Kerosene lighting contributes to household air pollution in rural Uganda.

The literature on the contribution of kerosene lighting to indoor air particulate concentrations is sparse. In rural Uganda, kitchens are almost universally located outside the main home, and kerosene is often used for lighting. In this study, we obtained longitudinal measures of particulate matter 2.5 microns or smaller in size (PM2.5 ) from living rooms and kitchens of 88 households in rural Uganda. Linear mixed-effects models with a random intercept for household were used to test the hypotheses that primary reported lighting source and kitchen location (indoor vs outdoor) are associated with PM2.5 levels. During initial testing, households reported using the following sources of lighting: open-wick kerosene (19.3%), hurricane kerosene (45.5%), battery-powered (33.0%), and solar (1.1%) lamps. During follow-up testing, these proportions changed to 29.5%, 35.2%, 18.2%, and 9.1%, respectively. Average ambient, living room, and kitchen PM2.5 levels were 20.2, 35.2, and 270.0 µg/m3 . Living rooms using open-wick kerosene lamps had the highest PM2.5 levels (55.3 µg/m3 ) compared to those using solar lighting (19.4 µg/m3 ; open wick vs solar, P=.01); 27.6% of homes using open-wick kerosene lamps met World Health Organization indoor air quality standards compared to 75.0% in homes using solar lighting.

Radiation dose to workers due to the inhalation of dust during granite fabrication.

There has been very little research conducted to determine internal radiation doses resulting from worker exposure to ionising radiation in granite fabrication shops. To address this issue, we estimated the effective radiation dose of granite workers in US fabrication shops who were exposed to the maximum respirable dust and silica concentrations allowed under current US regulations, and also to concentrations reported in the literature. Radiation doses were calculated using standard methods developed by the International Commission on Radiological Protection. The calculated internal doses were very low, and below both US occupational standards (50 mSv yr(-1)) and limits applicable to the general public (1 mSv yr(-1)). Workers exposed to respirable granite dust concentrations at the US Occupational Safety and Health Administration (OSHA) respirable dust permissible exposure limit (PEL) of 5 mg m(-3) over a full year had an estimated radiation dose of 0.062 mSv yr(-1). Workers exposed to respirable granite dust concentrations at the OSHA silica PEL and at the American Conference of Governmental Industrial Hygienists Threshold Limit Value for a full year had expected radiation doses of 0.007 mSv yr(-1) and 0.002 mSv yr(-1), respectively. Using data from studies of respirable granite dust and silica concentrations measured in granite fabrication shops, we calculated median expected radiation doses that ranged from <0.001 to 0.101 mSv yr(-1).

Predicted indoor radon concentrations from a Monte Carlo simulation of 1,000,000 granite countertop purchases.

Previous research examining radon exposure from granite countertops relied on using a limited number of exposure scenarios. We expanded upon this analysis and determined the probability that installing a granite countertop in a residential home would lead to a meaningful radon exposure by performing a Monte Carlo simulation to obtain a distribution of potential indoor radon concentrations attributable to granite. The Monte Carlo analysis included estimates of the probability that a particular type of granite would be purchased, the radon flux associated with that type, the size of the countertop purchased, the volume of the home where it would be installed and the air exchange rate of that home. One million countertop purchases were simulated and 99.99% of the resulting radon concentrations were lower than the average outdoor radon concentrations in the US (14.8 Bq m(-3); 0.4  pCi l(-1)). The median predicted indoor concentration from granite countertops was 0.06 Bq m(-3) (1.59 × 10(-3) pCi l(-1)), which is over 2000 times lower than the US Environmental Protection Agency's action level for indoor radon (148 Bq m(-3); 4 pCi l(-1)). The results show that there is a low probability of a granite countertop causing elevated levels of radon in a home.

Annual ryegrass toxicity in Thoroughbred horses in Ceres in the Western Cape Province, South Africa.

An outbreak of annual ryegrass toxicity occurred on a Thoroughbred stud in Ceres in the Western Cape Province of South Africa. This is the 1st report of annual ryegrass toxicity in horses in South Africa, although the condition has been reported in cattle and sheep populations in the past. Annual ryegrass toxicity is characterised by a variety of neurological signs including tremors, convulsions, recumbency and in many cases death. The description of the outbreak includes the history, clinical presentation and treatment protocol administered during the outbreak. Various epidemiological variables and their influence in the outbreak are also considered.

A splice-site mutation causing ovine McArdle's disease.

McArdle's disease is an autosomal recessive myopathy with symptoms of exercise intolerance caused by deficiency of the enzyme muscle glycogen phosphorylase which releases glucose for contraction during exercise. The human cDNA has been sequenced and disease-causing mutations identified. An ovine equivalent of McArdle's disease has been diagnosed and the mutation responsible identified by PCR-amplification of the ovine glycogen myophosphorylase cDNA in six overlapping fragments followed by single strand conformation polymorphism (SSCP) analysis. Two fragments showed SSCPs in the glycogen myophosphorylase cDNA from affected sheep. The SSCP in fragment one was a silent polymorphism, while that in fragment six, was an eight base deletion at the 5' end of exon 20. This deletion will cause a frame-shift, a premature stop codon and remove the last 31 amino-acid residues from the protein. The cDNA deletion suggested that the genomic mutation most likely involved a splice-site. Sequencing intron 19 identified the mutation as an adenine for guanine substitution at the intron 19 3' splice-site. This eliminated an XbaI site present in normal sheep allowing diagnosis of normal, affected and carrier sheep. This ovine model of McArdle's disease is now available for therapeutic trials.

Accuracy and implications of a reported family history of glaucoma: experience from the Glaucoma Inheritance Study in Tasmania.

OBJECTIVES: To ascertain the prevalence of previously undiagnosed primary open-angle glaucoma (POAG) within 5 large POAG pedigrees and to evaluate the reliability of a reported family history of glaucoma within these pedigrees. METHODS: The Glaucoma Inheritance Study in Tasmania (GIST) identified several large adult POAG pedigrees. Intraocular pressure (IOP), optic disc stereophotography, and automated perimetry were performed on all adult pedigree members. Participants were classified as normal (IOP <22 mm Hg and normal optic disc and field); glaucoma suspect (normal field, but an IOP >/=22 mm Hg and/or suspicious optic disc); or POAG (field defect and glaucomatous optic disc). Some individuals with POAG had been previously diagnosed by their local ophthalmologist; others were diagnosed as a result of the GIST project. Family members with a prior diagnosis of POAG were asked to report if they were aware of any relatives with POAG. This reported family history was then directly compared with the actual pedigree (before the diagnosis of new cases) to calculate agreement. MAIN OUTCOME MEASURE: The rate of glaucoma in pedigrees and percentage of previously diagnosed glaucoma cases who were aware of the positive family history of POAG. RESULTS: Four hundred forty-two subjects (mean age, 54 years [range, 13-97 years]) from 5 pedigrees were examined: 316 subjects (71%) were normal, 47 (11%) were previously diagnosed with POAG, and 8 (2%) were previously diagnosed glaucoma suspects; 30 cases (7%) of POAG and 41 suspects (9%) were newly diagnosed as a direct result of the GIST examination. Of the 47 previously diagnosed POAG cases, 41 were questioned about their prior knowledge of any family history and 11 (27%) were unaware of their family history of POAG. CONCLUSIONS: Examination of all adult subjects from POAG families yields new cases. Even in large POAG pedigrees, 27% of previously diagnosed POAG patients were unaware of their positive family history. These findings suggest that a higher percentage of adult POAG may be inherited than hitherto reported. Arch Ophthalmol. 2000;118:900-904

The spectrum of accuracy in memories of childhood trauma.

In the context of public outcry about "false memories" of childhood sexual abuse, many persons with posttraumatic stress disorder are dismayed by their confusion about the historical basis of their intrusive memories. Numerous interacting factors impinge on memory of trauma to yield a broad spectrum of accuracy. In their endeavors to reconstruct coherent narratives of traumatic experience, clinicians and their patients will benefit from thinking in shades of gray rather than in terms of "true" versus "false" memories.

Transference interpretation in the psychotherapy of borderline patients: a high-risk, high-gain phenomenon.

The effectiveness of transference interpretation in the psychodynamic psychotherapy of patients with borderline personality disorder has been highly controversial. Both highly expressive approaches that stress the value of transference interpretation and supportive strategies that eschew transference work have been advocated in the literature. We review this literature and identify three emerging trends in thought: (1) Primarily interpretive approaches should be reserved for patients with greater levels of ego strength. (2) Whichever technique is used, a strong therapeutic alliance is the foundation of treatment. (3) Expressive and supportive techniques should not be juxtaposed as polarized opposites; supportive interventions often pave the way for transference interpretation. Our psychotherapy process study revealed that transference interpretations tended to have greater impact--both positive and negative--than other interventions made with patients with borderline personality disorder. We conclude that such factors as neuropsychologically based cognitive dysfunction, a history of early trauma, patterns of object relations involving interpersonal distance, masochistic tendencies, and anaclitic rather than introjective psychopathology are among the patient characteristics that influence the impact of transference interpretation on the therapeutic alliance. Bias toward expressive technique and countertransference issues appear to be relevant to the therapist's difficulty in shifting to a more supportive approach when indicated.

Postoperative analgesia following total knee arthroplasty: a study comparing spinal anesthesia and combined sciatic femoral 3-in-1 block.

BACKGROUND AND OBJECTIVES: The quality of analgesia and subsequent morphine requirements following spinal anesthetic block (SAB) or combined sciatic and femoral (3-in-1) block (SFB) for total knee arthroplasty were compared. METHODS: The 39 patients studied were randomly assigned to receive either SAB (n = 19) or SFB (n = 20). All patients received a standardized general anesthetic, patient-controlled analgesia, and regular diclofenac. Visual analog pain scores and morphine requirements were recorded for 48 hours following surgery. Observations were grouped into four 12-hour periods. Pain scores (0-10 cm) were expressed as 95% confidence intervals; the criterion for analgesic success was a confidence interval in the range 0-3 cm. RESULTS: Although pain-free on awakening, the SAB patients failed to achieve analgesic success in any of the four periods, while the SFB patients did so in three of the four periods. Morphine consumption was significantly higher in the SAB group during the first two periods but similar to the SFB group thereafter. CONCLUSION: In comparison with SAB, SFB resulted in superior analgesia and reduced morphine consumption for the first 24 hours following total knee arthroplasty.

Evaluation of intensive inpatient treatment of patients with severe personality disorders.

OBJECTIVE: The purpose of this study was to determine whether severe personality disorders improve or deteriorate with intensive inpatient treatment. METHODS: Overall 216 patients diagnosed as having personality disorders by DSM-III-R criteria were prospectively monitored at two private psychiatric hospitals from admission through discharge to one-year follow-up. RESULTS: Substantial positive change in the sample was recorded at discharge, and the improvements held up at one-year follow-up. The proportion of patients with scores of 50 or more on the Global Assessment Scale was 3.7 percent at the time of admission. By discharge the proportion had increased to 55.1 percent, and by one-year follow-up it had risen to 66.3 percent. CONCLUSIONS: These results suggest that patients with severe personality disorders benefit from intensive inpatient treatment. We found no evidence that hospitalization of such patients is associated with regression or deterioration of function.

Zinc toxicity in ruminants.

Four natural occurrences of zinc toxicity in sheep and one in calves were studied. To assist in the confirmation of a diagnosis of zinc toxicity, 2 experiments were conducted in which sheep were given toxic amounts of zinc. The clinical findings, clinical pathology, and gross and microscopic pathology are given. Clinical manifestations included inappetance, loss of condition, diarrhoea with dehydration or subcutaneous oedema, profound weakness and jaundice. Significant rises in the concentration of zinc were usually found in the liver, kidney and pancreas, but occasionally in only 1 or 2 of these organs. Many affected sheep were anaemic. Pathological changes were found in the pancreas, kidney, liver, rumen, abomasum, small intestine and adrenal gland. Lesions in the kidney and abomasum apparently made the most significant contribution to the deterioration in health of affected animals, but the pancreas was the only organ consistently affected. The degenerative changes in the pancreas were mainly restricted to the exocrine portion of the organ, and regeneration of the damaged tissue was observed although exposure to toxic amounts of zinc continued. Attention is drawn to the importance of the pancreas in the diagnosis of zinc toxicity and in estimating the period of exposure.

Renal lesions and tissue concentrations of zinc, copper, iron and manganese in experimentally zinc intoxicated sheep.

Renal lesions were produced in three out of 10 sheep dosed with large quantities of zinc for two to 14 weeks. Administration of the zinc resulted in significant increases in the concentrations of zinc in the kidneys, liver and pancreas, and of copper and iron in the kidneys and pancreas, and a significant decrease in the concentration of manganese in the pancreas. The sheep with kidney damage had increased plasma creatinine concentrations and significantly higher mean concentrations of zinc in their livers and pancreases, and of copper and iron in their kidneys, than the sheep with no kidney damage.

Assessment of therapeutic alliances in the psychiatric hospital milieu.

The authors developed scales to assess long-term hospital patients' collaboration in milieu treatment and their working relationships with various staff members. A factor analysis of patients' ratings of their collaboration in several areas of treatment yielded three dimensions: Goal Orientation, Involvement, and Use of Structure. While each dimension of collaboration correlated positively with working relationships and progress, Goal Orientation was the most substantial contributor. Patients' and staff members' perceptions of their working relationships corresponded to a statistically significant-but modest-degree. Only nurses' ratings of progress related significantly to patients' ratings. The authors highlight divergent perceptions of the treatment process, and advocate that different perspectives be openly discussed and clarified in the service of improved collaboration.

Problems to anticipate in treating difficult patients in a long-term psychiatric hospital.

In a previous report, the authors identified four dimensions of patient pathology associated with treatment difficulty: withdrawn psychoticism, character pathology, violence-agitation and suicidal-depressed behavior. In a subsequent study, they linked these dimensions to patterns of countertransference. The present research extends the two prior reports by examining the relations of the patient pathology dimensions to staff members' dissatisfaction with four areas of treatment: interpersonal approaches, structure and control, quality of teamwork, and medication. The major findings are: withdrawn psychoticism primarily relates to dissatisfaction with interpersonal treatment approaches; character pathology entails dissatisfaction with the level of structure and control; violence-agitation poses particular problems for teamwork; and suicidal-depressed behavior is unrelated to dissatisfaction with any dimension of treatment. The authors propose that these various problems in treatment are, in part, mediated by patterns of countertransference which they described in the prior paper. These findings should help staff members to focus their attention on areas of treatment in which problems are bound to arise in work with different types of difficult patients.

Laryngeal mask airway and fibre-optic tracheal inspection in thyroid surgery: a method for timely identification of tracheomalacia requiring tracheostomy.

Use of the laryngeal mask airway combined with fibre-optic laryngoscopy in thyroid surgery was first described in 1991. In this unit, it has been successfully used in over 130 cases. The advantages in identification and preservation of the recurrent laryngeal nerves using this technique have been demonstrated. However, to date, no report exists of a further advantage, namely the management of tracheomalacia.

Use of the laryngeal mask airway in thyroid and parathyroid surgery as an aid to the identification and preservation of the recurrent laryngeal nerves.

A prospective study was carried out in patients undergoing thyroid and parathyroid surgery using a laryngeal mask airway (LMA) and electrical nerve stimulation to identify the recurrent laryngeal nerves. A total of 150 consecutive patients undergoing thyroid and parathyroid surgery by a single surgeon were assessed for suitability of anaesthesia via the LMA. Peroperatively, a fibre-optic laryngoscope was passed through the LMA to enable the anaesthetist to visualise the vocal cords while adduction of the cords was elicited by applying a nerve stimulator in the operative field. In all, 144 patients were selected for anaesthesia via the LMA. Fibre-optic laryngoscopy and nerve stimulation were performed in 64 patients (42.7%). The trachea was deviated in 51 (34.0%) and narrowed in 33 (22.0%). The recurrent laryngeal nerves were identified in all patients. There were no cases of vocal cord dysfunction resulting from surgery. The LMA can be safely used for thyroid and parathyroid surgery even in the presence of a deviated or narrowed trachea. It can assist in identification and preservation of the recurrent laryngeal nerve and is, therefore, of benefit to both patient and surgeon.

The Brain laryngeal mask. An alternative to difficult intubation.

We report the case of a young man undergoing fixation of bilateral mandibular fractures, where the anaesthetist was unable to intubate. A Brain laryngeal mask was employed, thus enabling surgery to proceed. This relatively new device enabled the airway to be safeguarded whilst preserving reasonable surgical access for the attachment of Erich arch bars and a four hole osteosynthetic bone plate. The surgical and anaesthetic procedures are summarised. The laryngeal mask is described and its performance and limitations are discussed. We believe this to be the first report of mandibular fracture fixation performed with a Brain laryngeal mask in situ.

Spongy transformation of the brain in sheep with lupinosis.

Spongy transformation in the brain of sheep affected with chronic lupinosis in the field is described. Identical lesions were reproduced in sheep with experimental acute and chronic lupinosis. The primary brain lesion was vacuolation of the white matter of the brain stem with no malacia, neuronal damage or gliosis being present. The extent and severity of the vacuolation was related to the severity of the liver lesion.

The effect of lupinosis on liver copper, selenium and zinc concentrations in merino sheep.

Merino wether weaners were exposed to toxic lupin stubbles for periods of one, two and six to nine weeks, and the effect on their liver copper, selenium and zinc concentrations studied. After the one week period there was a slight decrease in liver copper and selenium concentrations in sheep severely affected with lupinosis. This was attributed to loss of these elements from necrotic cells, and greatly increased quantities of fat in the liver. In the same period liver zinc concentrations declined and were negatively correlated with the degree of liver injury. After two weeks or more of exposure to toxic lupins a positive correlation existed between both the liver copper and selenium concentrations, and the degree of liver injury. Furthermore, total liver copper and selenium levels were also positively correlated with the degree of liver injury. Liver zinc concentrations were negatively correlated with the degree of liver injury. It is suggested that when the liver is under the influence of the toxins causing lupinosis for more than two weeks, it stores copper and selenium, and loses zinc.