing providers, charities, word of mouth, and snowball sampling. Analysis was co-produced with five individuals with lived experience using interpretative phenomenological analysis. NVivo release 1·5 was used to organise quotes. Ethics approval was granted by the Faculty of Medical Sciences Research Ethics Committee, part of Newcastle University's Research Ethics Committee (ref 2034/6698/2020.)

Findings

Experiences shared depicted unique stories with commonalities across the findings through five main themes: (1) surreality of day-to-day life—searching for understanding and lost autonomy; (2) an emotional rollercoaster—confronting negative emotions; (3) loneliness is my best friend—learning from being alone; (4) adversity is the only consistency—recognising past and present hardship, violence, and loss; and (5) coping with uncertainty—using drugs, mindfulness, and technology to survive.

Interpretation

The pandemic has affected the daily lives of people who experience homelessness in a variety of ways, including personal growth, no change, and regression. This study is limited by its localised recruitment in Newcastle and Gateshead in the UK; however, this local focus and involvement of individuals with lived experience has strengthened the study's implications for policy and practice in the region. Initiatives or policies developed to support post-pandemic recovery should reflect the array of impacts, while giving special recognition to loneliness, adversity, and resiliency among individuals who experience homelessness.

Funding

National Institute for Health Research School for Public Health Research.

Peer advocacy and access to healthcare for people who are homeless in London, UK: a mixed method impact, economic and process evaluation protocol

INTRODUCTION

People who are homeless experience higher morbidity and mortality than the general population. These outcomes are exacerbated by inequitable access to healthcare. Emerging evidence suggests a role for peer advocates-that is, trained volunteers with lived experience-to support people who are homeless to access healthcare.

METHODS AND ANALYSIS

We plan to conduct a mixed methods evaluation to assess the effects (qualitative, cohort and economic studies); processes and contexts (qualitative study); fidelity; and acceptability and reach (process study) of Peer Advocacy on people who are homeless and on peers themselves in London, UK. People with lived experience of homelessness are partners in the design, execution, analysis and dissemination of the evaluation.

ETHICS AND DISSEMINATION

Ethics approval for all study designs has been granted by the National Health Service London-Dulwich Research Ethics Committee (UK) and the London School of Hygiene and Tropical Medicine's Ethics Committee (UK). We plan to disseminate study progress and outputs via a website, conference presentations, community meetings and peer-reviewed journal articles.

Exploring the experiences of changes to support access to primary health care services and the impact on the quality and safety of care for homeless people during the COVID-19 pandemic: a study protocol for a qualitative mixed methods approach

Background

Despite high level of health care need amongst people experiencing homelessness, poor access is a major concern. This is sometimes due to organisational and bureaucratic barriers, but also because they often feel stigmatised and treated badly when they do seek health care. The COVID-19 pandemic and the required social distancing measures have caused unprecedented disruption and change for the organisation of primary care, particularly for people experiencing homelessness. Against this backdrop there are many questions to address regarding whether the recent changes required to deliver services to people experiencing homelessness in the context of COVID-19 will help to address or compound problems in accessing care and inequalities in health outcomes.

Methods

An action led and participatory research methodology will be employed to address the study objectives. Interviews with people experiencing homelessness were will be conducted by a researcher with lived experience of homelessness. Researchers with lived experience are able to engage with vulnerable communities in an empathetic, non-judgemental way as their shared experience promotes a sense of trust and integrity, which in turn encourages participation in research and may help people speak more openly about their experience. The experiences of health professionals and stakeholders delivering and facilitating care for people experiencing homelessness during the pandemic will also be explored.

Discussion

It is important to explore whether recent changes to the delivery of primary care in response to the COVID-19 pandemic compromise the safety of people experiencing homelessness and exacerbate health inequalities. This could have implications for how primary healthcare is delivered to those experiencing homelessness not only for the duration of the pandemic but in the future.

Strategies to improve oral health behaviours and dental access for people experiencing homelessness: a qualitative study

Objectives The present study aimed to identify strategies to improve oral health behaviours as well as access to and provision of dental care for people experiencing homelessness.Method We conducted focus groups with people living in a residential homeless centre and semi-structured interviews with other stakeholders working with or supporting people experiencing homelessness. Following an inductive approach, thematic analysis was used to synthesise the findings on NVivo software.Results Participants included 11 British males experiencing homelessness and 12 other stakeholders from various professional backgrounds. Themes identified included: awareness and empowerment; supportive environment and dental health system; flexible and holistic care; outreach and community engagement; collaboration with other health and social services; and effective communication.Conclusions Efforts to improve oral health among people experiencing homelessness via improved oral health habits and engagement with services need to be directed at both the recipients of care and the healthcare teams. Well-powered empirical studies are needed to evaluate whether the strategies identified can improve engagement and care provision for this population.

Jumping and take-off in a winged scorpion fly (Mecoptera, Panorpa communis)

High-speed videos were used to analyse whether and how adults of a winged species of scorpion fly (Mecoptera, Panorpa communis) jump and determine whether they use the same mechanism as that of the only other mecopteran known to jump, the wingless snow flea, Boreus hyemalis Adult females are longer and heavier than males and have longer legs, but of the same relative proportions. The middle legs are 20% longer and the hind legs 60% longer than the front legs. A jump starts with the middle and hind legs in variable positions, but together, by depressing their coxo-trochanteral and extending their femoro-tibial joints, they accelerate the body in 16-19 ms to mean take-off velocities of 0.7-0.8 m s^-1; performances in males and females were not significantly different. Depression of the wings accompanies these leg movements, but clipping them does not affect jump performance. Smooth transition to flapping flight occurs once airborne with little loss of energy to body rotation. Ninety percent of the jumps analysed occurred without an observable stimulus; the remaining 10% were in response to a mechanical touch. The performance of these jumps was not significantly different. In its fastest jumps, a scorpion fly experiences an acceleration of 10 g , expends 23 µJ of energy and requires a power output less than 250 W kg^-1 of muscle that can be met by direct muscle contractions without invoking an indirect power amplification mechanism. The jumping mechanism is like that of snow fleas.

Insect jumping springs

A quick guide to the springs used by insects to achieve remarkable feats of jumping.

Do enlarged hind legs of male thick-legged flower beetles contribute to take-off or mating?

The volume of the hind femora in adult male flower beetles, Oedemera nobilis, is 38 times greater than in adult females. To determine what advantage limbs with swollen femora might provide, the behaviour of these insects was analysed with high speed videography. First, because large hind legs are often associated with jumping and take-off, the performance of this behaviour by the two sexes was determined. Take-off was generated by a series of small amplitude wing beats followed by larger ones with the hind legs contributing little or no propulsion. The mean acceleration time to take-off was not significantly different in males (46.2 ms) and females (45.5 ms), but the mean take-off velocity of males was 10% higher than in females. Second, to determine if enlarged hind legs were critical in specifically male behaviour, interactions between males and females, and between males were videoed. A male mounted a female and then encircled her abdomen between the enlarged femora and tibiae of both his hind legs. The joint between these leg parts acted like a mole wrench (vise grip) so that when the tibia was fully flexed a triangular space of 0.3 square mm remained in which a female abdomen (cross-sectional area 0.9 square mm) could be compressed and restrained firmly without inflicting damage. The flexor tibiae muscle in a male hind femur was 5.9 times larger than the extensor. In interactions between males, attempts to achieve a similar entrapment were frequently thwarted by the pursued male extending his hind legs vertically.

Antimicrobial Prescribing in Dogs and Cats in Australia: Results of the Australasian Infectious Disease Advisory Panel Survey

Background

Investigations of antimicrobial use in companion animals are limited. With the growing recognition of the need for improved antimicrobial stewardship, there is urgent need for more detailed understanding of the patterns of antimicrobial use in this sector.

Objectives

To investigate antimicrobial use for medical and surgical conditions in dogs and cats by Australian veterinarians.

Methods

A cross‐sectional study was performed over 4 months in 2011. Respondents were asked about their choices of antimicrobials for empirical therapy of diseases in dogs and cats, duration of therapy, and selection based on culture and susceptibility testing, for common conditions framed as case scenarios: 11 medical, 2 surgical, and 8 dermatological.

Results

A total of 892 of the 1,029 members of the Australian veterinary profession that completed the survey satisfied the selection criteria. Empirical antimicrobial therapy was more common for acute conditions (76%) than chronic conditions (24%). Overall, the most common antimicrobial classes were potentiated aminopenicillins (36%), fluoroquinolones (15%), first‐ and second‐generation cephalosporins (14%), and tetracyclines (11%). Third‐generation cephalosporins were more frequently used in cats (16%) compared to dogs (2%). Agreement with Australasian Infectious Disease Advisory Panel (AIDAP) guidelines (generated subsequently) was variable ranging from 0 to 69% between conditions.

Conclusions and Clinical Importance

Choice of antimicrobials by Australian veterinary practitioners was generally appropriate, with relatively low use of drugs of high importance, except for the empirical use of fluoroquinolones in dogs, particularly for otitis externa and 3rd‐generation cephalosporins in cats. Future surveys will determine whether introduction of the 2013 AIDAP therapeutic guidelines has influenced prescribing habits.

Jumping performance of flea hoppers and other mirid bugs (Hemiptera, Miridae)

The order Hemiptera includes jumping insects with the fastest take-off velocities, all generated by catapult mechanisms. It also contains the large family Miridae or plant bugs. Here, we analysed the jumping strategies and mechanisms of six mirid species from high-speed videos and from the anatomy of their propulsive legs, and conclude that they use a different mechanism in which jumps are powered by the direct contractions of muscles. Three strategies were identified. First, jumping was propelled only by movements of the middle and hind legs, which were, respectively, 140% and 190% longer than the front legs. In three species with masses ranging from 3.4 to 12.2 mg, depression of the coxo-trochanteral and extension of femoro-tibial joints accelerated the body in 8-17 ms to take-off velocities of 0.5-0.8 m s^-1 The middle legs lost ground contact 5-6 ms before take-off so that the hind legs generated the final propulsion. The power requirements could be met by the direct muscle contractions so that catapult mechanisms were not implicated. Second, other species combined the same leg movements with wing beating to generate take-off during a wing downstroke. Third, up to four wingbeat cycles preceded take-off and were not assisted by leg movements. Take-off velocities were reduced and acceleration times lengthened. Other species from the same habitat did not jump. The lower take-off velocities achieved by powering jumping by direct muscle contractions may be offset by eliminating the time taken to load catapult mechanisms.

Monomeric, porous type II collagen scaffolds promote chondrogenic differentiation of human bone marrow mesenchymal stem cells in vitro

Osteoarthritis (OA) is a common cause of pain and disability and is often associated with the degeneration of articular cartilage. Lesions to the articular surface, which are thought to progress to OA, have the potential to be repaired using tissue engineering strategies; however, it remains challenging to instruct cell differentiation within a scaffold to produce tissue with appropriate structural, chemical and mechanical properties. We aimed to address this by driving progenitor cells to adopt a chondrogenic phenotype through the tailoring of scaffold composition and physical properties. Monomeric type-I and type-II collagen scaffolds, which avoid potential immunogenicity associated with fibrillar collagens, were fabricated with and without chondroitin sulfate (CS) and their ability to stimulate the chondrogenic differentiation of human bone marrow-derived mesenchymal stem cells was assessed. Immunohistochemical analyses showed that cells produced abundant collagen type-II on type-II scaffolds and collagen type-I on type-I scaffolds. Gene expression analyses indicated that the addition of CS - which was released from scaffolds quickly - significantly upregulated expression of type II collagen, compared to type-I and pure type-II scaffolds. We conclude that collagen type-II and CS can be used to promote a more chondrogenic phenotype in the absence of growth factors, potentially providing an eventual therapy to prevent OA.

Take-off mechanisms in parasitoid wasps

High speed video analyses of the natural behaviour of parasitoid wasps revealed three strategies used to launch themselves into the air. Which strategy is the most energy efficient? In Pteromalus puparum, 92% of take-offs by were propelled entirely by movements of the middle and hind legs which were depressed at their coxo-trochanteral and extended at their femoro-tibial joints. The front legs left the ground first, followed by the hind legs, so that the middle legs provided the final propulsion. Second, in other species of a similar mass, Cotesia glomerata and Leptopilina boulardi, all take-offs were propelled by a mean of 2.8 and 3.8 wingbeats respectively with little or no contribution from the legs. The first strategy resulted in take-off times that were four times shorter (5 versus 22.8 ms) and take-off velocities that were four times faster (0.8 versus 0.2 m s–1). Calculations from the kinematics indicate that propulsion by the legs was the most energy efficient strategy, because more energy is put into propulsion of the body, whereas in take-off propelled by repetitive wing movements energy is lost to generating these movements and moving the air. In heavier species such as Netelia testacea and Amblyteles armatorius, take-off was propelled by the combined movements of the middle and hind legs and wingbeats. In A. armatorius, this resulted in the longest mean take-off time of 33.8 ms but an intermediate take-off velocity of 0.4 m s–1. In all three strategies the performance could be explained without invoking energy storage and power amplification mechanisms.

Take-off speed in jumping mantises depends on body size and a power-limited mechanism

Many insects such as fleas, froghoppers and grasshoppers use a catapult mechanism to jump, and a direct consequence of this is that their take-off velocities are independent of their mass. In contrast, insects such as mantises, caddis flies and bush crickets propel their jumps by direct muscle contractions. What constrains the jumping performance of insects that use this second mechanism? To answer this question, the jumping performance of the mantis Stagmomantis theophila was measured through all its developmental stages, from 5 mg first instar nymphs to 1200 mg adults. Older and heavier mantises have longer hind and middle legs and higher take-off velocities than younger and lighter mantises. The length of the propulsive hind and middle legs scaled approximately isometrically with body mass (exponent=0.29 and 0.32, respectively). The front legs, which do not contribute to propulsion, scaled with an exponent of 0.37. Take-off velocity increased with increasing body mass (exponent=0.12). Time to accelerate increased and maximum acceleration decreased, but the measured power that a given mass of jumping muscle produced remained constant throughout all stages. Mathematical models were used to distinguish between three possible limitations to the scaling relationships: first, an energy-limited model (which explains catapult jumpers); second, a power-limited model; and third, an acceleration -: limited model. Only the model limited by muscle power explained the experimental data. Therefore, the two biomechanical mechanisms impose different limitations on jumping: those involving direct muscle contractions (mantises) are constrained by muscle power, whereas those involving catapult mechanisms are constrained by muscle energy.

Jumping mechanisms and strategies in moths (Lepidoptera)

To test whether jumping launches moths into the air, take-off by 58 species, ranging in mass from 0.1 to 220 mg, was captured in videos at 1000 frames s−1. Three strategies for jumping were identified. First, rapid movements of both middle and hind legs provided propulsion while the wings remained closed. Second, middle and hind legs again provided propulsion but the wings now opened and flapped after take-off. Third, wing and leg movements both began before take-off and led to an earlier transition to powered flight. The middle and hind legs were of similar lengths and were between 10 and 130% longer than the front legs. The rapid depression of the trochantera and extension of the middle tibiae began some 3 ms before similar movements of the hind legs, but their tarsi lost contact with the ground before take-off. Acceleration times ranged from 10 ms in the lightest moths to 25 ms in the heaviest ones. Peak take-off velocities varied from 0.6 to 0.9 m s−1 in all moths, with the fastest jump achieving a velocity of 1.2 m s−1. The energy required to generate the fastest jumps was 1.1 µJ in lighter moths but rose to 62.1 µJ in heavier ones. Mean accelerations ranged from 26 to 90 m s−2 and a maximum force of 9 g was experienced. The highest power output was within the capability of normal muscle so that jumps were powered by direct contractions of muscles without catapult mechanisms or energy storage.

Impacts of Crop Variety and Time of Inoculation on the Susceptibility and Tolerance of Winter Wheat to Wheat streak mosaic virus

Plant genotype, age, size, and environmental factors can modify susceptibility and tolerance to disease. Understanding the individual and combined impacts of these factors is needed to define improved disease management strategies. In the case of Wheat streak mosaic virus (WSMV) in winter wheat, yield losses and plant susceptibility have been found to be greatest when the crop is exposed to the virus in the fall in the central and southern Great Plains. However, the seasonal dynamics of disease risk may be different in the northern Great Plains, a region characterized by a relatively cooler fall conditions, because temperature is known to modify plant-virus interactions. In a 2-year field study conducted in south-central Montana, we compared the impact of fall and spring WSMV inoculations on the susceptibility, tolerance, yield, and grain quality of 10 winter wheat varieties. Contrary to previous studies, resistance and yields were lower in the spring than in the fall inoculation. In all, 5 to 7% of fall-inoculated wheat plants were infected with WSMV and yields were often similar to uninoculated controls. Spring inoculation resulted in 45 to 57% infection and yields that were 15 to 32% lower than controls. Although all varieties were similarly susceptible to WSMV, variations in tolerance (i.e., yield losses following exposure to the virus) were observed. These results support observations that disease risk and impacts differ across the Great Plains. Possible mechanisms include variation in climate and in the genetic composition of winter wheat and WSMV across the region.

Relative Susceptibility Among Alternative Host Species Prevalent in the Great Plains to Wheat streak mosaic virus

Wild grasses, crops, and grassy weeds are known to host Wheat streak mosaic virus (WSMV) and its vector, the wheat curl mite (WCM). Their relative importance as a source of WSMV was evaluated. A survey of small-grain fields throughout Montana was conducted between 2008 and 2009. Cheatgrass was the most prevalent grassy weed and the most frequent viral host, with 6% infection by WSMV in 2008 (n = 125) and 15% in 2009 (n = 358). By mechanically inoculating plants with WSMV in the greenhouse, the highest susceptibility was found in rye brome (52.1%), jointed goatgrass (80.9%), and wild oat (53.9%. Quackgrass, not previously reported as a host, was susceptible to WSMV (12.7%). Mite transmission efficiency from susceptible grass species was lower than from wheat, and grass species must be a host for both WSMV and the WCM to serve as a virus source. WCM transmission was more efficient than mechanical transmission. Overall, results indicate that grass species can serve as a viral reservoir, regional variation in a weed species' susceptibility to WSMV cannot explain geographic variation in epidemic intensity, and crop species and closely related weeds (e.g., jointed goatgrass) remain the best reservoirs for both WSMV and the WCM.

Jumping mechanisms in jumping plant lice (Hemiptera, Sternorrhyncha, Psyllidae)

Jumping mechanisms and performance were analysed in three species of psyllids (Hemiptera, Sternorrhyncha) that ranged from 2 to 4 mm in body length and from 0.7 to 2.8 mg in mass. Jumping was propelled by rapid movements of the short hind legs, which were only 10-20% longer than the other legs and 61-77% of body length. Power was provided by large thoracic muscles that depressed the trochantera so that the two hind legs moved in parallel planes on either side of the body. These movements accelerated the body to take-off in 0.9 ms in the smallest psyllid and 1.7 ms in the largest, but in all species imparted a rapid forward rotation so that at take-off the head pointed downwards, subtending angles of approximately -60 deg relative to the ground. The front legs thus supported the body just before take-off and either lost contact with the ground at the same time as, or even after, the hind legs. In the best jumps from the horizontal, take-off velocity reached 2.7 m s(-1) and the trajectory was steep at 62-80 deg. Once airborne, the body spun rapidly at rates of up to 336 Hz in the pitch plane. In many jumps, the wings did not open to provide stabilisation, but some jumps led directly to sustained flight. In their best jumps, the smallest species experienced a force of 637 g. The largest species had an energy requirement of 13 μJ, a power output of 13 mW and exerted a force of nearly 10 mN. In a rare jumping strategy seen in only two of 211 jumps analysed, the femoro-tibial joints extended further and resulted in the head pointing upwards at take-off and the spin rate being greatly reduced.

A buckling region in locust hindlegs contains resilin and absorbs energy when jumping or kicking goes wrong

If a hindleg of a locust slips during jumping, or misses its target during kicking, energy generated by the two extensor tibiae muscles is no longer expended in raising the body or striking a target. How, then, is the energy in a jump (4100-4800 μJ) or kick (1700 μJ) dissipated? A specialised buckling region found in the proximal hind-tibia where the bending moment is high, but not present in the other legs, buckled and allowed the distal part of the tibia to extend. In jumps when a hindleg slipped, it bent by a mean of 23±14 deg at a velocity of 13.4±9.5 deg ms(-1); in kicks that failed to contact a target it bent by 32±16 deg at a velocity of 32.9±9.5 deg ms(-1). It also buckled 8.5±4.0 deg at a rate of 0.063±0.005 deg ms(-1) when the tibia was prevented from flexing fully about the femur in preparation for both these movements. By experimentally buckling this region through 40 deg at velocities of 0.001-0.65 deg ms(-1), we showed that one hindleg could store about 870 μJ on bending, of which 210 μJ was dissipated back to the leg on release. A band of blue fluorescence was revealed at the buckling region under UV illumination that had the two key signatures of the elastic protein resilin. A group of campaniform sensilla 300 μm proximal to the buckling region responded to imposed buckling movements. The features of the buckling region show that it can act as a shock absorber as proposed previously when jumping and kicking movements go wrong.

Effectiveness of a nurse-led alcohol liaison service in a secondary care medical unit

Alcohol misuse is a common reason for hospital admission. While there is considerable evidence from other areas that provision of specialised alcohol services can reduce alcohol intake, there is currently less evidence for medical departments in an acute hospital setting. Nottingham hospitals initiated such a service in 2002-3 based around two nurse specialists who provided input to inpatients with alcohol-related physical disease and provided links to community-based services for alcohol misuse. This service assessed 3632 patients over five years and has seen a reduction in hospital admissions, violent incidents against staff and primary care attendances. It is believed that this model of care is an effective means of intervening in people with alcohol-related problems.

Jumping mechanisms and performance of pygmy mole crickets (Orthoptera, Tridactylidae)

Pygmy mole crickets live in burrows at the edge of water and jump powerfully to avoid predators such as the larvae and adults of tiger beetles that inhabit the same microhabitat. Adults are 5–6 mm long and weigh 8 mg. The hind legs are dominated by enormous femora containing the jumping muscles and are 131% longer than the body. The ratio of leg lengths is: 1:2.1:4.5 (front:middle:hind, respectively). The hind tarsi are reduced and their role is supplanted by two pairs of tibial spurs that can rotate through 180 deg. During horizontal walking the hind legs are normally held off the ground. Jumps are propelled by extension of the hind tibiae about the femora at angular velocities of 68,000 deg s−1 in 2.2 ms, as revealed by images captured at rates of 5000 s−1. The two hind legs usually move together but can move asynchronously, and many jumps are propelled by just one hind leg. The take-off angle is steep and once airborne the body rotates backwards about its transverse axis (pitch) at rates of 100 Hz or higher. The take-off velocity, used to define the best jumps, can reach 5.4 m s−1, propelling the insect to heights of 700 mm and distances of 1420 mm with an acceleration of 306 g. The head and pronotum are jerked rapidly as the body is accelerated. Jumping on average uses 116 μJ of energy, requires a power output of 50 mW and exerts a force of 20 mN. In jumps powered by one hind leg the figures are about 40% less.

The mechanics of azimuth control in jumping by froghopper insects

Many animals move so fast that there is no time for sensory feedback to correct possible errors. The biomechanics of the limbs participating in such movements appear to be configured to simplify neural control. To test this general principle, we analysed how froghopper insects control the azimuth direction of their rapid jumps, using high speed video of the natural movements and modelling to understand the mechanics of the hind legs. We show that froghoppers control azimuth by altering the initial orientation of the hind tibiae; their mean angle relative to the midline closely predicts the take-off azimuth. This applies to jumps powered by both hind legs, or by one hind leg. Modelling suggests that moving the two hind legs at different times relative to each other could also control azimuth, but measurements of natural jumping showed that the movements of the hind legs were synchronised to within 32 mus of each other. The maximum timing difference observed (67 micros) would only allow control of azimuth over 0.4 deg. to either side of the midline. Increasing the timing differences between the hind legs is also energetically inefficient because it decreases the energy available and causes losses of energy to body spin; froghoppers with just one hind leg spin six times faster than intact ones. Take-off velocities also fall. The mechanism of azimuth control results from the mechanics of the hind legs and the resulting force vectors of their tibiae. This enables froghoppers to have a simple transform between initial body position and motion trajectory, therefore potentially simplifying neural control.

Energy storage and synchronisation of hind leg movements during jumping in planthopper insects (Hemiptera, Issidae)

The hind legs of Issus (Hemiptera, Issidae) move in the same plane underneath the body, an arrangement that means they must also move synchronously to power jumping. Moreover, they move so quickly that energy must be stored before a jump and then released suddenly. High speed imaging and analysis of the mechanics of the proximal joints of the hind legs show that mechanical mechanisms ensure both synchrony of movements and energy storage. The hind trochantera move first in jumping and are synchronised to within 30 micros. Synchrony is achieved by mechanical interactions between small protrusions from each trochantera which fluoresce bright blue under specific wavelengths of ultra-violet light and which touch at the midline when the legs are cocked before a jump. In dead Issus, a depression force applied to a cocked hind leg, or to the tendon of its trochanteral depressor muscle causes a simultaneous depression of both hind legs. The protrusion of the hind leg that moves first nudges the other hind leg so that both move synchronously. Contractions of the trochanteral depressor muscles that precede a jump bend the metathoracic pleural arches of the internal skeleton. Large areas of these bow-shaped structures fluoresce bright blue in ultraviolet light, and the intensity of this fluorescence depends on the pH of the bathing saline. These are key signatures of the rubber-like protein resilin. The remainder of a pleural arch consists of stiff cuticle. Bending these composite structures stores energy and their recoil powers jumping.

High-resolution peripheral QCT imaging of bone micro-structure in adolescents

SUMMARY

We examined the feasibility of high-resolution peripheral quantitative computed tomography (HR-pQCT) to assess bone microstructure in adolescents. Low radiation doses and clear images were produced using a region of interest (ROI) at 8% of tibial length. Active growth plates were observed in 33 participants. HR-pQCT safely assessed important elements of bone microstructure in adolescents.

INTRODUCTION

We examined the feasibility and safety of HR-pQCT to assess tibial bone microstructure in adolescents.

METHODS

We used XtremeCT (Scanco Medical) to assess bone microstructure at the distal tibia in 278 participants (15-20 years old).

RESULTS

The 2.8-min scan resulted in a relatively low radiation dose (<3 microSv) while producing artifact clear images in all participants. An 8% scan site was equivalent to 33 +/- 2 mm of total tibial length (400 +/- 30 mm). We observed active growth plates in 33 participants. The growth plate was located at 13 +/- 2 mm of total tibial length and was not included in the ROI for any participant.

CONCLUSIONS

HR-pQCT safely assessed important elements of bone microstructure in adolescents. Given the important contribution of bone geometry and structure to bone strength, it is essential to better understand the development and adaptation of these parameters in cortical and trabecular bone compartments.

The effect of leg length on jumping performance of short- and long-legged leafhopper insects

To assess the effect of leg length on jumping ability in small insects, the jumping movements and performance of a sub-family of leafhopper insects(Hemiptera, Auchenorrhyncha, Cicadellidae, Ulopinae) with short hind legs were analysed and compared with other long-legged cicadellids (Hemiptera,Auchenorrhyncha, Cicadellidae). Two species with the same jumping characteristics but distinctively different body shapes were analysed: Ulopa, which had an average body length of 3 mm and was squat, and Cephalelus, which had an average body length of 13 mm with an elongated body and head. In both, the hind legs were only 1.4 times longer than the front legs compared with 1.9–2.3 times in other cicadellid leafhoppers. When the length of the hind legs was normalised relative to the cube root of their body mass, their hind legs had a value of 1–1.1 compared with 1.6–2.3 in other cicadellids. The hind legs of Cephalelus were only 20% of the body length. The propulsion for a jump was delivered by rapid and synchronous rotation of the hind legs about their coxo-trochanteral joints in a three-phase movement, as revealed by high-speed sequences of images captured at rates of 5000 s–1. The hind tarsi were initially placed outside the lateral margins of the body and not apposed to each other beneath the body as in long-legged leafhoppers. The hind legs were accelerated in 1.5 ms (Ulopa) and 2 ms(Cephalelus) and thus more quickly than in the long-legged cicadellids. In their best jumps these movements propelled Ulopa to a take-off velocity of 2.3 m s–1 and Cephalelus to 2 m s–1, which matches that of the long-legged cicadellids. Both short-legged species had the same mean take-off angle of 56° but Cephalelus adopted a lower angle of the body relative to the ground(mean 15°) than Ulopa (mean 56°). Once airborne, Cephalelus pitched slowly and rolled quickly about its long axis and Ulopa rotated quickly about both axes. To achieve their best performances Ulopa expended 7 μJ of energy, generated a power output of 7 mW, and exerted a force of 6 mN; Cephalelus expended 23μJ of energy, generated a power output of 12 mW and exerted a force of 11 mN. There was no correlation between leg length and take-off velocity in the long- and short-legged species, but longer legged leafhoppers had longer take-off times and generated lower ground reaction forces than short-legged leafhoppers, possibly allowing the longer legged leafhoppers to jump from less stiff substrates.

Weight-bearing exercise and bone mineral accrual in children and adolescents: a review of controlled trials

INTRODUCTION

Osteoporosis is a serious skeletal disease and as there is currently no cure, there is a large emphasis on its prevention, including the optimisation of peak bone mass. There is increasing evidence that regular weight-bearing exercise is an effective strategy for enhancing bone status during growth. This systematic review evaluates randomised and non-randomised controlled trials to date, on the effects of exercise on bone mineral accrual in children and adolescents.

METHODS

An online search of Medline and the Cochrane database enabled the identification of studies. Those that met the inclusion criteria were included in the review and graded according to risk for bias.

RESULTS

Twenty-two trials were reviewed. Nine were conducted in prepubertal children (Tanner I), 8 in early pubertal (Tanner II-III) and 5 in pubertal (Tanner IV-V). Sample sizes ranged from n=10 to 65 per group. Exercise interventions included games, dance, resistance training and jumping exercises, ranging in duration from 3 to 48 months. Approximately half of the trials (n=10) included ground reaction force (GRF) data (2 to 9 times body weight). All trials in early pubertal children, 6 in pre pubertal and 2 in pubertal children, reported positive effects of exercise on bone (P<0.05). Mean increases in bone parameters over 6 months were 0.9-4.9% in prepubertal, 1.1-5.5% in early pubertal and 0.3-1.9% in pubertal exercisers compared to controls (P<0.05).

CONCLUSIONS

Although weight-bearing exercise appears to enhance bone mineral accrual in children, particularly during early puberty; it remains unclear as to what constitutes the optimal exercise programme. Many studies to date have a high risk for bias and only a few have a low risk. Major limitations concerned selection procedures, compliance rates and control of variables. More well designed and controlled investigations are needed. Furthermore, the specific exercise intervention that will provide the optimal stimulus for peak bone mineral accretion is unclear. Future quantitative, dose-response studies using larger sample sizes and interventions that vary in GRF and frequency may characterise the most and least effective exercise programmes for bone mineral accrual in this population. In addition, the measurement of bone quality parameters and volumetric BMD would provide a greater insight into the mechanisms implicated in the adaptation of bone to exercise.

Velocity at V(.)O(2 max) and peak treadmill velocity are not influenced within or across the phases of the menstrual cycle

Velocity at VO(2 max) (vV(.)O(2 max)) and peak treadmill velocity (PTV) are variables highly predictive of endurance performance. However, how these variables are affected by the menstrual cycle is unknown. The aim of this study was to assess the effect of the menstrual cycle on vV(.)O(2 max) and PTV. Ten, female runners were studied across three menstrual cycles. Training, menstrual history and mood states were assessed for 2 months, with daily salivary samples taken to detect menstrual phases. During the third menstrual cycle, participants completed a maximal test to determine V(.)O(2 max), vV(.)O(2 max) and PTV in the early follicular phase, late follicular phase, early luteal phase, late luteal phase and menses. Progesterone increased at the onset of the luteal phase [mean (SEM); 490 (73.6) pmol l(-1)] compared to the follicular phase [344.6 (59.7) pmol l(-1)). No significant differences in the psychological mood states between the phases of the menstrual cycle were found (P>0.05). No significant differences in vV(.)O(2 max) (P=0.611), or PTV (P=0.472) were found between the phases of the menstrual cycle. Thus, vV(.)O(2 max) and PTV are not affected by the monthly menstrual cycle in female endurance runners.

Properties of descending dorsal unpaired median (DUM) neurons of the locust suboesophageal ganglion

A group of six dorsal unpaired median (DUM) neurons of the suboesophageal ganglion (SOG) of locusts was studied with neuroanatomical and electrophysiological techniques. The neurons are located posteriorly in the SOG and have axons that descend into the ganglia of the ventral nerve cord, some as far as the terminal abdominal ganglion. Within thoracic ganglia the neurons have profuse dendritic ramifications in many neuropiles, including ventral sensory neuropiles. Based on their projection patterns three different morphological types of neurons can be distinguished. These neurons receive excitatory inputs through sensory pathways that ascend from the thoracic ganglia and are activated by limb movements. They may be involved in the modulation of synaptic transmission in thoracic ganglia.

Spike width reduction modifies the dynamics of short-term depression at a central synapse in the locust

Short-term synaptic depression is an important component of computation within neural networks, but little is known of its contribution to information processing during synaptically generated spike trains. We analyzed short-term synaptic depression at a synapse between two identified motoneurons innervating the hind leg of the locust: the FETi-FlTi synapse (fast extensor tibiae-flexor tibiae). Brief electrical stimulation of a single hind leg proprioceptor, the lump receptor (LR), led to prolonged sequences of spikes in FETi, similar in number and frequency to those during natural kicking movements. Depression at the FETi-FlTi synapse during LR-evoked spike bursts was compared quantitatively to that during antidromic spike trains evoked by electrical stimulation of FETi in the extensor tibiae muscle, and by modeling. The magnitude of the short-term depression was significantly greater during LR-evoked spike trains. On the basis of the model parameters required to fit the depression, the FETi-FlTi synapse is predominantly used for transmitting the timing of the onset of FETi spiking rather than its spike rate. During LR-evoked spike trains, there was a rapid reduction in presynaptic spike width that did not occur during antidromic spike trains under physiological calcium concentrations. This produced a concomitant reduction in the amplitude of the FlTi EPSP, suggesting that it contributed to the differences between the two stimulation regimes. Differences in the short-term depression between synaptically evoked and antidromic spike trains emphasize that the properties of synaptic information transfer are dependent on the in vivo conditions at the synapse and may not be reproduced by in vitro spike trains.

Physiological factors associated with low bone mineral density in female endurance runners

OBJECTIVE

To explore potential factors that could be associated with low bone mineral density (BMD) in female endurance runners.

METHODS

Fifty two female endurance runners (1,500 m to marathon), aged 18-44 years, took part. Body fat percentage, lumbar spine BMD, and femoral neck BMD were measured using the Hologic QDR 4,500w bone densitometer. Data on training, menstrual cycle status, osteoporosis, and health related factors were obtained by questionnaire. Dietary variables were assessed from a prospective seven day dietary record of macronutrients and micronutrients.

RESULTS

The mean (SD) lumbar spine and femoral neck BMD were 1.11 (0.11) and 0.89 (0.12) g/cm(2) respectively. A backward elimination regression analysis showed that age, body mass, body fat, distance run, magnesium, and zinc intake were the variables significantly associated with BMD. Lumbar spine BMD (g/cm(2)) = -1.90 + (0.0486 x age (years)) + (0.342 x log mass (kg)) - (0.000861 x age(2) (years)) - (0.00128 x distance (km/week)), with an R(2) = 30.1% (SEE = 0.089 (95% confidence interval (CI) 0.05 to 0.23); p<0.001). Femoral neck BMD (g/cm(2)) = -2.51 - (0.00989 x age (years)) + (0.720 x log mass (kg)) + (0.000951 x magnesium (mg/day)) -(0.0289 x zinc (mg/day)) - (0.00821 x body fat (%)) - (0.00226 x distance (km/week)), with an R(2) = 50.2% (SEE = 0.100 (95% CI 0.06 to 0.22); p<0.001). The negative association between skeletal BMD and distance run suggested that participants who ran longer distances had a lower BMD of the lumbar spine and femoral neck. Further, the results indicated a positive association between body mass and BMD, and a negative association between body fat and BMD.

CONCLUSIONS

The results suggest a negative association between endurance running distance and lumbar spine and femoral neck BMD, with a positive association between body mass and femoral neck and lumbar spine BMD. However, longitudinal studies are required to assess directly the effect of endurance running and body mass on BMD, and to see if the addition of alternative exercise that would increase lean body mass would have a positive effect on BMD and therefore help to prevent osteoporosis.

GABA-like immunoreactivity in nonspiking interneurons of the locust metathoracic ganglion

Nonspiking interneurons are important components of the premotor circuitry in the thoracic ganglia of insects. Their action on postsynaptic neurons appears to be predominantly inhibitory, but it is not known which transmitter(s) they use. Here, we demonstrate that many but not all nonspiking local interneurons in the locust metathoracic ganglion are immunopositive for GABA (γ-aminobutyric acid). Interneurons were impaled with intracellular microelectrodes and were shown physiologically to be nonspiking. They were further characterized by defining their effects on known leg motor neurons when their membrane potential was manipulated by current injection. Lucifer Yellow was then injected into these interneurons to reveal their cell bodies and the morphology of their branches. Some could be recognised as individuals by comparison with previous detailed descriptions. Ganglia were then processed for GABA immunohistochemistry. Fifteen of the 17 nonspiking interneurons studied were immunopositive for GABA, but two were not. The results suggest that the majority of these interneurons might exert their well-characterized effects on other neurons through the release of GABA but that some appear to use a transmitter other than GABA. These nonspiking interneurons are therefore not an homogeneous population with regard to their putative transmitter.

Synaptic Connections of Different Strength Between Wind-sensitive Hairs and an Identified Projection Interneuron in the Locust

An identified intersegmental interneuron in Locusta and Schistocerca, with its cell body in the fourth abdominal ganglion and an axon which projects to the brain is excited by mechanosensory inputs from receptors on the head and neck. The organization of its receptive field, the types of sensory receptors which contribute to it and the patterns and strengths of the afferent connections were investigated by intracellular recording from the axon of the interneuron close to a spike-initiating site in the prothoracic ganglion. The receptive field of the interneuron consists of a small patch of hairs on the head ipsilateral to the axon, and from hairs on two regions of the prosternum (a cuticular structure on the ventral surface of the prothoracic segment), first an ipsilateral, lateral region and second a medial but contralateral region. Hairs on the pronotum (dorsal neck) also contribute but were not investigated here. Each spike in the afferent from a hair with a filiform appearance and with a pigmented base on the prosternum consistently evokes an EPSP in the interneuron. These have a short and constant latency, indicating that the connection is probably direct. The head hairs also appear to make direct connections with the interneuron in the prothoracic ganglion, so that the spike-initiating site here can integrate signals evoked by wind on the head and on the prosternum. Stiff tactile hairs on the prosternum do not connect with the interneuron. The EPSPs evoked by the long filiform hairs are consistently larger than those produced by the short filiform hairs and a single spike in some of the afferents from the long filiform hairs can evoke a spike in the interneuron. The effectiveness of an afferent is therefore correlated with the length of the filiform hair it innervates. The hairs with the most powerful effects are always the longest and occur in the same position on every locust. The shape of the receptive field and the different strengths of connections are apparent even in early larval instars. The axonal branches of the interneuron are restricted to the same side of the ganglion as the axon itself. Afferents from filiform hairs on the medial region of the prosternum project contralaterally, and those from the lateral region project ipsilaterally. Afferents from some of the head hairs project ipsilaterally directly to the prothoracic ganglion. The terminals of all these afferents overlap with the branches of the interneuron. By contrast, the afferents of tactile hairs which do not connect, project to different regions of neuropile. The connections ensure that the high sensitivity of the filiform hairs is maintained at the first stage in the central processing and suggest a role for this interneuron in supplying information about small changes in air currents that may be of use in controlling steering manoeuvres during flight.

The menstrual cycle and its effect on the immune status of female endurance runners

Twenty highly trained, eumenorrhoeic female endurance runners were studied over three consecutive menstrual cycles. Average training distance per week, total years training and mood states were recorded throughout the three cycles. Salivary progesterone and menstrual cycle diaries were recorded over the first two cycles to identify luteal phase onset and the presence of any menstrual irregularities. Saliva samples were collected daily over the third cycle for analysis of immunoglobulin A (IgA) concentration and secretion and saliva flow rate. Two-way analysis of variance (ANOVA) revealed no significant differences in mood states across the phases of the menstrual cycle (P > 0.05). Training logs indicated that training did not alter throughout the 3 month study. One-way ANOVA revealed no significant differences in IgA concentration (P = 0.92), secretion rate (P = 0.84) or saliva flow rate (P = 0.95) across the phases of the menstrual cycle. Pearson's product-moment correlation revealed no relationship between IgA concentration and progesterone between the phases of the cycle (r = 0.39). We conclude that, in ovulatory female endurance runners whose physical and emotional stress are stable, IgA concentration is not significantly affected by fluctuations in progesterone during the menstrual cycle.

The kinematics and neural control of high-speed kicking movements in the locust

The tibiae of locust hind legs can be extended fully in a kick in 3 ms with peak angular velocities of at least 80° ms–1. If the mass of the distal part of the leg is halved, then the extension is complete in less than 1 ms with angular velocities of more than 200° ms–1. The high velocities and the associated power are generated by a preceding storage of energy and its sudden release produced by a specific motor pattern and specialisations of the femoro-tibial joints. To understand the dynamics of these rapid movements and the interrelations between joint mechanics and the motor pattern, kicks were analysed with high-speed video images coupled to simultaneous intracellular recordings from identified leg motor neurones. The first movement is a full tibial flexion followed by co-contraction of the extensor and flexor tibiae muscles for 0.3–1 s, during which the distal end of the femur is flattened dorso-ventrally and expanded laterally. The two semi-lunar processes on the distal femur are bent when the fast extensor tibiae motor neurone spikes so that their tips move ventrally by up to 0.6 mm. The inward projections of these processes into the femur form the proximal part of the hinge joint with the tibia, so that the pivot of the joint also changes and the tibia therefore moves proximally and ventrally, widening the gap between it and the femur. Extension of the tibia begins on average 34 ms after the flexor motor neurones are inhibited at the end of the co-contraction phase. The tibia then begins to extend slowly, reaching peak velocities only when it has extended by 60–70°. The semi-lunar processes do not start to unfurl until the tibia has extended by 55°, so they cannot provide the initial energy for extension. An audible click is produced when the semi-lunar processes unfurl. The peak velocity of tibial extension is correlated with the amount of bending of the semi-lunar processes and with the number of fast extensor motor spikes, but the same amount of semi-lunar bending can be produced by both short and long co-contractions. When the tibia reaches full extension, inertial forces may cause it to bend by as much as 33° at a plane of weakness in the proximal tibia, thus allowing further extension of the distal end.

Sumatriptan: economic evidence for its use in the treatment of migraine, the Canadian comparative economic analysis

The objective of this study was to evaluate economic and health effects of sumatriptan relative to customary therapy in Canada. The relationship between treatment and functionality was established based on analysis of existing data from a multinational study. A Monte Carlo model was developed to simulate 1 year for each of customary therapy and six sumatriptan formulations. Costs are expressed in 1998 Canadian dollars. Sumatriptan is expected to reduce the time spent with migraine symptoms and resulting time lost. Under customary therapy, the annual cost of lost time is estimated at pound908 ($1973). With sumatriptan, these costs ranged from pound406 ($882) with subcutaneous sumatriptan to pound577 ($1254) with nasal sumatriptan 10 mg, saving pound331-502 ($719-1091) in the annual cost of time lost. All these benefits are expected to be obtained at an additional drug cost ranging from pound869 ($1889) for subcutaneous sumatriptan to pound278 ($605) for sumatriptan suppository. The cost of sumatriptan treatment is significantly offset by a substantial reduction of costs associated with time lost due to migraine symptoms.

The use of echocardiographic colour kinetic wall motion to differentiate broad complex tachycardia

Discrimination between supraventricular tachycardia (SVT) with aberrant conduction from ventricular tachycardia (VT) is vital for the safe and effective management of both conditions. Electrocardiographic algorithms for the differentiation of broad complex tachycardia are complex and difficult to implement in the acute setting, with misdiagnosis occurring in up to 40% of acute presentations. This case study shows the potential for echocardiographic colour kinesis (eck) to support electrocardiographic differentiation. A 74-year old man in sinus rhythm with left bundle branch block (lbbb), a history of myocardial infarction and recurrent sustained VT underwent eck analysis of wall motion propagation during a programmed electrical ventricular stimulation study. Sequential 40 ms time frames of echocardiographic colour coded endocardial wall motion velocity were recorded on video during both induced VT of lbbb configuration and near isochronic atrially paced tachycardia in lbbb. During VT there was initial eck propagation of ventricular septal wall motion from the apex to the atria secondary to electrical depolarisation. During atrially paced tachycardia initial eck motion developed in the interatrial septum and atrial wall followed by propagation in the ventricular endocardial septal wall motion from the atria toward the ventricular apex. This eck technique potentially could be used to support the electrocardiographic diagnosis of a broad complex tachycardia.

The physiology of the highly trained female endurance runner

Continuing improvements in the performance of female endurance runners and increasing levels of participation have generated the need to know more about the physiology of this group. Specific research is needed in this area, as data referring to male endurance runners cannot legitimately be applied to the female endurance runner because of their markedly different physiological and hormonal profiles. Recent developments in our understanding of an athlete's physiology (mainly in relation to the male endurance runner) have revealed new areas of interest that need to be assessed with specific reference to the female athlete. Relatively little attention has been directed towards identifying the major physiological characteristics of the highly trained/elite female endurance runner in general, and that which has been published on such factors and the effects of the menstrual cycle have produced equivocal results. Moreover, the impact of such training upon the menstrual cycle and endurance running performance is a controversial area, especially when assessing its subsequent impact on health-related issues. Reports of the condition referred to as the 'female athlete triad' have increased in recent years, with a decrease in bone mineral density predisposing the female athlete to increased risks of stress fractures. The aetiology of this triad is multifactorial, with such risk factors including nutrition, menstrual status, training intensity and frequency, body size and composition and psychology/physical stress. However, research limitations and flaws have lead to controversy in the literature regarding the immediate and long term effects of the triad on the female athlete. Likewise, the effects of the oral contraceptive pill on health and endurance performance also remain elusive, with a dearth of research pertaining to how oral contraceptive agents can aid athletic performance and the long term health of the female athlete. The purpose of this paper is to critically appraise the existing literature to provide a current review of the physiological scientific knowledge base in relation to the female athlete, health, training and performance, with suggestions for future areas of research. It is well known that certain menstrual and health-related performance factors of the female athlete, that is, physiological predictors of performance and body fat, have been extensively investigated over the last 30 years. However, a variety of methodological flaws and inconsistencies are present within the research and thus only the most prominent and well controlled studies within this area over the past 30 years will be referred to.

Sensory afferents and motor neurons as targets for nitric oxide in the locust

In the adult locust, nitric oxide (NO) synthase is expressed in interneurons that innervate mechanosensory neuropils, indicating that NO may participate in mechanosensory processing. Here, we have identified potential neuronal targets of NO by localizing the expression and activity of soluble guanylyl cyclase (SGC), its principal molecular target in the nervous system. We used two complementary approaches, namely immunolocalization of SGC alpha-subunit (SGCalpha), and of cyclic GMP (cGMP) after exposure to an NO donor. The cell bodies, axons and central projections of thoracic exteroceptors, proprioceptors, auditory receptors, and chemoreceptors were strongly immunoreactive for SGCalpha. Strong SGCalpha immunoreactivity also occurred in all thoracic motor neurons, including their axon terminals. NO-donors induced a pattern of cGMP immunostaining that was similar to the distribution of SGCalpha, indicating that both sensory and motor neurons contain functional SGC. Therefore, NO may modulate both the input from these sensory neurons and the output of motor neurons. Although the expression of SGCalpha was highly consistent, NO donors did not always induce cGMP-staining in SGC-containing neurons, suggesting that SGC is coregulated by factors other than NO. Complementing previous reports in the visual and olfactory system, our results indicate a general role for NO-cGMP signaling in early sensory processing; diffusible signals may mediate a cross-adaptation or -sensitization within neural maps where similarly tuned neurons have adjacent projections, an anatomical arrangement shared by many sensory systems.

The migraine ACE model: evaluating the impact on time lost and medical resource Use

OBJECTIVE

To describe the Migraine Adaptive Cost-Effectiveness Model in the context of an analysis of a simulated population of Canadian patients with migraine.

BACKGROUND

The high prevalence of migraine and its substantial impact on patients' ability to function normally present a significant economic burden to society. In light of the recent availability of improved pharmaceutical treatments, a model was developed to assess their economic impact.

METHODS

The Migraine Adaptive Cost-Effectiveness Model incorporates the costs of time lost from both work and nonwork activities, as well as medical resource and medication use. Using Monte Carlo techniques, the model simulates the experience of a population of patients with migraine over the course of 1 year. As an example, analyses of a Canadian population were carried out using data from a multinational trial, surveys, national statistics, and the available literature.

RESULTS

Using customary therapy, mean productivity losses (amounting to 84 hours of paid work time, 48 hours of unpaid work time, and 113 hours of leisure time lost) were estimated to cost $1949 (in 1997 Canadian dollars) per patient, with medical expenditures adding an average of $280 to the cost of illness.

CONCLUSIONS

With customary treatment patterns, the costs of migraine associated with reduced functional capacity are substantial. The migraine model represents a flexible tool for the economic evaluation of different migraine treatments in various populations.

Assessment of blood lactate: practical evaluation of the Biosen 5030 lactate analyzer

PURPOSE

The aim of this study was to assess the validity and reliability of the Biosen 5030 lactate analyzer compared with a YSI 2300 lactate analyzer and a Kodak Ektachem DTII in a practical laboratory study context.

METHODS

To assess validity, 144 triplicate capillarized blood samples, across a range of values, were analyzed using the three analyzers. To assess reliability a further 665 samples were repeat analyzed. Temporal stability was determined by the reanalysis of resting and maximal exercise blood samples, after a period of storage ranging from 7 to 20 h, at room temperature. To measure inter- and intra-investigator reliability, 20 resting samples were taken from three different subjects by different investigators and a coefficient of variation was determined.

RESULTS

There were strong relationships between the Biosen, the YSI (r2 = 0.97), and the Kodak Ektachem (r2 = 0.91). An analysis of Biosen compared with YSI revealed a positive bias of 0.37 mmol x L(-1) (95% limits of agreement, -0.85 to 1.59 mmol x L(-1)). The test-retest reliability correlation was significant (r2 = 0.99, P < 0.05), but a paired t-test revealed a small (0.03 mmol x L(-1), P < 0.05) significant difference. The coefficient of variation from the three investigators across the 20 samples ranged from 1.3 to 3%. Blood lactate concentration in resting blood samples did significantly increase in value (0.2 mmol x L(-1), P < 0.05) after 7-h exposure to the air, whereas there was no change in maximal exercise blood lactate values after 20-h exposure to the air.

CONCLUSIONS

In a practical context, the Biosen 5030 lactate analyzer was comparable to the other analyzers giving fast reliable measures of blood lactate concentrations over the full range of values, which remained stable over extended periods at room temperature.

Maps of the somata of efferent neurones with axons in the lateral nerves of locust abdominal ganglia

We used the cobalt-backfilling method to map the somata of neurones with axons that project in the two paired lateral nerves of the abdominal neuromeres of the locust Schistocerca gregaria with the objective of expanding and bringing together the incomplete and scattered information on these efferent neurones. We compared somata sizes and positions, and the pathways of primary neurites, with information from previous studies on individual, or groups of, abdominal neurones and we identify many of the somata we mapped. The stained somata belong to paired motor neurones and paired neurosecretory neurones, to unpaired neuromodulatory neurones (dorsal unpaired median, DUM, neurones) and unpaired bilaterally projecting neurones. In different neuromeres, the total number of somata with axons in these lateral nerves ranges from 73 to 106. Within an individual segmental neuromere, approximately 25 % of the somata belong to neurones with axons in nerve 1 (N1) and 35 % to those with axons in nerve 2 (N2) of that segment, while the remaining 40 % belong to neurones with axons in N1 of the next posterior segment. This basic pattern is repeated in all abdominal neuromeres, with differences in the percentages depending on whether the neuromeres are pregenital fused, pregenital unfused or genital. Nerve 1 contains the axons of 26–37 neurones with central somata in different neuromeres, of which 40 % are in the segmental neuromere and 60 % in the next anterior neuromere. In the segmental neuromere, 15 % of somata are ipsilateral to the nerve, 30 % are at the midline and 55 % are contralateral, whereas in the next anterior neuromere, 70 % are ipsilateral, 10 % are at the midline and 20 % are contralateral. Nerve 2 contains the axons of 11–28 neurones in different neuromeres, all of which have somata in the same segmental neuromere from which the nerve projects. Of these, approximately 70 % are ipsilateral, 30 % at the midline and none contralateral, except for the first abdominal and eighth male abdominal neuromeres, where one and two somata, respectively, are contralateral.

NADPH diaphorase histochemistry in the thoracic ganglia of locusts, crickets, and cockroaches: species differences and the impact of fixation

The NADPH diaphorase (NADPHd) reaction is widely used as a histochemical marker for nitric oxide synthase (NOS). In this study on locusts, crickets, and cockroaches, we demonstrate 1) that related species can differ considerably in the fixation sensitivity of putatively NOS-related NADPHd; and 2) that prolonged fixation can induce NADPHd activity in cells that are diaphorase negative under mild fixation regimes. These two phenomena reconcile previous, contradictory reports on the distribution of NADPHd in locusts and crickets. In locusts, neuronal NADPHd is found exclusively in interneurones. The projection neuropiles of the exteroceptors contain a dense NADPHd-positive fibre meshwork, but sensory afferents do not stain. In crickets, staining has been reported in sensory afferents, in motor neurones and dorsal unpaired median (DUM) neurones, and in a non-fibrous distribution throughout the sensory neuropiles. We demonstrate that this widespread, non-selective staining is induced by strong formaldehyde fixation. Weak fixation resulted in a highly selective labelling of a few individual interneurones and of a fibre meshwork in the projection neuropiles of the exteroceptive afferents. Staining was absent in the afferents themselves, in motor neurones, and in efferent DUM neurones. Thus, after weak fixation, the staining pattern closely matched that in the locust. The similar distribution of putatively NOS-related NADPHd in the thoracic nervous systems of orthopteroid insects suggests a species-independent role for nitric oxide in the processing of mechanosensory information. Histopharmacological techniques such as permanganate oxidation, or incubation in the NOS inhibitors methylene blue or dichlorophenolindophenol, did not allow discrimination between the selective and the fixation-induced staining. The species-specific impact of different fixation regimes may necessitate reconsideration of results obtained in other cross-species comparisons.

Synaptic activation of efferent neuromodulatory neurones in the locust Schistocerca gregaria

The segmental ganglia of the locust contain efferent neuromodulatory neurones with cell bodies at the dorsal midline and axons that supply muscles and other tissue on both sides of the body. These are the dorsal unpaired median (DUM) neurones. Intracellular recordings were made from pairs of known metathoracic efferent DUM neurones in locusts in which all nerves were intact and in isolated metathoracic ganglia. The 19 metathoracic, efferent DUM neurones were identified according to the nerve roots through which their axons emerge from the ganglion. The synaptic potentials in these DUM neurones have been analysed to investigate how these neurones are activated and how their spikes are controlled. The degree of correlation between the synaptic potentials in particular pairs of neurones was quantified using a correlation analysis. This allowed the population of DUM neurones to be divided into three subsets that also map onto an anatomical grouping based on the distribution of their axons in the lateral nerves: (i) DUM1 neurones (DUMDL and DUM1b); (ii) DUM3 and DUM3,4 neurones; and (iii) DUM3,4,5, DUM5b neurones and DUMETi. Individual neurones within each subset showed strong correlations between their synaptic potentials, in both intact locusts and isolated ganglia, and tended to spike at the same time. Neurones in different subsets had few synaptic potentials in common and tended to spike independently. The persistence of common synaptic potentials in neurones of the three subsets in isolated ganglia indicates that they are derived from neurones within the metathoracic ganglion. The DUM neurones that had many common synaptic potentials in a quiescent locust responded in similar ways to mechanosensory stimulation of different parts of the body. DUM3,4, 5 and DUM5 neurones gave the clearest and most consistent responses to stimulation of mechanoreceptors on either hind leg. DUM3 and DUM3, 4 neurones responded variably, but usually with a hyperpolarisation. DUM1 neurones were rarely excited by mechanosensory stimuli but, like the preceding group, their responses were dependent upon whether the locust was moving its legs. These results lend further support to the idea that there is a subdivision of action amongst this population of DUM neurones, with those supplying the same targets being driven by the same presynaptic local neurones.