Painting a picture of trans-Tasman mortality.

OBJECTIVES: The determinants of health and mortality inequalities in New Zealand and Australia have been subjected to research, with the influence of a range of socio-economic and demographic influences (deprivation, social class, ethnicity) receiving notable attention. Both countries are considered privileged, positioned amongst the world leaders in rankings of mortality and life expectancy. This paper reports on observed rates of mortality and views how the countries have fared over time with respect to one another. STUDY DESIGN, OBSERVATIONAL, METHODS: This study derives comparable rates of mortality for both New Zealand and Australia, disaggregated by age and sex for the time period 1948-2008. The age-standardised rates are visualised using the Lexis mapping software program, showing the relative differences between the countries over time whilst simultaneously highlighting age, period and cohort effects. RESULTS: Relative to Australia, New Zealand had advantageous rates of mortality across almost all age groups between the years 1948 and 1980 (approximately). For both sexes, a dramatic reversal of fortunes in New Zealand has followed relative to Australia. For example, for younger males in New Zealand, the reversal is startling. Over the time period observed, males aged 10-20 years in New Zealand have moved from an advantageous position of having a mortality rate 20% lower than Australia to a relative position of 50% higher. CONCLUSIONS: The social and economic forces in both New Zealand and Australia which may have driven the divergence require further scrutiny. It is argued here, that the changing fortunes of the populations are linked to the process of selective migration and the large-scale population movements between the countries facilitated by the Trans-Tasman Travel Arrangement. These findings have important implications for policy formation and service planning, if the inequality in mortality between the areas of study is to be addressed.

Fat distribution in men of different waist girth, fitness level and exercise habit.

BACKGROUND: The risk of chronic disease is lower in obese men who are fit and active than obese men who are unfit and inactive. METHODS/OBJECTIVES: Magnetic resonance imaging and spectroscopy were used to assess total and regional adipose tissue in 13 men who were slim, fit and active (the slim-fit), in 12 men who were slim, unfit and inactive (the slim-unfit), in 13 men who were fat, fit and active (the fat-fit) and in 12 men who were fat, unfit and inactive (the fat-unfit), in order to investigate the hypothesis that visceral fat and liver fat are lower in the fat-fit than the fat-unfit. Waist girth was used to distinguish slim men (< or =90 cm) and fat men (> or =100 cm). Maximal oxygen consumption was used to identify fit men (above average for age) and unfit men (average or below for age). Fit men reported at least 60 min of vigorous aerobic activity per week and unfit men reported no regular moderate or vigorous activity in the last 2 years. RESULTS: Total fat was not significantly different in the slim-fit and the slim unfit, but the proportion of internal fat was significantly lower (P<0.05) and the proportion of visceral fat was almost significantly lower (P=0.06) in the slim-fit than all other groups. Total fat was not significantly different in the fat-fit and the fat-unfit, but visceral fat and liver fat were significantly lower in the fat-fit than the fat-unfit (P<0.01). Waist girth and years of exercise explained 84% of the variance in total fat, waist girth and maximal oxygen consumption explained 70% of the variance in visceral fat, and waist girth alone explained 25% of the variance in liver fat. CONCLUSION: Chronic disease risk may be lower because visceral fat and liver fat are lower in men who are fat, fit and active.

Suture urolithiasis in the renal pelvis secondary to prior subtotal colectomy.

We report upon a patient who underwent a subtotal colectomy 2 years prior to presenting for a percutaneous nephrolithotomy of a large stone in the left renal pelvis. At the time of surgery, a non-absorbable suture was found embedded in the stone. Both stone and suture were removed percutaneously.

Interventions for helping people recognise early signs of recurrence in bipolar disorder.

BACKGROUND: Recurrence rates for bipolar disorder are high despite effective treatments with mood stabiliser drugs. Self-help treatments and psychological treatments that teach patients to recognise and manage early warning symptoms and signs (EWS) of impending manic or depressive episodes are popular with patients. The main aim of such interventions is to intervene early and prevent bipolar episodes, thereby increasing the time to the next recurrence and preventing hospitalisation. OBJECTIVES: To compare the effectiveness of an EWS intervention plus treatment as usual (TAU ) versus TAU (involving and not involving a psychological therapy) on time to manic, depressive and all bipolar episodes (the primary outcome), hospitalisation, functioning, depressive and manic symptoms. SEARCH STRATEGY: Relevant studies identified by searching Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTR-Studies and CCDANCTR-References - searched on 20/10/2005), supplemented with hand searching the journal Bipolar Disorders, searching the UK National Research Register, checking reference lists of included studies and contacting authors. SELECTION CRITERIA: Only randomised controlled trials (RCTs) were included. Participants were adults with a diagnosis of bipolar disorder based on standardised psychiatric criteria. DATA COLLECTION AND ANALYSIS: Two reviewers independently rated trials for inclusion. Data were extracted from included trials by reviewers using a data extraction sheet. Authors of all the included studies were contacted for any additional information required. Time to recurrence data was summarised as log hazard ratios, dichotomous data as relative risk and continuous data as weighted mean difference, using random effects models to calculate effect size only when there was heterogeneity in the data. MAIN RESULTS: Eleven RCTs were identified, but only six provided primary outcome data. All six RCTs were of high quality. Time to first recurrence of any type (RE, hazards ratio 0.57, 95% CI 0.39 to 0.82), time to manic/hypomanic episode, time to depressive episode, and percentage of people hospitalised and functioning favoured the intervention group. Neither depressive nor hypomanic symptoms differed between intervention and control groups. AUTHORS' CONCLUSIONS: This review shows a beneficial effect of EWS in time to recurrence, percentage of people hospitalised and functioning in people with bipolar disorder. However, the absence of data on the primary outcome measure in so many included studies is a source of concern and a potential source of bias. Mental health services should consider routinely providing EWS interventions to adults with bipolar disorder, as they appear to reduce hospitalisation and therefore may be cost-effective.

Suitability of electrosurgical analysers for routine maintenance testing of electrosurgery units - a technical note.

PRIMARY OBJECTIVE: To evaluate the use of electrosurgical analysers in testing power output and leakage current from an electrosurgery unit and compare this to the manufacturer recommendations for routine testing. METHOD: Two electrosurgical analysers were compared to reference measurements (carried out using non-inductive resistors, a current transformer and oscilloscope) over a range of tests described in IEC 60601-2-2: 1998 measuring power output and leakage currents in different conditions. The analysers used were Metron QA-ES and Fluke 454A. OUTCOMES: Both analysers gave similar results to the reference measurements for power output. The Metron QA-ES gave similar results to the reference measurements for leakage current testing; however the Fluke 454A gave substantially different results when used as described in the manual. CONCLUSIONS: Electrosurgical analysers can be a valuable tool in the workshop, enabling rapid, accurate testing of electrosurgery equipment without needing additional equipment and setting up times. Not all analysers can perform all the tests that may be needed and in some cases the accuracy of the results is questionable. Users must be certain of the capabilities and limitations of the analyser before making decisions based on the results.

Medical equipment libraries: implementation, experience and user satisfaction.

The hospital-wide pooling and sharing of certain types of medical equipment can lead to both significant improvements in patient safety and financial advantages when compared with a department or ward-level equipment ownership system. In September 2003, a Medical Equipment Loan Service (MELS) was established, focusing initially on infusion pumps. The aims and expected benefits included; improving availability of equipment for both patients and clinical users, managing and reducing clinical risk, reducing equipment diversity, improving equipment management and reducing the overall cost of equipment provision. A user survey was carried out in 2005 and repeated in 2011. The results showed wide and continued satisfaction with the service. The process and difficulties of establishing the service and its development to include additional types of equipment are described. The benefits of managing medical equipment which is in widespread general use, through a MELS as part of a Clinical Engineering Department, are presented.

Exercise intensity does not affect the composition of diet- and exercise-induced body mass loss.

The effect of caloric restriction (1200 kcal/d intake) in combination with high (High) (80-90% of peak VO2) or low (Low) (40-50% of peak VO2) exercise work rates on the composition of lost body mass was determined in 27 obese women (percent fat, 36.7 +/- 4.2%; mean +/- SD). All subjects trained 3 d/wk for 8 wk, with the High (n = 14) and Low (n = 13) groups exercising for 25 and 50 min/d, respectively. After posttesting there were no differences between the groups with respect to pre- to posttest changes (mean of combined groups) in body mass (-7%), fat-free mass (-10%), fat mass (-16%), percent fat (-10%), and sum of five skinfold-thickness measurements (-16%). This study suggests that with regard to conservation of fat-free mass, the selection of an exercise intensity for a diet and exercise regimen may be left to the preference of the clinician and/or dieter.

Calcium entry blockers and activators: conformational and structural determinants of dihydropyrimidine calcium channel modulators.

Dihydropyrimidines 4, 6, and 15, uniquely designed to unambiguously establish structural and conformational determinants for DHP receptor occupation and for modulation of calcium channel function, were prepared and examined for calcium channel modulation. Our results confirm and firmly establish a preference for syn-orientation of an unsymmetrically substituted aryl moiety at the DHP receptor (15d vs 15e). We propose a normal vs capsized DHP boat model to explain structural and conformational requirements for modulation of calcium channel function that requires an obligatory left-hand side alkoxy cis-carbonyl interaction for maximal DHP receptor affinity, the effect of channel function being determined by orientation of the 4-aryl group. Enantiomers having an up-oriented pseudoaxial aryl group (normal DHP boat) will elicit calcium antagonist activity, whereas enantiomers having a down-oriented pseudoaxial aryl group (capsized DHP boat) will elicit calcium agonist activity. Single enantiomers of macrocyclic lactone 15b demonstrate opposite channel activity. Antagonist activity resides in enantiomer 15b-A (S-configuration, left-hand side alkoxy cis-carbonyl with up-oriented pseudoaxial aryl group and normal DHP boat), whereas agonist activity resides in enantiomer 15b-B (R-configuration, left-hand side alkoxy cis-carbonyl with down-oriented pseudoaxial aryl group and capsized DHP boat). Moreover, this model is consistent with and provides a rational explanation of previous literature in this area, most notably the observation of chiral inversion and potency diminution upon replacement of ester by hydrogen in the Bay K 8644 series.

Effects of consumption of milk and milk constituents on plasma concentrations of gastric inhibitory polypeptide and metabolites in preruminant goat kids.

Plasma concentrations of gastric inhibitory polypeptide (GIP) were measured in preruminant goat kids before and after consumption of milk, skimmed milk or solutions of milk fat, lactose, glucose or casein plus lactose. GIP concentrations increased significantly within 1 h of consumption of milk or milk fat, and were elevated for the remainder of the 5-h sampling period. The integrated mean change in GIP concentration during this period did not differ between these two meals. GIP levels were slightly increased above basal values 5 h after skimmed milk consumption, probably reflecting the absorption of a small amount of fat, but overall there was no significant GIP response to this or to any of the other test meals. The marked increase in GIP concentration after a milk feed indicates a physiological role for the hormone in preruminants but, in contrast to the situation in simple-stomached animals, carbohydrate absorption does not elicit GIP secretion in the preruminant goat. The data strongly suggest that fat is the major nutrient to stimulate GIP secretion in these animals.

Changes in the plasma concentration of gastric inhibitory polypeptide and other metabolites in response to feeding in sheep.

Plasma concentrations of gastric inhibitory polypeptide (GIP)-like activity were determined in sheep before and after refeeding following a 48-h fast. Plasma concentrations increased significantly after feeding, from about 250 pg/ml to about 550 pg/ml. Other metabolites in plasma also increased at this time, reflecting the absorption of nutrients from the gastrointestinal tract. Significant increases were observed in the plasma concentrations of acetate, beta-hydroxybutyrate and triacylglycerol. By comparing the time-courses of the changes in concentration of GIP and other metabolites in plasma, possible sites of secretion and secretagogues of GIP in ruminant animals are proposed. The results demonstrate that GIP is secreted in response to nutrient absorption in adult ruminants and that, as in simple-stomached animals, the absorption of long-chain free fatty acids plays an important role in this secretion.

Transitional cell carcinoma of bladder in patients under thirty years of age.

Seventy-nine cases of transitional cell carcinoma of the bladder in the age group under thirty years have been reviewed. The diagnosis and treatment are the same as in the older age group. The tumors are usually of low grade and low stage, but they can become more aggressive and more malignant. Contrary to previously held beliefs that transitional cell tumors in the younger age group rarely if ever recur, this series had a recurrence rate of 13.9 per cent with several patients having multiple recurrences. Therefore, the follow-up care of these patients must be vigilant and persistent.

Cauterising iris scissors.

The cauterising iris scissors described here are a modification achieved by suitably insulating the standard De Wecker's iris scissors. This modification provides in addition to cutting an advantageous cauterising effect, which could prove useful in the surgery of eye conditions with high risk of bleeding or metastasis. It utilises the optimum electric current range of 20-40 mA.

Compatibility of adaptive responses with combining strength and endurance training.

Impairment in strength development has been demonstrated with combined strength and endurance training as compared with strength training alone. The purpose of this study was to examine the effects of combining conventional 3 d.wk-1 strength and endurance training on the compatibility of improving both VO2peak and strength performance simultaneously. Sedentary adult males, randomly assigned to one of three groups (N = 10 each), completed 10 wk of training. A strength-only (S) group performed eight weight-training exercises (4 sets/exercise, 5-7 repetitions/set), an endurance-only (E) group performed continuous cycle exercise (50 min at 70% heart rate reserve), and a combined (C) group performed the same S and E exercise in a single session. S and C groups demonstrated similar increases (P < 0.0167) in 1RM squat (23% and 22%) and bench press (18% for both groups), in maximal isometric knee extension torque (12% and 7%), in maximal vertical jump (6% and 9%), and in fat-free mass (3% and 5%). E training did not induce changes in any of these variables. VO2peak (ml.kg-1.min-1) increased (P < 0.01) similarly in both E (18%) and C (16%) groups. Results indicate 3 d.wk-1 combined training can induce substantial concurrent and compatible increases in VO2peak and strength performance.

Hemoglobin, muscle oxidative capacity, and VO2max in African-American and Caucasian women.

PURPOSE: The purpose of this paper was to determine whether differences in hemoglobin (Hb) and muscle aerobic capacity exist between African-American (AA) and Caucasian (CA) premenopausal women and to determine whether Hb and aerobic capacity of the muscle are associated with the racial differences in maximum oxygen uptake (VO2max). METHODS: 43 AA and 46 CA sedentary premenopausal women were subjects. Percent body fat was determined by four-compartment model, leg lean tissue by dual energy x-ray absorptiometry, VO2max during a graded exercise test, aerobic capacity of the calf muscle by 31P magnetic resonance spectroscopy, and serum Hb by the cyanide method. RESULTS: AA women had reduced VO2max (AA 29.3 +/- 3.0 vs CA 33.6 +/- 5.6 mL.kg(-1) bdw(-1).min, P < 0.01), reduced muscle aerobic capacity (AA 24.3 +/- 5.8 vs CA 21.3 +/- 4.8 s, P = 0.01, where lower values indicate higher aerobic capacity), and reduced Hb (AA 11.8 +/- 1.3 vs CA 12.9 +/- 0.8 g.dL(-1), P < 0.01). The racial difference in VO2max persisted whether the values were unadjusted or adjusted for fat-free mass or leg lean tissue. Multiple regression analysis revealed that both Hb and muscle aerobic capacity were related to VO2max after adjusting for each other, race, and either fat-free mass or leg lean tissue. Being AA was associated with reduced VO2max in mL O2.kg leg lean tissue(-1).min(-1) (zero-order simple Pearson-product correlation -0.60, P < 0.01). When multiple regression was used, the correlation between race and VO2max decreased but persisted (-0.40, <0.01) after adjusting for Hb and muscle aerobic capacity. CONCLUSIONS: These data suggest that differences in Hb and aerobic capacity of muscle are related to reduced VO2max in AA women. However, Hb and aerobic capacity of the muscle can only partially explain the racial differences in VO2max.

The determination of oxalic acid in urine by high performance liquid chromatography with electrochemical detection.

A system for the determination of oxalic acid in human urine using ion exchange-ion pair, high performance liquid chromatography with electrochemical detection (HPLCEC) is described. Urine is acidified with HCl, and excess CaCl2 is added to precipitate oxalate ion. The precipitate is isolated, redissolved in dilute sulfuric acid, and separated on a strong cation exchange column using an acetic acid-solium acetate-tetrabutylammonium tetrafluoroborate mobile phase adjusted to pH 2.8. Using an electrochemical detector at 1.25 volts vs. the saturated calomel electrode (SCE), oxalic acid exhibits a linear dynamic range from 1 to 1000 mg/liter with a detection limit of 0.1 mg/liter. Quantitative data are obtained by the method of standard addition in the clinically significant range from 5 to 40 mg/liter. Percentage recovery for spiked urine samples was 97.8% with a relative standard deviation of 2.5%.

Varying fat and protein in diets of growing large white turkeys.

Two series of three consecutive 4-week experiments with a total of 1,370 Large White turkeys between 8 and 20 weeks of age were conducted to determine the effects of varying levels of dietary fat and protein on body weight gain and feed efficiency. Diets containing 0, 5, and 10% added fat and 18, 20, 22, and 24% protein in a 3 X 4 factorial were each fed to a total of three pens of males and three pens of females. At the end of each 4-week period, the turkeys were rerandomized to form 12 new equivalent groups, and similar diets with 2% less protein were fed. As part of this study, two fats, varying in fatty acid composition, were also compared but found not to affect significantly body weight gain or feed efficiency. Interaction effects of fat and protein on body weight gain, feed consumption, or feed efficiency were not significant. Body weight gain increased .5, .6, and 1.1%, feed consumption decreased 1.1, 1.0, and .9%, and feed efficiency increased 1.7, 1.8, and 2.2% for each 1% added fat during the 8 to 12-, 12 to 16-, and 16 to 20-week periods, respectively. The greater-than-expected increase in feed efficiency from added fat to diets of older turkeys is postulated to be due to stimulated feed consumption and body weight gain rather than to an extra caloric content of fat per se.

Lysine and protein requirements of growing turkeys.

A study was conducted with 1,751 Large White turkeys divided into 36 pens of males and 36 pens of females between 8 and 24 or 20 weeks of age, respectively, to determine the requirements of protein and lysine for turkeys. Diets were composed of ground yellow corn, dehulled soybean meal, 6% stabilized fat, 4% meat and bone meal, .4% methionine, minerals, and vitamins. A 3 X 3 factorial design of nine diets varying in protein (18, 21, and 24%) and added lysine (0, .1, and .2%) was used between 8 and 12 weeks of age. Birds were reassigned to new balanced pens at the end of each 4-week period, and protein levels were reduced by 3.0%. The addition of 3 and 6% protein, which provides .22 and .44% lysine, to diets of turkeys between 8 and 20 weeks of age increased body weight gains 18.3 and 24.7%, respectively, in contrast to an increase of only 2.2 and 3.6% from .1 and .2% added L-lysine per se. the minimum protein requirements of large White male turkeys at 10, 14, and 18 weeks of age are 21.3, 19.5, and 17.6% and for female turkeys 21.7, 18.4, and 15.0%, respectively. The minimum lysine requirements of large White turkeys to 12, 16, and 20 weeks of age are about 1.4, 1.2, and.9%, respectively, or 4.5, 3.7, and 3.0 g/kcal metabolizable energy. Another amino acid appears to be equally or more deficient than lysine in diets used in this study.

Neonatal intrahepatocellular lipid.

There is increasing evidence that preterm birth is a risk factor for the development of adiposity associated disease, although the pathophysiological basis is unclear. We have previously shown that preterm infants have increased internal abdominal (visceral) adiposity by term. In adults increased internal adiposity is associated with elevated intrahepatocellular lipid (IHCL). We measured IHCL using (1)H NMR spectroscopy in 26 infants (eight healthy preterm-at-term and 18 term-born) and compared values with a reference group of 32 adults. There was no significant difference between adult and term-born IHCL content. In preterm-at-term infants IHCL was significantly elevated when compared with term-born infants and with adults (IHCL CH2/water median (interquartile range): preterm 1.69 (1.04-3.53), term 0.21 (0-0.54) and adult 0.55 (0.08-1.57).

Lanolin and derivatives chemistry: relationship to allergic contact dermatitis.

This paper summarizes lanolin, the composition of its esters, acids and alcohols, its chemical and physical modifications, and refining. It discusses lanolin, its constituents and derivatives, and their relationship to allergic contant dermatitis.