A social-ecological examination of sleep among Airmen in technical training.

Inadequate sleep is an on-going risk to the health and mission readiness of U.S. Armed Forces, with estimates of sleep problems high above U.S. civilian populations. Intervening early in the career of active duty Air Force personnel (or "Airmen") with education and the establishment of healthy behaviors may prevent short and long term-detriments of sleep problems. This paper describes the results of a qualitative study seeking to understand the facilitators and barriers to achieving good sleep in a technical training school during the first year of entry into the United States Air Force. Using the social ecological framework and content analysis, three focus groups with Airmen were conducted to explore themes at the individual, social, environmental, and organizational/policy level. Overall, results indicated a cohort motivated to achieve good sleep, and also struggling with a number of barriers across each level. This paper highlights opportunities for population health interventions during technical training aimed at supporting Airmen in developing healthy sleep behaviors early in the course of their career.

Ten-year trends in benzodiazepine use in the Dutch population.

BACKGROUND: In the past decades knowledge on adequate treatment of affective disorders and awareness of the negative consequences of long-term benzodiazepine use increased. Therefore, a decrease in benzodiazepine use is expected, particularly in prolonged use. The aim of this study was to assess time trends in benzodiazepine use. METHODS AND MATERIAL: Data from the Longitudinal Aging Study Amsterdam (LASA) were used to investigate trends in benzodiazepine use between 1992 and 2002 in two population-based samples aged 55-64 years. Differences between the two samples with respect to benzodiazepine use and to sociodemographic, physical health and mental health characteristics were described and tested with chi-square tests and logistic regression analyses. RESULTS: Benzodiazepine use remained stable over 10 years, with 7.8% in LASA-1 (n = 874) and 7.9% in LASA-2 (n = 919) (p = 0.90) with a persisting preponderance in women and in people with low education, low income, chronic physical diseases, functional limitations, cognitive impairment, depression, anxiety complaints, sleep problems and when using antidepressants. Long-term use remained high with 70% in 1992 and 80% in 2002 of total benzodiazepine use. CONCLUSION: In the Dutch population aged 55-64, overall benzodiazepine use remained stable from 1992 to 2002, with a high proportion of long-term users, despite the effort to reduce benzodiazepine use and the renewal of the guidelines. More effort should be made to decrease prolonged benzodiazepine use in this middle-aged group, because of the increasing risks with ageing.

Seasonal and individual variation in singing behavior correlates with α2-noradrenergic receptor density in brain regions implicated in song, sexual, and social behavior.

In seasonally breeding male songbirds, both the function of song and the stimuli that elicit singing behavior change seasonally. The catecholamine norepinephrine (NE) modulates attention and arousal across behavioral states, yet the role of NE in seasonally-appropriate vocal communication has not been well-studied. The present study explored the possibility that seasonal changes in alpha 2-noradrenergic receptors (α(2)-R) within song control regions and brain regions implicated in sexual arousal and social behavior contribute to seasonal changes in song behavior in male European starlings (Sturnus vulgaris). We quantified singing behavior in aviary housed males under spring breeding season conditions and fall conditions. α(2)-R were identified with the selective ligand [(3)H]RX821002 using autoradiographic methods. The densities of α(2)-R in song control regions (HVC and the robust nucleus of the arcopallium [RA]) and the lateral septum (LS) were lower in Spring Condition males. α(2)-R densities in the caudal portion of the medial preoptic nucleus (POM) related negatively to singing behavior. Testosterone concentrations were highest in Spring Condition males and correlated with α(2)-R in LS and POM. Results link persistent seasonal alterations in the structure or function of male song to seasonal changes in NE α(2)-Rs in HVC, RA, and LS. Individual differences in α(2)-R in the POM may in part explain individual differences in song production irrespective of the context in which a male is singing, perhaps through NE modification of male sexual arousal.

Anxiety symptoms and cognitive performance in later life: results from the longitudinal aging study Amsterdam.

OBJECTIVES: This study investigates whether, and if so how, anxiety symptoms are related to cognitive decline in elderly persons and whether anxiety symptoms precede cognitive decline. METHOD: Data were obtained from the Longitudinal Aging Study Amsterdam. Anxiety symptoms were measured with the Hospital Anxiety and Depression Scale. General cognitive functioning was measured with the Mini-Mental State Examination, episodic memory with the Auditory Verbal Learning Test, fluid intelligence with the Raven's Coloured Progressive Matrices and information processing speed with the coding task. Multilevel analyses were performed to investigate the relationship between anxiety symptoms and cognitive decline over 9 years, taking into account confounding variables. RESULTS: Although not consistent across all dimensions of cognitive functioning, a curvilinear effect of anxiety on cognitive performance was found. Furthermore, we found that previous measurement of anxiety symptoms were not predictive of cognitive decline at a later time-point. CONCLUSION: This study suggests that the effect of anxiety on cognition depends on the severity of the present anxiety symptoms with mild anxiety associated with better cognition, whereas more severe anxiety is associated with worse cognition. The effect of anxiety symptoms on cognitive functioning seems to be a temporary effect, anxiety is not predictive of cognitive decline.

Effect of forage intake on bodyweight and performance.

The horse evolved to survive on rations high in forage. Many performance horses are fed rations containing reduced levels of forage, with a corresponding increase in concentrate supply. Such reductions in forage intake are widely established to be associated with a corresponding number of physiological and psychological adaptations. Therefore, the influence of forage intake on bodyweight (bwt) and performance was investigated. Four Thoroughbred-type geldings in light to moderate work received 4 diets (100% forage [100H]; 80% forage:20% concentrate [80H]; 60% forage:40% concentrate [60H] and 50% forage:50% concentrate [50H]) in a 4 x 4 Latin-square design. A submaximal standardised exercise test (SET) was performed for each diet. Rate of passage, bwt and water intakes were measured throughout the trial and maximum, recovery heart rates and postexercise rectal temperatures recorded for each SET. Mean +/- s.e. bwt was significantly (P<0.001) higher for the 100H compared to the 50H ration (556.89 and 546.28 kg, respectively). Rate of passage of digesta was significantly (P<0.01) slower for the 100H compared to the 50H ration. Water intakes and SET maximum and 1 min recovery heart rates were significantly (P<0.05) higher (mean +/- s.e. 44.72 and 39.07 l/day, 186 and 165 beats/min, and 105 and 96 beats/min, respectively) for 100H compared to the 50H diet. Post-SET rectal temperatures tended to increase with increasing forage intakes, although these effects were not significant (mean 39.85 and 38.65 degrees C for the 100H and 50H diets, respectively). In conclusion, forage intake has significant effects on equine bwt and submaximal performance and a compromise needs to be made between the potential detrimental effects of high forage intake on performance and the potential detrimental effects of low forage intake on equine welfare.

Use of height-specific weigh tapes to estimate the bodyweight of horses.

Two thousand horses of different ages, heights and breeds were divided into two height groups of up to 14.2 hands high (hh) and more than 14.2 hh, and weighed on a weighbridge; each horse then had its weight estimated by three weigh tapes, one height specific (tape 1 or 2, depending on the animal's height) and two for general use (tapes 3 and 4). For horses up to 14.2 hh, weigh tape 1 provided the most accurate estimate of mean (sd) bodyweight (100.5 [6.2] per cent), and weigh tapes 3 and 4 were 112 (6.8) and 97-0 (6.1) per cent accurate, respectively. For horses more than 14.2 hh, weigh tape 2 provided the most accurate estimate of bodyweight (98.6 [18.4] per cent), with weigh tapes 3 and 4 being 102.6 (17.4) and 90.8 (15.2) per cent accurate, respectively.

HLA-B allele frequencies in Côte d'Ivoire defined by direct DNA sequencing: identification of HLA-B*1405, B*4410, and B*5302.

Direct automated DNA sequencing was used to analyze exons 2 and 3 of HLA-B alleles present in forty-four unrelated individuals residing in the village of Adiopodoume, Côte d'Ivoire (Ivory Coast). Of the 23 HLA-B alleles observed, the most frequently detected allele was HLA-B*5301 (22.7%), which is believed to confer resistance to severe Plasmodium falciparum malaria. B*4501 (9.1%), B*1503 (8.0%), B*0705 (5.7%), B*1510 (5.7%) and B*3501 (5.7%) occurred frequently in the population. A second allele of B53 was identified; B*5302 contains a single amino acid variation at residue 171 (Y-->H). Two additional novel alleles, B* 1405 (a single amino acid variant of B*1402) and B*4410 (a five amino acid variant of B*4403) were characterized.

Diversity is demonstrated in class I HLA-A and HLA-B alleles in Cameroon, Africa: description of HLA-A*03012, *2612, *3006 and HLA-B*1403, *4016, *4703.

To examine the genetic diversity in west Africa, class I HLA-A and HLA-B alleles of 92 unrelated individuals from two areas in the Cameroon, the capital Yaoundé and the village of Etoa, were identified by direct automated DNA sequencing of exons 2 and 3 of the HLA-B locus alleles and sequence-specific oligonucleotide probe (SSOP) and/or sequencing of the HLA-A locus alleles. HLA-A*2301 (18.7%), A*2902 (10.4%), B*5301 (10.9%), and B*5802 (10.9%) were the most frequently detected alleles, present in at least 10% of the population. A total of 30 HLA-A locus and 33 HLA-B locus alleles, including six novel alleles, were detected. The novel alleles were HLA-A*03012, A*2612, A*3006 and HLA-B*1403, B*4016, and B*4703. HLA-B*4703 contains a novel amino acid sequence that is a combination of the first 5 amino acids of the Bw6 epitope and the last 2 residues of the Bw4 epitope. The addition of 6 alleles to the ever-expanding number of known class I HLA alleles supports our hypothesis that extensive genetic diversity, including previously undescribed alleles, would be observed in this African population. In the Yaoundé population, the allele frequency distribution at the HLA-A locus is consistent with distributions indicative of balancing selection. Extensive HLA-A-B haplotypes were observed in this population suggesting that only a fraction of the Cameroon HLA-A-B haplotype diversity has been observed.

Medical care at the Super Bowl.

Although coordinating medical care at the Super Bowl is something that we look forward to and have a lot of fun doing, we take it very seriously and understand the importance of delivering medical care at what many people consider to be the greatest sporting event in the world. It is certainly one of the most watched and recognized events in the world and because of this, we attempt to set up a system that will allow for the best medical care available and standardization of this medical care through our experience within Medical Sports Group.

Frequencies of HLA-A2 alleles in five U.S. population groups. Predominance Of A*02011 and identification of HLA-A*0231.

Direct DNA sequencing was used to determine the frequency of alleles within the HLA-A2 family in five US population groups. The most frequently detected HLA-A2 allele in all groups was HLA-A*02011. Caucasian and Native American populations appear to be the most homogeneous exhibiting 95.7% and 94.3% A*02011, respectively. Hispanic and Asian/Pacific Islander populations were the most allelicly diverse populations with 9 and 7 different HLA-A2 alleles present, respectively, but the majority of the populations were HLA-A*02011. African-Americans were also diverse, not in the number of alleles seen, but in the percentage of non-A*02011 alleles in the population. HLA-A*0202 (25.8%) and A*0205 (12.9%) were present in a large percentage of African-Americans. Only 13 of the 31 known HLA-A2 alleles were observed in the study. The allelic distributions reflected statistically significant differences among population groups.

Nursing care of older people: a personal construct theory perspective.

This paper outlines the use of the repertory grid technique, with nurses caring for elderly residents, and residents of a nursing home. The method focuses on the individuality of each person's attempt at making sense of her/his caring world. Previous papers have focused on a discussion of the repertory grid technique as a research method and tool for psychiatric nurses, an overview of studies using this technique with nurses and social workers, and applications of personal construct theory (from which the technique is derived) to nursing research. A paper by Rawlinson described content analysis of the role constructs elicited from the nurses. In this study, content analysis of caring constructs elicited by nurses and residents was also undertaken, and the results are presented. Additionally, principal component analysis of the repertory grids was carried out, and three examples are presented. This combined analysis provides an in-depth insight into nurses' perceptions of caring for others; perceptions which guide their caring behaviours. This information can be used by individual nurses to review their caring practice.

Barriers to effective screening for domestic violence by registered nurses in the emergency department.

Triage nurses in the emergency department are in a unique position to screen for domestic violence. This study, using Orlando's theory with a focus on two of her five major concepts, identifies barriers that prevent effective screening for domestic violence. A quantitative survey was distributed to 101 registered nurses employed in a large emergency department. Results identified three major barriers and a relationship between age and inservice attendance on domestic violence. Education on abuse and resources should be essential in nursing school curricula. Policy development and review should be part of an annual, mandatory inservice for all emergency nurses.

Pharmacists' liability into the year 2000.

OBJECTIVE: To educate the pharmacy community regarding areas of potential liability arising from the pharmacist's role in the changing health care delivery system. DATA SOURCES: Published cases (LEXIS and Westlaw), literature (NEXIS and Westlaw), and abstracts available through July 1998. CASE SELECTION AND DATA ABSTRACTION: Selected on the basis of the authors' objectives and the usefulness of the information for practicing pharmacists. DATA SYNTHESIS: As the pharmacist's role in the health care delivery system continues to change, so too does the pharmacist's exposure to liability. Although historically a pharmacist had no common law "duty to warn," new laws requiring a pharmacist to counsel patients, along with increased scrutiny by the media, have increased the pharmacist's potential for liability. An evaluation of recent case law indicates that state courts are increasingly willing to extend a pharmacist's duty to warn where the pharmacist has special knowledge of the patient or the patient's condition, contraindicated drug usage, where a prescription substantially exceeds the maximum safe dosage, or where a pharmacist fills or refills a prescription without physician authorization. A recent issue that may add to the list of potential liability concerns is the substitution of generically equivalent narrow therapeutic index drug products. CONCLUSION: The pharmacist's role in the ever changing health care delivery system, along with the public's increased scrutiny of pharmacists' dispensing practices, may inevitably extend a pharmacist's duty to warn a patient of potential problems related to prescription drug products. This trend is expected to continue into the new millennium.

Accuracy of different methods of estimating the weight of horses.

Six hundred horses of different ages, heights and breeds were weighed on a weighbridge and had their weights estimated by two weigh tapes, 1 and 2, by a formula, and by a visual estimate. For the population as a whole, the most accurate method was the formula (mean [sd] 98.6 [10.6] per cent) closely followed by weigh tape 2 (98.1 [8.1] per cent). Tape 1 and the visual estimate were the least accurate (112.0 [9.3] and 88.3 [20.1] per cent respectively). When the population was divided into two height groups, the formula and weigh tape 2 were the most accurate for horses < 15 hh (99.6 [5.2] per cent and 99.0 [5.6] per cent respectively), and weigh tape 1 and the visual estimate were 113.5 (6.5) per cent and 88.4 (16.3) per cent accurate respectively. For horses > or = 15 hh weigh tape 1 was most accurate (103.5 [9.1] per cent) and the formula, tape 2 and the visual estimate were 95.5 (13.1) per cent, 91.8 (9.2) per cent, and 89.3 (22.2) per cent accurate respectively. Overall the formula appeared to be the most accurate estimator of a horse's weight. However, owing to individual variation, it is recommended that the weights of horses < 15 hh are estimated by the formula or weigh tape 2, and that the weights of those > or = 15 hh are estimated with weigh tape 1.

Immunohistochemical localisation of alpha1B-adrenergic receptors in the rat iris.

Expression of the alpha1B-adrenergic receptor was investigated immunohistochemically in the rat iris, cornea and superior cervical ganglion by using antibodies raised in chickens immunised with a peptide corresponding to a portion of the 3rd intracellular loop common to the human, hamster and rat alpha1B-adrenergic receptor. Antibodies stained COS and HEK cell membranes of cells transfected with DNA encoding and expressing the hamster alpha1B-adrenergic receptor but not membranes from cells transfected with DNA encoding and expressing the rat alpha1A-adrenergic receptor or the rat alpha1D-adrenergic receptor. Staining was abolished by preincubation of the antibodies with the peptide used for immunisation. The distribution of alpha1B-adrenergic receptor was examined immunohistochemically with this antibody (1BI3) and a previously characterised antibody (Ab506) raised in rabbits against the carboxyl-terminal decapeptide of the receptor. In the iris, alpha1B-adrenergic receptor was detected in the dilator muscle, ciliary processes and posterior epithelium but no staining was observed in the superior cervical ganglion with either antibody. By contrast, differences in tissue staining between 1BI3 and Ab506 were observed for the sphincter muscle of the iris and for the cornea. 1BI3 stained both tissues intensely, whereas Ab506 only stained the cornea weakly and the sphincter not at all. Reverse transcription/polymerase chain reaction and nucleotide sequencing confirmed the presence of mRNA encoding the epitopes recognised by 1BI3 and Ab506 in cornea and other tissues. We conclude that (1) there is a good correlation between alpha1B-adrenergic receptor mRNA and protein expression in the iris, (2) mRNA, but not protein, is detected in the superior cervical ganglion and (3) additional processes may regulate receptor expression in the cornea.

An epitope structure for the C-terminal domain of dystrophin and utrophin.

The muscular dystrophy protein, dystrophin, and the closely related protein, utrophin, are large cytoskeletal proteins which link actin microfilaments to the plasma membrane. A panel of 38 monoclonal antibodies (mAbs) has been produced against the C-terminal domains of dystrophin and utrophin. This domain interacts with both dystrobrevins, via their "leucine zipper" coiled-coil helices, and syntrophins, adaptor proteins which also interact with nitric oxide synthetase and transmembrane sodium channels. The amino acid sequences recognized by the mAbs have now been identified using a variety of epitope mapping techniques, including fragmentation by transposon mutagenesis, synthetic peptides, phage-displayed peptide libraries, and mutant dystrophins expressed in transgenic mice. In addition to defining antibody recognition sites, mapping was sufficiently precise to provide structural information, since individual amino acids accessible on the surface of the native protein were identified in many cases. In two regions of the domain, short linear epitopes were found in proline-rich sequences which may form surface loops, turns, or linkers, but these were separated by a third region which contained mainly conformational epitopes. The results are consistent with a loose and flexible structure for much of the C-terminal domain, especially around the highly conserved second leucine zipper or coiled-coil helix (CC-H2), but there is evidence for denaturation-resistant tertiary structure in the syntrophin-binding region and the first coiled-coil helix (CC-H1).

Paediatric benchmarking: a review of its development.

In this article the author explains how a benchmarking network for paediatric services was developed. The principles are described and the process for topic selection is discussed.

Identification of four new DR52-associated DRB1 alleles: DRB1*1424, *1425, *1323 and *1324.

Four previously unreported DR52-associated DRB1 alleles have been characterized through DNA sequencing, contributing to the diversity of the HLA system. DRB1*1424 is nearly identical to DRB1*1402 in the second exon, except that it contains the "I---A" motif found at codons 67-71 common to the DRB1*15 alleles. DRB1*1425 contains the "A--H" motif, found in DRB1*1401 at codons 57-60, in a sequence otherwise identical with the second exon of DRB1*1307. Compared with DRB1*11012, DRB1*1323 contains three predicted amino acid changes at codons 58 (ala-->glu), 67 (phe-->ile), and 71 (arg-->glu). The sequence of DRB1*1324 is identical to exon 2 of DRB1*1103, except that DRB1*1324 does not contain the GAG at codon 58 characteristic of the DRB1*11 alleles. These new alleles may have arisen through gene conversion, and they contribute to the complexity of the DR6 family.

Diversity and evolution of the DRB1*03 family: description of DRB1*03022,*0307,*0308.

Three previously unreported DRB1*03 alleles are described, adding to the diversity of the DRB1 family of alleles. DRB1*03022 contains a silent substitution at codon 77. DRB1*0307 differs from DRB1*03011 by a substitution at codon 26 resulting in a predicted change from tyrosine to phenylalanine. DRB1*0308 is almost identical to DRB1*03011 differing at codon 58 which specifies the glutamic acid residue commonly found in DRB1*11 alleles. The new alleles (DRB1*03022,*0307,*0308) may have arisen by gene conversion-like events and add to the increasing complexity of the HLA system.