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With few curative treatments and a global yearly death rate of over 800,000, hepatocellular carcinoma (HCC) desperately needs new therapies. Although wild-type p53 gene therapy has been shown to be safe in HCC patients, it has not shown enough efficacy to merit approval. This work aims to show how p53 can be re-engineered through fusion to the pro-apoptotic BH3 protein Bcl-2 antagonist of cell death (Bad) to improve anti-HCC activity and potentially lead to a novel HCC therapeutic, p53-Bad*. p53-Bad* is a fusion of p53 and Bad, with two mutations, S112A and S136A. We determined mitochondrial localization of p53-Bad* in liver cancer cell lines with varying p53 mutation statuses via fluorescence microscopy. We defined the apoptotic activity of p53-Bad* in four liver cancer cell lines using flow cytometry. To determine the effects of p53-Bad* in vivo, we generated and analyzed transgenic zebrafish expressing hepatocyte-specific p53-Bad*. p53-Bad* localized to the mitochondria regardless of the p53 mutation status and demonstrated superior apoptotic activity over WT p53 in early, middle, and late apoptosis assays. Tumor burden in zebrafish HCC was reduced by p53-Bad* as measured by the liver-to-body mass ratio and histopathology. p53-Bad* induced significant apoptosis in zebrafish HCC as measured by TUNEL staining but did not induce apoptosis in non-HCC fish. p53-Bad* can induce apoptosis in a panel of liver cancer cell lines with varying p53 mutation statuses and induce apoptosis/reduce HCC tumor burden in vivo in zebrafish. p53-Bad* warrants further investigation as a potential new HCC therapeutic.

Background: This dataset relates to the biodiversity census carried out during the Belgica 121 (B121) expedition to the Western Antarctic Peninsula from February to March 2019. One of the aims of the campaign was to explore the surroundings of the Gerlache Strait and to carry out a detailed biodiversity census focusing on inter- and subtidal shallow-water areas using both classic descriptive marine ecology methods, as well as state-of-the art techniques (habitat mapping, genetics, trophic ecology). The biodiversity census was carried out onboard a nimble research vessel, RV Australis. This dataset will offer access to the raw data on biodiversity occurrences, obtained using a range of methods described in this data paper., New Information: New raw biodiversity data for a poorly-sampled region (Western Antarctic Peninsula) with a special focus on shallow ecosystems., (Bruno Danis, Henrik Christiansen, Charlène Guillaumot, Franz Maximilian Heindler, Quentin Jossart, Camille Moreau, Francesca Pasotti, Henri Robert, Ben Wallis, Thomas Saucède.)

Lipopolysaccharide (LPS) transport to the outer membrane (OM) is a crucial step in the biogenesis of microbial surface defenses. Although many features of the translocation mechanism have been elucidated, molecular details of LPS insertion via the LPS transport (Lpt) OM protein LptDE remain elusive. Here, we integrate native MS with hydrogen-deuterium exchange MS and molecular dynamics simulations to investigate the influence of substrate and peptide binding on the conformational dynamics of LptDE. Our data reveal that LPS induces opening of the LptD β-taco domain, coupled with conformational changes on β-strands adjacent to the putative lateral exit gate. Conversely, an antimicrobial peptide, thanatin, stabilizes the β-taco, thereby preventing LPS transport. Our results illustrate that LPS insertion into the OM relies on concerted opening movements of both the β-barrel and β-taco domains of LptD, and suggest a means for developing antimicrobial therapeutics targeting this essential process in Gram-negative ESKAPE pathogens.

Background: It is estimated that less than 25% of young people in need of treatment for mental illness receive specialized services, and even fewer receive a diagnosis by their doctor. These findings are troubling given that living with a mental illness can have a significant impact on a young person's life, the lives of his/her family members, the young person's community and society generally., Objective: The objective of this systematic review was to synthesize the best available qualitative evidence on the meanings young people assign to living with mental illness and their experiences in managing their health and lives., Inclusion Criteria: The current review considered both interpretive and critical research studies that drew on the experiences of young people with mental illness., Search Strategy: The search for published studies included the following databases: MEDLINE, CINAHL, Social Sciences Full Text, PsycINFO, Social Work Abstracts, Sociological Abstracts, Embase, Social Services Abstracts, Child Development and Adolescent Studies, Scopus, Web of Science and Academic Search Complete. The search for unpublished studies included conference proceedings and ProQuest Dissertations and Theses Database., Methodological Quality: Each paper was assessed independently by two reviewers for methodological quality. The Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to appraise the methodological quality of the articles., Data Extraction: Qualitative data were extracted from papers included in the review using the standardized data extraction tool from JBI-QARI., Data Synthesis: JBI-QARI was used to pool findings based on their similarity of meaning and developed into four synthesized findings., Results: Fifty-four research papers generated 304 study findings that were aggregated into nine categories. The nine categories were further aggregated into four synthesis statements: (1) A different way of being, (2) Getting through the difficult times, (3) Yearning for acceptance and (4) Room for improvement., Conclusion: Young people with mental illness experienced a range of feelings and thoughts that at times left them feeling uncomfortable in their body and world. Rejection by family and friends was a common fear. The changes experienced by young people required them to use a variety of strategies that were both negative and positive. The challenges young people faced in seeking and receiving care reinforce that there is a need for improvement in mental health services for youth living with mental illness.

Occupational health research has shown that certain worker and job characteristics are risk factors for workplace injuries. Workers who engage in physically demanding jobs, especially those jobs that involve repetitive motion, are at greater risk for work-related musculoskeletal disorders (WMSD). These risks are particularly prevalent in the health care sector. It is often reported that nurses are at higher risk of workplace musculoskeletal injury than other health care workers due to frequent lifting and transfer of patients and the prevalence of workplace violence. However, many analyses of the physical requirements of jobs do not consider the modifying effect of time spent on a physical task and the risk of WMSD. This study compared the risks of WMSD among workers in health care facilities based on the type of physical tasks and amount of time workers spent on such tasks. Workers who worked longer on a physical task reported more WMSD than those who spent less time on the same physical task. The risk of WMSD was twice as high (odds ratio [OR] = 2.3) among workers who sit less than 2 hours each day compared with those who sit longer. This study found that physical tasks associated with health care jobs and the amount of time spent on these tasks constitutes serious risk factors for WMSD., (© 2016 The Author(s).)

We present the mechanisms of formation of mesoporous scandia-stabilized zirconia using a surfactant-assisted process and the effects of solvent and thermal treatments on the resulting particle size of the powders. We determined that cleaning the powders with water resulted in better formation of a mesoporous structure because higher amounts of surfactant were preserved on the powders after washing. Nonetheless, this resulted in agglomerate sizes that were larger. The water-washed powders had particle sizes of >5 μm in the as-synthesized state. Calcination at 450 and 600 °C reduced the particle size to ∼1-2 and 0.5 μm, respectively. Cleaning with ethanol resulted in a mesoporous morphology that was less well-defined compared to the water-washed powders, but the agglomerate size was smaller and had an average size of ∼250 nm that did not vary with calcination temperature. Our analysis showed that surfactant-assisted formation of mesoporous structures can be a compromise between achieving a stable mesoporous architecture and material purity. We contend that removal of the surfactant in many mesoporous materials presented in the literature is not completely achieved, and the presence of these organics has to be considered during subsequent processing of the powders and/or for their use in industrial applications. The issue of material purity in mesoporous materials is one that has not been fully explored. In addition, knowledge of the particle (agglomerate) size is essential for powder handling during a variety of manufacturing techniques. Thus, the use of dynamic light scattering or any other technique that can elucidate particle size is essential if a full characterization of the powders is needed for achieving postprocessing effectiveness.

Background: Supraglottic airways (SGAs) have an established role in airway management of difficult airways in both adults and children. However, there are limited data regarding the use of SGAs for primary airway management in children. The aim of this study is to assess the success rates and adverse events related to the use of SGAs for primary airway management during anaesthesia in children with difficult airways., Methods: A retrospective analysis of SGA use for primary airway management in the difficult airway population in a single centre over a 4-yr period was performed. Difficult airway was defined as either a history of difficult direct laryngoscopy (a documented Cormack and Lehane Grade 3 or greater and the need for an alternate device to direct laryngoscopy for successful tracheal intubation), a history of difficult mask ventilation, or both. The difficult airway condition, patient characteristic data, type and length of procedure, type and size of SGA placed, number of attempts for successful device placement, success/failure associated with the device during anaesthetic maintenance, and complications were recorded., Results: A total of 77,272 children received general anaesthesia in a free-standing paediatric institution. Four hundred and fifty-nine patients were reported to have a difficult airway. Of those, 109 received general anaesthesia and an SGA for primary management, meeting the inclusion criteria for this study during a 4-yr period. An SGA was successfully used in 96% of these patients. In four patients, an alternative airway was needed., Conclusions: SGAs can be effectively utilized for airway maintenance in the paediatric difficult airway population.

Aim: To systematically review the literature investigating the incidence of fatal and or nonfatal low-speed vehicle run-over (LSVRO) incidents in children aged 0-15 years., Methods: The following databases were searched using specific search terms, from their date of conception up to June 2011: Cochrane Library, Medline, CINAHL, Embase, AMI, Sociological Abstracts, ERIC, PsycArticles, PsycInfo, Urban Studies and Planning; Australian Criminology Database; Dissertations and Thesis; Academic Research Library; Social Services Abstracts; Family and Society; Scopus; and Web of Science. A total of 128 articles were identified in the databases (33 found by hand searching). The title and abstract of these were read, and 102 were removed because they were not primary research articles relating to LSVRO-type injuries. Twenty-six articles were assessed against the inclusion (reporting population level incidence rates) and exclusion criteria, 19 of which were excluded, leaving a total of five articles for inclusion in the review., Findings: Five studies were identified that met the inclusion criteria. The incidence rate in nonfatal LSVRO events varied in the range of 7.09 to 14.79 per 100,000 and from 0.63 to 3.2 per 100,000 in fatal events., Discussion: Using International Classification of Diseases codes for classifying fatal or nonfatal LSVRO incidents is problematic as there is no specific code for LSVRO. The current body of research is void of a comprehensive secular population data analysis. Only with an improved spectrum of incidence rates will appropriate evaluation of this problem be possible, and this will inform nursing prevention interventions. The effect of LSVRO incidents is clearly understudied. More research is required to address incidence rates in relation to culture, environment, risk factors, car design, and injury characteristics., Conclusions: The lack of nursing research or policy around this area of injury, most often to children, indicates a field of inquiry and policy development that needs attention., (© 2013 Sigma Theta Tau International.)

Background: Increasing attention has been paid to the executive dysfunction hypothesis argued to underpin stereotyped behaviour in autism. The aim of this study is to investigate one component of this model, that stereotyped behaviours are related to impaired generativity and compromised behavioural inhibition, by examining whether episodes of these behaviours terminate naturally without external intervention., Methods: Using a naturalistic observational methodology the stereotyped behaviours of six participants with autism were recorded in real time over periods ranging from 3.59 to 9.20 h. Data were also recorded for teaching staff interactions with participants and environmental settings (one-to-one, group and freetime)., Results: In comparison with one-to-one settings stereotyped behaviours were more frequent when participants were in freetime settings with the exception of one participant. For the termination of stereotyped behaviours these behaviours stopped with no ongoing physical or verbal adult contact being evident for a median of 73.25% of the time. Additionally, for a median of 89.40% of the time stereotyped behaviour stopped without the initiation of adult contact., Discussion: The termination of bouts of stereotyped behaviour was frequently not associated with any adult contact and thus this form of external intervention. This finding warrants explanation by extending the hypothesis that compromised impaired generativity and behavioural inhibition offers a complete explanation of stereotyped behaviours., (© 2011 The Authors. Journal of Intellectual Disability Research © 2011 Blackwell Publishing Ltd.)

Introduction: Child pedestrian fatalities associated with motor vehicles reversing or moving at low speed are difficult to identify in surveillance data. This study aims to determine the incidence of fatalities associated with what is thought to be an under-reported and preventable fatal injury mechanism., Methods: The term low speed vehicle run-over (LSVRO) incidents encompasses pedestrian fatalities where vehicles run-over a child at low speed. Data were obtained for children aged 0-15 years in the Australian state of Queensland (January 2004-December 2008)., Results: There were 15 deaths (12 boys and 3 girls) during 2004-2008 (rate:1.67/100,000). Over half were aged 0 and 1 years of age (n=8; 53.3%, rate: 14.67/100,000), and one quarter were 2 and 3 years of age (n=4, 27%, rate 7.46/100,000). There were no LSVRO deaths recorded among 10-15 year olds. Most (13/15) of the incidents occurred on private property, and only two occurred on a street/road. Almost half of the fatalities were caused by a four wheel drive (4WD) vehicle; large family sedans were involved in four fatalities, and heavy vehicles were involved in three deaths. In 11 of the fatalities, parents were the drivers of the vehicle involved (mothers 5; fathers 6). In nine, the vehicle involved was reversing before it came in contact with the child. Fatalities occurred in each of the Socio-Economic Indexes For Areas (SEIFA) levels., Conclusion: The unique data provided by the child death review team has signalled that LSVRO fatalities are a significant problem in Queensland. The Commission for Children and Young People and Child Guardian (CCYPCG) continue to collect data, which, when combined, will provide outcomes that will act as an impetus for promoting intervention and child advocacy.

This study describes the first aid used and clinical outcomes of all patients who presented to the Royal Children's Hospital, Brisbane, Australia in 2005 with an acute burn injury. A retrospective audit was performed with the charts of 459 patients and information concerning burn injury, first-aid treatment, and clinical outcomes was collected. First aid was used on 86.1% of patients, with 8.7% receiving no first aid and unknown treatment in 5.2% of cases. A majority of patients had cold water as first aid (80.2%), however, only 12.1% applied the cold water for the recommended 20 minutes or longer. Recommended first aid (cold water for >or=20 minutes) was associated with significantly reduced reepithelialization time for children with contact injuries (P=.011). Superficial depth burns were significantly more likely to be associated with the use of recommended first aid (P=.03). Suboptimal treatment was more common for children younger than 3.5 years (P<.001) and for children with friction burns. This report is one of the few publications to relate first-aid treatment to clinical outcomes. Some positive clinical outcomes were associated with recommended first-aid use; however, wound outcomes were more strongly associated with burn depth and mechanism of injury. There is also a need for more public awareness of recommended first-aid treatment.

Aim: The aim of this study was to report on the severity and incidence of children injured by treadmills and to promote the implementation of safety standards., Method: This retrospective review of children with treadmill friction injuries was conducted in a single tertiary-level burns centre in Australia between January 1997 and June 2007., Results: The study revealed 37 children who sustained paediatric treadmill friction injuries. This was a presentation of 1% of all burns. Thirty-three (90%) of the injuries occurred in the last 3.5 years (January 2004 to June 2007). The modal age was 3.2 years. Thirty-three (90%) injuries were either full thickness or deep partial friction burns. Eleven (30%) required split thickness skin grafts. Of those who became entrapped, 100% required skin grafting., Conclusion: This study found that paediatric treadmill friction injuries are severe and increasing in incidence. Australian standards should be developed, implemented and mandated to reduce this preventable and severe injury.

A plume of water vapour escapes from fissures crossing the south polar region of the Saturnian moon Enceladus. Tidal deformation of a thin surface crust above an internal ocean could result in tensile and compressive stresses that would affect the width of the fissures; therefore, the quantity of water vapour released at different locations in Enceladus' eccentric orbit is a crucial measurement of tidal control of venting. Here we report observations of an occultation of a star by the plume on 24 October 2007 that revealed four high-density gas jets superimposed on the background plume. The gas jet positions coincide with those of dust jets reported elsewhere inside the plume. The maximum water column density in the plume is about twice the density reported earlier. The density ratio does not agree with predictions-we should have seen less water than was observed in 2005. The ratio of the jets' bulk vertical velocities to their thermal velocities is 1.5 +/- 0.2, which supports the hypothesis that the source of the plume is liquid water, with gas accelerated to supersonic velocity in nozzle-like channels.

The glutathione S-transferase P1 (GSTP1) gene promoter is methylated in tumour cells in more than 90% of prostate carcinomas. Recently, GSTP1 promoter methylation was identified in tumour-associated stromal cells in addition to the tumour epithelium. To define the extent and location of stromal methylation, epigenetic mapping using pyrosequencing quantification of GSTP1 promoter methylation and an anatomical three-dimensional reconstruction of an entire human prostate specimen with cancer were performed. Normal epithelium and stroma, tumour epithelium, and tumour-associated stromal cells were laser capture-microdissected from multiple locations throughout the gland. As expected, the GSTP1 promoter in both normal epithelium and normal stromal cells distant from the tumour was not methylated and the tumour epithelium showed consistently high levels of promoter methylation throughout. However, tumour-associated stromal cells were found to be methylated only in a localized and distinct anatomical sub-field of the tumour, revealing the presence of an epigenetically unique microenvironment within the cancer. Morphologically, the sub-field consisted of typical, non-reactive stroma, representing a genomic alteration in cells that appeared otherwise histologically normal. Similar epigenetic anatomical mapping of a control prostate gland without cancer showed low background methylation levels in all cell types throughout the specimen. These data suggest that stromal cell methylation can occur in a distinct sub-region of prostate cancer and may have implications for understanding tumour biology and clinical intervention.

Stratospheric temperatures on Saturn imply a strong decay of the equatorial winds with altitude. If the decrease in winds reported from recent Hubble Space Telescope images is not a temporal change, then the features tracked must have been at least 130 kilometers higher than in earlier studies. Saturn's south polar stratosphere is warmer than predicted from simple radiative models. The C/H ratio on Saturn is seven times solar, twice Jupiter's. Saturn's ring temperatures have radial variations down to the smallest scale resolved (100 kilometers). Diurnal surface temperature variations on Phoebe suggest a more porous regolith than on the jovian satellites.

Objective: The purpose of this study was to determine the frequency of use of play equipment in public schools and parks in Brisbane, Australia, and to estimate an annual rate of injury per use of equipment, overall and for particular types of equipment., Methods: Injury data on all children injured from playground equipment and seeking medical attention at the emergency department of either of the two children's hospitals in the City of Brisbane were obtained for the years 1996 and 1997. Children were observed at play on five different pieces of play equipment in a random sample of 16 parks and 16 schools in the City of Brisbane. Children injured in the 16 parks and schools were counted, and rates of injury and use were calculated., Results: The ranked order for equipment use in the 16 schools was climbing equipment (3762 uses), horizontal ladders (2309 uses), and slides (856 uses). Each horizontal ladder was used 2.6 times more often than each piece of climbing equipment. Each horizontal ladder was used 7.8 times more than each piece of climbing equipment in the sample of public parks. Slides were used 4.6 times more than climbing equipment in parks and 1.2 times more in public schools. The annual injury rate for the 16 schools and 16 parks under observation was 0.59/100 000 and 0.26/100 000 uses of equipment, respectively., Conclusions: This study shows that annual number of injuries per standardized number of uses could be used to determine the relative risk of particular pieces of playground equipment. The low overall rate of injuries/100 000 uses of equipment in this study suggests that the benefit of further reduction of injury in this community may be marginal and outweigh the economic costs in addition to reducing challenging play opportunities.

This paper arose from a research study and its follow-up in four schools of nursing and midwifery. The study was concerned with evaluating the extent to which a philosophy of health had been integrated into the educational curricula of nurses, midwives and health visitors. The purpose of the follow-up was to disseminate and implement the study findings in the four centres. The findings showed that the interpretation and implementation of a philosophy of health in nursing had been variable. Health was operationalized as both health education and health promotion ranging from individualized information giving and disease prevention. Action research was chosen as the appropriate methodology for the follow-up because of its emphasis on participation and partnership. As the follow-up study progressed a number of issues emerged which were indicative of the changes taking place in nurse education as its institutional base shifted into higher education. Other issues were associated with the gap between the rhetoric and reality of action research and the expectations and needs of the key partners. The authors conclude that the follow-up study presented both challenges and opportunities to nurse educators in their endeavour to undertaken research and implement educational change.

Headache often compounds chronic neck pain following whiplash injury. To better understand post-traumatic headache, the SCL-90-R symptom checklist was used to determine the psychological profiles of patients with whiplash-associated headache and of patients with whiplash-associated neck pain without headache. The psychological profiles of these patients were compared with previously published SCL-90-R profiles of patients with post-traumatic and nontraumatic headache, and of the normal population. Patients with whiplash-associated headache were not significantly different from those with other forms of post-traumatic headache or with whiplash-associated neck pain without headache. However, when patients with whiplash-associated headache and patients with nontraumatic headache were compared to normal data, significant differences emerged. Patients with nontraumatic headache exhibited higher scores on all subscales, whereas patients with whiplash-associated headache differed from the normal sample only on somatization, obsessive-compulsive, depression and hostility subscales, and the global severity index. These differences imply that patients with whiplash-associated headache suffer psychological distress secondary to chronic pain and not from tension headache and generalized psychological distress.

It is well recognised that patients with chronic pain, in particular, chronic whiplash-associated neck pain, exhibit psychological distress. However, debate continues as to whether the psychological distress precedes and causes the chronic pain or, conversely, the psychological distress is a consequence of chronic pain. Using cervical zygapophysial joint pain as a model for chronic pain, the effect of a definitive neurosurgical treatment on the associated psychological distress was studied. Seventeen patients with a single painful cervical zygapophysial joint participated in a randomised, double-blind, placebo-controlled trial of percutaneous radiofrequency neurotomy. Their pain and psychological status were evaluated pre-operatively and 3 months post-operatively by medical interview and examination, a visual analogue pain scale, the McGill Pain Questionnaire, and the SCL-90-R psychological questionnaire. All patients who obtained complete pain relief exhibited resolution of their pre-operative psychological distress. In contrast, all but one of the patients whose pain remained unrelieved continued to suffer psychological distress. Because psychological distress resolved following a neurosurgical treatment which completely relieved pain, without psychological co-therapy, it is concluded that the psychological distress exhibited by these patients was a consequence of the chronic somatic pain.

Background: Chronic pain in the cervical zygapohyseal joints is a common problem after whiplash injury, but treatment is difficult. Percutaneous radiofrequency neurotomy can relieve the pain by denaturing the nerves innervating the painful joint, but the efficacy of this treatment has not been established., Methods: In a randomized, double-blind trial, we compared percutaneous radio-frequency neurotomy in which multiple lesions were made and the temperature of the electrode making the lesions was raised to 80 degrees C with a control treatment using an identical procedure except that the radio-frequency current was not turned on. We studied 24 patients (9 men and 15 women; mean age, 43 years) who had pain in one or more cervical zygapophyseal joints after an automobile accident (median duration of pain, 34 months). The source of their pain had been identified with the use of double-blind, placebo-controlled local anesthesia. Twelve patients received each treatment. The patients were followed by telephone interviews and clinic visits until they reported that their pain had returned to 50 percent of the preoperative level., Results: The median time that elapsed before the pain returned to at least 50 percent of the preoperative level was 263 days in the active-treatment group and 8 days in the control group (P=0.04). At 27 weeks, seven patients in the active-treatment group and one patient in the control group were free of pain. Five patients in the active-treatment group had numbness in the territory of the treated nerves, but none considered it troubling., Conclusions: In patients with chronic cervical zygapophyseal-joint pain confirmed with double-blind, placebo-controlled local anesthesia, percutaneous radio-frequency neurotomy with multiple lesions of target nerves can provide lasting relief.

Background: Nutrition is recognised as an integral aspect of Australian medical education. Since medical students will learn more of a subject they consider important, there is a need for their perceptions of nutrition to be investigated., Aims: To identify final year medical students' perceptions about nutrition and its inclusion in their medical course, and to compare priority nutrition topics identified with those previously identified by Faculty and General Practitioners (GPs) who teach in the undergraduate curriculum., Methods: A cross-sectional survey of all final year medical students attending the University of Newcastle was conducted, using a distributed questionnaire, comprising three sections: demographics, perceptions about nutrition and its inclusion in the medical course, and a listing of 38 major nutrition topics. Main outcome measures were: interest in nutrition, and whether it should be included in the undergraduate medical curriculum; rated importance of listed nutrition topics; comparison between students and Faculty and GPs. Frequency distributions and Chi square analyses were used to compare group responses., Results: Seventy-one per cent of the students were interested in nutrition and 94% believed it should be included in the medical curriculum. More than 60% of the students nominated 21 of the 38 topics, essential or important. Thirteen of these topics were also highly rated by Faculty and GPs, although Faculty and GPs rated more topics as essential or important., Conclusions: Newcastle medical students are interested in nutrition and believe it should be included in their medical curriculum. This may be due to their clinical exposure and the educational milieu of the University of Newcastle Medical School. Exposure to nutrition in their undergraduate education appears to be an important determinant for priority designated nutrition topics.

The psychological symptom checklist, the SCL-90-R (Derogatis 1983), has been used to assess patients with a number of chronic pain syndromes. For whiplash injury, a characteristic profile has been found (Wallis et al. 1995). However, there is still a belief that patients with neck pain following whiplash injury may be malingering, and therefore the utility of the SCL-90-R as a screen for possible malingering is assessed here. Forty pain-free university students were asked to simulate chronic pain 6 months after a motor vehicle accident in order to ensure compensation. The SCL-90-R, McGill Pain Questionnaire and a visual analogue pain scale were used. Students' scores were compared with those of a group of 132 whiplash patients (Wallis et al. 1995). Differences between the two groups were striking; the students scored significantly higher than patients on all subscales of the SCL-90-R and on the visual analogue pain scale (Mann-Whitney P-values all less than 0.001). However, pain scores for both groups on the McGill Pain Questionnaire were similar. The conclusion was that it is very difficult for an ingenuine individual to fake a psychological profile typical of a whiplash patient.

Study Design: The authors developed a diagnostic double-blindfolded survey using placebo-controlled local anesthetic blocks., Objective: To determine the prevalence of cervical zygapophysial joint pain among patients with chronic neck pain (more than 3 months' duration) after whiplash injury., Summary of Background Data: The prevalence of cervical zygapophysial joint pain after whiplash has been studied by means of comparative local anesthetic blocks. The concern is that such blocks may be compromised by placebo responses and that prevalence estimates based on such blocks may exaggerate the importance of this condition., Methods: Sixty-eight consecutive patients referred for chronic neck pain after whiplash were studied. Patients with dominant headache were first screened with the use of comparative blocks of the C2-C3 zygapophysial joint. Patients who had positive responses concluded investigations. Those who did not experience pain relief together with the patients with dominant neck pain proceeded to undergo placebo-controlled local anesthetic blocks. Two different local anesthetics and a placebo injection of normal saline were administered in random order and under double-blindfolded conditions. A positive diagnosis was made if the patient's pain was completely and reproducibly relieved by each local anesthetic but not by the placebo injection., Results: Among patients with dominant headache, comparative blocks revealed that the prevalence of C2-C3 zygapophysial joint pain was 50%. Among those without C2-C3 zygapophysial joint pain, placebo-controlled blocks revealed the prevalence of lower cervical zygapophysial joint pain to be 49%. Overall, the prevalence of cervical zygapophysial joint pain (C2-C3 or below) was 60% (95% confidence interval, 46%, 73%)., Conclusion: Cervical zygapophysial joint pain is common among patients with chronic neck pain after whiplash. This nosologic entity has survived challenge with placebo-controlled, diagnostic investigations and has proven to be of major clinical importance.

Objective: To identify nutrition topics considered important for inclusion in Newcastle undergraduate medical education, and compare them to those from a traditional medical school., Design: A survey, using a mailed questionnaire, listing 38 major nutrition topics. Respondents were instructed to rank topics as essential, important, desirable, does not belong or don't know. Responses were identified by participant group only., Participants: All members of the University of Newcastle medical faculty, general practitioners (GPs) available for final year teaching and dietitians working in the region of the medical school., Main Outcome Measures: Rated importance of listed nutrition topics; comparison between participant groups and previous survey., Results: More than 60% of the Newcastle respondents overall nominated 30 of the 38 topics essential or important. For 31 of the 38 topics, a higher percentage of respondents in the Newcastle survey ranked the topic as essential or important. Newcastle medical faculty considered nutrition education significantly more essential (p=0.03) than their peers from a traditional medical faculty., Conclusions: Both Newcastle Medical Faculty and GPs have a strong commitment to nutrition in medical education. Differences between the level of interest in Nutrition education in problem based and traditional courses are postulated to be due to beliefs regarding the importance of nutrition in the practice of medicine, the structure of the course and the extent of integration within the curriculum.

Study Design: A survey of pain intensity and psychological symptoms in patients with chronic neck pain after whiplash injury., Objectives: To describe the pain and psychological profiles of patients with chronic whiplash., Summary of Background Data: Reports in the literature mention a constellation of symptoms associated with chronic whiplash injury but no systematic survey using objective patient report measures has been reported., Methods: One hundred forty consecutive referred patients with chronic neck pain after a motor vehicle accident were studied using the SCL-90-R psychological profile and the McGill Pain Questionnaire., Results: Psychological profiles and pain intensity ratings, similar to profiles obtained from patients suffering from rheumatoid arthritis and low back pain of organic origin, were obtained., Conclusions: The SCL-90-R is a convenient instrument to administer to patients with whiplash. It yielded a characteristic profile of pain and appears to be more expedient than other psychometric tests for these patients.

Study Design: A survey of the prevalence of cervical zygapophysial joint pain was conducted., Objectives: To determine the prevalence of cervical zygapophysial joint pain in patients with chronic neck pain after whiplash., Summary of Background Data: In a significant proportion of patients with whiplash, chronic, refractory neck pain develops. Provisional data suggest many of these patients have zygapophysial joint pain, but the diagnosis has been established by single, uncontrolled diagnostic blocks., Methods: Fifty consecutive, referred patients with chronic neck pain after whiplash injury were studied using double-blind, controlled, diagnostic blocks of the cervical zygapophysial joints. On separate occasions, the joint was blocked with either lignocaine or bupivacaine in random order., Results: A positive diagnosis was made only if both blocks relieved the patient's pain and bupivacaine provided longer relief. Painful joints were identified in 54% of the patients (95% confidence interval, 40% to 68%)., Conclusion: In this population, cervical zygapophysial joint pain was the most common source of chronic neck pain after whiplash.

A consecutive series of 100 patients was studied to determine the prevalence of third occipital nerve headache in patients with chronic neck pain (> three months in duration) after whiplash. Seventy one patients complained of headache associated with their neck pain. Headache was the dominant complaint of 40 patients, but was only a secondary problem for the other 31. Each patient with headache underwent double blind, controlled diagnostic blocks of the third occipital nerve. On two separate occasions the nerve was blocked with either lignocaine or bupivacaine, in random order. The diagnosis of third occipital nerve headache was made only if both blocks completely relieved the patient's upper neck pain and headache and the relief lasted longer with bupivacaine. The prevalence of third occipital nerve headache among all 100 whiplash patients was 27% (95% confidence interval (95% CI) 18-36%) and among those with dominant headache the prevalence was as high as 53% (95% CI 37-68%). There were no distinguishing features on history or examination that enabled a definitive diagnosis to be made before the nerve blocks. Those patients with a positive diagnosis, however, were significantly more likely to be tender over the C2-3 zygapophysial joint (p = 0.01). Third occipital nerve headache is a common condition in patients with chronic neck pain and headache after whiplash. Third occipital nerve blocks are essential to make this diagnosis.

Background: Chronic pain in the cervical zygapophyseal joints is a common problem after a whiplash injury. Treatment with intraarticular injections of corticosteroid preparations has been advocated, but the value of this approach has not been established. We compared the efficacy of a depot injection of a corticosteroid preparation with the efficacy of an injection of a local anesthetic agent in patients with painful cervical zygapophyseal joints., Methods: Sixteen men and 25 women with pain in one or more cervical zygapophyseal joints after automobile accidents (mean age, 43 years; median duration of pain, 39 months) were randomly assigned to receive an intraarticular injection of either bupivacaine (0.5 percent) or betamethasone (5.7 mg) under double-blind conditions. The patients were followed by means of regular telephone contact and clinic visits until they reported a return to a level of pain equivalent to 50 percent of the preinjection level. The time from treatment to a 50 percent return of pain was compared in the two groups with the use of a survival analysis., Results: Less than half the patients reported relief of pain for more than one week, and less than one in five patients reported relief for more than one month, irrespective of the treatment received. The median time to a return of 50 percent of the preinjection level of pain was 3 days in the 21 patients in the corticosteroid group and 3.5 days in the 20 patients in the local-anesthetic group (P = 0.42)., Conclusions: Intraarticular injection of betamethasone is not effective therapy for pain in the cervical zygapophyseal joints after a whiplash injury.

Objective: To determine the false-positive rate of anesthetic blocks of the medial branches of the cervical dorsal rami in the diagnosis of cervical zygapophysial joint pain., Design: Comparison between single diagnostic blocks, and a criterion standard of double-blind, controlled, differential anesthetic blocks., Setting: Tertiary referral center., Patients: The first 55 consecutive patients with neck pain for > 3 months after and attributable to a motor vehicle accident, and who had completed a second diagnostic block after an initial positive response. A total of 60 joints was studied, with five patients providing two joints each. The mean age was 41 years; 61% were female., Methods: Each patient had been investigated with radiologically controlled blocks of the medial branches of the cervical dorsal rami to anesthetize the target cervical zygapophysial joint. The initial block was performed using either 0.5% bupivacaine or 2% lignocaine, randomly selected. The duration of pain relief was assessed in a double-blind fashion. The procedure was repeated with the complementary anesthetic. Only patients experiencing a longer period of pain relief from bupivacaine were considered to have true-positive responses., Results: The second block failed to relieve pain in two of the tested joints. In a further 14 joints, the control blocks relieved pain, but the patient failed to correctly discriminate the longer acting anesthetic. The remaining 44 joints met the criteria for true-positive responses. The false-positive rate of single blocks was 16 of 60 or 27% (95% confidence interval 15%, 38%)., Conclusions: Uncontrolled diagnostic blocks are compromised by a significant false-positive rate that seriously detracts from the specificity of the test.

Analysis of the preliminary results from the Voyager mission to the Neptune system has provided the scientific community with several methods by which the temperature of Neptune's satellite Triton may be determined. If the 37.5 K surface temperature reported by several Voyager investigations is correct, then the photometry reported by the imaging experiment on Voyager requires that Triton's surface have a remarkably low emissivity. Such a low emissivity is not required in order to explain the photometry from the photopolarimeter experiment on Voyager. A low emissivity would be inconsistent with Triton having a rough surface at the approximately 100-microm scale as might be expected given the active renewal processes which appear to dominate Triton's surface.

A study was carried out to investigate the change in attitudes towards physically disabled people of a group of fifty-eight medical students during the first 3 years of their course. The students attended a newly established medical school which has developed a curriculum without the traditional division into preclinical and clinical years and where contact with patients occurs from the first year. Results demonstrated that, as expected, at the start of the course the attitudes of females towards disabled people were more positive than those of males. Also, a significant change in attitudes was found after 3 years, both males and females demonstrating more positive attitudes toward physical disability. The differences between males and females were maintained. The relationship between these students' attitudes and their behaviour was discussed and proposals for further research to investigate this are outlined.

The Voyager photopolarimeter successfully accomplished its objectives for the Neptune encounter, performing measurements on the planet, several of its satellites, and its ring system. A photometric map of Neptune at 0.26 micrometer (microm) shows the planet to be bland, with no obvious contrast features. No polar haze was observed. At 0.75 microm, contrast features are observed, with the Great Dark Spot appearing as a low-albedo region and the bright companion as being substantially brighter than its surroundings, implying it to be at a higher altitude than the Great Dark Spot. Triton's linear phase coefficients of 0.011 magnitudes per degree at 0.26 microm and 0.013 magnitudes per degree at 0.75 microm are consistent with a solid-surface object possessing high reflectivity. Preliminary geometric albedos for Triton, Nereid, and 1989N2 were obtained at 0.26 and 0.75 microm. Triton's rotational phase curve shows evidence of two major compositional units on its surface. A single stellar occultation of the Neptune ring system elucidated an internal structure in 1989N1R, in the approximately 50-kilometer region of modest optical depth. 1989N2R may have been detected. The deficiency of material in the Neptune ring system, when compared to Uranus', may imply the lack of a "recent" moon-shattering event.

The Voyager 2 photopolarimeter successfully completed the Uranus encounter, acquiring new data on the planet's atmosphere, its principal satellites, and its ring system. Spatially resolved photometry of the atmosphere at 0.27 micrometer shows no enhancement in absorption toward the pole, unlike the case for Jupiter and Saturn. Stellar occultation measurements indicate the temperature at the 1-millibar level over the north pole is near 90 kelvins. The geometric albedos of the five large satellites of Uranus were measured at 0.27 and 0.75 micrometer and indicate the presence of low albedo, spetrally flat absorbing material. Titania seems to have a fluffy surface, as indicated by its phase curve. The nine ground-based rings were detected, and their internal structure, optical depths, and positions were determined. The sharp edges of the in ring made it possible to measure its edge thickness (less than 150 meters) and particle sizes (less than 30 meters); little or no dust was detcted. New narrow rings and partial rings (arcs) were measured, and the narrow component of the eta ring was found to be discontinuous.

Neutral (Emmons modification) Sabouraud medium, Dermatophyte Test Medium and Littman oxgall agar, with substitutions in type of antibacterial antibiotic, were quantitatively evaluated by colony counts for ability to support growth when suspensions of trypsintreated guinea pig skin scales, infected with Trichophyton mentagrophytes, were used as inocula. Both liquid and powder form of gentamicin sulfate were used separately in place of other routinely used antibacterial antibiotics. Also evaluated were three isolation temperatures. No differences in ability to support growth were noted among media. No difference was noted between the two forms of gentamicin. No data were available on the antibacterial activities of the antibiotics because no bacterial growth was produced on any of the media. Room temperature (24 degrees-26 degrees C), 30 degrees C and 37 degrees C were found to support growth similarly as primary isolation temperatures for this fungus.

A card game concerning the assessment and management of patients involved in medical emergencies was constructed for use by medical students who were beginning Year 3 of a 5-year curriculum. Particular emphasis was place on the identification by the student of priorities for action and the justification for decisions made on the basis of underlying mechanisms. Our aim was to help the student sharpen his problem-solving skills in situations where decisions may have to be made and interventions undertaken before information gathering is complete. The game is simple in construct and may be played by individuals or groups. It has a major advantage over other forms of problem presentation in that the student can select and document his own decision-making pathway with minimal cueing and he may compare his pathway with that of the experts at the end of the game. Students and tutors found this approach enjoyable and realistic and considered the game a useful tool in our problem solving curriculum.