Effectiveness of laparoscopic removal of isolated superficial peritoneal endometriosis for the management of chronic pelvic pain in women (ESPriT2): protocol for a multi-centre randomised controlled trial.

BACKGROUND: Endometriosis affects 190 million women and those assigned female at birth worldwide. For some, it is associated with debilitating chronic pelvic pain. Diagnosis of endometriosis is often achieved through diagnostic laparoscopy. However, when isolated superficial peritoneal endometriosis (SPE), the most common endometriosis subtype, is identified during laparoscopy, limited evidence exists to support the common decision to surgically remove it via excision or ablation. Improved understanding of the impact of surgical removal of isolated SPE for the management of chronic pelvic pain in women is required. Here, we describe our protocol for a multi-centre trial to determine the effectiveness of surgical removal of isolated SPE for the management of endometriosis-associated pain. METHODS: We plan to undertake a multi-centre participant-blind parallel-group randomised controlled clinical and cost-effectiveness trial with internal pilot. We plan to randomise 400 participants from up to 70 National Health Service Hospitals in the UK. Participants with chronic pelvic pain awaiting diagnostic laparoscopy for suspected endometriosis will be consented by the clinical research team. If isolated SPE is identified at laparoscopy, and deep or ovarian endometriosis is not seen, participants will be randomised intraoperatively (1:1) to surgical removal (by excision or ablation or both, according to surgeons' preference) versus diagnostic laparoscopy alone. Randomisation with block-stratification will be used. Participants will be given a diagnosis but will not be informed of the procedure they received until 12 months post-randomisation, unless required. Post-operative medical treatment will be according to participants' preference. Participants will be asked to complete validated pain and quality of life questionnaires at 3, 6 and 12 months after randomisation. Our primary outcome is the pain domain of the Endometriosis Health Profile-30 (EHP-30), via a between randomised group comparison of adjusted means at 12 months. Assuming a standard deviation of 22 points around the pain score, 90% power, 5% significance and 20% missing data, 400 participants are required to be randomised to detect an 8-point pain score difference. DISCUSSION: This trial aims to provide high quality evidence of the clinical and cost-effectiveness of surgical removal of isolated SPE. TRIAL REGISTRATION: ISRCTN registry ISRCTN27244948. Registered 6 April 2021.

Coordinated modulation of multiple processes through phase variation of a c-di-GMP phosphodiesterase in Clostridioides difficile.

The opportunistic nosocomial pathogen Clostridioides difficile exhibits phenotypic heterogeneity through phase variation, a stochastic, reversible process that modulates expression. In C. difficile, multiple sequences in the genome undergo inversion through site-specific recombination. Two such loci lie upstream of pdcB and pdcC, which encode phosphodiesterases (PDEs) that degrade the signaling molecule c-di-GMP. Numerous phenotypes are influenced by c-di-GMP in C. difficile including cell and colony morphology, motility, colonization, and virulence. In this study, we aimed to assess whether PdcB phase varies, identify the mechanism of regulation, and determine the effects on intracellular c-di-GMP levels and regulated phenotypes. We found that expression of pdcB is heterogeneous and the orientation of the invertible sequence, or 'pdcB switch', determines expression. The pdcB switch contains a promoter that when properly oriented promotes pdcB expression. Expression is augmented by an additional promoter upstream of the pdcB switch. Mutation of nucleotides at the site of recombination resulted in phase-locked strains with significant differences in pdcB expression. Characterization of these mutants showed that the pdcB locked-ON mutant has reduced intracellular c-di-GMP compared to the locked-OFF mutant, consistent with increased and decreased PdcB activity, respectively. These alterations in c-di-GMP had concomitant effects on multiple known c-di-GMP regulated processes, indicating that phase variation of PdcB allows C. difficile to coordinately diversify multiple phenotypes in the population to enhance survival.

ESHRE guideline: endometriosis.

STUDY QUESTION: How should endometriosis be diagnosed and managed based on the best available evidence from published literature? SUMMARY ANSWER: The current guideline provides 109 recommendations on diagnosis, treatments for pain and infertility, management of disease recurrence, asymptomatic or extrapelvic disease, endometriosis in adolescents and postmenopausal women, prevention and the association with cancer. WHAT IS KNOWN ALREADY: Endometriosis is a chronic condition with a plethora of presentations in terms of not only the occurrence of lesions, but also the presence of signs and symptoms. The most important symptoms include pain and infertility. STUDY DESIGN SIZE DURATION: The guideline was developed according to the structured methodology for development of ESHRE guidelines. After formulation of key questions by a group of experts, literature searches and assessments were performed. Papers published up to 1 December 2020 and written in English were included in the literature review. PARTICIPANTS/MATERIALS SETTING METHODS: Based on the collected evidence, recommendations were formulated and discussed within specialist subgroups and then presented to the core guideline development group (GDG) until consensus was reached. A stakeholder review was organized after finalization of the draft. The final version was approved by the GDG and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE: This guideline aims to help clinicians to apply best care for women with endometriosis. Although studies mostly focus on women of reproductive age, the guideline also addresses endometriosis in adolescents and postmenopausal women. The guideline outlines the diagnostic process for endometriosis, which challenges laparoscopy and histology as gold standard diagnostic tests. The options for treatment of endometriosis-associated pain symptoms include analgesics, medical treatments and surgery. Non-pharmacological treatments are also discussed. For management of endometriosis-associated infertility, surgical treatment and/or medically assisted reproduction are feasible. While most of the more recent studies confirm previous ESHRE recommendations, there are five topics in which significant changes to recommendations were required and changes in clinical practice are to be expected. LIMITATIONS REASONS FOR CAUTION: The guideline describes different management options but, based on existing evidence, no firm recommendations could be formulated on the most appropriate treatments. Also, for specific clinical issues, such as asymptomatic endometriosis or extrapelvic endometriosis, the evidence is too scarce to make evidence-based recommendations. WIDER IMPLICATIONS OF THE FINDINGS: The guideline provides clinicians with clear advice on best practice in endometriosis care, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in endometriosis. STUDY FUNDING/COMPETING INTERESTS: The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive payments. C.M.B. reports grants from Bayer Healthcare and the European Commission; Participation on a Data Safety Monitoring Board or Advisory Board with ObsEva (Data Safety Monitoring Group) and Myovant (Scientific Advisory Group). A.B. reports grants from FEMaLE executive board member and European Commission Horizon 2020 grant; consulting fees from Ethicon Endo Surgery, Medtronic; honoraria for lectures from Ethicon; and support for meeting attendance from Gedeon Richter; A.H. reports grants from MRC, NIHR, CSO, Roche Diagnostics, Astra Zeneca, Ferring; Consulting fees from Roche Diagnostics, Nordic Pharma, Chugai and Benevolent Al Bio Limited all paid to the institution; a pending patent on Serum endometriosis biomarker; he is also Chair of TSC for STOP-OHSS and CERM trials. O.H. reports consulting fees and speaker's fees from Gedeon Richter and Bayer AG; support for attending meetings from Gedeon-Richter, and leadership roles at the Finnish Society for Obstetrics and Gynecology and the Nordic federation of the societies of obstetrics and gynecology. L.K. reports consulting fees from Gedeon Richter, AstraZeneca, Novartis, Dr KADE/Besins, Palleos Healthcare, Roche, Mithra; honoraria for lectures from Gedeon Richter, AstraZeneca, Novartis, Dr KADE/Besins, Palleos Healthcare, Roche, Mithra; support for attending meetings from Gedeon Richter, AstraZeneca, Novartis, Dr KADE/Besins, Palleos Healthcare, Roche, Mithra; he also has a leadership role in the German Society of Gynecological Endocrinology (DGGEF). M.K. reports grants from French Foundation for Medical Research (FRM), Australian Ministry of Health, Medical Research Future Fund and French National Cancer Institute; support for meeting attendance from European Society for Gynaecological Endoscopy (ESGE), European Congress on Endometriosis (EEC) and ESHRE; She is an advisory Board Member, FEMaLe Project (Finding Endometriosis Using Machine Learning), Scientific Committee Chair for the French Foundation for Research on Endometriosis and Scientific Committee Chair for the ComPaRe-Endometriosis cohort. A.N. reports grants from Merck SA and Ferring; speaker fees from Merck SA and Ferring; support for meeting attendance from Merck SA; Participation on a Data Safety Monitoring Board or Advisory Board with Nordic Pharma and Merck SA; she also is a board member of medical advisory board, Endometriosis Society, the Netherlands (patients advocacy group) and an executive board member of the World Endometriosis Society. E.S. reports grants from National Institute for Health Research UK, Rosetrees Trust, Barts and the London Charity; Royalties from De Gruyter (book editor); consulting fees from Hologic; speakers fees from Hologic, Johnson & Johnson, Medtronic, Intuitive, Olympus and Karl Storz; Participation in the Medicines for Women's Health Expert Advisory Group with Medicines and Healthcare Products Regulatory Agency (MHRA); he is also Ambassador for the World Endometriosis Society. C.T. reports grants from Merck SA; Consulting fees from Gedeon Richter, Nordic Pharma and Merck SA; speaker fees from Merck SA, all paid to the institution; and support for meeting attendance from Ferring, Gedeon Richter and Merck SA. The other authors have no conflicts of interest to declare. DISCLAIMER: This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose (Full disclaimer available at www.eshre.eu/guidelines.).

The Effect of Increasing Topsoil Disturbance on Surface-Active Invertebrate Composition and Abundance under Grazing and Cropping Regimes on Vertisols in North-West New South Wales, Australia.

Agricultural intensification practices involve varying degrees of disturbance to the soil ecosystem. This study evaluated six agricultural management regimes with increasing levels of topsoil disturbance, on the composition and abundance of surface-active invertebrates on Vertisols at a sub-catchment scale. Two grazing (native and introduced pastures), and four cropping (combining short and long fallow, with zero and conventional tillage) management regimes were examined. Surface-active invertebrates were collected seasonally with pitfall traps over 2 years (8 seasons), and identified to order, while ants (Formicidae) that comprised 47% of total invertebrates collected, were identified to genera. Season had a significant effect on ant abundance and number of genera recorded with higher abundance and twice the number of genera in summer than all other seasons. Ants, particularly Iridomyrmex, were mainly active in summer, while other invertebrates especially Coleoptera, were more active in winter. Surface-active invertebrates were 30% more abundant in grazing than cropping land use types. Native pasture, with little surface soil disturbance, recorded the highest number of invertebrates, mainly ants, compared to other agricultural management regimes. Coleoptera and Dermaptera were higher in abundance under conventional tillage compared with those agricultural management regimes that disturb the topsoil less. Optimizing surface-active invertebrate activity on Vertisols for most taxa will require reducing topsoil disturbance. However, the research findings also suggest that the impact of agricultural management regimes on invertebrate activity was difficult to predict with any certainty as the three main ant genera, and most abundant invertebrate collected, did not respond in a consistent manner.

Using latent class analysis to identify academic and behavioral risk status in elementary students.

Identifying classes of children on the basis of academic and behavior risk may have important implications for the allocation of intervention resources within Response to Intervention (RTI) and Multi-Tiered System of Support (MTSS) models. Latent class analysis (LCA) was conducted with a sample of 517 third grade students. Fall screening scores in the areas of reading, mathematics, and behavior were used as indicators of success on an end of year statewide achievement test. Results identified 3 subclasses of children, including a class with minimal academic and behavioral concerns (Tier 1; 32% of the sample), a class at-risk for academic problems and somewhat at-risk for behavior problems (Tier 2; 37% of the sample), and a class with significant academic and behavior problems (Tier 3; 31%). Each class was predictive of end of year performance on the statewide achievement test, with the Tier 1 class performing significantly higher on the test than the Tier 2 class, which in turn scored significantly higher than the Tier 3 class. The results of this study indicated that distinct classes of children can be determined through brief screening measures and are predictive of later academic success. Further implications are discussed for prevention and intervention for students at risk for academic failure and behavior problems. (PsycINFO Database Record

The Kindergarten Academic and Behavior Readiness Screener: The utility of single-item teacher ratings of kindergarten readiness.

The purpose of the study was to explore the effectiveness of a brief, feasible, and cost-effective universal screener for kindergarten readiness. The study examined whether teacher ratings of kindergarteners' academic, behavioral, and overall readiness at the beginning of the year were predictive of academic, emotional, and behavioral outcomes at the end of the year. Participants included 19 kindergarten teachers and their students (n = 350) from 6 urban elementary schools; all teachers were female and the majority of children were African American (74%) or White (23%). Thirty-six percent of children qualified for free or reduced lunch. Teachers completed single-item ratings of student readiness as well as full scale ratings of student prosocial skills, disruptive behaviors, and academic competence. Students also completed a standardized academic achievement test. Independent observers rated disruptive behaviors in the classroom. Readiness items had statistically significant relations with a range of academic, emotional, and behavior indicators. Hierarchical linear regression analyses found that readiness items predicted end-of-year outcomes when controlling for baseline covariates. Items also predicted higher likelihood of negative academic and behavior categorical outcomes and demonstrated classification utility. Schools need universal screening options that are feasible and easy to implement school-wide. The screening tool presented in this study offers a viable, psychometrically strong option for school teams and professionals interested in universal screening.

Parental Emotion Coaching: Associations With Self-Regulation in Aggressive/Rejected and Low Aggressive/Popular Children.

This study investigated associations between maternal and paternal emotion coaching and the self-regulation skills of kindergarten and first-grade children. Participants were 54 children categorized as either aggressive/rejected or low aggressive/popular by peer reports. Findings indicated a statistical trend for fathers of low aggressive/popular children to engage in more emotion coaching than fathers of aggressive/rejected children. Paternal emotion coaching accounted for significant variance in children's regulation of attention. Maternal emotion coaching moderated the relation between children's status and regulation of emotion. Findings suggest that interventions focused on parental emotion coaching may prove beneficial for increasing the self-regulation and attention skills of children with social and conduct problems.

Marriage and long-term survival after coronary artery bypass grafting.

OBJECTIVE: To examine the effects of marital status and marital satisfaction on survival after coronary artery bypass grafting (CABG). METHODS: Participants were 225 people who had CABG between 1987 and 1990. Marital status at the time of surgery and marital satisfaction 1 year after surgery were used to predict survival 15 years after surgery. RESULTS: Married people were 2.5 times (p < .001) more likely to be alive 15 years after CABG than those who were not married. This finding was true for men and women, although the result for women was marginally significant adjusting for age. Those in high-satisfaction marriages were 3.2 times (p < .003) more likely to be alive 15 years after CABG compared with those reporting low marital satisfaction. Highly satisfied men were 2.7 times (p < .03) and highly satisfied women were 3.9 times (p < .15) more likely to be alive adjusting for age. Although the result was not significant for women, the effect size for marital satisfaction was actually larger for women than for men. CONCLUSIONS: Being married, especially being in a highly satisfying marriage, offered a significant benefit to long-term survival after CABG. Why marital status and marital satisfaction have this effect on survival is surely mulitfactorial, most likely a combination of spousal support and survivor motivation to adopt a healthy lifestyle, along with the provision of emotional support to the survivor, which all could have the effect of modulating the physiologic mechanisms responsible for slowing the advancement of CVD.

Is premigration health screening for tuberculosis worthwhile?

OBJECTIVE: To determine whether premigration screening for tuberculosis is worth undertaking in visa applicants, and whether screening resources are being appropriately directed towards intending migrants at highest risk of tuberculosis. DESIGN, SETTING AND PARTICIPANTS: A 12-month survey of all intending migrants with tuberculosis necessitating treatment detected during the premigration health assessment process, whose medical examinations were submitted to the Department of Immigration and Citizenship's Global Health Branch for assessment by a Medical Officer of the Commonwealth between 1 July 2009 and 30 June 2010. MAIN OUTCOME MEASURES: Individuals diagnosed with active tuberculosis; proportions diagnosed by sputum smear and culture tests or clinically, and with susceptibility test results; distribution of visa types among people diagnosed. RESULTS: In premigration assessments, 519 people were diagnosed with active tuberculosis (prevalence, 137 per 100,000 in examined population). The top source countries for people with tuberculosis were the Philippines (21.8%), India (16.8%), Vietnam (16.2%) and China (8.3%). Positive sputum smear test results were submitted for 67 cases (12.9%). Positive culture test results were obtained in 230 cases (44.3%), but only 95 of these (41.3%) had susceptibility test results, with 83 fully susceptible. Four people had multidrug-resistant tuberculosis (prevalence, 1.06 per 100 000 population). Five people had both active tuberculosis and HIV infection. Of all those diagnosed with tuberculosis, 162 (31.2%) were intending students, 82 (15.8%) were intending visitors, and 53 (10.2%) were applicants for humanitarian (refugee and Special Humanitarian Program) visas. CONCLUSIONS: Premigration health screening of intending migrants is identifying substantial numbers of people who would have required treatment for tuberculosis after arrival in Australia. The high proportion of students, visitors and refugee and humanitarian entrants with tuberculosis validates the current screening program. The screening is of benefit to the applicants, whose tuberculosis is treated earlier than it otherwise would have been, and to the Australian population, by averting exposure to people with active tuberculosis.

Montreal Cognitive Assessment and Mini-Mental Status Examination compared as cognitive screening tools in heart failure.

BACKGROUND: Heart failure (HF) patients run four times the risk of developing cognitive impairment than does the general population, yet cognitive screening is not routinely performed. METHODS: This cross-sectional study enrolled 90 community-dwelling adults with HF aged 50 years and above. Participants took the Mini Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA), to measure cognitive function in persons with HF. Participants were predominately men (66%) and Caucasian (78%), aged 50-89 years (62 SD, 9 years), and 77% had an ejection fraction <40%. RESULTS: Fifty-four percent of participants scored ≤26 on the MoCA, suggesting mild cognitive impairment (MCI), and 17% scored ≤22, suggesting moderate cognitive impairment, compared with 2.2% on the MMSE. The MoCA scores were lowest for visuospatial/executive domain, short-term memory, and delayed recall. These findings were similar to those in published reports. CONCLUSION: These preliminary findings support the use of MoCA for cognitive screening in stable HF.

Short-term effects of organic amendments on properties of a Vertisol.

Application of organic waste products as amendments has been proposed as a management option whereby soil quality of Vertisols could be improved. An incubation experiment was, therefore, conducted for 4 weeks under controlled temperature conditions (30 degrees C) to identify those potential organic amendments that might improve the quality of a Vertisol. Twelve organic amendments were investigated: cotton gin trash from three sources, cattle manure from two sources, green waste compost, chicken manure from three sources including a commercial product, biosolids and two commercial liquefied vermicomposts. Except for the biosolids, no other organic amendments had any effect on soil microbial biomass and respiration. Compared with NO3-N levels in the control, there was a 50% decrease in soil amended with 10 t ha(-1) green waste compost (65 microg g(-1)). The three different types of chicken manures increased the NO3-N concentration from 75% (228 microg g(-1)) to 226% (424 microg g(- 1)) over the control. Approximate recovery of P added by the amendment as resin-extractable soil P was 53% for cattle manure and 39% for chicken manure. Application of cattle manure resulted in a 22% increase in soil-exchangeable K over levels found in control. Organic amendments application also resulted in a significant increase in exchangeable Na concentration. Some of the organic wastes, viz. cotton gin trash (10 t ha(-1)), cattle manure (10 t ha(-1)), biosolids (10 t ha(-1)) and composted chicken manure (3 t ha(-1)) have value as a source of nutrients to soil and hence showed potential to improve Vertisol properties.

Uncertainty and operational considerations in mass prophylaxis workforce planning.

BACKGROUND: The public health response to an influenza pandemic or other large-scale health emergency may include mass prophylaxis using multiple points of dispensing (PODs) to deliver countermeasures rapidly to affected populations. Computer models created to date to determine "optimal" staffing levels at PODs typically assume stable patient demand for service. The authors investigated POD function under dynamic and uncertain operational environments. METHODS: The authors constructed a Monte Carlo simulation model of mass prophylaxis (the Dynamic POD Simulator, or D-PODS) to assess the consequences of nonstationary patient arrival patterns on POD function under a variety of POD layouts and staffing plans. Compared are the performance of a standard POD layout under steady-state and variable patient arrival rates that may mimic real-life variation in patient demand. RESULTS: To achieve similar performance, PODs functioning under nonstationary patient arrival rates require higher staffing levels than would be predicted using the assumption of stationary arrival rates. Furthermore, PODs may develop severe bottlenecks unless staffing levels vary over time to meet changing patient arrival patterns. Efficient POD networks therefore require command and control systems capable of dynamically adjusting intra- and inter-POD staff levels to meet demand. In addition, under real-world operating conditions of heightened uncertainty, fewer large PODs will require a smaller total staff than many small PODs to achieve comparable performance. CONCLUSIONS: Modeling environments that capture the effects of fundamental uncertainties in public health disasters are essential for the realistic evaluation of response mechanisms and policies. D-PODS quantifies POD operational efficiency under more realistic conditions than have been modeled previously. The authors' experiments demonstrate that effective POD staffing plans must be responsive to variation and uncertainty in POD arrival patterns. These experiments highlight the need for command and control systems to be created to manage emergency response successfully.

Is a history of gestational diabetes related to risk factors for coronary heart disease?

Coronary heart disease (CHD) risk in 20 non-diabetic women with and 20 without a distant history of gestational diabetes (hGDM), matched on age, body mass index, and time since GDM-affected pregnancy, was compared in a case control study. Women with an hGDM had lower high-density lipoprotein cholesterol (HDL-c), p = .02, and higher triglycerides, p < or = .001, versus controls. The combination of high triglycerides and low HDL-c occurred in 25% of hGDM cases versus 0% of controls, p

Symptom presentation and time to seek care in women and men with acute myocardial infarction.

BACKGROUND: Leventhal's common sense model of illness representation was used to examine symptom presentation, time to seek care, and expectations about the experience of having an acute myocardial infarction (AMI). HYPOTHESES: (1) Women with AMI will report a different symptom set than men, (2) women's expectations about AMI, for level of risk and symptoms, will be different than men's, (3) women will take longer to seek care than men, and (4) as suggested by the common sense model, a match between expected and actual symptoms will be related to shorter time to seek care. METHOD: A descriptive, correlational design was used. Thirty woman and 30 men diagnosed with AMI or an evolving MI treated with thrombolytic therapy or primary percutaneous coronary intervention were interviewed using the Symptom Representation Questionnaire. RESULTS: Gender differences in symptom presentation were limited. The majority of women and men reported that their symptoms were different from what they expected an AMI would be like. Most stated that their pain was less than expected, whereas some reported either the location of discomfort or associated symptoms as different then expected. There was no gender difference in time to seek care. Logistic regression and survival analysis demonstrated that participants who reported a match between symptoms expected and actual symptoms experienced arrived in the emergency department sooner than those whose symptoms did not match their expectations. CONCLUSION: The findings provide support for the use of the common sense model to explain care-seeking behavior in AMI.

The glycotope-specific RAV12 monoclonal antibody induces oncosis in vitro and has antitumor activity against gastrointestinal adenocarcinoma tumor xenografts in vivo.

RAV12 is a chimeric antibody that recognizes an N-linked carbohydrate antigen (RAAG12) strongly expressed on multiple solid organ cancers. More than 90% of tumors of colorectal, gastric, and pancreatic origin express RAAG12, and a majority of these tumors exhibit uniform RAAG12 expression. RAV12 exhibits potent cytotoxic activity in vitro against COLO 205 colon tumor cells via an oncotic cell death mechanism. RAV12-treated COLO 205 cells undergo morphologic changes consistent with oncosis, including cytoskeletal rearrangement, rapid plasma membrane swelling, and cell lysis. RAV12 inhibited the growth of RAAG12-expressing gastrointestinal tumor xenografts in athymic mice. In the case of SNU-16 tumor cells, twice weekly treatment of established s.c. tumors with 10 mg/kg RAV12 caused a approximately 70% suppression of tumor growth at the end of the study. This preclinical data has led to the initiation of a phase I/IIA clinical study of RAV12 in patients with metastatic or recurrent adenocarcinoma.

Symptom clusters in acute myocardial infarction: a secondary data analysis.

BACKGROUND: Early recognition of acute myocardial infarction (AMI) symptoms and reduced time to treatment may reduce morbidity and mortality. People having AMI experience a constellation of symptoms, but the common constellations or clusters of symptoms have yet to be identified. OBJECTIVES: To identify clusters of symptoms that represent AMI. METHODS: This was a secondary data analysis of nine descriptive, cross-sectional studies that included data from 1,073 people having AMI in the United States and England. Data were analyzed using latent class cluster analysis, an a theoretical method that uses only information contained in the data. RESULTS: Five distinct clusters of symptoms were identified. Age, race, and sex were statistically significant in predicting cluster membership. None of the symptom clusters described in this analysis included all of the symptoms that are considered typical. In one cluster, subjects had only a moderate to low probability of experiencing any of the symptoms analyzed. DISCUSSION: Symptoms of AMI occur in clusters, and these clusters vary among persons. None of the clusters identified in this study included all of the symptoms that are included typically as symptoms of AMI (chest discomfort, diaphoresis, shortness of breath, nausea, and lightheadedness). These AMI symptom clusters must be communicated clearly to the public in a way that will assist them in assessing their symptoms more efficiently and will guide their treatment-seeking behavior. Symptom clusters for AMI must also be communicated to the professional community in a way that will facilitate assessment and rapid intervention for AMI.

Comparison of methods for measuring soil microbial activity using cotton strips and a respirometer.

In order to develop a method of measuring the level of microbial activity in soil that is suitable for use by farmers, land managers, and other non-scientists, a simple method for determining soil microbial activity was evaluated and compared with two standard techniques. Soils sampled from vegetable farms in south east Queensland were incubated in the laboratory under controlled moisture and temperature conditions. Three methods were used to measure soil microbial activity, a respirometry method and two methods using the cotton strip assay (CSA) technique (image analysis and tensometer). The standard CSA method measured loss of tensile strength over a 35 day incubation period of buried cotton strips using a tensometer. The new CSA technique measured the intensity of staining by microbes using a flatbed scanner to create an image of the cotton strip whose staining percentage was determined using Photoshop software. The respirometry method used the substrate induced respiration rate (SIR) to determine microbial biomass in the soil at day 12 of incubation. The strong correlation between the image analysis method and the tensometer method (r(2)=0.81), a technique used by scientific researchers, suggests that the image analysis method could be used to monitor aspects of soil biological health by general community land-care groups and farmers. The image analysis method uses equipment which is readily available and, while not strongly correlated with more precise measurements of soil biological activity such as microbial biomass (r(2)=0.26), it can detect gross trends in biological health in a soil monitoring program. The CSA method using image analysis was the cheapest technique to measure soil microbial activity. CSA using image analysis can be a valuable tool in conjunction with other simple indicators of soil physical and chemical health such as slaking and pH to monitor soil amelioration or rehabilitation programs.

Heart and brain matters in heart failure: a literature review.

Heart failure (HF) patients are reported to have twice the risk of having cognitive deficits compared to the general population. Cognitive impairment in this population may cause non-compliance to prescribed self-care regimens and delay in seeking care that may potentially lead to frequent readmissions. Although cognitive deficit is common among people with HF, cognitive screening is not routinely performed due to lack of a simple screening tool and the misconception that cognitive changes are part of normal aging. Therefore, future research needs to focus on identifying a simple screening tool that nurses can use to screen for subtle changes in cognition including forgetfulness and delayed recall. Early identification of subtle cognitive changes has the potential to guide healthcare providers to formulate feasible strategies to understand and/or prevent a low cardiac output state before major cognitive impairment becomes evident.

Hormonal responses to the 6-minute walk test in women and men with coronary heart disease: a pilot study.

BACKGROUND: Women with coronary heart disease (CHD) are more likely than men to develop congestive heart failure (CHF). Dysregulation of sympathetic and volume-regulatory hormones may contribute to the onset of symptomatic CHF. We hypothesized that this hormonal dysregulation develops at an earlier stage of CHD in women than in men. OBJECTIVES: The study goals were (1) to determine the effect of gender on basal and exercise-induced plasma concentrations of catecholamines and volume-regulatory hormones in patients diagnosed with CHD, New York Heart Association class I and (2) to determine efficacy of the 6-minute walk test as a stimulus for release of these hormones. METHODS: Study participants were 9 women and 9 men with normal left ventricular ejection fraction (>50%) and CHD confirmed by arteriography. Data were collected under resting conditions, and after the 6-minute walk test, in the general clinical research center of a northeastern university medical center. RESULTS: Basal plasma vasopressin (VP) concentration was significantly higher in men than in women (P = .018). Exercise, for women and men combined, significantly increased atrial natriuretic peptide (P < .0005), VP (P = .04), norepinephrine (P < .0005), and epinephrine (P = .038) but not plasma renin activity (P = .09). No further gender differences were detected for basal levels, or for the magnitude of exercise-induced increases, for any of the hormones measured. CONCLUSIONS: The 6-minute walk test is an exercise of sufficient intensity and duration to initiate the release of hormones associated with sympathetic activation and fluid-electrolyte regulation in both women and men with CHD. It appears that a gender difference was detected only for basal VP levels.