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Background: Patient-reported outcomes (PROS) are widely accepted measures for evaluating outcomes of surgical interventions. As patient-reported information is stored in electronic health records, it is essential that there are valid electronic PRO (ePRO) instruments available for clinicians and researchers. The aim of this study was to evaluate the validity of electronic versions of five widely used foot and ankle specific PRO instruments. Methods: Altogether 111 consecutive elective foot/ankle surgery patients were invited face-to-face to participate in this study. Patients completed electronic versions of the Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), the modified Lower Extremity Function Scale (LEFS), the Manchester-Oxford Foot Questionnaire (MOXFQ), and the Visual Analogue Scale Foot and Ankle (VAS-FA) on the day of elective foot and/or ankle surgery. Construct validity, coverage, and targeting of the scales were assessed. Results: Based on general and predefined thresholds, construct validity, coverage, and targeting of the ePRO versions of the FAAM, the FAOS, the MOXFQ, and the VAS-FA were acceptable. Major issues arose with score distribution and convergent validity of the modified LEFS instrument. Conclusions: The ePRO versions of the FAAM, the FAOS, the MOXFQ and the VAS-FA provide valid scores for foot and ankle patients. However, our findings do not support the use of the modified LEFS as an electronic outcome measure for patients with orthopedic foot and/or ankle pathologies. (C) 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

The aim of this study was to assess postures and movements of the trunk and upper arm during paper mill work, and to determine the extent to which they differ depending on method of assessment. For each of 28 paper mill workers, postures and movements were assessed during three full shifts using inclinometer registration and observation from video. Summary metrics for each shift, e.g., 10th, 50th, and 90th posture percentile, were averaged across shifts and across workers. In addition, the standard deviation between workers, and the standard deviation between shifts within worker were computed. The results showed that trunk and arm postures during paper mill work were similar to other occupations involving manual materials handling, but the velocities of arm movements were lower. While postures determined by inclinometry and observation were similar on a group level, substantial differences were found between results obtained by the two methods for individual workers, particularly for extreme postures. Thus, measurements by either method on individuals or small groups should be interpreted with caution.

Food-borne infections are major causes of public health concern in developing and developed countries. During the past decade, the Institut Hospitalo-Universitaire Méditerranée Infection has conducted or been involved in multiple investigations that aimed at identifying the sources and strains responsible for food-borne diseases and therefore at improving the understanding, diagnosis, prevention and control of these infections. Investigations were conducted in the Mediterranean area and in sub-Saharan Africa on more than 15 food-borne agents, 17 food products and 14 antibiotic resistance-associated genes. Multiple sources, including unexpected ones, and pathogens, including emerging ones, were involved. Travelling in developing countries and zoonoses are major contributors to food-borne infections, while food-borne transmission of resistance-associated genes is increasingly reported. However, risk factors and pathogens associated with food-borne infections likely remain untapped and must be more extensively investigated, monitored and regularly reassessed. Diagnostic tests based on new technologies and real-time surveillance tools based on microbiology laboratory data are promising approaches to detect known food-borne infections and decipher new ones. Studies of the microbiota and its relationships with dietary patterns are also worth being conducted. Keywords: Africa, bacteria, food, food-borne, fungus, IHU Mediterranée Infection, infections, Mediterranean Basin, virus, zoonosis

We review reviewing our experience of point-of-care and mass spectrometry in Senegal as two disruptive technologies promoting the rapid diagnosis of infection, permitting better medical management of patients. Keywords: Arthropods, bacteria, borne vectors, MALDI-TOF, point of care

Diabetes mellitus (DM) is a major health care burden associated with significant morbidity and serious impact on the quality of life. Estimating blood glucose levels is the currently employed method for screening for DM. Due to the invasive nature of access to blood glucose; new methods are being suggested that depend upon different targets than blood or another biochemical pathway altogether. But these are not cost effective and have inherent limitations related to public screening. We hypothesize a simple, non invasive and cheap paper strip method to estimate tear film glucose levels for screening purposes at community level. We also discuss the ideal properties of such a paper strip and the process of validation the technique should undergo before being employed for mass usage.

Observers rank partly visible postures on video frames differently than fully visible postures, but it's not clear if this is due to differences in observer perception. This study investigated the effect of posture visibility on between-observer variability in assessments of trunk and arm posture. Trained observers assessed trunk and arm postures from video recordings of 84 pulp mill shifts using a work sampling approach; postures were also categorized as ‘fully’ or ‘partly’ visible. Between-worker, between-day, and between-observer variance components and corresponding confidence intervals were calculated. Although no consistent gradient was seen for the trunk, right upper arm posture showed smaller between-observer variance when all observers rated a posture as fully visible. This suggests that, partly-visible data, especially when observers disagree as to the level of visibility, introduces more between-observer variability when compared to fully visible data. Some previously-identified differences in daily posture summaries may be related to this phenomenon.

A study of the quantities of cocaine on banknotes in general circulation was conducted to investigate regional variations across England and Wales. No meaningful support was found for the proposition that there is regionalvariation in the quantities of cocaine in banknotes in general circulation in England and Wales.

The aim of this study was to evaluate the clinical-epidemiological factors associated with victims of rattlesnake envenoming in the state of Roraima, Brazil. In this location, rattlesnake accidents are caused by the subspecies Crotalus durissus ruruima. This is a prospective observational study carried out at the General Hospital of Roraima from april 2017 until july 2018. A total of 37 alleged rattlesnake victims had their medical records evaluated. However only one of them proved to be by C. d. ruruima. All individuals were residents from the savannas (lavrados) of Roraima. The town of Bonfim on the border between Brazil and Guyana had the highest occurrence of rattlesnake bites. The most affected group were males aged 13–20 years and farmers. The highest number of incidents occurred during daytime and lower limbs (feet) were the most major affected part of the body. Tourniquets were used as first aid after snake envenoming in 32.4% of victims. Out of 37 patients, 16.2% were classified as severe cases of snakebite envenoming and in 5.4% dry bites seem to have occurred. Among the symptomatic patients, 100% presented local manifestations and 70.3% presented systemic manifestations. The clinical setting showed local effects such as pain and edema while the systemic effects were blurred vision, myalgias, myasthenic facies, palpebral ptosis, muscle weakness and headache. Laboratory results of aspartate aminotransferase (62.2%), creatine phosphokinase (51.3%), lactic dehydrogenase (37.8%), urea level (32.4%) and serum creatinine (29.7%) were increased significantly in relation to the reference standards. In 16.2% of the cases, the victims presented acute kidney injury. Patients were treated with anticrotalic serum in 70.3% of the cases and antibotropic + anticrotalic serum in 24.3%. The victims of C. d. ruruima in Roraima showed a local symptomatology similar to Bothrops envenoming, while systemic symptoms and laboratory analysis proved kidney and muscular injuries, similar to envenoming by Crotalus d. terrificus in Brazil., Highlights • This report describes the envenoming of victims of snakes Crotalus d. ruruima. • In Roraima, rattlesnake accidents are caused by Crotalus durissus ruruima. • The symptoms and signs at the bite site were similar to envenoming by Bothrops. • The systemic symptoms were similar to envenoming by Crotalus d. terrificus. • After specific treatment all victims of envenoming evolved to cure.

Objective Most preventable adverse drug events and medication errors occur during medication ordering. Medication order entry and clinical decision support are available on paper or as computerized systems. In this post-hoc analysis we investigated frequency and clinical impact of blood glucose (BG) documentation- and user-related calculation errors as well as workflow deviations in diabetes management. We aimed to compare a paper-based protocol to a computerized medication management system combined with clinical workflow and decision support. Methods Seventy-nine hospitalized patients with type 2 diabetes mellitus were treated with an algorithm driven basal-bolus insulin regimen. BG measurements, which were the basis for insulin dose calculations, were manually entered either into the paper-based workflow protocol (PaperG: 37 patients) or into GlucoTab ® —a mobile tablet PC based system (CompG: 42 patients). We used BG values from the laboratory information system as a reference. A workflow simulator was used to determine user calculation errors as well as workflow deviations and to estimate the effect of errors on insulin doses. The clinical impact of insulin dosing errors and workflow deviations on hypo- and hyperglycemia was investigated. Results The BG documentation error rate was similar for PaperG (4.9%) and CompG group (4.0%). In PaperG group, 11.1% of manual insulin dose calculations were erroneous and the odds ratio (OR) of a hypoglycemic event following an insulin dosing error was 3.1 (95% CI: 1.4–6.8). The number of BG values influenced by insulin dosing errors was eightfold higher than in the CompG group. In the CompG group, workflow deviations occurred in 5.0% of the tasks which led to an increased likelihood of hyperglycemia, OR 2.2 (95% CI: 1.1–4.6). Discussion Manual insulin dose calculations were the major source of error and had a particularly strong influence on hypoglycemia. By using GlucoTab ® , user calculation errors were entirely excluded. The immediate availability and automated handling of BG values from medical devices directly at the point of care has a high potential to reduce errors. Computerized systems facilitate the safe use of more complex insulin dosing algorithms without compromising usability. In CompG group, missed or delayed tasks had a significant effect on hyperglycemia, while in PaperG group insufficient precision of documentation times limited analysis. The use of old BG measurements was clinically less relevant. Conclusion Insulin dosing errors and workflow deviations led to measurable changes in clinical outcome. Diabetes management systems including decision support should address nurses as well as physicians in a computerized way. Our analysis shows that such systems reduce the frequency of errors and therefore decrease the probability of hypo- and hyperglycemia.

O BESITY IS A PUBLIC HEALTH burden associated with a number of adverse health conditions and high health care costs. As an integral part of standard behavior-based therapy, selfmonitoring has been used in many lifestyle intervention programs to address the obesity epidemic. In weight management, self-monitoring usually consists of tracking dietary intake, physical activity, body weight, and/ or other health measurements. Previous research examined the efficacy of dietary self-monitoring on weight management. However, most of those studies addressed self-monitoring using traditional paper methods. The subsequent development and use of advanced technology-based self-monitoring approaches shows promising effects inweight loss.We evaluated the emerging evidence on the efficacy and adherence to different types of dietary self-monitoring, including traditional paper methods, web-based self-monitoring, and the use of mobile devices such as personal digital assistants, wearables, and tablets/mobile smartphones. Motivations and barriers to dietary selfmonitoring are described and strategies to improve adherence are identified. A discussion on future directions of dietary self-monitoring approaches in research and practice is also provided.

Objective To demonstrate a cost-effective, quick, and easily reproducible three-dimensional sticky note model to enhance the understanding and conceptualization of the geometry and steps of the pharyngeal flap and sphincter pharyngoplasty. Methods The method involves making specified incisions and rearrangements of readily available components, including disposable clear plastic cups, yellow and pink sticky notes, and white paper. Once assembly is complete, further incisions and remodeling are performed to simulate a pharyngeal flap or sphincter pharyngoplasty. Results The cost of the materials to make one model was $0.94. Average construction time was less than 10 min. Conclusion This three-dimensional model is an efficient, interactive, and simple visual aid to teach surgical trainees the geometry and steps of the pharyngeal flap and sphincter pharyngoplasty.

Alternatives to bisphenol A (BPA) are more and more used in thermal paper receipts. To get an overview of the situation in Switzerland, 124 thermal paper receipts were collected and analyzed. Whereas BPA was detected in most samples (n=100), some alternatives, namely bisphenol S (BPS), Pergafast® 201 and D-8 have been found in 4, 11 and 9 samples respectively. As no or few data on their endocrine activity are available, these chemicals and bisphenol F (BPF) were tested in vitro using the H295R steroidogenesis assay. 17β-Estradiol production was induced by BPA and BPF, whereas free testosterone production was inhibited by BPA and BPS. Both non-bisphenol substances did not show significant effects. The binding affinity to 16 proteins and the toxicological potential (TP) were further calculated in silico using VirtualToxLab™. TP values lay between 0.269 and 0.476 and the main target was the estrogen receptor β (84.4 nM to 1.33 μM). A substitution of BPA by BPF and BPS should be thus considered with caution, since they exhibit almost a similar endocrine activity as BPA. D-8 and Pergafast® 201 could be alternatives to replace BPA, however further analyses are needed to better characterize their effects on the hormonal system.

To compare the Disabilities of the Arm, Shoulder, and Hand (DASH) patient-reported outcome measure as administered by tablet computer to the traditional paper format.In a prospective, randomized study design, 223 consecutive adult patients who presented to the clinic of a single hand surgeon at a tertiary medical center were randomized by visit time to receive the DASH by either paper or tablet computer. Test completeness, time to completion, DASH score, and diagnostic and demographic data were collected and compared between the two cohorts. In total, 120 participants took the DASH using the tablet and 103 using paper.43% of the paper surveys had at least one question that was omitted, compared with 13% in the tablet group; 14% of the paper surveys were not scoreable ( 27 questions answered) compared with 4% of the tablet surveys. The mean time to complete was 3.1 minutes for the paper version of the DASH and 4.3 minutes for the tablet version. Among our study population, there was no influence of age, sex, or diagnosis category on the time required to complete either version of the test. The mean DASH score was 45 for the paper version and 32 for the tablet version.The use of digital data entry methods in the arena of health care outcomes research is increasing. Administration of the DASH via a tablet computer resulted in more complete data, slightly increased responder burden, and a lower DASH score. This finding may have important implications for the use of this metric in an electronic format in future research endeavors.Diagnostic II.

Objectives To estimate the internal consistency, test–retest reliability and comparability of paper and computer versions of the Finnish version of the Tampa Scale of Kinesiophobia (TSK-FIN) among patients with chronic pain. In addition, patients’ personal experiences of completing both versions of the TSK-FIN and preferences between these two methods of data collection were studied. Design Test–retest reliability study. Paper and computer versions of the TSK-FIN were completed twice on two consecutive days. Participants The sample comprised 94 consecutive patients with chronic musculoskeletal pain participating in a pain management or individual rehabilitation programme. The group rehabilitation design consisted of physical and functional exercises, evaluation of the social situation, psychological assessment of pain-related stress factors, and personal pain management training in order to regain overall function and mitigate the inconvenience of pain and fear-avoidance behaviour. Results The mean TSK-FIN score was 37.1 [standard deviation (SD) 8.1] for the computer version and 35.3 (SD 7.9) for the paper version. The mean difference between the two versions was 1.9 (95% confidence interval 0.8 to 2.9). Test–retest reliability was 0.89 for the paper version and 0.88 for the computer version. Internal consistency was considered to be good for both versions. The intraclass correlation coefficient for comparability was 0.77 (95% confidence interval 0.66 to 0.85), indicating substantial reliability between the two methods. Conclusion Both versions of the TSK-FIN demonstrated substantial intertest reliability, good test–retest reliability, good internal consistency and acceptable limits of agreement, suggesting their suitability for clinical use. However, subjects tended to score higher when using the computer version. As such, in an ideal situation, data should be collected in a similar manner throughout the course of rehabilitation or clinical research.

This study assessed validity, reliability, and feasibility of a filter paper blood spot insulin-like growth factor 1 (IGF-1) assay for retinopathy of prematurity (ROP) research. Blood samples were collected from 45 healthy children. Half of each sample was spun to obtain serum; half was applied to filter cards and stored for varying times and at different temperatures. IGF-1 assays were performed using a commercially available kit. Intraclass correlation between blood spot and serum IGF-1 values was high (0.97) for validity, and the mean differences were low for test-retest reliability. Time (up to 25 days) and temperature (4° C to 37° C) had no significant effect on sample stability. Feasibility was further assessed in a second cohort study of 74 premature infants being screened for ROP. A total of 817 filter card samples were successfully collected and transported to a central lab, where IGF-1 assays were successfully performed.

Background Lysosomal storage diseases (LSD) are a group of genetic conditions which could present a vast spectrum of abnormalities that may include skeletal abnormalities, organ dysfunction, neuronal involvement, and tissue accumulation of complex molecules, among other manifestations. Definitive diagnosis of LSD is generally obtained by specific enzyme assays performed in leukocytes, fibroblasts, or more recently, dried-blood filter paper (DBFP) samples. Methods We recently introduced dried-leukocytes filter paper (DLFP) as an alternative source of enzyme to assay heparan sulfamidase and galactocerebrosidase activities, which could not be measured in DBFP samples using fluorometric methods. We present a new fluorometric methods on DLFP samples, for evaluation of α-glucosidase (GAA), β-glucosidase (GBA), and N-acetylgalactosamine-6-sulfatase (GALNS) activities, key enzyme assays for the identification of patients with Pompe disease (PD), Gaucher disease (GD), and Morquio A disease (MD), respectively. Results We show a clear discrimination between confirmed PD, GD, and MD patients and healthy controls. Conclusions We conclude that the assays of GAA, GBA, and GALNS on DLFP are reliable and useful methods for the identification of PD, GD, and MD diseases, respectively. As sample preparation is feasible in standard biochemical laboratories and transportation is very simple, it could enable patients living in remote areas to be investigated, diagnosed and eventually treated with the specific therapies available for these diseases.

To date, the most successful and popular vitrification method is based on the minimum volume cooling (MVC) concept, in which embryos are vitrified in a very small volume of vitrification solution (VS) and then stored in cryotubes in liquid nitrogen (LN 2 ). Unfortunately, these methods need special devices and may not be suitable for vitrifying a large number of embryos. Theoretically, more embryos in VS on a paper (MVC concept) in cryotubes can be vitrified effectively. Therefore, this study directly vitrifies mouse embryos on a Kimwipes tissue in an 1.8 mL cryotube. The ICR 2-celled to blastocyst embryos were used for testing this procedure. In Treatment 1, embryos transferred with 1–2 μL of VS into a cryotube. Treatment 2 was similar to Treatment 1 except that the cryotube was filled with LN 2 . Treatment 3 was identical to Treatment 1 except that a small piece (5 mm 2 ) of a sterilized Kimwipes tissue was placed on the top of VS. Treatment 4 was identical to Treatment 3 except for the cryotube being filled with LN 2 . After each treatment, the cryotubes were capped and transferred to a LN 2 tank. After warming, the recovered embryos were cultured in KSOM+AA for 1–3 days. There were no differences in the recovery rate, overnight survival rate, blastocyst rate, and birth rate after embryo transfer among all treatment groups. Our results demonstrated an alternative simple, efficient, and mass reproducible method for vitrifying mouse embryos using papers as a vehicle and cryotubes as a container.

Background: Peer review of university classroom teaching can increase the quality of teaching but is not universally practiced in Australian universities. Aim: To report an evaluation of paired peer-review process using both paper and web based teaching evaluation tools. Methods: Twenty university teachers in one metropolitan Australian School of Nursing and Midwifery were randomly paired and then randomly assigned to a paper based or web-based peer review tool. Each teacher reviewed each other's classroom teaching as part of a peer review program. The participants then completed an 18 question survey evaluating the peer review tool and paired evaluation process. Responses were analyzed using frequencies and percentages. Results: Regardless of the tool used, participants found this process of peer review positive (75%), collegial (78%), supportive (61%) and non-threatening (71%). Participants reported that the peer review will improve their own classroom delivery (61%), teaching evaluation (61%) and planning (53%). The web-based tool was found to be easier to use and allowed more space than the paper-based tool. Conclusion: Implementation of a web-based paired peer review system can be a positive method of peer review of university classroom teaching. Pairing of teachers to review each other's classroom teaching is a promising strategy and has the potential to improve teaching in teaching universities. Refereed/Peer-reviewed

Background: Patients’ perspectives provide valuable information on quality of care. This study evaluates the feasibility and validity of Internet administration of Service Satisfaction Scale for Cancer Care (SCA) to assess patient satisfaction with outcome, practitioner manner/skill, information, and waiting/access. Patients and methods: Primary data collected from November 2007 to April 2008. Patients receiving cancer care within 1 year were recruited from oncology, surgery, and radiation clinics at a tertiary care hospital. An Internet-based version of the 16-item SCA was developed. Participants were randomised to Internet SCA followed by paper SCA 2 weeks later or vice versa. Seven-point Likert scale responses were converted to a 0–100 scale (minimum–maximum satisfaction). Response distribution, Cronbach’s alpha, and test–retest correlations were calculated. Results: Among 122 consenting participants, 78 responded to initial SCA. Mean satisfaction scores for paper/Internet were 91/90 (outcome), 95/94 (practitioner manner/skill), 89/90 (information), and 86/86 (waiting/access). Response rate and item missingness were similar for Internet and paper. Except for practitioner manner/skill, test–retest correlations were robust r = 0.77 (outcome), 0.74 (information), and 0.75 (waiting/access) (all P < 0.001). Conclusions: Internet SCA administration is a feasible and a valid measurement of cancer care satisfaction for a wide range of cancer diagnoses, treatment modalities, and clinic settings.

This study describes the validation of a new electronic appetite rating system, and a statistical variance model for visual analogue scale (VAS) research. Thirty volunteers rated hunger, fullness, desire to eat, prospective intake, thirst and liking on 100 mm paper VAS and on 70 mm electronic VAS presented on a Dell™ Pocket PC, after consuming breakfast, in a repeated trial. The electronic method was comparable in relative accuracy and reproducibility to the paper method, with weak differences between tests (within-subject SD ≤ 14 mm). The data obtained were used to generate a model for VAS data variability.

Children now have considerable exposure to new information technologies (IT) such as desktop computers. A reported association between computer use and discomfort in children has prompted concerns about the musculoskeletal stresses associated with computer use. There were no detailed data on children reading and writing, nor any evidence on the variability of postures and muscle activity whilst children use IT. Twenty-four children (10–12 years old; 12 male) performed a reading and writing task using new IT (computer/keyboard/mouse with high display and mid height display) and old IT (book/paper/pen). Spinal and upper limb 3D posture and muscle activity were recorded and estimates of mean and variation calculated. The mean postures for children reading and writing with computers were more neutral than when they read and wrote with old IT. Similarly, mean muscle activity levels were lower during computer use than old IT use. However, new IT use also resulted in less variable, more monotonous postures and muscle activities. Moderate differences in computer display height had little effect on posture and muscle activity variation. Variation in musculoskeletal stresses is considered an important component of the risk of musculoskeletal disorders. Children should therefore be encouraged to ensure task variety when using new IT to offset the greater posture and muscle activity monotony.

Compliance and acceptance for the finger-prick method of blood collection is generally better than for venipuncture. A finger-prick method of blood collection with quantitative antibody recovery is even more important for seroepidemiological surveys. Finger-prick blood collected and dried onto filter paper has been used; but, unfortunately, this method has several disadvantages, including loss of antibody activity, possible contact contamination from blood spots on adjacent filter papers, and difficulties in extracting antibodies, justifying the search for other methods of collecting and transporting blood samples. We report on a simple method of collecting a measured amount of finger-prick blood onto a sample pad, which is immediately transferred to storage/extraction buffer. The diluted blood sample is never dried, and because of the storage buffer, can be transported and stored without refrigeration. Furthermore, the diluted blood samples can then be tested directly without further preparation. We systematically compared several storage/extraction buffers and commercially available filter papers. We showed that antibody recovery was not significantly affected by the type of filter papers used but was significantly affected by the storage/extraction buffer used. The best such buffer is StabilZyme Select.

Background The mucopolysaccharidoses (MPS) are inherited metabolic disorders with bone, joint, and visceral abnormalities, leading to multi-organ dysfunction and, sometimes, neurological manifestations. These diseases are caused by storage of glycosaminoglycans (GAGs) and other complex molecules in tissues, among other pathogenic mechanisms. Definitive diagnosis of the affected individual is mainly based on the identification of the specific enzyme deficiency. New therapies are available or are in development for these pathologies, and early diagnosis seems to be important for the therapy outcomes. Almost all MPS patients have increased levels of GAGs in urine being their evaluation usually the first step in the screening of these conditions. Test on urine may be challenging as transportation of liquid urine samples in appropriate conditions for long distances, especially across international borders, could be difficult. Methods With the aim of overcoming the difficulties related to the use of liquid samples, we extended and validated previous studies about colorimetric determination of GAGs in dried-urine filter paper (DUFP) samples. Results In the conditions we described, there are no differences in the concentration of GAGs between urine and DUFP samples. Untreated patients with MPS and normal controls were well discriminated using any of the samples. Conclusions Dried-urine filter paper is a suitable sample for the colorimetric quantitation of GAGs, and that its incorporation as an additional tool for screening of MPS should be considered by reference laboratories.

Objectives To describe lung function in correlation with information on exposure to dust and fibers in soft tissue paper-producing factories in Germany. Methods Ambient monitoring was performed for inhalable, respirable dust and fibers in nine soft tissue paper-producing factories. In a study group of 1,047 workers (189 control subjects, 240 workers with moderate exposure, and 618 workers with high exposure), spirometry (FVC, FEV 1 ) was performed. Information on occupational history, duration of exposure, workshop within the company, former occupational exposures, and smoking habits were collected. By employing multiple linear regression modeling, the potentially confounding effects of age, sex, body mass index, smoking habits, and factory were incorporated into the analysis of FVC, FEV 1 , and FEV 1 in percent of FVC (FEV 1 %FVC). By employing a logistic regression model, odds ratios were calculated for FVC Results The mean concentrations for inhalable, respirable, and fibrous dusts were 12.4 mg/m 3 , 0.28 mg/m 3 , and 420,000 fibers per cubic meter. With relation to cumulative dust and fiber exposure, a decrease of FVC from 105.4% predicted to 96.9% predicted (dust) and 97.1% predicted (fibers) in the subgroup with highest cumulative exposure was observed. For FEV 1 , a decrease from 107.3% predicted to 103.0% predicted (dust) and 102.8% predicted (fibers) was found. The parameter estimates show dose-response relationships that are more pronounced for FVC compared to FEV 1 . FEV 1 %FVC did not change significantly with increasing cumulative exposure, indicating a restrictive pattern of the findings. Conclusions Due to high ambient dust concentrations and the observed adverse effects on lung function, a reduction of dust exposure and secondary preventive measures is advised.

This study sought to compare sickness absence and early retirement at two workplaces in Sweden before and after they had received financial support from the Working Life Fund and implemented vocational rehabilitation activities. Two paper and pulp manufacturing plants were compared and a cohort study was set up. The cohort included everyone born in 1934 or later who was employed in December 1988 (918 employees at Plant A and 1543 at Plant B). For 10 years (1989–98), sick leave and disability pensions were monitored. The periods before and after the intervention (1989–93 and 1994–98, respectively) were compared. Cumulative incidence was calculated for short-, long-term and very long-term sick leave, company pension and early retirement. There was no difference between the plants in terms of the three different outcomes when sick leave was measured before and after the intervention. Sick leave in Period 1 was strongly correlated with an elevated risk of sick leave in Period 2. The cumulative incidence of short-term sick leave decreased from 0.92 (95% CI, 0.91–0.93) in Period 1 to 0.79 (95% CI, 0.77–0.80) in Period 2. For employees in the upper age groups, relative risk for long-term and very long-term sick leave was elevated in both periods. The incidence of early retirement and company pension differed between the companies. We conclude that the size of financial investments in rehabilitation programmes has no significant impact on sickness absence or disability pension, based on a comparison between two paper and pulp manufacturing plants in Sweden during the early 1990s.

Handwashing and hand drying are key elements of infection control. Paper towels are generally accepted as the most hygienic means of drying hands and are often distributed from generic dispensers. Effective dispensing of towels is of importance economically and may influence infection control objectives if hands become contaminated during hand drying. In this study, a method to identify potential exposure routes for hand contamination and evaluate the efficiency of paper-towel dispensing is described and applied to 5 different folded paper towels using a generic wall-mounted dispenser. A total of 18 male and female participants of varying heights participated in pull testing of 400 paper towels each, in controlled hand-drying simulations. All events having the potential for hand contamination, including towel jamming, towels falling onto the floor, and incidental contact of paper exits, were monitored and documented. There was considerable variation in dispensing efficiency between different towel brands. One towel (Z) had significantly (P.05) superior dispensing properties from the generic dispenser. Participants of a shorter height obtained a lower incidence of dispensing malfunctions using all towel products and type. The results indicated likely contamination exposure routes and wastage levels for each towel type. Environmental service managers and infection control practitioners should carefully consider, for economic and infection control reasons, the siting and design of towel dispensers and the types of towel purchased.

It is known that US paper currency in the general circulation is contaminated with cocaine. Several mechanisms have been offered to explain this finding, including contamination due to handling during drug deals and the use of rolled up bills for snorting. Drug is then transferred from one contaminated bill to others during counting in financial institutions. The possibility of contamination of currency with other drugs has not been reported. In this study, the author reports the analysis of 10 randomly collected US$ 1 bills from five cities, for cocaine, heroin, 6-acetylmorphine (6-AM), morphine, codeine, methamphetamine, amphetamine and phencyclidine (PCP). Bills were immersed in acetonitrile for 2h prior to extraction and GC-MS analysis. Results showed that 92% of the bills were positive for cocaine with a mean amount of 28.75+/-139.07 microg per bill, a median of 1.37 microg per bill, and a range of 0.01-922.72 microg per bill. Heroin was detected in seven bills in amounts ranging from 0.03 to 168.50 microg per bill: 6-AM and morphine were detected in three bills; methamphetamine and amphetamine in three and one bills, respectively, and PCP was detected in two bills in amounts of 0.78 and 1.87 microg per bill. Codeine was not detected in any of the US$ 1 bills analyzed. This study demonstrated that although paper currency was most often contaminated with cocaine, other drugs of abuse may be detected in bills.

Classic CAH (salt-wasting and simple virilizing) meets all of the recommended criteria for newborn screening. There are reliable and efficient newborn screening tests, the disorder results in high morbidity and mortality if left undetected, there is effective treatment that reduces negative outcomes, and there is a relatively high incidence. When compared with the case findings without the benefit of screening, the data from screening programs show reduced adrenal crises, reduced incorrect sex assignments, and reduced deaths. Racial/ethnic prevalence differences are present in newborn screening program data. The Texas data indicate a lower disease frequency in African-Americans when compared with Caucasians, and international data indicate higher frequencies in native Yupik Eskimos, Brazilians, residents of La Reunion, and Filipinos. When worldwide clinical ascertainment data are compared with newborn screenng data, it is clear that newborns with CAH (especially males) die when screening is not done. To be effective in reducing mortality, newborn screening must be performed soon after birth, and the results must be available quickly so that early salt-wasting crises can be averted. It is preferable that newborn screening laboratiories be operational 7 days a week, and that sample delivery from the collection site to testing laboratory be as efficient as possible, including weekends and holidays, so that undue testing delays are not encountered. These two requirements pose major challenges for most programs, but they are critical to optimal screening outcome. Based on the studies in Texas, with second screening samples collected at approximately 2 weeks of age, some newborns with simple virilizing CAH are missed on initial screening using current testing protocols. There is need to set a screening cut-off such that the false-positive rate does not oversaturate the follow-up system, in part owing to the insensitivity of current kit methodologies and the biochemical manifestations of CAH. With advances in genetic testing procedures and improved automation techniques, it may soon be possible for CAH screening programs to include genotyping as a second-tier confirmation as a part of the newborn screening protocol. Despite the fact that CAH is a continuum of disorders, the correlation between genotype and phenotype is fairly consistent in most cases. For the purpose of screening, genotyping will likely be useful only for differential diagnoses of non-salt wasters, given the necessary time constraints and expense of obtaining genotypes and the need for immediate diagnosis/treatment of salt wasters. It is hoped that newborn screening programs will begin to provide answers to some of these question in addition to their primary function of reducing the morbidity and mortality resulting from CAH.

Summary Aim To adapt the Asthma Quality of Life Questionnaire (AQLQ(S)), the Asthma Control Questionnaire (ACQ) and the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ(S)) for a personal digital assistant (Palm TX) and to examine the validity of the electronic versions by comparing them with the original paper versions. Methods 84 adults with asthma and 32 with rhinitis were randomised to complete either the paper or the electronic version first. After 2h, they completed the other version. Results 68 asthma and 27 rhinitis patients provided analysable data. For the AQLQ(S) and RQLQ(S) differences between paper and electronic were significant. Concordance between paper and electronic, evaluated using an intraclass correlation coefficient were: AQLQ=0.92, ACQ=0.90 and RQLQ=0.85. Concordance for the individual domains of the AQLQ and RQLQ ranged from 0.52 to 0.94. These levels of concordance did not reach the a priori defined requirement for validity. Conclusions The significant bias between paper and electronic versions and only modest concordance provides evidence that patients may respond differently to questionnaires in different formats and show that different formats must not be used interchangeably.

A case is presented of a 30-year-old man suffering from borderline personality disorder who committed suicide by means of smothering. He was hospitalized at the psychiatric department of a public hospital for several months and was found dead in the seclusion room. The death resulted from an obstruction of the upper aerodigestive tract after ingurgitation of pellets of toilet paper. A literature review revealed several cases of suicidal asphyxia by smothering of patients with a history of psychiatric illness. Our patient's operating process had not been reported before to our knowledge.

Introduction: The preparation of bloodspot calibrators and quality control samples for neonatal thyrotropin (TSH), as part of the national quality assessment scheme in The Netherlands, is sometimes problematic. Often, the recovery of the added TSH is well above 100% when measured in plasma. Results from other External Quality Assessment Schemes for neonatal TSH show similar problems. Methods and Results: A questionnaire was sent to 17 kit manufacturers and organizers of EQAS concerning the preparation of bloodspot calibrators for TSH; 13 completed questionnaires were returned. There are large differences with respect to type of filterpaper, matrix, assessment of TSH-concentrations to the calibrators, size of the bloodspots, shelf life, etc. Discussion: Attention is focused on several items to be considered when attempting standardization of the preparation of TSH bloodspot calibrators.

Our purpose was to evaluate second-trimester prenatal screening for open neural tube defects and Down syndrome by use of dried blood specimen collection and transport.A prospective study of 7497 dried blood specimens from patients35 years old was performed. Specimens were assayed for maternal blood alpha-fetoprotein and free beta-human chorionic gonadotropin. Patient-specific risks for both disorders were calculated and used to determine whether further evaluation was indicated. The study included an evaluation of the median and SD of analyte multiple of the median levels.The initial positive rate for open neural tube defect was 4.4% adjusted to 2.7% after ultrasonographic revision and collection of a second sample. The initial positive rate for Down syndrome was 3.6% adjusted to 2.8% after ultrasonographic revision. All seven cases of open neural tube defect were detected within the increased risk group. Six of 8 (75%) cases of Down syndrome were detected. The median alpha-fetoprotein multiple of the median was 3.5 in open neural tube defect cases and 0.6 in Down syndrome cases. The median free beta-human chorionic gonadotropin multiple of the median was 2.4 in Down syndrome cases. The SD (log e) of alpha- fetoprotein and free beta-human chorionic gonadotropin in 5868 unaffected white patients was 0.4022 and 0.5635, respectively.Second-trimester dried blood screening for open neural tube defects and Down syndrome can achieve screening efficiency comparable to serum-based protocols with distinct advantages over the conventional method of blood collection.

Background: A connection between patch test reactions to paper extracts and contact allergy to rosin (colophony) has been demonstrated. Objective: We wanted to determine whether a difference in the allergenic activity of various types of paper is related to a difference in the pulp. Methods: Patients with dermatitis who were frequently exposed to paper were patch tested with extracts from various papers and the standard series. The extracts were also tested in volunteers with or without contact allergy to rosin and in animals. The rosin compounds in the papers were analyzed by gas chromatography. Results: The subjects reacting to paper extracts also reacted to rosin. Most reactions were found to the papers produced from mechanical pulps, which contained the highest analyzed amounts of rosin compounds. Animals sensitized to rosin reacted only to paper from mechanical pulp. Conclusion: Papers based on mechanical pulps that are considered to be environmentally friendly have a greater potential to elicit positive patch test reactions than papers made from other pulps. The increased use of mechanical pulps in different applications may increase the incidence of rosin-related hand eczema.

We assessed the role of long-term exposure to ambient air malodorous sulfur compounds released from pulp mills as a determinant of eye and respiratory symptoms and headache in children. Adverse health effects of environmental exposure to these compounds in children have not been reported previously. The parents of 134 children living in a severely polluted (n = 42), moderately polluted (n = 62) and rural nonpolluted (n = 30) community responded to a cross-sectional questionnaire. The response rate was 83%. The adjusted odds ratios (OR) for symptoms experienced during the previous 4 weeks and 12 months in the severely versus nonpolluted community were estimated in logistic regression analysis controlling for age and gender. The risk of nasal symptoms (4 weeks OR 1.40, 95% CI 0.59-3.31; 12 months OR 2.47, 95% CI 0.93-6.53), cough (4 weeks OR 1.83, 95% CI 0.75-4.45; 12 months OR 2.28, 95% CI 0.95-5.47), eye symptoms (12 months OR 1.15, 95% CI 0.43-3.05), and headache (12 months OR 1.77, 95% CI 0.69-4.54) was considerably increased in the severely polluted community, although not quite reaching statistical significance. The results suggest that exposure to malodorous sulfur compounds may affect the health of children.

Human tear fluid was collected with blunted glass capillaries before and after performing the Schirmer test (ST). The test caused an increase in the tear fluid (TF) plasmin concentration (from 0.40 +/- 0.29 microgram ml-1 (mean +/- S.E.M.) to 1.14 +/- 0.26 microgram ml-1; Mann-Whitney test P less than 0.001) and a decrease in plasminogen activator activity (from 2.04 +/- 0.24 IU ml-1 to 1.04 +/- 0.17 IU ml-1; Mann-Whitney test P less than 0.002). In the filter paper used for ST, that segment that had been in contact with the conjunctiva (5 mm) usually contained higher amounts of plasmin than the following 5 mm of the paper overhanging the lidmargin. The present results indicate that the TF collection may affect the plasminogen activator-plasmin system in TF, depending on the collection method used.

Objective: To report the quantitative assessment of visual fields (VF) in patients with pituitary macroadenomas, and the time course and predictive factors for recovery of vision. Methods: Retrospective study of 41 patients with pituitary adenomas and visual disturbance. Patients underwent pre- and postoperative VF assessment at one week, three to six months, one year, two years, and five years using the Humphrey field analyser, which gives a quantitative measure of VF in each quadrant. Results: 36/41 patients (88%) presented with a visual disturbance. Mean (SEM) duration of symptoms was 94 (50) weeks (range 0.5 to 1500); 12 (29%) had optic atrophy at presentation. Impairment of VF was greatest in the upper temporal quadrant, followed by the lower temporal. VF recovery was progressive and apparent even at the five year follow up (p

Considerable controversy exists concerning the origin and composition of Alzheimer neurofibrillary tangles (ANT) and of paired helical filaments (PHF), the abnormal cytoplasmic fibers which ultrastructurally are the major components of ANT. Thus far, the unusual solubility properties of PHF have hindered the analysis of ANT. A new procedure is presented for isolating purified PHF which are soluble in the presence of sodium dodecyl sulfate. The purification protocol involves differential and rate zonal centrifugation, treatment with the detergents sarcosyl and sulfobetain 3–14, and sonication. The isolated PHF from Alzheimer disease/senile dementia of the Alzheimer type (7 cases) and Down's syndrome (one case) have been characterized structurally by negative-stain electron microscopy, biochemically by PAGE, and immunologically by both the ELISA technique and Western blot analysis using a monoclonal antibody prepared against ANT. Distinct polypeptides were shown to be associated with this structure and not seen in preparations from young and age-matched normal brains.

A randomized, crossover study comparing the acceptance of and attitudes towards two dosage forms of the same oral contraceptive product - a paper presentation and the conventional tablet, was carried out in a network of rural and suburban research centers in the State of Durango, México. The results failed to show any significant advantage (in terms of acceptability or continuation) of the paper formulation. Although two-thirds of the participants indicated a preference for the conventional tablet, there was a high degree of acceptance of the paper formulation among new oral contraceptive acceptors.A randomized, crossover study comparing the acceptance of and attitude towards 2 dosage forms of the same oral contraceptive product -- a paper presentation and the conventional tablet -- was carried out in a network of rural and suburban research centers in the State of Durango, Mexico. 68 women used the paper pill for 3 months and then switched to the tablet for another 3, while 70 women took the tablet 1st and switched to the paper pill. The results failed to show any significant advantage in terms of acceptability or continuation for the paper formulation. Both formulations were perceived as effective and easy to use. 2/3 of the participants indicated a preference for the tablets at the end of the study, but there was a high degree of acceptance of the paper formulation among new oral contraceptive acceptors. The authors believe that an improved paper formulation could be successfully introduced into a national program, if there were substantial savings in cost associated with the "paper pill."

An immunoradiometric two-site assay for thyrotrophin (TSH) in dried blood filter paper spots is described. The assay is automated by means of the Kemtek 3000 automated immunoassay system. The technique uses a 6.0 mm disc punched from the dried blood samples collected as part of the screening programme for phenylketonuria. The method is sensitive and precise, and results correlate well with those obtained in TSH assays of serum samples. The procedure is rapid, results being available within 24 h of receipt of samples. Of 25204 specimens so far screened by this assay, 99.9% have TSH levels less than 15 mU/1. One false positive result has been obtained and six confirmed cases of neonatal hypothyroidism detected, giving a prevalence of 1 in 4200.

Until now, the disadvantages of the nitroblue tetrazolium method of detecting myocardial necrosis have been that the colour reaction tended to fade and the wet heart slices were inconvenient for demonstration and storage. We have therefore modified the rapid technique of mounting sections of whole organs on paper to preserve the colour reaction. We can now show the extent of necrosis in permanent, readily portable, paper-mounted heart sections within 24 hours (although 48 hours is more convenient). Multiple preparations from multiple slices can be prepared for clinicopathological correlation, comparison with other cases, teaching, presentation at meetings, use in the case notes and distribution with the postmortem report.

We have recently developed an immunoassay that can measure thyroxine rapidly and accurately in the eluate of 40 mul of dried blood spotted on filter paper at the fifth day of life. The method is completely automated and by using the samples received by the Central Laboratory of the Quebec Network for Genetic Medicine and their follow-up facilities, we are now screening every newborn in the province of Quebec for neonatal hypothyroidism. To date, from 47,000 measurements, three newborn infants with abnormally low TBG and seven hypothyroid infants have been detected. From these data we conclude that the frequency of congenital hypothyroidism is about one in 7,000 births and that our method is effective in detecting thyroid hormone abnormalities with an acceptable percentage of false positive measurements; no false negative results have occurred to our knowledge.

Ocular signs and serum vitamin A concentrations are commonly used for the diagnosis ofvitamin A deficiency. Recently, impression cytology was suggested as a method for early detection of this condition. A clinical trial was conducted to compare the results of impression cytology with the other two indicators of vitamin A status. A total of 246 children aged 1-10 y were investigated. About 25% ofthe children with normal eyes showed abnormal cytology. Their mean vitamin A concentrations were significantly lower compared with those with normal cytology, which suggests that abnormal cytology reflects subclinical deficiency. After treatment with vitamin A, most of the children who had abnormal cytology at baseline examination showed improvement. These observations suggest that abnormal cytology is spe- cific to vitamin A deficiency. Impression cytology is a relatively simple technique and can be used for assessing the magnitude of the problem, especially in communities where the preva- lence ofclinical disease is low. Am J C/in Nutr 1989;50:8l4-7.

The rate of urea formation in rat liver slices was retarded when any of the following metabolites was added to the incubation medium: glucose, fructose, lactate, pyruvate or succinate. Acetate and octonoate were without effect. Pyruvate appeared to be the most potent of the inhibitors tested. Attempts to elucidate the mechanism of the pyruvate effect revealed that the inhibition was substrate dependent and could be offset by an excess of ornithine. This and other evidence was thought to suggest that pyruvate might act by transaminating with ornithine, thereby interrupting urea synthesis by siphoning off this “catalytic” intermediate of the urea cycle. The results suggest that one of the biochemical events following carbohydrate intake might be a direct, hormone-independent interaction between the intermediary metabolism of carbohydrate and the process of urea synthesis. The possible relationship between these observations and the protein-sparing action of carbohydrates is discussed.

We have conducted an experimental study in which dentine disks and Whatman paper were used to test discoloring effects of disinfectants, antibiotics, and flushing solutions used in endodontics. Each of the chemicals was tested alone and in the presence of a 1 per cent suspension of human erythrocytes in saline solution. Polyantibiotic and disinfectant pastes were used as dressings on recently extracted teeth, which were then split open to show discoloration. The most severe discoloring action was exhibited by the two N2 pastes and by polyantibiotic pastes containing Terramycin and Declomycin.

Summary 250 urine specimens were classified into 7 categories on the basis of viable counts and the bacteria found. The results of 7 bacteriuria screening tests performed on the same specimens are presented in relation to this classification. Four rapid culture tests and a triphenyltetrazolium chloride reduction test proved capable of detecting specimens classed as ‘significant’ or ‘not significant’ bacteriuria with accuracies between 95 and 85%. For more accurate and subtle categorization of specimens, a calibrated drop viable count procedure is recommended.

A patient suffering from rheumatoid arthritis and bilateral parotid and submaxillary gland swellings was followed for 5 years. During this time samples of parotid saliva (when available) and serum were tested by paper electrophoresis and immunoelectrophoresis. The findings were consistent with other data obtained on patients with Sjogren's syndrome except that no serum IgM immunoglobulin could be detected. Because of the glandular enlargements, radiation was directed first to the right side and, 1 year later, to the left side. The clinical data obtained in this study indicate that radiation restores enlarged glands to normal size and enhances the flow of saliva. Biochemical investigations reveal some improvement in serum and salivary patterns within 2 years after radiation. Four years after therapy the data suggest a remission of the disease and the appearance of IgM immunoglobulin in the serum.

1. 1. The protein composition of rat serum and whey was studied by paper electrophoresis in non-lactating rats and rats on the 13th and 20th days of lactation, and the turnover of serum proteins and their transfer to the milk were measured using 131I-labelled purified rat albumin, acidic α1-glycoprotein, haptoglobin, transferrin and γ-globulin. 2. 2. Lactation was accompanied by a decrease in serum albumin concentration and by increases of the α- and β-globulins. Whey contained lower concentrations of the electrophoretic fractions, but showed a marked increase in β-globulin between the 13th and 20th days of lactation. The fractional and absolute turnover rates of all five proteins were greater in the lactating than in the non-lactating rats, and all of the proteins were transferred to the milk. It is concluded that the rates of catabolism of all the proteins were increased during lactation due to loss into the milk, and that there was also an increase in their rates of synthesis. With the exception of transferrin the relative rates of transmission of the proteins to whey was in inverse relation to their molecular weight, suggesting that the mammary gland acts as a molecular sieve for serum proteins.