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Cancer is currently one of the leading causes of death worldwide and is one of the most challenging major public health problems. The main challenges faced by clinicians in the management and treatment of cancer mainly arise from difficulties in early diagnosis and the emergence of tumor chemoresistance and metastasis. The structures of chemokine receptor 9 (CCR9) and its specific ligand chemokine ligand 25 (CCL25) have been elucidated, and, interestingly, a number of studies have demonstrated that CCR9 is a potential tumor biomarker in diagnosis and therapy, as it has been found to be highly expressed in a wide range of cancers. This expression pattern suggests that CCR9 may participate in many important biological activities involved in cancer progression. Researchers have shown that CCR9 that has been activated by its specific ligand CCL25 can interact with many signaling pathways, especially those involved in tumor chemoresistance and metastasis. This review, therefore, focuses on CCR9 induction activity and summarizes what is currently known regarding its role in cancers and its potential application in tumor-targeted therapy.

The purpose of this systematic review was to assess the characteristics and effectiveness of community-based interventions designed to increase physical activity participation in older adults (aged 65 years or more) living in rural or regional areas. Relevant peer-reviewed literature was obtained, using four primary electronic search engines, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses statement. The initial search identified 4,690 articles. After removal of duplicates and excluded articles, seven articles were included in the review. Few consistencies existed between intervention types, duration, outcome measures, and follow-up. Results provide some evidence to support the effectiveness of community-based interventions that include low- to moderate-intensity exercise to increase physical activity, physical function, and psychological state. However, without more rigorous studies it is difficult to identify the most critical characteristics of community-based interventions for older adults in rural and regional settings.

The effects of a para substituent, as the electron-donating -OCH3 and -OtBu groups and the electron-withdrawing -Br and -F atoms, on azobenzene isomerization have been investigated in a series of imidazolium ionic liquids (BMIM PF6, BMIM BF4, BMIM Tf2N, EMIM Tf2N, BM2IM Tf2N, and HMIM Tf2N). The thermal cis-trans conversion tends to be improved in the presence of the substituent, as pointed out by the first-order rate constants measured at 25 °C. Both the rotation and the inversion mechanisms occur in BMIM Tf2N, EMIM Tf2N, and HMIM Tf2N, as highlighted by typical V-shape Hammett plots, but only rotation takes place in BMIM PF6, BMIM BF4, and BM2IM Tf2N. The possible interactions between the cation and the anion of the solvent and both the isomers of the azobenzene derivatives have been studied by small-wide-angle X-ray scattering (SWAXS). The calculated cis population in the photostationary state and the hardness parameter η of the trans isomer show that azobenzene and F-azobenzene are the less reactive molecules for the trans-cis conversion in all the investigated ionic liquids.

The large-scale population genetic structure of northern shrimp, Pandalus borealis, was investigated over the species' range in the North Atlantic, identifying multiple genetically distinct groups. Genetic divergence among sample localities varied among 10 microsatellite loci (range: FST = -0.0002 to 0.0475) with a highly significant average (FST = 0.0149; P < 0.0001). In contrast, little or no genetic differences were observed among temporal replicates from the same localities (FST = 0.0004; P = 0.33). Spatial genetic patterns were compared to geographic distances, patterns of larval drift obtained through oceanographic modelling, and temperature differences, within a multiple linear regression framework. The best-fit model included all three factors and explained approximately 29% of all spatial genetic divergence. However, geographic distance and larval drift alone had only minor effects (2.5-4.7%) on large-scale genetic differentiation patterns, whereas bottom temperature differences explained most (26%). Larval drift was found to promote genetic homogeneity in parts of the study area with strong currents, but appeared ineffective across large temperature gradients. These findings highlight the breakdown of gene flow in a species with a long pelagic larval phase (up to 3 months) and indicate a role for local adaptation to temperature conditions in promoting evolutionary diversification and speciation in the marine environment., (© 2015 John Wiley & Sons Ltd.)

The Cdk12/CycK complex promotes expression of a subset of RNA polymerase II genes, including those of the DNA damage response. CDK12 is among only nine genes with recurrent somatic mutations in high-grade serous ovarian carcinoma. However, the influence of these mutations on the Cdk12/CycK complex and their link to cancerogenesis remain ill-defined. Here, we show that most mutations prevent formation of the Cdk12/CycK complex, rendering the kinase inactive. By examining the mutations within the Cdk12/CycK structure, we find that they likely provoke structural rearrangements detrimental to Cdk12 activation. Our mRNA expression analysis of the patient samples containing the CDK12 mutations reveals coordinated downregulation of genes critical to the homologous recombination DNA repair pathway. Moreover, we establish that the Cdk12/CycK complex occupies these genes and promotes phosphorylation of RNA polymerase II at Ser2. Accordingly, we demonstrate that the mutant Cdk12 proteins fail to stimulate the faithful DNA double strand break repair via homologous recombination. Together, we provide the molecular basis of how mutated CDK12 ceases to function in ovarian carcinoma. We propose that CDK12 is a tumor suppressor of which the loss-of-function mutations may elicit defects in multiple DNA repair pathways, leading to genomic instability underlying the genesis of the cancer., (© The Author(s) 2015. Published by Oxford University Press on behalf of Nucleic Acids Research.)

Objective: Early readmission rates are becoming an integral measure of the quality of care for hospitalized patients with chronic diseases. The incidence and predictors of early readmission in patients with inflammatory bowel disease (IBD) are uncertain. Risk factors for readmission over the first few weeks may differ from those that influence re-hospitalization at later time points. We examined the incidence and predictors of both 30-day and 90-day readmissions among ulcerative colitis (UC) patients., Materials and Methods: A retrospective, cohort study was performed including all severe UC patients admitted to a tertiary-care hospital between January 2007 and December 2011. All-cause readmissions to the medical or surgical service within 30 and 90 days were recorded to allow the calculation of early readmission rates. We used multiple logistic regression to analyze demographic, hospital-related, general medical and IBD-specific factors as potential risk factors for readmission., Results: There were a total of 229 patients discharged following hospitalization for severe UC. The 30- and 90-day readmission rates were 11.7% and 20.5%, respectively. Forty-seven percent of early readmissions were for colectomy. In the 30-day analysis, only the presence of extensive colitis (odds ratio 3.59; 95% confidence interval [CI] 1.41-9.13) compared with left-sided disease was independently associated with readmission. Extensive colitis (3.09, 95% CI 1.33-7.08), albumin on admission (0.56, 0.31-0.99) and being admitted to a housestaff service (2.87, 95% CI 1.14-6.54), were independent predictors of readmission at 90 days., Conclusions: Early readmission is common in IBD. Independent risk factors for early readmission included extensive colitis, admission albumin, and being admitted to a housestaff service.

Objective: A systematic review and meta-analysis of randomized controlled trials to determine if motivational interviewing leads to increased physical activity, cardiorespiratory fitness or functional exercise capacity in people with chronic health conditions., Data Sources: Seven electronic databases (MEDLINE, PsychINFO, EMBASE, AMED, CINHAL, SPORTDiscus and the Cochrane Central Register of Controlled trials) were searched from inception until January 2014., Trial Selection: Two reviewers independently examined publications for inclusion. Trials were included if participants were adults (>18 years), had a chronic health condition, used motivational interviewing as the intervention and examined physical activity, cardiorespiratory fitness or functional exercise capacity., Data Extraction: Two reviewers independently extracted data. Risk of bias within trials was assessed using the Physiotherapy Evidence Database Scale., Data Synthesis: Meta-analyses were conducted with standardized mean differences and 95% confidence intervals (CIs) were calculated. The Grades of Recommendation, Assessment, Development and Evaluation approach was used to evaluate the quality of the evidence., Results: Eleven publications (of ten trials) were included. There was moderate level evidence that motivational interviewing had a small effect in increasing physical activity levels in people with chronic health conditions relative to comparison groups (standardized mean differences = 0.19, 95% CI 0.06 to 0.32, p = 0.004). Sensitivity analysis based on trials that confirmed treatment fidelity produced a larger effect. No conclusive evidence was observed for cardiorespiratory fitness or functional exercise capacity., Conclusion: The addition of motivational interviewing to usual care may lead to modest improvements in physical activity for people with chronic health conditions., (© The Author(s) 2014.)

To analyse the effect of exercise-based rehabilitation programs for improving lower limb muscle strength in individuals with hip or knee osteoarthritis (OA). A systematic search utilizing seven databases identified randomized controlled trials (RCTs) evaluating lower limb strength outcomes of exercise-based interventions for participants with hip or knee OA. All studies were screened for eligibility and methodological quality. Quality of evidence was assessed using Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Data were pooled and meta-analyses performed where appropriate. Forty RCTs were included and the majority (77%) involved resistance based exercise programs. For knee OA populations, there was high quality evidence for improved knee extension (standardized mean difference (SMD) = 0.47, 95% confidence intervals (CI) 0.29, 0.66) and flexion strength (SMD = 0.74, 95% CI 0.56, 0.92) with low-intensity resistance program when compared to a control at short term (ST) follow-up. There was moderate quality evidence for a large effect favouring high-intensity resistance programs (SMD = 0.76, 95% CI 0.47, 1.06) when compared to a control. This effect was sustained at intermediate term (IT) follow-up (SMD = 0.80, 95% CI 0.44, 1.17). Few studies reported on outcomes at long term (LT) follow-up. Only one study reported on a population with hip OA. When compared to a control group, high-intensity resistance exercise demonstrated moderate quality of evidence for large and sustained improvements for knee muscle strength in knee OA patients. Further work is needed to compare different modes of exercise at a LT follow-up for knee OA patients and to address the dearth of literature evaluating exercise interventions in people with hip OA., (Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

Various regulatory mechanisms of pulmonary oxygen uptake (V̇O2) kinetics have been postulated. The purpose of this study was to investigate the relationship between vagal withdrawal, measured using RMSSDRR, the root mean square of successive differences in cardiac interval (RR) kinetics, a mediator of oxygen delivery, and V̇O2 kinetics. Forty-nine healthy adults (23 ± 3 years; 72 ± 13 kg; 1.80 ± 0.08 m) performed multiple repeat transitions to moderate- and heavy-intensity exercise. Electrocardiography, impedance cardiography, and pulmonary gas exchange parameters were measured throughout; time domain measures of heart rate variability were subsequently derived. The parameters describing the dynamic response of V̇O2, cardiac output (Q) and RMSSDRR were determined using a mono-exponential model. During heavy-intensity exercise, the phase II τ of V̇O2 was significantly correlated with the τ of RR (r = 0.36, P < 0.05), Q (r = 0.67, P < 0.05), and RMSSDRR (r = 0.38, P < 0.05). The τ describing the rise in Q explained 47% of the variation in V̇O2 τ, with 30% of the rate of this rise in Q explained by the τ of RR and RMSSDRR. No relationship was evident between V̇O2 kinetics and those of Q, RR, or RMSSDRR during moderate exercise. Vagal withdrawal kinetics support the concept of a centrally mediated oxygen delivery limitation partly regulating V̇O2 kinetics during heavy-, but not moderate-, intensity exercise., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The use of nutritional ergogenic aids in team sports such as soccer is now commonplace. Aligned with the primary aim of soccer, which is to score more goals than the opposition within the allotted time, the quality of performance of technical actions (i.e., skills) executed during soccer-specific exercise is likely to determine success. However, when seeking to maintain soccer skill performance, information about the efficacy of nutritional interventions is lacking and factors which might modulate the efficacy of such strategies are unclear., Objective: This review aimed (i) to systematically evaluate the current research that examines the efficacy of nutritional interventions on soccer skills, and (ii) to provide a qualitative commentary on factors that have the potential to modulate the efficacy of such strategies., Data Sources: Relevant databases (PubMed and SPORTDiscus) were searched up to and including 1 July, 2013 for studies that investigated the efficacy of acute nutritional interventions on soccer skill performances., Study Selection: Overall, 279 records were retrieved. Articles were sequentially excluded from the review based on specific criteria, being: (A) articles that did not report outcomes directly relating to skilled performances in soccer, (B) articles that examined the influence of interventions that were not nutritional in origin and/or were nutritional in origin but provided >3 hours before skill testing commenced, (C) articles that were review papers, and (D) post-acceptance withdrawal of articles methods from database., Study Appraisal and Synthesis Methods: Articles were independently assessed for the quality of the methods employed based upon the Physiotherapy Evidence Database (PEDro) scale. Records achieving a minimum PEDro score of 5 out of 10 were included in this review. Qualitative appraisal of 13 articles was performed after the application of exclusion criteria and quality assurance processes. The majority (n = 8) of articles examined the influence of carbohydrates on technical performance whereas fewer studies investigated the influence of caffeine ingestion (n = 2) and fluid provision (n = 3)., Results: Findings were reported for a total of 171 participants and all but one of the included articles used cross-over study designs. Most participants (94 %) were male, highly trained (reported maximal aerobic capacity range 50-59 ml·kg(-1)·min(-1)) and exercised in temperate environments (reported temperature range 13-25 °C). Six of the eight studies reported that carbohydrates, consumed in the form of a 6-8 % solution of glucose, sucrose or maltodextrin at rates of 30-60 g·h(-1), enhanced at least one aspect of skilled performance over the duration of exercise (75-90 min). Although some evidence exists to support the consumption of caffeine (6 mg·kg(-1) body mass [BM]) and prescribed fluid to preserve skills performed during soccer-specific exercise, findings from the small number of included studies were inconsistent., Limitations: The outcome measures and methods used to quantify skilled performance were not consistent across studies; consequently, it was not possible to perform meta-analyses to produce pooled effect sizes in this review., Conclusions: The findings from this systematic review suggest that nutritional interventions, which provide carbohydrate, caffeine and fluid, have potential to preserve skills performed under conditions that induce soccer-specific fatigue. The weight of current evidence supports the consumption of carbohydrate, but is less conclusive with respect to caffeine and fluid provision. It is likely that the efficacy of a nutritional intervention will be modulated by factors including the dose consumed, the mode of administration, individual responsiveness to the intervention and interactions with other physiological changes occurring during soccer-specific exercise. Consequently, these factors should be considered when using carbohydrates, caffeine and fluid provision to maintain skilled performances in soccer. Future research should seek to optimise the nutritional strategies employed to maintain technical performance throughout match-play.

Context: The ingestion of carbohydrate (CHO) before and during exercise and at halftime is commonly recommended to soccer players for maintaining blood glucose concentrations throughout match play. However, an exercise-induced rebound glycemic response has been observed in the early stages of the second half of simulated soccer-specific exercise when CHO-electrolyte beverages were consumed regularly. Therefore, the metabolic effects of CHO beverage consumption throughout soccer match play remain unclear., Objective: To investigate the blood glucose and blood lactate responses to CHOs ingested before and during soccer match play., Design: Crossover study., Setting: Applied research study., Patients or Other Participants: Ten male outfield academy soccer players (age = 15.6 ± 0.2 years, height = 1.74 ± 0.02 m, mass = 65.3 ± 1.9 kg, estimated maximal oxygen consumption = 58.4 ± 0.8 mL·kg(-1)·min(-1))., Intervention(s): Players received a 6% CHO-electrolyte solution or an electrolyte (placebo) solution 2 hours before kickoff, before each half (within 10 minutes), and every 15 minutes throughout exercise. Blood samples were obtained at rest, every 15 minutes during the match (first half: 0-15, 15-30, and 30-45 minutes; second half: 45-60, 60-75, and 75-90 minutes) and 10 minutes into the halftime break., Main Outcome Measure(s): Metabolic responses (blood glucose and blood lactate concentrations) and markers of exercise intensity (heart rate) were recorded., Results: Supplementation influenced the blood glucose response to exercise (time × treatment interaction effect: P ≤ .05), such that glucose concentrations were higher at 30 to 45 minutes in the CHO than in the placebo condition. However, in the second half, blood glucose concentrations were similar between conditions because of transient reductions from peak values occurring in both trials at halftime. Blood lactate concentrations were elevated above those at rest in the first 15 minutes of exercise (time-of-sample effect: P < .001) and remained elevated throughout exercise. Supplementation did not influence the pattern of response (time × treatment interaction effect: P = .49)., Conclusions: Ingestion of a 6% CHO-electrolyte beverage before and during soccer match play did not benefit blood glucose concentrations throughout the second half of exercise.

Objectives: This study compared the effects of three carbohydrate-hydration strategies on blood glucose concentration, exercise performance and hydration status throughout simulated soccer match-play., Design: A randomized, double-blind and cross-over study design was employed., Methods: After familiarization, 14 recreational soccer players completed the soccer match simulation on three separate occasions. Participants consumed equal volumes of 9.6% carbohydrate-caffeine-electrolyte (∼ 6 mg/kg BW caffeine) solution with carbohydrate-electrolyte gels (H-CHO), 5.6% carbohydrate-electrolyte solution with electrolyte gels (CHO) or electrolyte solution and electrolyte gels (PL). Blood samples were taken at rest, immediately before exercise and every 15 min during exercise (first half: 15, 30, 45 min; second half: 60, 75, 90 min)., Results: Supplementation influenced blood glucose concentration (time × treatment interaction: p<0.001); however, none of the supplementation regimes were effective in preventing a drop in blood glucose at 60 min. Mean sprint speed was 3 ± 1% faster in H-CHO when compared with PL (treatment: p=0.047). Supplementation caused a 2.3 ± 0.5% increase in plasma osmolality in H-CHO (p<0.001) without change in CHO or PL. Similarly, mean sodium concentrations were 2.1 ± 0.4% higher in H-CHO when compared with PL (p=0.006)., Conclusions: Combining high carbohydrate availability with caffeine resulted in improved sprint performance and elevated blood glucose concentrations throughout the first half and at 90 min of exercise; however, this supplementation strategy negatively influenced hydration status when compared with 5.6% carbohydrate-electrolyte and electrolyte solutions., (Copyright © 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

The high-resolution microendoscope (HRME) is a novel imaging modality that may be useful in the surveillance of Barrett's esophagus in low-resource or community-based settings. In order to assess accuracy and interrater reliability of microendoscopists in identifying Barrett's-associated neoplasia using HRME images, we recruited 20 gastroenterologists with no microendoscopic experience and three expert microendoscopists in a large academic hospital in New York City to interpret HRME images. They prospectively reviewed 40 HRME images from 28 consecutive patients undergoing surveillance for metaplasia and low-grade dysplasia and/or evaluation for high-grade dysplasia or cancer. Images were reviewed in a blinded fashion, after a 4-minute training with 11 representative images. All imaged sites were biopsied and interpreted by an expert pathologist. Sensitivity of all endoscopists for identification of high-grade dysplasia or cancer was 0.90 (95% confidence interval [CI]: 0.88-0.92) and specificity was 0.82 (95% CI: 0.79-0.85). Positive and negative predictive values were 0.72 (95% CI: 0.68-0.77) and 0.94 (95% CI: 0.92-0.96), respectively. No significant differences in accuracy were observed between experts and novices (0.90 vs. 0.84). The kappa statistic for all raters was 0.56 (95% CI: 0.54-0.58), and the difference between groups was not significant (0.64 vs. 0.55). These data suggest that gastroenterologists can diagnose Barrett's-related neoplasia on HRME images with high sensitivity and specificity, without the aid of prior microendoscopy experience., (© 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.)

Background: Squamous cell carcinoma (SCC), which has one of the highest incidences of all cancers in the United States, is an age-dependent disease, with the majority of these cancers diagnosed in people age 70 and older. Recent findings have led to a new hypothesis on the pathogenesis of SCC., Objectives: To evaluate the potential of preventive therapies to reduce the incidence of SCC in at-risk geriatric patients., Materials and Methods: Survey of current literature on wounding therapies to prevent SCCs., Results: This new hypothesis of SCC photocarcinogenesis states that senescent fibroblasts accumulate in the dermis, resulting in a reduction in dermal insulin-like growth factor-1 (IGF-1) expression. This lack of IGF-1 expression sensitizes epidermal keratinocytes to fail to suppress ultraviolet light B (UVB)-induced mutations, leading to increased proclivity to photocarcinogenesis. Recent evidence suggests that dermal wounding therapies, specifically dermabrasion and fractionated laser resurfacing, can decrease the proportion of senescent dermal fibroblasts, increase dermal IGF-1 expression, and correct the inappropriate UVB response found in geriatric skin, protecting geriatric keratinocytes from UVB-induced SCC initiation., Conclusions: In this review, we will discuss the translation of pioneering basic science results implicating commonly used dermal fibroblast rejuvenation procedures as preventative treatments for SCC., (© 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.)

Aims: A Portable Multi-use Automated Concentration System (PMACS) concentrates micro-organisms from large volumes of water through automated dead-end ultrafiltration and backflushing. The ability to detect microbial targets from ground, surface and cooling tower waters collected using standard methods was compared with samples from the PMACS in this study., Methods and Results: PMACS (100 l) and standard grab samples (100-500 ml) were collected from sites in Florida and South Carolina, USA. Samples were analysed for the presence of faecal indicator bacteria (FIB; ground and surface water) or Legionella pneumophila (Lp; cooling tower water). FIB were enumerated by growth on selective media following membrane filtration or in IDEXX defined substrate media. Lp cells were detected by direct fluorescence immunoassay using FITC-labelled monoclonal antibodies targeting serogroups 1, 2, 4 and 6. FIB were found in PMACS samples from ground and surface waters when their concentrations were below detection limits in grab samples. The concentrations of Lp in cooling tower samples collected over 5 months were more consistent in PMACS samples than grab samples., Conclusions: These data demonstrate that PMACS concentration is advantageous for water monitoring. FIB were detected in PMACS samples when their concentrations were below the detection limits of the standard methods used. PMACS processing provided more representative samples of cooling tower waters reducing sample variability during long-term monitoring., Significance and Impact of the Study: This study highlights the utility of PMACS processing for enhanced monitoring of water for low-level microbial targets and for reducing sample variability in long-term monitoring programmes., (© 2012 The Authors Journal of Applied Microbiology © 2012 The Society for Applied Microbiology.)

Objectives: This study investigated the influence of carbohydrate supplementation on skill performance throughout exercise that replicates soccer match-play., Design: Experimentation was conducted in a randomised, double-blind and cross-over study design., Methods: After familiarization, 15 professional academy soccer players completed a soccer match simulation incorporating passing, dribbling and shooting on two separate occasions. Participants received a 6% carbohydrate-electrolyte solution (CHO) or electrolyte solution (PL). Precision, success rate, ball speed and an overall index (speed-precision-success; SPS) were determined for all skills. Blood samples were taken at rest, immediately before exercise, every 15 min during exercise (first half: 15, 30 and 45 min; second half: 60, 75 and 90 min), and 10 min into the half time (half-time)., Results: Carbohydrate supplementation influenced shooting (time×treatment interaction: p<0.05), where CHO attenuated the decline in shot speed and SPS index. Supplementation did not affect passing or dribbling. Blood glucose responses to exercise were influenced by supplementation (time×treatment interaction: p<0.05), where concentrations were higher at 45 min and during half-time in CHO compared with PL. Blood glucose concentrations reduced by 30±1% between half-time and 60 min in CHO., Conclusions: Carbohydrate supplementation attenuated decrements in shooting performance during simulated soccer match-play; however, further research is warranted to optimise carbohydrate supplementation regimes for high-intensity intermittent sports., (Copyright © 2012 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: Debates surrounding the use of conventional approaches in public health and the existence of perceived barriers to using the results of economic evaluations have led to questions posed as to how to establish priorities within public health schemes. The aims of this study were therefore to explore the feasibility and validity of economic evaluation techniques in developing priorities within public health programmes and consider the extent to which different presentational approaches are likely to be incorporated into decision-making, from perspectives of relevant stakeholders., Methods: An advisory board, representative of potential users of economic evaluations, was set up to identify preferences for how findings from economic evaluations might be presented to decision makers and to test the impact of different approaches, different outputs and different presentational styles. The board was divided into two groups, each of which was given three hypothetical 'scenarios' to consider. The scenarios comprised descriptions of methods and outputs, with costs, effects, target population and context of intervention constant across all scenarios., Results: The perceived validity of estimates of effectiveness was vitally important, along with sufficient information to gauge whether designs were appropriate and to assess implementation practicalities. Cost-benefit analysis and cost-utility analysis were the preferred approaches despite their complexity, although participants required benchmarks to place net-benefit estimates from cost-benefit analyses into context., Conclusion: Further research is required to substantiate and build on these preliminary findings and collaborations between economists and policy makers are needed to develop clear, rigorous and standard guidance relating to economic evaluation, recognizing the diversity of public health strategies.

The ability to maintain technical performances (i.e. skills) throughout soccer match-play is considered to be crucial in determining the outcome of competitive fixtures. Consequently, coaches dedicate a large proportion of time to practicing isolated skills, such as passing, shooting and dribbling. Unlike other elements that contribute to team-sport performances, it is unusual for coaches to use methods other than observations to assess changes resulting from technical training. Researchers have employed various tests to measure isolated soccer skills; however, reliance on outcome measures that include number of contacts (ball juggling tasks), time (dribbling tasks) and points scored (criterion-based passing and shooting tests) means that the outcomes are difficult for coaches to interpret. Skill tests that use video-analysis techniques to measure ball speed, precision and success of soccer skills offer valid and reliable alternatives. Although equivocal results are published, skill performances can be affected by assorted factors that threaten homeostasis, including match-related fatigue, dehydration and reductions in blood glucose concentrations. While acknowledging methodological constraints associated with using skill tests with limited ecological validity and cognitive demands, the effects of these homeostatic disturbances might vary according to the type of skill being performed. Shooting performances appear most susceptible to deterioration after exercise. Strategies such as aerobic training, fluid-electrolyte provision and acute carbohydrate supplementation have been found to improve proficiency in technical actions performed after soccer-specific exercise. However, mechanisms that cause deterioration in skill during soccer-specific exercise remain to be fully elucidated and strategies to optimize technical performance throughout match-play are warranted.

Purpose: This study examined the effects of exercise-induced fatigue on soccer skills performed throughout simulated match play., Methods: Fifteen academy soccer players completed a soccer match simulation (SMS) including passing, dribbling, and shooting skills. Precision, success rate, and ball speed were determined via video analysis for all skills. Blood samples were obtained before exercise (preexercise), every 15 min during the simulation (15, 30, 45, 60, 75, and 90 min), and 10 min into half-time., Results: Preliminary testing confirmed test-retest repeatability of performance, physiological, and metabolic responses to 45 min of the SMS. Exercise influenced shooting precision (timing effect: P = .035) and passing speed (timing effect: P = .011), such that shots taken after exercise were 25.5 ± 4.0% less accurate than those taken before exercise and passes in the last 15 min were 7.8 ± 4.3% slower than in the first 15 min. Shot and pass speeds were slower during the second half compared with the first half (shooting: 17.3 ± 0.3 m·s-1 vs 16.6 ± 0.3 m·s-1, P = 0.012; passing: 13.0 ± 0.5 m·s-1 vs 12.2 ± 0.5 m·s-1, P = 0.039). Dribbling performance was unaffected by exercise. Blood lactate concentrations were elevated above preexercise values throughout exercise (time of sample effect: P < .001)., Conclusions: These findings demonstrate that soccer-specific exercise influenced the quality of performance in gross motor skills, such as passing and shooting. Therefore, interventions to maintain skilled performance during the second half of soccer match play are warranted.

In this study, we examined the reliability and construct validity of new soccer skills tests. Twenty soccer players (10 professional and 10 recreational) repeated trials of passing, shooting, and dribbling skills on different days. Passing and shooting skills required players to kick a moving ball, delivered at constant speed, towards one of four randomly determined targets. Dribbling required players to negotiate seven cones over 20 m. Each trial consisted of 28 passes, 8 shots, and 10 dribbles. Ball speed, precision, and success were determined for all tests using video analysis. Systematic bias was small (<9% in all measures) and all outcome measures were similar between trials. Test-retest reliability statistics were as follows: ball speed (passing, shooting, dribbling; coefficient of variation [CV]: 6.5%, 6.9%, 2.4%; ratio limits of agreement [RLOA]: 0.958 ×/÷ 1.091, 0.990 ×/÷ 1.107, 0.993 ×/÷ 1.039), precision (passing, shooting, dribbling; CV: 10.0%, 23.5%, 4.6%; RLOA: 0.956 ×/÷ 1.147, 1.030 ×/÷ 1.356, 1.000 ×/÷ 1.068), and success (passing, shooting, dribbling; CV: 11.7%, 14.4%, 2.2%; RLOA: 1.017 ×/÷ 1.191, 0.913 ×/÷ 1.265, 0.996 ×/÷ 1.035). Professional players performed better than recreational players in at least one outcome measure for all skills. These findings demonstrate the reliability and validity of new soccer skill protocols.

Innovative technology and product advancements in cosmetic procedures have been developing at a rapid pace. Advances in neuromodulators and fillers as well as new technology in skin tightening, body contouring and skin resurfacing have been profound over the past few years. This article will discuss the most current and promising cosmetic procedures available today as well as those soon to be available.

Many degenerative diseases are associated with increased oxidative stress. Creatine has the potential to act as an indirect and direct antioxidant; however, limited data exist to evaluate the antioxidant capabilities of creatine supplementation within in-vivo human systems. This study aimed to investigate the effects of oral creatine supplementation on markers of oxidative stress and antioxidant defenses following exhaustive cycling exercise. Following preliminary testing and two additional familiarization sessions, 18 active males repeated two exhaustive incremental cycling trials (T1 and T2) separated by exactly 7 days. The subjects were assigned, in a double-blind manner, to receive either 20 g of creatine (Cr) or a placebo (P) for the 5 days preceding T2. Breath-by-breath respiratory data and heart rate were continually recorded throughout the exercise protocol and blood samples were obtained at rest (preexercise), at the end of exercise (postexercise), and the day following exercise (post24 h). Serum hypdroperoxide concentrations were elevated at postexercise by 17 +/- 5% above pre-exercise values (P = 0.030). However, supplementation did not influence lipid peroxidation (serum hypdroperoxide concentrations), resistance of low density lipoprotein to oxidative stress (t1/2max LDL oxidation) and plasma concentrations of non-enzymatic antioxidants (retinol, alpha-carotene, beta-carotene, alpha-tocopherol, gamma-tocopherol, lycopene, and vitamin C). Heart rate and oxygen uptake responses to exercise were not affected by supplementation. These findings suggest that short-term creatine supplementation does not enhance non-enzymatic antioxidant defence or protect against lipid peroxidation induced by exhaustive cycling in healthy males.

Background: Previous research has indicated that phosphatidylserine (PS) supplementation has the potential to attenuate the serum cortisol response to acute exercise stress. Equivocal findings suggest that this effect might be dose dependent. This study aimed to examine the influence of short-term supplementation with a moderate dose of PS (600 mg per day) on plasma concentrations of cortisol, lactate, growth hormone and testosterone before, during, and following moderate intensity exercise in healthy males., Methods: 10 healthy male subjects participated in the study. Each subject was assigned to ingest 600 mg PS or placebo per day for 10 days using a double-blind, placebo-controlled, crossover design. Serial venous blood samples were taken at rest, after a 15 minute moderate intensity exercise protocol on a cycle ergometer that consisted of five 3-minute incremental stages beginning at 65% and ending at 85% VO2 max, and during a 65 minute passive recovery. Plasma samples were assessed for cortisol, growth hormone, testosterone, lactate and testosterone to cortisol ratio for treatment (PS or placebo)., Results: Mean peak cortisol concentrations and area under the curve (AUC) were lower following PS (39 +/- 1% and 35 +/- 0%, respectively) when compared to placebo (p < 0.05). PS increased AUC for testosterone to cortisol ratio (184 +/- 5%) when compared to placebo (p < 0.05). PS and placebo supplementation had no effect on lactate or growth hormone levels., Conclusion: The findings suggest that PS is an effective supplement for combating exercise-induced stress and preventing the physiological deterioration that can accompany too much exercise. PS supplementation promotes a desired hormonal status for athletes by blunting increases in cortisol levels.

Breathing rates during physical exercise suggest that, during these conditions, the high-frequency (HF) bandwidth of heart rate variability (HRV) analysis should be extended beyond conventional guidelines. However, there has been little investigation of the most appropriate choice of HF bandwidth during exercise. HRV analysis was performed in 10 males and six females during progressive bicycle exercise. Cardiac cycle (RR) interval and breath-by-breath respiratory data were simultaneously recorded. HRV powers were determined for the band-limited ranges 0.04-0.15 Hz [low-frequency (LF)], 0.15-0.4 Hz (HF 0.4) and 0.15-bf Hz (HF bf, where bf represents maximum breathing frequency). Mono-exponential functions described the relationship between HRV and work rate for each bandwidth (r=0.92-0.95) and were used to calculate the "HRV decay constant" (work rate associated with a 50% reduction in HRV power). The HRV decay constants for each bandwidth were linearly related to maximal work rate (r>0.71; P<0.001) and were substantially greater in males than in females (P<0.001). There was a significant difference between the HRV decay constants for HF 0.4 and HF bf (P<0.005) in both genders. The HRV decay constants for the LF and HF bf bandwidths appear to provide an indication of work capacity from submaximal exercise, without prior assumption regarding heart rate and its relationship with work rate.

Phospholipids are essential components of all biological membranes. Phosphatidylcholine (PC) and Phosphatidylserine (PS) are Phosphatidyl-phospholipids that are required for normal cellular structure and function. The participation in physical activity often challenges a variety of physiological systems; consequently, the ability to maintain normal cellular function during activity can determine sporting performance. The participation in prolonged intense exercise has been shown to reduce circulatory choline concentrations in some individuals. As choline is a pre-cursor to the neurotransmitter Acetylcholine, this finding has encouraged researchers to investigate the hypothesis that supplementation with PC (or choline salts) could enhance sporting performance. Although the available data that evaluates the effects of PC supplementation on performance are equivocal, acute oral supplementation with PC (~0.2 g PC per kg body mass) has been demonstrated to improve performance in a variety of sporting activities where exercise has depleted circulatory choline concentrations. Short term oral supplementation with soy-derived PS (S-PS) has been reported to attenuate circulating cortisol concentrations, improve perceived well-being, and reduce perceived muscle soreness after exercise. More recently, short term oral supplementation (750 mg per day of S-PS for 10 days) has been demonstrated to improve exercise capacity during high intensity cycling and tended to increase performance during intermittent running. Although more research is warranted to determine minimum dietary Phospholipid requirements for optimal sporting performance, these findings suggest that some participants might benefit from dietary interventions that increase the intakes of PC and PS.

Squash is a popular racket sport that requires intermittent activity with frequent bursts of near maximal-intensity exercise. Consequently, effective physiological and thermoregulatory responses are important contributors to performance during squash match-play. Controlled field-based simulation protocols have been introduced in a growing number of sports, which allow sports scientists to investigate changes in physiology and the efficacy of various interventions in sport-specific contexts. This study aimed to develop an exercise protocol that simulates the physiological requirements of elite squash match-play. Eight elite junior squash players (age 16.2+/-0.8 years, height 1.76+/-0.06 m, body mass 61.3+/-5.9 kg; mean+/-s) completed the following in a randomized order: (1) a squash match against a player of similar standard and (2) a squash-specific incremental exercise protocol (multistage squash test [MST]) followed by the squash simulation protocol (SSP). The multistage squash test was continued for 18.0+/-1.0 min and elicited near maximal post-MST heart rates, blood lactate concentrations and ratings of perceived exertion (198+/-9 beats.min-1, 5.7+/-1.7 mmol.l-1 and 18+/-1, respectively). The SSP was 12.2 min in length compared with mean game length during competitive matches of 10.0+/-1.6 min (P=0.27). Peak heart rates were similar during the SSP and match-play (192+/-11 and 189+/-6 beats.min-1, respectively; P=0.44). Mean exercising heart rates were similar during the SSP (180+/-8 beats.min-1) and match-play (179+/-13 beats.min-1; P=0.73). Peak blood lactate concentrations during the SSP and match-play were 3.5+/-1.5 and 2.4+/-1.2 mmol.l-1 (P=0.07), respectively. Peak ratings of perceived exertion during the SSP and match-play were similar (17+/-2 and 17+/-2, respectively; P=0.64). It was concluded that the SSP closely replicated the demands of squash match-play in elite junior squash players. Furthermore, the SSP provides coaches and scientific support staff with a controlled squash-specific exercise protocol that has potential application in the objective investigation of a range of interventions such as training programmes, nutritional supplements and strategies to maintain core body temperature.

Phosphatidylserine (PtdSer) is a ubiquitous phospholipid species that is normally located within the inner leaflet of the cell membrane. PtdSer has been implicated in a myriad of membrane-related functions. As a cofactor for a variety of enzymes, PtdSer is thought to be important in cell excitability and communication. PtdSer has also been shown to regulate a variety of neuroendocrine responses that include the release of acetylcholine, dopamine and noradrenaline. Additionally, PtdSer has been extensively demonstrated to influence tissue responses to inflammation. Finally, PtdSer has the potential to act as an effective antioxidant, especially in response to iron-mediated oxidation. The majority of the available research that has investigated the effects of PtdSer supplementation on humans has concentrated on memory and cognitive function; patients experiencing some degree of cognitive decline have traditionally been the main focus of investigation. Although investigators have administered PtdSer through intravenous and oral routes, oral supplementation has wider appeal. Indeed, PtdSer is commercially available as an oral supplement intended to improve cognitive function, with recommended doses usually ranging from 100 to 500 mg/day. The main sources that have been used to derive PtdSer for supplements are bovine-cortex (BC-PtdSer) and soy (S-PtdSer); however, due to the possibility of transferring infection through the consumption of prion contaminated brain, S-PtdSer is the preferred supplement for use in humans. Although the pharmacokinetics of PtdSer have not been fully elucidated, it is likely that oral supplementation leads to small but quantifiable increases in the PtdSer content within the cell membrane.A small number of peer-reviewed full articles exist that investigate the effects of PtdSer supplementation in the exercising human. Early research indicated that oral supplementation with BC-PtdSer 800 mg/day moderated exercise-induced changes to the hypothalamo-pituitary-adrenal axis in untrained participants. Subsequently, this finding was extended to suggest that S-PtdSer 800 mg/day reduced the cortisol response to overtraining during weight training while improving feeling of well-being and decreasing perceived muscle soreness. However, equivocal findings from our laboratory might suggest that the dose required to undertake this neuroendocrine action may vary between participants.Interestingly, recent findings demonstrating that short-term supplementation with S-PtdSer 750 mg/day improved exercise capacity during high-intensity cycling and tended to increase performance during intermittent running might suggest an innovative application for this supplement. With the findings from the existing body of literature in mind, this article focuses on the potential effects of PtdSer supplementation in humans during and following exercise.

Ambulatory heart rate monitors and clinical electrocardiographic (ECG) devices are capable of measuring the length of consecutive cardiac periods (RR intervals). The aim of the study was to assess the agreement between the Polar 810s heart rate monitor (Polar) and the Reynolds digital ambulatory ECG using Pathfinder software version 8.4 (Reynolds v8.4) during cycle ergometry. For this purpose, eight subjects completed incremental cycling exercise that began at 60 W and increased by 30 W each 2-minute period until volitional fatigue. Simultaneous recording of the ECG (Reynolds Pathfinder), RR interval (Polar), and respiratory parameters (Metamax 3B) were undertaken at rest and throughout the exercise period. No significant differences were found in RR intervals measured by Polar and Reynolds v8.4 at any relative intensity. Polar and Reynolds v8.4 displayed strong linear relationships at all relative intensities (r2=0.927 to 0.998). Bland and Altman analyses between Polar and Reynolds v8.4 consistently demonstrated minimal bias in absolute RR interval (<0.10 ms) and the limits of agreement for group differences in RR interval and heart rate were less than +/- 10 ms and +/- 2 beats.min (-1) for all relative intensities, respectively. Power spectral analysis provided similar results for both systems in all bandwidths studied during rest and low intensity exercise. However, significant differences and large relative limits of agreement (>100 % of mean of paired means) were identified in UF at intensities > 40 % VO2max, HF at intensities > 60 % VO2max and LF during exercise at 80-100 % VO2max. These findings demonstrate that RR intervals and heart rate measurements obtained using Polar and Reynolds v8.4 are in good agreement. However, caution should be exercised when interpreting spectral analysis of RR interval data derived from different acquisition systems during physical activity.

The anaerobic bacterium Dehalococcoides ethenogenes is the only known organism that can completely dechlorinate tetrachloroethene or trichloroethene (TCE) to ethene via dehalorespiration. One of two corrinoid-containing enzymes responsible for this pathway, TCE reductive dehalogenase (TCE-RDase) catalyzes the dechlorination of TCE to ethene. TCE-RDase dehalogenated 1,2-dichloroethane and 1, 2-dibromoethane to ethene at rates of 7.5 and 30 micromol/min/mg, respectively, similar to the rates for TCE, cis-dichloroethene (DCE), and 1,1-DCE. A variety of other haloalkanes and haloalkenes containing three to five carbon atoms were dehalogenated at lower rates. The gene encoding TCE-RDase, tceA, was cloned and sequenced via an inverse PCR approach. Sequence comparisons of tceA to proteins in the public databases revealed weak sequence similarity confined to the C-terminal region, which contains the eight-iron ferredoxin cluster binding motif, (CXXCXXCXXXCP)(2). Direct N-terminal sequencing of the mature enzyme indicated that the first 42 amino acids constitute a signal sequence containing the twin-arginine motif, RRXFXK, associated with the Sec-independent membrane translocation system. This information coupled with membrane localization studies indicated that TCE-RDase is located on the exterior of the cytoplasmic membrane. Like the case for the two other RDases that have been cloned and sequenced, a small open reading frame, tceB, is proposed to be involved with membrane association of TCE-RDase and is predicted to be cotranscribed with tceA.

Context: In May and June 1998, reported Vibrio parahaemolyticus infections increased sharply in Texas., Objective: To determine factors that contributed to the increase in V parahaemolyticus infections., Design, Setting, and Participants: Cross-sectional survey of persons reporting gastroenteritis after eating seafood in Texas; survey of environmental conditions in Galveston Bay., Main Outcome Measures: Traceback of oysters, water quality measures in harvest areas, presence of V parahaemolyticus in stool cultures; comparison of median values for environmental conditions before and during the outbreak compared with during the previous 5 years., Results: Between May 31 and July 10, 1998, 416 persons in 13 states reported having gastroenteritis after eating oysters harvested from Galveston Bay. All 28 available stool specimens from affected persons yielded V parahaemolyticus serotype O3:K6 isolates. Oyster beds met current bacteriologic standards during harvest and fecal coliform counts in water samples were within acceptable limits. Median water temperature and salinity during May and June 1998 were 30.0 degrees C and 29.6 parts per thousand (ppt) compared with 28.9 degrees C and 15.6 ppt for the previous 5 years (P<.001)., Conclusions: This is the first reported outbreak of V parahaemolyticus serotype O3:K6 infection in the United States. The emergence of a virulent serotype and elevated seawater temperatures and salinity levels may have contributed to this large multistate outbreak of V parahaemolyticus. Bacteriologic monitoring at harvest sites did not prevent this outbreak, suggesting that current policy and regulations regarding the safety of raw oysters require reevaluation. Consumers and physicians should understand that raw or undercooked oysters can cause illness even if harvested from monitored beds. In patients who develop acute gastroenteritis within 4 days of consuming raw or undercooked oysters, a stool specimen should be tested for Vibrio species using specific media. JAMA. 2000;284:1541-1545.

An algorithm for bacterial identification using matrix-assisted laser desorption/ionization (MALDI) mass spectrometry is being developed. This mass spectral fingerprint comparison algorithm is fully automated and statistically based, providing objective analysis of samples to be identified. Based on extraction of reference fingerprint ions from test spectra, this approach should lend itself well to real-world applications where samples are likely to be impure. This algorithm is illustrated using a blind study. In the study, MALDI-MS fingerprints for Bacillus atrophaeus ATCC 49337, Bacillus cereus ATCC 14579T, Escherichia coli ATCC 33694, Pantoea agglomerans ATCC 33243, and Pseudomonas putida F1 are collected and form a reference library. The identification of test samples containing one or more reference bacteria, potentially mixed with one species not in the library (Shewanella alga BrY), is performed by comparison to the reference library with a calculated degree of association. Out of 60 samples, no false positives are present, and the correct identification rate is 75%. Missed identifications are largely due to a weak B. cereus signal in the bacterial mixtures. Potential modifications to the algorithm are presented and result in a higher than 90% correct identification rate for the blind study data, suggesting that this approach has the potential for reliable and accurate automated data analysis of MALDI-MS.

A method to aid in the analysis of bacterial samples of unknown concentration by matrix-assisted laser desorption/ionization (MALDI) mass spectrometry is demonstrated. It is shown that in MALDI analysis of bacteria, the intensities of resulting peaks in spectra are sensitive to the microbial concentration. At the high and low ends of the concentration range, no signal can be obtained, leaving very concentrated or very dilute samples indistinguishable. The addition of cytochrome c as an internal control allows the differentiation of these concentrated and dilute samples. The presence of the internal control causes only a 20% to 30% decrease in signal intensity when the bacterial concentration is optimum. However, the signal quality is improved when the internal control is added to some low concentrations of bacteria.

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOFMS) was used to demonstrate the reproducibility of bacterial spectra collected on different days. The reproducibility of analysis by MALDI-MS of intact Escherichia coli and Bacillus atrophaeus is presented as a replicate culture study in which spectra were collected on ten different occasions over a three-month period and by two different operators. The analysis resulted in the detection of specific biomarkers in the m/z 2000-20 000 range. Some of the peaks in the Escherichia coli spectra are identified by comparison with other published work. All of the spectra obtained are reproducible over the course of the experiment, but operator variability does exist. The Escherichia coli spectra show operator variability while the Bacillus atrophaeus spectra do not. This work demonstrates the utility of MALDI in obtaining consistent spectra from bacteria over a period of time., (Copyright 1999 John Wiley & Sons, Ltd.)

Concentrations of 99 organochlorine compounds were measured in the blubber of 196 harbour porpoises, Phocoena phocoena, killed in commercial gill net fisheries in the western North Atlantic. PCBs and chlorinated bornanes (CHB) were the dominant contaminants in all porpoises. Mean concentrations (with standard deviations) of PCBs and CHBs from the three regions were as follows: Bay of Fundy/Gulf of Maine, PCB males 17.3 +/- 11.2 microg/g, PCB females 11.4 +/- 4.8 microg/g, CHB males 11.5 +/- 6.6 microg/g, CHB females 8.4 +/- 5.3 microg/g; Gulf of St Lawrence, PCB males 10.6 +/- 5.4 microg/g, PCB females 7.2 +/- 3.9 microg/g, CHB males 14.1 +/- 8.8 microg/g, CHB females 9.0 +/- 6.3 microg/g; southeast Newfoundland, PCB males 5.2 +/- 2.5 microg/g, PCB females 5.5 +/- 4.4 microg/g, CHB males 7.0 +/- 2.2 microg/g, CHB females 5.5 +/- 3.0 microg/g. The relative composition of the major contaminant groups found in male and female harbour porpoise blubber from the three locations varied. In order of decreasing concentration, porpoises from Fundy/Maine had PCBs > CHB > DDT > chlordanes (CHL), whereas Gulf of St Lawrence and Newfoundland porpoises had CHB > PCB > DDT > CHL. Significant increases with age were observed for most contaminants in male harbour porpoises, and significant decreases were observed in females. Females lose about 15% of their contaminant burden per birth. PCB and DDT levels in porpoises from the Bay of Fundy are significantly lower than those recorded in the 1970s.

Proteolytic systems are involved via multiple mechanisms in the regulation of gene expression, including tightly controlled metabolism of transcription factors. In this study, we demonstrate that differentiation of mouse embryonal carcinoma cells to parietal endoderm-like cells is accompanied by the appearance of nuclear protease activity. Interestingly, this nuclear-associated protease activity is not observed in the visceral endoderm-like cell line, PSA-5E, or in the differentiated cells derived from both mouse embryonic stem cells and the human embryonal carcinoma cell line NT2/D1. We also determined that this differentiation-associated nuclear protease activity causes proteolysis of a wide range of different transcription factors, including ATF-1, Sp1, NF-YA and B, and octamer-binding proteins Oct-1 and Oct-3. Based on the effects of specific inhibitors, the nuclear protease(s) can be classified as a cysteine protease; however, lack of inhibition by calpastatin and EGTA distinguishes this protease activity from the calpain family of proteases. Given the properties of the differentiation-associated nuclear protease(s), we discuss the possibility that this protease(s) plays a role in the metabolism of transcription factors during the differentiation of specific embryonic cells.

This article describes the development of a specialized unit for individuals requiring prolonged mechanical ventilation. The unit uses a collaborative approach to care, with the goal to provide quality care in a cost effective setting, and to facilitate transition to a more independent environment.

Grief that is not acknowledged and worked through may manifest itself in some emotional, mental or physical problem. In recent years much as been learned about coping with grief which the hospice program can utilize to help family members cope with their grief. This study was carried out to determine the helpfulness of the bereavement care of Severance Hospice and to learn more about the grief response of the bereaved. The tools used to collect data were an assessment form used in the bereavement program and the Grief Experience Inventory developed by Sanders and revised and translated by the researcher. Data was obtained from bereaved family members (54 for the final grief assessment and 39 for the grief response assessment) receiving bereavement follow-up, from July 1989 to March 1991. Results of the study were as follows: 1. Final Grief Assessment Regarding the resolution of their grief the majority of the bereaved accepted the reality of the death of their family member, while slightly more than three-quarters were able to express their feelings toward their loss. A large majority had returned to activities of daily living well or fairly well and had reinvested their energy in a person other than the deceased. In addition, the physical condition of the majority was good or fairly good. A majority of the bereaved considered the bereavement care to be helpful and almost three-quarters were not considered to be in need of more follow-up. 2. Grief Response Assessment Age was found to have a moderately positive correlation to appetite disturbance (r = .41, P less than .01) and loss of vigor (r = .37, P less than .01) A moderately positive correlation was found between the number of contacts and sleep disturbance (r = 2.38, P less than .01) Significant differences were found between men and women in regard to guilt (t = 2.38, P less than .05), social isolation (t = 2.44, P less than .05) and depersonalization (t = 2.07, P less than .05) with men having the more intense grief. Significant differences were found in the grief responses of somatization (F = 5.82, P less than .001), physical symptoms (F = 5.87, P less than .001), appetite disturbance (F = 4.40, P less than .01), despair (3.79, P less than .01), anger (Fp2.83, P less than .05), social isolation (F = 3.61, P less than .05), guilt (F = 3.62, P less than .05) and depersonalization (F = 2.58, P less than .05).(ABSTRACT TRUNCATED AT 400 WORDS)

The pathogenicity gene, pthA, of Xanthomonas citri is required to elicit symptoms of Asiatic citrus canker disease; introduction of pthA into Xanthomonas strains that are mildly pathogenic or opportunistic on citrus confers the ability to induce cankers on citrus (S. Swarup, R. De Feyter, R. H. Brlansky, and D. W. Gabriel, Phytopathology 81:802-809, 1991). The structure and the function of pthA in other xanthomonads and in X. citri were further investigated. When pthA was introduced into strains of X. phaseoli and X. campestris pv. malvacearum (neither pathogenic to citrus), the transconjugants remained nonpathogenic to citrus and elicited a hypersensitive response (HR) on their respective hosts, bean and cotton. In X. c. pv. malvacearum, pthA conferred cultivar-specific avirulence. Structurally, pthA is highly similar to avrBs3 and avrBsP from X. c. pv. vesicatoria and to avrB4, avrb6, avrb7, avrBIn, avrB101, and avrB102 from X. c. pv. malvacearum. Surprisingly, marker-exchanged pthA::Tn5-gusA mutant B21.2 of X. citri specifically lost the ability to induce the nonhost HR on bean, but retained the ability to induce the nonhost HR on cotton. The loss of the ability of B21.2 to elicit an HR on bean was restored by introduction of cloned pthA, indicating that the genetics of the nonhost HR may be the same as that found in homologous interactions involving specific avr genes. In contrast with expectations of homologous HR reactions, however, elimination of pthA function (resulting in loss of HR) did not result in water-soaking or even moderate levels of growth in planta of X. citri on bean; the nonhost HR, therefore, may not be responsible for the "resistance" of bean to X. citri and may not limit the host range of X. citri on bean. The pleiotropic avirulence function of pthA and the heterologous HR of bean to X. citri are both evidently gratuitous.

Strain UHM-5, a pSym Exo derivative of the aluminum-tolerant Rhizobium leguminosarum bv. phaseoli strain CIAT899, was equally tolerant of aluminum (Al) as the parental culture. Dialyzed culture supernatants of the wild-type cells grown in YEM broth (10 cells ml) contained 185 mug of glucose equivalents ml whereas UHM-5 culture supernatants yielded 2 mug of glucose ml. The Exo derivative and the parental strain gave essentially similar growth in medium containing from 0 to 300 muM Al, indicating that the pSym of CIAT899, and extracellular polysaccharide, were not involved in the aluminum tolerance of this strain. However, increasing the level of Al from 80 to 150 muM increased the lag phase, induced a slight killing of the inoculum, and depressed the final populations by about fivefold. Doubling the aluminum concentration from 150 to 300 muM presented a severe aluminum stress to CIAT899 and UHM-5: the inoculum level dropped 10-fold, indicating killing of the inoculum, and remained depressed for ca. 4 days before continuing to grow slowly; the final population was decreased 15-fold relative to that of cultures grown in medium containing 80 muM Al. The production by CIAT899 of other extracellular or intracellular aluminum tolerance factors was investigated in culture by using aluminum-sensitive rhizobia as stress indicators. These experiments, conducted at 80 muM Al, demonstrated that CIAT899 produced neither extracellular nor intracellular products that could alleviate toxicity for the Al-sensitive indicator rhizobia.

Limitations associated with immunofluorescence enumeration of bacteria in soil derive largely from the efficiency with which cells can be separated from soil particles and collected on membrane filters for staining. Many tropical soils fix added bacteria tightly, resulting in low recoveries. Eight soils, representative of three of the major soil orders found in the tropics (oxisols, vertisols, and inceptisols), were tested for recovery of added Rhizobium strains. All except one Hawaiian andept (Typic Eutrandept) yielded recoveries ranging from <1 to 13%. Recovery from the andept was 100%. In soil-sand mixtures, addition of only a small amount of soil caused a dramatic decrease in recovery of added rhizobia. Increasing the soil content of the mixture from 0% (10 g of sand) to 50% (5 g of soil-5 g of sand) reduced recoveries from >90 to <1%. Varying the ionic strength and pH of the extracting solution did not cause marked increases in recovery. Protein solutions, ethylenediaminetetraacetate, and NaHCO(3), on the other hand, improved release of bacteria. We report a modification to the usual membrane filter immunofluorescence procedure which yielded consistently high and reproducible recovery (coefficient of variation, 30%) of rhizobia from several tropical soils. In the modified procedure, partially hydrolyzed gelatin, diluted in ammonium phosphate, was used to suspend the soil. This caused dispersion of the soil and release of the bacteria from soil flocs. The efficiency of recovery of Rhizobium spp. from several tropical and two temperate soils remained high as the content of these soils in soil-sand mixtures was increased from 0 to 100%. The modified membrane filter immunofluorescence procedure was used to follow the growth of a strain of chickpea (Cicer arietinum) Rhizobium in a sterilized oxisol. The results showed a close agreement with viable counts at different stages during the growth cycle. Diluent for the hydrolyzed gelatin also had a marked effect on recovery. The efficiency of release of Rhizobium spp. from an oxisol was in the following order for the diluents used: 0.1 M (NH(4))(2)HPO(4) > 0.1 M Na(2)HPO(4) = 0.1 M sodium-phosphate-buffered saline (pH 7.2) > 0.2 M NH(4)Cl > 0.2 KCl > NaCl = LiCl > water.