Comparison of Dosing Accuracy Between the ENFit LDT and a Neonatal-Specific ISO-Compliant Enteral Syringe.

OBJECTIVE: To evaluate the dosing accuracy of 2 female enteral syringe types for use in neonates. METHODS: This was an in vitro study evaluating dosing accuracy of ENFit with low dose tip (LDT) and Nutrisafe2 (NS2) syringes. Acceptable dosing variance (DV) was +/- 10%. Outcomes included tests exceeding 10% DV and DV by syringe size, dispensing source, and intended dosing volume. RESULTS: A total of 300 tests were performed (LDT = 150, NS2 = 150) with 3 syringe sizes (0.5, 1, 3 or 2.5 mL). Compared with NS2, LDT had significantly more tests with unacceptable DV (48% vs 4.7%, p < 0.0001) and higher absolute DV (11.9% vs 3.5%, p < 0.001). Dosing variance was inversely proportional to syringe size, where the smallest syringes were least accurate (0.5 mL LDT 16.1% vs 4.6%, p < 0.001). The largest syringes had acceptable DV (3 mL LDT 8.8% vs 2.5 mL NS2 3.3%, p < 0.001). Bulk bottle with adapters demonstrated a higher DV with LDT compared with NS2 (13.3% vs 3.9%, p < 0.001). Medication cups without adapters were associated with acceptable DV for both LDT and NS2 (9.7% vs 2.9%, p < 0.001). CONCLUSIONS: The Nutrisafe2 syringe has greater dosing accuracy as compared with ENFit LDT syringe. Smaller syringes are associated with greater dosing inaccuracy, but this effect was within acceptable DV for the NS2 syringe. Bulk bottle adapters did not improve the accuracy of the LDT. More clinical evaluations are needed to determine if the ENFit can be safely used in the neonatal population.

INITIAL TL/OSL/EPR CONSIDERATIONS FOR COMMERCIAL DIATOMACEOUS EARTH IN RETROSPECTIVE DOSIMETRY AND DATING.

Diatomaceous earth is found in various locations around the planet. It is caused by the deposited exoskeleton material formed by the death of large concentrated populations of diatoms. The exoskeleton is effectively pure silicate and as such becomes a prospective material for retrospective dosimetry and dating. This work investigated the thermoluminescence (TL) and optically stimulated luminescence properties of commercially obtained diatomaceous earth. The material was not found to have useful dosimetric properties with conventional TL methodologies but did provide large dose estimates using the Single Aliquot Regeneration technique on some subset samples. These findings for organic silicate did suggest some mechanisms explaining the sensitization process in geological silicate materials utilized in dosimetry and dating. Electron paramagnetic resonance was identified as a potential future method for evaluating this material as it revealed unique signal components not found in igneous or commercially produced silicates.

Dose Deposition Profiles in Untreated Brick Material.

In nuclear forensics or accident dosimetry, building materials such as bricks can be used to retrospectively determine radiation fields using thermoluminescence and/or optically stimulated luminescence. A major problem with brick material is that significant chemical processing is generally necessary to isolate the quartz from the brick. In this study, a simplified treatment process has been tested in an effort to lessen the processing burden for retrospective dosimetry studies. It was found that by using thermoluminescence responses, the dose deposition profile of a brick sample could be reconstructed without any chemical treatment. This method was tested by estimating the gamma-ray energies of an Am source from the dose deposition in a brick. The results demonstrated the ability to retrospectively measure the source energy with an overall energy resolution of approximately 6 keV. This technique has the potential to greatly expedite dose reconstructions in the wake of nuclear accidents or for any related application where doses of interest are large compared to overall process system noise.

Should MD-PhD programs encourage graduate training in disciplines beyond conventional biomedical or clinical sciences?

The goal of MD-PhD training programs is to produce physician-scientists with unique capacities to lead the future biomedical research workforce. The current dearth of physician-scientists with expertise outside conventional biomedical or clinical sciences raises the question of whether MD-PhD training programs should allow or even encourage scholars to pursue doctoral studies in disciplines that are deemed nontraditional, yet are intrinsically germane to major influences on health. This question is especially relevant because the central value and ultimate goal of the academic medicine community is to help attain the highest level of health and health equity for all people. Advances in medical science and practice, along with improvements in health care access and delivery, are steps toward health equity, but alone they will not come close to eliminating health inequalities. Addressing the complex health issues in our communities and society as a whole requires a biomedical research workforce with knowledge, practice, and research skills well beyond conventional biomedical or clinical sciences. To make real progress in advancing health equity, educational pathways must prepare physician-scientists to treat both micro and macro determinants of health. The authors argue that MD-PhD programs should allow and encourage their scholars to cross boundaries into less traditional disciplines such as epidemiology, statistics, anthropology, sociology, ethics, public policy, management, economics, education, social work, informatics, communications, and marketing. To fulfill current and coming health care needs, nontraditional MD-PhD students should be welcomed and supported as valuable members of our biomedical research workforce.

Beyond the clinic: improving child health through evidence-based community development.

BACKGROUND: Promoting child wellbeing necessarily goes beyond the clinic as risks to child health and development are embedded in the social and physical environmental conditions in which children live. Pediatricians play a vital role in promoting the health of children in the communities they serve and can maximize their impact by advocating for and supporting efficacious, evidence-based strategies in their communities. METHODS: To provide a succinct guide for community pediatric efforts to advance the wellbeing of all children and particularly disadvantaged children in a community, we conducted a theory-driven and structured narrative review to synthesize published systematic and meta-analytic reviews of policy-relevant, local-level strategies addressing potent and malleable influences on child health and development. An exhaustive list of policy-relevant, local-level strategies for improving child health was used to conduct a comprehensive search of recent (1990-2012), English language peer-reviewed published meta-analyses and systematic reviews in the 10 core databases of scientific literature. Our review of the literature encompassed six key conceptual domains of intervention foci, including distal influences of child health (i.e., income and resources, social cohesion, and physical environment) and proximal influences (i.e., family, school and peer). We examined intervention effects on four key domains of child health and development: cognitive development, social and emotional competence, psychological and behavioral wellbeing, and physical health. RESULTS: Published reviews were identified for 98 distinct policy-relevant community interventions, evaluated across 288 outcomes. We classified 46 strategies as meeting scientific criteria for efficacy by having consistent, positive outcomes from high-quality trials (e.g., tenant-based rental assistance, neighborhood watch programs, urban design and land use policies, access to quality childcare services, class size reductions, after-school programs that promote personal/social skills). Another 21 strategies were classified as having consistent evidence of positive outcomes from high-quality observational studies only, while 28 strategies had insufficient evidence available to assess their effectiveness based on published reviews. We did not limit the review to studies conducted in the United States, but the vast majority of them were U.S.-based, and the results therefore are most applicable to the U.S. context. CONCLUSIONS: Based on our synthesis of published literature on community development strategies, we provide an illustration combining a comprehensive set of evidence-based strategies to promote child health and development across a wide-range of child health outcomes.

Associations between bar patron alcohol intoxication and tobacco smoking.

OBJECTIVE: To examine the event-specific relationship between alcohol intoxication and nighttime tobacco smoking among college bar patrons. METHODS: In this secondary analysis of existing data, we examined event-specific associations between self-report measures of tobacco smoking and breath alcohol concentration (BrAC) readings obtained from 424 patrons exiting on-premise drinking establishments. RESULTS: In a multivariable logistic regression analysis, acute alcohol intoxication was positively associated with same-night incidents of smoking tobacco, adjusting for the effects of established smoking practices and other potential confounders. CONCLUSIONS: This investigation is the first known study using data collected in an on-premise drinking setting to link alcohol intoxication to specific incidents of tobacco smoking.

Perceived racial/ethnic discrimination, problem behaviors, and mental health among minority urban youth.

OBJECTIVES: We examined perceived frequency and intensity of racial/ethnic discrimination and associations with high-risk behaviors/conditions among adolescents. DESIGN: With surveys from 2490 racial/ethnic minority adolescents primarily with low socioeconomic status, we used regression analysis to examine associations between racial/ethnic discrimination and behavioral health outcomes (alcohol use, marijuana use, physical aggression, delinquency, victimization, depression, suicidal ideation, and sexual behaviors). RESULTS: Most adolescents (73%) experienced racial/ethnic discrimination and 42% of experiences were 'somewhat-' or 'very disturbing.' Adolescents reporting frequent and disturbing racial/ethnic discrimination were at increased risk of all measured behaviors, except alcohol and marijuana use. Adolescents who experienced any racial/ethnic discrimination were at increased risk for victimization and depression. Regardless of intensity, adolescents who experienced racial/ethnic discrimination at least occasionally were more likely to report greater physical aggression, delinquency, suicidal ideation, younger age at first oral sex, unprotected sex during last intercourse, and more lifetime sexual partners. CONCLUSION: Most adolescents had experienced racial/ethnic discrimination due to their race/ethnicity. Even occasional experiences of racial/ethnic discrimination likely contribute to maladaptive behavioral and mental health outcomes among adolescents. Prevention and coping strategies are important targets for intervention.

5-HTTLPR genotype and associations with intoxication and intention to drive: results from a field study of bar patrons.

The serotonin transporter promoter polymorphism (5-HTTLPR) has been linked to a number of human behavioral traits and disorders. The variants of 5-HTTLPR are commonly reported in three forms, L/L, S/L and S/S, with the latter most often associated with emotional distress and/or behavioral dysfunction. Missing from the research literature are investigations that assess event-level associations between 5-HTTLPR genotype and specific incidents of risk behavior in natural drinking settings. This study reports associations between 5-HTTLPR, alcohol intoxication and intention to drive among young adult patrons exiting on-premise drinking establishments (i.e. bars) at night. Self-report measures, breath alcohol concentration (BrAC) readings and saliva samples for DNA analysis were collected from 477 bar patrons. Analyses were performed on 225 patrons likely to be near their peak intoxication level for the night. Results from a linear regression revealed that the 5-HTTLPR genotype was associated with exiting patron BrAC, after adjusting for random and fixed effects of other variables. An interaction effect involving 5-HTTLPR and bar-sponsored drink specials also had an independent association with BrAC, suggesting that selection of price-discounted alcoholic beverages increased intoxication in patrons with an L allele. In addition, results from logistic regression indicated that patrons with the S/S genotype were three times more likely to intend to drive a motor vehicle (after drinking on the night of study participation) compared with those with the L/L genotype. The 5-HTTLPR genotype may play an important role in the etiology of problems associated with on-premise drinking establishments.

Event-level analyses of energy drink consumption and alcohol intoxication in bar patrons.

AIM: To assess event-level associations between energy drink consumption, alcohol intoxication, and intention to drive a motor vehicle in patrons exiting bars at night. METHOD: Alcohol field study. Data collected in a U.S. college bar district from 802 randomly selected and self-selected patrons. Anonymous interview and survey data were obtained as well as breath alcohol concentration (BrAC) readings. RESULTS: Results from logistic regression models revealed that patrons who had consumed alcohol mixed with energy drinks were at a 3-fold increased risk of leaving a bar highly intoxicated (BrAC> or =0.08g/210L), as well as a 4-fold increased risk of intending to drive upon leaving the bar district, compared to other drinking patrons who did not consume alcoholic beverages mixed with energy drinks. DISCUSSION: These event-level associations provide additional evidence that energy drink consumption by young adults at bars is a marker for elevated involvement in nighttime risk-taking behavior. Further field research is needed to develop sound regulatory policy on alcohol/energy drink sales practices of on-premise establishments.

Relationships between drinking onset, alcohol use intensity, and nighttime risk behaviors in a college bar district.

OBJECTIVE: To identify antecedents of risk behavior events in college bar patrons. METHODS: In this nighttime field study, self-report data and alcohol intoxication readings were collected from patrons immediately upon exiting bars (n = 618). RESULTS: Multilevel structural equation modeling revealed positive associations between age of drinking onset and both alcohol use intensity in the past year and recent bar-going frequency. In turn, alcohol use intensity in the past year was positively associated with bar-going frequency and intoxication at bar exit. An association between drinking onset and bar-going frequency was mediated by alcohol use intensity in the past year. CONCLUSIONS: Discernable paths from age of drinking onset to monthly bar-going frequency and intoxication level after leaving a bar can be identified. The results highlight the critical role of drinking onset in development of college student alcohol abuse. Research is needed to determine whether college bars are environmental pathogens mediating between genetic risk factors and patron risk behavior.

Alcohol price and intoxication in college bars.

BACKGROUND: Many population studies find that alcohol prices are inversely related to alcohol consumption and alcohol-related problems, including among college students and young adults. Yet, little is known about the "micro-level" effects of alcohol price on the behavior of individual consumers in natural drinking settings such as college bars. Therefore, we assessed patron's cost per gram of ethanol consumed at on-premise drinking establishments and its association with intoxication upon leaving an establishment. METHODS: On 4 consecutive nights during April 2008, data were collected from 804 patrons exiting 7 on-premise establishments in a bar district located adjacent to a large university campus in the southeastern United States. Anonymous interview and survey data were collected as well as breath alcohol concentration (BrAC) readings. We calculated each patron's expenditures per unit of ethanol consumed based on self-reported information regarding the type, size, number, and cost of consumed drinks. RESULTS: A multivariable model revealed that a 10-cent increase in cost per gram of ethanol at on-premise establishments was associated with a 30% reduction in the risk of exiting an establishment intoxicated (i.e., BrAC > or = 0.08 g/210 l). CONCLUSIONS: The results are consistent with economic theory and population-level research regarding the price elasticity of alcoholic beverages, which show that increases in alcohol prices are accompanied by less alcohol consumption. These findings suggest that stricter regulation of the drink discounting practices of on-premise drinking establishments would be an effective strategy for reducing the intoxication levels of exiting patrons.

Event-specific analyses of poly-drug abuse and concomitant risk behavior in a college bar district in Florida.

OBJECTIVE: The authors describe the epidemiology of risk behavior associated with poly-drug use in a college bar district of a large campus community. PARTICIPANTS: A total of 469 bar patrons participated in the study. METHODS: The authors used self-report data and biological measures collected from patrons outside bars in July and August of 2007. RESULTS: The mean breath alcohol concentration of the exiting patrons was 0.09. Illicit and prescription drug use on the nights of data collection and in the recent past were significant features of the profile of patron risk behavior. About one-quarter of the patrons using only alcohol reported an intention to drive a vehicle within 60 minutes of leaving an establishment, compared with almost one-half of those using both alcohol and marijuana. CONCLUSIONS: A substantial amount of high-risk behavior was generated from the bar district on 4 typical nights. College bar districts should be a priority focus for prevention efforts.

An exploratory study of bar and nightclub expectancies.

OBJECTIVE: The authors identified the principal components of bar and nightclub expectancy in college students and the associations between these factors and the risk behavior of night-clubbing. PARTICIPANTS: A total of 4,384 undergraduates enrolled at a large, public university participated. METHODS: In the first phase (July-September 2007), the authors collected preliminary data from a convenience sample. In the second phase (March 2008), the authors collected data from a separate probability sample. RESULTS: A principal components analysis revealed 4 reliable and distinct expectancy factors. Regression analyses revealed that after adjusting for the effects of alcohol and demographic variables, expectancies explained a significant proportion of variance in bar/nightclub attendance. Different expectancy profiles distinguished high-frequency nightclubbers from the most common bar attendance practice and nonmonogamous nightclubbers from monogamous nightclubbers. CONCLUSIONS: From a developmental perspective, nightclubbing appears to assist young adults with establishing and maintaining social networks, romantic and sexual relationships, and collegiate acculturation.

A field study of bar-sponsored drink specials and their associations with patron intoxication.

OBJECTIVE: The study examined associations between bar-sponsored drink specials and alcohol intoxication at the patron level. METHOD: Data were collected in a college bar district located in a large campus community in the southeastern United States. Random and self-selected samples of patrons were interviewed after exiting college bars at night on four different nights (N=383). Anonymous interview and questionnaire data were collected as well as breath alcohol concentration (BrAC) readings. RESULTS: Significant gender differences existed in patron drinking practices. Women were more likely to take advantage of drink specials, whereas men reported greater alcohol expenditures, consumed more drinks, and drank for longer periods of time. Gender differences in BrAC were very small and not meaningful. Patrons who did not take advantage of drink specials reported consuming more drinks before bar entry than patrons who did participate in these promotions. Participation in "all-you-can-drink" promotions was significantly associated with higher BrAC readings after adjusting for covariates and random effects attributable to drinking establishment. Other drink specials did not have significant associations with alcohol intoxication. CONCLUSIONS: The all-you-can-drink special may be the specific discounting practice with the greatest potential for boosting patron intoxication and thus may need to be a stronger focus of alcohol-control policies aimed at improving the beverage service of drinking establishments.

Drink specials and the intoxication levels of patrons exiting college bars.

OBJECTIVES: To determine whether drink specials independently increase patrons' risk of achieving a high level of intoxication upon exiting drinking establishments. METHODS: In a campus community, data were collected from exiting patrons (N=291) via sidewalk interviews and breath tests on 6 nights of 2 consecutive semesters. RESULTS: A multivariate model revealed that taking advantage of a drink special was associated with a fourfold increase in risk of achieving a BAC >or= 80 mg/dl. CONCLUSIONS: These findings are the first to document that the drink discounting practices of college bars can be linked to higher intoxication levels among exiting patrons.

Aerial migration of the Dictyostelium slug.

The Dictyostelium slug lays down curved marks in its slime sheath trail as it migrates across an agar substrate. These 'footprints' are caused by elevation of the slug anterior as it initiates a period of aerial migration and can be used as a measure of the slug's propensity for this behavior. A variety of factors have been found to affect the number of footprints created per distance migrated. Smaller slugs produce a higher incidence of footprints than larger slugs. Migration in the light and lower temperatures during migration increase footprint incidence. Activated charcoal reduces, while exogenous addition of ammonia increases, the incidence of footprints. Simulation of the three-dimensional (3D) environment of the soil suggests that aerial migration plays a role in the slug's movement through the cavities of its natural environment. A model proposes that aerial migration is initiated by a small group of continually changing prestalk cells that acts as a pacemaker and is moved around the circumference of the slug tip by the rotation of the prestalk cells. As this pacemaker reaches the upper surface of the slug it can initiate aerial migration.