Places for Healthy Play: A Multi-Pronged Evaluation of Context, Design, and Perceptions for Play Space Improvements.

Community design interventions have prioritized the creation of quality play space, especially in easy to access public places, to improve health outcomes and to reduce health inequities. Evaluations of health-relevant play interventions often fail to assess essential context, design, and perceptions. The Play Everywhere Philadelphia Challenge, led by KABOOM!, funded 16 play spaces to support child health and development and literacy skills for low-income neighborhoods across Philadelphia. In June-October 2022, our interdisciplinary team conducted a process evaluation of completed play space installations (k=9) to identify site aspects that facilitated greater use. We mapped neighborhood context (e.g., child amenities, sociodemographics, pedestrian and bike accessibility), and conducted direct and systematic observations of play space design (e.g., signage, shade), visitation (i.e., number of visitors/hour), and engagement. We summarized visitation and engagement across contextual and design data. While many visitors passed through sites, over half of the children we observed engaged with the installation. Installations with poor condition (i.e., cleanliness and maintenance) had the lowest visitation and engagement. More active/kinetic installations drew more children and engagement. This process evaluation comprehensively analyzed play space design elements and neighborhood context and provides evidence to inform recommendations to increase use of urban play spaces.

Antidepressants in Surface Waters: Fluoxetine Influences Mosquitofish Anxiety-Related Behavior at Environmentally Relevant Levels.

Pharmaceutical contamination is an increasing problem globally. In this regard, the selective serotonin reuptake inhibitors (SSRIs)-a group of antidepressants-are particularly concerning. By disrupting the serotonergic system, SSRIs have the potential to affect ecologically important behaviors in exposed wildlife. Despite this, the nature and magnitude of behavioral perturbations resulting from environmentally relevant SSRI exposure among species is poorly understood. Accordingly, we investigated the effects of two field-realistic levels of the SSRI fluoxetine (61 and 352 ng/L) on sociability and anxiety-related behaviors in eastern mosquitofish ( Gambusia holbrooki) for 28 days. Additionally, we measured whole-body tissue concentrations of fluoxetine and norfluoxetine. We found that fluoxetine altered anxiety-related behavior but not sociability. Specifically, female fish showed reduced anxiety-related behavior at the lower treatment level, while males showed an increase at the higher treatment level. In addition, we report a biomass-dependent and sex-specific accumulation of fluoxetine and norfluoxetine, with smaller fish showing higher relative tissue concentrations, with this relationship being more pronounced in males. Our study provides evidence for nonmonotonic and sex-specific effects of fluoxetine exposure at field-realistic concentrations. More broadly, our study demonstrated that neuroactive pharmaceuticals, such as fluoxetine, can affect aquatic life by causing subtle but important shifts in ecologically relevant behaviors.

Context-specific behavioural changes induced by exposure to an androgenic endocrine disruptor.

Pharmaceutical contaminants are being detected with increased frequency in organisms and ecosystems worldwide. This represents a major environmental concern given that various pharmaceuticals act on drug targets that are evolutionarily conserved across diverse taxa, are often persistent in the environment, and can bioconcentrate in organisms and bioaccumulate in food chains. Despite this, relatively little is known about the potential for pharmaceutical contaminants to affect animal behaviour, especially across multiple fitness-related contexts. Here, we investigated impacts of 21-day exposure of wild-caught male eastern mosquitofish (Gambusia holbrooki) to a field-realistic level of the veterinary pharmaceutical 17ß-trenbolone-a growth-promoting steroid used extensively in beef production worldwide and a potent androgenic endocrine disruptor repeatedly detected in surface waters affected by livestock effluent run-off. First, we examined male boldness, activity, and exploratory behaviour in a novel environment (maze arena) and found no significant effect of 17ß-trenbolone exposure. Second, the same males were tested in a reproductive assay for their tendency to associate with a stimulus (unexposed) female behind a partition. Exposed males exhibited reduced association behaviour, taking longer to first associate with, and spending less time within close proximity to, a female. Third, all males were assayed for sperm function (computer-assisted sperm analysis, sperm viability) or quantity (total sperm count) and, although no significant main effects of 17ß-trenbolone were seen on sperm traits, exposure altered the relationship between male morphology and sperm function. Lastly, morphological traits were assessed and exposed males were found to have, on average, increased mass relative to length. In combination, these results demonstrate that exposure to a field-realistic level of 17ß-trenbolone can produce subtle but important trait alterations in male fish-including context-specific behavioural changes, disruption of key sperm function trade-offs, and altered morphology-with potential impacts on exposed wildlife.

HOW MATE AVAILABILITY INFLUENCES FILIAL CANNIBALISM.

Parents sometimes eat their young to reduce the consequences of brood overcrowding, for nutritional gain, and/or to redirect investment toward future reproduction. It has been predicted that filial cannibalism should be more prevalent when mate availability is high as parents can more easily replace consumed young. Reviewing the available evidence--which comes almost exclusively from studies of paternal caring fish--we find support in some species, but not others. To explain this, we hypothesize that sexual selection against filial cannibalism and/or the tendency to acquire larger broods under conditions of high mate availability discourages filial cannibalism. Additionally, filial cannibalism might occur when mate availability is low to facilitate survival until access to mates improves. Since attractiveness can also influence remating opportunities, we review its effect on filial cannibalism, finding that attractive parents engage in less filial cannibalism. More research is needed to determine if this relationship is a result of individuals showing adaptive plasticity in filial cannibalism based on self-perceived attractiveness, or if the attractiveness of individuals is reduced by their propensity to commit filial cannibalism. More generally, to advance our understanding of how mate availability influences filial cannibalism, future studies should also focus on a wider range of taxa.

Experts and performance in histopathology--a study in breast pathology.

This study was undertaken to determine if it was possible to identify expertise within Histopathologists (trainees, district general pathologists and pathologists with a special interest in breast disease) using an objective measure of performance. The method of assessment of performance is based on the CWS (Cochran-Weiss-Shanteau) ratio formed by the individual's ability to discriminate between a spectrum of disease categories and their level of inconsistency when assessed at intervals. The slides circulated represented the spectrum of breast disease seen in routine practice. The results demonstrated the average CWS ratio to be lowest in trainees and highest in pathologists with a special interest in breast pathology although there was no statistical difference in the CWS scores obtained between the district general pathologists and pathologists with a special interest. Differences in inconsistency rather than discriminatory ability mainly accounted for the difference in the CWS ratio observed between the groups studied. The study shows that the CWS ratio is potentially a very useful tool in the assessment of pathologists with regard to assessing their progress through training.

Adult endomysial antibody-negative coeliac disease and cigarette smoking.

OBJECTIVE: To determine the relative incidence and characteristics of endomysial antibody (EMA)-negative coeliac disease in adults. DESIGN: Retrospective analysis of prospectively collected data on adults with newly diagnosed coeliac disease, with determination of EMA status before gluten withdrawal. SETTING: District general hospital (secondary care institution). PARTICIPANTS: Sixty consecutive incident cases. MAIN OUTCOME MEASURES: (i) Proportion of cases who were EMA-negative; (ii) comparison of clinical and laboratory variables at diagnosis for EMA-positive and EMA-negative subjects. RESULTS: Fifteen subjects (25%, 95% CI 15-38%) were EMA negative, of whom only two were IgA deficient. There was clinical evidence in all 15 patients and histological evidence in 13 patients of a response to gluten withdrawal. No significant differences were found between EMA-positive and EMA-negative subjects with respect to histological features, age, gender, clinical manifestations, concurrent autoimmune disorders, family history of coeliac disease, or haemoglobin and albumin concentrations at diagnosis. However, EMA-negative status at diagnosis was associated strongly with current or recent cigarette smoking (OR 7.0, 95% CI 1.7-31.5, P= 0.003). CONCLUSIONS: A substantial minority of patients with otherwise typical coeliac disease are EMA negative, and most of these are IgA replete. The value of EMA as a screening tool is therefore limited. EMA status in untreated coeliac disease correlates strongly with cigarette smoking history: this may be of pathogenic significance, given the previously demonstrated association between smoking and the risk of coeliac disease.

Personal performance profiles: a useful adjunct to quality assurance in cervical cytology.

In our laboratory, which processes approximately 40,000 smears annually, the reporting patterns of each individual primary screener have been continuously monitored over a 6-year period. The detection rates for minor abnormalities (borderline/mild dyskaryosis) and major abnormalities (moderate dyskaryosis and worse) are published quarterly in the laboratory. Individual continuous monitoring rapidly identifies screeners with low detection rates. It is a useful adjunct to existing methods of quality assurance; rescreening can be more appropriately directed to smears reported by screeners with low detection rates. It also identifies training needs and may be used to assess the value of update courses for each screener. It is a faster method of identifying poor performance than rapid review of all smears. The reporting rate of inadequate smears is also calculated and published on a quarterly basis. This promotes a degree of uniformity within the laboratory in the rate at which smears are reported as inadequate, and also reduces the inadequate rate.

The quality of histopathology data in a computerised cancer registration system: implications for future audit of care.

Electronic linkage between pathology data sources and other information systems has not realised its full potential benefits due to the poor quality of histopathology coding. This study showed that 38% of a sample of 158 pathology reports were coded accurately. Of the incorrectly coded reports, 25% had the potential to distort published cancer incidence figures. The incidence figures of the most common cancers are less likely to be affected by coding errors. Areas in which all errors, both topographical and morphological, could have significant impact include examining resource allocation at directorate level and adjusting outcome indicators for casemix. This study concludes that electronic linkage between histopathology systems and cancer registries is not sufficient to improve the quality of registration data. As cancer registries become more dependent on computerised information provided through hospital information systems, registries need to be aware of poor quality data and put in place appropriate quality assurance measures specifically tailored to support electronic cancer registration. Purchasers and providers need to be aware that incomparable datasets could be produced if other bodies use computerised pathology datasets without first validating the data.

Adult coeliac disease and cigarette smoking.

BACKGROUND: Genetic predisposition and gliadin exposure are known to be crucial factors in the development of coeliac disease. Circumstantial evidence suggests that other unidentified environmental factors may also be of pathogenetic importance. AIM: To define the relation between cigarette smoking and the risk of development of symptomatic adult onset coeliac disease. SUBJECTS: Eighty six recently diagnosed adult coeliac disease patients and 172 controls matched for age and sex. METHOD: Matched case control study, using a simple questionnaire to determine smoking history, and in particular smoking status at the time of diagnosis of coeliac disease. RESULTS: At the time of diagnosis, the proportion of current smokers was 7% in the coeliac group, and 32.6% in the control group, giving a matched odds ratio of 0.15 (95% confidence intervals 0.06, 0.38). The difference could not be accounted for by social class, nor by coeliac patients giving up smoking after the onset of symptoms as most non-smokers in the coeliac group had never smoked. CONCLUSION: Cigarette smoking, or a factor closely linked to it, seems to exert a major protective effect against the development of symptomatic adult onset coeliac disease. The implication is that gliadin exposure is not the only important environmental factor involved in the pathogenesis of this condition.

Lymphocyte predominance Hodgkin's disease--an immunohistochemical study.

Lymph node biopsies from 57 local and referred cases, previously diagnosed at Southampton between 1978 and 1987 as lymphocyte predominance Hodgkin's disease were examined using the monoclonal antibodies MT1, UCHL1, L26, LN-1, E29/68 (EMA), Leu-M1 (CD15) and Ber-H2 (CD30). Of the 34 cases with a nodular architecture, 21 (19 male, two female) contained polylobated Reed-Sternberg cell variants with a B-cell phenotype, which lacked expression of CD15. In all cases, the polylobated cells showed positive staining with L26 and LN-1. Six cases expressed EMA and three showed positive staining with Ber-H2. Two cases lacking polylobated cells were reclassified as reactive follicular hyperplasia with progressive transformation of germinal centres. The remaining 11 cases had an atypical immunophenotype and were reclassified, mainly as mixed cellularity Hodgkin's disease. In six cases, the lymph node architecture showed a mixture of nodular and diffuse growth patterns. Five of these cases contained polylobated cells with the typical morphology and immunophenotype of those seen in nodular lymphocyte predominance Hodgkin's disease. The sixth case contained cells expressing CD15, and was reclassified as nodular sclerosing Hodgkin's disease. Of the fifteen biopsies with a diffuse architecture, four contained polylobated B-cells lacking expression of CD15. These were considered to be diffuse lymphocyte predominance Hodgkin's disease. The remaining 11 cases were reclassified as either Hodgkin's disease, mixed cellularity or as T-cell lymphomas.

The fine anatomy of the human spinal meninges. A light and scanning electron microscopy study.

The fine anatomy of the human spinal meninges was examined in five postmortem spinal cords taken within 12 hours after death from patients aged 15 months to 46 years. Specimens of spinal cord were viewed in transverse section and from the dorsal and ventral aspects by scanning electron microscopy. Transverse sections of spinal cord and meninges were also examined by light microscopy. The arachnoid mater was seen to be closely applied to the inner aspect of the dura. An intermediate fenestrated leptomeningeal layer was observed attached to the inner aspect of the arachnoid mater and was reflected ventrally to form a series of dorsal septa. As it arborized laterally over the surface of the cord to surround nerves and blood vessels, the intermediate layer became highly fenestrated but remained distinct from the pia and arachnoid mater. The pia mater appeared to form a continuous layer which was reflected off the surface of the cord to coat blood vessels within the subarachnoid space in a manner similar to that described in the leptomeninges over the human cerebral cortex. Each dentate ligament consisted of a collagenous core which was continuous with the subpial connective tissue and was attached at intervals to the dura; pia-arachnoid cells coated the surface of the dentate ligaments. The present study suggests that the fine anatomy of the human spinal meninges differs significantly from that described in other mammals.