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This article examines the need for identifying the business reasons for including people with disabilities in the workplace. Attitudes of businesses will be addressed, as well as strategies for bringing about a reduction in the unemployment of people with disabilities. The authors will discuss suggestions made by Human Resource personnel, as well as first line managers regarding issues of recruiting, hiring, accommodating, and promoting people with disabilities. [ABSTRACT FROM AUTHOR]

Between 23 June and 15 July 1994, 21 cases (19 primary and 2 secondary) of Escherichia coli O157:H7 infection were identified in the Bethel, Connecticut, area. Three pulsed-field gel electrophoresis (PFGE) patterns from 15 isolates (I, n = 13; II, n = 2; and III, n = 1) were observed. A case-control study that excluded secondary cases and patients with PFGE II and III patterns (n = 16) demonstrated that consumption of food from one supermarket was associated with illness (15/16 cases vs. 31/47 geographically matched controls, odds ratio [OR] undefined, lower 95% confidence interval OR = 1.45, P = .018). No one food was associated with illness. Inspection of the supermarket revealed deficiencies in hygiene and meat handling practices. The 2 cases with PFGE II ate raw beef and raw lamb from a second supermarket. These outbreaks demonstrate the value of PFGE in supporting epidemiologic investigations and the potential for outbreaks arising from retail outlets. [ABSTRACT FROM AUTHOR]

Background: Vertebral compression fractures are common and result in significant pain and loss of function. Treatment strategy, however, remains controversial. We conducted a meta-analysis of randomized trials to elucidate the impact of bracing on these injuries., Methods: A comprehensive literature review utilizing Embase, OVID MEDLINE, and the Cochrane Library was performed to identify randomized trials evaluating brace therapy for adult patients with thoracic and lumbar compression fractures. Two independent reviewers assessed the eligibility of studies and risk of bias. The primary assessed outcome was pain after injury. Secondary outcomes were function, quality of life, opioid use, and kyphotic progression [anterior vertebral body compression percentage (AVBCP)]. Continuous variables were analyzed using mean differences and standardized mean differences, and dichotomous variables were analyzed using odds ratios in random-effects models. GRADE criteria were applied., Results: Of 1,502 articles, a total of 3 studies with 447 patients (96% female) were included. Fifty-four patients were managed without a brace, and 393 with a brace (195 rigid, 198 soft). At 3 to 6 months post-injury, rigid bracing resulted in significantly less pain compared to no brace (SMD =-1.32, 95% CI: -1.89 to -0.76, P<0.05, I 2 =41%), though this diminished at long-term follow-up of 48 weeks. Radiographic kyphosis, opioid use, function, or quality of life were not significantly different at any timepoint., Conclusions: Moderate quality evidence demonstrates rigid bracing of vertebral compression fractures may decrease pain up to 6 months post-injury, though there is no difference in radiographic parameters, opioid use, function, or quality of life at short- or long-term follow-up. No difference was found between rigid and soft bracing; therefore, soft bracing may be an adequate alternative., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jss.amegroups.com/article/view/10.21037/jss-22-78/coif). RP reports that he received royalties from Globus, and consulting fees from Globus and Bioventus. IA has received consulting fees from Globus and research support from Orthofix and Nuvasive. The other authors have no conflicts of interest to declare., (2023 Journal of Spine Surgery. All rights reserved.)

Background: The available classifications and preoperative planning tools for total hip arthroplasty assume that: 1) there is no variation in the sagittal pelvic tilt (SPT) if the radiographs are repeated, and 2) there is no significant change in the postoperative SPT postoperatively. We hypothesized that there would be significant differences in postoperative SPT tilt as measured by the sacral slope, thus rendering the current classifications and tools flawed., Methods: This study was a multicenter, retrospective analysis of preoperative and postoperative (1.5-6 months) full-body imaging of 237 primary total hip arthroplasty (standing and sitting positions). Patients were categorized as 1) stiff spine (standing sacral slope sitting sacral slope < 10°) and 2) normal spine (standing sacral slope-sitting sacral slope ≥ 10°). Results were compared using the paired t-test. The posthoc power analysis showed a power of 0.99., Results: The difference in mean standing and sitting sacral slope between the preoperative and postoperative measurements was 1°. However, in standing position, this difference was more than 10° in 14.4% of patients. In the sitting position, this difference was more than 10° in 34.2% of patients and more than 20° in 9.8% of patients. Postoperatively, 32.5% of patients switched groups based on the classification, which rendered the preoperative planning suggested by the current classifications flawed., Conclusion: Current preoperative planning and classifications are based on a single acquisition of preoperative radiographs without the incorporation of possible postoperative changes in SPT. Validated classifications and planning tools should incorporate repeated measurements to determine the mean and variance in SPT and consider the significant postoperative changes in SPT., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Many of the current total hip arthroplasty (THA) planning tools only consider sagittal pelvic tilt in the standing and relaxed sitting positions. Considering that the risk of postoperative dislocation is higher when bending forward or in sit-to-stand move, sagittal pelvic tilt in the flexed seated position may be more relevant for preoperative planning. We hypothesized that there was a significant difference in sagittal pelvic tilt between the relaxed sitting and flexed seated positions as measured by the sacral slope in preoperative and postoperative full-body radiographs., Methods: This was a multicenter retrospective analysis of the preoperative and postoperative simultaneous biplanar full-body radiographs of 93 primary THA patients in standing, relaxed sitting, and flexed seated positions. The sagittal pelvic tilt was measured using the sacral slope relative to the horizontal line., Results: The mean difference between the preoperative sacral slope in the relaxed sitting position and the flexed seated position was 11.3° (-13° to 43°) ( P < .0001). This difference was >10° in 52 patients (56%) and >20° in 18 patients (19.4%). The mean difference between the postoperative sacral slope in a relaxed sitting position and the sacral slope in a flexed seated position was 11.3° ( P < .0001). This difference was >10° in 51 patients (54.9%) and >30° in 14 patients (15.1%) postoperatively., Conclusions: There was a significant difference in sagittal pelvic tilt between the relaxed and flexed seated positions. A flexed seated view provides valuable information that might be more relevant for preoperative THA planning in order to prevent postoperative THA instability., (© 2023 The Authors.)

Identification of alcoholism is clinically important because of the way it affects the operation of the brain. Alcoholics are more vulnerable to health issues, such as immune disorders, high blood pressure, brain anomalies, and heart problems. These health issues are also a significant cost to national health systems. To help health professionals to diagnose the disease with a high rate of accuracy, there is an urgent need to create accurate and automated diagnosis systems capable of classifying human bio-signals. In this study, an automatic system, denoted as (CT-BS- Cov-Eig based FOA-F-SVM), has been proposed to detect the prevalence and health effects of alcoholism from multichannel electroencephalogram (EEG) signals. The EEG signals are segmented into small intervals, with each segment passed to a clustering technique-based bootstrap (CT-BS) for the selection of modeling samples. A covariance matrix method with its eigenvalues (Cov-Eig) is integrated with the CT-BS system and applied for useful feature extraction related to alcoholism. To select the most relevant features, a nonparametric approach is adopted, and to classify the extracted features, a radius-margin-based support vector machine (F-SVM) with a fruit fly optimization algorithm (FOA), (i.e., FOA-F-SVM) is utilized. To assess the performance of the proposed CT-BS model, different types of evaluation methods are employed, and the proposed model is compared with the state-of-the-art models to benchmark the overall effectiveness of the newly designed system for EEG signals. The results in this study show that the proposed CT-BS model is more effective than the other commonly used methods and yields a high accuracy rate of 99%. In comparison with the state-of-the-art algorithms tested on identical databases describing the capability of the newly proposed FOA-F-SVM method, the study ascertains the proposed model as a promising medical diagnostic tool with potential implementation in automated alcoholism detection systems used by clinicians and other health practitioners. The proposed model, adopted as an expert system where EEG data could be classified through advanced pattern recognition techniques, can assist neurologists and other health professionals in the accurate and reliable diagnosis and treatment decisions related to alcoholism., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Al-Hadeethi, Abdulla, Diykh, Deo and Green.)

Experts usually inspect electroencephalogram (EEG) recordings page-by-page in order to identify epileptic seizures, which leads to heavy workloads and is time consuming. However, the efficient extraction and effective selection of informative EEG features is crucial in assisting clinicians to diagnose epilepsy accurately. In this paper, a determinant of covariance matrix (Cov-Det) model is suggested for reducing EEG dimensionality. First, EEG signals are segmented into intervals using a sliding window technique. Then, Cov-Det is applied to each interval. To construct a features vector, a set of statistical features are extracted from each interval. To eliminate redundant features, the Kolmogorov-Smirnov (KST) and Mann-Whitney U (MWUT) tests are integrated, the extracted features ranked based on KST and MWUT metrics, and arithmetic operators are adopted to construe the most pertinent classified features for each pair in the EEG signal group. The selected features are then fed into the proposed AdaBoost Back-Propagation neural network (AB&#95;BP&#95;NN) to effectively classify EEG signals into seizure and free seizure segments. Finally, the AB&#95;BP&#95;NN is compared with several classical machine learning techniques; the results demonstrate that the proposed mode of AB&#95;BP&#95;NN provides insignificant false positive rates, simpler design, and robustness in classifying epileptic signals. Two datasets, the Bern-Barcelona and Bonn datasets, are used for performance evaluation. The proposed technique achieved an average accuracy of 100% and 98.86%, respectively, for the Bern-Barcelona and Bonn datasets, which is considered a noteworthy improvement compared to the current state-of-the-art methods.

Electromyogram (EMG) signals have had a great impact on many applications, including prosthetic or rehabilitation devices, human-machine interactions, clinical and biomedical areas. In recent years, EMG signals have been used as a popular tool to generate device control commands for rehabilitation equipment, such as robotic prostheses. This intention of this study was to design an EMG signal-based expert model for hand-grasp classification that could enhance prosthetic hand movements for people with disabilities. The study, thus, aimed to introduce an innovative framework for recognising hand movements using EMG signals. The proposed framework consists of logarithmic spectrogram-based graph signal (LSGS), AdaBoost k-means (AB-k-means) and an ensemble of feature selection (FS) techniques. First, the LSGS model is applied to analyse and extract the desirable features from EMG signals. Then, to assist in selecting the most influential features, an ensemble FS is added to the design. Finally, in the classification phase, a novel classification model, named AB-k-means, is developed to classify the selected EMG features into different hand grasps. The proposed hybrid model, LSGS-based scheme is evaluated with a publicly available EMG hand movement dataset from the UCI repository. Using the same dataset, the LSGS-AB-k-means design model is also benchmarked with several classifications including the state-of-the-art algorithms. The results demonstrate that the proposed model achieves a high classification rate and demonstrates superior results compared to several previous research works. This study, therefore, establishes that the proposed model can accurately classify EMG hand grasps and can be implemented as a control unit with low cost and a high classification rate., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Published clinical trials of the treatment of HCV are largely multicentre prospective pharmaceutical trials. Patients in clinical trials tend to have more favorable outcomes than patients in the 'real-world', due to strict patient selection and differences in treatment conditions and available resources., Objectives: To assess the outcomes of Hepatitis C infected patients treated at the Barwon Health Liver Clinic with combination Pegylated interferon (PEG-IFN) and Ribavirin (RBV) therapy and to determine factors associated with a treatment response., Methods: Retrospective review of patients who received treatment for Hepatitis C at our institution's Liver Clinic from January 2001-September 2011. Patient demographics, comorbidities, treatment-related parameters and side effects were extracted from medical records and analyzed., Results: A total of 190 patients (120 male, 70 female) with a mean age of 42.8 years (range 20-68 years) commenced treatment. The most common genotype was genotype 3 (48.9%), followed by genotype 1 (42.6%). 150 of 190 patients (78.9%) completed treatment and had end of treatment data available. 107 of 182 patients, (58.8%) for whom sustained virologic response (SVR) rate data was available achieved an SVR. Overall response rates were; 46.9%, 68.8% and 62.4% in genotypes 1, 2 and 3 respectively. The response rate was significantly lower in 29 patients with documented cirrhosis (20.7%). Age, diabetes and alcohol abuse did not predict treatment response in our cohort. Side effects reported in 81.6% of patients included general malaise, hematological disturbance and psychiatric issues, and necessitated cessation of therapy in 16 patients (8.4%) and dose reduction in 26 patients (13.7%)., Conclusions: Response rates to combination PEG-IFN and RBV therapy at our institution are comparable to other 'real-world' and pharmaceutical registration trials. Side effects of combination therapy were prominent but resulted in fewer discontinuations of therapy compared to pharmaceutical trials.

Crikey is a daily electronic bulletin aimed at providing independent news. It was established in 2000. In 2007, journalists and public health advocates collaborated with Crikey to initiate an innovative health reporting project, the Crikey Health and Medical Panel (CHAMP). CHAMP members contribute articles and news tips to Crikey, broadening Crikey's scope of public health coverage. CHAMP continues to evolve, and has expanded to include a freely accessible online health forum, Croakey. CHAMP was established to enhance public debate about health, to encourage public health advocates to engage in debate, and to help the media to identify public health advocates and issues as sources for articles.

Background: Fetal Alcohol Spectrum Disorders (FASD) affect a significant number of children in this country. This article addresses diagnostic issues related to fetal alcohol syndrome (FAS) and other alcohol-related disabilities, discusses associated features and behaviors of FASD, and introduces interventions to support children with FASD in school settings., Methods: A comprehensive review of FAS and FASD literature as it relates to school functioning was conducted., Results: Prenatal alcohol exposure can result in a broad range of negative developmental consequences, including deficits in cognitive and academic functioning, psychological disorders, behavioral problems, and difficulties with independent living. Children with prenatal alcohol exposure are at risk for a spectrum of difficulties at school., Conclusions: This topic is of considerable relevance to all professionals in a school setting, including teachers, administrators, school psychologists, special education providers, special service providers, and school nurses who interact with children who may be prenatally exposed to alcohol. Successful interventions will need to balance the use of environmental modifications, immediate and meaningful positive and negative consequences for behaviors, and opportunities to teach children skills to monitor and modify their behavior.

The purpose of this study was to assess whether there are any differences in postprandial physiological responses to skim milk powder enriched with milk calcium (SMP + milk calcium) and skim milk powder enriched with calcium carbonate (SMP + CaCO3), with each of the milks providing 1200 mg calcium. This was a randomised, controlled, crossover study involving 16 men and 29 women over 55 years of age. Measurements of calcium and bone metabolism were taken after an overnight fast before each drink, and postprandially every hour for 8 h. The impact of time and drink on the responses was analysed by repeated measures of analysis of variance. Serum calcium was significantly higher between 2 and 8 h after consumption of SMP + CaCO3 compared with SMP + milk calcium (P < 0.0001). Serum phosphate was significantly higher between 2 and 5 h after drinking the SMP + milk calcium compared with SMP + CaCO3 (P < 0.0001). The level of parathyroid hormone (PTH) was virtually unchanged after consumption of SMP + milk calcium, but decreased between 1 and 4 h after SMP + CaCO3 (P = 0.02). The serum C-telopeptide level, a marker of bone resorption, was significantly lower after SMP + CaCO3, compared with SMP + milk calcium, between 4 and 8 h after drinking the milk (P < 0.05). We conclude that serum calcium levels have a higher increase after SMP + CaCO3 consumption than after SMP + milk calcium consumption, and that this is associated with lower serum PTH concentrations and a more prolonged postprandial decrease in bone resorption.

Objective: To assess whether there are any differences in the postprandial physiological responses to apple drink (control), calcium phosphate (tricalcium phosphate, TCP) and high-calcium skim milk (HCSM) with or without additional magnesium in postmenopausal women., Design: Randomized, controlled, cross-over. Measurements after overnight fast before each drink, and subsequently every hour for 8 h postprandially., Setting: Human Nutrition Studies Laboratory, Milk and Health Research Centre, Massey University, Palmerston North, New Zealand., Subjects: Twenty-one healthy postmenopausal women., Intervention: Four drinks, each 400 ml. (1) Apple drink (25% fruit juice). (2) TCP dispersed in water containing 1200 mg Ca. (3) HCSM containing 1200 mg Ca and 65.5 mg Mg. (4) HCSM containing 1200 mg Ca and 172 mg Mg., Results: There was no difference in baseline serum calcium, PTH or C-telopeptide levels between drinks. There were no overall differences in serum calcium after apple or after either milk, but after TCP serum calcium increased from a baseline value of 2.12+/-0.08 to a mean peak of 2.21+/-0.12 mmol/l (s.d.) (P=0.0001) after 2 h. There were no significant differences in serum PTH after either apple or HCSM+Mg. In contrast, after TCP, serum PTH decreased from 2.76+/-0.69 to a mean nadir of 2.23+/-0.65 pmol/l (P=0.0001) after 1 h, and after HCSM, it decreased from 2.71+/-0.78 to a mean nadir of 2.51+/-0.87 pmol/l (P=0.007) after 2 h. Serum C-telopeptides decreased after each drink, reaching nadirs after 5 h. At this time the serum values for each of the high calcium drinks were not different from each other, but were significantly less than for apple (P=0.001 for each), being 0.22+/-0.09 ng/ml for apple, 0.15+/-0.08 for TCP, 0.14+/-0.07 for HCSM and 0.16+/-0.07 for HCSM+Mg., Conclusion: Despite differences in serum calcium and PTH responses to the three high-calcium drinks that we tested, there was no distinguishable difference in serum C-telopeptides between high calcium drinks.

CLA has a range of biological properties, including effects on lipid metabolism and body composition in experimental animals. The prevalent isomer of CLA found in the human diet is 9c,11 t-CLA, and it is predominantly found in products containing fat from ruminant animals. This study investigated the effect of dietary CLA on energy balance in mice. Synthetic CLA reduced body fat in growing male BALB/c mice in a dose-dependent manner over the range 0.25-1.0% w/w CLA in the diet. Weight gain was also reduced at the highest levels of dietary CLA, being only 5.88 +/- 2.68 g/4 mice (mean +/- 1 SD) after 4 wk of 2.0% CLA in the diet, compared with weight gains of 7.51 +/- 2.22 to 8.17 +/- 2.34 g/4 mice in the 0-0.5% CLA groups. There was no significant effect on weight gain if diets contained 0.5% synthetic CLA or less. These results suggest that high levels of a synthetic mixture of CLA isomers modify energy metabolism and body composition and that high levels of synthetic CLA impair weight gain and reduce body fat pad mass in growing mice.

The purpose of this study was to assess the agreement between the 24 h diet recall and a short 17-item 24 h food intake recall in assessing calcium intake. The calcium intakes of 21 women over the age of 50 were assessed by both methods on four occasions. The mean calcium intakes were similar using both methods, being 1034+/-398 mg/day by 24 h diet recall and 822+/-412 mg/day (SD) by 17-item 24 h food intake recall. The 17-item 24 h food intake recall tended to underestimate calcium intake compared with the 24 h diet recall, with the limits of agreement being between -1197 and -727 below and 370 and 682 mg/day above 24 h diet recall values over the four assessments. The 17-item 24 h food intake recall identified 8% more women with inadequate calcium intakes than the 24 h diet recall method did. Although there is poor agreement in calcium intake between the 24 h diet recall method and the 17-item 24 h food intake recall, the latter provides a quick and simple means for assessing extremes of calcium intake and whether day to day calcium intake is adequate.

The aim of this study was to investigate the impact of magnesium-enriched, high-calcium milk on serum parathyroid hormone (PTH) and biochemical markers of bone turnover in postmenopausal women. We recruited 50 healthy postmenopausal women to take part in this randomised controlled study. Half of the women consumed two serves of high-calcium skim milk enriched with magnesium (milk group) and half consumed two serves apple drink per day (apple group), each for 4 weeks. The milk provided 1200 mg calcium and an additional 106 mg magnesium. We investigated the responses of serum PTH, as well as the serum and urinary calcium, magnesium and biochemical markers of bone turnover. There was no effect of time or drink on the clinical biochemistry, serum PTH or urine markers of bone resorption (free deoxypyridinoline and N-telopeptides). Serum C-telopeptides (CTX), another marker of bone resorption, did not change with time in the apple group. However, in the milk group, serum CTX deceased significantly from 0.43 +/- 0.04 ng/mL to 0.32 +/- 0.02 at 2 weeks (p < 0.0001) and 0.28 +/- 0.02 at 4 weeks (p < 0.0001). In the milk group, urinary calcium and magnesium each increased during the night but not during the day. Overall, these data suggest that milk has an antiresorptive effect on bone, but that this is not accompanied by measurable changes in serum PTH.

We evaluated the impact of wearing an ambulatory blood pressure (ABP) monitor on the usual daily activity of 16 healthy men and women. Daily ABP and heart rate (HR) were recorded on 2 days using the DynaPulse 5000 A system. Daily HR and activity were recorded on two further days using a dedicated HR monitoring system. All four sets of measurements were made for 8 h during which time the volunteers kept a simultaneous diary record of their physical activity. There was no detectable difference in physical activity records on any day. Mean daily HR was lower during ABP monitoring than during the dedicated HR monitoring carried out on different occasions (73+/-7 versus 81+/-7 beats min(-1), P<0.001). The lower mean HR observed during ABP monitoring compared with dedicated HR monitoring may reflect subtle differences in the physical behaviour of subjects being monitored, which could not be detected from the diary records.

The frequency of Shiga toxin-producing Escherichia coli (STEC) serotypes associated with postdiarrheal hemolytic uremic syndrome (HUS) cases among children and adults in the United States and the proportion with IgM or IgG lipopolysaccharide antibodies to E. coli O157 were determined by use of a nationwide sample from January 1987 through December 1991. Among 83 patients, STEC were isolated from 30 (43%) of 70 whose stool cultures yielded bacterial growth (25 E. coli O157 isolates and 5 non-O157 STEC isolates). Fifty-three (80%) of 66 patients with serum samples had positive O157 lipopolysaccharide antibody titers. Of the 83 patients, 60 (72%) had evidence of STEC infection, including 6 of 8 adults whose illnesses also met criteria for thrombotic thrombocytopenic purpura. Data from a subset of patients suggest that E. coli O157 was the cause of > or = 80% of the STEC infections. All 3 women who were postpartum had evidence of E. coli O157 infection. STEC infection should be considered the likely cause for all persons with postdiarrheal HUS.

The aim of this study was to assess the awareness of national health promotion messages in a group of self-selected New Zealanders. This study involved 104 self-selected New Zealanders (41 men and 63 women) over the age of 40. Awareness of national health promotion messages was assessed using a mailed out questionnaire, and 69 of these were returned. Basic anthropometric measurements were made (height, weight, hip and waist circumference) and habitual physical activity was defined using a questionnaire. Food intake was estimated by 24-h dietary recall. Overall, this group of people met the New Zealand national guidelines for exercise, physical activity and food intake. There was good awareness of the public health organisations in New Zealand, but only half the people that we sampled had a general idea about the content of the health messages of these organisations. This group of New Zealand adults had a healthy lifestyle that was not associated with a high awareness of public health messages, suggesting that other sources of health information are used.

Objective: To describe a family cluster of Shiga toxin-producing Escherichia coli O111ac:NM infection., Study Design: The index case was identified as part of a United States prospective study of hemolytic-uremic syndrome. Epidemiologic investigation was conducted through interviews. E. coli O111:NM infection was characterized through culture and serology. Shiga toxin 1 and 2 gene sequences were determined with oligonucleotide DNA probes., Results: All three children and both parents had nonbloody diarrhea, vomiting and abdominal cramps, and one child developed hemolytic-uremic syndrome. Shiga toxin 1- and 2-producing E. coli O111ac:NM was isolated from two children. IgG antibodies to E. coli O111 were detected in all three children., Conclusions: To our knowledge this is the first reported cluster of O111 infection and only the second caused by non-O157 Shiga toxin-producing E. coli in North America.

Epidermal growth factor family members are widely expressed in human breast cancer and are thought to play an important dual role in mammary gland development and tumorigenesis. Overexpression of two relatively new members of this family, amphiregulin (AR) and Cripto-1 (CR-1), has been previously shown to transform immortalized human and mouse mammary epithelial cells. Here, we extend these results and address the disregulated expression of AR and CR-1 in many types of transgenic neoplastic mouse mammary tissues. Transgenic mouse strains overexpressing the oncogenes transforming growth factor-alpha, neu, int-3, polyoma virus middle T antigen, and simian virus 40 large T antigen have been previously shown to develop spontaneous mammary neoplasia. These models were each examined for mammary-tumor expression of AR and CR-1 by reverse transcription-polymerase chain reaction, western blot, and immunocytochemical analyses. Mammary tumors from each source expressed AR and CR-1. Western blot analysis revealed that, in all mammary tumors, AR and CR-1 protein species were processed differently than in virgin and lactating mouse mammary tissue. In addition, immunohistochemical detection of AR and CR-1 in tumor tissue revealed different patterns of growth-factor localization in different types of transgenic mouse mammary-derived tumors. These findings are consistent with the possibility of widespread roles for AR and CR-1 in the promotion and/or progression stages of mouse mammary tumorigenesis.

Two hundred thirty-three isolates of Escherichia coli O157:H7 were analyzed by both pulsed-field gel electrophoresis (PFGE) and bacteriophage typing. All 26 isolates from persons whose illness was associated with a recent multistate outbreak of E. coli O157:H7 infections linked to the consumption of undercooked hamburgers and all 27 isolates from incriminated lots of hamburger meat had the same phage type and the same PFGE pattern. Twenty-five of 74 E. coli O157:H7 isolates from Washington State and 10 of 27 isolates from other states obtained during the 6 months before the outbreak had the same phage type as the outbreak strain, but only 1 isolate had the same PFGE pattern. PFGE thus appeared to be a more sensitive method than bacteriophage typing for distinguishing outbreak and non-outbreak-related strains. The PFGE patterns of seven preoutbreak sporadic isolates and five sporadic isolates from the outbreak period differed from that of the outbreak strain by a single band, making it difficult to identify these isolates as outbreak or non-outbreak related. Phage typing and PFGE with additional enzymes were helpful in resolving this problem. While not as sensitive as PFGE, phage typing was helpful in interpreting PFGE data and could have been used as a simple, rapid screen to eliminate the need for performing PFGE on unrelated isolates.

The resting energy expenditure (REE) and substrate oxidation rates in 16 patients with cystic fibrosis who had mild chest disease and 11 healthy controls were measured using indirect calorimetry. The mean REE (% predicted) in the patients with cystic fibrosis was 11% greater than in the controls. Five patients with cystic fibrosis were hypermetabolic but only one of these had a clinically significant reduction of respiratory function. A greater proportion of REE was derived from carbohydrate oxidation in the cystic fibrosis patients (43.5% v 29.9%). However, the 24 hour dietary intake of carbohydrate was greater in the cystic fibrosis group (49.6 v 45.8% of energy intake). These data suggest that a high dietary intake of carbohydrate may contribute to the increased oxidation of carbohydrate in these cystic fibrosis patients. All patients with cystic fibrosis, including those with apparently mild lung disease, should continue to receive a high energy diet.

In twenty-eight healthy subjects, ten men and eighteen women, with a range in body mass index (BMI) of 17.9-31.6 kg/m2 and an age range 20-60 years, body composition was estimated by dual-energy X-ray absorptiometry (DEXA), skinfold anthropometry (SFA) and bioelectrical impedance analysis (BIA) of the 'whole body' and body segments. In thirteen subjects muscle mass was also estimated by 24 h urinary creatinine excretion. The relationship between fat-free mass (FFM) determined by DEXA and the impedance index of each body segment (calculated as length2/impedance (Z)) was analysed. The strongest correlation was between FFM (DEXA) and height2/'whole-body' Z (ZW) (r 0.97 for the combined sexes, standard error of estimate (SEE) 2.72 kg). Separate prediction equations were found to be necessary for males and females when estimating FFM from BIA measurement of the arm (for men, r 0.93, SEE 1.98 kg; for women, r 0.75, SEE 2.87 kg). Muscle mass derived from 24 h creatinine excretion showed weak correlation with FFM (DEXA) (r 0.57, P = 0.03) and no correlation with FFM (SFA). FFM (SFA) correlated well with both FFM (DEXA) (r 0.96, SEE = 3.12 kg) and with height2/ZW (r 0.92, SEE 4.52 kg). Measurement of the impedance of the arm offers a simple method of assessing the composition of the whole body in normal individuals, and it appears comparable with other methods of assessment.

1. Some patients with the emphysematous type of tobacco-related chronic obstructive pulmonary disease are hypermetabolic. Since the likely mechanism is the increased work of breathing, other groups of patients with chronic obstructive pulmonary disease should be similar. We have now measured basal metabolic rate and diet-induced thermogenesis in six patients with chronic obstructive pulmonary disease with an arterial partial pressure of CO2 of less than 5 kPa (emphysematous), nine patients with chronic obstructive pulmonary disease with an arterial partial pressure of CO2 of greater than 6 kPa (bronchitic), eight patients with chronic obstructive pulmonary disease due to chronic asthma and seven control subjects. Diet-induced thermogenesis was measured for 4h after a meal of 87% carbohydrate, 11% protein and 2% fat as energy, with a total energy content of 40% of basal metabolic rate. 2. There was no difference between measured and predicted basal metabolic rate in the control (5541 +/- 272 versus 5881 +/- 245 kJ/24h) or emphysematous (5552 +/- 370 versus 6239 +/- 197 kJ/24h) groups, but measured basal metabolic rate was significantly higher than predicted in the bronchitic (6126 +/- 387 versus 5405 +/- 250 kJ/24h) and asthmatic (6293 +/- 197 versus 5701 + 245, mean +/- SEM, P less than 0.01) groups. All the control subjects had measured basal metabolic rates within 10% of predicted, whereas two out of six emphysematous patients, four out of nine bronchitic patients and five out of eight asthmatic patients were hypermetabolic. The contributions of fat, carbohydrate and protein oxidation rates to the overall basal metabolic rate were similar between groups. 3. Diet-induced thermogenesis was similar between groups.(ABSTRACT TRUNCATED AT 250 WORDS)

The healthy small intestine plays a vital role in the absorption of fluid, electrolytes, and nutrients. This function is severely compromised after surgical resection, although the remaining gut has a large capacity for adaptation. The nature of the nutritional support offered to patients with short-bowel syndrome depends on the length and site of small intestine resected, time after surgery, underlying disease, and nutritional status of the patient. If sufficient gut remains, oral supplementation is the treatment of choice, but attention must be given to potential malabsorption, particularly of micronutrients. Oral feeding is perhaps the most important means of promoting intestinal adaptation, which can be much delayed. Inevitably, some patients will not be able to tolerate or thrive on oral nutrition, and these few may need to resort to intravenous feeding support. This approach is often considerably challenging and should be managed only by those with expertise, because numerous and sometimes significant difficulties can be encountered.

Most babies treated with dexamethasone for bronchopulmonary dysplasia exhibit an appreciable rise in the blood urea concentration, from a mean of 2.3 mmol/l before steroid to a mean of 7.1 mmol/l after. In order to discover whether this was primarily the result of increased protein catabolism, nitrogen balance studies before and after the start of dexamethasone were performed and a mean deficit in nitrogen retention of 158 mg/kg/24 hours was found. Similarly the urinary 3-methylhistidine (3MH):creatinine ratio before and after the commencement of dexamethasone treatment in a group of preterm babies was measured. It was found that there was a substantial increase in 3MH excretion after dexamethasone: from a mean 3MH:creatinine ratio of 46 in the week before steroids to a mean ratio of 77 in the week after. As 3MH emanates almost exclusively from the breakdown of actin in skeletal muscle cell, this finding implies the loss of muscle tissue. It was also found that the babies were in less positive nitrogen balance after dexamethasone, to a degree which is significant relative to their protein reserves. The long term consequences of a period of increased catabolism are not yet known but the authors suggest caution in the use of dexamethasone, at least in babies with milder degrees of bronchopulmonary dysplasia in whom the ratio of benefit to risk may be less favourable.

Wasting is common in end-stage primary biliary cirrhosis and causes concern in patients facing liver transplantation. We have quantified resting metabolic rate and diet-induced thermogenesis in seven patients with primary biliary cirrhosis, in seven patients after liver transplantation who had previously been diagnosed as having primary biliary cirrhosis and in seven controls. Resting metabolic rate was elevated in the primary biliary cirrhosis group (4.44 +/- 0.81 kJ/hr/kg body wt; mean +/- S.D.) compared with the post-liver-transplantation group (3.39 +/- 0.40 kJ/hr/kg body wt) (p less than 0.005) and compared with control subjects (3.65 +/- 0.23 kJ/hr/kg body wt) (p less than 0.01). A highly significant relationship was found between the severity of liver disease in the primary biliary cirrhosis group, as assessed by Child-Pugh score, and the resting metabolic rate group (r = 0.93; p less than 0.005). After a liquid meal (41 kJ/kg body wt), the metabolic rate increased, with similar peak changes from baseline occurring in all three groups. However, the rise persisted significantly longer in the primary biliary cirrhosis patients, and thus the integrated mean postprandial energy expenditure over the 4-hr postprandial observation period was greater in the primary biliary cirrhosis group than in the other two groups (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)