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Peri-operative hypothermia is associated with significant morbidity, yet limitations exist regarding non-invasive temperature assessment in the post-anaesthesia care unit (PACU). In this prospective study of 100 patients, we aimed to determine the reliability of two commonly used temperature measurement devices, forehead temporal artery temperature and tympanic measurement, in addition to an indwelling urinary catheter with temperature probe, in comparison with the final nasopharyngeal core temperature at the end of surgery. Agreement of forehead measurement with nasopharyngeal temperature showed a mean bias (±95% limits of agreement) of 0.15 °C (±1.4 °C), with a steep slope of the relationship on the Bland-Altman plot of -0.8, indicating a tendency to normalise patient temperature readings to 36.4 °C. Only 54% of hypothermic cases were correctly detected by the forehead measurement device. Agreement of tympanic measurement with nasopharyngeal core temperature measurement was marginally improved with a mean bias of 0.13 °C (95% limits of agreement ±1.15 °C). In contrast, agreement of bladder temperature with nasopharyngeal temperature showed a mean (SD) bias of 0.19 (0.28) °C (95% limits of agreement ±0.54 °C), with a relatively flat line of best fit. We demonstrated that two commonly used temperature measurement devices, forehead temporal artery temperature and tympanic measurement, compared with nasopharyngeal core temperature, were imprecise and unreliable following major surgery. However, the indwelling catheter with temperature sensor was precise and acceptable for continuous core temperature measurement in the PACU.

Despite the frequency of videolaryngoscope use, to the authors’ knowledge, there are no publications exploring the role of playback video recording in real time to improve patient care. We present a patient with a difficult airway complicated by trauma during GlideScope® (Verathon Inc., Bothell, WA, USA) intubation. The injury was not recognised by any of the anaesthetic staff observing the intubation, and was only identified when playback video footage was viewed. This provided the opportunity for early ear, nose and throat surgical review prior to extubation. Airway trauma can be missed by the anaesthetist. Reviewing video playback footage at an appropriate time during the case may enable more timely recognition of airway injuries and, ultimately, improved patient care.

OBJECTIVES: Black Caribbeans in the United States have been the victims of major discrimination (e.g., unfairly fired, denied a promotion, denied housing). What is not known is the degree to which they also experience more routine forms of everyday discrimination such as receiving poor restaurant service, being perceived as dishonest, and being followed in stores. This paper investigates the distribution and correlates of everyday discrimination among a national sample of black Caribbeans in the U.S. DESIGN: This analysis used the black Caribbean sub-sample (n=1,621) of the National Survey of American Life. Demographic and immigration status correlates of ten items from the Everyday Discrimination Scale were investigated: being treated with less courtesy, treated with less respect, receiving poor restaurant service, being perceived as not smart, being perceived as dishonest, being perceived as not as good as others, and being feared, insulted, harassed, or followed in stores. RESULTS: Roughly one out of ten black Caribbeans reported that, on a weekly basis, they were treated with less courtesy and other people acted as if they were better than them, were afraid of them, and as if they were not as smart. Everyday discrimination was more frequent for black Caribbeans who were male, never married, divorced/separated, earned higher incomes, and who were second or third generation immigrants. Black Caribbeans attributed the majority of the discrimination they experienced to their race. CONCLUSION: To our knowledge, this is the first study to provide an in-depth investigation of everyday discrimination among the black Caribbean population. It provides the frequency, types and correlates of everyday discrimination reported by black Caribbeans in the United States. Understanding the frequency and types of discrimination is important because of the documented negative impacts of everyday discrimination on physical and mental health.

We examined how sociopolitical context (marked by generational cohort) and maternal skin color interacted to influence preterm delivery (PTD) rates in sample of Black women. Data were from 1410 Black women, ages 18–45 years, residing in Metropolitan Detroit, MI enrolled (2009–2011) in the Life-course Influences on Fetal Environments (LIFE) Study. Because we hypothesized that generational differences marked by changes in the sociopolitical context would influence exposure to racism, we categorized women into two cohorts by maternal birth year: a) Generation X, 1964–1983 and b) Millennial, 1984–1993. Descriptive results showed similar PTD rates by generational cohort, Generation X: 16.3% vs. Millennials: 16.1%. Yet, within each generation, PTD rates varied by women's skin tone (categorized: light, medium, and dark brown). Poisson regression models confirmed a significant interaction between generational cohort and maternal skin tone predicting PTD (P = 0.001); suggesting a salubrious association between light brown skin tone (compared to medium and dark) and PTD for Generation X. However, Millennials with medium and dark brown skin experienced lower PTD rates than their light Millennial counterparts. Research should consider sociopolitical context and the salience of skin tone bias when investigating racial health disparities, including those in perinatal health.

Introduction Literature posits that discrimination can be a barrier to racial and ethnic minorities’ healthcare use. This study examines the relationship between perceived discrimination in the form of racial microaggressions and delayed prenatal care in African American women. It also investigates whether this relationship is modified by women's shade of skin color owing to societal attitudes and beliefs tied to colorism (also known as skin-tone bias). Methods Data were collected from a cohort of 1,410 black, African American women in metropolitan Detroit, Michigan, enrolled in 2009–2011 (analyzed between August 2017 and July 2018). Perceived racial microaggressions were assessed using the 20-item Daily Life Experiences of Racism and Bother scale. Logistic regression modeled the relationship between the Daily Life Experiences of Racism and Bother scale and delayed prenatal care, defined as third trimester or no prenatal care entry. Results Nearly a quarter (24.8%) of women had delayed prenatal care. Logistic regression models showed that a Daily Life Experiences of Racism and Bother score above the median was associated with delayed prenatal care (AOR=1.31, 95% CI=1.00, 1.71). This association was moderated by self-reported maternal skin tone (interaction p=0.03). A higher Daily Life Experiences of Racism and Bother score was associated with delayed prenatal care among African-American women at either end of the color continuum (light brown: AOR=1.64, 95% CI=1.02, 2.65; dark brown: AOR=2.30, 95% CI=1.20, 4.41) but not in the middle (medium brown women). Conclusions Skin tone–based mistreatment in tandem with racial discrimination in the form of racial microaggressions may influence African American women's use of prenatal care. These findings have implications related to the engagement of women of color, particularly African American women, in healthcare systems and maternal and child health programs.

This case demonstrates a novel preoxygenation technique in a patient with difficult access to the airway after a traumatic facial injury. To find a solution, a fusion of oxygenation equipment was trialed by altering and combining a tracheostomy mask and the tubing of an Optiflow circuit from which the nasal cannula component had been removed. This novel combination delivered high-flow humidified oxygen (60 L/min) orally, avoided further facial injury, and was well tolerated by the patient. Effective preoxygenation was confirmed by arterial gas measurements. This study supports the use of this novel Optiflow-tracheostomy mask fusion device in appropriately selected cases.

OBJECTIVE: This paper examines how mortality covaries with observed skin tone among blacks and in relation to whites. Additionally, the study analyzes the extent to which social factors such as socioeconomic status affect this relationship. DESIGN: This study uses data from the 1982 General Social Survey (N = 1,689) data linked to the National Death Index until 2008. We use this data to examine the links between race, observed skin tone among blacks, and all-cause mortality. Piecewise exponential hazard modeling was used to estimate disparities in skin tone mortality among blacks, and relative to whites. The multivariate models control for age, education, gender, region, metropolitan statistical area, marital status, labor force status, and household income. RESULTS: Observed skin tone is a significant determinant of mortality among blacks and in relation to whites. Light skinned blacks had the lowest mortality hazards among blacks, while respondents with medium and dark brown skin experienced significantly higher mortality. The observed skin tone mortality disparities covaried with education; there are significant mortality disparities across observed skin tone groups among black respondents with high school or more education, and nonsignificant disparities among those with less education. CONCLUSION: It is crucial to identify the social processes driving racial disparities in health and mortality. The findings reveal that the nuanced social experiences of blacks with different observed skin tones markedly change the experience of racial inequality. Research on the nuanced social processes and biological mechanisms that connect differences in observed skin tone to mortality outcomes promises to better illuminate the experience of racial inequality and policy mechanisms we can use to undermine it.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • The intradermal capsaicin model of neuropathic pain has been previously developed and used in healthy volunteers. • Few previous studies have used this model in pain patients. WHAT THIS STUDY ADDS • We have compared the response to intradermal capsaicin in the painful and nonpainful legs of patients with unilateral sciatica and compared these with healthy, pain-free control subjects. Pain and hyperalgesia responses were enhanced in both legs of patients with unilateral sciatica compared with healthy controls. The time course of hyperalgesia was different in sciatica patients, demonstrating a slower and larger evolution. • Qualitative and quantitative differences between pain patients and healthy controls suggest that the use of a neuropathic pain model such as intradermal capsaicin to screen for novel antineuropathic agents might be superior in patients with pre-existing neuropathic pain syndromes. AIM This study compared the responses between patients with unilateral sciatica and pain-free volunteers following administration of intradermal capsaicin. METHODS Fourteen patients with unilateral sciatica and 12 pain-free volunteers received one injection per hour over 4 h of 1 µg and 10 µg capsaicin, into each calf. For each dose, spontaneous pain (10 cm VAS), area of flare (cm2) and the sum of allodynia and hyperalgesia radii across eight axes (cm) were recorded pre-injection and at 5, 15, 30, 45 and 60 min post injection. RESULTS Sciatica subjects experienced higher spontaneous pain and hyperalgesia responses in both legs compared with pain-free volunteers. The largest mean difference in spontaneous pain was 2.8 cm (95% CI 1.6, 3.9) at 5 min in the unaffected leg following 10 µg. The largest mean difference in hyperalgesia was 19.7 cm (95% CI 12.4, 27.0) at 60 min in the unaffected leg following 10 µg. Allodynia was greater in patients than in controls with the largest mean difference of 2.9 cm (95% CI 1, 4.8) at 5 min following 10 µg in the affected leg. Allodynia was also higher in the affected leg compared with the unaffected leg in sciatica patients with the highest mean difference of 3.0 cm (95% CI 1.2, 4.7) at 5 min following 10 µg. CONCLUSIONS The responses to intradermal capsaicin are quantitatively and qualitatively different in unilateral sciatica patients compared with pain-free controls.

Hurricane Katrina constitutes the most costly natural as well as technology-induced disaster, in terms of both human suffering and financial loss in the history of the United States. Even years later, it continues to profoundly impact the livelihoods and the mental and physical health of those who have experienced evacuation and return and those who have begun lives anew elsewhere. Our study focuses on these geographical processes associated with the Katrina disaster experiences of African Americans and Vietnamese Americans comprising an overwhelming majority (93.4 percent) of residents in a racially mixed pre-Katrina eastern New Orleans neighborhood. We examine the spatial morphology of routes, volumes, and frequencies of evacuees; their return rates and experiences; and rationales and motivations to return or stay. The conceptual framework is based on the disaster migration, place attachment, and social network literature. Both quantitative and qualitative evidence indicates that the evacuation and retu...

The flooding of New Orleans in the wake of Hurricane Katrina on 29 August 2005 uncovered critical issues in local, state, and national strategies for emergency preparedness and disaster relief. The Katrina disaster reveals the persistent racial inequality and economic disparities in American society. This paper examines the pre-Katrina socio-spatial configuration of the African-American and Vietnamese-American communities in an eastern New Orleans suburb. Using a combination of quantitative and qualitative methods to collect data and compare the two groups, our study reveals media are the first and foremost information sources for both groups. Many Katrina victims evacuated more than once, some not with their families during their first and subsequent relocations. However, the communities mobilized to provide intra- and inter-group self-help among families and relatives, friends and neighbors, while receiving assistance from community organizations, religious institutions, and the government. Compared to ...

Background: The flooding of New Orleans after Hurricane Katrina revealed the disproportionate vulnerability of ethnic minority communities for emergency preparedness, disaster relief and health. Nurses need to analyse Katrina's health consequences for the most vulnerable segments of our society. Aim: To examine factors contributing to differential health outcomes among the New Orleans Vietnamese community in response to Katrina. Methods: A sample of 113 adult Vietnamese Katrina survivors from New Orleans was recruited. A mixed-method approach, including survey and focus groups, was used to collect data. Survey questions were modified from standardized instruments to evaluate survivors' health status and factors contributing to health outcomes. Multivariate and content analysis were used to investigate effects of prior trauma, financial strain, social support and acculturation level in predicting survivors' health outcomes. Results: Findings suggested financial strain was the strongest risk factor for Vietnamese survivors' post-traumatic stress disorder (PTSD) symptoms, and physical and mental health post-disaster; while social support was a strong protective factor for health. Survivors who perceived higher impact from previous traumatic experiences had poorer physical health, but not PTSD symptoms or poor mental health after controlling for financial strain and social support, suggesting complex relationships among these measures in predicting PTSD symptoms and health. Less-acculturated individuals also reported higher levels of PTSD symptoms and poorer physical health. Conclusions: Catastrophic events like Katrina can result in disproportionate risk of negative health outcomes among vulnerable populations. Nurses should take into account prior trauma, financial strain, social support network and acculturation level, to adequately address survivors' needs.

To investigate the use of alternative therapies among different racial/ethnic groups in the USA. Specifically, we examined whether alternative medicine use differs for working aged whites, Asian Americans, African Americans, and Hispanics.Using the 1996 Medical Expenditure Panel Survey, racial differences in utilization were investigated at two levels: (1) the bivariate level with no controls for other factors and (2) at the multivariate level with controls for age, sex, region, marital status, education, income, health status, satisfaction with conventional healthcare, and access measures.Americans in this sample population used alternative and complementary therapies at a fairly low rate (6.5%). This 6.5%, however, was not consistent across all groups. African Americans and Hispanics were less likely than whites to utilize alternative therapies, whereas Asian Americans did not differ significantly from whites.The use of alternative and complementary therapies varied across racial/ ethnic groups. Evidence showed that individuals who were dissatisfied with the availability of conventional healthcare, who were in poor health, but very satisfied with their conventional provider were more likely to use complementary and alternative medicine (CAM) therapies. The addition of these variables to a logistic regression model did not change the findings for differential use by ethnicity, the relative ranking of groups, or the overall strength of the relationship.

Purpose: We investigated whether health status (i.e., need characteristics) and financial resources (i.e., enabling characteristics) were important predictors of two types of functional adaptations among elderly adults: home modifications such as putting nonslip tape on rugs or installing more telephones and use of equipment for mobility or activities of daily living (ADLs) such as canes or walkers. Design and Methods: Participants were identified from the National Survey of Self-Care and Aging ( n � 3,485), a nationally representative sample of noninstitutionalized U.S. adults aged 65 and older. Need and enabling characteristics were used to predict home modifications and equipment use in multinomial logistic analysis, controlling for predisposing characteristics. Results: Although several health-status (need) variables had significant, direct effects on functional adaptations, the effects of ADL limitations were diminished at higher levels of impairment. Among the financial (enabling) variables, subjective income measures and supplemental insurance had significant, direct effects on functional adaptations. Implications: Promotion of functional adaptations among elderly people may benefit from both a proactive approach that targets elders with few limitations and a consideration of financial factors in addition to health status.

Evidence-based choices of volatile agents can increase health cost efficiencies. In this pharmaco-economic study, we evaluated the trends and costs of volatile agent use in Australian public hospitals. The total number of volatile agent (isoflurane, sevoflurane and desflurane) bottles ordered and inflation-adjusted costs were collected from 65 Victorian public hospitals from 2005 to 2011. Environmental costs were measured through the 100-year global warming potential index as carbon dioxide equivalents. During this time period, the aggregate inflation-adjusted expenditure was $39,209,878. Time series analysis showed that bottles of isoflurane ordered decreased by 419/year (99% confidence interval [CI] −603 to −235); costs decreased by $56,017/year (99% CI -$93,243 to -$18,791). Bottles of sevoflurane increased by 1,330/year (99% CI 1141 to 1519); costs decreased by $423,3573/year (99% CI -$720,030 to -$112,783). Bottles of desflurane increased by 726/year (99% CI 288 to 1,164); costs increased by $171,578/year (99% CI $136,951 to $206,205). The amount of calculated greenhouse gas emissions released into the atmosphere over this period was 37,000 tonnes of carbon dioxide equivalents, with isoflurane contributing 6%, sevoflurane 17%, and desflurane 77% of this total. In conclusion, isoflurane is no longer being used in the majority of Victorian public hospitals, with sevoflurane and desflurane remaining as the primary volatile agents, utilised respectively at a ratio of 2.2 to 1, and costs at 0.8 to 1.

Background Human ascending thoracic aortic aneurysms ( ATAAs ) are life threatening and constitute a leading cause of mortality in the United States . Previously, we demonstrated that collagens α2(V) and α1(XI) mRNA and protein expression levels are significantly increased in ATAAs . Methods and Results In this report, the authors extended these preliminary studies using high‐throughput proteomic analysis to identify additional biomarkers for use in whole blood real‐time RT ‐ PCR analysis to allow for the identification of ATAAs before dissection or rupture. Human ATAA samples were obtained from male and female patients aged 65±14 years. Both bicuspid and tricuspid aortic valve patients were included and compared with nonaneurysmal aortas (mean diameter 2.3 cm). Five biomarkers were identified as being suitable for detection and identification of ATAAs using q RT ‐ PCR analysis of whole blood. Analysis of 41 samples (19 small, 13 medium‐sized, and 9 large ATAAs ) demonstrated the overexpression of 3 of these transcript biomarkers correctly identified 79.4% of patients with ATAA of ≥4.0 cm ( P CI =0.62 to 0.91; specificity 1.00, 95% CI =0.42 to 1.00). Conclusion A preliminary transcript biomarker panel for the identification of ATAAs using whole blood q RT ‐ PCR analysis in men and women is presented.

Background Large-scale epidemiological studies support an important role for susceptibility genes in the pathogenesis of ischemic stroke, with phosphodiesterase 4D identified as the first gene predisposing to ischemic stroke. Several single nucleotide polymorphisms within the phosphodiesterase 4D gene have been implicated in the pathogenesis of stroke. Aim Undertake a multivariate analysis of six single nucleotide polymorphisms within the phosphodiesterase 4D gene in a previously defined Australian stroke cohort, to determine whether these single nucleotide polymorphisms have an association with ischemic stroke. Methods This case–control study was performed using an existing genetic database of 180 ischemic stroke patients and 301 community controls, evaluated previously for cerebrovascular risk factors (hypertension, hypercholesterolemia, diabetes, paroxysmal atrial fibrillation, smoking and history of stroke in a first-degree relative). Based on previously reported associations with large vessel disease, ischemic stroke, cardioembolic stroke or a mixture of these, six single nucleotide polymorphisms in the phosphodiesterase 4D gene were selected for study, these being single nucleotide polymorphisms 13, 19, rs152312, 45, 83 and 87, based on previously utilized DeCODE nomenclature. Single nucleotide polymorphisms were genotyped using a sequence-specific polymerase chain reaction method and gel electrophoresis. Logistic regression was undertaken to determine the relevance of each polymorphism to stroke. Further analysis was undertaken to determine the risk of stroke following stratification for stroke sub-type and etiology. Results Significant odds ratios were found to be associated with cardioembolic strokes in two single nucleotide polymorphisms: rs152312 and SNP 45 ( PConclusions Our findings demonstrated an association between cardioembolic stroke and phosphodiesterase 4D single nucleotide polymorphisms rs152312 and 45. No significant association was found for the other four single nucleotide polymorphisms investigated within the phosphodiesterase 4D gene. We propose that the results from this Australian population support the concept that a large prospective international study is required to investigate the role of phosphodiesterase 4D in the cardiogenic cause of ischemic stroke.

There is currently an experts' agreement discouraging interruption of antiretroviral treatment (ART) during the first trimester of pregnancy in women infected with human immunodeficiency virus type 1 (HIV-1). However, this recommendation is poorly supported by data. We evaluated the effects of discontinuing ART during pregnancy on the rate of mother-to-child transmission.Logistic regression models were performed in a prospective cohort of 937 children who were perinatally exposed to HIV-1 to estimate adjusted odds ratios for confounding factors on mother-to-child transmission, including maternal interruption of ART.Among 937 pregnant women infected with HIV-1, ART was interrupted in 81 (8.6%) in the first trimester and in 11 (1.2%) in the third trimester. In the first trimester, the median time at suspension of ART was 6 weeks (interquartile range [IQR], 5-6 weeks) and the time without treatment was 8 weeks (IQR, 7-11 weeks). In the third trimester, the median time at suspension of ART was 32 weeks (IQR, 23-36 weeks) and the time without treatment was 6 weeks (IQR, 2-9 weeks). The plasma viral load was similar in women who had treatment interrupted in the first trimester and in those who did not have treatment interrupted. Overall, the rate of mother-to-child transmission in the whole cohort was 1.3% (95% confidence interval [CI], 0.7%-2.3%), whereas it was 4.9% (95% CI, 1.9%-13.2%) when ART was interrupted in the first trimester and 18.2% (95% CI, 4.5%-72.7%) when ART was interrupted in the third trimester. In the multiple logistic regression models, only interruption of ART during either the first or the third trimester, maternal mono- or double therapy, delivery by a mode other than elective cesarean delivery, and a viral load at delivery4.78 log(10) copies/mL were independently associated with an increased rate of mother-to-child transmission.Discontinuing ART during pregnancy increases the rate of mother-to-child transmission of HIV-1, either when ART is stopped in the first trimester and subsequently restarted or when it is interrupted in the third trimester. This finding supports recommendations to continue ART in pregnant women who are already receiving treatment for their health.

Previous studies have demonstrated that acculturation is associated with negative birth outcomes among mothers in numerous immigrant populations, including Latinas. This study used structural equation models to reanalyze data employed in the 1989 Scribner and Dwyer study on the effect of acculturation (measured through the Cuellar scale) on mothers' low-birthweight status. Data revealed that language components dominate the effects of acculturation on low-birthweight status. Acculturuation appears to affect low-birthweight status indirectly through smoking and dietary intake but not through parity. Acculturation has a persistent direct effect on low-birthweight status, suggesting that other intervening variables are operant.

Between 1952 and 1970, DOE buried mixed waste in pits and trenches that now have special cleanup needs. The disposal practices used decades ago left these landfills and other trenches, pits, and disposal sites filled with three million cubic meters of buried waste. This waste is becoming harmful to human safety and health. Today's cleanup and waste removal is time-consuming and expensive with some sites scheduled to complete cleanup by 2006 or later. An interim solution to the DOE buried waste problem is to encapsulate and hydraulically isolate the waste with a geomembrane barrier and monitor the performance of the barrier over its 50-yr lifetime. The installed containment barriers would isolate the buried waste and protect groundwater from pollutants until final remediations are completed. The DOE has awarded a contract to RAHCO International, Inc.; of Spokane, Washington; to design, develop, and test a novel subsurface barrier installation system, referred to as a Subsurface Containment System (SCS). The installed containment barrier consists of commercially available geomembrane materials that isolates the underground waste, similar to the way a swimming pools hold water, without disrupting hazardous material that was buried decades ago. The barrier protects soil and groundwater from contamination and effectively meetsmore » environmental cleanup standards while reducing risks, schedules, and costs. Constructing the subsurface containment barrier uses a combination of conventional and specialized equipment and a unique continuous construction process. This innovative equipment and construction method can construct a 1000-ft-long X 34-ft-wide X 30-ft-deep barrier at construction rates to 12 Wday (8 hr/day operation). Life cycle costs including RCRA cover and long-term monitoring range from approximately $380 to $590/cu yd of waste contained or $100 to $160/sq ft of placed barrier based upon the subsurface geology surrounding the waste. Project objectives for Phase I were to validate the SCS construction equipment and process, evaluate the system performance, validate the barrier constructability, and assess the barrier effectiveness. The objectives for Phase 11, which is a full-scale demonstration at a DOE site, are to perform an extensive characterization of the test site, to demonstrate the equipment and the installation process under site-specific performance and regulatory requirements, to validate the operational performance of the equipment, and to perform long-term verification of the barrier using monitoring wells. To date, significant progress has been made to establish the technical and economical feasibility of the SCS. This report describes the SCS conventional and specialized equipment, barrier materials, and construction process. It presents results of the specialized equipment Factory Test, the SCS Control Test and the SCS Advance Control Test at the RAHCO facility. Provided herein are the system performance capabilities and an estimated construction cost and schedule for a 1000-ft-long X 34-ft-wide X 29-ft-deep containment barrier at the DOE Oak Ridge Bear Creek Burial Grounds are also provided.« less

Unchanging patterns of low birthweight deliveries reveal the need for increased emphasis on nutritional management of high-risk neonates. The research of Thompson (JADA 94:400) shows only 38% of the nation's neonatal care centers currently include a dietitian in their intensive care units. The National Institute of Health supports medical nutrition therapy as a "clinical priority" in the management of preterm and low birthweight infants. It is imperative that undergraduate students receive exposure to the specialized field of neonatal nutrition to assist in meeting the urgent need. This project, designed through the Honors Program, provided an educational experience at a leading neonatal care center. Participation in a summer neonatal nutrition fellowship increased interest in specialization and prepared the student for pursuing an advanced-level degree in pediatric nutrition. Commitment of dietetic professionals to create extended educational opportunities for students will be rewarded with a generation of dietitians qualified to meet the demands of providing advanced-level nutritional care. Undergraduate dietetic education will be effectively enhanced both now and in the future.

This research compared two methods of instruction, lecture-discussion and independ ent study, for a college level course in the social and psychological aspects of clothing. A secondary aspect of the study was to compare the effectiveness of independent study for both on-campus and off-campus students. The methods were compared in terms of cognitive gain, retention of course material, student course evaluation, and affective behavior. Results indicated no significant difference between treatment groups.

This study tested the hypothesis that students with a field-independent cognitive style would learn most about numeration systems if they had minimum guidance and maximum opportunity for discovery through the use of manipulative materials. Field-dependent students were expected to perform best with maximum guidance and a symbolic treatment. Data were gathered on 46 prospective elementary school teachers who had been randomly assigned to the two treatment groups. Multiple regression analysis revealed a significant disordinal interaction for one of two achievement measures. The interaction supported the hypothesis that field-independent students achieve most in a discovery treatment, and field-dependent students learn best in expository instruction.

Two questions formed the structure for examining the formal communication among researchers using the Journal of Consumer Studies and Home Economics (JCSHE) The first question pertained to the interrelationship between the literature published and cited in JCSHE. The second asked what impact the literature published in JCSHE had on authors publishing in other journals. By performing Bradford analysis using the 1,160 journal references cited by authors of 210 articles in the first seven volumes of JCSHE, 26 core journals were identified. JCSHE was ranked second because it was cited 54 times in 37 articles by 29 authors. Through citation analysis 17 citing articles published in 12 journals other than JCSHE were found. Seven of these 17 citing articles were published in other home economics journals.

Two basic questions formed the structure for examining the effectiveness of communication among researchers using the Home Economics Research Journal (HERJ). The first question pertained to the interrelationship between the literature published and cited in HERJ. The second question asked what impact the re search published in HERJ had on authors publishing in other journals. By per forming Bradford analyses using the 2,440 journal references cited by authors of 316 articles in the first 10 volumes of HERJ, core journals were identified. The core journals varied among the subject matter subsets and between individual subsets and the total set of journal references. HERJ ranked high in six of seven cores. Through citation analysis 133 articles citing 88 HERJ articles were found in 62 journals other than HERJ. Seven of the top 10 citing journals were also included in at least one of the cores identified by the Bradford analyses. To the extent that citations are an indication of the use made of research, implications are drawn regarding the effectiveness of HERJ within the written communication network.

Serum from 21 patients with lymphoblastic leukemia, five with myeloblastic leukemia and 30 age matched control subjects tested for thymic hormone activity in an assay that measures the induction of T cell surface antigen. This activity was subnormal in serum from 10 of 16 patients with untreated lymphoblastic leukemia (p less than 0.001) but was within the normal range when the leukemia was in remission. Low inductive activity was associated with an inhibitor of T cell induction which was less than 30,000 daltons in molecular size and interfered with induction by purified thymopoietin plus a high concentration of ubiquitin or by normal serum alone.

Serum thymic hormone activity was measured in 36 patients with myasthenia gravis and in 10 control subjects from each age decade. In all 25 patients under 50 years of age results were within, or close to, the normal range. Activity at levels considered normal for juveniles was detected in 10 of the 11 older patients whereas levels normally decline in older subjects. One week after thymectomy, 13 of 17 patients (76 per cent) had no demonstrable serum thymic hormone activity. However, 10 months or longer after thymectomy only five patients (30 per cent) lacked thymic hormone activity in the serum. There was a significant correlation between clinial improvement and sustained lowering of serum thymic hormone activity after thymectomy.

The 1980 National Center for Health Statistics life tables for the U. S. black and white populations reveal a difference in life expectancy of 7 years between black and white males and 6 years between black and white females. Using cause-substituted life tables, we show that a number of causes of death contribute to the difference. The largest contributors are cardiovascular disease for both sexes and homicide and cancer for males.

The relationship between locus of control and three dimensions of discovery learning was investigated in a series of studies. Mathematics students were randomly assigned to treatments that differed in level of guidance, inductive or deductive sequencing, or use of small groups. A significant aptitude-treatment interaction occurred between locus of control and small-group instruction on the topic of networks. The other studies did not produce significant interactions, although varying the level of guidance did produce a trend in the predicted direction. Using inductive or deductive sequences of instruction did not appear to interact with locus of control.

Complement dependent cytotoxicity to malignant melanoma tumor cells was demonstrated in incubations that included rheumatoid factor (RF) positive plasma and normal plasma. Cytotoxicity was not demonstrated to cells from a number of normal tissues. The phenomenon involved coating of tumor cells with immunoglobulins and complement fixation. The activity in RF positive plasma was present in high titer an may not be RF. The activity in normal plasma was present in low titer, was found in plasma from eight out of 11 healthy subjects and may be a naturally occurring antibody. This previously undescribed humoral cytotoxicity system may participate in tumor host interactions, especially after therapy, when the majority of patients become RF seropositive.

In this survey for rheumatoid factor (RF) seropositivity on patients with neoplasms, an 85% rate of positive screening tests was recorded under certain circumstances. This high rate of RF seropositivity occurred after irradiation and/or chemotherapy of breast and lung cancers. Treated patients with breast cancers who had no evidence of residual tumor had an 89% rate of positive RF tests. Conversely, the incidence of RF seropositivity was low among untreated patients with similar tumors and treated patients with glioblastomas or multiple myeloma. The administration of cytotoxic drugs (e.g., azathiprene) was not itself associated with RF production even in renal allograft recipients. The data indicate that RF production occurs frequently after therapy of certain tumors and suggest that in these circumstances RF may be an expression of tumor-host interaction.

Health policy in the United States has paid scant notice to physical activity until recently. This current policy focus on physical activity has revealed not only that there is less than adequate data about it but also that the single survey questions used for the purpose of measuring its prevalence should be interpreted carefully. A case in point is the example presented in this article, which gives estimates of physical activity prevalence levels for women of child-bearing ages from several National Center for Health Statistics (NCHS) surveys. The amount of physical activity reported, and thus the proportion of women at risk for various diseases due to limited activity, depends on how the question is asked and the type of responses offered as options. Various questions used in three different NCHS surveys produced prevalence estimates of limited physical activity levels ranging from 3.9 to 39.1%. These findings have important implications for survey assessments of physical activity at all policy levels.

Although HLA-B27 carries a high relative risk for development of ankylosing spondylitis (AS), most B27 positive individuals do not have spondylitis. One interpretation of this observation is that there may be 2 types of B27, 1 which carries the risk factor and 1 which does not. If this were the case, then with the help of markers closely linked to HLA-B, it might be possible to detect differences between the B27 haplotypes in AS patients and those in healthy probands. We studied 197 members of 18 families with known AS and 110 members of 19 families in which HLA-B27 was present without any known inflammatory spinal disease. HLA antigens A, B, and C and alleles of complement components C2, C4, and Factor B and glyoxalase-1 were determined in all cases. Detailed haplotypes were assigned and their associations with development of the disease were examined. We were unable to identify any distinct HLA-B27 haplotype associated with AS; 2 common haplotypes and several miscellaneous ones were found in both groups. Thinking that the development of AS might be influenced by the other, non-B27 haplotype, we analyzed this and found that there was no detectable influence. The data do not contradict the notion that B27 in whites is a single entity and is itself the susceptibility factor predisposing to the development of ankylosing spondylitis.

Serum T-cell-inducing activity was measured in sera from 25 young patients with systemic lupus erythematosus and 30 age-matched controls. Subnormal activity was recorded on 14 of the patients. The occurrence of low values correlated with the presence of disease activity (P < 0.05). In individual patients higher values were recorded when the disease was inactive than during periods of disease activity (P < 0.001). Subnormal serum thymic hormone activity appeared to be due to reduced serum content rather than the presence of an inhibitor.

Andersen's (1968) behavioral model was used to assess whether factors predictive of health services utilization are the same or different for elderly blacks and whites. We hypothesized that because the black elderly have fewer resources, lower psychological well-being, and are in worse health, situational and attitudinal factors suggested by the model have different effects for blacks and whites. Using three measures of utilization--physician contact, hospital contact, and nights hospitalized--our findings show some support for differential effects, particularly in the case of physician contact. Neither resource factors such as health insurance nor psychological well-being were predictive of utilization within the black population. We conclude with some suggestions for future research.

In this study ethnic and gender differences in occupational prestige of health care workers are used to measure the extent of inequality in the health care delivery systems of large SMSAs. Aggregate characteristics of these communities and of their health care delivery systems are used to explain variations in occupational prestige among health workers. The analysis is guided by Blau's macrostructural theory of intergroup relations. It employs 1980 U.S. Census information on the number of men, women, whites, blacks, and Hispanics in 19 health occupations in the 31 largest SMSAs. The results include a description of the size of the health care delivery systems and the proportions of women and minority workers in the systems, as well as the average occupational prestige of categories of respondents, their level of concentration among the occupations, and the relative presence of respondents in the occupations of physicians and registered nurses. Multivariate regression analysis is used to explore intergroup differences in occupational prestige. As deduced from Blau's theory, groups with greater relative occupational dispersion, greater political participation, advanced education, and higher sex ratios have greater relative occupational prestige in the health care delivery system.

Reinterpreting ethnicity's role in the prevailing behavioral model of health services usage reveals among older Americans a patient pattern of inequality favoring the Anglo-American population. Demand for hospital and physicians' care among minority elderly is far more constrained and sensitive to health needs than it is for their Anglo-American counterparts. The findings underscore the importance of examining ethnic differences in determinants of health behavior as well as in health service utilization. Such results also appear to strengthen the grounds for developing new programs aimed at eliminating inequalities of access to health care that older members of minorities now face.

Objectives: To evaluate the inter-observer reliability of modified Response Evaluation Criteria In Solid Tumours (mRECIST) of patients with hepatocellular carcinoma (HCC) undergoing neo-adjuvant treatments before liver transplant (LT). The agreement of tumor number, size, transplant criteria, and the radiological-pathological concordance were also assessed. Methods: A total of 180 radiological studies before/after neo-adjuvant therapies performed on 90 patients prior to LT were reviewed from three expert centers. Kappa-statistic and intraclass correlation (ICC) were evaluated on mRECIST and on tumoral features. Complete radiological response (CR) was compared with complete pathological response (CPR). Results: Before neo-adjuvant therapies, the agreement on tumor number, size, and transplant criteria ranged from moderate (defined as ICC of 0.41–0.60) to almost perfect (ICC of 0.81–0.99), being higher with magnetic resonance imaging (MRI) than CT (0.657–0.899 and 0.422–0.776, respectively). After neo-adjuvant therapies, the agreement decreased, as ICCs ranged between 0.518 and 0.663 with MRI and between 0.508 and 0.677 with CT. Concordant mRECIST pairs were 201 of 270 reviews (76.3%) with a kappa of 0.648 indicating substantial agreement. When the three observers completely agreed on CR, the positive predictive value for CPR was 51.6%. The negative predictive value was 94.2% with a kappa of 0.512 indicating fair agreement between radiology and pathology. Conclusions: mRECIST agreement was substantial among the three observers involved. The agreement on tumor number, size, and transplant criteria ranged from moderate to almost perfect, with the highest ICCs obtained with MRI before neo-adjuvant therapies. Finally, the predictive value of mRECIST in the diagnosis of CPR was only fair. Key Points: • The review of 180 radiological exams of patients with hepatocellular carcinoma before and after neo-adjuvant therapies showed that the concordance among three different raters on mRECIST diagnosis was substantial. • The inter-observer reliability on fulfilment of transplant criteria slightly decreased when evaluated through CT and after loco-regional therapies. • The radiological diagnosis of complete response after neo-adjuvant therapies was predictive of complete pathological response in only 51.6% of cases.

Background: Invasive mold infections in children with hematological malignancies are associated with high mortality rates. The use of combination antifungal therapy in cases with a severe clinical course is increasing, although information on the efficacy and safety of this approach is limited. Methods: We present a case series of 13 children affected by hemato-oncological disorders who received combination antifungal therapy for invasive mold infections at our center (Pediatric Hematology, San Gerardo Hospital, Monza, Italy) from 2011 to 2016, with the aim of describing their clinical characteristics, types of infections, treatment regimens, clinical outcomes, and treatment safety. Medical records were retrospectively reviewed in order to describe patients’ characteristics. Results: Combination antifungal therapy included liposomal amphotericin associated with caspofungin (5/13, 38.4%), voriconazole (5/13, 38.4%), or posaconazole (3/13, 23.1%). The 12-week treatment response rate was 69.2% (6/13 patients showed complete response, 3/13 partial response). The crude mortality was 30.7% (4/13): half was related to invasive mold infections (2/13, 15.38%) and half to disease progression (2/13, 15.38%). Overall, treatment was well tolerated, and we did not observe any permanent discontinuation of antifungals due to related side effects. Conclusions: In our experience, combination antifungal therapy seems to be a safe option in immunocompromised children with invasive mold infections. Well-designed studies are needed to confirm the safety of this approach and to better understand its efficacy in the pediatric setting. Keywords: antifungal therapy; mold; hematological malignancies

Catheter-related bacteremias carry high mortality rates in hematological patients. When a multidrug-resistant microorganism is involved, the catheter should ideally be removed; however, this approach is not always possible. Tigecycline lock therapy was used in two pediatric oncohematological patients with intravascular catheter-related infection due to KPC-producing Klebsiella pneumoniae . The catheter was salvaged in both cases, and the patients were later discharged. Our experience suggests the usefulness of this approach in treating this type of infection.