Applying adaptive management and lessons learned from national assessments to address logistical challenges in the National Wetland Condition Assessment.

The National Wetland Condition Assessment (NWCA) is one of a series of probability-based National Aquatic Resource Surveys (NARS) conducted by the U.S. Environmental Protection Agency (USEPA) to provide a comprehensive assessment of the condition of the Nation's waters. Randomized design and standardized training and protocols allow USEPA to analyze data that are nationally consistent and regionally relevant. Each NARS assessment was preceded by careful consideration of key logistical elements that included pre-survey planning, training, sampling logistics, and laboratory analysis. Numerous state, tribal, and contractor crews were supported across the country for each assessment; sampling and sample analyses were tracked from initiation; laboratory analyses were completed at USEPA, state, regional, and contract laboratories; and the data analyses and reporting were completed by USEPA-led workgroups, states, and contractors. The complexity and difficulty of each step offered unique challenges and provided lessons learned for each of the NARS assessments. Major logistical elements for implementing large scale assessments that are constrained by sampling period and number and duration of visits are covered in this paper. These elements include sample transport, equipment and supplies, sampling and sample tracking, information management regional technical expertise, and a sound field training program. This paper describes how lessons from previous assessments were applied to the NWCA and how new challenges faced in the NWCA were addressed and carried forward into future surveys.

Cervical spine clearance in adult trauma patients.

Up to 4% of adults with blunt trauma suffer cervical spine injury. Clinicians who evaluate trauma patients can use validated clinical decision tools to assess whether patients are at risk for these injuries. Beyond these tools, imaging (most often CT) remains the mainstay of evaluation. Further challenges exist when patients have persistent pain or cannot be evaluated clinically. This article reviews the evidence available to assist clinicians in evaluating adults for significant cervical spine injury after blunt trauma.

Patterns of cyto-nuclear linkage disequilibrium in Silene latifolia: genomic heterogeneity and temporal stability.

Non-random association of alleles in the nucleus and cytoplasmic organelles, or cyto-nuclear linkage disequilibrium (LD), is both an important component of a number of evolutionary processes and a statistical indicator of others. The evolutionary significance of cyto-nuclear LD will depend on both its magnitude and how stable those associations are through time. Here, we use a longitudinal population genetic data set to explore the magnitude and temporal dynamics of cyto-nuclear disequilibria through time. We genotyped 135 and 170 individuals from 16 and 17 patches of the plant species Silene latifolia in Southwestern VA, sampled in 1993 and 2008, respectively. Individuals were genotyped at 14 highly polymorphic microsatellite markers and a single-nucleotide polymorphism (SNP) in the mitochondrial gene, atp1. Normalized LD (D') between nuclear and cytoplasmic loci varied considerably depending on which nuclear locus was considered (ranging from 0.005-0.632). Four of the 14 cyto-nuclear associations showed a statistically significant shift over approximately seven generations. However, the overall magnitude of this disequilibrium was largely stable over time. The observed origin and stability of cyto-nuclear LD is most likely caused by the slow admixture between anciently diverged lineages within the species' newly invaded range, and the local spatial structure and metapopulation dynamics that are known to structure genetic variation in this system.

Descriptive and factor analysis of the Developmental Coordination Disorder Questionnaire (DCDQ'07) in a population-based sample of children with and without Developmental Coordination Disorder.

BACKGROUND: The Developmental Coordination Disorder Questionnaire (DCDQ'07) discriminates children with Developmental Coordination Disorder (DCD) from their peers. Studies employing the DCDQ have typically used clinical samples. To further validate the DCDQ'07, this study: (1) described its distributions in a population-based sample, and a sample of children with DCD; (2) explored sex and age differences at important cut-points; and (3) examined its factor structure. METHODS: This secondary analysis of data collected from 23 schools (n = 3151) included a sample of 3070 children (1526 boys, 1544 girls) and a sample of 122 children (73 boys, 49 girls) who met DCD diagnostic criteria. DCDQ'07 distributions were described by age and sex. Chi-square analyses were conducted using three clinically important percentile ranges; a factor analysis explored the construct validity of DCDQ scores. RESULTS: Parents of 3070 children (97.4%) completed the questionnaire independently. Significant sex differences were noted in both samples. Significant differences in proportions by sex, and DCDQ means by age were found in the population sample. A three-factor solution was found, accounting for 70.3% of the variance. CONCLUSIONS: This is one of the largest studies using the DCDQ'07 with a non-clinical sample. The three-factor solution, including item loading, was consistent with previous research. When using DCDQ cut-offs it is important to consider sex and age.

Assessment of environmental factors in disabled children 2-12 years: development and reliability of the Craig Hospital Inventory of Environmental Factors (CHIEF) for Children-Parent Version.

BACKGROUND: Children with disabilities and their families experience environmental barriers in the school and community environments. There is a need to understand and appropriately measure environmental factors that influence activity and participation for disabled children. The purpose of this paper is to describe the adaptation process of the Craig Hospital Inventory of Environmental Factors (CHIEF) to make it suitable as a parent proxy measure for disabled children aged 2-12 years. METHODS: The adaptation process consisted of four steps using data from previous research conducted at CanChild: (i) analysis of item-total correlations from all items on the CHIEF; (ii) frequency of endorsement; (iii) determination of the representativeness of the questions; and (iv) correlations on selected items. Once the items were selected, a test-retest reliability study was conducted. RESULTS: The internal consistencies (α) for the time 1 and time 2 administrations were 0.76 and 0.78, respectively. Test-retest reliability of the questionnaire was ICC = 0.73 for the total product score. CONCLUSION: The 10-item CHIEF for Children-Parent Version is an acceptable, easy-to-complete and reliable measure of perceived environmental barriers for disabled children 2-12 years of age.

Development of an outcome measurement system for service planning for children and youth with special needs.

AIM: This study described the process used in developing an outcome measurement framework for system planning to improve services for children and youth with special needs and their families in a Canadian province. The study reports the results of several parent-completed measures, which would be useful in service planning as well as the acceptability and utility of these measures for use by families and service centres. METHODS/RESULTS: Development of a theoretical framework, consultation with key stakeholders, testing the utility of selected outcome measures and initial dissemination of results were critical elements in the successful development of an outcome system. Consultation with stakeholders confirmed use of the International Classification of Functioning, Disability and Health and the child-within-family-within community model as theoretical frameworks while building valuable partnerships and identifying potential barriers to implementation. Pilot testing showed three outcome measures were feasible for families to complete and the measures provided information about services for children that was valuable to families as well as service providers. Gaps in service delivery were identified and the need for better communication between service providers and communities to facilitate integrated services was highlighted. CONCLUSION: The findings from this study can be used to implement an outcome measurement system for children with special needs and may serve as a resource for international researchers who are working to develop valid tools as well as outcome systems that are useful for system planning.

Silene as a model system in ecology and evolution.

The genus Silene, studied by Darwin, Mendel and other early scientists, is re-emerging as a system for studying interrelated questions in ecology, evolution and developmental biology. These questions include sex chromosome evolution, epigenetic control of sex expression, genomic conflict and speciation. Its well-studied interactions with the pathogen Microbotryum has made Silene a model for the evolution and dynamics of disease in natural systems, and its interactions with herbivores have increased our understanding of multi-trophic ecological processes and the evolution of invasiveness. Molecular tools are now providing new approaches to many of these classical yet unresolved problems, and new progress is being made through combining phylogenetic, genomic and molecular evolutionary studies with ecological and phenotypic data.

Detection of rare paternal chloroplast inheritance in controlled crosses of the endangered sunflower Helianthus verticillatus.

A variety of questions in population and evolutionary biology are studied using chloroplast DNA (cpDNA). The presumed maternal inheritance in angiosperms allows for certain assumptions and calculations to be made when studying plant hybridization, phylogeography, molecular systematics and seed dispersal. Further, the placement of transgenes in the chloroplast to lessen the probability of 'escape' to weedy relatives has been proposed since such genes would not move through pollen. In many studies, however, strict maternal inheritance is assumed but not tested directly, and some studies may have sample sizes too small to be able to detect rare paternal leakage. Here, we study the inheritance of cpDNA simple sequence repeats in 323 offspring derived from greenhouse crosses of the rare sunflower Helianthus verticillatus Small. We found evidence for rare chloroplast paternal leakage and heteroplasmy in 1.86% of the offspring. We address the question of whether one can extrapolate the mode of chloroplast transmission within a genus by comparing our results to the findings of another sunflower species study. The findings of occasional paternal transmission of the chloroplast genome are discussed in the framework of using these markers in studies of population and evolutionary biology both in Helianthus and other angiosperms.

Fusion of immunoscintigraphy single photon emission computed tomography (SPECT) with CT of the chest in patients with non-small cell lung cancer.

In non-small cell lung cancer (NSCLC), accurate staging is critical in deciding between potentially curative surgery and palliative treatment. Image registration, or fusion, combines the unique functional information provided by SPECT imaging with the excellent anatomic detail offered by computed tomography (CT) or magnetic resonance imaging to better characterize the information provided by each separate modality. In this study, we explored the role of fusion of immunoscintigraphy SPECT with CT in the staging of NSCLC. We fused chest CT with 99mTc-labeled IMMU-4 anti-carcinoembryonic antigen Fab' antibody fragment SPECT in 14 patients with NSCLC using a landmark-based algorithm. The algorithm's accuracy was a measure from the center-to-center distance and the percentage overlap of two regions of interest: one drawn on CT and warped onto SPECT, the other drawn directly on the SPECT. We found that the average center-to-center distance was 1.3 +/- 0.8 pixels. Average overlap was 46 +/- 20%. CT-SPECT fusion helped differentiate tumor from normal blood pool, necrotic areas within viable tumor, tumor recurrence from scar, and malignant lymphadenopathy from hyperplasia. We conclude that fusion of CT and SPECT augments the information provided by each separate modality. Future clinical applications of fusion in NSCLC staging using immunoscintigraphy appear promising.

The survival of mutants at very low frequencies in tribolium populations.

Forty population cages, each with 499 adult T. castaneum of the wild-type UPF strain, received a bb female newly mated with UPF males. Half of the immigrants had a Chicago Black genetic background, the other half a UPF background. These conditions simulate, respectively, the fate of a rare, genetically differing immigrant or the fate of a mutation in populations of considerable size. Adults were censused for 11 discrete generations. The semi-dominant autosomal black gene survived in 26 out of 40 cultures by the end of the experiment, demonstrating its selective advantage at these very low frequencies. The gene increased from an initial frequency of 0.002 to 0.055 (at generation 11) in at least one replicate. Although frequency-dependent fitness has been shown for black at higher frequencies, no such dependence could be demonstrated at the low frequencies of this study. The cultures simulating mutations (immigrants with native backgrounds) had a higher average gene frequency, different distribution of gene frequencies across replicates, and a lower extinction rate of black than did the cultures with alien background immigrants. The observations only partially fitted expectation based on a branching process model. The data show a tendency for the persistence of a few heterozygotes in cultures and for a deficiency of cultures that lost the mutant or those with many heterozygotes. The increase in frequency of black cannot be attributed to increased reproductive success of heterozygotes. The advantage of heterozygotes appears due to delayed developmental period as a result of tactile stimulation and probable differential cannibalism among pupae.

A quantitative genetic analysis of nuclear-cytoplasmic male sterility in structured populations of Silene vulgaris.

Gynodioecy, the coexistence of functionally female and hermaphroditic morphs within plant populations, often has a complicated genetic basis involving several cytoplasmic male-sterility factors and nuclear restorers. This complexity has made it difficult to study the genetics and evolution of gynodioecy in natural populations. We use a quantitative genetic analysis of crosses within and among populations of Silene vulgaris to partition genetic variance for sex expression into nuclear and cytoplasmic components. We also use mitochondrial markers to determine whether cytoplasmic effects on sex expression can be traced to mitochondrial variance. Cytoplasmic variation and epistatic interactions between nuclear and cytoplasmic loci accounted for a significant portion of the variation in sex expression among the crosses. Source population also accounted for a significant portion of the sex ratio variation. Crosses among populations greatly enhanced the dam (cytoplasmic) effect, indicating that most among-population variance was at cytoplasmic loci. This is supported by the large among-population variance in the frequency of mitochondrial haplotypes, which also accounted for a significant portion of the sex ratio variance in our data. We discuss the similarities between the population structure we observed at loci that influence sex expression and previous work on putatively neutral loci, as well as the implications this has for what mechanisms may create and maintain population structure at loci that are influenced by natural selection.

Gallium-67 scans of the chest in patients with acquired immunodeficiency syndrome.

Eighty-six [67Ga]citrate chest scans were performed in 71 adult patients with the acquired immunodeficiency syndrome. Forty-five of these patients also had Kaposi's sarcoma. Only 29 of 57 abnormal scans were correlated with abnormal chest radiographs. Chest radiographs were negative for 27 scans and unavailable for one. Several scan patterns were seen. Diffusely increased lung uptake was seen most commonly with Pneumocystis carinii pneumonia, but also other infections and noninfectious inflammatory conditions. Focal uptake corresponding to regional lymph node groups occurred most often with Mycobacterium avium-intracellulare but aslo with lymphoma. Localized intrapulmonary uptake was seen in bacterial pneumonias. Perihilar activity occurred in two cases. When chest radiographs were abnormal and 67Ga scans negative, the most common diagnosis was pulmonary Kaposi's sarcoma.

Linkage disequilibrium and phylogenetic congruence between chloroplast and mitochondrial haplotypes in Silene vulgaris.

Both the chloroplast and mitochondrial genomes are used extensively in studies of plant population genetics and systematics. In the majority of angiosperms, the chloroplast DNA (cpDNA) and mitochondrial DNA (mtDNA) are each primarily transmitted maternally, but rare biparental transmission is possible. The extent to which the cpDNA and mtDNA are in linkage disequilibrium is argued to be dependent on the fidelity of co-transmission and the population structure. This study reports complete linkage disequilibrium between cpDNA and mtDNA haplotypes in 86 individuals from 17 populations of Silene vulgaris, a gynodioecious plant species. Phylogenetic analysis of cpDNA and mtDNA haplotypes within 14 individuals supports a hypothesis that the evolutionary histories of the chloroplasts and mitochondria are congruent within S. vulgaris, as might be expected if this association persists for long periods. This provides the first documentation of the evolutionary consequences of long-term associations between chloroplast and mitochondrial genomes within a species. Factors that contribute to the phylogenetic and linkage associations, as well as the potential for intergenomic hitchhiking resulting from selection on genes in one organellar genome are discussed.

Early lung cancer action project: annual screening using single-slice helical CT.

The advent of helical CT imaging held promise for the early diagnosis, and thereby, for enhanced curability of lung cancer--a highly fatal disease. In 1993, the Early Lung Cancer Action Project (ELCAP) was initiated and experimentally screened a cohort of 1,000 high-risk persons. Here we summarize the results of the baseline and annual repeat CT screening of these 1,000 subjects. CT-based screening (compared to traditional radiology) was clearly shown to enhance the detection of lung cancer at earlier and more curable stages. A discussion follows of the meaning of the results and possible future screening protocols.

Effect of different mathematical methods on etoposide area under the curve estimations and pharmacodynamic response predictions.

Different methods to calculate interval area under the curve (AUC) data may produce substantial error. The purpose of this study was to compare methods of calculating etoposide AUC and determine the effect of these values on white blood cell (WBC) count nadir predictions calculated from a previously reported equation. Three AUC calculation methods were used: (1) the linear trapezoidal method, (2) a combination of the linear and logarithmic trapezoidal methods, and (3) the Lagrange method. Since none of the methods for determining the AUC could be considered the standard, the methods were evaluated by comparing differences between pairs of calculated AUC values by each method. The 95% CI for differences between all pairs of AUC values were greater than zero (no difference) indicating significance. Consistent with the smoother fitting function between data points, the Lagrange method tended to produce a larger AUC, lower clearance values, and lower WBC nadir count predictions than the other methods. The largest difference encountered was between the Lagrange and the linear-log AUC methods with a mean value of 16.9 micrograms h/ml (95% CI 9.4-24.3) This difference would account for approximately 11% of the total AUC. Using a previously published equation, where WBC nadir = -0.057 +0.048 x etoposide clearance, with clearance determined as dose/AUC, mean differences in calculated WBC nadir count values between the three AUC methods ranged from 80 to 220 cells/microliters, which would be expected to be of little clinical consequence. The precision of this equation, using data derived from linear trapezoidal AUC calculations, had a mean absolute error of 0.93 x 10(3)/microliters (95% CI 0.53-1.32). Our findings suggest that any of the three mathematical methods studied would produce similar etoposide AUC values and pharmacodynamic predictions. Further, these findings also suggest that the major limitation in predicting etoposide leukopenia lies with the imprecision of the pharmacodynamic model more so than the ability to accurately determine the AUC. However, our findings may not be applicable if other factors intervene which dramatically alter the shape of the etoposide concentration-time curve.

Absent right and persistent left superior vena cava without other congenital anomaly: a rare combination diagnosed by transesophageal echocardiography.

A 70-year old man with a history of anorexia, weight loss, and progressive shortness of breath was studied by transesophageal echocardiography. In addition to a mass occupying the right ventricular outflow tract, a rare congenital heart anomaly was discovered serendipitously: persistent left superior vena cava, absent right superior vena cava, and no other congenital abnormality. The echocardiographic findings were confirmed by computed tomographic scanning and later during heart surgery performed to resect the malignant tumor.

Pitfalls in the diagnosis of thoracic aortic aneurysm by transesophageal echocardiography.

A 74-year-old man underwent transesophageal echocardiography to evaluate the possibility of dissection of the descending aorta. The study demonstrated a round lumen that contained an echogenic mass mimicking aortic aneurysm with thrombus. However, computerized tomographic scanning identified the lumen as the pleural cavity containing a collapsed lung. The esophagus was on the right side of the spine, and the transesophageal technique could not visualize the descending aorta.

Tailoring health services to the needs of individual communities.

In order to assess the need for community health services in different neighbourhoods within Greater Glasgow, it was decided to present a wide variety of health information for each community as a set of summary profiles. These profiles clearly demonstrate that the same areas have the highest standardised mortality ratios, the least favourable socioeconomic circumstances, the highest hospital admission rates, and the poorest child health characteristics. The greatest benefit in overall health would be achieved by targeting community resources on these disadvantaged communities. Adoption of this policy should reduce existing inequalities in health, and we argue that such 'positive discrimination' is implied in the formulae used in Great Britain for allocation of revenue expenditure for community services. The health profiles that we describe provide the baseline information necessary to target community services to particular communities according to objective measures, and to evaluate the effectiveness of new and existing methods of health promotion.

High-dose chemotherapy with stem-cell rescue for the treatment of breast cancer.

The use of high-dose chemotherapy with stem-cell rescue (HDC-SCR) in the treatment of breast cancer is reviewed. The rationale for HDC-SCR in breast cancer is based on the principles of dose response and dose intensity. After conventional-dose chemotherapy, hematopoietic progenitor cells are harvested from the bone marrow or peripheral blood. The patient then undergoes HDC-SCR. Peripheral-blood progenitor cells are becoming the preferred cells for hematopoietic rescue. Most clinical trails of HDC-SCR in metastatic breast cancer have resulted in high overall objective response rates (57-100%), with the highest rates occurring in patients with minimal residual disease or chemotherapy-sensitive disease at the time of high-dose treatment. Most protocols now include induction therapy before HDC-SCR; only patients who show sensitive disease proceed to high-dose therapy. In most studies published to date, the median duration of remission was less than one year from the time of high-dose therapy; however, 10-15% of patients achieved complete remissions lasting two or more years. Most patients relapse, however. Some studies have suggested value of HDC-SCR as consolidation therapy in the adjuvant setting for women at high risk of relapse. Short-term toxicities of HDC-SCR are manageable in experienced hands. Notable long-term adverse effects include leukemia, sterility, pulmonary toxicity, and hemolytic uremic syndrome. Unresolved issues include the utility of purging occult cancer cells from stem-cell-bearing specimens, the best preparative regimen, the implications of autologous graft-versus-host disease, the use of sequential cycles of high-dose chemotherapy, cost-effectiveness, and effectiveness compared with standard therapy. HDC-SCR appears to be a valid option for selected patients with metastatic breast cancer, and in the adjuvant setting for patients at high risk of recurrence. The cost-benefit profile remains to be defined in randomized trials.

Prediction of chemical residues in aquatic organisms for a field discharge situation.

A field study was performed which compared predicted and measured concentrations of chemicals in receiving water organisms from three sampling locations on Five Mile Creek, Birmingham, Al. Two point source discharges, both from coke manufacturing facilities, were included in the field site and five chemicals were studied, i.e., biphenyl, phenanthrene, anthracene, fluoranthene, and pyrene. Composite samples of effluent, receiving water organisms, crayfish (Decapoda) and sunfish (Lepomis sp.), and stream and discharge flow data were collected in March and April 1990. For the crayfish and sunfish, the measured residues were within a factor of 5 for 80% (12 of 15) and 53% (8 of 15) of the residues predicted using EPA's draft procedure (US-EPA 199 lb), respectively, and were within a factor of 5 for 60% (9 of 15) and 40% (6 of 15) of the residues predicted using EPA's procedure with a BCF set equal to the chemical's Kow (after adjustment for lipid content of the organism), respectively. The predicted residues tended to be larger than the measured residues and with increasing Kow, greater disagreement between the predicted and measured values was observed.