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Background: Internationally there is a shortage of psychiatrists, whilst clinical psychology training is generally oversubscribed. School students interested in psychological health may not be aware of the possibility of studying medicine before specialising in psychiatry. This has implications for the mental health workforce., Aims: To evaluate the knowledge and attitudes relating to a potential career in psychiatry amongst secondary (high) school students., Method: A cross-sectional survey evaluated attitudes and knowledge relating to psychiatry and clinical psychology, targeting students from five schools who were studying chemistry, biology and/or psychology at an advanced level., Results: 186 students completed the survey (response rate 41%). Knowledge was generally poor with only 57% of respondents knowing that psychiatrists had medical degrees, and most participants substantially underestimating the salaries of consultant psychiatrists. Attitudinal response patterns were explained by two underlying factors, relating to generally negative attitudes towards psychiatry and positive attitudes towards the effectiveness of psychiatric treatments. Females and those studying psychology reported more positive attitudes towards psychiatry. Those studying chemistry reported more negative attitudes towards the effectiveness of mental health treatment., Conclusions: Studying psychology predicted positive attitudes towards psychiatry. Such students could be targeted by recruitment campaigns, which emphasise factual information about the specialty.

Competing Interests: Competing interests: None declared.

Background and Objectives: Electronic healthcare records have become central to patient care. Evaluation of new systems include a variety of usability evaluation methods or usability metrics (often referred to interchangeably as usability components or usability attributes). This study reviews the breadth of usability evaluation methods, metrics, and associated measurement techniques that have been reported to assess systems designed for hospital staff to assess inpatient clinical condition., Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, we searched Medline, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, and Open Grey from 1986 to 2019. For included studies, we recorded usability evaluation methods or usability metrics as appropriate, and any measurement techniques applied to illustrate these. We classified and described all usability evaluation methods, usability metrics, and measurement techniques. Study quality was evaluated using a modified Downs and Black checklist., Results: The search identified 1336 studies. After abstract screening, 130 full texts were reviewed. In the 51 included studies 11 distinct usability evaluation methods were identified. Within these usability evaluation methods, seven usability metrics were reported. The most common metrics were ISO9241-11 and Nielsen's components. An additional "usefulness" metric was reported in almost 40% of included studies. We identified 70 measurement techniques used to evaluate systems. Overall study quality was reflected in a mean modified Downs and Black checklist score of 6.8/10 (range 1-9) 33% studies classified as "high-quality" (scoring eight or higher), 51% studies "moderate-quality" (scoring 6-7), and the remaining 16% (scoring below five) were "low-quality.", Conclusion: There is little consistency within the field of electronic health record systems evaluation. This review highlights the variability within usability methods, metrics, and reporting. Standardized processes may improve evaluation and comparison electronic health record systems and improve their development and implementation., (© 2021 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)

Seasonal windows of opportunity represent intervals of time within a year during which organisms have improved prospects of achieving life history aims such as growth or reproduction, and may be commonly structured by temporal variation in abiotic factors, bottom-up factors, and top-down factors. Although seasonal windows of opportunity are likely to be common, few studies have examined the factors that structure seasonal windows of opportunity in time. Here, we experimentally manipulated host-plant age in two milkweed species (Asclepias fascicularis and Asclepias speciosa) in order to investigate the role of plant-species-specific and plant-age-varying traits on the survival and growth of monarch caterpillars (Danaus plexippus). We show that the two plant species showed diverging trajectories of defense traits with increasing age. These species-specific and age-varying host-plant traits significantly affected the growth and survival of monarch caterpillars through both resource quality- and quantity-based constraints. The effects of plant age on monarch developmental success were comparable to and sometimes larger than those of plant-species identity. We conclude that species-specific and age-varying plant traits are likely to be important factors with the potential to structure seasonal windows of opportunity for monarch development, and examine the implications of these findings for both broader patterns in the ontogeny of plant defense traits and the specific ecology of milkweed-monarch interactions in a changing world., (© 2020 by the Ecological Society of America.)

We have investigated the distribution of a heavy oil residue in the coastal sediments of the Gulf of Mexico. The amount of the contamination was determined by high-temperature pyrolysis coupled with the Gas Chromatography-Mass Spectrometry (GCMS) of air-dried sediments. The pyrolysis products contain straight-chain saturated and unsaturated hydrocarbons, such as dodecane and 1-dodecene, resulting in a very characteristic pattern of double peaks in the GCMS. Hydrocarbons containing 8 to 23 carbon atoms were detected in the pyrolysis products. Using thermal pyrolysis we have found that the sediment samples collected along Texas, Louisiana, and Mississippi shores contain no detectable traces of oil residue, but most of the samples collected along Alabama and Florida shores contain ~200ppm of heavy oil residue., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: To analyze the challenges encountered during surgical quality improvement interventions, and explain the relative success of different intervention strategies., Summary Background Data: Understanding why and how interventions work is vital for developing improvement science. The S3 Program of studies tested whether combining interventions addressing culture and system was more likely to result in improvement than either approach alone. Quantitative results supported this theory. This qualitative study investigates why this happened, what aspects of the interventions and their implementation most affected improvement, and the implications for similar programs., Methods: Semistructured interviews were conducted with hospital staff (23) and research team members (11) involved in S3 studies. Analysis was based on the constant comparative method, with coding conducted concurrently with data collection. Themes were identified and developed in relation to the program theory behind S3., Results: The superior performance of combined intervention over single intervention arms appeared related to greater awareness and ability to act, supporting the S3 hypothesis. However, we also noted unforeseen differences in implementation that seemed to amplify this difference. The greater ambition and more sophisticated approach in combined intervention arms resulted in requests for more intensive expert support, which seemed crucial in their success. The contextual challenges encountered have potential implications for the replicability and sustainability of the approach., Conclusions: Our findings support the S3 hypothesis, triangulating with quantitative results and providing an explanatory account of the causal relationship between interventions and outcomes. They also highlight the importance of implementation strategies, and of factors outside the control of program designers.

Historically, patients on extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome have received ventilatory "lung rest" with conventional or high-frequency oscillating ventilators. We present a series of adults treated with high-frequency percussive ventilation (HFPV) to enhance recovery and recruitment during ECMO. Adult respiratory patients, treated between January 2009 and December 2012 were cared for with a combination of standard ECMO practices and a protocol of recruitment strategies, including HFPV. Data are reported as mean ± standard error of the mean, percentage, or median. Comparisons are made by χ for categorical variables and by t-test and Mann-Whitney test for continuous variables. Significance is noted at the 95% confidence level (p < 0.05). There were 39 HFPV patients. They were 39.9 ± 2.2 years of age and had 3.0 ± 0.37 days of mechanical ventilation before the initiation of ECMO. Their pre-ECMO PaO2 to FiO2 ratio (PF ratio) was 52.3 ± 3.0 and their pCO2 was 50.22 ± 2.4. HFPV patients required a mean of 143.1 ± 17.6 hours and a median of 106 hours (range 45.75-350.25) of ECMO support and had a 62% survival to discharge. The post-ECMO PF ratio in the HFPV cohort was 301.8 ± 16.7. A protocolized practice of active recruitment that includes HFPV is associated with reduced duration of ECMO support in adults with respiratory failure.

Background: We previously developed and validated the Oxford NOTECHS rating system for evaluating the non-technical skills of an entire operating theatre team. Experience with the scale identified the need for greater discrimination between levels of performance within the normal range. We report here the development of a modified scale (Oxford NOTECHS II) to facilitate this. The new measure uses an eight-point instead of a four point scale to measure each dimension of non-technical skills, and begins with a default rating of 6 for each element. We evaluated this new scale in 297 operations at five NHS sites in four surgical specialities. Measures of theatre process reliability (glitch count) and compliance with the WHO surgical safety checklist were scored contemporaneously, and relationships with NOTECHS II scores explored., Results: Mean team Oxford NOTECHS II scores was 73.39 (range 37-92). The means for surgical, anaesthetic and nursing sub-teams were 24.61 (IQR 23, 27); 24.22 (IQR 23, 26) and 24.55 (IQR 23, 26). Oxford NOTECHS II showed good inter-rater reliability between human factors and clinical observers in each of the four domains. Teams with high WHO compliance had higher mean Oxford NOTECHS II scores (74.5) than those with low compliance (71.1) (p = 0.010). We observed only a weak correlation between Oxford NOTECHS II scores and glitch count; r = -0.26 (95% CI -0.36 to -0.15). Oxford NOTECHS II scores did not vary significantly between 5 different hospital sites, but a significant difference was seen between specialities (p = 0.001)., Conclusions: Oxford NOTECHS II provides good discrimination between teams while retaining reliability and correlation with other measures of teamwork performance, and is not confounded by technical performance. It is therefore suitable for combined use with a technical performance scale to provide a global description of operating theatre team performance.

We present a review of current expert opinion on the effects of combined exposures to trunk rotation and whole-body vibration (WBV), commonly experienced by operators of agricultural machinery. We evaluate the level of agreement between academic experts in the field of ergonomics, human response to WBV and agricultural operators, on the effects of exposure to WBV and trunk rotation. A total of 83 individuals responded to the paper-based questionnaire, which included questions on risk levels from individual and combined exposures, discomfort development, exposure duration limits and tasks within agriculture. The results showed that all groups considered exposure to WBV and trunk rotation as risk factors for the development of back pain. The experts were not in consensus regarding acceptable exposure durations, areas of discomfort experienced or recommendations for cab developments.

Background: The World Health Organization (WHO) Surgical Safety Checklist is reported to reduce surgical morbidity and mortality, and is mandatory in the U.K. National Health Service. Hospital audit data show high compliance rates, but direct observation suggests that actual performance may be suboptimal., Methods: For each observed operation, WHO time-out and sign-out attempts were recorded, and the quality of the time-out was evaluated using three measures: all information points communicated, all personnel present and active participation., Results: Observation of WHO checklist performance was conducted for 294 operations, in five hospitals and four surgical specialties. Time-out was attempted in 257 operations (87.4 per cent) and sign-out in 26 (8.8 per cent). Within time-out, all information was communicated in 141 (54.9 per cent), the whole team was present in 199 (77.4 per cent) and active participation was observed in 187 (72.8 per cent) operations. Surgical specialty did not affect time-out or sign-out attempt frequency (P = 0.453). Time-out attempt frequency (range 42-100 per cent) as well as all information communicated (15-83 per cent), all team present (35-90 per cent) and active participation (15-93 per cent) varied between hospitals (P < 0.001 for all)., Conclusion: Meaningful compliance with the WHO Surgical Safety Checklist is much lower than indicated by administrative data. Sign-out compliance is generally poor, suggesting incompatibility with normal theatre work practices. There is variation between hospitals, but consistency across studied specialties, suggesting a need to address organizational culture issues., (© 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.)

Background: Patients with severe H1N1 pneumonia created a sudden demand for extracorporeal membrane oxygenation (ECMO) capacity. In a single referral center, the established procedures, protocols, and staff of the Level I trauma service were adapted to help manage this nontrauma critical care crisis., Methods: When airway pressure release ventilation and high-frequency oscillator ventilation failed, we used standard ECMO circuits and the VDR-4 critical care ventilator. We cannulated patients percutaneously in the intensive care unit and transported them on ECMO. Trauma service resources included a mobile surgical transport team, direct to OR resuscitations, massive transfusion protocols, trauma performance improvement processes, trauma resuscitation nurses, in-house attending doctors, and experienced staff familiar with protocol-driven care., Results: During an 84-day period, 15 patients with severe H1N1 pneumonia were treated with ECMO. All patients were referred; 10 were transported on ECMO. Patients were aged 34.4 ± 4.1 years (6-58 years); 47% were male, and they had been ventilated 3.5 ± 0.8 days. Pre-ECMO PaO2/FIO2 ratios were 62.3 ± 6.1; ECMO duration was 9.4 ± 1.3 days for survivors; and post-ECMO PaO2/FIO2 ratio was 295.0 ± 35.1. Recovery occurred in 67% and 60% survived to discharge. No patient died of lung failure. Surviving patients were discharged at their neurologic baseline., Conclusion: H1N1 created a severe public health challenge for referral centers with ECMO capability. The resources of our trauma service were adapted to this nontrauma critical care crisis without disruption of other hospital services. These H1N1 patients treated with ECMO had a 67% recovery rate and a 60% survival rate. All survivors were discharged to home., Level of Evidence: Therapeutic/epidemiologic study, level V.

Background: The investigators present a series of adults with severe acute respiratory distress syndrome (ARDS) who were treated with extracorporeal membrane oxygenation (ECMO) at a regional referral center., Methods: Patients with refractory hypoxic ARDS received ECMO until they recovered lung function or demonstrated futility. ECMO was initiated at the referring facility if necessary, and aggressive critical care was maintained throughout., Results: ARDS due to multiple etiologies was managed with ECMO in 36 adults. The pre-ECMO ratio of partial pressure of oxygen to fraction of inspired oxygen was 48.3 ± 2.2. Regional facilities referred 89% of these patients, and 69% required ECMO for transport. The mean duration of ECMO was 7.1 ± .9 days for survivors, and the mean post-ECMO ratio of partial pressure of oxygen to fraction of inspired oxygen was 281.2 ± 11. ECMO was successfully weaned in 67% of patients, and 60% survived to discharge., Conclusions: ECMO provides support that prevents ventilator-induced lung injury while the lungs heal. The investigators present a series of 36 adults with refractory hypoxemic ARDS (ratio of partial pressure of oxygen to fraction of inspired oxygen <50) from 17 different facilities who, treated with ECMO at a single referral center, had a 60% survival rate., (Copyright © 2013 Elsevier Inc. All rights reserved.)

This is the second extract taken from the War Diaries of Brigadier JG Morgan CBE TD MD and is specifically taken from papers he used to prepare a talk for a Civil Defence Audience in the 1950's. Having introduced a system of filtering in Tripoli in 1943 when in command of 48th General Hospital, he was specifically appointed to oversee the medical arrangements for the Battle of Cassino and was awarded the CBE for his work which is outlined below. It has been prepared from the original documents and edited by his sons.

The MSSE gene predisposes to multiple invasive but self-healing skin tumours (multiple self-healing epitheliomata). MSSE was previously mapped to chromosome 9q22-q31 and a shared haplotype in affected families suggested a founder mutation. We have refined the MSSE critical region (<1 cM, <1 Mb) between the zinc-finger gene ZNF169 and the Fanconi anaemia gene FANCC. By genetic mapping we have excluded ZNF169 and FANCC as well as PTCH (PATCHED) and TGFBR1 (transforming growth factor beta receptor type-1) genes. The CDC14B cell cycle phosphatase gene also lies in the region but screening of the complete coding region revealed no mutation in MSSE patients. Somatic cell hybrids created by haploid conversion of an MSSE patient's cells enabled screening of the MSSE chromosome 9 and showed no CDC14B deletion or mutation that abrogates CDC14B mRNA expression. Thus, CDC14B is unlikely to be the MSSE gene. We also report the first molecular analysis of MSSE tumours showing loss of heterozygosity of the MSSE region, with loss of the normal allele, providing the first evidence that MSSE is a tumour suppressor gene.

The angiotensin II type 1 (AT1) receptor, transforming growth factor beta1 (TGFbeta1) and Oncostatin M (OSM) control key pathways that may be important during placentation. Although interactions between them exist in other tissues, trophoblast cells have not been investigated. Extravillous trophoblast cells, SGHPL-4, were stimulated with 10 ng/ml TGFbeta1 +/- 100 ng/ml OSM for 24 h. Real-time PCR showed that AT1 expression increased 2.76-fold [95% confidence interval (CI) = 1-6.74, P = 0.05] in response to TGFbeta1 and 4.21-fold (95% CI = 1.33-11.76, P = 0.03) with TGFbeta1 + OSM. Luciferase reporter gene constructs containing three haplotypes of the 59 flanking region of the AT1 receptor gene were transfected into SGHPL-4 and HepG2 cells and stimulated with 0.1, 1 and 10 ng/ml TGFbeta1 and 50 ng/ml OSM. Responses were dose and cell dependent. Luciferase activity increased in HepG2 cells in response to TGFbeta1 alone or together with OSM (P < 0.001); transcriptional activation differed between AT1 receptor gene haplotypes. In SGHPL-4 cells, luciferase activity was reduced on exposure to low concentrations of TGFbeta1 or high concentrations of TGFbeta1 combined with OSM (P = 0.003); the response was unaffected by haplotype. Interaction between AT1 and TGFbeta1 is a novel observation in trophoblast and suggests new avenues for the study of placentation.

Background: The need to make health services and research relevant to the general public through user involvement and consultation has been recognized and formalized in guidelines and research publications., Objectives: We had the following objectives (i) to involve and enable lay people to identify and direct a research study as co-researchers consulting members of the general public about their awareness and knowledge of stroke and stroke risk; and (ii) to consult members of the general public aged between 40 and 65 years old to identify what they know about the signs of stroke and potential risk factors in order to inform local public health programmes., Methods: A 20-point multiple choice questionnaire was designed by two consumers trained in research skills at a year long training programme. The questionnaire was sent to 250 randomly selected patients from one general practice in North Staffordshire., Results: A 57% response rate was achieved (142 out of 250), with 139 being appropriate for analysis. The current knowledge and awareness of stroke and stroke risk was relatively good. Almost 90% knew that stroke occurs in the brain and most correctly identified the causes as related to impaired blood supply to the brain. Further, upon recognizing signs of stroke, 96% thought it was 'extremely important' to get immediate treatment for someone who may be having a stroke. Seventy-eight percent of respondents stated that they would like further information about stroke. The most popular sources of information identified were: their general practice (51%); television and radio (36%); and friends and family (33%)., Conclusion: The consumers' involvement has essentially allowed lay people to consult other members of the general public about health issues of national priority with specific local relevance. The involvement of consumers in research needs to be considered as worthwhile if it is to have any lasting impact on local or national services. Future research using consumer involvement will need to decide upon the balance between scientific integrity and the level of consumer direction.

A simple protein-DNA interaction analysis has been developed using both a high-affinity/high-specificity zinc finger protein and a low-specificity zinc finger protein with nonspecific DNA binding capability. The latter protein is designed to mimic background binding by proteins generated in randomized or shuffled gene libraries. In essence, DNA is immobilized onto the surface of microplate wells via streptavidin capture, and green fluorescent protein (GFP)-labeled protein is added in solution as part of a crude cell lysate or protein mixture. After incubation and washing, bound protein is detected in a standard microplate reader. The minimum sensitivity of the assay is approximately 0.4 nM protein. The assay format is ideally suited to investigate the interactions of DNA binding proteins from within crude cell extracts and/or mixtures of proteins that may be encountered in protein libraries generated by codon randomization or gene shuffling.

Objective: Undertriage has seldom been evaluated in the trauma population. In rural states patients often go to the nearest hospital first, where they are evaluated and, if necessary, transferred to another hospital. If they are undertriaged when transferred to the second hospital, they will require a second transfer to a higher-level trauma center., Methods: The authors retrospectively reviewed the charts of all trauma patients at a level I trauma center from 1996 to 1999 who were seen at two acute care facilities because of a single acute traumatic event before reaching the trauma center. Ninety-three patient charts were analyzed., Results: Forty-six percent of the patients were victims of a motor vehicle crash. Patients were mostly transferred to the level I trauma center for non-spine orthopedic injuries (28%), followed by spine injuries (14%) and head injuries (13%). These patients were stable, as manifested by an average trauma score of 11.6. However, there was a significant positive interaction between injury severity score and time to definitive care., Conclusions: The authors infer from the data analysis that more serious or complex injuries took longer to evaluate. Since these patients were physiologically stable, reducing the number of twice-transferred trauma patients will involve refining transfer protocols concerning the need for specialty care.

The purpose of this study was to analyze the outcome of elderly burn victims and to determine an instrument to predict survival in this population. Charts of three hundred and eight burn patients > or =60 yr of age who were admitted to a university-based hospital between the years of 1977-1996 were retrospectively analyzed. The mean age of the population was 71.5+/-8.6, with a male predominance (1.8 to 1, P < 0.001). The majority of the burns were secondary to flame injuries (210, 68.6%). The median body surface area (BSAB) was 13.0% with an in-hospital mortality rate of 30.2%. We demonstrated improved survival in patients aged 60-74 yr as compared to 1965-1971 national burn survival data. A similar trend could not be shown in the very old (> 75 yr of age). Only age and BSAB were related to death by multiple stepwise forward linear regression. The Baux score, which adds age and BSAB, was predictive of outcome in 87.0% of our population. In conclusion, this study reinforces the high mortality associated with burn injuries in the elderly and the superior ability of the Baux score (age + percent burn) in predicting outcome in this population.

Although chemical injuries account for only a small number of one burn unit's cases, the diversity, resulting complications, and sequelae of these burns pose special problems. We reviewed a 19-year period of the chemical burn experience of our burn unit. The population of patients with these types of burns consisted of young men (mean age: 29.8 years), the majority of whom were injured on the job. Unique to our series is the largest collection of injuries (30%) resulting from the common fertilizer anhydrous ammonia. Another population of concern, accounting for 14% of the injuries in our unit, is that of patients injured at home with routine household cleaners. Nearly one half of those patients injured at home incurred injuries that required grafting. The cornerstone of chemical burn prevention and treatment involves education regarding the caustic nature of chemicals, proper handling, adequate protection, and copious irrigation of the wound at the scene. From the analysis of our retrospective review, adequate education and treatment at the scene appear to be well implemented in the industrial and farming communities. The focus of our education efforts should be directed toward the public and emphasize the safe use of household chemicals. Finally our review illuminated the potential benefit of immediate excision and grafting for decreasing the length of stay, complications, and loss of productivity.

The purpose of this investigation was to determine whether insulin-stimulated phosphatidylinositol 3-kinase (PI3-kinase) activity is detectable in needle biopsies of human skeletal muscle. Sixteen healthy nonobese males matched for age, percent fat, fasting insulin, and fasting glucose participated in one of two experimental protocols. During an intravenous glucose tolerance test (IVGTT) protocol, insulin-stimulated PI3-kinase activity was determined from percutaneous needle biopsies at 2, 5, and 15 min post-insulin administration (0.025 U/kg). In the second group, a 2-h, 100 mU . m-2 . min-1 euglycemic hyperinsulinemic clamp was performed, and biopsies were obtained at 15, 60, and 120 min after insulin infusion was begun. Insulin stimulated PI3-kinase activity by 1.6 +/- 0.2-, 2. 2 +/- 0.3-, and 2.2 +/- 0.4-fold at 2, 5, and 15 min, respectively, during the IVGTT. During the clamp protocol, PI3-kinase was elevated by 5.3 +/- 1.3-, 8.0 +/- 2.6-, and 2.7 +/- 1.4-fold above basal at 15, 60, and 120 min, respectively. Insulin-stimulated PI3-kinase activity at 15 min post-insulin administration was significantly greater during the clamp protocol vs. the IVGTT (P < 0.05). These observations suggest that insulin-stimulated PI3-kinase activity is detectable in needle biopsies of human skeletal muscle, and furthermore, that the euglycemic, hyperinsulinemic clamp protocol may be a useful tool to assess insulin signaling in vivo.

This study assessed the effect of frequency of consumption of a diet containing 10 g fat/100 g, with a (n-3):(n-6) polyunsaturated fatty acid (PUFA) ratio of 0.5, on tissue fatty acid composition and eicosanoid synthesis in CD-1 mice. With greater (n-3) PUFA consumption frequency, hepatic and peritoneal cell (n-3) PUFA levels changed to 14.4 +/- 1.3 and 12.4 +/- 0.9 mol/100 mol, respectively, from 2.4 +/- 0.3 and 1.9 +/- 0.3 mol/100 mol in control animals consuming a diet without (n-3) PUFA. Hepatic and peritoneal cell (n-6) PUFA levels were reduced to 6.4 +/- 0.5 and 7.6 +/- 0.5 mol/100 mol, respectively, with daily (n-3) PUFA consumption, compared with 23.6 +/- 0.7 and 17.9 +/- 0.7 mol/100 mol in control animals. Prostaglandin E, 6-keto-prostaglandin F1 alpha, and 4-series sulfidopeptide leukotriene biosyntheses reflected frequency of (n-3) PUFA consumption, with daily (n-3) PUFA consumption reducing prostaglandin E, consumption of (n-3) PUFA every other day reducing 6-keto-prostaglandin F1 alpha, and (n-3) PUFA consumption every 3 d reducing leukotriene C4 and leukotriene E4. Leukotriene C5 and leukotriene E5 changed from undetectable in animals consuming the control diet to > 40% of total leukotriene production in animals consuming (n-3) PUFA daily. Daily to biweekly consumption of fish or fish oil [1.26-0.63 g/wk of (n-3) PUFA, 6-3% of energy] may be a means for changing eicosanoid production. Consumption of (n-3) PUFA less often than twice a week may not change eicosanoid synthesis.

Advances in perinatal and neonatal care in the past decade have produced a change in the population of infants with perforated necrotizing enterocolitis (NEC) treated at our institution: the majority are now of very low birth weight (VLBW, < 1,000 g). Peritoneal drainage has been reported as an initial resuscitative procedure for unstable infants who have complicated NEC. Initial success with peritoneal drainage prompted us to adopt an aggressive approach to its use in this patient population. Since 1987, peritoneal drainage has been the primary treatment for most infants weighing less than 1,500 g who have perforation, and for unstable infants weighing more than 1,500 g. Perforation was documented by pneumoperitoneum or aspiration of meconium by paracentesis. Intestinal resection was performed in most infants weighing more than 1,500 g and in those for whom drainage was ineffective. Twenty-nine infants with low or VLBW (mean gestational age, 27 weeks; mean birth weight, 994 g) were treated with one or two drains in the right lower quadrant. Broad spectrum antibiotics were continued until all drains were removed, usually within 10 to 14 days. Nasogastric suction was continued until patency of the gastrointestinal (GI) tract was confirmed by a nonionic upper GI series. Six (21%) infants died, although one of the deaths occurred 5 months after drainage; the patient had chronic lung disease and an intact GI tract. Seventeen of the 23 (74%) survivors required no further operative procedure, and 6 (26%) required laparotomy and resection because drainage had been ineffective. Peritoneal drainage provided definitive treatment in 18 of 29 (62%) infants in this series.(ABSTRACT TRUNCATED AT 250 WORDS)

Measurements of glycated haemoglobin by electroendosmotic and chromatographic methods, fructosamine, and fructosamine:albumin ratio were made in 91 non-diabetic subjects with chronic renal failure managed conservatively (n = 25), by continuous ambulatory peritoneal dialysis (n = 22), by haemodialysis (n = 22), or by renal transplantation (n = 22). Results were compared with those in a control group of 43 non-diabetic subjects with normal renal function. Mean glycated haemoglobin measured by electroendosmosis was significantly greater in all groups with chronic renal failure except the transplant group. Mean glycated haemoglobin measured by affinity chromatography was not significantly different from controls in any of the groups with chronic renal failure. No difference in mean fructosamine concentration was detected in the transplant or conservatively managed groups compared to controls, but values were significantly lower in the CAPD group, and greater in the haemodialysis group predialysis. Post-haemodialysis samples showed a significant reduction in mean fructosamine concentration when compared with prehaemodialysis samples. Fructosamine:albumin ratios were elevated in all groups of patients with renal failure, with the exception of the transplant group. Of the four indices of glycaemic control considered in this study, only glycated haemoglobin measured by affinity chromatography appears to be unaffected by chronic renal failure.

Thirty-seven infants were treated for posthemorrhagic hydrocephalus (PHH) with external ventricular drainage (EVD) in 1977-1985. The mean age at EVD placement was 13 days; the mean duration of drainage was 21 days, and an average of 1.8 drains was used per patient. Complications were apnea (10%), hemorrhage (8%) and ventriculitis (6%). Ten infants died from pulmonary disease unrelated to the surgery. Thirty-two percent of the survivors did not require a permanent shunt. Neurodevelopmental outcome was evaluated at a mean age of 38 months. Eighteen of the twenty-seven survivors (67%) had normal cognitive function, 3 had borderline and 6 (22%) had moderate to profound mental retardation. Nine of the children (33%) had a normal neuromuscular exam. One child had mild, 11 had moderate and 6 had severe cerebral palsy. Four children had serious visual impairment. The worst outcomes were in the children with parenchymal or large intraventricular hemorrhages.

The serum level of galactosyltransferase was measured in a group of 218 patients with a variety of solid tumors and most with advanced disease. The pretreatment enzyme level showed little potential as a diagnostic tumor marker, and its change with treatment did not reflect the initial response. There was, however, a significant correlation between the length of survival and the pretreatment enzyme level. Patients with normal levels survived over twice as long as those with elevated levels. When Cox's proportional hazards regression analysis was used to compare the prognostic potential of galactosyltransferase with a number of known clinical indicators of prognosis, the variable most related to survival was performance status (P less than 10(-4) followed by galactosyltransferase (P = 0.01) and then the extent of disease (P = 0.03). The other variables, such as previous therapy, the type, site, and size of primary tumor, did not contribute significantly to the relationship with survival. The pretreatment level of galactosyltransferase is therefore a relatively independent prognosticator of survival and, as such, could be potentially useful in patient management by increasing the accuracy of the initial assessment of prognosis.

Neonatal mortality risk for all birth weight-gestational age categories has been prepared based on data from an inborn population at the University of Colorado Health Sciences Center for the years 1974 to 1980. There were 14,413 live births and 252 neonatal deaths during this six-year period, reflecting fairly current clinical practices. Based on birth weight alone, neonatal mortality was 0.47% for infants weighing greater than 2,500 gm; based on gestational age alone, mortality was 0.28% for infants greater than 34 weeks. A chart of neonatal mortality risk has been constructed based on birth weights and gestational ages of all these infants. The zones of mortality risk have been color matched to equivalent areas of mortality for the 1958 to 1969 data previously published from the Center for easy comparison. These two populations have also been compared on a graph plotting the predicted mortality at the estimated gestational age and its fiftieth percentile birth weight. This may be useful for consultation by perinatal obstetricians who must make decisions about transfer and care of high-risk mothers before delivery occurs. Where comparisons can be made with other perinatal centers, there is a remarkable similarity in neonatal survival rates, indicating that continuing communication between obstetric perinatologists and neonatologists is a prime factor in reducing mortality, rather than specific new therapeutic procedures at any single clinical center.