Therapeutic Hypothermia in ICUs.

Recent research on Therapeutic Hypothermia (TH) post cardiac arrest has raised questions about its implementation and benefits. TH to 32-34 degrees C is still included in international guidelines for post-cardiac arrest care. We investigated how Irish ICUs are utilising TH as part of their management of patients post cardiac arrest using a telephone survey of all Irish ICUs. All 25 ICUs in Ireland participated. As of quarter 2 2014, TH was part of post-cardiac arrest management in 20 ICUs (80%), which is similar to international figures. 2011 was the median year for units to start using TH in Ireland. Over half 13 (52%) of Irish ICUs have experience with cooling more than 10 patients. Despite lack of evidence for its benefit, 12 ICUs (48%) use TH for OHCA non VF-VT arrests. Lack of resources was cited by 2 ICUs (8%) as well as no local consensus by 1 ICU (4%) prevented a small minority adopting the protocol. Similar methods of inducing and maintaining TH were found in Ireland as with overseas. Interest was expressed in recent research on TH and in 2 ICUs local practice had changed because of it. An updated international resuscitation guideline is awaited.

Low sleep and low socioeconomic status predict high body mass index: a 4-year longitudinal study of Australian schoolchildren.

OBJECTIVE: The objective of this study was to examine the longitudinal relationships between body mass index (BMI), sleep duration and socioeconomic status (SES) in a 4-year cohort of 939 children aged 7-12 years. METHODS: Children and their mothers completed an annual questionnaire to assess usual weekday sleep and wake times, amount of sleep, physical activity, parental education and school SES. 93% of children were enrolled (939/1010) and retention was 88%, 83% and 81% in consecutive years. Height and weight were measured annually. RESULTS: BMI increased with decreasing amount of sleep and less sleep predicted greater International Obesity Task Force measures of obesity and overweight. In all 4 years, after controlling for baseline BMI, low SES was a significant predictor of high BMI. Children in the upper tertile of sleep in year 1 had a 2.3 kg lower weight gain (standard error [SE]: 0.5) between years 1 and 4 (P < 0.0001) than children in the lower tertile of sleep and a 0.45 kg m(-2) lower increase in BMI (SE: 0.15) (P = 0.004). The difference between children with consistently low and high sleep duration over 4 years was 1 BMI point. Those with the lowest BMI were the children with both high SES and high sleep duration. PA was not associated with BMI. CONCLUSIONS: Both low SES and short sleep duration predict obesity risk in children after controlling for baseline BMI and this trend becomes stronger as children enter adolescence. Obesity prevention should include a sleep promotion component and this may be more beneficial to children of low SES and/or socially disadvantaged backgrounds.

Acute liver failure following recreational use of psychotropic "head shop" compounds.

The recreational use of the so-called "legal-highs" has been in both the medical and political arena over the last year as a result of the appearance of "head shops" in many towns in Ireland. These shops specialized in selling new psychotropic compounds that circumvented established drug legislation. Little is known about the potentially harmful effects of these substances but case reports suggest a plethora of harmful psychological and physical effects. Our case describes for the first time acute liver failure associated with the ingestion of two of these amphetamine type compounds.

Uptake of radionuclides by vegetation at a High Arctic location.

Radionuclide levels in vegetation from a High Arctic location were studied and compared to in situ soil concentrations. Levels of the anthropogenic radionuclide 137Cs and the natural radionuclides 40K, 238U, 226Ra and 232Th are discussed and transfer factor (TF) values and aggregated transfer (Tag) values are calculated for vascular plants. Levels of 137Cs in vegetation generally followed the order mosses > lichen > vascular plants. The uptake of 137Cs in vascular plants showed an inverse relationship with the uptake of 40K, with 137Cs TF and Tag values generally higher than 40K TF and Tag values. 40K activity concentrations in all vegetation showed little correlation to associated soil concentrations, while the uptake of 238U, 226Ra and 232Th by vascular and non-vascular plants was generally low.

Variation in intubation decisions for patients with chronic obstructive pulmonary disease in one critical care network.

BACKGROUND: Anecdotal evidence suggests variation in intubation decisions for chronic obstructive pulmonary disease (COPD) patients with respiratory failure, but little is known about the extent of or reasons for this variability. AIM: To describe clinician decision-making for patients with exacerbations of COPD considered for intubation. DESIGN: Telephone simulation study. METHODS: Consultants responsible for COPD admissions in the Heart of England Critical Care network were asked to decide whether or not to admit three patients with COPD to ICU on the basis of information conveyed over the telephone. Consultants were also asked to predict patients survival in ICU hospital and at 180 days on the assumption that the patient did receive ICU care. RESULTS: Of the 120 consultants, 98 (82%) took part; 89% would admit patient 1, 64% patient 2, and 40% patient 3. The prediction of survival if ICU admission had occurred differed significantly between admitters and non-admitters. Mean predicted post-ICU hospital survival for patient 1 was 46% (95%CI 43-49) for admitters, and 13% (95%CI 6-19) for non-admitters (p < 0.001). The respective figures for patient 2 were 38% (95%CI 34-42) vs. 12% (95%CI 8-15) (p < 0.001), and for patient 3, 28% (95%CI 24-33) vs. 13% (95%CI 10-16) (p < 0.001). For a housebound COPD patient in their mid 70s, the mean (SD) threshold of predicted hospital survival below which consultants would recommend not admitting to ICU was 22% (13.2%). CONCLUSIONS: Consultants differed markedly in their admitting decisions about identical patients. Objective outcome prediction models might improve equity in ICU bed use for patients with COPD.

Association between socioeconomic status, weight, age and gender, and the body image and weight control practices of 6- to 19-year-old children and adolescents.

The aim of the study was to examine the effect of socioeconomic status (SES), age, weight and gender on the body image and weight control practices of children and adolescents, and to investigate whether health education about weight issues should target low socioeconomic groups. The study participants were a randomly selected group of school children who completed a questionnaire, and had their height and weight measured. Participants (n = 1131) were aged 6-19 years from 12 schools in New South Wales. SES, age, gender, body weight, body image, skipping breakfast, physical self-esteem, attempts to lose or gain weight, and dietary and weight control advice received from others were examined. Log-linear, chi 2 and MANOVA analyses were used to determine interactions between variables. Low SES children were more likely to be overweight, to skip breakfast, to perceive themselves as 'too thin', to be trying to gain weight and less likely to receive dietary or weight control advice. Physical self-esteem was lowest among overweight girls of middle/upper SES and greatest among boys of low SES, despite the latter being more likely to be overweight. Being overweight does not appear to adversely affect the physical self-esteem of children of low SES, particularly boys. Health educators should examine these issues with young people to help make health education and nutrition education most relevant and appropriate.

Body mass index, menarche, and perception of dieting among peripubertal adolescent females.

OBJECTIVE: To examine perceptions of dieting among pre and postmenarchial female school students. METHOD: All 51 female students of mean (SD) age 12.6 (0.6) years from a state school volunteered to complete a questionnaire about general health, eating and weight control behaviors, and menstrual status. Height and weight were measured. Focus groups using structured questions and discussion were used to elicit responses about the meaning of dieting and its association with menarche. RESULTS: Postmenarchial females were significantly more likely than the same age premenarchial students to have increased their body mass index (BMI), to clearly articulate the meaning of dieting, to report trying to lose weight, and to use diet and exercise to lose weight. Premenarchial females did not have a clear perception of dieting. Premenarchial females who reported trying to lose weight equated dieting with healthy eating and did not include losing weight or the behaviors and feeling associated with the concept of dieting unless their BMI had increased and menarche was imminent. DISCUSSION: The concept of dieting that may result in weight loss and the behaviors and feelings associated with dieting did not develop until menarche and is likely to be associated with the rapid increase in height, weight, and body fat that precedes menarche. Educational interventions aimed at preventing eating disorders among premenarchial adolescents may therefore be inappropriate, ineffective, and potentially dangerous.

Knowledge, beliefs, attitudes, and behaviors related to weight control, eating disorders, and body image in Australian trainee home economics and physical education teachers.

OBJECTIVE: To examine the knowledge, beliefs, and attitudes about weight control and eating disorders among trainee home economics and physical education teachers and to assess their body image and weight control practices. The association between actual body weight and body image was also examined. DESIGN: Survey research was undertaken using a self-report questionnaire. Height and weight were measured. SUBJECTS/SETTINGS: Trainee home economics and physical education teachers (N = 216, 96% participation rate) in their last month of training at three major state teacher training universities completed a questionnaire during their regular class times. MAIN OUTCOME MEASURES: Advice teachers give to overweight adolescents knowledge and beliefs about eating disorders, body image, desired weight, food habits, dieting, body appearance ratings, weight control practices, and diagnosed and self-reported eating disorders. STATISTICAL ANALYSIS PERFORMED: Descriptive statistics, chi square, and analyses of variance compare gender and Body Mass Index differences. RESULTS: Males (85%) and females (87%) advised young overweight adolescents to diet to lose weight. Twenty percent of females and 13% of males regularly skipped breakfast. The advise given showed a lack of specific nutrition education about weight control, adolescent nutritional needs, and fad diets. Participants held misconceptions about eating disorders, and a range of 14% to 72% answered these questions incorrectly. Fourteen percent of females self-reported that they currently had an eating disorder, but only 6% had received treatment. Some females used potentially dangerous methods of weight loss, including 19% who abused laxatives and 10% who induced vomiting. IMPLICATIONS: Trainee home economics and physical education teachers need specific nutrition information and training about eating disorders, weight control, and suitable advice for overweight students. The female trainee teachers in our study had a poor body image and disordered eating similar to other young women in Western countries, and this should be taken into account by teacher training institutions.

Generation of retroviral packaging and producer cell lines for large-scale vector production and clinical application: improved safety and high titer.

For many applications, human clinical therapies using retroviral vectors still require many technological improvements in key areas of vector design and production. These improvements include higher unprocessed manufacturing titers, complement-resistant vectors, and minimized potential to generate replication-competent retrovirus (RCR). To address these issues, we have developed a panel of human packaging cell lines (PCLs) with reduced homology between retroviral vector and packaging components. These reduced-homology PCLs allowed for the use of a novel high multiplicity of transduction ("high m.o. t.") method to introduce multiple copies of provector within vector-producing cell lines (VPCLs), resulting in high-titer vector without the generation of RCR. In a distinct approach to increase vector yields, we integrated manufacturing parameters into screening strategies and clone selection for large-scale vector production. Collectively, these improvements have resulted in the development of diverse VPCLs with unprocessed titers exceeding 2 x 10(7) CFU/ml. Using this technology, human Factor VIII VPCLs yielding titers as high as 2 x 10(8) CFU/ml unprocessed supernatant were generated. These cell lines produce complement-resistant vector particles (N. J. DePolo et al., J. Virol. 73: 6708-6714, 1999) and provide the basis for an ongoing Factor VIII gene therapy clinical trial.

Improving the body image, eating attitudes, and behaviors of young male and female adolescents: a new educational approach that focuses on self-esteem.

OBJECTIVE: This study examines the effect of an interactive, school-based, self-esteem education program on the body image and eating attitudes and behaviors of young male and female adolescents following the program and after 12 months. METHOD: All 470 eligible students (63% female) aged 11-14 years volunteered to participate. The intervention group students participated in the program, whereas the control group students received their scheduled personal development and health class. RESULTS: The program significantly improved the body satisfaction of the intervention students and significantly changed aspects of their self-esteem; social acceptance, physical appearance, and athletic ability became less important for the intervention students and more important for control students. Female intervention students rated their physical appearance as perceived by others significantly higher than control students and allowed their body weight to increase appropriately by preventing the age increase in weight-losing behaviors of the control students. One year after the intervention, body image and attitude changes were still present. These findings also held for the 116 students (63% females) with low self-esteem and higher anxiety, who were considered at risk for the development of eating disorders. These students also had significantly lower drive for thinness and greater body satisfaction following the intervention and the decreased importance of physical appearance to their self-esteem was present at 12 months. Control at-risk students significantly decreased their body weight, whereas the weight of the intervention at-risk students significantly increased. The intervention program was effective, safe, having no effect on measures of students' anxiety or depression, and was rated highly by students. DISCUSSION: This is the first controlled educational intervention to successfully improve body image and to produce long-term changes in the attitudes and self-image of young adolescents. This new approach to prevent the development of eating disorders by improving self-esteem may be effective, particularly if reinforced by teachers and family.

Preventing eating and body image problems in children and adolescents using the Health Promoting Schools Framework.

This paper outlines the Health Promoting Schools Framework and how it may be implemented in schools for preventing eating and body image problems. Discussion focuses on the efficacy of preventive school-based strategies, and on the safest and most successful interventions. The Framework encompasses three major areas of intervention in the school and community: 1) School curriculum, teaching, and learning; 2) School ethos, environment, and organization; and 3) School-community partnerships and services. Suggested strategies for implementing the Framework are outlined. A case study of how a girls high school adapted the new approach for dealing with the problem of eating and body image problems is presented.

Association between self-concept and body weight, gender, and pubertal development among male and female adolescents.

This study examined the effects and interactions of gender, pubertal status, and body weight on the self-concept of 462 young adolescent Australian students from two different schools. All students enrolled in Years 7 and 8 completed the Self-Perception Profile for Adolescents, which includes several self-concept subscales and ratings of the importance of each subscale. The self-concept subscales ranked as most important by male and female students were Close Friendship, Scholastic Competence, and Job Competence. Females rated their ability to form close friendships significantly higher and of greater importance than did males. Standard body weight was related to students' Physical Appearance subscale scores, with higher weight students having lower self-concept, and postmenarcheal females having the poorest opinion of their physical appearance. Higher body weight males had lower scores on Athletic Competence, Job Competence, and Behavioral Conduct than did other males. Overweight females and normal weight males considered athletic competence to be more important than did other students. Pubertal status was related to students' scores on Athletic Competence, with postpubertal males who were not overweight scoring highest, and on Physical Appearance, with postmenarcheal females having the lowest opinion of their appearance. The mean self-concept score was significantly related to students' standard body weight, and there was an interaction between gender and puberty, with postpubertal males having the highest and postmenarcheal females the lowest self-concept score. The discrepancy score suggested that females felt they had failed to meet their ideal self-concept significantly more than did males. The results suggest that school programs should be implemented to provide exercise and job skill training suitable for all students, especially those who are overweight. These programs, while taking into account students' pubertal status, should aim to improve self-image without resulting in feelings of failure.

Onset of disordered eating attitudes and behaviors in early adolescence: interplay of pubertal status, gender, weight, and age.

The interplay of puberty, gender, weight, and age in regard to body image and disordered eating behaviors and attitudes was investigated in a sample of early adolescents. It was found that, after menarche, females had increased personal expectations and were dissatisfied with weight/shape changes. They wanted to reduce their weight and between-meal eating (which was associated with increased feelings of inadequacy, loss of control, and decreased self-esteem). Young postmenarcheal females who were higher achievers and had higher trait anxiety were more likely to have lower weight. Young males at puberty desired to build up their bodies, believing that appearance was important to their sexual appeal. They were also more willing to form close relationships. Postpubertal males felt most in control of their lives, had the highest self-esteem, and were more trusting of their body cues. Overall, high achieving, more anxious postmenarcheal females were at greatest risk for eating disturbances. These results indicate that the interaction of pubertal status and gender must be considered when developing intervention programs.

Genetic immunization of chimpanzees chronically infected with the hepatitis B virus, using a recombinant retroviral vector encoding the hepatitis B virus core antigen.

Cytotoxic T lymphocyte (CTL) activity and CD4+ helper T cell responses to the hepatitis B virus (HBV) core antigen (HBcAg) have been implicated in clearance of acute and chronic HBV infections. We showed that intramuscular injections of a novel recombinant retroviral vector expressing an HBcAg-neomycin phosphotransferase II (HBc-NEO) fusion protein induces HBc/eAg-specific antibodies and CD4+ and CD8+ T cell responses in mice and rhesus monkeys. We have now immunized three chronically infected chimpanzees, each with 10(10) CFU of nonreplicating retroviral vector particles expressing the HBc-NEO fusion protein. Of two immunized chimpanzees examined for CTL responses, one developed HBcAg-specific CTLs and showed marginal, transient elevations of alanine aminotransferase (ALT) levels following injection. However, both chimpanzees remained positive for serum HBeAg, negative for anti-HBe antibody by conventional assays, and displayed no change in HBV viral load throughout the study. In contrast, the third chimpanzee exhibited a traditional seroconversion evidenced by a loss of serum HBeAg and the subsequent emergence of anti-HBe antibodies within 24 weeks after the first injection. Simultaneously, two transient ALT flares and a significant decrease in the serum HBV DNA levels were noted. Despite its limitations, the present study demonstrates (1) the safety of treatment with high titers of retroviral vector in chimpanzees, (2) the capability of a retroviral vector expressing HBcAg to stimulate immune responses in HBV chronic carrier chimpanzees, and (3) that retroviral vector immunization may be therapeutically beneficial in the treatment of chronic HBV infection.

Coronary artery bypass graft surgery in Newfoundland and Labrador.

BACKGROUND: Newfoundland and Labrador, like other health care jurisdictions, is faced with widening gaps between the demands for health care and a strained ability to supply the necessary resources. The authors carried out a study to determine the rates of appropriate and inappropriate coronary artery bypass grafting (CABG) in the province and the waiting times for this surgery. METHODS: This retrospective cohort study was performed in the tertiary care hospital that receives all referrals for coronary angiography and coronary artery revascularization for Newfoundland and Labrador. By reviewing the hospital records, the authors identified 2 groups of patients: those in whom critical coronary artery disease was diagnosed on the basis of coronary angiography and who were referred for CABG between Apr. 1, 1994, and Mar. 31, 1995, and those who actually underwent the procedure during that period. By applying specific criteria developed by the RAND Corporation, the authors determined the appropriateness and necessity of CABG in each case. They also compared waiting times for CABG with optimal waiting times; as determined by a consensus-based priority score. RESULTS: A total of 338 patients underwent CABG during the study period. The cases were characterized by multivessel disease and late-stage angina symptoms. Almost all of the patients had high appropriateness scores (7-9), and nearly 95% had high necessity scores (7-9). However, during the study period, the waiting list increased by about 20%, because a total of 391 patients were referred by the weekly cardiovascular surgery conference; the authors identified these and an additional 31 patients as having necessity scores of 7 or more. Only 7 (23%) of 31 patients for whom CABG was considered very urgent underwent surgery within the recommended 24 hours, and only 30 (24%) of the 122 patients for whom CABG was considered urgent underwent surgery within the recommended 72 hours. INTERPRETATION: These results provide evidence that the cardiac surgery program in Newfoundland and Labrador is performing CABG in patients for whom surgical revascularization is highly appropriate and necessary. Access to CABG is less than ideal, however, since the waiting list continues to expand, and many patients wait beyond the recommended time for surgery.