Seatbelt use among bus passengers in Ghana: observed versus self-reported measures.

Many road traffic injuries in low- and middle-income countries (LMICs) are to bus passengers. We sought to determine the availability, functionality, and observed vs. self-reported use of seatbelts in large intercity buses in Ghana. We observed seatbelt use for 1,184 passengers in 35 large intercity buses. We interviewed a separate group of 633 bus passengers. All buses observed had seatbelts and most (92.6%) were functional. A little over a fifth (21.6%) of passengers were observed to wear seatbelts. However, 34.5% of passengers in the self-reported survey indicated always wearing seatbelts when riding in buses. Passengers on 5 buses out of the 35 observed where the driver verbally prompted them to wear seatbelts were more likely (57.8%) to wear seatbelts than on the other buses (15.3%, p = 0.001). Comparing the self-reported survey with observations, passengers tended to overinflate seatbelt use by a factor of 1.6. This study provides useful information for efforts to increase and monitor seatbelt use among large intercity bus passengers in LMICs.Supplemental data for this article is available online at.

A retrospective analysis of factors associated with anesthetic case duration for cesarean deliveries.

INTRODUCTION: Accurately predicting cesarean delivery case duration is an integral component of designing appropriate workflow protocols and ensuring adequate provider availability. Our primary objective was to describe the variability of case duration, based on factors that we hypothesized would be influential, such as hospital facility type, United States region, time of day, case volume, and patient and provider characteristics. METHODS: We analyzed hospital-, patient-, and provider-level variables from the National Anesthesia Clinical Outcomes Registry, a voluntary registry created to share anesthesia-related data and outcomes. Multivariable linear regression was performed to assess the association of these variables to case duration. RESULTS: A total of 205332 cases were included in the final analysis. The majority of these cases came from medium-sized community hospitals (50.8%). Mean and median case duration were 115 and 79 minutes, respectively. Mean duration was longest for cases performed at university hospitals (143 min, standard deviation 136 min). Case duration varied in clinically meaningful ways based on hospital facility type, United States region, presence of a Certified Registered Nurse Anesthetist, and anesthesia type. Differences were not clinically significant with respect to other variables studied. CONCLUSION: This study analyzed national cesarean delivery data and determined factors associated with cesarean delivery duration. We showed that case durations varied in meaningful ways according to facility type, United States region, presence of a Certified Registered Nurse Anesthetist, and anesthesia type. Our work contributes to a small but growing body of research on optimal staffing models for anesthesia practices.

Testing clinical surveillance of acute flaccid paralysis in Egypt post-eradication of poliomyelitis.

OBJECTIVE: To assess the knowledge of polio detection and notification by front-line clinicians in Egypt. METHODS: This study examines clinicians' knowledge and awareness of polio detection and notification using a multiple-choice questionnaire (maximum score=43) in three large health care centres in central Cairo (n=52). RESULTS: The results reveal a significant variation of knowledge amongst doctors, with junior and senior house officers scoring an average of 30.6 (95% CI: 29.5-31.7), specialist registrars and consultant paediatricians 30.3 (CI 28.9-31.7), and public health doctors 35.4 (CI 32.9-36.8). Mean total scores of public health doctors were significantly higher than those of other clinicians. Senior paediatricians performed no better than newly qualified doctors. CONCLUSIONS: The results suggest that there is a need for more clinical teaching and training amongst junior doctors as well as senior clinicians and consultants. Appropriate knowledge of diagnosing AFP and of the correct protocol amongst clinicians is essential to maintain the high quality of the WHO programme in Egypt.

Tuberculosis in socio-economically deprived neighborhoods: missed opportunities for prevention.

OBJECTIVE: To evaluate tuberculosis (TB) risk in three different US locations--Chicago, Illinois; Fulton County, Georgia; and the state of South Carolina--using two census-based measures of neighborhood-level deprivation and a geographic information system. METHOD: Individual-level data, including race and ZIP code of residence, were obtained for the three sites. TB cases were geocoded at the ZIP code tabulation area (ZCTA) level. Socio-economic status (SES) was defined at the ZCTA level using two Census 2000-based measures of socio-economic disadvantage: 1) percentage of population below poverty and 2) Townsend Deprivation Index. Based separately on the distributions of poverty and Townsend social deprivation scores, ZCTAs in each site were grouped into quartiles reflecting relative socio-economic well-being. To evaluate TB incidence in low- vs. high-SES neighborhoods, average annual TB incidence rates were calculated for the highest and lowest ZCTA quartiles. RESULTS: In all sites, TB incidence rates were significantly higher in high poverty/high social deprivation ZCTAs (P < 0.0001). CONCLUSIONS: Both census-based indicators performed well in distinguishing areas with high TB incidence rates from areas with little or no TB. Due to simplicity, the single poverty measure rather than the multifactorial Townsend index might be especially useful in identifying high-risk neighborhoods for targeted TB prevention efforts.

Periparturient cortisol, acute phase cytokine, and acute phase protein profiles of gilts housed in groups or stalls during gestation.

Use of gestation stalls in pork production remains a controversial topic in animal welfare. Immune status and measures are frequently used to assess stress levels and thus well-being of confined animals. The important welfare issue of close confinement among gestating gilts was tested by quantifying cortisol, acute phase cytokine, and acute phase protein pro-files before and after farrowing of gilts housed in 2 systems. Landrace x Yorkshire crossbred gilts housed in groups of 4 (group, n = 8) in pens (3.9 x 2.4 m with 4 individual feeding spaces, 9.36 m(2) total or 2.34 m(2)/gilt) were compared with gilts housed in standard industry stalls (stall, n = 16; 2.2 x 0.6 m, 1.32 m(2)/gilt). Floors were fully slatted, and a substrate was not provided for either system. Cortisol was determined from saliva on d 105 of gestation, 1 h after moving the gilts into farrowing stalls (d 111), and 24 h and 7 d after farrowing. Cortisol was greater (P = 0.04) for group gilts compared with stall gilts 1 h after moving them into farrowing stalls and 24 h after farrowing. Cortisol concentrations decreased (P = 0.001) over time. Leukocyte mRNA expression of IL-1, IL-1 receptor antagonist, and tumor necrosis factor-alpha was determined by quantitative, reverse transcription PCR on d 35, 63, and 91 of gestation and 72 h after farrowing. Cytokine mRNA expression of peripheral blood mononuclear cells did not differ between housing systems for IL-1, its receptor antagonist, or for tumor necrosis factor-alpha. Acute phase proteins, including fibrinogen, haptoglobin, and alpha(1)-acid glycoprotein were determined for plasma samples taken at d 35, 63, and 91 of gestation and 72 h and 14 d after farrowing. In contrast to cortisol, plasma fibrinogen concentrations increased (P < 0.005) over time. Haptoglobin did not differ between treatments (P > 0.10). Stall gilts tended to have greater (P = 0.07) plasma alpha(1)-acid glycoprotein concentrations than group animals at d 35 of gestation and d 14 after farrowing. These data showed a trend (P < 0.07) for alpha(1)-acid glycoprotein concentrations to return to baseline more quickly in group-housed gilts, which did not appear to be directly related to increased cortisol just before farrowing. In conclusion, few differences in the acute phase response were detected between housing systems, suggesting that the resting immunological responses are only mildly affected by gestation stalls.

Factors associated with preweaning mortality on commercial pig farms in England and Wales.

Data from 67 pig farms with a variety of farrowing systems were used to identify factors associated with preweaning mortality in British pig herds. The median mortality reported by the farmers was 10.7 per cent (interquartile range 8.5 to 14 per cent). There was a significantly higher mortality when the pigs were weaned when they were older. A multivariable Poisson model was developed into which the types of farrowing system on each farm and the age at weaning were forced. Factors associated with a lower preweaning mortality rate were insulating the farrowing building, providing extra heat at farrowing, giving the piglets iron injections, dipping their navels, using fan ventilation and using artificial lighting systems. Factors associated with a higher mortality rate were a later weaning age, the use of infra-red lamps rather than other forms of supplementary heat, and the use of a creep without any bedding.

Postnatal behavioral and physiological responses of piglets from gilts housed individually or in groups during gestation.

Gestational housing of sows remains a controversial issue that may affect the well-being of both sows and piglets. Therefore, 2 types of gestational housing were used to evaluate the stress imposed on pregnant gilts by each system and the effects on the offspring by comparing production, physiology, and behavioral measures of the piglets. Forty-eight Landrace x Yorkshire gilts were randomly assigned to groups (G) of 4 per pen (n = 8 pens; 3.9 m x 2.4 m) or to individual stalls (S; n = 16 stalls; 2.21 m x 0.61 m). Gilts were moved into individual farrowing crates 5 d before the expected farrowing date. Piglets were weighed at birth, d 14, and d 35. Two barrows from each litter were weaned at d 14 (early weaning) and housed together in pens. Maintenance behaviors (head in feeder, drinking, lying, eating mash) were videotaped and observed for the first 3 d after weaning using a 10-min interval scan sampling. Belly nosing and play/fight interactions were recorded from video observations for 3 d postweaning. An isolation test (30-min duration) was performed on one piglet from each pen of barrows on d 35. Time spent lying, the number of jumps against test box walls, and grunts and squeals were recorded in real time. Salivary cortisol was collected at 30-min intervals from baseline, and 0, 30, 60, and 90 min posttest. Jugular blood was collected from 2 barrows from each litter on d 1, 7, 14, 17, 21, and 28. Plasma TNF-alpha was analyzed by ELISA, and haptoglobin, alpha1-acid glycoprotein, and immunoglobulin G were analyzed by radial immunodiffusion. More piglets from the S treatment needed to be fed a liquid feed at weaning and drank more frequently on d 2 postweaning (P < 0.05). Additionally, by d 35 piglets from S gilts had a lighter BW (10.3 kg) than G piglets (12.8 kg; P < 0.01). Piglets from S gilts also grunted more during the 30-min isolation test (number of grunts = 356) than G piglets (number of grunts = 138; P < 0.01). Salivary cortisol and immune measures were not different. These data show some behavioral and production differences between piglets from individually stalled gilts and group-housed gilts. Therefore, there may be production advantages to housing first parity gilts in groups.

Expectations and perceptions of professional satisfaction in a cohort of Medunsa dental graduates in compulsory community service.

A study was initiated at Medunsa to track the expectations and perceptions of career satisfaction in a cohort of 2003 dental graduates. This paper reports on the expectations of career satisfaction held by this group shortly before graduating in 2003 from the Dental Faculty at Medunsa as well as perceptions gained from the year of Compulsory Community Service (CCS) during 2004. A previously validated questionnaire, the Dentist Satisfaction Survey (DSS) was self administered to the 2003 (N=43) group of learners. An expanded survey instrument the Dentist Satisfaction Questionnaire (DSQ) was self administered to the 2004 (N= 33) group of dentists. The 2004 survey included a Quality of Life (QoL) section as well as two visual analogue scales (VAS) that measured overall job satisfaction and dentistry-related stress. The respondents also had the opportunity to make any comments they felt could add value to their responses. Regression analyses were performed on both groups. The best set of predictor variables for overall job satisfaction in the 2003 group were Respect and Stress. Analysis of the data on the 2004 group revealed that Professional Time, Practice Management,

Relationship between ambulation and obesity in older persons with and without low back pain.

CONTEXT: For obese older persons, ambulation is both functionally important and a means of weight control. The relationship between weight and ambulation is not known in this population. Also, the extent to which pain interferes with ambulation is not studied. OBJECTIVE: To examine the relationship between obesity and ambulation, and to determine the effect of pain and body mass index (BMI) on ambulation in older persons. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of 82 older persons, ages 55-79 y, some with no back pain recruited from the community, others with back pain or spinal stenosis recruited from a magnetic resonance imaging (MRI) scanner as part of a larger university study of spinal stenosis. OUTCOME MEASURES: Age, Visual Analog Scales for pain, BMI, patient diagnosis (no pain, mechanical back pain, and spinal stenosis), walking velocity and stride length on a 15-min laboratory ambulation test, and 1-week community ambulation measured with a pedometer (steps, distance, and energy expenditure). RESULTS: BMI had a significant inverse relationship with ambulatory measurements in terms of the distance walked, steps taken, and walking velocity. Pain severity and pain category also had a significant inverse relationship with these measures. A negative correlation was observed between pain and obesity, although the relationship was statistically nonsignificant. DISCUSSION: Obese older people walked less than the nonobese older people. Pain was associated with decreased ambulation. Clinicians who intend to encourage increased ambulation in older obese persons should consider possible barriers posed by musculoskeletal pain.

The use of iodised salt in the manufacturing of processed foods in South Africa: bread and bread premixes, margarine, and flavourants of salty snacks.

Salt is widely used by the food industry, but information on the use of iodised salt as an ingredient in the manufacturing of processed foods in South Africa is not available. The iodine content of salt used in the manufacturing of bread, margarine and salty snack flavourants was investigated in a cross-sectional descriptive study. Questionnaire information and salt sampled on 1 day per week for 5 consecutive weeks were obtained from 12 food manufacturers (eight bread and bread premix manufacturers, two margarine manufacturers and two salty snack flavourant manufacturers). The iodine concentration of salt samples was analysed using the potentiometric titration method. Eleven of the 12 manufacturers surveyed reported that they used non-iodised salt. The reported reasons for using non-iodised salt included properties of the final product, health reasons, and financial considerations. However, substantial amounts of iodine were found in the salt of one-third of these manufacturers (n = 4), ranging from a mean content of 39-69 ppm. Three of these four particular manufacturers distributed their products countrywide. This information serves as a strong indication that iodised salt does not necessarily cause the adverse affects that food manufacturers fear may affect their products. Although the amounts of iodine in the salt were variable, our results showed that an appreciable percentage of the food companies used iodised salt unknowingly in the manufacturing of frequently consumed processed foods, and this may have a considerable impact on the daily iodine intake of consumers.

Multifactorial genetics of exencephaly in SELH/Bc mice.

BACKGROUND: The SELH/Bc mouse strain has 10-30% exencephaly and is an animal model for human neural tube closure defects. This study examined the number of causative genes, their dominance relationships, and linkage map positions. METHODS: The SELH/Bc strain (S) was crossed to the normal LM/Bc strain (L) and frequencies of exencephaly were observed in the F(1), BC(1), and F(2) generations. 102 F(2) males were individually testcrossed by SELH/Bc. The extremes, the 10 highest and 10 zero exencephaly-producing F(2) sires, were typed for 109 SSLP marker loci in a genome screen. Next, the resultant five provisional chromosomal regions were tested for linkage in 31 F(2) exencephalic embryos. Finally, 12 males, SS or LL for the Chr 13 region on an LM/Bc background, were testcrossed by SELH/Bc. RESULTS: The exencephaly frequencies in the F(1) (0.3%), BC(1) (4.4%), and F(2) (3.7%), and the distribution of F(2) males' testcross values (0-15.5%), indicated that the high risk of exencephaly in SELH/Bc is due to the cumulative effect of two or three loci. Linkage studies indicated the location of semidominant exencephaly-risk genes on Chr 13 near D13Mit13 (P < 0.001), Chr 5 near D5Mit168 (P < 0.025), and possibly Chr 11 near D11Mit10 (P < 0.07). The gene on Chr 13, Exen1, and the strong role of other loci were confirmed by the congenic males. CONCLUSIONS: The high risk of exencephaly in SELH/Bc mice is caused by the cumulative effect of two to three semidominant genes. Candidate genes include Msx2, Madh5, Ptch, and Irx1 (Chr 13) and Actb and Rac1 (Chr 5).

Limiting the spread of HIV/AIDS in Sierra Leone: opportunities for intervention.

The global pandemic of HIV/AIDS is at catastrophic levels in sub-Saharan Africa, while the need for research and treatment initiatives throughout the developing world remains critical. The West African country of Sierra Leone is representative of both of these facts. The purposes of this study were to assess the HIV-related knowledge, attitudes, and behaviors of adult Sierra Leoneans to determine what type of HIV prevention efforts are needed in this population and to determine how such efforts could be developed and implemented. Interviews with 487 adults residing in the capital city of Freetown, Sierra Leone, and in the Northern Province of that country revealed HIV/AIDS-related knowledge, attitudes, and behaviors that reflect the impact of culture and tradition on the spread of HIV/AIDS. The challenges for HIV prevention raised through this study indicate the need to examine in greater depth the culturally specific use of traditional healers and traditional theater as channels of information that could serve to make HIV prevention initiatives more effective in Sierra Leone.

Spin correlations in Ho2Ti2O7: a dipolar spin ice system.

The pyrochlore material Ho2Ti2O7 has been suggested to show "spin ice" behavior. We present neutron scattering and specific heat results that establish unambiguously that Ho2Ti2O7 exhibits spin ice correlations at low temperature. Diffuse magnetic neutron scattering is quite well described by a nearest neighbor spin ice model and very accurately described by a dipolar spin ice model. The heat capacity is well accounted for by the sum of a dipolar spin ice contribution and an expected nuclear spin contribution, known to exist in other Ho3+ salts. These results settle the question of the nature of the low temperature spin correlations in Ho2Ti2O7 for which contradictory claims have been made.

Unravelling the complex genetics of cleft lip in the mouse model.

Nonsyndromic cleft lip in "A" strain mice and humans is genetically complex and is distinct from isolated cleft palate. Cleft lip embryos recovered in 2.4% of 1485 first backcross (BC1) segregants from a cross of A/WySnJ (24% cleft lip) and C57BL/6J (no cleft lip) in A/WySnJ mothers, and in testcrosses of 10 recombinant inbred (RI) strains (AXB/Pgn or BXA/Pgn), were used for gene mapping and for inference of genetic architecture. The A/WySnJ maternal genotype increased cleft lip risk in reciprocal crosses; the relevant genetic difference between AXB-6/Pgn (8%) and A/WySnJ (24%) is entirely maternal. A combination of new mapping panels (325 meioses), new markers, and a recombinant cleft lip embryo redefined the location of a recessive factor essential to cleft lip risk, clf1, and candidate genes Itgb3 and Crhr, to between D11Mit146/360 and D11Mit166/147. A screen of 54 YACs for 46 genes and SSLP loci located Wnt15, Wnt3, Crhr, Mtapt, Itgb3, Dlx3, and Dlx7 within the clf1 candidate region. The clf2 locus was newly mapped to Chromosome (Chr) 13 by a genome screen of BC1 segregants, and further defined to a 4-cM region between D13Mit13/54 and D13Mit231 by strain distribution patterns of cleft lip liability and markers in testcrossed RI strains. Specific combinations of marker genotypes associated with cleft lip risk indicated that high risk in A/WySnJ mice is caused by epistatic interaction between clf1 and clf2 in the context of a genetic maternal effect. Human homologs of clf1 and clf2 are expected to be on 17q and 5q/9q.

Identification of the apical membrane-targeting signal of the multidrug resistance-associated protein 2 (MRP2/MOAT).

The human canalicular multispecific organic anion transporter (cMOAT), known as the multidrug resistance-associated protein 2 (MRP2), is normally expressed in the liver and to a lesser extent in the kidney proximal tubules. In these tissues MRP2 specifically localizes to the apical membrane. The construction of MRP2 fused to the green fluorescent protein, and subsequent site-directed mutagenesis enabled the identification of a targeting signal in MRP2 that is responsible for its apical localization in polarized cells. The specific apical localization of MRP2 is due to a C-terminal tail that is not present in the basolaterally targeted MRP1. Deletion of three amino acids from the C-terminal of MRP2 (DeltaMRP2) causes the protein to be localized predominantly in the basolateral membrane in polarized Madin-Darby canine kidney cells. Interestingly, MRP2 expressed in a mouse leukemia cell line (L1210 cells) predominantly accumulates intracellularly with minimal cell membrane localization. In contrast, DeltaMRP2 was shown to predominantly localize in the cell membrane in L1210 cells. Increased transport of 2,4-dinitrophenyl glutathione from L1210 cells expressing DeltaMRP2 showed that the re-targeted protein retains its normal function.

Detection of inadequate effort on neuropsychological testing: a meta-analytic review of selected procedures.

Thirty-two studies of commonly researched neuropsychological malingering tests were meta-analytically reviewed to evaluate their effectiveness in discriminating between honest responders and dissimulators. Overall, studies using the Digit Memory Test (DMT), Portland Digit Recognition Test (PDRT), 15-Item Test, 21-Item Test, and the Dot Counting Test had average effect sizes indicating that dissimulators obtain scores that are approximately 1.1 standard deviations below those of honest responders. The DMT separated the means of groups of honest and dissimulating responders by approximately 2 standard deviations, whereas the 21-Item Test and the PDRT separated the groups by nearly 1.5 and 1.25 standard deviations, respectively. The 15-Item Test and the Dot Counting Test were less effective, separating group means by approximately 3/4 of a standard deviation. Although the DMT, PDRT, 15-, and 21-Item Tests all demonstrated very high specificity rates, at the level of individual classification, the DMT had the highest sensitivity and overall hit-rate parameters. The PDRT and 15-Item Test demonstrated moderate sensitivity, whereas the 21-Item Test demonstrated poor sensitivity. The less than perfect sensitivities of all the measures included in this review argue against their use in isolation as malingering screening devices.

Cross-sectional study of older outpatients with schizophrenia and healthy comparison subjects: no differences in age-related cognitive decline.

OBJECTIVE: Little is known about the progression of cognitive deficits in older, community-dwelling patients with schizophrenia, especially in comparison to healthy subjects. METHOD: The authors examined the relationship of age to performance on the Mattis Dementia Rating Scale in 116 outpatients with schizophrenia and 122 normal comparison subjects. Subjects ranged in age from 40 to 85 years. RESULTS: Dementia Rating Scale scores were lower in the schizophrenia group but correlated negatively with age in both groups, with no significant differences seen between the schizophrenia and normal comparison groups in slopes that depicted age-related variation. CONCLUSIONS: This cross-sectional study suggests a relatively stable long-term course of cognitive impairment in individuals with schizophrenia, with no evidence of faster cognitive decline in outpatients with schizophrenia than in normal comparison subjects.