Tolerance of soya lecithin in children with non-immunoglobulin E-mediated soya allergy: a randomised, double-blind, cross-over trial.

BACKGROUND: Soya lecithin is present in a wide variety of foods regularly consumed by children, in the form of an emulsifier or stabiliser. Children with non-immunoglobulin (Ig)E-mediated allergies who commonly have to avoid milk and soya will have a significantly restrictive diet with reduced alternative foods if soya lecithin also has to be eliminated. The present study aimed to establish whether children with non-IgE-mediated gastrointestinal soya allergy react to soya lecithin in food products. METHODS: A double-blind, cross-over study was performed in soya-allergic children aged between 8 months and 5 years. Eligible children had their soya allergy status confirmed with a home challenge. Children were randomly assigned to either placebo or challenge dose of soya lecithin (1.5 g per day) in a custom-made biscuit. This was followed by a 1-week washout period and cross-over to another 1 week of challenge or placebo dose. Symptoms were recorded prior to commencing the study and at the end of each week's challenge. RESULTS: Twenty-two children, 16 boys, with a median age of 44 months (range 21-58 months) were recruited, although only 20 completed the full study. The median number of foods avoided in addition to soya was 3. Over the challenge period, the parents reported reactions in six cases: five cases (23%) to the placebo and one case (5%) to the challenge dose. There was no statistical difference (P = 0.025) between the groups. CONCLUSIONS: One child with a non-IgE-mediated gastrointestinal allergy had a slight reaction to soya lecithin. Although single cases may react to soya lecithin, we suggest that soya lecithin should be included in children with this delayed allergy, unless they have a confirmed reaction to traces of soya within this emulsifier.

Prognostic impact of PIK3CA protein expression in triple negative breast cancer and its subtypes.

BACKGROUND: Triple negative breast cancer (TNBC) harbors a heterogeneous group of carcinomas with poor prognosis and high genetic variability. As a potential aim for targeted therapy, genetic mutations leading to an activation of the phosphoinositide 3-kinase pathway in a catalytic subunit (PIK3CA) in breast cancer have been analyzed currently. Little is known about the clinical impact and prognostic or predictive value of this marker in TNBC subtypes. METHODS: Samples from 119 TNBC cases were submitted to immunohistochemical PIK3CA protein expression analysis and scored semi-quantitatively as negative, weak (1 +), or strongly expressed (2 +). Expression scores were correlated to patient's characteristics, imaging features, and TNBC subtypes. TNBC subtypes were categorized into four subtypes: basal like, mesenchymal like, luminal androgen receptor (LAR), and immunomodulatory. RESULTS: We did not observe differences in clinical aspects and imaging features between TNBC with and without PIK3CA expression. PIK3CA expression was in general higher in the LAR subtype. The disease-free survival and overall survival were significantly better in TNBC with PIK3CA protein expression, independent of TNBC subtypes. CONCLUSION: Despite conflicting results in the literature, our study clearly shows a better outcome of PIK3CA-expressing TNBC, independent of TNBC subtypes. PIK3CA expression in TNBC is not associated with specific clinical or diagnostic features. Further molecular studies and meta-analysis are warranted to clarify the prognostic and predictive role of PIK3CA protein expression.

The impact of distinct triple-negative breast cancer subtypes on misdiagnosis and diagnostic delay.

BACKGROUND: Triple-negative breast cancer (TNBC) includes mostly aggressive types of breast cancer with poor prognosis. Due to its growth pattern, misinterpretation in clinical imaging is more frequent than in non-TNBC. As the group of TNBC contains heterogeneous types of tumors, marker expression-based subtypes have recently been established. We analyzed clinical features and false-negative imaging findings that could potentially lead to diagnostic delay within the subtypes. METHODS: An exploratory analysis compared the imaging features across the a priori defined subtypes and related these findings to molecular subtype, disease stage, potential diagnostic delay, and patient outcome. RESULTS: TNBC cases were categorized into basal-like (BL; 38.6%), mesenchymal-like (ML; 19.9%), luminal androgen receptor (LAR; 28.3%), and immunomodulatory (IM; 13.3%) subtype. In almost every third patient, malignant classification was missed in at least one imaging method. Misclassification in mammogram was more frequent in ML, while benign ultrasound features were reported more often in the BL subtype. Diagnostic delay due to misclassification in imaging led to tumor growth and/or upgrading of the tumor stage in 8.9% of BL tumors, which had the lowest overall survivals. Despite misclassification rate was higher in the ML subtype it showed better outcomes. Misdiagnosis of axillary lymph node metastasis was higher in LAR; however, this subtype showed a higher percentage of affected axillary lymph nodes. CONCLUSION: TNBC subtypes have different clinical features, benign appearances, and diagnostic delay, which can lead to tumor stage upgrade. Future clinical studies on TNBC outcomes might consider the confounder of clinical delay in the subtypes.

Parental perception of their child's quality of life in children with non-immunoglobulin-E-mediated gastrointestinal allergies.

BACKGROUND: Food allergy can have a significant impact on health-related quality of life (HRQoL). Parental proxy questionnaires are commonly used when children are too young to complete questionnaires themselves. Little data are available on HRQoL in children with non-IgE-mediated gastrointestinal food allergy (GIFA). The aim of this study was to evaluate HRQoL in these children by parent proxy. METHODS: A cross-sectional questionnaire study was conducted with children aged 2-16 years with confirmed GIFA. Parents of these children completed the Pediatric Quality of Life Inventory (PedsQL™ ) and the family impact module of the PedsQL. The PedsQL scores were compared to two published cohorts: functional abdominal pain (FAP) and IgE-mediated food allergy. RESULTS: Fifty-two parents of children with GIFA completed the PedsQL™ parent proxy. The GIFA cohort had significantly better overall HRQoL compared with the FAP cohort, but lower emotional functioning scores. The GIFA cohort also had poorer physical QoL compared with the IgE cohort (all p < 0.05). The more foods excluded, comorbidity of nasal congestion, abdominal pain, back arching, the persistence of flatus and gastrointestinal symptom severity after elimination diet were related to poorer QoL in this non-IgE cohort. Regression analyses showed that number of foods and nasal congestion significantly predicted total QoL score as perceived by parents. CONCLUSIONS: This study has shown that different areas of HRQoL of children with GIFA are affected compared with children with FAP or IgE-mediated food allergy, highlighting the need for a specific GIFA HRQoL questionnaire to better understand the impact on these children.

Perceptual classes established with forced-choice primary generalization tests and transfer of function.

In Experiment 1, 20 college students learned two identity conditional discriminations using squares that differed in interior-fill percentage (called Fill23 and Fill77). A two-choice generalization test was then presented with number of test trials varied across groups of subjects. The test samples were 19 squares that ranged in fill value from 23% to 77%; the comparisons were squares with Fill23 and Fill77. The resulting gradients did not vary as a function of number of test trials. When the generalization test was repeated with a third comparison, "neither," the ranges of fill values that occasioned the exclusive selection of Fill23 or Fill77 were direct functions of the number of prior two-choice generalization trials. Finally, a disriminability test revealed that Fill23 and Fill77 were disciminable from the intermediate fill values. In Experiment 2, perceptual classes were established with 5 new students using 760 forced-choice generalization test trials. The student were then trained to select a different glyph in the presence of Fill23 and Fill77, followed by a three-choice generalization test in which the 19 fill stimuli served as samples and the two glyphs served as comparisons. The gradients ovelapped with those previously obtained during the three-choice generalization test that used Fill23 and Fill77 as comparisons. Finally, a discriminability test showed that many adjacent stimuli along thc fill dimension were discriminable from each other. Together, the results of both experiments suggest that ranges of fill-based stimuli functioned as members of perceptual classes, and each class also functioned as a transfer network for a new selection-based response.

Assessing service quality in paediatric audiology and early deaf education.

Quality monitoring and assurance is a key aspect of evidence-based service provision in health and education. Part I of the present paper summarizes the results from a survey in which performance of health-based paediatric audiology services in the UK was assessed against existing good practice guidelines (NDCS, 1994, 1996). The results of the survey indicated varied levels of provision, with guidelines commonly not followed. Part II of the paper reports the detailed development of two short questionnaires designed to provide scores (out of 100) reflecting aspects of service quality in paediatric audiology services and in early deaf education services. The results from the use of the two indices (the Paediatric Audiology Service Index (PASI) and the Deaf Education Early Service Index (DEESI)) are presented along with data from some component questions. Although some services are functioning close to guideline levels of service, the overall distribution of scores is such as to raise serious concerns about the variability of quality and the consequent inequity of provision for children with permanent hearing loss and their families in both health and education services.

Tobacco cessation intervention in a nurse practitioner managed clinic.

Tobacco cessation counseling by health care professionals has been associated with increased tobacco cessation rates. In this study we compare the effectiveness of two smoking cessation approaches administered by nurse practitioners--a stepped care approach (n = 34) and a routine care approach (n = 41), using a pre- and post-test control group study design. Additionally, this study was guided by the "stages of change" construct of the transtheoretical model. Study results indicated that nurse practitioners delivered consistent office-based advice about tobacco use. In addition, nurse practitioner smoking cessation interventions contributed to positive shifts in stage of change for smoking cessation.

Predicting the extension of equivalence classes from primary generalization gradients: the merger of equivalence classes and perceptual classes.

In Experiment 1, 6 college students were given generalization tests using 25 line lengths as samples with a long line, a short line, and a "neither" option as comparisons. The neither option was to be used if a sample did not go with the other comparisons. Then, four-member equivalence classes were formed. Class 1 included three nonsense words and the short line. Class 2 included three other nonsense words and the long line. After repeating the generalization test for line length, additional tests were conducted using members of the equivalence classes (i.e., nonsense words and lines) as comparisons and intermediate-length lines as samples. All Class 2 comparisons were selected in the presence of the test lines that also evoked the selection of the long line in the generalization test that had been given before equivalence class formation. Class 1 yielded complementary findings. Thus, the preclass primary generalization gradient predicted which test lines acted as members of each equivalence class. Regardless of using comparisons that were nonsense words or lines, the post-class-formation gradients overlapped, showing the substitutability of class members. Experiment 2 assessed the discriminability of the intermediate-length test lines from the Class 1 (shortest) and Class 2 (longest) lines. The test lines that functioned as members of an equivalence class were discriminable from the line that was a member of the same class by training. Thus, these test lines also acted as members of a dimensionally defined class of "long" or "short" lines. Extension of an equivalence class, then, involved its merger with a dimensionally defined class, which converted a close-ended class to an open-ended class. These data suggest a means of predicting class membership in naturally occurring categories.

The nurse as exemplar: smoking status as a predictor of attitude toward smoking and smoking cessation.

The smoking behavior of oncology nurses is of particular concern, not only because of the personal risk, but also because of the negative influence the behavior may have on the public. A survey of 316 female oncology nurses in Texas was conducted to assess smoking prevalence in this sample and the manner in which smoking status impacts the attitudes of these nurses toward their roles as exemplars and advocates for nonsmoking. The prevalence of smoking in this sample of oncology nurses was 7%, with an additional 26.2% being ex-smokers, supporting a downward trend in smoking among oncology nurses. Differences among oncology nurses who were smokers, ex-smokers, or nonsmokers concerning their attitudes toward smoking were investigated. Nonsmokers and ex-smokers showed a more positive attitude toward their roles as exemplars and in counseling the public about the health hazards of smoking.

A parametric variation of delayed reinforcement in infants.

This study is an exploration of the parameters of delayed reinforcement with 6 infants (2 to 6 months old) in two experiments using single-subject repeated-reversal designs. In Experiment 1, unsignaled 3-s delayed reinforcement was used to increase infant vocalization rate when compared to a differential-reinforcement-of-other-than-vocalization condition and a yoked, no-contingency comparison condition. In Experiment 2, unsignaled 5-s delayed reinforcement was used to increase infant vocalization rate when compared to an alternating-treatments comparison condition. The alternating-treatments comparison consisted of 3-min components of differential reinforcement of other behavior and 3-min components of a nontreatment baseline. Successful conditioning was obtained in both experiments. These results contrast with those of previous infancy researchers who did not obtained conditioning with delays of 3 s and who attributed their findings to the limitations of the infant's memory capacity. We present an alternative conceptual framework and methodology for the analysis of delayed reinforcement in infants.

Effects of delayed reinforcement on infant vocalization rate.

Three previous studies have failed to demonstrate conditioning in infants using a 3-s delay of reinforcement. The effects of a delayed reinforcement schedule on vocalization rates therefore were explored in a single-subject repeated-reversal experimental design for 3 4- to 6-month-old normally developing infants. Each infant received delayed social reinforcement from his or her parent for vocalizing. The comparison condition was a schedule of differential reinforcement of behavior other than vocalizations to control for elicitation by social stimulation. An operant level of infant vocalizations was the initial condition, after which the differential reinforcement schedule was implemented in an across-subjects multiple baseline design. Infants' vocalization rates increased above levels measured during differential reinforcement following onset of the delayed reinforcement condition. Also, vocalization rates decreased during differential reinforcement compared to operant levels. The successful use of delayed reinforcement schedules with infants in this study, as opposed to others, is discussed in terms of procedural differences among them.

Stimulus generalization and equivalence classes: a model for natural categories.

Two three-member classes were formed by training AB and BC using a conditional discrimination procedure. The A and B stimuli were nonsense syllables, and the C stimuli were sets of "short" or "long" lines. To test for equivalence, C1 or C2 was presented as a sample with A1 and A2 as comparisons. Once the class-related comparison was chosen consistently, different line lengths were substituted for the training lines in the CA tests. In general, the likelihood of choosing a given comparison was an inverse function of the difference in the length of the test line from the training line. Stimuli in an equivalence class became functionally related not only to each other but also to novel stimuli that resembled a member of the equivalence class. The combination of primary generalization and equivalence class formation, then, can serve as a model to account for the development of naturally occurring categories.

Generalized vocal imitation in infants.

Effects of modeling and response-contingent social praise on the vocal imitation of three 9- to 13-month-old infants were analyzed. Three infants and parents participated in 2 to 4 experimental sessions a week for 2 to 4 months. During each 20-min-long session, the parent presented vocal models for the infant to imitate. During the model-alone condition, no social praise was programmed for infant imitation. During the model-and-praise condition, social praise was provided by the parent for infant imitation on training trials, but not probe trials. All three infants showed systematic increases in matching during training trials following the introduction of the model-and-praise condition. Although matching during probe trials was not directly reinforced, probe-trial responding increased systematically with training-trial responding. Furthermore, non-matching infant vocalizations did not increase systematically with the introduction of the model-and-praise procedure. Together these findings provide a demonstration of generalized vocal imitation in infants, a population in which it had not previously been shown to occur.

An outbreak of gastroenteritis due to enteropathogenic Escherichia coli, which are also enterotoxigenic.

Details are presented of the first documented outbreak of gastroenteritis in New Zealand due to an enterotoxigenic Escherichia coli. This is also the first report of strains of the enteropathogenic serogroup 0126 producing the heat stable enterotoxin. The additional isolation of E. coli 055 producing the heat labile enterotoxin from one of the patients is the first report of an E. coli of this 0 group being enterotoxigenic.