The "double-fired" gastro-jejunostomy as a form of improved efficiency during Whipple procedure

BACKGROUND

Gastro-jejunostomy (GJ) after pylorus-resecting pancreatoduodenectomy (PD) is most commonly performed in a hand-sewn fashion. Intestinal stapled anastomosis are reported to be as effective as hand-sewn in terms of patency and risk of leakage in other indications. However, the use of a stapled gastro-jejunostomy hasn't been fully assessed in PD. The aim of the present technical report is to evaluate functional outcomes of stapled GJ during PD, its associated effect on operative time and related complications.

METHODS

The institutional database for pancreatic duct adenocarcinoma (PDAC) was retrospectically reviewed. Pylorus resecting open PD without vascular or multivisceral resections were considered for the analysis. The incidence of clinically significant delayed gastric emptying (DGE from the International Stufy Group of Pancreatic Surgery (ISGPS) grade B and C), other complications, operative time and overall hospitalization were evaluated.

RESULTS

Over a 10-years study period, 1182 PD for adenocarcinoma were performed and recorded in the database. 243 open Whipple procedures with no vascular and with no associated multivisceral resections were available and constituted the study population. Hand-sewn (HS) anastomosis was performed in 175 (72 %), stapled anastomosis (St) in 68 (28 %). No significant differences in baseline characteristics were observed between the two groups, with the exception of a higher rate of neoadjuvant chemotherapy in the HS group (74 % St vs. 86 % HS, p = 0.025). Intraoperatively, a significantly reduced median operative time in the St group was observed (248 min St vs. 370 mins HS, p < 0.001). Post-operatively, rates of clinically relevant delayed gastric emptying (7 % St vs. 14 % HS, p = 0.140), clinically relevant pancreatic fistula (10 % St, 15 % HS, p = 0.300), median length of stay (7 days for each group, p = 0.289), post-pancreatectomy hemorrhage (4.4 % St vs. 6.3 % HS, p = 0.415) and complication rate (22 % St vs. 34 % HS, p = 0.064) were similar between groups. However, readmission rates were significantly lower after St GJ (13.2 % St vs 29.7 % HS, p = 0.008).

CONCLUSION

Our results indicate that a stapled GJ anastomosis during a standard Whipple procedure is non-inferior to a hand-sewn GJ, with a comparable rate of DGE and no increase of gastrointestinal related long term complications. Further, a stapled GJ anastomosis might be associated with reduced operative times.

Phytoremediation of Lead-Contaminated Soil in the Westside of Atlanta, GA

Phytoremediation has been explored as a cost-effective method to remediate soil Pb contamination. A greenhouse study was conducted to evaluate the efficacy of Vigna unguiculata, Brassica pekinensis, Gomphrena globose, and Helianthus annuus for removing and immobilizing Pb in soil collected from the Westside Lead Superfund site in Atlanta. Plants were cultivated in sampled soil with a Pb concentration of 515 ± 10 mg/kg for 60 days. Soils growing H. annuus were additionally treated with ethylenediaminetetraacetic acid (EDTA) (0.1 g/kg) or compost (20% soil blend) to assess their capabilities for enhancing phytoremediation. Mean post-phytoremediation Pb concentrations in the four plant species were 23.5, 25.7, 50.0, and 58.1 mg/kg dry weight (DW), respectively, and were substantially higher than 1.55 mg/kg DW in respective plant species grown in control soils with no Pb contamination. The highest Pb concentration, translocation factor, and biomass were found in V. unguiculate among four species without soil amendments. H. annuus treated with EDTA and compost resulted in a significant increase in the total Pb uptake and larger biomass compared to non-treated plants, respectively. Although this study found that V. unguiculata was the best candidate for Pb accumulation and immobilization among four species, soil remediation was limited to 54 mg/kg in a growing season. We find that it is critically important to perform phytostabilization in a secure manner, since Pb bioavailability of edible plant parts implies the potential risk associated with their unintentional consumption. Efficiently and effectively remediating Pb-contaminated soils in a low-cost manner needs to be further studied.

Trends in Clinical Severity of Hospitalized Patients With Coronavirus Disease 2019-Premier Hospital Dataset, April 2020-April 2021

Background

Clinical severity of coronavirus disease 2019 (COVID-19) may vary over time; trends in clinical severity at admission during the pandemic among hospitalized patients in the United States have been incompletely described, so a historical record of severity over time is lacking.

Methods

We classified 466677 hospital admissions for COVID-19 from April 2020 to April 2021 into 4 mutually exclusive severity grades based on indicators present on admission (from most to least severe): Grade 4 included intensive care unit (ICU) admission and invasive mechanical ventilation (IMV); grade 3 included non-IMV ICU and/or noninvasive positive pressure ventilation; grade 2 included diagnosis of acute respiratory failure; and grade 1 included none of the above indicators. Trends were stratified by sex, age, race/ethnicity, and comorbid conditions. We also examined severity in states with high vs low Alpha (B.1.1.7) variant burden.

Results

Severity tended to be lower among women, younger adults, and those with fewer comorbidities compared to their counterparts. The proportion of admissions classified as grade 1 or 2 fluctuated over time, but these less-severe grades comprised a majority (75%–85%) of admissions every month. Grades 3 and 4 consistently made up a minority of admissions (15%–25%), and grade 4 showed consistent decreases in all subgroups, including states with high Alpha variant burden.

Conclusions

Clinical severity among hospitalized patients with COVID-19 has varied over time but has not consistently or markedly worsened over time. The proportion of admissions classified as grade 4 decreased in all subgroups. There was no consistent evidence of worsening severity in states with higher vs lower Alpha prevalence.

Phenotypic presentation trends of transthyretin amyloid cardiomyopathy: are we getting better?

Introduction

Transthyretin amyloid cardiomyopathy (ATTR-CM) is being increasingly recognized due to recent advances in non-invasive imaging notably bone scintigraphy and newer effective therapies - particularly tafamidis, which was shown to improve survival and decrease heart failure hospitalizations in the ATTR-ACT trial. Earlier tafamidis use appeared to be more beneficial, as reflected by NYHA class I and II patients being associated with lower mortality and hospitalizations compared to NYHA class III. Increased awareness will likely lead to an increasing number of ATTR-CM patients being diagnosed with concerns regarding applicability of ATTR-ACT criteria on these patients.

Purpose

To investigate ATTR-CM phenotypic presentation trends based on initial clinical, biomarkers and transthoracic echocardiographic (TTE) data.

Methods

From 2005–2020, 116 ATTR-CM patients were seen at our amyloidosis center, who were stratified into 3 time periods based on the date of diagnosis: Early (21 patients, pre-2016), Mid (46 patients, 2016–2018), and Recent (49 patients, 2018–2020). ATTR-CM diagnosis was established based on the standard criteria of confirmed ATTR variant + typical TTE features; histological confirmation endomyocardial biopsy; or typical diffuse cardiac tracer uptake on bone scintigraphy while ruling out light chain amyloidosis. With less typical imaging, cardiac MRI typically served as a confirmatory test prior to pursuing histological confirmation. Demographics, cardiac biomarkers, diagnostic method used, and TTE variables that raise the suspicion of ATTR-CM were compared across time periods using one-way ANOVA test and Fischer's exact test.

Results

There was a significant change in the predominant method of diagnosis with the majority of patients in the Early time period diagnosed by endomyocardial biopsy, whereas in the Recent time period the majority of patients were diagnosed via pyrophosphate scintigraphy (Figure). Despite increasing number of patients being diagnosed, the clinical phenotype at diagnosis did not change significantly with similar proportion of patients NYHA class I/II, median daily diuretic dose, biomarkers, having at least one heart failure hospitalization prior to diagnosis, and similar TTE phenotype (Table). Only the age at diagnosis significantly increased across time periods. Women represented the minority of patients across all time periods.

Conclusion

Despite the increased awareness of ATTR-CM, there have been no major changes in the clinical, cardiac biomarker, or TTE phenotype on presentation in patients referred to our center for suspicion or a diagnosis of ATTR-CM. Our findings challenge the assumption that patients with ATTR-CM are being identified earlier with milder phenotypes. Women with ATTR-CM likely remain largely undiagnosed in our community. Continued education and knowledge dissemination are essential to identify ATTR-CM patients earlier to achieve better outcomes in this population.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Pranav Chandrashekar is supported by an educational grant from Pfizer, Inc paid to Oregon Health and Science University. Table 1

A practical guide to development of a successful robotic abdominal surgery program: The path to implementation

The authors describe current situation in robotic assisted operations. The most important aspects of establishing a successful robotic program are patience and flexibility. The improved patient satisfaction, return to function, and decreased perioperative pain for patients and surgeons will be seen, but the road is long and requires careful navigation.Key Words: robot abdominal surgery - program development.

Avian influenza in Australia: a summary of 5 years of wild bird surveillance

BACKGROUND

Avian influenza viruses (AIVs) are found worldwide in numerous bird species, causing significant disease in gallinaceous poultry and occasionally other species. Surveillance of wild bird reservoirs provides an opportunity to add to the understanding of the epidemiology of AIVs.

METHODS

This study examined key findings from the National Avian Influenza Wild Bird Surveillance Program over a 5-year period (July 2007-June 2012), the main source of information on AIVs circulating in Australia.

RESULTS

The overall proportion of birds that tested positive for influenza A via PCR was 1.9 ± 0.1%, with evidence of widespread exposure of Australian wild birds to most low pathogenic avian influenza (LPAI) subtypes (H1-13, H16). LPAI H5 subtypes were found to be dominant and widespread during this 5-year period.

CONCLUSION

Given Australia's isolation, both geographically and ecologically, it is important for Australia not to assume that the epidemiology of AIV from other geographic regions applies here. Despite all previous highly pathogenic avian influenza outbreaks in Australian poultry being attributed to H7 subtypes, widespread detection of H5 subtypes in wild birds may represent an ongoing risk to the Australian poultry industry.

Waterbird movement across the Great Dividing Range and implications for arbovirus irruption into southern Victoria

BACKGROUND

  Waterbirds are the major hosts of various arboviruses. Murray Valley encephalitis virus (MVEV) is an arbovirus native to northern Australia, the major hosts of which are Phalacrocoraciformes (cormorants), Ciconiiformes (herons) and other waterbirds. MVEV is transmitted to humans by mosquitoes and can cause acute encephalomyelitis. In Victoria, MVEV is restricted to the northern side of the Great Dividing Range (GDR), suggesting that waterbirds cannot cross the high country.

METHODS AND RESULTS

  We tested this hypothesis by analysing data on waterbird banding and recovery and discovered that 12 species can cross the GDR.

CONCLUSION

  Waterbirds have the potential to carry arboviruses, including MVEV, into southern Victoria.

Chronic impairments in spatial learning and memory in rats previously exposed to chlorpyrfos or diisopropylfluorophosphate

The acute toxicity of organophosphates (OPs) has been studied extensively; however, much less attention has been given to the subject of repeated exposures that are not associated with overt signs of toxicity (i.e., subthreshold exposures). The objective of this study was to determine if the protracted spatial learning impairments we have observed previously after repeated subthreshold exposures to the insecticide chlorpyrifos (CPF) or the alkylphosphate OP, diisopropylfluorophosphate (DFP) persisted for longer periods after exposure. Male Wistar rats (beginning at two months of age) were initially injected subcutaneously with CPF (10.0 or 18.0mg/kg) or DFP (0.25 or 0.75 mg/kg) every other day for 30 days. After an extended OP-free washout period (behavioral testing begun 50 days after the last OP exposure), rats previously exposed to CPF, but not DFP, were impaired in a radial arm maze (RAM) win-shift task as well as a delayed non-match to position procedure. Later experiments (i.e., beginning 140 days after the last OP exposure) revealed impairments in the acquisition of a water maze hidden platform task associated with both OPs. However, only rats previously exposed to DFP were impaired in a second phase of testing when the platform location was changed (indicative of deficits of cognitive flexibility). These results indicate, therefore, that repeated, subthreshold exposures to CPF and DFP may lead to chronic deficits in spatial learning and memory (i.e., long after cholinesterase inhibition has abated) and that insecticide and alkylphosphate-based OPs may have differential effects depending on the cognitive domain evaluated.

The relationship between in vivo limb and in vitro tendon mechanics after injury: a potential novel clinical tool for monitoring tendon repair

REASONS FOR PERFORMING THE STUDY

Highly prevalent superficial digital flexor tendon (SDFT) injury results in compromised tendon function through fibrosis and high frequency of re-injury due to altered biomechanical function. This study investigated the consequences of SDF tendinopathy on limb mechanics in relation to the mechanical properties of injured tendon.

OBJECTIVES

To develop and validate a noninvasive in vivo assessment of tendon mechanics to investigate the effect of recent SDFT injury on limb stiffness index, providing an objective method to assess quality of healing.

HYPOTHESES

Limb stiffness index would reduce as a consequence of SDFT injury and progressively increase during tendon healing and correlate with in vitro mechanical properties of the respective SDFTs.

METHODS

Kinematic analysis was performed at walk in 10 horses that had sustained career-ending SDFT injury. Stiffness index was derived from limb force recorded via a series of force plates and measurement of change in metacarpophalangeal joint angle using 3D motion analysis software. Horses were subjected to euthanasia 7 months after injury, the SDFTs removed and subjected to nondestructive in vitro mechanical testing.

RESULTS

Limb stiffness index was reduced following SDFT injury in comparison with the contralateral limb and increased during the convalescent period, approximating that of the contralateral limb by 7 months post injury. There was a significant positive correlation between in vivo limb stiffness index and in vitro SDFT stiffness.

CLINICAL RELEVANCE

The ability to assess and monitor SDFT mechanical competence through limb stiffness measurement techniques in horses recovering from SDFT injury and the possibility of corroborating this with functional tendon healing may permit a more objective and accurate assessment of optimal tendon repair in the horse. This technique may be a useful method for assessing the efficacy of treatment regimens for tendinopathy and could be utilised to predict time to safe return to performance or re-injury.

Protracted effects of chronic oral haloperidol and risperidone on nerve growth factor, cholinergic neurons, and spatial reference learning in rats

The primary therapeutic agents used for schizophrenia, antipsychotic drugs, ameliorate psychotic symptoms; however, their chronic effects on cognition (or the physiologic processes of the brain that support cognition) are largely unknown. The purpose of this rodent study was to extend our previous work on this subject by investigating persistent effects (i.e. during a 14 day drug-free washout period) of chronic treatment (i.e. ranging from 45 days to 6 months) with a representative first and second generation antipsychotic. Drug effects on learning and memory and important neurobiological substrates of memory, the neurotrophin, nerve growth factor (NGF) and its receptors, and certain components of the basal forebrain cholinergic system were investigated. Behavioral effects of oral haloperidol (2.0 mg/kg/day), or risperidone (2.5 mg/kg/day) were assessed in an open field, a water maze task, and a radial arm maze procedure and neurochemical effects in brain tissue were subsequently measured by enzyme-linked immunosorbent assays (ELISAs). The results indicated that both antipsychotics produced time-dependent and protracted deficits in the performance of a water maze procedure when compared with vehicle-treated controls, while neither drug was associated with significant alterations in radial arm maze performance. Interestingly, haloperidol, but not risperidone, was detectible in the rodent brain in appreciable levels for up to 2 weeks after drug discontinuation. Both antipsychotics were also associated with reduced levels of NGF protein in the basal forebrain and prefrontal cortex and significant (or nearly significant) decreases in phosphorylated tropomyosin-receptor kinase A (TrkA) protein and the vesicular acetylcholine transporter (depending on the brain region analyzed). Neither antipsychotic markedly affected TrkA or p75 neurotrophin receptor levels. These data in rats indicate that chronic treatment with either haloperidol or risperidone may be associated with protracted negative effects on cognitive function as well as important neurotrophin and neurotransmitter pathways that support cognition.

Induction interferon and ribavirin for re-treatment of chronic hepatitis C patients unresponsive to interferon alone

BACKGROUND

The optimal treatment for hepatitis C patients unresponsive to interferon is unclear. High-dose induction interferon may enhance early viral clearance, whilst ribavirin reduces relapse; in combination, they may improve sustained virological response rates.

AIM

To compare the efficacy and safety of re-treatment with interferon induction, with or without ribavirin, in interferon non-responders.

METHODS

We randomized 218 biochemical interferon non-responders to 10 MU interferon alpha 2b daily for 4 weeks, followed by 5 MU thrice weekly for 48 weeks plus ribavirin (II + R), or to the same interferon regimen plus placebo (II + P). All patients were viraemic at entry.

RESULTS

The sustained virological response in the II + R group was 39%[95% confidence interval (CI), 30-48%], compared with 16% (95% CI, 9-23%) in the II + P group (P < 0.002). The study drug was discontinued for intolerable symptoms during induction in 9% of the II + R group and in 5% of the II + P group. By logistic regression, a sustained virological response was more likely following II + R treatment (odds ratio, 4.4; 95% CI, 2.1-9.7) and less likely in patients with genotype 1 or 4 (odds ratio, 0.16; 95% CI, 0.07-0.36).

CONCLUSION

High-dose induction interferon plus ribavirin is well tolerated and effective for patients unresponsive to interferon alone.

Calcitonin: characterisation and expression in a teleost fish, Fugu rubripes

The present report describes the structure and expression of the calcitonin gene in Fugu rubripes. It is composed of 4 exons and 3 introns. Splicing of exons 1, 2 and 3 generates the calcitonin pre-proprotein, while splicing of exons 1, 2 and 4 generates calcitonin gene-related protein (CGRP). Exons 1 and 2 encoding the signal sequence and the N-terminal peptide are common in both the gene products and this gene organisation has been conserved in human, rat, chicken and salmon. The gene environment around calcitonin in Fugu has been poorly conserved when compared with human, apart from a small gene cluster. The calcitonin gene in Fugu has a widespread tissue distribution but it is most highly expressed in the brain. The abundance of gene expression in the ultimobranchial gland and the pituitary indicates that these are important sites of production and that the peptide is probably secreted into the circulation and/or acts as a paracrine or autocrine controlling factor. Whilst the function of calcitonin in fish is still largely unknown, the distribution described here suggests that one of the potential functions may be as a neuropeptide.

Evidence that Equine rhinitis A virus VP1 is a target of neutralizing antibodies and participates directly in receptor binding

Equine rhinitis A virus (ERAV) is a respiratory pathogen of horses and is classified as an Aphthovirus, the only non-Foot-and-mouth disease virus (FMDV) member of this genus. In FMDV, virion protein 1 (VP1) is a major target of protective antibodies and is responsible for viral attachment to permissive cells via an RGD motif located in a distal surface loop. Although both viruses share considerable sequence identity, ERAV VP1 does not contain an RGD motif. To investigate antibody and receptor-binding properties of ERAV VP1, we have expressed full-length ERAV VP1 in Escherichia coli as a glutathione S-transferase (GST) fusion protein (GST-VP1). GST-VP1 reacted specifically with antibodies present in serum from a rabbit immunized with purified ERAV virions and also in convalescent-phase sera from horses experimentally infected with ERAV. An antiserum raised in rabbits to GST-VP1 reacted strongly with viral VP1 and effectively neutralized ERAV infection in vitro. Using a flow cytometry-based binding assay, we found that GST-VP1, but not other GST fusion proteins, bound to cell surface receptors. This binding was reduced in a dose-dependent manner by the addition of purified ERAV virions, demonstrating the specificity of this interaction. A separate cell-binding assay also implicated GST-VP1 in receptor binding. Importantly, anti-GST-VP1 antibodies inhibited the binding of ERAV virions to Vero cells, suggesting that these antibodies exert their neutralizing effect by blocking viral attachment. Thus ERAV VP1, like its counterpart in FMDV, appears to be both a target of protective antibodies and involved directly in receptor binding. This study reveals the potential of recombinant VP1 molecules to serve as vaccines and diagnostic reagents for the control of ERAV infections.

Women in special hospitals: understanding the presenting behaviour of women diagnosed with borderline personality disorder

This paper critically examines the development of the concept of borderline personality disorder (BPD) in terms of the assumed centrality of abnormal early environments and abusive relationships. It is suggested that if BPD is conceptualized as an expression of past experiences in adult life, information regarding early histories can assist in 'making sense' of later behaviour. The aim of this review therefore is to explore how histories of women diagnosed as BPD, within a High Secure Psychiatric Hospital, may facilitate an interpretation of the 'adaptive' nature of presenting 'symptomology'. Case note material is utilized to gain insight into specific aspects of childhood experiences that have been documented, and are thus deemed significant. These findings support the perception that the role of the early environment and associated relationships are significant within written accounts of women diagnosed as having BPD. By exploring the links between trauma and BPD, this article suggests that an understanding of the effects of trauma and the importance of relationships can offer a way forward for self-reflection and future care.

Generation and analysis of 25 Mb of genomic DNA from the pufferfish Fugu rubripes by sequence scanning

We have generated and analyzed >50,000 shotgun clones from 1059 Fugu cosmid clones. All sequences have been minimally edited and searched against protein and DNA databases. These data are all displayed on a searchable, publicly available web site at. With an average of 50 reads per cosmid, this is virtually nonredundant sequence skimming, covering 30%-50% of each clone. This essentially random data set covers nearly 25 Mb (>6%) of the Fugu genome and forms the basis of a series of whole genome analyses which address questions regarding gene density and distribution in the Fugu genome and the similarity between Fugu and mammalian genes. The Fugu genome, with eight times less DNA but a similar gene repertoire, is ideally suited to this type of study because most cosmids contain more than one identifiable gene. General features of the genome are also discussed. We have made some estimation of the syntenic relationship between mammals and Fugu and looked at the efficacy of ORF prediction from short, unedited Fugu genomic sequences. Comparative DNA sequence analyses are an essential tool in the functional interpretation of complex vertebrate genomes. This project highlights the utility of using the Fugu genome in this kind of study.

Sequence scanning chicken cosmids: a methodology for genome screening

The chicken genome is relatively poorly studied at the molecular level. The karyotype 2n=78 is divided into three main chromosomal sub-groups: the macrochromosomes (six pairs), the intermediate microchromosomes (four pairs) and the microchromosomes (29 pairs). Whilst the microchromosome group comprise only 25% of the DNA, increasing evidence is proving that this is disproportionate to their gene content. This paper demonstrates the utility of cosmid sequence scanning as a potential method for analysing the chicken genome, providing an economical method for the production of a molecular map. The GC content, gene density and repeat distribution are analysed relative to chromosomal origin. Results indicate that gene density is higher on the microchromosomes. During the scanning process an example of conserved linkage between chicken and human (12q34.2) has been demonstrated.

Body composition and health-related quality of life in patients with obstructive airways disease

This study evaluated the effects of body weight and lean mass abnormalities on health-related quality of life (HRQL) in obstructive airways disease. Body weight, lean mass (using dual-energy X-ray absorptiometry), and HRQL (using the St George's Respiratory Questionnaire (SGRQ)) were measured in 50 patients. Low lean mass was defined as a lean mass index (lean mass/height2) below the fifth percentile of a control population. Dyspnoea was measured by the baseline dyspnoea index. The mean (SD) age was 69+/-9 yrs; the forced expiratory volume in one second (FEV1) was 39+/-19% of predicted. Patients had 2.4+/-4.1 kg less lean mass than predicted. Increased dyspnoea was the most influential predictor of poor HRQL. Compared to normal-weight patients, those who were underweight had significantly greater impairment in activity, impact, and total SGRQ scores, while those who were overweight had greater impairment in impact and total SGRQ scores. Low lean mass was associated with greater impairment in symptoms, activity and impact subscores and the total SGRQ score. When dyspnoea was added to the model as a covariate, neither weight nor lean mass remained significantly related to HRQL. Thus, although body weight and lean mass abnormalities influence health-related quality of life, their effects appear to be mediated through increased levels of dyspnoea.

Schizophrenic patients' experiences of neuroleptic medication: a Q-methodological investigation

Q-methodology was used to explore the experiences of 50 medicated schizophrenic patients. Four main factors were identified. Participants loading on the first factor agreed with statements suggesting an uncomplaining attitude towards their medication and also with statements indicating a dependent attitude towards the medical profession. Those loading on the second factor endorsed statements indicative of a sceptical attitude towards medication, together with a concern for personal autonomy. Participants loading on the third factor had apparently made a balanced appraisal of the advantages and disadvantages of their medication, whereas those who loaded positively on the final factor reported positive benefits of medication but a sceptical attitude towards medical advice. The study highlights the complexity of psychiatric patients' attitudes to treatment.

Controlling microbial contamination on beef and lamb meat during processing

The microbiological quality of carcases, meat and environmental surfaces was evaluated in commercial boning rooms processing beef and lamb. There was considerable variation in the level of microbial contamination on both carcases and meat, with counts ranging from less than 20 to 10(8)/cm2 on carcases and to 2 x 10(7)/cm2 on meat. The level of microbial contamination on meat was influenced by the level of carcase contamination at boning and by the boning process itself. Carcase contamination was the major determinant of microbiological quality, as more than 70% of carcase had microbial counts greater than 10(3)/cm2. Cutting boards were a major source for microbial dissemination during boning, particularly when carcase counts were less than 10(3)/cm2. If carcases were heavily contaminated, the contamination of processing surfaces was irrelevant in determining microbial loads on meat. Where carcase contamination was at low to moderate levels, the contribution of the boning process to the contamination on meat assumed increased significance. Under these conditions, improved sanitation of cutting surfaces in the boning room resulted in a significant reduction in microbial contamination on the surface of meat. These results can form the basis for ensuring that improvements made in carcase management before boning, to improve microbiological quality, will be preserved through attention to cutting board hygiene during boning.

Immunisation of mares to control endometritis caused by Streptococcus zooepidemicus

Normal mares were immunised by the intramuscular and intrauterine administration of an antigen with adjuvant and they and unimmunised control mares were later challenged by the intrauterine instillation of pathogenic Streptococcus zooepidemicus; the response of all the mares was monitored clinically and bacteriologically for seven days. Significantly fewer S zooepidemicus were present in cervical swabs taken from the immunised mares than from the control mares (P < 0.01) and the degree of inflammation in the genital tract of the immunised mares was also significantly less (P < 0.001). This protective effect of immunisation was associated with the specific IgG response in the serum, and an IgG and IgA response in the uterine secretions. These results are the first demonstration that a previous immunisation with a suitable antigen can reduce an infection of the reproductive tract of mares.

The cost-effectiveness of a nursing demonstration project, Part II

The Milieu Enhancement Project was funded for 3 years by the Division of Nursing, Department of Health and Human Services. The goals, setting, project personnel, roles, and implementation activities are described. This project allowed faculty and graduate students to practice independently in a children's residential setting. A needs assessment identified problems related to organizational, academic, and sex- and health-related concerns. These concerns were addressed and outcome measurements identified. A cost-effectiveness framework was used to describe the interventions in terms of improvement. Statistical analyses supported the effectiveness of several project activities.

The cost-benefits of a nursing demonstration project, Part III

The Milieu Enhancement Nursing project was funded for 3 years by the Division of Nursing, Department of Health and Human Services. One of the project goals was to perform a cost/benefit analysis of project activities. The conceptual framework and formulas used for data analysis are presented. The project was deemed successful, as data supported a favorable cost to benefit ratio.

The Milieu Enhancement Model: a nursing practice model, Part I

The Milieu Enhancement Nursing Practice Model (MEM) served as the conceptual framework for implementing a 3-year project funded by the Department of Health and Human Services through the Division of Nursing as a demonstration grant (No. 1 D10 NU 600013) from October 1987 through September 1990. The MEM is described and examples of its use in developing health care forms, conducting research, guiding practice, and categorizing enhancements are presented.

Pregnancy characteristics and outcomes of Cambodian refugees

This study describes the perinatal characteristics of Cambodian refugees in Massachusetts. Data were abstracted from the records of 452 consecutive pregnancies among Cambodian women and 110 low-income Whites receiving obstetrical services at the same clinic and hospital in Lowell, Massachusetts. Pregnancies of Cambodian women were marked by a higher proportion of older mothers, grand multiparas, previous adverse birth outcomes, and short interpregnancy intervals. We identified maternal anemia (29.9 percent with hemoglobin less than 110 g/L) and inadequate utilization of prenatal care (32.3 percent with first visit in the 3rd trimester) as possible risk factors for the Cambodians. The prevalence of primary cesarean birth was only 6.3 percent in the Cambodians, compared to 15.6 percent in the comparison group, largely due to the infrequent occurrence of prolonged labor among multiparas. Despite the prominence of several risk factors for adverse birth outcomes in this population, major pregnancy complications were less common and the prevalence of low birthweight (6.4 percent) was close to the state average. Logistic regression analysis of risk factors for low birthweight identified young maternal age and short stature as the strongest factors operative in this community. Many of our findings are consistent with a strong cultural emphasis on managing the size of the baby to avoid a difficult labor and delivery.

Creating presentation graphics with MS-DOS computer technology

This article describes how The University of Iowa College of Nursing Instructional Design Services uses MS-DOS computer technology to create presentation graphics to support nursing education, research, scholarly productivity, and service. Hardware and software are described and examples are presented to illustrate the use of software to create alphanumeric, schematic, and freeform pictures. The authors stress that the use of computer-aided design and production does not eliminate the use of traditional principles of visual design, but rather necessitates their application.

Distribution of paraoxon hydrolytic activity in the serum of patients after myocardial infarction

The activity of paraoxonase in serum was found to be bimodally distributed, both in a control group and in a group of patients who had suffered myocardial infarction. Activity in the myocardial infarct group was significantly lower than in the control group. Low paraoxonase activity in serum may provide an indication of susceptibility to the development of coronary heart disease.

Distribution of paraoxon hydrolytic activity in the serum of patients after myocardial infarction

The activity of paraoxonase in serum was found to be bimodally distributed, both in a control group and in a group of patients who had suffered myocardial infarction. Activity in the myocardial infarct group was significantly lower than in the control group. Low paraoxonase activity in serum may provide an indication of susceptibility to the development of coronary heart disease.

The separation of sheep and human serum "A"-esterase activity into the lipoprotein fraction by ultracentrifugation

Using sheep and human serum the relationship between centrifugation time and yield of total lipoprotein, HDL-cholesterol and "A"-esterase in lipoprotein was studied employing different centrifuge rotors. More rapid separation of these components was obtained with a vertical rotor than with an angled rotor. The procedures commonly employed for lipoprotein separation gave low yields of lipoprotein "A"-esterase and HDL-cholesterol. The separation of sheep serum "A"-esterase into the lipoprotein fraction was not in phase with that of HDL-cholesterol and the pattern of separation was different from that in human serum. These results provide further evidence that serum "A"-esterase activity is associated with different species of HDL-particle.

Financial planning. Budgeting

A short-term financial plan (STFP) is like a road map--you are more likely to reach your destination (financial goals) with one than without. A STFP need not be a drudge; a well-designed plan must be so comprehensive so as to include personal freedom money and even small luxuries. Once started, it actually becomes rewarding and fun to see your financial goals coming to fruition.

Listeria pneumonitis: influence of route of immunization on resistance to airborne infection

Mice that are immunized with an airborne inoculum of BCG are more highly resistant to airborne challenge with Mycobacterium tuberculosis than are mice that are immunized by the subcutaneous or intravenous route. To discover whether this phenomenon is peculiar to tuberculosis, we studied the influence of the route of immunization upon pulmonary resistance in Listeria monocytogenes infection. Mice were immunized by the airborne, intravenous, or footpad route and were subsequently challenged by the same route at 1 to 4 weeks after immunization. Mice were highly and uniformly resistant to intravenous challenge, regardless of the route of immunization. The route of immunization bore no influence upon resistance to footpad infection, but resistance was appreciably better in mice challenged within 2 weeks of immunization than it was at later time points. In mice immunized by the footpad and intravenous routes, the pattern of resistance to airborne and footpad challenges was similar, in that there was substantially less immunity at 4 weeks than at 2 weeks after immunization. However, mice immunized by the airborne route were highly resistant to airborne challenge, regardless of the interval between immunization and reinfection. In this last respect, resistance of the lungs to reinfection was similar after Listeria and tuberculosis pneumonitis. It is suggested that a similar pattern of resistance may prevail in pneumonitis caused by other facultative intracellular parasites.

Listeria pneumonitis: induction of immunity after airborne infection with Listeria monocytogenes

After implantation of approximately 10(3) Listeria monocytogenes organisms into the lungs, mice develop an acute pneumonitis with dissemination of infection to a mediastinal lymph node (MedLN), liver, and spleen. The infections in a MedLN and spleen resolve in approximately 7 days, but the lung infection persists for a few days longer. Pneumonitis is accompanied by a lymphoproliferative response in a MedLN and spleen, and immunity to Listeria is conferred adoptively with MedLN and spleen cells but not with mesenteric lymph node cells. Although the spleen appears to be the major repository of sensitized lymphocytes, splenectomized mice combat Listeria pneumonitis as effectively as normal mice. It is concluded that the induction of immunity to lung infection with L. monocytogenes is efficient and that the cause for the rather protracted pneumonitis is due to a defect in the expression of the cell-mediated immunity effector mechanism.