Economic analysis of prenatal fetoscopic vs open-hysterotomy repair of open neural tube defect.

OBJECTIVE: Fetal repair of an open neural tube defect (ONTD) by open hysterotomy has been shown to reduce the need for ventriculoperitoneal shunting and improve motor outcomes for infants, but increases the risk of Cesarean section and prematurity. Fetoscopic repair is an alternative approach that may confer similar neurological benefits but allows for vaginal delivery and reduces the incidence of hysterotomy-related complications. We sought to compare the costs of care from fetal surgery until neonatal discharge, as well as the clinical outcomes, associated with each surgical approach. METHODS: This was a retrospective cohort study of patients who underwent prenatal ONTD repair, using either the open-hysterotomy or the fetoscopic approach, at a single institution between 2012 and 2018. Clinical outcomes were collected by chart review. A cost-consequence analysis was conducted from the hospital perspective, and included all inpatient and ambulatory hospital and physician costs incurred for the care of mothers and their infants, from the time of maternal admission for fetal ONTD repair up to postnatal maternal and infant discharge. Costs were estimated using cost-to-charge ratios for hospital billing and the Medicare physician fee schedule for physician billing. RESULTS: Seventy-eight patients were included in the analysis, of whom 47 underwent fetoscopic repair and 31 underwent open-hysterotomy repair. In the fetoscopic-repair group, compared with the open-repair group, fewer women underwent Cesarean section (53% vs 100%; P < 0.001) and the median gestational age at birth was significantly higher (38.1 weeks (interquartile range (IQR), 35.2-39.1 weeks) vs 35.7 weeks (IQR, 33.9-37.0 weeks); P < 0.001). No case of uterine dehiscence was observed in the fetoscopic-repair group, compared with an incidence of 16% in the open-repair group. After adjusting for baseline characteristics, there was no significant difference in the total cost of care between the fetoscopic-repair and the open-repair groups (median, $76 978 (IQR, $60 312-$115 386) vs $65 103 (IQR, $57 758-$108 103); P = 0.458). CONCLUSIONS: Fetoscopic repair of ONTD, when compared with the open-hysterotomy approach, reduces the incidence of Cesarean section and preterm delivery with no significant difference in total costs of care from surgery to infant discharge. This novel approach may represent a cost-effective alternative to improve maternal and neonatal outcomes for this high-risk population. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Morphometric characterization and differentiation of West African Dwarf goat populations in Ghana.

A study was carried out to characterize and differentiate four West African Dwarf goat populations on the basis of morphometric traits and also predict their body weights using linear body measurements. A total of 384 goats were sampled from four agro-ecological zones from the middle belt and southern part of Ghana. The morphometric traits examined for phenotypic differentiation using univariate and multivariate analysis were body weight, body length, withers height, chest girth, chest depth, shoulder point width, rump length, rump width, head length, head width, shin circumference, horn length, ear length, tail length, and hair length. Results obtained showed that agro-ecological zone and age significantly (p < 0.05) influenced the performance of most traits. The phenotypic correlations among the traits were low to high (0.06-0.67) indicating linear relationships among these traits which may be caused by both genetic and environmental factors. The regression analysis also revealed that a single trait which may be used to predict the body weight of male West African Dwarf goats of ages 1-4 years is chest/heart girth and that of female counterparts is withers height. All the populations were significantly (p < 0.0001) distant (differentiated) from each other, but the largest (4.62) estimated Mahalanobis distance (D2) was between West African Dwarf goat populations in the transitional zone P1 and the rainforest P3 while the least (1.61) was observed between transitional zone P1 and semi-deciduous forest zone P2. The highest similarity between individuals within population was found in the rainforest P3 (79.76%) and the lowest in the transitional zone P1 (47.13%). The three canonical components (Can1, Can2, and Can3) explained the total (100%) between-population variation in morphometric traits. However, in partitioning of the variance, the first two canonical components (Can1 and Can2) accounted for cumulative proportion of 84.35% of between-population variance. In order of importance, tail length, head length, ear length, shin circumference, head width, and shoulder point width were the most discriminating variables responsible for the variations among the four goat populations. In conclusion, morphometric variations exist among West African Dwarf goat populations of Ghana. Yet, further studies on molecular genetic diversity of the populations are recommended to support a sustainable breed improvement strategy. Also, equations have been developed that can be used to reliably predict the body weight of WAD goats and future research should also focus on developing single variable weight estimator measuring tapes based only on either the chest girth, withers height, or body length prediction equations for farmers to use in the absence of weighing scale.

Characteristics and trait preferences of West African Dwarf goat keepers in Ghana.

A study was conducted to evaluate the characteristics of West African Dwarf (WAD) goat keepers and their trait preferences as part of a broader phenotypic characterisation work with the aim of providing information for improving the household management, conservation and productivity of the breed in Ghana. A total of 384 respondent households were selected from four agro-ecological zones in the middle belt and southern part of the country for questionnaire administration and direct observation of animals under field conditions. The results showed that there are slightly more women (54.2%) keeping WAD goats than men (45.8%) and fall within the economically active population of youthful and middle age categories (53.9%). A majority of these goat keepers were married (73.8%) and educated (87.3%) in one way or the other. They obtained their starter or foundation stock mainly from neighbours (80.5%) and the open market (16.0%). The average flock size from the households sampled was 7.9 ± 1.5, whereas the flock structure constituted 56.1% adult females, 27.5% adult intact males, 1.2% castrates and 15.2% kids of both sexes. Survivability, fast growth rate and larger litter size were the farmers' most preferred quantitative traits, whereas most of these respondents preferred to keep WAD goats which do not have qualitative traits such as horn, wattle and beard. From the findings of the research, it was concluded that the favourable socio-economic characteristics of WAD goat keepers could sustain intensification and increase the productivity of the breed when given the necessary input assistance along the goat value chain. The primary objective of WAD goat farmers is to produce matured animals for various purposes and the breeding goal for a WAD goat breeding programme would be to increase survival, growth rate and litter size of light coat (white, grey and light brown) goats. Finally, most farmers lack knowledge on the significance of tropically beneficial qualitative traits such as horn, wattle, beard and light coat colouration on the survivability, climate adaptability or resilience and productivity of their goats. Educating farmers on the importance of conserving and inclusion of animals possessing such traits in their selection practices under the Government's Rearing for Food and Jobs Initiative is therefore suggested.

Genetic and non-genetic factors influencing the performance of the West African Dwarf (WAD) goat kept at the Kintampo Goat Breeding Station of Ghana.

A study was conducted to analyze the effect of genetic and non-genetic factors influencing the growth performance of the West African Dwarf goat. Breed records of 836 kids born by 259 does, and 8 bucks from 2011 to 2017 at the station were used. Growth performance traits studied were birth weight, weaning weight, 6-month body weight, 9-month body weight, yearling weight, and pre-weaning and post-weaning growth rates. The fixed effects of sex of kid (male or female), season of kidding (major, minor, and dry), year of kidding (2011-2017), and type of birth (single, twins, or triplets) on growth performance were determined. Genetic parameters such as heritability and correlations among the traits were also estimated. The non-genetic data (fixed factors) obtained were analyzed using the general linear model procedures of GenStat (Discovery Edition 12). Heritability estimates obtained for the growth traits were 0.45 ± 0.15, 0.57 ± 0.29, 0.04 ± 0.05, 0.74 ± 0.59, 0.49 ± 0.35, 0.55 ± 0.39, and 0.54 ± 0.36, respectively, an indication of high genetic variation existing among the traits (with the exception of 6-month body weight). This could be harnessed and utilized for genetic improvement within the flock. The phenotypic correlation coefficients among the traits ranged from low to high (0.04-0.95), indicating that there is a linear relationship among body traits of the goats which may be caused by either genetic or environmental factors of correlation. The genetic correlations were also medium to high (0.30-0.96). The general implications are that selection for any of these growth traits in a breed improvement programme would have a considerable simultaneous positive impact on each other. The overall birth weight, weaning weight, 6-month body weight, 9-month body weight, yearling weight, and pre- and post-weaning growth rates obtained were 1.48 kg, 5.35 kg, 6.56 kg, 8.30 kg, 10.00 kg, 32.26 g/day, and 19.39 g/day, respectively. These growth performances were found to be significantly influenced by the non-genetic factors studied. There is therefore the need to factor these in future breed improvement programmes to ensure their success.

Sun exposure of indoor workers in the UK - survey on the time spent outdoors.

Assessment of ultraviolet (UV) exposure is essential for evaluation of the risks and benefits to optimise public health outcomes. The exposure depends on available environmental UV radiation and individual behaviour, and it can be obtained from dosimetry studies; however, the use of dosimeters is often not feasible for large population groups or over long periods of time. In this study, a lifestyle questionnaire has been used to obtain information on the time spent outdoors by indoor workers that could be used in combination with dosimetry studies in smaller targeted groups to quantify UV exposure for health risk/benefit analysis. 894 office and laboratory workers at the Public Health England, UK, responded to the survey. Questions addressed the time of day and the duration of time; staff were outdoors on weekdays, at weekends and during holidays. The majority of the responders spent negligible time outdoors on weekdays. Outdoor activities before and after work were constrained by the work pattern and commuting. The average time for those who go outdoors before and after commuting was 22.5 ± 16.2 min and 30.4 ± 21.4 min, respectively. Only 7% of participants regularly spent their lunch break outdoors for 21.5 ± 12.2 min and weekday exposure may contribute less than 13% of the daily available erythema dose. At the weekend, on average responders spend 5.0 ± 2.6 h outdoors over the two days: if taken around midday, it accounts for approximately 50% of available UV exposure. In winter months in the UK, November to March, the combination of very low environmental UV and low ambient temperatures results in negligible UV exposure. Holidays contributed to the majority of the annual UV exposure. In summer, 45% of responders went to destinations where the UV levels may be up to 2 times higher than in the UK; durations of overseas holidays are also longer than UK breaks. The UV dose from two weeks of holiday in extreme UV index level destinations could be comparable to a 1.5-2 summer months holiday in the UK. The survey data were validated with 6 months of dosimetry within the same cohort; very strong and strong correlation was found between the survey and measurements. This shows that a lifestyle survey can be used in combination with targeted dosimetry studies in small groups to obtain information about the time spent outdoors.

The effects of breed, season and parity on the reproductive performance of pigs reared under hot and humid environments.

A research aimed at evaluating the reproductive performance of pigs as influenced by breed, season, and parity was carried out. Reproductive performance records of 1383 sows made up of 204 primiparous and 1179 multiparous large white (687) and Duroc × large white crosses (696) obtained over a 3-year period (2013 to 2016) were used. Data on reproductive performance taken were farrowing rate, litter size at birth and at weaning, piglet weight at birth and at weaning farrowing interval and pre-weaning mortality. To determine the effect of season, parity and breed on reproductive performance, the 4-way analysis of variance (ANOVA) was used. A mixed model was fitted using the generalized linear model (GLM) procedure of the GenStat (Discovery Edition) to investigate the fixed effects of breed (two classes), season of birth (three classes) and parity (five classes) on the reproductive traits. Where differences in means were observed, the means were separated using the least significant difference at 5% level of significance. Results obtained indicated litter size at birth of 12.5 ± 0.3 and 14.2 ± 0.5 for the large white and the Duroc × large white respectively and farrowing rates of 90.0 ± 2.3 and 94.5 ± 2.5% for the large white and the Duroc × large white respectively. Litter size at birth and at weaning, farrowing rate and piglet weight at birth were all influenced by parity and season with increasing parity significantly reducing litter size at birth and at weaning. Reproductive traits of the sows were superior during the rainy season, an indication of the need to consider season of birth in making decision.

Long term variations in erythema effective solar UV at Chilton, UK, from 1991 to 2015.

In this paper erythema effective UV radiant exposure data from the PHE solar network Chilton site for the 25 year period from 1991 to 2015 are presented. The year with the highest average daily erythema effective radiant exposure was 2003 at 1577 J m-2 and the year with the lowest average daily radiant exposure was 2010 at 1149 J m-2. Overall, the average daily radiant exposure per year ranged from 5655 J m-2 to 9.98 J m-2 with the average being 1306 J m-2. A preliminary analysis of the data set is carried out. A statistically significant (p = 0.01) increase in annual radiant exposure of 4.4% per year was observed from 1991-1995. Thereafter a small decrease in annual erythema effective radiant exposure of 0.8% (p = 0.002) per year was observed from 1995-2015 with a slightly faster rate of decrease from 2000-2015 of 1.0% (p = 0.007) per year. In terms of seasonal analyses, a statistically significant increase in erythema effective UV radiant exposure of 5.1% (p = 0.02) per year in the summer during 1991-1995 has been found along with small decreases in spring and summer during 1995-2015 (-1.0%; p = 0.01 and -0.7%; p = 0.01 respectively) and 2000-2015 (-1.1%; p = 0.03 and -1.2%; p = 0.003 respectively). The data suggest that the erythema effective UV dose available for impacting public health has been decreasing in recent years.

Immunological profiling in chronic rhinosinusitis with nasal polyps reveals distinct VEGF and GM-CSF signatures during symptomatic exacerbations.

BACKGROUND: The mechanisms and immune pathways associated with chronic rhinosinusitis (CRS) are not fully understood. Immunological changes during acute exacerbation of CRS may provide valuable clues to the pathogenesis and perpetuation of the disease. OBJECTIVE: To characterize local and systemic immune responses associated with acute worsening of sinonasal symptoms during exacerbation in CRS with nasal polyps (CRSwNP) compared to controls. METHODS: This was a non-interventional prospective study of individuals with CRSwNP and normal controls. Subjects underwent a baseline visit with collection of nasal secretions, nasal washes, and serum specimens. Within 3 days of acute worsening of sinonasal symptoms, subjects underwent a study visit, followed by a post-visit 2 weeks later. The sinonasal outcome test-22 (SNOT-22) scores and immunological parameters in the specimens were analysed using a novel, unsupervised learning method and by conventional univariate analysis. RESULTS: Both CRSwNP patients and control subjects showed a significant increase in SNOT-22 scores during acute exacerbation. Increased nasal levels of IL-6, IL-5, and eosinophil major basic protein were observed in CRSwNP patients. A network analysis of serum specimens revealed changes in a set of immunological parameters, which are distinctly associated with CRSwNP but not with controls. In particular, systemic increases in VEGF and GM-CSF levels were notable and were validated by a conventional analysis. CONCLUSIONS: CRSwNP patients demonstrate distinct immunological changes locally and systemically during acute exacerbation. Growth factors VEGF and GM-CSF may be involved in the immunopathogenesis of subjects with CRS and nasal polyps experiencing exacerbation.

The risk of asthma exacerbation after reducing inhaled corticosteroids: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Asthma guidelines suggest reducing controller medications when asthma is stable. METHODS: The purpose of the study is to estimate the risk of asthma exacerbation in stable asthmatics who reduce inhaled corticosteroids (ICS) compared to those who maintain a stable ICS dose. We identified articles from a systematic review of English and non-English articles using MEDLINE, EMBASE, Web of Science, and CENTRAL (inception to May 25, 2013). We included randomized controlled trials (RCTs) with a stable asthma run-in period of 4 weeks or more, an intervention to reduce ICS, and a follow-up period of at least 3 months. RESULTS: The search strategy identified 2253 potential articles, of which 206 were reviewed at the full-text level and 6 met criteria for inclusion. The relative risk of an asthma exacerbation in individuals who reduced ICS compared to those who maintained the same ICS dose was 1.25 (95% CI 0.96, 1.62; P = 0.10; I(2)  = 0%) in studies with a mean follow-up of 22 weeks. Individuals who reduced ICS had a decreased% predicted FEV1 of 0.87% (95% CI -1.58%,3.33%; P = 0.49, I(2)  = 58%) and a decreased mean morning peak expiratory flow of 9.57 l/min (95% CI 1.25, 17.90; P = 0.02; I(2)  = 74%) compared to those individuals who maintained a stable ICS dose. CONCLUSIONS: Asthma exacerbations were statistically no more likely among individuals who reduced ICS compared to those who maintained their ICS dose, supporting current guidelines which recommend decreasing ICS by 50% after a period of asthma stability.

Growth performance of crossbred naked neck and normal feathered laying hens kept in tropical villages.

1. Two experiments were conducted to develop naked neck (Na/na) and normal feathered (na/na) crossbreds and compare their growth performance, linear body measurements and carcass characteristics in the first and second filial generations. 2. In the first experiment, 4 indigenous naked neck males (Na/na) were mated to 36 Lohmann commercial females (na/na) in a ratio of 1:9. The two genotypes (Na/na, na/na) were allocated randomly according to batches of hatch, sire lines and sex to three different villages. 3. In the second experiment, 10 males and 100 females of F1 Na/na birds were selected and mated inter se in a ratio of 1:10. The three genotypes (Na/Na, Na/na and na/na) were compared in a randomised complete block design experiment, with the three villages, hatch and sex as blocks and the three genotypes as treatments. F1 Na/na birds had significantly higher (P < 0.05) feed conversion ratio, body weight, body weight gain, linear body measurements, survivability and carcass yield than their na/na counterparts. 4. In the F2 generation, Na/Na and Na/na birds had significantly higher (P < 0.05) feed conversion ratio, body weight, body weight gain, linear body measurements, survivability and carcass yield compared to their na/na counterparts. 5. The birds showing the naked neck phenotype appeared to show superior performance compared to normal feathered birds and could be exploited for potential utilisation in local poultry production.

Effect of the frizzle gene (F) on egg production and egg quality of laying hens kept in tropical villages.

1. Two experiments were conducted to determine the influence of the frizzle gene (F) on the production and quality of chicken eggs kept on village farms in Ghana. 2. In the first experiment, 144 pullets, 72 each of Ff and ff pullets from F1 birds, were compared in a randomised complete block design (RCBD), with three villages and 4 batches of hatch as blocks and the two feather genotypes (Ff and ff) as the treatments. 3. The Ff pullets were superior (P < 0.05) to their ff counterparts in terms of the number of eggs per clutch, egg mass and hen-housed and hen-d rates of lay, whereas age at first egg was lower (P < 0.05) in ff layers compared to Ff ones. 4. The eggs of the F1 heterozygous frizzle (Ff) layers had higher values for albumen height, Haugh unit and yolk height compared with eggs from their normal feathered counterparts. 5. In the second experiment, 144 pullets, 48 each of FF, Ff and ff pullets, were compared in a RCBD, with three villages and 4 batches of hatch as blocks and the two feather genotypes (Ff and ff) as the treatments. 6. The F2 birds with genotypes Ff and FF were better than their ff counterparts in terms of the number of eggs per clutch, egg mass, and hen-housed and hen-d rates of lay. Age at first egg was significantly lower in ff layers compared to FF and Ff ones. 7. The Haugh unit value was higher in the homozygous and heterozygous frizzles compared to the normal feathered ones. 8. The presence of the frizzle gene (F) in egg type chickens led to an improvement in egg production and egg quality traits in village chickens, and the cross-breeding scheme evaluated in this project could contribute to improved productivity.

A systematic, genome-wide, phenotype-driven mutagenesis programme for gene function studies in the mouse.

As the human genome project approaches completion, the challenge for mammalian geneticists is to develop approaches for the systematic determination of mammalian gene function. Mouse mutagenesis will be a key element of studies of gene function. Phenotype-driven approaches using the chemical mutagen ethylnitrosourea (ENU) represent a potentially efficient route for the generation of large numbers of mutant mice that can be screened for novel phenotypes. The advantage of this approach is that, in assessing gene function, no a priori assumptions are made about the genes involved in any pathway. Phenotype-driven mutagenesis is thus an effective method for the identification of novel genes and pathways. We have undertaken a genome-wide, phenotype-driven screen for dominant mutations in the mouse. We generated and screened over 26,000 mice, and recovered some 500 new mouse mutants. Our work, along with the programme reported in the accompanying paper, has led to a substantial increase in the mouse mutant resource and represents a first step towards systematic studies of gene function in mammalian genetics.

Evaluation of correlation between dose and clinical outcomes in subcutaneous immunoglobulin replacement therapy.

The importance of serum immunoglobulin (Ig)G concentration in IgG replacement therapy for primary immunodeficiency diseases is established in certain settings. Generally, IgG is infused via the intravenous (IVIG) or subcutaneous (SCIG) route. For IVIG infusion, published data demonstrate that higher IgG doses and trough levels provide patients with improved protection from infection. The same conclusions are not yet accepted for SCIG; data from two recent Phase III studies and a recent post-hoc analysis, however, suggest the same correlation between higher SCIG dose and serum IgG concentration and decreased incidence of infection seen with IVIG. Other measures of clinical efficacy have not been considered similarly. Thus, combined analyses of these and other published SCIG studies were performed; a full comparison of the 13 studies was, however, limited by non-standardized definitions and reporting. Despite these limitations, our analyses indicate that certain clinical outcomes improve at higher SCIG doses and associated higher serum IgG concentrations, and suggest that there might be opportunity to improve patient outcomes via SCIG dose adjustment.

Safety of light emitting diodes in toys.

Light emitting diodes (LEDs) are increasingly being used in toys. An assessment methodology is described for determining the accessible emission limits for the optical radiation from the toys, which takes account of expected use and reasonably foreseeable misuse of toys. Where data are available, it may be possible to assess the toy from the data sheet alone. If this information is not available, a simple measurement protocol is proposed.

[Mortality risk of cardiovascular diseases for occupationally exposed workers].

Results of the risk analysis of mortality from ischemic heart disease (IHD) in the cohort of Mayak nuclear workers (18763 individuals) first employed in 1948-1972, with follow-up to 31.12.2005, were summarized. The mortality risk of IHD in the cohort of Mayak workers depended on the non-radiation factors such as gender, age, calendar period, smoking, alcohol consumption, arterial hypertension, body mass index. There was no statistically significant relationship between mortality from 1HD and total external dose. The risk of mortality from IHD was significantly higher for workers exposed to the total absorbed dose to liver > 0.025 Gy from internal alpha-radiation. There was a significantly increasing trend (ERR/Gy) of the IHD mortality with the total absorbed dose to liver from internal alpha-radiation due to incorporated plutonium. However, there was a decreasing trend of ERR/Gy with restriction of the follow-up to Ozyorsk and adjustment for the external dose.

[Risk of cerebrovascular disease incidence in the cohort of Mayak production association workers first employed during 1948-1958].

Incidence of cerebrovascular diseases (CVD) has been studied in a cohort of 12210 workers first employed at one of the main plants (reactors, radiochemical or plutonium) of the Mayak nuclear facility during 1948-1958 and followed up to the end of 2000. Information on external gamma doses is available for virtually all (99.9%) of these workers; the mean (+/- one standard deviation) total gamma dose was 0.91 +/- 0.95 Gy (99% percentile 3.9 Gy) for men and 0.65 +/- 0.75 Gy (99% percentile 2.99 Gy) for women. Plutonium body burden was measured only for 30.0% of workers. Amongst those monitored, the mean (+/- standard deviation) cumulative liver dose from plutonium alpha exposure was 0.40 +/- 1.15 Gy (99% percentile 5.88 Gy) for men and 0.81 +/- 4.60 Gy (99% percentile 15.95 Gy) for women 4418 cases (first diagnosis) of CVD were identified in the studied cohort. A statistically significant increasing trend in CVD incidence with total external gamma dose was revealed after adjustment for non-radiation factors and internal exposure from incorporated plutonium-239. Excess relative risk per Gy was 0.464 (95% confidence interval 0.360-0.567). Incidence of CVD was statistically significantly higher for the workers chronically exposed to external gamma rays at a dose above 1.0 Gy A statistically significant increasing trend in CVD incidence with internal liver dose from plutonium alpha exposure was observed after adjustment for non-radiation factors and external exposure. ERR per Gy was 0.155 (95% confidence interval 0.075-0.235). CVD incidence was statistically significantly higher among workers with a plutonium liver dose above 0.1 Gy, although the trend estimates differed between workers at different plants. The incidence risk estimates for external radiation are generally compatible with estimates from the study of Chernobyl clean-up workers, although the incidence data point to higher risk estimates compared to those from the Japanese A-bomb survivors.

Evaluation of short-term fluoride release from fluoride varnishes.

OBJECTIVE: The aim of this study was to compare the rate of fluoride release from fluoride varnishes over a 48-hour period and ascertain the time at which a plateau occurred. This data provides clinically relevant time points to resume tooth brushing after fluoride varnish application. STUDY DESIGN: Four commercially available fluoride varnishes, Premier Enamel ProVarnish (EP), Colgate PreviDent (CP), Omni Vanish (OV) and Omni VanishXT (OVXT) were applied on 40 extracted permanent human teeth. Ten teeth served as controls. The teeth were immersed in artificial saliva. At 1, 2, 4, 8, 12, 24 and 48 hours, the teeth were sequentially transferred to new vials. TISAB III and ion selective electrode was used to measure fluoride release. Statistical tools were used to compare the rates of fluoride release and plateau of fluoride release. RESULTS: CP, EP and OV showed a plateau of fluoride release after 4 hours. OVXT did not show a significant change in fluoride release at any time point. EP had the highest fluoride release in the first 8 hours. CONCLUSIONS: CP, EP and OV released maximum rate of fluoride release in the first 4 hours whereas OVXT did not have a plateau. The studied varnishes released different concentrations of fluoride despite the fact that they all contained 5% sodium fluoride.

Meta-analysis comparing temperature on arrival at the referral hospital of newborns with hypoxic ischemic encephalopathy cooled with a servo-controlled device versus no device during transport.

BACKGROUND: Therapeutic hypothermia reduces mortality and neurological injury for neonates with hypoxic ischemic encephalopathy (HIE). The aim of this meta-analysis is to evaluate use of servo-controlled devices during transport to the referral hospital. METHODS: PubMed and Medline (Ovid) searches were used to identify studies comparing HIE patients' temperatures on arrival at the referral hospital for those cooled with servo-controlled devices versus no device during transport. Random effects models were used to conduct a meta-analysis comparing the two groups' proportion of patients arriving in the target temperature range as well as the mean and variability in body temperature on arrival. Studies' level of evidence and risk of bias were also assessed. RESULTS: Eight published studies with total of 573 patients met the inclusion criteria, with a "B" grade of recommendation overall. A significantly higher proportion of infants cooled with a servo-controlled device arrived in the target temperature range (pooled relative risk = 2.47, 95% confidence interval: 1.46-4.17, p < 0.001). The arrival temperature in the device cooled group was on average 0.82°C lower (95% CI: 0.29-1.35°C, p = 0.002) with an 82% lower temperature variance. CONCLUSIONS: Although the predominance of observational studies and presence of some risks of bias somewhat limits the strength of recommendation, the existing research consistently indicates that using a servo-controlled device during transport of neonates with HIE increases the probability of arriving at the referral hospital in the target temperature range, with a lower body temperature and less variability. Future research is needed to investigate differences in mortality and neurological impairment.

Analysis of gene expression in two large schizophrenia cohorts identifies multiple changes associated with nerve terminal function.

Schizophrenia is a severe psychiatric disorder with a world-wide prevalence of 1%. The pathophysiology of the illness is not understood, but is thought to have a strong genetic component with some environmental influences on aetiology. To gain further insight into disease mechanism, we used microarray technology to determine the expression of over 30 000 mRNA transcripts in post-mortem tissue from a brain region associated with the pathophysiology of the disease (Brodmann area 10: anterior prefrontal cortex) in 28 schizophrenic and 23 control patients. We then compared our study (Charing Cross Hospital prospective collection) with that of an independent prefrontal cortex dataset from the Harvard Brain Bank. We report the first direct comparison between two independent studies. A total of 51 gene expression changes have been identified that are common between the schizophrenia cohorts, and 49 show the same direction of disease-associated regulation. In particular, changes were observed in gene sets associated with synaptic vesicle recycling, transmitter release and cytoskeletal dynamics. This strongly suggests multiple, small but synergistic changes in gene expression that affect nerve terminal function.

Mortality and cancer incidence following occupational radiation exposure: third analysis of the National Registry for Radiation Workers.

Mortality and cancer incidence were studied in the National Registry for Radiation Workers in, relative to earlier analyses, an enlarged cohort of 174 541 persons, with longer follow-up (to 2001) and, for the first time, cancer registration data. SMRs for all causes and all malignant neoplasms were 81 and 84 respectively, demonstrating a 'healthy worker effect'. Within the cohort, mortality and incidence from both leukaemia excluding CLL and the grouping of all malignant neoplasms excluding leukaemia increased to a statistically significant extent with increasing radiation dose. Estimates of the trend in risk with dose were similar to those for the Japanese A-bomb survivors, with 90% confidence intervals that excluded both risks more than 2-3 times greater than the A-bomb values and no raised risk. Some evidence of an increasing trend with dose in mortality from all circulatory diseases may, at least partly, be due to confounding by smoking. This analysis provides the most precise estimates to date of mortality and cancer risks following occupational radiation exposure and strengthens the evidence for raised risks from these exposures. The cancer risk estimates are consistent with values used to set radiation protection standards.