Food play: A novel research methodology for visceral geographers and health researchers.

This paper reinforces the value of visceral geographic approaches to health research as a method 'beyond talking'. The paper establishes and sets out an integrative embodied multi-sensory research methodology - food play. Researchers across the social sciences and sciences are exploring the limits of logo and researcher centric research methods and exploring peoples sensory experience of themselves and the wider world using participatory, patient-centred, multi-sensory, visceral and biosocial geographic approaches. With reference to the growing interest in visceral approaches to research in geography, and sensory research in neurology, anthropology and embodied cognition in psychology, we argue that the presence and pungency of food uniquely animates research, and for our research, provided highly individualised insight into the lived experience of living long term with eating difficulties, allowing visceral difference to emerge and be expressed. We illustrate our approach with reference to a six-year research project, Resources for Living, co-produced with survivors of head and neck cancer and underpinned by a series of food play workshops to address post-treatment and chronic difficulties with food and eating.

Altered eating: a definition and framework for assessment and intervention.

BACKGROUND: Eating can be a significant challenge for cancer survivors; however, to date there is no systematic way of assessing and addressing food related quality of life in this group. The purpose of our study was to develop a framework for doing so. METHODS: Over the course of 6 years in participant-led food workshops, we worked alongside 25 head and neck cancer (HNC) survivors and their partners, employing video-reflexive ethnographic (VRE) methods. The current study reports on data from the two summative workshops of this series where we worked with participants to cohere the emergent themes. Video and transcripts were reviewed and coded with participants and stakeholders according to domains of life that were affected by food. Three of the authors, one of whom is both survivor and researcher, arrived at the consensus framework. RESULTS: Seven areas of life were identified as affecting, or being affected by, altered eating. Three were physiological: anatomical, functional and sensory. Two captured the cognitive and behavioural labour of eating. Social life and identity were altered. The foregoing had an enduring emotional impact. CONCLUSIONS: Altered eating has physical, emotional and social consequences. The altered eating framework provides a systematic way of exploring those consequences with individual survivors. This framework has the potential to improve both the assessment and treatment of altered eating, to benefit food-related quality of life.

Some relationships between age, immune responsiveness and resistance to parasites in ruminants.

In the Australian livestock industries, susceptibility to infectious diseases is generally greater in young than in mature ruminants. The increased susceptibility is manifest as respiratory and intestinal infections (viral and bacterial) of calves, as well as fleece rot, flystrike and, especially, gastrointestinal parasitic infestations of young sheep. Lower resistance to infectious disease in young ruminants appears to be due largely to immunological hyporesponsiveness, and is not simply a consequence of their not having been exposed sufficiently to pathogens to develop active immunity. Young sheep have significantly lower proportions of CD4+ and CD8+ lymphocytes, but similar proportions of T19+ and B lymphocytes in blood, lymph and skin compared with mature sheep. Blood lymphocytes from young sheep produce less interferon-gamma in culture and young sheep invariably mount smaller antibody responses than do mature animals. Taken together, these findings begin to explain why young ruminants are more susceptible to infectious diseases in general, and to gastrointestinal parasites in particular, when compared to mature animals. Haematological markers of disease resistance, the prevalence of non-selected diseases and immune responses to vaccination were examined in the internal parasite-resistance flocks in Armidale NSW and the fleece rot/flystrike selection flocks at Trangie NSW. Any programme that seeks to improve resistance to parasitic or any other disease should have the capacity to make contemporary measurements of resistance to other diseases which are important in, or threaten, the production system.

Pregnancy outcome in 303 cases with severe preeclampsia.

The purpose of the present clinical investigation was to determine the influence of aggressive management, associated medical/obstetric complications, race, and gestational age on fetal, neonatal, and maternal risks associated with severe preeclampsia. Three hundred and three consecutive pregnancies complicated by severe preeclampsia were studied. All patients were delivered within 48 hours after admission to the perinatal center. In 91 patients the disease was superimposed on chronic hypertension. There was a significant difference between patients with and those without prior chronic hypertension regarding perinatal mortality (32 versus 7.7%), incidence of abruptio placentae (10 versus 4%), and frequency of small-for-gestational-age infants (33 versus 14%). Fifty-one patients (17%) had thrombocytopenia, 26 (8.5%) had hemolysis, elevated liver enzymes and low platelet count syndrome, and 22 (7.3%) had disseminated intravascular coagulopathy. There was significant difference between white and black patients regarding the frequency of thrombocytopenia (28 versus 13%), hemolysis, elevated liver enzymes, and low platelet count syndrome (19.7 versus 5.3%), and coagulopathy (13 versus 1.4%). However, most of this apparent racial difference resulted from higher incidence of abnormal hematologic findings among patients who had conservative management by private physicians before transfer. Perinatal survival was zero when severe preeclampsia developed at or before 28 weeks, whereas it was 100% when disease developed after 36 weeks' gestation. The above factors should be considered in counselling patients with severe preeclampsia.

Effect of magnesium sulfate on electroencephalographic findings in preeclampsia-eclampsia.

Electroencephalograms (EEGs) were recorded in 36 eclamptic, 14 preeclamptic, and 13 normotensive control patients. In the eclamptic group, EEGs were recorded while patients were receiving intravenous magnesium sulfate (MgSO4) with serum magnesium (Mg) levels of 4.5 to 11 mg/dL, and recorded again after MgSO4 was discontinued (serum Mg levels 1.8 to 2.5 mg/dL). In preeclamptic patients, EEGs were recorded before starting MgSO4, during administration of the loading dose (serum Mg levels 6 to 10 mg/dL), and eight hours through the maintenance dose (serum Mg levels 3.6 to 6.2 mg/dL). Twenty-seven (75%) eclamptic patients had abnormal EEGs, four patients showed paroxysmal spike activity, and the others showed focal or diffuse slowing (delta waves). Seven (50%) preeclamptic women had abnormal EEGs (all had generalized slowing). In preeclamptic-eclamptic patients who had serial EEG recordings, the gross EEG findings obtained during MgSO4 infusion and in the absence of MgSO4 were similar. In addition, the abnormal EEG findings were frequent despite the serum Mg levels considered therapeutic in the clinical management of these patients. Two eclamptic patients had seizure activity at serum Mg levels of 9.6 and 11 mg/dL. These findings suggested that abnormal EEGs are frequent in preeclamptic-eclamptic patients. Abnormal EEG findings in such patients are not altered by serum Mg levels achieved in the clinical management of these patients.

Maternal-fetal correlations in patients with severe preeclampsia/eclampsia.

A prospective pair-controlled study of maternal, cord blood, and neonatal hematologic findings was done in 50 severely preeclamptic/eclamptic and 50 well-matched normotensive pregnancies. There were no neonatal complications in mature infants. Neonatal complications were similar in premature infants of both study and control group; however, neonatal deaths were higher in the study group. In the study group, there was a poor correlation between maternal and cord blood hematocrit (r = .07), platelet count (r = .11), and fibrinogen (r = .05). In addition, there was no correlation (r = .06) between maternal and cord blood thrombocytopenia. Within each subgroup, abnormal neonatal hematologic findings were usually associated with fetal growth retardation, perinatal asphyxia, acidosis, sepsis, or intracranial hemorrhage. The present findings suggest that abnormal hematologic findings described in neonates of severely preeclamptic/eclamptic pregnancies are the result of associated neonatal complications, rather than a direct consequence of preeclampsia.

Bromocriptine mesylate for lactation suppression: a risk for postpartum hypertension?

The etiology of postpartum eclampsia and hypertension remains controversial. Recent reports have suggested a possible idiosyncratic hypertensive reaction associated with the use of bromocriptine mesylate. The purpose of this study was to determine whether bromocriptine, used for lactation suppression, is a risk factor for postpartum hypertension. In 1813 consecutively delivered staff patients, blood pressures at three separate home visits were obtained between 3-21 days postpartum. Postpartum hypertension, defined for the purposes of this study as systolic pressure of 140 mmHg or greater and/or diastolic pressure of 90 mmHg or greater on any of the three home visits, was the dependent variable; bromocriptine exposure was the independent variable. Covariates included age, race, chronic hypertension, pregnancy-induced hypertension, and antihypertensive medication. Discriminant analysis, including the first-order interactions, revealed that race, history of chronic hypertension, pregnancy-induced hypertension, and antihypertensive medication contributed significantly to postpartum hypertension (F (7, 1803) = 107.9; P less than .001, explained variance 30%). Of all the interaction terms, only the bromocriptine by pregnancy-induced hypertension interaction was significant. These findings support the contention that patients with antepartum pregnancy-induced hypertension who receive bromocriptine for lactation suppression are at increased risk for postpartum hypertension. Avoiding the elective use of this drug in patients with pregnancy-induced hypertension might constitute a reasonable clinical response to these findings.

Fetal supraventricular tachycardia: in utero therapy with digoxin and quinidine.

Digoxin has been successfully used to treat fetal supraventricular tachycardia. When therapy with digoxin fails, alternative therapies have met with equivocal success. In this report, successful fetal therapy with maternally administered digoxin and quinidine is presented in three consecutive patients with fetal supraventricular tachycardia. The arrhythmia was eliminated in each instance. Fetal ascites, present in two fetuses, was completely reversed. Intrapartum fetal distress was not observed. The rationale of this therapy and a review of pertinent literature are also presented.

Uterine activity compared with symptomatology in the detection of preterm labor.

The relative contribution of uterine activity obtained by home monitoring with a guard ring tocodynamometer compared with seven specific signs and symptoms reported during patient/nurse contact as an aid in detecting preterm labor has not been studied. In this prospective, multicenter study, patients at risk for developing early labor who were randomized to receive home uterine activity monitoring and perinatal nursing support were assessed. The initiator of provider contact (uterine activity detected on routine transmission, patient-perceived signs and symptoms of preterm labor during perinatal nurse contact, or both) resulting in a diagnosis of preterm labor was recorded. Contraction data were then analyzed for an association with preterm labor. There was a strong association of increased uterine activity (four or more contractions per hour) on a repeat monitoring strip with preterm labor (P less than .001). Among patients diagnosed with preterm labor, 31% had increased uterine activity detected on a routine transmission without patient-reported signs and symptoms, compared with 24% who were diagnosed as the result of patient-reported symptoms without increased uterine activity. Daily objective uterine activity data alone have greater incremental value over and above other signs and symptoms as an aid to the physician in diagnosing preterm labor.

The contribution of symptomatology and/or uterine activity to the incidence of unscheduled visits.

Home uterine activity monitoring and perinatal nursing support have been shown to be associated with a decrease in preterm births with no increase in the number of unscheduled patient visits. This prospective, randomized multicenter study compared the frequency of unscheduled visits in patients receiving home uterine activity monitoring and perinatal nursing support with that of patients receiving education regarding the detection and reporting of preterm labor symptomatology. The contribution of patient-reported signs and symptoms versus objective uterine activity data to unscheduled visits is assessed. The overall frequency of unscheduled visits was similar in both groups. In the home uterine activity monitoring and perinatal nursing support group, the contributions of uterine activity versus signs and symptoms to the diagnosis of preterm labor were equal, with 36% of patients diagnosed with preterm labor sent to the physician for increased uterine activity and 36% for signs and symptoms. The sensitivity for the group receiving monitoring and nursing support in detecting preterm labor was 93%. The majority of false-positive visits were associated with patient symptoms. These data show that this combination service does not lead to a clinically significant increase in unscheduled visits. Further, the visits resulting from the combination service provide a sensitive predictive method to aid physicians in detecting early labor.

Relationship of uterine contractility to preterm labor.

An increased uterine contraction rate is associated with preterm labor. The contraction rate in individual patients, however, has not been evaluated critically as to its predictive value in forecasting early labor. In this randomized multicenter study, 105 patients at high risk for preterm delivery monitored their contraction rate at home on a daily basis. An analysis was conducted to determine the association of at least four contractions per hour on a routine strip followed by at least four contractions per hour on a repeat tracing with subsequent preterm labor. Using this threshold, 70% of the patients were correctly classified. This contraction rate resulted in a sensitivity of 57%, a specificity of 80%, a positive predictive value of 72%, and a negative predictive value of 68%. A threshold rate of at least four contractions per hour on a remonitor strip identifies a patient at increased risk for preterm labor (P = .003).

Preventing preterm birth in twin gestation: home uterine activity monitoring and perinatal nursing support.

In this investigation, 45 women with twin gestations in four centers were randomly assigned to either daily home uterine activity monitoring and perinatal nursing support (19) or an education group (26). Patients in the home uterine activity monitoring and perinatal nursing support group monitored uterine activity twice daily, transmitted the data each day, and had 24 hour-a-day access to nursing support. Education patients were counseled regarding the common signs and symptoms of preterm labor. Both groups had scheduled prenatal visits at least every 2 weeks. Sixteen (62%) of the education group and 14 (74%) of the home uterine activity monitoring and perinatal nursing support group developed preterm labor, values that were not significantly different. Of the monitored group who experienced preterm labor, all 14 were dilated 3 cm or less at diagnosis of the first preterm labor, compared with ten of 16 in the education group (P = .01; one-tailed Fisher test). The mean cervical dilatation at the first preterm labor episode in the group receiving daily monitoring and contact (1.6 cm) was significantly less (P = .01) than that in the education group (2.9 cm). Thus, fewer preterm births were recorded in the home uterine activity monitoring and perinatal nursing support group and significantly fewer patients delivered because of failed tocolysis (P = .03).

Home uterine activity monitoring is associated with a reduction in preterm birth.

The value of home uterine activity monitoring plus perinatal nursing support in the prevention of preterm birth among high-risk patients has been demonstrated by several studies. Other reports with less stringent guidelines and less intensive nursing contact have questioned the contribution of home uterine activity monitoring and perinatal nursing support to a preterm birth prevention program. In this large, prospective, randomized multicenter study, patients were assigned to receive either daily monitoring and nursing contact or a preterm birth prevention program including intensive education and more frequent prenatal visits. Among the monitored patients, there was a significant increase in early detection of preterm labor (2 cm or less), successful tocolysis, and prolongation of pregnancy to term. Thirty-one percent of these diagnoses of preterm labor resulted from evaluation of increased uterine activity without associated patient-perceived symptoms. We conclude that a program of daily uterine activity monitoring and perinatal nursing support results in earlier diagnosis of preterm labor and subsequently more effective tocolysis.

Management of preterm labor patients at home: does daily uterine activity monitoring and nursing support make a difference?

Daily home uterine activity monitoring and perinatal nursing support were compared with standard care in managing patients with recurrent preterm labor during the current pregnancy in an effort to reduce preterm birth. Sixty-seven successfully treated preterm labor patients were randomly assigned in this multicenter study to daily home uterine activity monitoring and perinatal nursing support or to a standard-care group. Recurrent preterm labor occurred in 15 (45%) of monitored patients and 19 (56%) of standard-care patients. The risk of preterm birth (before 37 weeks) for patients with recurrent preterm labor was significantly reduced (P = .025) in the monitored group (seven, or 47%) compared with the standard-care group (16, or 84%). The relative risk of delivering because of failed tocolysis was 2.8 for the standard-care group versus the monitored group. There were no patients in the monitored group who delivered at the first recurrence of preterm labor for failed tocolysis. The data suggest that home uterine activity monitoring and perinatal nursing support are helpful in achieving term birth through earlier detection and treatment of recurrent preterm labor.

Dextromethorphan and dextrorphan as calcium channel antagonists.

Dextromethorphan and dextrorphan, which reduce excitatory amino acid-induced neurotoxicity, decreased K+ depolarization-evoked 45Ca2+ uptake into brain synaptosomes and cultured neural (PC12) cells. Half-maximal inhibition of synaptosomal 45Ca2+ uptake occurred with 48 microM dextromethorphan or 200 microM dextrorphan, which are similar to concentrations associated with protection from excitotoxicity. The ability to decrease Ca2+ flux through N-type (synaptosomal) and L-type (PC12) voltage-gated Ca2+ channels may therefore contribute to the neuroprotective effects of these compounds.

Calcium channel antagonist receptors in cerebral cortex from alcoholic patients.

Exposure to ethanol for days to weeks enhances the expression of voltage-dependent Ca2+ channels in the brains of experimental animals and in cultured neural cell lines. To determine if similar changes occur in the brains of alcoholic patients, we measured the binding of (+)-[3H]PN 200-110 to cerebral cortex samples obtained at autopsy from alcoholic and non-alcoholic patients. No difference in (+)-[3H]PN 200-110 binding was observed, suggesting that ethanol-induced changes in Ca2+ channel expression are more likely to be related to acute withdrawal than to chronic ethanol exposure alone.

Immunological cross-reactivity between pseudocapsular antigens of strains of Staphylococcus aureus isolated from cases of bovine mastitis.

An assay was developed to measure the degree of immunological cross-reactivity between the pseudocapsules of a vaccine (reference) strain of Staphylococcus aureus and pseudocapsules of strains of S. aureus isolated from cases of bovine mastitis. The field strains were obtained from Australia, New Zealand, Norway, the U.K. and the U.S.A. There was large variation among strains in cross-reactivity of their pseudocapsules with those of the reference strain. For 104 Australian strains, the range of cross-reactivity indices (CRI) was 6.1-63.2% (on a scale of 0-100%, with 0% being complete identity and 100% being nil identity); for 61 overseas strains the range of CRI values was 25.7-72.1%. The data indicated that pseudocapsule antigens of Australian strains were antigenically more closely related to those of the reference strain than were pseudocapsular antigens of strains from the 4 other countries.

Influence of adjuvants on the immune response of sheep to a novel Staphylococcus aureus vaccine.

Sheep were immunized twice with two Staphylococcus aureus vaccines which contained either killed bacterial cells shrouded with pseudocapsules or toxoided beta haemolysin, together with various adjuvants. Circulating antibody responses were monitored using an ELISA (anti-pseudo-capsule responses) and an anti-beta haemolysin assay. Combining a killed cell/pseudocapsule/dextran sulphate (DXS) vaccine and the toxoid vaccine did not cause any diminution of antibody responses compared with separate injection of the two preparations. Addition of calcium phosphate to DXS as an adjuvant for the combined vaccine did not extend the duration of anti-pseudocapsule responses compared with those obtained with dextran sulphate alone. Nor was there any benefit in terms of durability of the response by increasing the amount of DXS: doses of DXS of 10-20 mg/kg liveweight provoked significantly higher peak responses but caused acute clinical reactions at the vaccination site and did not prolong the antibody response. In contrast, the combined vaccine given with DXS and emulsified in Freund's Incomplete Adjuvant (FIA) resulted in a large anti-pseudocapsule response with elevated levels of antibody being sustained for at least one year; there was a significant IgG2 anti-pseudocapsule response in animals receiving the vaccine with DXS and FIA. In the above experiments, 10(10) pseudocapsule-shrouded bacterial cells were used in the vaccine. Reducing the concentration of cells to 10(9) caused a slightly reduced anti-pseudocapsule response (not significant) whereas increasing the concentration to 10(11) did not increase the response.

Colony morphology of Staphylococcus aureus in serum-soft agar following in vivo and in vitro growth.

Staphylococcus aureus isolated from cases of mastitis in ruminants were grown in vitro and in vivo and subsequently examined for expression of diffuse colony morphology in serum-soft agar. Growth in the bovine mammary gland, but not in the ovine mammary gland or ovine peritoneal cavity, resulted in subsequent expression of diffuse colony morphology.