Weight estimation in an inner-city pediatric ED: the effect of obesity.

BACKGROUND AND OBJECTIVE: Weight estimation for pediatric resuscitation occurs frequently in emergency departments. Historically, different approaches to estimation have been studied with varied results. With increasing obesity rates among inner-city children, this study aims to determine the best method for pediatric weight estimation in our population. METHODS: This is a prospective, nonblinded, observational study. A total of 324 patients (aged 1 month to 12 years) were enrolled in the study to exceed sample size calculations. The accuracy of 4 methods for weight estimation--the Broselow tape, advanced pediatric life support formulas, the PAWPER tape, and mid-arm circumference formula--were compared across age ranges and body sizes to determine the most appropriate method for our population. RESULTS: In this inner-city population, 32% of the patients 2 to 12 years of age were found to be overweight or obese. This rate increased to 41% for patients 6 to 12 years of age. In this setting, the PAWPER tape outperformed the other 3 methods, estimating patients' weight within ±5% of actual weight in 35.2% of our cohort. When compared with the other 3 methods tested, the PAWPER tape was statistically superior with a P value less than .02 in each case. CONCLUSION: Each of the methods tested in our population performed poorly. Current methods for weight estimation should be used with caution, especially for populations with an increased prevalence of obesity. Efforts should be dedicated to improving or deriving new methods for weight estimation that perform better in this vulnerable population.

A two-dose regimen of a vaccine against type III secreted proteins reduced Escherichia coli O157:H7 colonization of the terminal rectum in beef cattle in commercial feedlots.

A large-scale clinical vaccine trial of commercially fed cattle was conducted to test the efficacy of a two-dose regimen of a vaccine product against type III secreted proteins of enterohemorrhagic Escherichia coli O157:H7 on the probability to detect the same organism from terminal rectal mucosa (TRM) as a measure of gut colonization. Vaccine was administered to all cattle within treated pens at arrival processing and at reimplant processing. At harvest, TRM was collected from a sample of cattle from within vaccinated and nonvaccinated pens. The TRM were collected by scraping the mucosa of the terminal rectum 3-5 cm proximal to the rectoanal juncture. E. coli O157:H7 was isolated and identified from TRM using standard culture methods involving selective enrichment, immunomagnetic separation, and PCR confirmation. The probability to detect E. coli O157:H7 from TRM was modeled using a generalized linear mixed model with a logit link function and accounting for random effects of pen within feedlot. Seven hundred eighteen cattle were tested from within 21 pens of cattle (11 vaccinated and 10 not vaccinated) representing 3683 cattle. E. coli O157:H7 was cultured from 68 of 718 (9.5%) TRM samples. Eleven of 382 (2.9%) vaccinated cattle and 57 of 336 (17.0%) nonvaccinated cattle were TRM culture positive. From the multilevel logistic model, vaccinated cattle were 92% less likely to be colonized with E. coli O157:H7 than nonvaccinated cattle (odds ratio [OR] = 0.07, p = 0.0008). Additional explanatory variables were region of the state (OR = 7.4, p = 0.04), and pens with fewer cattle (OR = 0.22, p = 0.05). We concluded that the two-dose vaccine regimen effectively reduced the probability for E. coli O157:H7 colonization of the terminal rectum of commercially fed cattle at harvest.

A two-dose regimen of a vaccine against Escherichia coli O157:H7 type III secreted proteins reduced environmental transmission of the agent in a large-scale commercial beef feedlot clinical trial.

A clinical vaccine trial of commercially fed cattle tested the effect of a two-dose regimen of a vaccine product against type III secreted proteins of enterohemorrhagic Escherichia coli O157:H7 on the probability of detecting the organism on environmental sampling devices. Within commercial feedlots, pens of vaccinated and unvaccinated cattle were matched by reprocessing schedule and time of sampling. Vaccine was administered to all cattle within treated pens at arrival processing and again at re-implant processing. Pens of cattle were sampled 1 week after the second dose of vaccine and every 3 weeks for four test periods. Pair-matched pens of cattle were sampled concurrently. Test samples were seven ropes per pen hung overnight from the feed-bunk neck-rail (ROPES). Recovery of E. coli O157:H7 from at least one rope classified pens ROPES-positive. E. coli O157:H7 isolates were identified by standard biochemical methods and multiplex polymerase chain reaction. The probability for pens of cattle to test ROPES-positive was modeled using multilevel logistic regression with variance adjustment for clustering by matched pens and repeated measures. We studied 140 pens of cattle representing 20,556 cattle in 19 feedlots February through October 2004. Vaccinated pens of cattle were less likely to test ROPES-positive (OR = 0.59, p = 0.004). Because ROPES testing identifies organisms in the mouth of cattle, and the outcome is both associated with presence of the organism in the pen environment and correlated with the prevalence of fecal shedding, we conclude the two-dose vaccine regimen reduces the probability for environmental transmission of E. coli O157:H7 within commercial cattle feeding systems.

Heavy metal transport and behavior in the lower Columbia River, USA.

The primary objective of this study was to evaluate temporal changes in heavy metal content of lower Columbia River sediment following terminated or reduced soluble heavy metal loading from the world's largest lead-zinc refinery and mining districts in the USA and Canada. Sediment cores were collected from two fine sediment depositional sites ( approximately 600 km downstream) in August 1999 and were analyzed for total metal content, texture, and age/dating parameters. Zinc, cadmium and lead contents in 1999 declined by only a factor of two over their depth profile maxima (dated as between 1970 and 1980). In sharp contrast, more than a 10-fold decrease in dissolved metal loading occurred during this same period. Zinc in filtered Columbia River water at downstream locations also declined by > 10-fold, consistent with the reduced upper river solute-metal loading. Once soluble metal releases are reduced or terminated, the solute half-time in Columbia River water is months versus approximately 20 yr for adsorbed metals on surficial (or resuspended) bed sediments. The much slower rate of decline for sediment, as compared to the solute phase, is attributed to resuspension, transport and redeposition of irreversibly bound metals from upstream sedimentary deposits. This implies downstream exposure of benthic or particle-ingesting biota can continue for years following source remediation and/or termination of soluble metal releases. Accordingly, contaminant contents of both particulate and solute phases of river water, as well as sediment core sections, are suggested for assessing long-term biotic exposure/response to mitigation activities in the Columbia River and similar fluvial ecosystems.

The pre-nervous serotonergic system of developing sea urchin embryos and larvae: pharmacologic and immunocytochemical evidence.

Forty serotonin-related neurochemicals were tested on embryos and larvae of Lytechinus variegatus and other sea urchin species. Some of these substances (agonists of 5-HT1 receptors, antagonists of 5-HT2, 5-HT3 or 5-HT4 receptors, and inhibitors of the serotonin transporter, SERT) perturbed post-blastulation development, eliciting changes in embryonic/larval phenotypes typical for each class of receptor ligand. These developmental malformations were prevented completely or partially by serotonin (5-HT) or 5-HT analogs (5-HTQ, AA-5-HT), providing evidence for the putative localization of cellular targets. Immunoreactive 5-HT, 5-HT receptors and SERT were found in pre-nervous embryos and larvae of both L. variegatus and Strongylocentrotus droebachiensis. During gastrulation, these components of the serotonergic system were localized to the archenteron (primary gut), mesenchyme-like cells, and often the apical ectoderm. These results provide evidence that pre-nervous 5-HT may regulate early events of sea urchin embryogenesis, mediated by 5-HT receptors or the 5-HT transporter.

A Fringe-modified Notch signal affects specification of mesoderm and endoderm in the sea urchin embryo.

Fringe proteins are O-fucose-specific beta-1,3 N-acetylglucosaminyltransferases that glycosylate the extracellular EGF repeats of Notch and enable Notch to be activated by the ligand Delta. In the sea urchin, signaling between Delta and Notch is known to be necessary for specification of secondary mesenchyme cells (SMCs). The Lytechinus variegatus Fringe homologue is expressed in both the signaling and receiving cells during this first Delta-Notch signal. Perturbation of Fringe expression through morpholino antisense oligonucleotide (MO) injection results in fewer SMCs but also causes decreased and delayed archenteron invagination. Partial endoderm specification occurs but expression of some endoderm genes is compromised. The data are consistent with a Fringe-requiring Notch signal as one upstream component of archenteron morphogenesis. Finally, Fringe perturbations result in more severe phenotypes than those previously reported for Notch dominant-negative (LvN(neg)) injections or reported here for Notch MO (NMO) injections. Injecting a combination of LvN(neg) and NMO results in a more severe phenotype than either treatment alone, and this combination phenocopies the fringe MO embryos. Taken together, the results show that Fringe is necessary both for maternal and zygotic Notch signals, and these Notch signals affect specification of mesoderm and endoderm.

LvTbx2/3: a T-box family transcription factor involved in formation of the oral/aboral axis of the sea urchin embryo.

T-box family transcription factors have been identified in many organisms and are frequently associated with patterning events during embryonic development. With an interest in the molecular basis of patterning in the sea urchin embryo, we identified several members of the T-box family in Lytechinus variegatus. Here, we report the cloning and characterization of an ortholog of the Tbx2/3 subfamily, LvTbx2/3. To characterize the spatial distribution of LvTbx2/3 protein throughout sea urchin embryogenesis, a polyclonal antiserum was generated. Nuclear localization of LvTbx2/3 initiated at the mesenchyme blastula stage and protein was present into the pluteus stage. Localization was asymmetric throughout this period and costaining with marker genes indicated that asymmetry was about the oral/aboral (O/A) axis. Asymmetric distribution of LvTbx2/3 was observed in the aboral territories of all three germ layers. In the skeletogenic mesoderm lineage, LvTbx2/3 expression was dynamic because expression appeared initially in all skeletogenic mesenchyme cells (PMCs) but, subsequently, became refined solely to the aboral ones during skeletogenesis. To determine if the aboral expression of LvTbx2/3 is linked between germ layers, and to place LvTbx2/3 in the sequence of events that specifies the O/A axis, the effects of a series of perturbations to O/A polarity on LvTbx2/3 expression in each germ layer were examined. Preventing the nuclear localization of beta-catenin, pharmacological disruption of the O/A axis with NiCl(2), overexpression of BMP2/4 and disruption of the extracellular matrix all blocked LvTbx2/3 expression in all germ layers. This indicates that expression of LvTbx2/3 in the aboral territories of each germ layer is a common aspect of O/A specification, downstream of the molecular events that specify the axis. Furthermore, blocking the nuclear localization of beta-catenin, overexpression of BMP2/4 and disruption of the extracellular matrix also prevented the oral (stomodael) expression of LvBrachyury (LvBrac) protein, indicating that the O/A axis is established by a complex series of events. Last, the function of LvTbx2/3 in the formation of the O/A axis was characterized by examining the phenotypic consequences of ectopic expression of LvTbx2/3 mRNA on embryonic development and the expression of marker genes that identify specific germ layers and tissues. Ectopic expression of LvTbx2/3 produced profound morphogenetic defects in derivatives of each germ layer with no apparent loss in specification events in those tissues. This indicates that LvTbx2/3 functions as a regulator of morphogenetic movements in the aboral compartments of the ectoderm, endoderm and mesoderm.

Primary mesenchyme cell patterning during the early stages following ingression.

Sea urchin primary mesenchyme cells (PMCs) ingress into the blastocoel during an epithelial-to-mesenchymal transition (EMT), migrate along the blastocoelar wall for a period of time, and then settle into a subequatorial ring to form the larval skeleton. Fluorescent-marked blastomeres alone, or in combination with blastomere recombination, were used to track the position of PMCs during the early phases of this movement. Micromeres expressing Golgi-tethered GFP (galtase-GFP) were transplanted onto TRITC-stained hosts (in place of the endogenous micromere) to observe the progeny of a single micromere. Galtase-GFP as a Golgi marker is not transferred between PMCs when the syncytium forms. Thus, the position of cells can be followed relative to beginning position for longer periods than previously reported. The PMC progeny of a single micromere do not disperse upon ingression, but instead remain in a closely associated cluster. Generally, progeny of a single micromere remain in the quadrant of origin. In total, greater than approximately 94% of labeled PMCs remain within the local region of ingression. By contrast, when a transplanted micromere is placed at the vegetal plate after removing all 4 host micromeres, the resultant PMCs ingress and migrate into all 4 quadrants. Similarly, if 1 blastomere is injected at the 2-cell stage, and later the 2 unlabeled micromeres are removed at the 16-cell stage, the remaining PMCs ingress into all 4 quadrants of the vegetal plate. We conclude that the normal restriction of PMCs to a quadrant is due to mechanical constraint from other micromere-PMCs. If a labeled micromere is placed ectopically at the macromere/mesomere boundary, the PMC progeny ingress ectopically and migrate longitudinally along the animal-vegetal axis only. Injection of galtase-GFP into one blastomere at the 4-cell stage shows a 2-step pattern of localization. At late mesenchyme blastula and early gastrula stages, greater than 90% of GFP-expressing PMCs remain in the injected quadrant, while at mid- to late-gastrula stage and beyond, more PMCs are found outside the injected quadrant. The migration that sets up the asymmetry of the larval skeleton first occurs around mid- to late-gastrula stages, when some PMCs from an aboral quadrant migrate to the adjacent oral quadrant. In all, these data combined with previous data suggest that freshly ingressed PMCs migrate along a longitudinal path toward the animal pole and back toward the vegetal pole. Beginning at mid- to late-gastrula stage, PMCs utilize oral-aboral cues from the ectoderm for the first time. At this time, some aboral PMCs migrate into the adjacent oral quadrant to assist in the formation of the ventrolateral cluster.