Pregabalin versus placebo in targeting pro-nociceptive mechanisms to prevent chronic pain after whiplash injury in at-risk individuals - a feasibility study for a randomised controlled trial.

BACKGROUND: Whiplash-associated disorders (WAD) are an enormous and costly burden to Australian society. Up to 50% of people who experience a whiplash injury will never fully recover. Whiplash is resistant to treatment and no early management approach has yet been shown to prevent chronic pain. The early presence of central sensitization is associated with poor recovery. Pregabalin's effects on central sensitization indicate the potential to prevent or modulate these processes after whiplash injury and to improve health outcomes, but this has not been investigated. This paper describes the protocol for a feasibility study for a randomised controlled trial of pregabalin plus evidence-based advice compared to placebo plus evidence-based advice for individuals with acute whiplash injury who are at risk of poor recovery. METHODS: This double blind, placebo-controlled randomised feasibility study will examine the feasibility and potential effectiveness of pregabalin and evidence-based advice (intervention) compared to placebo and evidence-based advice (control) for individuals with acute whiplash injury at risk of poor recovery. Thirty participants (15 per group) aged 18-65 years with Grade II WAD, within 48 hours of injury and currently experiencing at least moderate pain (NRS: ≥ 5/10) will be recruited from Emergency Departments of public hospitals in Queensland, Australia. Pregabalin will be commenced at 75 mg bd and titrated up to 300 mg bd as tolerated for 4 weeks followed by 1 week of weaning. RESULTS: The feasibility of trial procedures will be tested, as well as the potential effect of the intervention on the outcomes. The primary outcome of neck pain intensity at 3 months from randomisation will be compared between the treatment groups using standard analysis of variance techniques. DISCUSSION: Feasibility and potential effectiveness data will inform an appropriately powered full trial, which if successful, will provide an effective and cost-effective intervention for a costly and treatment resistant condition. It will also have implications for the early management of other traumatic conditions beyond whiplash. TRIAL REGISTRATION: Clinical Trials Primary Registry: Australian and New Zealand Clinical Trials Registry. CLINICAL TRIAL REGISTRATION NUMBER: ACTRN12617000059369 . Date of Registration: 11/01/2017. Primary Trial Sponsor: The University of Queensland, Brisbane QLD 4072 Australia.

Evaluation of the use of malic acid decarboxylase-deficient starter culture in NaCl-free cucumber fermentations to reduce bloater incidence.

AIMS: Accumulation of carbon dioxide (CO2 ) in cucumber fermentations is known to cause hollow cavities inside whole fruits or bloaters, conducive to economic losses for the pickling industry. This study focused on evaluating the use of a malic acid decarboxylase (MDC)-deficient starter culture to minimize CO2 production and the resulting bloater index in sodium chloride-free cucumber fermentations brined with CaCl2 . METHODS AND RESULTS: Attempts to isolate autochthonous MDC-deficient starter cultures from commercial fermentations, using the MD medium for screening, were unsuccessful. The utilization of allochthonous MDC-deficient starter cultures resulted in incomplete utilization of sugars and delayed fermentations. Acidified fermentations were considered, to suppress the indigenous microbiota and favour proliferation of the allochthonous MDC-deficient Lactobacillus plantarum starter cultures. Inoculation of acidified fermentations with L. plantarum alone or in combination with Lactobacillus brevis minimally improved the conversion of sugars. However, inoculation of the pure allochthonous MDC-deficient starter culture to 107 CFU per ml in acidified fermentations resulted in a reduced bloater index as compared to wild fermentations and those inoculated with the mixed starter culture. CONCLUSIONS: Although use of an allochthonous MDC-deficient starter culture reduces bloater index in acidified cucumber fermentations brined with CaCl2 , an incomplete conversion of sugars is observed. SIGNIFICANCE AND IMPACT OF THE STUDY: Economical losses due to the incidence of bloaters in commercial cucumber fermentations brined with CaCl2 may be reduced utilizing a starter culture to high cell density.

Molecular characterization of Cryptosporidium parvum isolates from human cryptosporidiosis cases in Scotland.

Cryptosporidium parvum (C. parvum) is one of the most prevalent protozoan pathogens responsible for inducing human and animal disease worldwide. In this study, the glycoprotein-60 (gp60) subtyping tool was employed to assess the molecular diversity of C. parvum from human feces throughout Scotland during potential outbreaks. Over a 24-month period, microscopy analysis revealed 1139 positive feces containing Cryptosporidium species with 256 identified by molecular methods specifically as C. parvum. Cryptosporidium parvum was shown to be more prevalent in rural areas of Scotland and subtyping of 87 isolates demonstrated the predominant family as IIa, which occurred in 94% (n=82) of isolates. The IIaA15G1R1 subtype was most common, being isolated from 47% (n=41) of Scottish human cases. Non-IIa strains constituted a total of 5 isolates and included subtypes from the IIc, IId and IIg families. This information contributes significantly to existing knowledge and understanding of C. parvum subtypes in Scotland which is vital in assisting with the management of future local and national outbreaks.

Genetic diversity of Cryptosporidium spp. within a remote population of Soay Sheep on St. Kilda Islands, Scotland.

This is the first report to characterize the genotypes and subtypes of Cryptosporidium species infecting a geographically isolated population of feral Soay sheep (Ovis aries) on Hirta, St. Kilda, Scotland, during two distinct periods: (i) prior to a population crash and (ii) as host numbers increased. Cryptosporidium DNA was extracted by freeze-thawing of immunomagnetically separated (IMS) bead-oocyst complexes, and species were identified following nested-PCR-restriction fragment length polymorphism (RFLP)/PCR sequencing at two Cryptosporidium 18S rRNA loci. Two hundred fifty-five samples were analyzed, and the prevalent Cryptosporidium species in single infections were identified as C. hominis (11.4% of all samples tested), C. parvum (9%), C. xiaoi (12.5%), and C. ubiquitum (6.7%). Cryptosporidium parvum was also present with other Cryptosporidium species in 27.1% of all samples tested. Cryptosporidium parvum- and C. hominis-positive isolates were genotyped using two nested-PCR assays that amplify the Cryptosporidium glycoprotein 60 gene (GP60). GP60 gene analysis showed the presence of two Cryptosporidium genotypes, namely, C. parvum IIaA19G1R1 and C. hominis IbA10G2. This study reveals a higher diversity of Cryptosporidium species/genotypes than was previously expected. We suggest reasons for the high diversity of Cryptosporidium parasites within this isolated population and discuss the implications for our understanding of cryptosporidiosis.

Epithelial nuclear factor-κB signaling promotes lung carcinogenesis via recruitment of regulatory T lymphocytes.

The mechanisms by which chronic inflammatory lung diseases, particularly chronic obstructive pulmonary disease, confer enhanced risk for lung cancer are not well-defined. To investigate whether nuclear factor (NF)-κB, a key mediator of immune and inflammatory responses, provides an interface between persistent lung inflammation and carcinogenesis, we utilized tetracycline-inducible transgenic mice expressing constitutively active IκB kinase ß in airway epithelium (IKTA (IKKß trans-activated) mice). Intraperitoneal injection of ethyl carbamate (urethane), or 3-methylcholanthrene (MCA) and butylated hydroxytoluene (BHT) was used to induce lung tumorigenesis. Doxycycline-treated IKTA mice developed chronic airway inflammation and markedly increased numbers of lung tumors in response to urethane, even when transgene expression (and therefore epithelial NF-κB activation) was begun after exposure to carcinogen. Studies using a separate tumor initiator/promoter model (MCA+BHT) indicated that NF-κB functions as an independent tumor promoter. Enhanced tumor formation in IKTA mice was preceded by increased proliferation and reduced apoptosis of alveolar epithelium, resulting in increased formation of premalignant lesions. Investigation of inflammatory cells in lungs of IKTA mice revealed a substantial increase in macrophages and lymphocytes, including functional CD4+/CD25+/FoxP3+ regulatory T lymphocytes (Tregs). Importantly, Treg depletion using repetitive injections of anti-CD25 antibodies limited excessive tumor formation in IKTA mice. At 6 weeks following urethane injection, antibody-mediated Treg depletion in IKTA mice reduced the number of premalignant lesions in the lungs in association with an increase in CD8 lymphocytes. Thus, persistent NF-κB signaling in airway epithelium facilitates carcinogenesis by sculpting the immune/inflammatory environment in the lungs.

Inhibition of NF-kappa B activity in mammary epithelium increases tumor latency and decreases tumor burden.

The transcription factor nuclear factor kappa B (NF-κB) is activated in human breast cancer tissues and cell lines. However, it is unclear whether NF-κB activation is a consequence of tumor formation or a contributor to tumor development. We developed a doxycycline (dox)-inducible mouse model, termed DNMP, to inhibit NF-κB activity specifically within the mammary epithelium during tumor development in the polyoma middle T oncogene (PyVT) mouse mammary tumor model. DNMP females and PyVT littermate controls were treated with dox from 4 to 12 weeks of age. We observed an increase in tumor latency and a decrease in final tumor burden in DNMP mice compared with PyVT controls. A similar effect with treatment from 8 to 12 weeks indicates that outcome is independent of effects on postnatal virgin ductal development. In both cases, DNMP mice were less likely to develop lung metastases than controls. Treatment from 8 to 9 weeks was sufficient to impact primary tumor formation. Inhibition of NF-κB increases apoptosis in hyperplastic stages of tumor development and decreases proliferation at least in part by reducing Cyclin D1 expression. To test the therapeutic potential of NF-κB inhibition, we generated palpable tumors by orthotopic injection of PyVT cells and then treated systemically with the NF-κB inhibitor thymoquinone (TQ). TQ treatment resulted in a reduction in tumor volume and weight as compared with vehicle-treated control. These data indicate that epithelial NF-κB is an active contributor to tumor progression and demonstrate that inhibition of NF-κB could have a significant therapeutic impact even at later stages of mammary tumor progression.

Sporadic Cryptosporidium infection in Nigerian children: risk factors with species identification.

A cross-sectional study was conducted to investigate risk factors for sporadic Cryptosporidium infection in a paediatric population in Nigeria. Of 692 children, 134 (19·4%) were infected with Cryptosporidium oocysts. Cryptosporidium spp. were identified in 49 positive samples using PCR-restriction fragment length polymorphism and direct sequencing of the glycoprotein60 (GP60) gene. Generalized linear mixed-effects models were used to identify risk factors for all Cryptosporidium infections, as well as for C. hominis and C. parvum both together and separately. Risk factors identified for all Cryptosporidium infections included malaria infection and a lack of Ascaris infection. For C. hominis infections, stunting and younger age were highlighted as risk factors, while stunting and malaria infection were identified as risk factors for C. parvum infection.

Foodservice satisfaction domains in geriatrics, rehabilitation and aged care.

OBJECTIVE: To develop a foodservice satisfaction instrument for residential aged care and geriatric/rehabilitation units. The quality of care and food provided for clients in long-term care facilities is critical for the prevention of malnutrition. DESIGN: Cross-sectional survey and in-depth interviews. SETTING: Nine residential aged care facilities and two geriatric/rehabilitation units in Southeast Queensland, Australia. PARTICIPANTS: A total of 103 geriatric/rehabilitation patients and 210 aged care residents. The median age was 84 years, with 72.1 % females. MEASUREMENTS: Candidate satisfaction items were obtained from: (i) secondary analysis of acute care foodservice satisfaction data; (ii) focus groups with expert geriatrics/rehabilitation and aged care dietitians; (iii) pre-testing of instrument content, presentation format and response-scale (n=40) and (iv) pilot testing of the instrument (n=313). Sixty-one items on foodservice attributes, an overall satisfaction question, and demographic/contextual information were tested. RESULTS: Principal components factor analysis and Velicer's MAP test revealed foodservice satisfaction was represented by 18 items within four factors: meal quality and enjoyment (α =0.91), autonomy (α =0.64), staff consideration (α =0.79), hunger and food quantity (α =0.67) and six independent items, totalling 24 foodservice characteristics. This represented around 40% of the variance in foodservice satisfaction. When a further 13 foodservice items were retained due to practical importance, the analysis explained around 64% of the variance in foodservice satisfaction. CONCLUSION: The Resident Foodservice Satisfaction Questionnaire is a novel measure of resident foodservice satisfaction and can be used to provide evidence for changes to food services that may improve or enhance resident satisfaction and assist in the prevention of a significant and modifiable cause of malnutrition.

Identification of Cryptosporidium species and genotypes in Scottish raw and drinking waters during a one-year monitoring period.

We analyzed 1,042 Cryptosporidium oocyst-positive slides (456 from raw waters and 586 from drinking waters) of which 55.7% contained 1 or 2 oocysts, to determine species/genotypes present in Scottish waters. Two nested PCR-restriction fragment length polymorphism (RFLP) assays targeting different loci (1 and 2) of the hypervariable region of the 18S rRNA gene were used for species identification, and 62.4% of samples were amplified with at least one of the PCR assays. More samples (577 slides; 48.7% from raw water and 51.3% from drinking water) were amplified at locus 1 than at locus 2 (419 slides; 50.1% from raw water and 49.9% from drinking water). PCR at loci 1 and 2 amplified 45.4% and 31.7% of samples containing 1 or 2 oocysts, respectively. We detected both human-infectious and non-human-infectious species/genotype oocysts in Scottish raw and drinking waters. Cryptosporidium andersoni, Cryptosporidium parvum, and the Cryptosporidium cervine genotype (now Cryptosporidium ubiquitum) were most commonly detected in both raw and drinking waters, with C. ubiquitum being most common in drinking waters (12.5%) followed by C. parvum (4.2%) and C. andersoni (4.0%). Numerous samples (16.6% total; 18.9% from drinking water) contained mixtures of two or more species/genotypes, and we describe strategies for unraveling their identity. Repetitive analysis for discriminating mixtures proved useful, but both template concentration and PCR assay influenced outcomes. Five novel Cryptosporidium spp. (SW1 to SW5) were identified by RFLP/sequencing, and Cryptosporidium sp. SW1 was the fourth most common contaminant of Scottish drinking water (3%).

Cryptosporidium oocysts on fresh produce from areas of high livestock production in Poland.

Samples of fresh vegetables and soft fruit were collected from farmers' markets in the Lublin Area of Poland during 2006-2007; the produce was grown in areas of high to moderate livestock production. Cryptosporidium sp. oocysts were eluted from food surfaces, separated from residual food materials by IMS and identified by immunofluorescence and Nomarski differential interference contrast microscopy. Cryptosporidium sp. oocysts were detected in 6 of 128 vegetable samples (range 1-47 oocysts), but not in any of 35 fruit samples. Both empty and intact oocysts were detected. Species identity of oocyst-positive samples was performed by molecular analysis at four genetic loci. One of two 18S rRNA loci amplified DNA from 5 of the 6 oocyst-positive samples, but insufficient DNA for RFLP or sequencing analysis was available from 4 of these samples. An oocyst-positive celery sample generated an RFLP pattern consistent with C. parvum at two loci, but insufficient DNA was available for subtyping (GP60 sequencing) this isolate. Oocyst-contaminated foods originated from districts with the highest numbers of homesteads possessing cattle herds and no contaminated produce was detected from districts containing lower numbers of cattle-owning homesteads, strengthening the assumption that the origin of the contamination was livestock. The results of this study strengthen the evidence for the potential for zoonotic foodborne transmission of Cryptosporidium.

Personal assistance, income and employment: the spinal injuries survey instrument (SISI) and its application in a sample of people with quadriplegia.

INTRODUCTION: Our aim was to ascertain what effect access to personal care package (PCP) has on the labour market activities of people who have a spinal cord injury (SCI). We developed a new instrument called the spinal injuries survey instrument (SISI). The SISI is a 35-item instrument, which contains items on health, education, employment, along with measures of personal assistance, mobility and psychological attribution style. MATERIALS AND METHODS: The SISI was administered, with the Short Form 36 (SF-36) health status instrument, to 250 people with an SCI. The response rate was 72%. A retrospective, matched case-control sampling approach matched individuals who received a PCP, with a cohort who did not. The matching criteria included the site and severity of spinal lesion, age and gender. RESULTS: Although data on the reliability of the instrument are currently lacking, our empirical results are consistent with other studies: (1) mean annual health care costs (AUD$8741) are comparable with Walsh's estimates (2) SF-36 data support Kreuter's contention that mental health is resilient to SCI and (3) a post-injury employment rate of 29.7% corroborates Murphy et al. We present additional data describing income, educational attainment and family support. DISCUSSION: Our discussion borrows a conceptualization of disability by Sen, that includes both an 'earning handicap' (an impediment to earn income) and a 'conversion handicap' (an impediment to the enjoyment of income). Our application of the SISI provides evidence of both. The labour income of people with quadriplegia is AUD$10,007 per annum, while diminished health status, increased out-of-pocket health expenditure and loss of time suggest a conversion handicap.

Army nurse readiness instrument: psychometric evaluation and field administration.

The purpose of this study was to construct and evaluate the psychometric properties of an instrument to estimate the level of individual readiness among U.S. Army nurses. This study constitutes phase II of congressionally sponsored research to establish the degree to which Army nurses are prepared for the expectations of deployment. An expert panel established the validity of the initial readiness questionnaire. Changes were then incorporated into the first Readiness Estimate and Deployability Index (READI) questionnaire. Internal consistency and test-retest techniques assessed multiple reliabilities from pilot administrations. The READI was refined based on the results. Analysis of field administrations of the revised READI to three separate groups of nurses replicated earlier reliability results. Principle component analyses appear to support the hypothesized dimensional structure underlying questionnaire attitude items. The READI produced psychometrically stable ratings and results with great utility for the Army and potential adaptation for other military services.

Variations in feminine hygiene practices of military women in deployed and noncombat environments.

There is limited information on how military women manage feminine hygiene practices in combat and noncombat environments. The purpose of this study was to describe feminine hygiene practices of military women in deployed and noncombat (normal) environments. A nonexperimental descriptive research design was used. The study used a survey questionnaire, the Deployed Female Health Practice Questionnaire, which was developed specifically for military women to report their experiences with hygiene issues. Significant differences between deployed and normal environments were found in the areas of types of menses management products used and in douching and handwashing practices. Continuing education about safe feminine hygiene practices will help military women cope better in deployed (field) environments. Recommendations suggest further study on intervention strategies for hygiene management practices.

Biphasic regulation of NF-kappa B activity underlies the pro- and anti-inflammatory actions of nitric oxide.

Expression of inducible NO synthase (iNOS) by macrophages is a prerequisite for the production of high output NO, which mediates many bactericidal and tumoricidal actions of these immune cells. The expression of iNOS in mammalian cells is governed predominantly by the transcription factor, NF-kappa B, which regulates the expression of many host defense proteins. In the present study, we characterize a novel, biphasic effect of NO on NF-kappa B activity in murine macrophages. This mechanism depends on the local concentration of NO and enables it both to up- and down-regulate the expression of host defense proteins including iNOS, cyclooxygenase-2, and IL-6. This biphasic activity of NO appears to play a pivotal role in the time course of activation of these immune cells and, by inference, in facilitating the initiation of a defense response against pathogenic stimuli and in its termination to limit tissue damage. This mechanism may explain at least in part the reported ability of NO to act in both a pro- and anti-inflammatory manner.

Faculty perceptions of characteristics needed for clinical success at military nurse anesthesia programs.

In this exploratory descriptive study, an investigator-developed survey tool was used to describe military clinical faculty's perception of the characteristics that nurse anesthesia students need for success in the clinical portion of graduate education. Study participants consisted of 29 clinical faculty from the Army, Air Force, and Navy (100% response). The survey tool consisted of a quantitative part with 35 characteristics in 4 categories: academic knowledge, nursing knowledge, clinical skills, and personal characteristics. Seven qualitative questions made up the second part of the survey. The faculty rated 28 of the 35 characteristics as essential or important for clinical success. All categories contained characteristics rated important or higher, with personal characteristics and clinical awareness receiving the highest ratings. Qualitative analysis of the 7 additional questions further supported the importance of personal characteristics and clinical awareness. The findings give a description of the successful student as perceived by faculty. If a student successfully completes the didactic portion of the education, personal characteristics and clinical awareness have a large role in success in the clinical portion. Knowing what characteristics are thought important allows the characteristics to be studied further. With the emphasis in this study on personal characteristics, ways to assess the difficult-to-measure personal traits need to be developed.

Medicare, fee-for-service subsidies, and market outcomes: a partial description of Australia's health care financing labyrinth.

In Australia, both in-hospital and out-of-hospital services are subsidized via a national, social health insurance scheme, referred to as "Medicare." Revenue for the scheme is raised via general taxation and an earmarked "tax," which is presently 1.5 percent of taxable income. Members are entitled to the subsidized consumption of a broad range of medical practitioner services provided on both an in-hospital and an out-of-hospital basis, in both private and public facilities. Moreover, the range of services subsidized by the Australian scheme is broad, and includes the types of medical care that are available only to those U.S. Medicare patients who have opted for the Supplementary Medical Insurance Program. The purpose of this article is to provide a descriptive account of the Australian Medicare arrangements, particularly those that pertain to private, fee-for-service, medical practice. This article emphasizes the fact that, although the provisions are nationally uniform in application, these arrangements do not give rise to homogeneity of consumer payments and medical practitioner revenue. The article's theme is that, just as the simple terms "Medicare" and "Medicaid" belie the complexity of U.S. social health insurance, the Australian application of the term "Medicare" also describes a health care financing labyrinth.

Improving qualitative proposals: common problem areas.

Advanced practice nurses conducting clinical research may decide to use qualitative methods. These types of studies also are now receiving more positive consideration for funding than they have in the past. When writing a proposal for research projects, investigators new to qualitative research frequently have misconceptions about this type of research and the assumptions on which the research is based. These misconceptions lead to problems within the proposals that make it difficult for reviewers to evaluate adequately the research plan. In this article, the authors outline problems frequently observed in qualitative proposals, offer advice on how to correct the problems, and provide some examples from their own funded proposals.