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.

Poisoning of livestock in oregon in the 1940s to 1960s attributed to corynetoxins produced by Rathayibacter in nematode galls in chewings fescue (Festuca nigrescens).

Tunicaminyluracil antibiotics, similar to the corynetoxins produced by Rathayibacter toxicus in Australia and South Africa, were found in old nematode seed-galls from Festuca nigrescens from New Jersey (USA) and New Zealand (NZ). The toxin profiles from the NZ and USA galls were similar to each other, but differed from those produced by R toxicus from Australia and South Africa, suggesting that a geographical variant of R toxicus or closely related species may be involved. The NZ galls gave a positive response to a R toxicus-specific monoclonal antibody assay, albeit a considerably weaker response than that seen with Australian R toxicus galls, but the older USA galls were negative, possibly due to deterioration of the antigen. From these findings, it is postulated that livestock deaths associated with the feeding of nematode and bacterial infected screenings of F nigrescens in Oregon, USA, in the 1940s to 1960s were caused by corynetoxin-like toxins produced by the bacterium.

A model for brief assessment of attachment and its application to women in inpatient treatment for trauma-related psychiatric disorders.

We adapted self-report measures of attachment style to the psychological assessment of women in specialized inpatient treatment for trauma-related disorders. The study employed 2 measures of adult attachment style, the Relationship Questionnaire (Bartholomew & Horowitz, 1991) and the Adult Attachment Scale (Collins & Read, 1990) as well as our Current Attachment Relationships questionnaire, which assesses the extent of social support in secure attachments. We administered these measures to 99 patients and to a convenience sample of 154 women in the community. We found modest correspondence between the 2 attachment style measures and substantial relations between attachment styles and range of secure attachment relationships. Women in the trauma sample reported insecure attachment styles and relatively few secure attachment figures. We discuss the implications of these findings for clinical assessment.

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.

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

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.

Course of illness following specialized inpatient treatment for women with trauma-related psychopathology.

The authors report findings from repeated assessments of 101 women who received intensive inpatient treatment focused on trauma-related disorders. All patients were assessed at admission and discharge, and half were reassessed at 1-year follow-up. Measures included the Global Assessment Scale, Brief Psychiatric Rating Scale, Brief Symptom Inventory, Role Functioning Scales, Follow-up Adjustment Scale, and Client Satisfaction Questionnaire. As a group, patients improved substantially during hospitalization and maintained gains at follow-up, although they showed a trend toward relapse in some symptom areas. However, a substantial minority of patients continued to show severe impairment at follow-up. In light of continual need for changes in clinical programs in the face of declining reimbursement, there is a pressing need for future outcome research on specialized trauma programs to relate subsequent clinical course to specific treatment interventions.

A second generation synthesis of the MBr1 (globo-H) breast tumor antigen: new application of the n-pentenyl glycoside method for achieving complex carbohydrate protein linkages.

A new synthesis of the hexasaccharide MBr1 antigen (globo-H) is reported. A revised construction with improved efficiency was necessary because an anti-cancer vaccine containing this antigen is entering phase II and phase III clinical trials for prostate cancer. The key feature of this second generation synthesis is the preparation of globo-H as its n-pentenyl glycoside. This group serves as an anomeric protecting group and as a linker for bioconjugation to carrier protein. The resultant synthesis allows for the production of suitable quantities of globo-H for clinical trials.

Alkalinization of amide local anaesthetics by addition of 1% sodium bicarbonate solution.

A number of methods exist by which the pH of local anaesthetic solutions may be increased. Most commonly, these require the addition of differing amounts of sodium bicarbonate solution according to the local anaesthetic drugs. Sodium bicarbonate (1%) was titrated against pH in six commonly used local anaesthetic solutions. Titration curves of pH and volume of sodium bicarbonate solution added are shown for this group of local anaesthetics. This study demonstrates that 1 mL of 1% sodium bicarbonate solution may be used to alkalinize this range of local anaesthetics without the risk of precipitation. We also conclude that Ropivacaine (at concentration 0.75% and 1.0%), is unsuitable for alkalinization since it precipitates at a pH of 6.0.

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.