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Rakesh K. Sharma, Fabio F. Pasqualotto, Anthony J. Thomas Jr., David Nelson, and Ashok Agarwal, Cleveland, OH (Presented by Dr. Sharma). INTRODUCTION AND OBJECTIVES: Levels of reactive oxygen species (ROS) and the total antioxidant capacity (TAC) in the seminal ejaculate are indicators of oxidative stress. A new composite ROS-TAC score may provide important clinical information not available from individual ROS and TAC results. In this study we determined the clinical usefulness of ROS-TAC index in infertile patients with different diagnoses. METHODS: Semen specimens from 199 men attending our infertility clinic were examined according to the WHO criteria. Patients were classified into 5 groups based on their clinical diagnosis: group 1 = varicocele (n = 71), group II = varicocele with prostatitis (n = 10), group III = prostatitis (n = 41), group IV = vasectomy reversal (n = 41), and group V = idiopathic infertility (n = 36). ROS-TAC index was calculated by creating a ROS-TAC scale. We compared ROS and TAC alone to a ROS-TAC composite index. This index was created using principal component analysis to provide a standardized score using donors as a reference point. The area under curve calculated from the receiver operating characteristics (ROC) was determined for all 5 diagnoses. RESULTS: The lowest ROS-TAC index observed in group II was significantly different than all other diagnoses (p

National surveillance for Reye syndrome conducted during five years, including the period 1973-1974 and December 1976 through November 1980, has resulted in the reporting of more than 2,000 cases of Reye syndrome. The highest reported incidence of Reye syndrome occurred during years of primary influenza B and A (H1N1) activity; the reported incidence during one period of influenza A (H3N2) activity was somewhat lower. Regional outbreaks of Reye syndrome have been associated with influenza A (H1N1) and B but not with influenza A (H3N2). Cases of Reye syndrome in whites tend to be distributed throughout all age groups whereas a large percentage of cases in blacks have been reported in infants

Congenital cataracts and other ocular media opacities are a leading cause of preventable childhood blindness. Because of the importance of early recognition and treatment of congenital media opacities in newborn infants, we designed a study to determine the ability of relatively inexperienced examiners to detect such ocular abnormalities with either of two instruments. Eight third-year medical students examined eight children and young adults with ocular media opacities and eight age-matched normal subjects with an ophthalmoscope or a retinoscope. With respect to detection of abnormalities requiring referral to an ophthalmologist, there was an underreferral rate of 7% and overreferral rate of 5%. There was no significant difference between instruments. Based on an estimated incidence of congenital cataracts of 0.4%, the positive predictive value of this screening in the population of newborn infants is 18.7% and the negative predictive value is 99.96%. Therefore, overreferral is unavoidable in the effort to detect infants with congenital media opacities. We conclude that this examination can be easily taught and accurately performed with the readily available ophthalmoscope. The importance and technique of examining the red reflex should be stressed in the training of those caring for newborns.

Pediatric cardiopulmonary resuscitation drug therapy is based upon body weight, a statistic that often requires estimation. Using two current techniques of estimating body weight and the devised weight-estimating method (DWEM), the authors estimated the weights of 258 children. The DWEM, which is based on body habitus and height, was more accurate than other methods (P less than 0.01). Using height, habitus, sex, and age in a multiple regression analysis, habitus and height--two readily available measurements--were the best predictors of body weight. The DWEM, based on these two measurements, is a simple method of estimating children's weights and is more accurate than currently used body-weight estimations.

Aflatoxin levels were determined in serum and urine of 17 patients with Reye's syndrome and in control subjects. No significant difference in aflatoxin levels was found for the two groups. However, 23% of all persons studied had levels of aflatoxin indicative of recent exposure. Aflatoxin levels were associated with ingestion of cornmeal and corn bread but not peanut-containing products. This prevalence of aflatoxin may be of public health importance.

Five infants who had been patients in the same Neonatal Intensive Care Unit (NICU) were readmitted with respiratory illness. The illness was charac terized by cough, congestion, apnea, and infiltration of the lungs revealed by radiographic examination. Only one infant was febrile. All five patients recovered; however, one infant required prolonged intubation and mechani cally assisted ventilation. Investigation revealed that the illness was associated with prematurity and contact with ill family members. Illness was not associated with exposure to ill personnel in the NICU, low birth weight, or previous lung disease. This outbreak demonstrates the dangers involved in sending premature infants home when respiratory illness is prevalent in the family.

The performance of life-saving procedures by prehospital care personnel was reviewed in the cases of 114 pulseless, nonbreathing pediatric patients. Children 18 months to 18 years of age had a significantly greater chance of having prehospital endotracheal intubation and vascular access established compared to children younger than 18 months of age. For all patients, witnessed arrest and initial rhythm of ventricular fibrillation were significantly associated with survival. In the younger children, endotracheal intubation also was associated significantly with survival. Nine (8%) patients survived, and only three of the survivors were without neurologic sequelae. The number of neurologically intact survivors was too small to show a statistically significant association with these factors.

Medulloblastoma is the most common malignant childhood brain tumor in which aggressive growth produces recurrence in approximately 50% of appropriately treated cases and metastases along the neuraxis in 30%. To date, no studies exist concerning the production of autocrine growth factors by this brain tumor type. Malignant brain tumors in adults often produce platelet-derived growth factor (PDGF). A medulloblastoma cell line, TE-671, has been used for many years in pediatric neuro-oncologic studies. We assayed this medulloblastoma cell line for the production of PDGF. PDGF is produced by medulloblastoma cells grown in monolayer tissue culture and stimulates PDGF-sensitive 3T3 fibroblasts to incorporate tritiated thymidine in a dose-dependent fashion. This biologic activity is blocked by PDGF antibodies in a dose-dependent relationship. We postulate that PDGF produced by medulloblastoma cells plays a role in the growth of this tumor by stimulating mitogenic activity.

The U.S. Dept. of Energy discusses concept improvement in the tokamak and concept improvement in the mirror. Controlled Thermonuclear Research comments on what constitutes an attractive fusion reactor, and provides a table of achieved parameters of RFP, FRC and the spheromak experiments. GA Technologies Inc. remarks on the direction which industry must take in the fusion program. The Lawrence Livermore National Laboratory concentrates on commercial reactor studies. Spectra Technology focuses on problems dealing with fusion proponents making a convincing and clear economic argument for fusion based on a mils per kilowat basis, and the large costs of flagship experiments. The Oak Ridge National Laboratory remarks on the need for an economic energy source for fusion. A table of cost of electricity contours is shown.

Natriuretic and sodium transport inhibitory activity in plasma of volume-expanded dogs. Ultrafiltrates of jugular vein plasma from dogs acutely expanded with saline caused a 25 ± 3.1% (mean ± sem) inhibition of toad bladder short circuit current (SCC). Similar ultrafiltrates obtained from dogs acutely volume-depleted following furosemide administration caused a change of 3 ± 1.7% in SCC (P < 0.001). Plasma ultrafiltrates of volume-expanded dogs also inhibited SCC of the frog skin. SCC inhibition was not due to blood dilution with saline. Antinatriferic activity passed readily through a permselective membrane with a molecular weight cutoff of 500. On Sephadex G-10 column chromatography, antinatriferic activity was confined to a single fraction with a molecular weight less than 700. The same fraction which inhibited SCC caused an increase in sodium excretion and urine volume in partially nephrectomized rats undergoing a maximum water diuresis. These results indicate that plasma of volume-expanded dogs contains a humoral factor with a molecular weight less than 500 to 700 which inhibits sodium transport in vitro and causes natriuresis in vivo. This factor could modulate renal sodium excretion under some physiologic conditions.Activité natriurétique et inhibitrice du transport de sodium dans le plasma de chiens ayant subi une expansion de liquides extracellulaires. Des ultrafiltrats de plasma de sang jugulaire de chiens ayant subi une expansion aiguë avec du salin physiologique déterminant une diminution du courant de court-circuit (SCC) de 25 ± 3,1% (m ± sem). Des ultrafiltrats semblables, mais obtenus à partir de chiens ayant subi une déplétion par la furosémide ont déterminé une modification de 3 ± 1,7% de SCC (P < 0,001). Des ultrafiltrats de chiens ayant subi une expansion ont aussi inhibé le SCC de la peau de grenouille. L'inhibition du SCC n'est pas due à la dilution de sang par la solution physiologique. L'activité antinatriférique traverse une membrane permsélective dont le poids moléculaire critique est de 500. La chromatographie sur colonne de Séphadex G10 localise l'activité antinatriférique à une seule fraction dont le poids moléculaire est inférieur à 700. La même fraction qui inhibe le SCC détermine une augmentation de l'excrétion du sodium et du débit urinaire chez des rats partiellement néphrectomisés subissant une diurèse aqueuse maximale. Ces résultats indiquent que le plasma des chiens ayant subi une expansion contient un facteur humoral dont le poids moléculaire est inférieur à 500 à 700, qu inhibe le transport de sodium in vitro et détermine une natriurèse in vivo. Ce facteur pourrait moduler l'excrétion rénale du sodium dans certaines circonstances physiologiques.

BACKGROUND Physician implicit (unconscious, automatic) bias has been shown to contribute to racial disparities in medical care. The impact of medical education on implicit racial bias is unknown.

A prospective study was made of postoperative wound infections at Milwaukee Children's Hospital for 1 year. Essentially all procedures requiring a skin incision were included. The clean surgical wound infection rate was 3.1% (26 infections in 849 cases). There were no significant differences in clean wound infection rates among the individual surgeons or among the four busiest surgical services. The occurrence of postoperative wound infections was associated with administration of prophylactic antibiotics, longer duration of surgical procedures and longer hospital stay before and after surgery. About 50% of patients having a clean surgical procedure were given prophylactic antibiotics. Prophylactic antibiotic were given for 4 days or more in about half the cases.

A 1-year retrospective chart review was performed to evaluate the effect of intraosseous infusions (IO) on the time required to establish vascular access in pediatric patients requiring immediate vascular access for resuscitation. Eighty-one patients were identified, including 29 pulseless and non-breathing and 52 noncardiopulmonary arrest children, who required intravenous fluids or medication for resuscitation. Comparing the results with a previous review, the IO method effectively reduced the time needed to establish vascular access in the arrested group when standard techniques failed, particularly in the child less than 2 years old. The IO method was not used effectively in the non-arrest group, as evidenced by a significantly greater mean time required to establish vascular access. There were no significant complications related to the IO procedure. Nine (50%) of the patients receiving IO fluids or medication had clinical and/or laboratory evidence that these substances reached the central circulation. Early use of IO infusion in the resuscitation is recommended for not only the arrested patient, but also the critical nonarrested patient requiring immediate vascular access.

Much of the epidemiology of Reye syndrome is still not well understood, particularly in the age group A 1973 to 1977 epidemiologic study of Reye syndrome in Ohio by the Ohio State Department of Health and the Center for Disease Control (CDC) has shown different age-specific attack rates for black children and for white children.2 Although the overall attack rates of Reye syndrome for black and for white children were not significantly different, among children

The preliminary results of the national surveillance for Guillain-Barre syndrome(GBS) are reported. In the first 6 months of 1978, 327 cases of GBS were reported to the Center for Disease Control (CDC). A statistically significant difference was observed between sex-specific attack rates, and a direct correlation also was observed between advancing age and increasing risk of GBS.

• During a prospective evaluation of intravenous therapy with peripheral Teflon catheters in children, we found 30 episodes of phlebitis (10.4%). This rate is less than that reported in adults. Catheter colonization was not related to phlebitic episodes, and catheter-related infections did not occur. No patient's hospital course was prolonged because of phlebitis. Thirty percent of the episodes developed after the catheter was removed, and premonitory symptoms were not helpful in predicting the onset of phlebitis. Factors associated with an increased phlebitic risk were parenteral nutrition, administration of nafcillin sodium or aminoglycosides, and patient age. Parenteral nutrition prolonged the course of phlebitis. No factors hastened the onset of phlebitis. The duration of cannulation was not significantly related to phlebitis, suggesting that in some children the catheters can remain in place longer than 72 hours.

In 60 pediatric patients, 75 central venous catheters representing 1866 patient days were placed to provide parenteral nutrition. During the 21-month study period, surgical residents were responsible for dressing changes during the first 16 months and a specially trained nurse was responsible during the final 5 months. Twenty percent of the lines became infected. The infection rate was significantly higher in the lines cared for by residents, 28.8% compared to 3.3% in the lines cared for by the nurse. This occurred in spite of the lines being in place significantly longer in the nurse group (31.7 us 20.3 patient days/line).These data indicate that a specially trained person using aseptic techniques can reduce infection rates in patients receiving central venous parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 10:220-222, 1986)

Some major epidemiologic features of Reye syndrome have been elucidated since the first description of this clinical entity. Multiple studies have shown an association with epidemic influenza B and endemic varicella. Little population data are available on age, sex, race, geographic distribution, and secular trends. A five-year retrospective population-based study of 190 Ohio residents diagnosed with Reye syndrome from January 1, 1973-December 31, 1977, is reported here. The temporal relationships between the occurrence of Reye syndrome and influenza B and varicella were confirmed; however, a high number of blacks and city dwellers with Reye syndrome were found in this study.

Between December 1, 1976, and November 30, 1977, 454 cases of Reye syndrome were reported to the Centers for Disease Control by 43 states. Analysis of data about these cases revealed that Reye syndrome primarily affected white children under age 18 years, with a mean age of 7.7 years and bimodal incidence peaks in infancy and at age 6-7 years, was temporally and geographically associated with influenza B for about 75% of cases, but also occurred sporadically and not in association with influenza B activity. Although Reye syndrome was reported infrequently for non-white children aged one year or older, there was a high incidence in minority infants, and the case-fatality ratio in infants of all races was significantly higher than that of the older children. Favorable outcome was associated with prolonged interval between onset of prodromal illness and hospitalization, admission to hospital at a milder stage of illness, and treatment in hospitals with established pediatric training programs.

An ongoing surveillance program was intensified to determine whether an increased risk of acquiring vaccine-related Guillain-Barre syndrome (GBS) (similar to that observed after vaccination with the A/New Jersey swine-influenza vaccine in 1976) existed for the approximately 12.5 million adults (greater than or equal to 18 years old) vaccinated in the 1978-1979 influenza campaign. In the contiguous United States (excluding Maryland) 544 cases of GBS with onset between September 1, 1978, and March 31, 1979, were reported, including 12 adults who had been vaccinated within eight weeks before the onset of GBS and 393 who had not. The relative risk of vaccine-associated GBS for adults reported in this surveillance was 1.4 (95% confidence limits, 0.7 to 2.7)--significantly below the risk (6.2) associated with A/New Jersey vaccine for the equivalent eight-week period. In contrast to the A/New Jersey vaccine, the 1978-1979 influenza vaccine was not associated with a statistically significant excess risk of GBS.

Natural and forced ventilation tests were conducted during 1964 at eight shelter sites. Included were: three (summer) tests in high-rise building core areas; two (summer) tests in public school corridors and basements; one (summer) test in a home basement; one (summer) test in a buried community shelter; one (winter) test in a buried private shelter. Using electro- mechanical 'Simocs' to simulate shelter occupancy, the resulting physical environment was measured and analyzed. Manual ventilation devices and water- cooled heat exchangers were developed and tested to determine their ability to provide a more tolerable shelter environment. Formulas for predicting shelter ventilation and temperatures are discussed. Methods for improving ventilation rate are suggested. The report concludes that effective temperature (ET) in naturally ventilated above-ground shelters (loading: one person/10 sq. ft.) will not exceed 85F with outside air at N.Y.C. 15% summer design level. In naturally ventilated buried or semi-buried shelters (one person/10 sq. ft.), ET may exceed 85F at same design level. During normal winter weather (Conn.), naturally ventilated underground shelters with efficient heat sinks will have uncomfortably low ET (40F-50F), if loaded with fewer than one person/10 sq. ft. Radiant reflective insulating paper is found to increase ET by 10-15F while preserving the heat sink.

Infectious complication rates and associated risk factors occurring during peripheral intravenous therapy with Teflon catheters were determined during a prospective study of 286 cannula insertions. Suppurative phlebitis, cannula-related sepsis or suspected sepsis did not occur. Semiquantitative cannula cultures revealed a colonization rate of 10.4% (12 of 115). Coagulase-negative nonadherent Staphylococcus was the most common colonizing organism occurring in 10 of 12 positive catheters. Alpha Streptococcus and adherent coagulase-negative Staphylococcus colonized the remaining catheters. Colonization was not related to the rate of phlebitis, extravasation or cannulation time. No patient- or catheter-related factors increased the risk of colonization. In children in a general pediatric ward the risk of catheter colonization and subsequent sepsis should not be used as reasons for routinely removing complication-free peripheral Teflon catheters at 72 hours.

Background There is a paucity of evidence on how to train medical students to provide equitable, high quality care to racial and ethnic minority patients. We test the hypothesis that medical schools’ ability to foster a learning orientation toward interracial interactions (i.e., that students can improve their ability to successfully interact with people of another race and learn from their mistakes), will contribute to white medical students’ readiness to care for racial minority patients. We then test the hypothesis that white medical students who perceive their medical school environment as supporting a learning orientation will benefit more from disparities training. Methods Prospective observational study involving web-based questionnaires administered during first (2010) and last (2014) semesters of medical school to 2394 white medical students from a stratified, random sample of 49 U.S. medical schools. Analysis used data from students’ last semester to build mixed effects hierarchical models in order to assess the effects of medical school interracial learning orientation, calculated at both the school and individual (student) level, on key dependent measures. Results School differences in learning orientation explained part of the school difference in readiness to care for minority patients. However, individual differences in learning orientation accounted for individual differences in readiness, even after controlling for school-level learning orientation. Individual differences in learning orientation significantly moderated the effect of disparities training on white students’ readiness to care for minority patients. Specifically, white medical students who perceived a high level of learning orientation in their medical schools regarding interracial interactions benefited more from training to address disparities. Conclusions Coursework aimed at reducing healthcare disparities and improving the care of racial minority patients was only effective when white medical students perceived their school as having a learning orientation toward interracial interactions. Results suggest that medical school faculty should present interracial encounters as opportunities to practice skills shown to reduce bias, and faculty and students should be encouraged to learn from one another about mistakes in interracial encounters. Future research should explore aspects of the medical school environment that contribute to an interracial learning orientation. Electronic supplementary material The online version of this article (doi:10.1186/s12909-016-0769-z) contains supplementary material, which is available to authorized users.

In Minneapolis, 107 cases of hepatitis A were identified and traced primarily to consumption of cold sandwiches served for lunch in a department store's popular basement restaurant. A sandwich-maker in the restaurant was the index patient. The date of onset of her illness and the dates of food consumption and onset of illness of infrequent restaurant patrons were consistent with accepted periods of infectivity and incubation for hepatitis A. Because the sandwich-maker frequently touched her hands to her mouth when she worked, and because we could not find evidence for fecal, airborne, or other modes of transmission, we believe that she may have contaminated food with infectious oropharyngeal secretions. The secondary attack rate was much lower among household contacts who received immune serum globulin than among those who had not. ( JAMA 234:289-294, 1975)

The purpose of this study was to examine the natural history of PHL during peripheral intravenous therapy with Teflon® catheters (TC). Sites (286) were selected randomly and inspected daily for signs of PHL. Sites that developed PHL were followed until symptoms resolved. A random sample of TC tips were cultured. Ten percent (30/286) of the sites developed PHL. TC induced sepsis did not occur and colonization was not associated with PHL. Factors associated with an increased risk of PHL were: nafcillin (p younger, p black, p 72 hours, p

Although some institutions use a specially trained nurse to change CVPN dressings, the actual effect such an individual has on reducing infection rates and decreasing complications of CVPN has not been proven. During a 9 month period all children receiving CVPN were followed for both mechanical and infectious complications. For 4 months, surgical residents (group R) were responsible for the dressing changes and for the subsequent 5 months, two trained nurses were responsible for dressing changes (group N). The protocol for handling the lines was otherwise the same for the two groups. The two groups were comparable for most known confounding variables. These include primary illness, serum albumin, lymphocyte count, age, race and sex; however, lines from group N were in place longer (t=2.21,p

Dr Wray's comments are, of course, very appropriate and encouraging. Aflatoxin was first detected in food commodities from other parts of the world. As concentrations in other parts of the world have usually been higher, little attention has been paid to the possibility of aflatoxin exposure in humans in the United States except by those who are directly involved in monitoring the human food supply (US Department of Agriculture, the food industry, and the US Food and Drug Administration).

Between January 1, 1978, and March 31, 1979, 1,034 cases of Guillain-Barré syndrome (GBS) were reported to the Centers for Disease Control by the 1,813 American Academy of Neurology sentinel physicians who participated in the national GBS surveillance program. A direct correlation was observed between increasing age and the age-specific attack (incidence) rates. Based on the cases observed and the total US population, age-adjusted attack rates were statistically higher in males (0.52 per 100,000) than in females (0.40). Rates for whites were 0.44 and those for blacks 0.28 per 100,000; although the difference is statistically significant, uncertainties as to the true denominators by race preclude acceptance of these differences as valid. Sixty-seven percent, or 682 of the patients, reported that they had had an antecedent illness within 8 weeks before onset of GBS, and among them the peak period of onset of GBS was in the second week after the onset of the prior illness. There were also 52 patients (5%) who had undergone surgery and 45 (4.5%) who had received vaccinations, both within the 8 weeks before onset of GBS. However, the high proportions of antecedent illness in these groups (45% of those operated and 53% of those vaccinated) made attribution of GBS to the procedures tenuous. Risk of GBS in patients who reported receiving a swine influenza vaccination in 1976 was no greater than in those who reported that they did not receive this vaccine.