Evidence of Antineutrinos from Distant Reactors Using Pure Water at SNO.

The SNO+ Collaboration reports the first evidence of reactor antineutrinos in a Cherenkov detector. The nearest nuclear reactors are located 240 km away in Ontario, Canada. This analysis uses events with energies lower than in any previous analysis with a large water Cherenkov detector. Two analytical methods are used to distinguish reactor antineutrinos from background events in 190 days of data and yield consistent evidence for antineutrinos with a combined significance of 3.5σ.

Experimental constraints on left-right symmetric models from muon decay.

The TWIST Collaboration has completed a new measurement of the energy-angle spectrum of positrons from the decay of highly polarized muons. A simultaneous measurement of the muon decay parameters ρ, δ, and P(µ)(π)ξ tests the standard model in a purely leptonic process and provides improved limits for relevant extensions to the standard model. Specifically, for the generalized left-right symmetric model |(g(R)/g(L))ζ|<0.020 and (g(L)/g(R))m(2)>578 GeV/c(2), both 90% C.L.

Psychological impact of structured treatment interruptions in patients with prolonged undetectable HIV-1 viral loads.

Structured treatment interruption strategies may help overcome problems of highly active antiretroviral therapy, but might also represent a cause of stress. We present data that indicate a psychological benefit from structured treatment interruption. Although some disturbances appear at the resumption of therapy, no definitive problems are found that preclude such therapeutic approaches from a psychological perspective. However, a close follow-up of patients during interruption periods is advisable to avoid difficulties reported at treatment resumption presenting a risk to patients' health.

Quality of life in young adults having received a BMT during childhood: a GETMON study. Grupo Español de Trasplante de Médula Osea en el Niño.

A quality-of-life questionnaire study was administered in a group of 98 disease-free survivors more than 3 years after BMT. All participants were over the age of 17 years at the time of the survey. The transplants were performed between 1981 and 1993 in eight Spanish hospitals. Eighty-three percent of patients had undergone BMT for neoplastic disease. Seventy-three per cent received an allogeneic bone marrow transplantation. A modified version of a questionnaire applied in Stanford Hospital to evaluate quality of life in adults after BMT was used. A single investigator was responsible for interviewing all subjects by telephone. We compare these results with the same questionnaire applied in a control group of 58 healthy subjects of similar age. The most significant results were: BMT patients valued their quality of life more highly than the control group. The mean score for global quality of life was 8.19+/-0.17 in BMT group as compared to 7.54+/-0.13 in control group (P=0.0013). Studies were cited as the major concern in both groups: 24% in BMT group and in 69% in control group (C.I. 95%=0.59 to 0.30). The patients in the BMT group considered they had fewer problems in comparison with the control group regarding interpersonal relationships with family members and friends, sleep, depression and leisure possibilities. However, they considered they had more problems concerning their physical appearance, studies and work possibilities than their peers. Considerations regarding weight, height, sexual functioning, anxiety, tendency to suffer illness and problems with insurance were similar in both groups.

Effects of metabolic control on vitamin E nutritional status in children with type 1 diabetes mellitus.

OBJECTIVE: To evaluate the effects of the metabolic control of the insulin-dependent diabetes mellitus (IDDM) on the nutritional status of vitamin E. METHODS: A total of 47 children with IDDM and a mean age of 11.91+/-1.60 (mean+/-SD) years were studied, matched for age and sex with 16 healthy children (11.75+/-1.83 years). Following the American and British Associations for IDDM, we used a classification of "good", "moderate" or "poor" control of the illness: (a) good control [glycosilated haemoglobin (HbAlc) < or =7%]; (b) moderate control (7%< HbAlc < or =8%); and (c) poor control (HbAlc>8%). Serum concentrations of total cholesterol (CHOL), triglycerides (TG), high-density lipoproteins-cholesterol (HDLc), very low- and low-density lipoproteins cholesterol (VLDLc and LDLc), plasma and erythrocyte vitamin E (Vit Ep and Vit Ee) and plasma vitamin A (Vit Ap) were measured in all children. RESULTS: The children with "poor" metabolic control of the illness presented significantly higher plasma concentrations of CHOL, LDLc, VLDLc, LDLc/HDLc, (VLDL+LDL)c/HDLc, TG and Vit Ep; higher indices Vit Ep/Vit Ee and Vit Ep/Vit Ap relative to those with a "good" control of the illness. Direct-linear correlations were found between Vit Ep and the percentage of HbAlc and with the markers of atherogenic risk in the IDDM children. CONCLUSION: There is a significant rise in Vit Ep concentrations as metabolic control of the illness worsens, whereas Vit Ee remained unchanged. These results suggest that vitamin E maintains its nutritional status despite a poor control of the IDDM during childhood.

Apparent nitrogen balance and 3-methylhistidine urinary excretion in intravenously fed children with trauma and infection.

This study was designed to compare and evaluate the effects of two isocaloric parenteral nutrition infusions, FreAmine and F080, differing in their amino acid composition, on the apparent nitrogen balance and urinary excretion of 3-methylhistidine in children with trauma (n = 27) or grave infection (n = 24). Trauma patients at the beginning of parenteral nutrition showed a more negative nitrogen balance than infected children, but in all children the apparent nitrogen balance increased to become positive and the 3-methylhistidine urinary excretion dropped. No differences related to the amino acid composition of the parenteral nutrition solutions were found. Apparent nitrogen balance and 3-methylhistidine excretion were correlated in all study groups irrespective of urine sample time. The enriched branched chain amino acid solution used for parenteral nutrition of trauma and infected children did not show a better effect than the non-enriched one in terms of muscle catabolism and nitrogen balance. The use of adequate nutritional support including both amino acids and energy source is of major importance in children recovering from trauma and infection.

Vitamin A, retinol binding protein and lipids in type 1 diabetes mellitus.

OBJECTIVE: A case-control study was conducted to evaluate the effects of type 1 diabetes mellitus (IDDM) on plasma levels of vitamin A (retinol) and serum levels of retinol-binding protein (RBP) and their relationship with the atherogenic indicators. SUBJECTS: A total of 47 randomised IDDM children were recruited from those treated at the Endocrinology Unit of the University Hospital of Granada (Spain). They were matched for age and sex with 16 healthy children. METHODS: The following parameters were measured in all patients: serum concentrations of total cholesterol, triglycerides, high (HDL, spectrophotometry), very low (VLDL) and low (LDL) density lipoprotein cholesterol (Friedewald's formula); serum levels of RBP (kinetic nephelometry); plasma vitamin A and glycosilated haemoglobin (HbA1c; high performance chromatography). RESULTS: Higher RBP concentrations in IDDM children (P=0.05), lower retinol levels (P=0.05) and lower vitamin A/cholesterol ratio (P=0.02) than in the control group were found; no differences in the atherogenic indicators were observed. There was a correlation between RBP and vitamin A (P=0.0001). Relationships between retinol, RBP and atherogenic indicators were demonstrated in the IDDM group (A-LDLc/HDLc (P=0.01); A-(VLDL+LDL)c/HDLc (P=0.007); RBP-LDLc/HDLc (P=0.05); RBP-(VLDL+LDL)c/HDLc (P=0.02)), and an inverse relationship was found between the vitamin A/TG ratio and HbA1c (P=0.004). The children with HbA1c>8% showed increased atherogenic indicators and lower vitamin A/CHOL and vitamin A/TG ratios than those with good control of the illness. CONCLUSIONS: The IDDM children with poor metabolic control face a higher atherogenic risk and vitamin A 'relative deficiency' risk than those with good metabolic control of their illness. Relationships between retinol and RBP with atherogenic indicators were found. The results suggest that vitamin A therapeutic supplements in IDDM children may reduce or prevent atherogenic risk.

Some current controversies on nutritional requirements of full-term and pre-term newborn infants.

Many controversial topics have still to be resolved regarding the nutritional requirements of the newborn, and in particular of the pre-term infant. The term 'controversy' bears the connotation of prolonged dispute and such a situation has arisen for various reasons: (a) from inadequate research methodologies; (b) from the misinterpretation of, or bias within, the results of studies undertaken; (c) from not taking into account the multifactorial etiology of physiopathological situations or illnesses suffered by suckling neonates and newborn infants. Nevertheless, controversy as such is not always a negative factor, as investigation and discussion enable advances in therapeutic methods.

Evaluation of carnitine nutritional status in full-term newborn infants.

Carnitine supplements may be advisable not only in premature but also in artificially-fed full-term babies. The acyl-carnitine/free carnitine (AC/FC) and FC/total carnitine (FC/TC) ratios have been considered markers of "carnitine insufficiency" and "carnitine deficiency", respectively. Values of AC/FC>0.40 are considered abnormal and mean that FC has a low bioavailability to the cells and so reflects a "carnitine insufficiency". Values of FC/TC<0.7 indicate "carnitine deficiency". We analyze the validity of such ratios and the limits for them in three groups of full-term neonates (n=66): 22 breast-fed (BF), 22 with formula (F); and 22 fed with carnitine-supplemented formula. Several studies have shown the need to give supplements of carnitine to the neonate because of its "essentiality", but no one has demonstrated the adequate dosages. We therefore propose to establish new limit levels for these ratios to control carnitine nutritional status in neonates, based on the control of percentile ranges for normal BF infants (in this study: 97th percentile of AC/FC>0.83; 3rd percentile of FC/TC<0.54) and on evaluating the needs of neonates and dosages required to supplement F. The supplement of 2.2 mg of L-carnitine/100 ml in the cow's milk formula used in the present study produces a similar biochemical pattern of plasma carnitine and ACs to that observed in BF infants, together with a lower risk of developing "carnitine deficiency" or "carnitine insufficiency" than those babies fed with nonenriched F. Considering that human milk is the best source of nutrition for full-term infants, the limit established for AC/FC and FC/TC ratios at other ages of life seems to be "inadequate" for neonates.

Role of intrapartum hypoxia in carnitine nutritional status during the early neonatal period.

We analyze markers of carnitine insufficiency and deficiency, lysine (LYS) and methionine (MET), in 39 neonates with intrapartum hypoxia (selection criteria: umbilical artery pH <7.20, lactate >1.8 mmol/l and PaO2 <25 mm Hg), and in 35 healthy newborn infants (control group) in the early neonatal period (1-7 days of life). Free (FC), total (TC) carnitine and acylcarnitines (AC=short-chain+long-chain acylcarnitines) were measured using a radioisotopic micromethod; LYS and MET were determined by high-pressure liquid chromatography. AC and TC plasma concentrations and AC/FC ratio were higher while FC/TC ratio was lower in the hypoxic neonates than in the control group. Hypoxic newborn infants (59%) presented "carnitine deficiency" (FC/TC <0.7) and 60% of them "carnitine insufficiency" (AC/FC ratio >0.4) vs. 31% and 28%, respectively, for the neonates of the control group (p<0.05). In the healthy neonates group, MET correlated with FC/TC and the AC/FC ratio. FC, TC, AC, AC/FC and umbilical artery pH (pHua) were inversely correlated. FC/TC and MET correlated with pHua. We conclude that: (1) an important percentage of newborn infants with intrapartum hypoxia suffer carnitine deficiency and carnitine insufficiency in the early neonatal period, related to MET plasma levels; (2) the carnitine deficiency or insufficiency in the neonate is determined by the degree of intrapartum acidosis.

Diet and organochlorine contaminants in women of reproductive age under 40 years old.

The diet of the breast-feeding mother impacts on the quality and quantity of the milk that she feeds her child. Milk can be a vehicle for toxins, such as drugs and their metabolites, viruses, nicotine, caffeine, alcohol, and organochlorine molecules such as PCBs, DDT, HCB, HCH and dioxins, which can harm the health of the breast-feeding child. The 24-h recall diet was considered appropriate to adequately study the diet of breast-feeding mothers and was used in the present preliminary study to establish the possible relationship between the food items consumed and the presence of pesticides in her milk. Two groups of randomly selected healthy breast-feeding volunteers aged between 17 and 35 years from two different areas were recruited: 34 from intensive agriculture zone, El Ejido (Almeria), from the "Hospital de Poniente" and 21 urban zone, the city of Granada, from the "Clinico" University Hospital. Application of the Spearman Correlation Test to the results from Almeria showed a certain positive correlation between the total intake of fats and both the p,p'DDD (rho=0.53, p< or =0.05) and methoxychlor (rho=0.48, p< or =0.05) in mature milk, and between the energy supplied by vegetables and the endosulfan-lactone in mature milk (rho=0.50, p< or =0.05). Among the group of breast-feeding women from Granada, there was a strong correlation between the intake of fats and both the p,p'DDT in transition milk (rho=0.90, p< or =0.05) and the p,p'DDD in mature milk (rho=0.90, p< or =0.05). In conclusion, there is a statistically significant relationship between the consumption of fatty foods and some organochlorine molecules and between the consumption of vegetables and pesticides, and the latter relationship occurs in Almeria but not in Granada.

Analysis of organochlorine pesticides in human milk: preliminary results.

In the face of evidence of human milk contamination by organochlorine pesticides, an analysis was performed on samples of milk obtained from healthy lactating women in the provinces of Granada and Almeria in Southern Spain. The samples were obtained by the Neonate Section of the Department of Pediatrics of Granada University Hospital (Neonatology Division) and by the Neonatal Service of Poniente Hospital in El Ejido, Almería. A liquid-liquid extraction procedure was performed. The cleaning of the sample before gas chromatography-mass spectrometry (GC-MS) used silica Sep-Pak. Among other pesticides, aldrin, dieldrin, DDT and its metabolites, lindane, methoxychlor and endosulfan were identified. The presence of these products was confirmed by mass spectrometry. The identification and quantification of these organochlorine molecules is important because they have estrogenic effects.

Unreliability of the Cold Pressor Test Method in pain studies.

The Cold Pressor Test Method is one of the most widely used techniques in laboratory pain studies. Many research projects use it to evaluate analgesic therapies, including pharmacological methods. However, a review of these projects shows that both the way in which the test is applied and the results obtained from it differ widely. There is, therefore, an urgent need to establish optimal conditions under which reliable results can be obtained. We have analyzed the effect of test repetition on parameters normally used in this method. Our results show great variability, especially in some subjects, in the measurement of pain threshold, withdrawal threshold and subjective pain. Standardization of the technique, design of new evaluation methods and continual recording of the way in which subjects interact with laboratory conditions must be developed if we want to find valid results with the Cold Pressor Test method in pain studies.

A way to screen for suffering in palliative care.

We report a new tool for screening the suffering of terminally ill patients in a palliative care service. We systematically asked 371 terminal oncological and AIDS patients on 665 different occasions, "How long did yesterday seem to you?"; we then asked them to assess their current condition. The simple answer about subjective length of time correlated well with subjective suffering in approximately half the patients. Thus it may be a good starting point for future assessment and more extensive explorations.

[Contributions of the functional analysis of behavior to the problem of AIDS]. / Aportaciones del analisis funcional de la conducta al problema del SIDA.

PIP: Epidemiological patterns in the spread of HIV infection and the potential role of psychologists in encouraging behavioral changes intended to reduce risks of infection are examined. The 1st great wave of AIDS cases in the industrialized countries occurred primarily in specific, fairly self-contained subgroups such as male homosexuals, hemophiliacs, and IV drug users. Large proportions in these groups are either infected or have adapted risk reduction behavior. The risk of infection for the general heterosexual population in industrialized countries is very low but likely to increase progressively unless measures are taken to reduce risks. Psychologists, who expend considerable effort researching and attempting to effect behavioral changes, thus have a potentially significant role in slowing the spread of the AIDS epidemic. The means of avoiding HIV infection in sexually active persons and drug users are known, but the means of motivating individuals to change to less risky behaviors are not as well understood. Several factors have been identified that appear to influence the vulnerability of the organism to HIV infection or to development of AIDS once infected. Several are capable of modification through behavioral changes, such as high-risk sexual practices, use of particular contraceptive methods, inadequate hygiene, poor nutrition, and self-administration of drugs. Several aspects of HIV infection and its spread are capable of producing psychological stress, including anxiety over possible infection and testing, reaction to diagnosis, fear of rejection by others, watching friends and relatives sicken and die of AIDS, encountering suspicious symptoms, and perceiving signs of physical deterioration. Psychological support in these situations can help to prolong life and improve its quality. Examples abound of individuals who continue to display a risk behavior despite being well informed of its risks; physicians who smoke are 1 such group. Information is a necessary but not sufficient condition for adapting preventive behaviors. Functional behavioral analysis suggests that immediate pleasure, ephemeral though it may be, outweighs the mere possibility of an unpleasant consequence at some hypothetical future date.^ieng