A systematic review of outcomes in postoperative pain studies in paediatric and adolescent patients: towards development of a core outcome set.

Systematic reviews of postoperative pain in children have called into question the consistency of outcomes measured by clinical triallists as well as the measurement instruments used for assessment. Core outcome set methodology may be a solution to improve standardisation. This study provides an evidence-based foundation for the development of a core outcome set for paediatric postoperative pain studies. We searched ClinicalTrials.gov to identify relevant postoperative pain studies in children. The search yielded 300 registered trials. The following data were then extracted from each of the trials: phase of trial; study type; study design; sample size; all outcomes; whether the outcome was listed as primary, secondary, or tertiary; the measurement instrument for each reported outcome; the specific metric for each outcome; and the type of clinical procedure. Following screening, 134 studies were included in our study. Pain measurement was the most commonly reported outcome (n = 123), followed by total postoperative analgesic dosage (n = 83) and side-effects (n = 25). Temporal trends indicated that pain assessment and unexpected events increased in use between 2000 and 2016, whereas postoperative analgesia measurement decreased. We found a lack of standardisation among outcomes and measurement instruments in paediatric postoperative pain studies. Development of a core outcome set may improve the quality of future trials and allow for more accurate study-to-study comparisons.

Intrapulmonary arteries respond to serotonin and adenosine triphosphate in broiler chickens susceptible to idiopathic pulmonary arterial hypertension.

This study examined factors contributing to increased vascular resistance and plexiform lesion formation in broiler chickens susceptible to idiopathic pulmonary arterial hypertension (IPAH). A diet supplemented with excess tryptophan (high-Trp diet), the precursor for serotonin, was used to accelerate the development of IPAH. Broilers fed the high-Trp diet had higher pulmonary arterial pressures than broilers fed the control diet, and plexiform lesion incidences tended to be higher (P = 0.11) in the high-Trp group than in the control group at 30 d of age. The intrapulmonary arteries were assessed for vasoconstriction in response to serotonin and adenosine triphosphate (ATP) and for activities of key metabolic enzymes for serotonin and ATP. The pulmonary artery (defined as the first major branch of the pulmonary artery inside the lung) and the primary pulmonary arterial rami (defined as the second major branch of the pulmonary artery inside the lung) both exhibited vasoconstriction in response to serotonin and ATP. This is the first study to demonstrate purinergic-mediated vasoconstriction in intrapulmonary arteries from broilers. Arteriole responsiveness did not differ between broilers fed the control diet or the high-Trp diet. Therefore, the high-Trp diet enhanced the development of IPAH but did not affect the artery's sensitivity to serotonin or ATP. Monoamine oxidase activity, responsible for the breakdown of serotonin, was severely impaired in pulmonary arteries from broilers in the high-Trp group. Accordingly, serotonin may persist longer and elicit an amplified response in broilers fed the high-Trp diet.

Helical filaments produced by a Mycoplasma-like organism associated with corn stunt disease.

Mycoplasma-like bodies with helical filaments were seen by phase contrast microscopy in juice expressed from tissues of plants infected with corn stunt agent. Each filament is bounded by a "unit membrane" and no cell wall, sheath, envelope, or second membrane has yet been discerned by electron microscopy. The association of these filaments with development of disease, their occurrence in phloem cells as seen by both freeze-etching and thin-section electron microscopy, the diagnosis of infection based on their presence in plants without symptoms, and their absence in noninfected corn are consistent with the hypothesis that these unusual filaments are formed by the mycoplasma-like organism presumed to be the corn stunt agent.

Use of geotextile tubes with chemical amendments to dewater dairy lagoon solids.

Three geo-textile filtration tubes were used to dewater lagoon solids from a first stage dairy lagoon using chemical amendments (aluminum sulfate and a polymer) to enhance the separation process. This experiment had previously been done without chemical amendment. The chemical amendments speeded the dewatering process so that filling could be accomplished sooner, and also increased the removal rate of nutrients, especially phosphorus into the solid phase. Chemically amended slurry was pumped from the lagoon into the tube with the filtered liquid seeping from the tube and returning to the lagoon. Each tube was filled five to six times at 2-5-day intervals, and then allowed to dewater for 2 weeks before sampling the solid fraction in the tube. Separation efficiency improved from 79% to 99% for phosphorous and from 92% to 100% for organic nitrogen with chemical amendment. Time required for dewatering was significantly reduced by chemical amendment. Cost for the tube was approximately $10/m(3) of recovered solids with no chemical amendment and cost including the chemicals was approximately $14/m(3) of recovered solids.

Inhibition of human breast cancer cell proliferation in tissue culture by the neuroleptic agents pimozide and thioridazine.

Permanent cell culture lines derived from human breast cancer tissue are important experimental models in the study of human breast cancer cell proliferation. In the present work, pimozide, thioridazine, W-13, and W-12 were shown to inhibit MCF-7 human breast cancer cell growth. The 50% inhibition concentration values determined in two proliferation assays, [3H]thymidine incorporation and cell number, were in close agreement for each compound tested. The order of potency for growth inhibition in the presence of 2% stripped calf serum was pimozide (Ki 2 microM) greater than thioridazine (Ki 5 microM) greater than W-13 (Ki 15 microM) greater than W-12 (Ki 39 microM). Similar concentrations of these compounds blocked estradiol-induced growth of MCF-7 cells, but estrogen receptor (ER) interactions do not seem to be involved. Pimozide and thioridazine had no effect on the estradiol binding properties of the MCF-7 ER, nor did pimozide interfere with the induction of progesterone receptors by estradiol. Furthermore, pimozide also inhibited incorporation of [3H]thymidine into MCF-7 cells stimulated by polypeptide hormones in serum-free medium. The Ki for pimozide in serum-free medium alone, 0.46 microM, was similar to that determined in the presence of insulin (0.42 microM), insulin-like growth factor I (0.54 microM), and epidermal growth factor (0.43 microM). The effects of pimozide on breast cancer cell growth were not limited to the MCF-7 cell line. Pimozide also blocked cell growth and [3H]thymidine incorporation into the ER-positive T47D and ZR75-1B human breast cancer cell lines and the ER-negative human breast cancer cell line, MDA-MB-231. Although numerous mechanisms of action of pimozide and thioridazine have been identified, both drugs are calmodulin antagonists at drug concentrations that inhibit breast cancer cell growth in vitro. Inhibition of MCF-7 cell growth by the selective calmodulin antagonists W-13 and W-12 is consistent with a role for calmodulin antagonism in the broad growth-inhibitory properties of pimozide. We conclude that pimozide and thioridazine may be useful in the control of estradiol- and polypeptide hormone-induced growth of ER-positive and ER-negative human breast tumors.

Trimethyloxonium modification of single batrachotoxin-activated sodium channels in planar bilayers. Changes in unit conductance and in block by saxitoxin and calcium.

Single batrachotoxin-activated sodium channels from rat brain were modified by trimethyloxonium (TMO) after incorporation in planar lipid bilayers. TMO modification eliminated saxitoxin (STX) sensitivity, reduced the single channel conductance by 37%, and reduced calcium block of inward sodium currents. These effects always occurred concomitantly, in an all-or-none fashion. Calcium and STX protected sodium channels from TMO modification with potencies similar to their affinities for block. Calcium inhibited STX binding to rat brain membrane vesicles and relieved toxin block of channels in bilayers, apparently by competing with STX for the toxin binding site. These results suggest that toxins, permeant cations, and blocking cations can interact with a common site on the sodium channel near the extracellular surface. It is likely that permeant cations transiently bind to this superficial site, as the first of several steps in passing inward through the channel.

Ion permeation, divalent ion block, and chemical modification of single sodium channels. Description by single- and double-occupancy rate-theory models.

Calcium ions, applied internally, externally, or symmetrically, have been used in conjunction with rate-theory modeling to explore the energy profile of the ion-conducting pore of sodium channels. The block, by extracellular and/or intracellular calcium, of sodium ion conduction through single, batrachotoxin-activated sodium channels from rat brain was studied in planar lipid bilayers. Extracellular calcium caused a reduction of inward current that was enhanced by hyperpolarization and a weaker block of outward current. Intracellular calcium reduced both outward and inward sodium current, with the block being weakly dependent on voltage and enhanced by depolarization. These results, together with the dependence of single-channel conductance on sodium concentration, and the effects of symmetrically applied calcium, were described using single- or double-occupancy, three-barrier, two-site (3B2S), or single-occupancy, 4B3S rate-theory models. There appear to be distinct outer and inner regions of the channel, easily accessed by external or internal calcium respectively, separated by a rate-limiting barrier to calcium permeation. Most of the data could be well fit by each of the models. Reducing the ion interaction energies sufficiently to allow a small but significant probability of two-ion occupancy in the 3B2S model yielded better overall fits than for either 3B2S or 4B3S models constrained to single occupancy. The outer ion-binding site of the model may represent a section of the pore in which sodium, calcium, and guanidinium toxins, such as saxitoxin or tetrodotoxin, compete. Under physiological conditions, with millimolar calcium externally, and high potassium internally, the model channels are occupied by calcium or potassium much of the time, causing a significant reduction in single-channel conductance from the value measured with sodium as the only cation species present. Sodium conductance and degree of block by external calcium are reduced by modification of single channels with the carboxyl reagent, trimethyloxonium (TMO) (Worley et al., 1986) Journal of General Physiology. 87:327-349). Elevations of only the outermost parts of the energy profiles for sodium and calcium were sufficient to account for the reductions in conductance and in efficacy of calcium block produced by TMO modification.

Fluorescence imaging in human identity testing.

We have investigated the use of fluorescence detection and the FluorImager S1 System (Molecular Dynamics) for analyzing a comprehensive set of human DNA typing tests. We used an alkaline phosphatase-conjugated YNH24 oligonucleotide probe to the repeat-containing D2S44 locus to detect both alleles in 50 ng of human genomic DNA (0.025 amol) by Southern hybridization using a chemifluorescent substrate. We used a similar approach to quantify human DNA using an enzyme-conjugated oligonucleotide probe to the D17Z1 locus. Both fluorescent nucleic acid gel staining and direct fluorescent labeling methods were tested to detect PCR-based D1S80 and short tandem repeat (STR) multiplex allele profiles. The fluorescent staining method sensitively detected these allelic profiles in both denaturing and non-denaturing acrylamide gels using a simple, 10-min procedure. Fluorescent primers eliminate the doublet band patterns often seen with staining methods, which label both strands of the amplified products. This complicates interpretation of STR typing tests. Only one primer for each locus is labeled, so only one strand of the DNA product is detected. Fluorescein end-labeled primers were used in multiplex PCR to amplify, detect and type STRs.

Block of sodium channels in planar lipid bilayers by guanidium toxins and calcium. Are the mechanisms of voltage dependence the same?

The block of single, batrachotoxin-activated sodium channels by saxitoxin (STX), tetrodotoxin (TTX), and Ca2+ has been investigated in planar bilayers. All three substances block in a voltage-dependent manner with hyperpolarizing potentials favoring block. Extracellular Ca2+ competitively inhibits binding of STX and relieves STX block. Trimethyloxonium, a carboxyl-methylating agent, eliminates block by STX and TTX and dramatically reduces block by Ca2+. These results suggest that STX, TTX, and Ca2+ compete for a negative site on the outside of the channel. The voltage dependence of block by STX (divalent cation) and TTX (monovalent) was similar (40 mV/e-fold), suggesting that voltage dependence is due to a conformational change in the channel rather than to the toxins entering the membrane electric field to block. A physical model, with an external binding site for toxins and Ca2+ and another site deeper within the electric field (associated with the "selectivity filter") that is accessible to Ca2+ but not toxins, predicts voltage-dependence Ca2+ block without invoking the conformational change needed to explain the voltage dependence of block by TTX and STX.

Physical abuse among high school students. Prevalence and correlation with other health behaviors.

OBJECTIVE: To better understand the epidemiology of physical abuse among adolescents. DESIGN: School-based survey of students in grades 9 through 12. SETTING: Twenty-five schools throughout Oregon in 1993. MAIN OUTCOME MEASURES: Prevalence of ever being physically abused, prevalence of most recent occurrence of physical abuse, and correlation of physical abuse with high-risk health behaviors. RESULTS: Of the 1957 respondents, 31.5% reported having ever been physically abused, with female subjects (34.6%) more likely than male subjects (28.0%) to have ever been abused. Overall, 3.7% of students had been physically abused in the past week, 7.8% in the past month, and 16.3% in the past year. Based on multivariate models, students physically abused in the past year were more likely than students who had never been physically abused to engage in a variety of high-risk behaviors; these included weapon carrying (odds ratio, 1.9), suicidal ideation (odds ratio, 2.1), cigarette smoking (odds ratio, 1.8), cocaine use (odds ratio, 3.2), or multiple sexual partners (odds ratio, 1.9). CONCLUSIONS: Physical abuse, an important problem among high school students, is correlated with many high-risk behaviors. Using consistent definitions, periodic surveys of children about physical abuse and other types of violent behavior are needed to provide better estimates of the extent of these problems.

Household firearm storage practices: do responses differ by whether or not individuals ever use firearms?

INTRODUCTION: The prevalence with which firearms are stored loaded or unlocked has been measured in previous surveys. Our purpose was to compare household firearm storage practices reported by firearm users and nonusers. METHODS: We analyzed telephone survey data from the 1992 and 1993 Oregon Behavioral Risk Factor Surveillance System on 2454 randomly selected adults in households with firearms. We compared reported firearm storage practices among persons who ever used firearms with persons who had never used firearms by demographics and type of firearm. RESULTS: Nonusers of firearms were much less likely than firearm users to report that household firearms were always or sometimes stored loaded [odds ratio (OR) = 0.45, 95% confidence interval (CI):0.36-0.54] or stored loaded and unlocked (OR = 0.46, 95% CI: 0.36-0.57). Except for persons aged 18 to 34 years and persons in handgun-only households, differences in reported firearm storage practices between nonusers and users varied little by demographic characteristics or by type of firearm. Nonusers of household firearms may be unaware that firearms are stored loaded or stored loaded and unlocked in their homes. CONCLUSIONS: Surveys that do not consider firearm use status may underestimate household exposure to loaded firearms or to loaded and unlocked firearms.

Using the youth risk behavior survey to estimate prevalence of sexual abuse among Oregon high school students.

To estimate the extent of childhood sexual abuse, questions were added to the 1993 Oregon Youth Risk Behavior Survey of students in grades 9-12. Twenty-five high schools throughout Oregon participated in the survey. Among the 2,332 students who answered sexual abuse questions, 20.9% had ever been sexually abused; females (33.1%) were much more likely to have ever been abused than were males (8.1%). Females (10.3%) also were more likely than males (3.4%) to have been sexually abused within the past year. High school students sexually abused in the past year engaged in many high risk health behaviors such as weapon carrying, substance abuse, seriously considering suicide in the past year, and sexual activity when compared with students who had never been sexually abused. Further educational efforts with teachers, health care providers, parents, and child care providers, as well as development and use of school curricula, are needed to reduce sexual abuse.

Reliability of three clinical measures of muscle tone in the shoulders and wrists of poststroke patients.

Muscle tone was tested at the shoulders and wrists of 49 randomly selected poststroke patients with the use of resting joint position (SJP and WJP), resistance to passive movement or stiffness (SRM and WRM), and angle of appearance of resistance (SAR and WAR). Subjects were tested while seated with their arm supported in a suspension sling adapted for free movement. Five of the first and immediately repeated measurement pairs showed strong correlations and interrater reliability (SJP, .839; WJP, .900; SRM, .886; WRM, .904; SAR, .884 [p less than .05]). The sixth (WAR) showed moderate reliability (.618, p less than .05). Resting joint position measurements were most reliable among subjects with higher tone. The joint first measured had a slight order effect on SRM among subjects with higher muscle tone. Its second measurements were slightly increased over the first among those subjects whose shoulders were measured first and slightly reduced when measured immediately after the wrist. Reliable means of clinical evaluation of muscle tone at the shoulder and wrist are available if the influence of level of tone and the mutual influence of muscles tested are prudently considered.

Reliability of potential clinical measures of muscle tone in the elbows of patients after stroke.

OBJECTIVES: This study investigated the reliability of joint resting position (EJP), resistance to passive movement (ERM), and the angle of appearance of the resistance (EAR) as measures of muscle hypertonus of elbow flexors in patients after stroke. Previously, similar measures had been found reliable when applied to measuring shoulder and wrist hypertonus in patients after stroke. METHOD: Forty-five subjects with stroke were randomly selected from occupational therapy admissions at two rehabilitation centers. Tone of elbow flexors was measured twice at the same sitting by two examiners. EJP and EAR were measured with a goniometer, and ERM was measured with a resistance rating scale. Correlations were calculated between first and second measurements by center and by high tone and poor upper extremity function subgroups (with correction for multiple correlations) to determine reliability. RESULTS: Each of the three measures was highly reliable as demonstrated by a high correlation in at least one of the subgroups (Center 1: EJP, r = .964 for high tone subgroup; ERM, r = .789, EAR, r = .902, both in poor upper extremity function subgroup; and Center 2: EJP, r = .892, ERM, r = .938, both in poor upper extremity function subgroup; EAR, r = .666 for all subjects; all p values < .05). Correlations were especially high when data for subjects with high upper extremity function were eliminated. CONCLUSION: Reliability of these three methods of measuring upper extremity muscle tone enhances their usefulness as well as therapists' confidence in their judicial application.

Diagnosis and management of inflammatory bowel disease.

The chronic, unpredictability of inflammatory bowel disease makes it difficult for patients to cope. In fact several studies quoted by Cox (1995) found that the Majority of IBD patients, even the one's who considered themselves "well," experienced some impairment in quality of life. Early detection of IBD is essential in developing patient confidence and providing motivation for cooperation in treatment. Irvine (1997) conducted a study dealing with the quality of life issues with IBD and concluded that despite impairments, most patients with IBD overcame the obstacles imposed by their illness and managed to remain productive members of society. Similar management (with anti-inflammatory drugs) makes differentiating between Crohn's disease and ulcerative colitis during the early stages of the disease, unnecessary. Situations that require differentiation include: right sided pain or tenderness, steatorrhea, nutritional deficiencies, or a palpable mass (Macrae & Bhathal, 1997). Although IBD continues to be of unknown etiology, recent advances and further study in the areas of the immune system, genetics and environmental influences may provide helpful treatment options in the future. For now, the clinician/patient goal must be to maintain adequate nutrition, promote healing, treat complications, and maintain an optimal lifestyle.

Augmentation mammoplasty: implications for the primary care provider.

PURPOSE: To inform primary care nurse practitioners (NPs) of the risks and possible complications of augmentation mammoplasty and suggest guidelines for counseling and monitoring women who have undergone this procedure. DATA SOURCES: Selected research and clinical articles, government documents, and the author's experience. CONCLUSIONS: Because so many women have had breast augmentation mammoplasty, it is inevitable that NPs will see patients in the primary care settings who have complications related to the procedure or the type of implant. The most common complications include (a) changes in breast sensation, (b) capsular contracture, (c) calcifications, (d) mammography distortion or inaccuracies, (e) gel-bleed, (f) implant rupture or leakage, and (g) possible systemic reactions involving the immune system. IMPLICATIONS FOR PRACTICE: In addition to providing support and high quality preventive care, NPs may need to take on the task of coordinating other specialities and services when treating complications or when screening for breast cancer or implant rupture.

Development of a measure of nurses' AIDS attitudes and conservative views.

The literature concerning measurement of nurses' attitudes toward AIDS was reviewed. A short scale to measure nurses' attitudes toward AIDS was developed and evaluated. The instrument has three subscales on (a) willingness to care for those who are HIV positive, homosexuals, and intravenous drug users as patients, (b) attitudes toward homosexuals and intravenous drug users, and (c) general conservative views on religious, political, and family issues. The three subscales were supported by results of a factor analysis. Coefficient alpha ranged from .69 to .92.

Relationships among three clinical measures of muscle tone at the elbows of individuals after a stroke.

Patterns of associations among three common clinical muscle tone measures were investigated to determine their degree, and patterns of agreement. Data contributing to selection of clinical measures of muscle tone and understanding factors contributing to occupational dysfunctions were also sought. Forty five persons who were admitted after stroke to two occupational therapy rehabilitation programs were randomly selected. Their affected elbow's resting position (EJP), resistance to passive extension (ERM) and the angle where resistance first appeared (EAR) were measured by one, then a second therapist who also measured voluntary muscle function. Correlations among the three measures were calculated for both administrations and among patient subgroups with statistical correction for multiple correlations. Statistically significant associations appeared between ERM and EAR and between EJP and EAR. Highest statistically significant associations appeared among subjects with poor upper extremity function and those with low muscle tone. Patterns of associations were similar for the first and second administrations at both centres, though patterns among subgroups differed between centres. Correlation patterns suggest that biomechanical factors may influence the joint's resting position (EJP) more than ERM and EAR. Measures may be used interchangeably only with selected patient subgroups, which should also be the basis of method selection.