History of concussion is associated with higher head acceleration and reduced cervical muscle activity during simulated rugby tackle: An exploratory study.

OBJECTIVES: The objective of this study is to explore the effect of concussion history on head control during front on rugby tackles in non-professional male and female Rugby Union players. DESIGN: An observational cross-sectional design. SETTING: A laboratory-based study of simulated front on rugby tackles with a dynamic relatively-weighted (∼50% body-mass) tackle bag. PARTICIPANTS: 27 club Rugby Union players were recruited; 10 (7female) with no-concussion history, 10 (3female) within 12-months of concussion and 7 (3female) with 24 + months since last concussion. MAIN OUTCOME MEASURES: Linear and rotational head acceleration measured with a skin mounted CSx® triaxial accelerometer. Normalized Surface EMG amplitude of the bilateral sternocleidomastoid (Scm), upper trapezius (Trap) and splenius capitis (Spl). All outcome measures were synchronised with moment of impact with the tackle bag. RESULTS: A mixed-model analysis showed that players with 12-Month concussion history had the highest head acceleration (females = 48.6g, males = 68.3g, p < 0.05) with lower Trap (6.9-11.7%, p < 0.05) and Spl (3-12%, p < 0.05) amplitudes compared to athletes with No-concussion. CONCLUSIONS: These findings suggest probable disruption to neuromuscular control of the head in athletes with concussion history as a potential mechanism for recurrent concussion incidence.

Emergence of group B Streptococcus serotype IV in women of child-bearing age in Ireland.

This study determined the carriage rate and serotype distribution of group B Streptococcus (GBS) in women of child-bearing age in the southern region of Ireland. A total of 2000 vaginal swabs collected in two periods in 2004 and 2006 were examined and revealed a GBS carriage rate of 16·1%. Serotyping of isolates showed that serotypes Ia, II, III, IV, and V were the most prevalent. A high prevalence of serotype IV was found, increasing from 7·6% to 15·2% between 2004 and 2006. Random amplified polymorphic DNA analysis demonstrated considerable genetic heterogeneity in the serotype IV isolates. This serotype should be considered for inclusion in potential vaccines for use in Ireland.

CLN5 mutations are frequent in juvenile and late-onset non-Finnish patients with NCL.

OBJECTIVES: To explore a potential expansion of the phenotypic and genotypic characteristics of Finnish variant late-infantile neuronal ceroid lipofuscinosis (NCL), we screened a collection of 47 patients with clinically diagnosed NCL in whom no molecular diagnosis had been made. METHODS: We used PCR amplification of genomic DNA, followed by fluorescent-labeled dideoxy-nucleotide chain termination sequencing and multiplex ligation-dependent probe amplification, to screen our cohort of patients for mutations in CLN5. We collected ethnic background, clinical, and pathologic information, as available, to clarify the breadth of CLN5 disease expression and to explore possible genotype-phenotype correlations. RESULTS: We identified 10 patients with pathogenic CLN5 mutations, including 11 mutations not previously described: 4 missense, 5 out-of-frame insertion/deletion mutations, and 2 large intragenic deletions. We also documented 3 previously reported CLN5 mutations. The age at disease onset in this cohort is predominantly juvenile rather than late infantile. Importantly, we have identified 2 adult-onset patients who share a common pathogenic allele. The majority of patients presented with motor and visual impairments and not seizures. In those patients with available longitudinal data, most had progressed to global neurodevelopmental and visual failure with seizures within 1 to 4 years. CONCLUSIONS: Our study suggests that CLN5 mutations 1) are more common in patients with neuronal ceroid lipofuscinosis (NCL) than previously reported, 2) are found in non-Finnish NCL patients of broad ethnic diversity, and 3) can be identified in NCL patients with disease onset in adult and juvenile epochs. CLN5 genetic testing is warranted in a wider population with clinical and pathologic features suggestive of an NCL disorder.

Analysis of phenotype, genotype and serotype distribution in erythromycin-resistant group B streptococci isolated from vaginal flora in Southern Ireland.

The screening of 2000 women of childbearing age in Cork between 2004 and 2006 produced 37 erythromycin-resistant group B streptococcus (GBS) isolates. PCR analysis was performed to determine the basis for erythromycin resistance. The ermTR gene was most frequently expressed (n = 19), followed by the ermB gene (n = 8). Four isolates harboured the mefA gene. Six isolates yielded no PCR products. Some phenotype-genotype correlation was observed. All isolates expressing the mefA gene displayed the M phenotype whilst all those expressing ermB displayed the constitutive macrolide resistance (cMLS(B)) phenotype. Of 19 isolates that expressed the ermTR gene, 16 displayed the inducible macrolide resistance (iMLS(B)) phenotype. Serotype analysis revealed that serotypes III and V predominated in these isolates. The identification of two erythromycin-resistant serotype VIII isolates among this collection represents the first reported finding of erythromycin resistance in this serotype. A single isolate was non-typable using two latex agglutination serotyping kits.

Genetic testing for early-onset torsion dystonia (DYT1): introduction of a simple screening method, experiences from testing of a large patient cohort, and ethical aspects.

Early-onset, generalized primary torsion dystonia (PTD) is an autosomal dominantly inherited disorder, characterized by involuntary movements and abnormal postures. The majority of cases are caused by a 3-bp deletion in the DYT1 gene on chromosome 9q34 that allows for specific genetic testing. We developed a simple, reliable, and cost-effective, PCR-based screening method for this mutation. Testing results from a cohort of 550 cases, including patients with different forms of dystonia and unclassified movement disorders, revealed that 72.2% of the patients with typical early-onset generalized PTD carried the GAG deletion in the DYT1 gene. Among 300 cases with late-onset focal/segmental dystonia, only 3 patients tested positive for the GAG deletion whereas 12.8% of the patients with an unclassified movement disorder were GAG positive. Our results confirm a genotype/phenotype correlation in early-onset PTD and show that application of strict clinical criteria leads to accurate prediction of carrier status in more than two-thirds of patients with this type of dystonia. Currently, we suggest that testing be recommended in individuals with age of onset of dystonia below 30 years and/or a positive family history of early-onset PTD. Testing is not recommended in patients with onset of symptoms after 30 years or in asymptomatic individuals under the age of 18.

Neoliberalism revised? A critical account of World Bank conceptions of good governance and market friendly intervention.

This article examines recent World Bank reports on the role of the state in the development process, with particular reference to the rise of the East Asian newly industrializing countries and the crisis of "governance" in sub-Saharan Africa. The concepts of market friendly intervention and good governance are critically discussed, and are found to be inadequate as explanations for East Asian "success" and African "failure." The author presents an alternative explanation for the rise of the newly industrializing countries, which draws out some of the implications for the developing world.

PIP: This article examines recent World Bank reports on the role of the state in the development process among newly industrializing countries in Eastern Asia and the crisis of governance in sub-Saharan Africa. The concepts of neoliberalism and good governance are discussed by first reviewing the "classical" neoliberal approach to development among Eastern Asian countries along with the reasons why this view has been undermined. Then the neoliberal view is outlined wherein the idea of market friendly intervention and good governance are introduced. Reviews of the World Bank literature on market friendly intervention and good governance are found to be inadequate in explaining the success for East Asian and African failure. It displays a continued reluctance to recognize the key role of the state in capitalist development, dismissing intervention as insignificant or irrelevant and reducing governance to purely technical questions of policy-making. Although technical policy-making is an important factor in promoting economic growth, in the case of the World Bank's interpretation, it is far too narrow and continues to focus one-sidedly on the question of "getting price right". However, states are not necessarily inefficient. Markets, on the other hand, are unequal, hierarchical, and incapable of working without the existence of states.

A framework for designing and implementing community benefit standards.

Increasingly, health care professionals and the public are asking questions about the role of the hospital in meeting community need including its not-for-profit tax status. This article reviews the community benefit literature, provides a framework for understanding how a hospital community benefit program was developed, and delineates through a structured case study the lessons learned from this experience. It provides the practitioner with a context in which other hospitals may replicate the program and gives researchers a substantive case study that may be used as the basis for the empirical testing of community benefit models. The authors also outline the many difficult issues faced by a typical community hospital as it attempted to examine and develop additional responses to community need.

Normal expression of myosin fast alkali light chain 3 in the hindlimb muscle of chick embryos paralyzed with curare.

We have used a monoclonal antibody (Mab) raised against the fast alkali light chains of quail pectoral muscle myosin to study the expression of MLC1f and MLC3f in the hindlimb muscle of a staged series of control chick embryos and 16-day embryos that had been paralyzed with curare. The Mab (QBM-2) is highly specific for the fast myosin alkali light chains of chick, hamster, and human muscle myosin. On Western blots, MLC1f is detected in hindlimb actomyosin at all of the stages examined, whereas MLC3f cannot be detected until Embryonic Day 14 (E14). Most of the E16 embryos that had been paralyzed with curare since E4 express detectable levels of both MLC1f and MLC3f in their hindlimb muscles, even though embryos incubated under these conditions do not exhibit spontaneous limb movements. Contrary to other reports, our results demonstrate that muscle contraction is not required for the accumulation of MLC3f. In light of our previous finding that innervation is essential for MLC3f accumulation in limb buds grafted onto the chorioallantoic membrane of chick hosts, these results suggest that some neural influence other than contraction, possibly a trophic factor, may play a role in the developmentally regulated expression of MLC3f in avian limb muscle.

Chronic eosinophilic pancreatitis and ulcerative colitis in a horse.

A generalized debilitating disease in a horse was believed to be related to hypersensitivity to migrating strongyle larvae. The clinical signs included weight loss, diarrhea, and ulcers on all 4 coronary bands. The mare's condition deteriorated rapidly, so the mare was euthanatized and necropsied. The major histopathologic findings were chronic multifocal eosinophilic pancreatitis, hepatic portal fibrosis, biliary hyperplasia, and chronic ulcerative eosinophilic colitis. This case was similar to previously reported cases of chronic eosinophilic gastroenteritis in horses. Although the etiologic agent was not evident, the distribution and character of the lesions were consistent with a hypersensitivity response to migrating parasitic larvae, most probably Strongylus equinus.