Substance use patterns in 9-10 year olds: Baseline findings from the adolescent brain cognitive development (ABCD) study.

BACKGROUND: The Adolescent Brain Cognitive Development ™ Study (ABCD Study®) is an open-science, multi-site, prospective, longitudinal study following over 11,800 9- and 10-year-old youth into early adulthood. The ABCD Study aims to prospectively examine the impact of substance use (SU) on neurocognitive and health outcomes. Although SU initiation typically occurs during teen years, relatively little is known about patterns of SU in children younger than 12. METHODS: This study aims to report the detailed ABCD Study® SU patterns at baseline (n = 11,875) in order to inform the greater scientific community about cohort's early SU. Along with a detailed description of SU, we ran mixed effects regression models to examine the association between early caffeine and alcohol sipping with demographic factors, externalizing symptoms and parental history of alcohol and substance use disorders (AUD/SUD). PRIMARY RESULTS: At baseline, the majority of youth had used caffeine (67.6 %) and 22.5 % reported sipping alcohol (22.5 %). There was little to no reported use of other drug categories (0.2 % full alcohol drink, 0.7 % used nicotine, <0.1 % used any other drug of abuse). Analyses revealed that total caffeine use and early alcohol sipping were associated with demographic variables (p's<.05), externalizing symptoms (caffeine p = 0002; sipping p = .0003), and parental history of AUD (sipping p = .03). CONCLUSIONS: ABCD Study participants aged 9-10 years old reported caffeine use and alcohol sipping experimentation, but very rare other SU. Variables linked with early childhood alcohol sipping and caffeine use should be examined as contributing factors in future longitudinal analyses examining escalating trajectories of SU in the ABCD Study cohort.

The estimated effect of reducing the maternal smoking rate on neonatal intensive care unit costs in Victorian public hospitals.

This analysis estimates the expected number of Victorian public hospital neonatal intensive care unit cot-days that could be saved annually by reducing the maternal smoking rate. Approximately 106 cot-days could be saved if the maternal smoking rate was reduced from 8.4% to 6.4% (estimated annual cost saving of A$276 000).

Impact of a Pilot Videogame-Based Physical Activity Program on Walking Speed in Adults with Schizophrenia.

The purpose of this report is to describe the impact of a videogame-based physical activity program using the Kinect for Xbox 360 game system (Microsoft, Redmond, WA) on walking speed in adults with schizophrenia. In this randomized controlled trial, 28 participants played either an active videogame for 30 min (intervention group) or played a sedentary videogame for 30 min (control group), once a week for 6 weeks. Walking speed was measured objectively with the Short Physical Performance Battery at enrollment and at the end of the 6-week program. The intervention group (n = 13) showed an average improvement in walking speed of 0.08 m/s and the control group (n = 15) showed an average improvement in walking speed of 0.03 m/s. Although the change in walking speed was not statistically significant, the intervention group had between a small and substantial clinically meaningful change. The results suggest a videogame based physical activity program provides clinically meaningful improvement in walking speed, an important indicator of health status.

Disinfection of human cardiac valve allografts in tissue banking: systematic review report.

Cardiovascular allografts are usually disinfected using antibiotics, but protocols vary significantly between tissue banks. It is likely that different disinfection protocols will not have the same level of efficacy; they may also have varying effects on the structural integrity of the tissue, which could lead to significant differences in terms of clinical outcome in recipients. Ideally, a disinfection protocol should achieve the greatest bioburden reduction with the lowest possible impact on tissue integrity. We conducted a systematic review of methods applied to disinfect cardiovascular tissues. The use of multiple broad spectrum antibiotics in conjunction with an antifungal agent resulted in the greatest reduction in bioburden. Antibiotic incubation periods were limited to less than 24 h, and most protocols incubated tissues at 4 °C, however one study demonstrated a greater reduction of microbial load at 37 °C. None of the reviewed studies looked at the impact of these disinfection protocols on the risk of infection or any other clinical outcome in recipients.

Rest-activity and behavioral disruption in a patient with frontotemporal dementia.

The neurological deterioration in dementia is associated with disturbances in circadian rhythms and rest-activity patterns. These disruptions have been documented in Alzheimer's disease (AD) and dementia with Lewy bodies but little is known about rest-activity patterns in patients with frontotemporal dementia (FTD). We report longitudinal (2 year) actigraphy results for a patient who met diagnostic criteria for FTD and his family caregiver. The subject and his family caregiver wore Actiwatches continuously for 2 weeks at 1-year intervals. The findings suggest that with disease progression there is worsening in multiple areas of rest-activity measures for the patient and a negative impact on sleep quality for the family caregiver.

Development of a rapid, multi-class method for the confirmatory analysis of anti-inflammatory drugs in bovine milk using liquid chromatography tandem mass spectrometry.

A rapid liquid chromatography tandem mass spectrometry (LC-MS/MS) method has been developed and validated for the simultaneous identification, confirmation and quantitation of seven licensed anti-inflammatory drugs (AIDs) in bovine milk. The method was validated in accordance with the criteria defined in Commission Decision 2002/657/EC. Two classes of AIDs were investigated, corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs). The developed method is capable of detecting and confirming dexamethasone (DXM), betamethasone (BTM), prednisolone (PRED), tolfenamic acid (TLF), 5-hydroxy flunixin (5-OH-FLU), meloxicam (MLX) and 4-methyl amino antipyrine (4-MAA) at their associated maximum residue limits (MRLs). These compounds represent all the corticosteroids and NSAIDs licensed for use in bovine animals producing milk for human consumption. These compounds have never been analysed before in the same method and also 4-methyl amino antipyrine has never been analysed with the other licensed NSAIDs. The method can be considered rapid as permits the analysis of up to 30 samples in one day. Milk samples are extracted with acetonitrile; sodium chloride is added to aid partition of the milk and acetonitrile mixture. The acetonitrile extract is then subjected to liquid-liquid purification by the addition of hexane. The purified extract is finally evaporated to dryness and reconstituted in a water/acetonitrile mixture and determination is carried out by LC-MS/MS. Decision limit (CCalpha) values and detection capability (CCbeta) values have been established for each compound.

Determination of ibuprofen, ketoprofen, diclofenac and phenylbutazone in bovine milk by gas chromatography-tandem mass spectrometry.

A method has been developed to analyse for ibuprofen (IBP), ketoprofen (KPF), diclofenac (DCF) and phenylbutazone (PBZ) residues in bovine milk. Milk samples were extracted with acetonitrile and sample extracts were purified on Isolute C(18) solid-phase extraction cartridges. Aliquots were analysed by gas chromatography-tandem mass spectrometry (GC-MS/MS). The method was validated in bovine milk, according to the criteria defined in Commission Decision 2002/657/EC. The decision limits (CCalpha were 0.59, 2.69, 0.90 and 0.70 ng ml(-1), respectively, for IBP, KPF, DCF and PBZ, and detection capabilities (CCbeta) of 1.01, 4.58, 1.54 and 1.19 ng ml(-1), respectively, were obtained. The measurement uncertainty of the method was 17.8%, 80.9%, 28.2% and 20.2% for IBP, KPF, DCF and PBZ, respectively. Fortifying bovine milk samples (n = 18) in three separate assays show the accuracy of the method to be between 104% and 112%. The precision of the method, expressed as relative standard deviations for the within-laboratory reproducibility at the three levels of fortification (5, 7.5 and 10 ng ml(-1)) was less than 8% for IBP, DCF and PBZ, respectively. Poor precision was obtained for KPF with a relative standard deviation of 28%.

Reaching across the pond: a global exchange between health systems.

AIM: This article describes a unique programme begun in 2001 through a partnership between the historic St Bartholomew's Hospital and the London National Health Service Trust, in London, England and Valley Health in Winchester, Virginia, USA. Dubbed the RN International Exchange Program, selected registered nurses have the opportunity to experience first-hand healthcare delivery in another country and participate in a creative way of expanding knowledge about nursing. BACKGROUND: Professional nurses are persistent in seeking new ways to enhance nursing practice and improve patient care. This happens in several ways, including academic study, research, continuing education and dialogue with other healthcare professionals. One method to advance nursing practice is through the sharing of knowledge between nurses, both at home and across the globe. CONCLUSION: Participating nurses see this type of global educational opportunity as a once-in-a-lifetime experience that could never be duplicated in the traditional classroom setting.

Radiography of perforating centerfire rifle wounds of the trunk.

All deaths resulting from perforating centerfire rifle wounds of the chest and abdomen, investigated by the Office of the Chief Medical Examiner for the Province of Alberta from 1988 to 1995. were reviewed retrospectively to determine whether the radiographic distribution of bullet fragments in such cases is a useful predictor of bullet trajectory. Study cases were limited to single gunshot wounds without surgical intervention or intermediate targets, and for which adequate radiography was available. Three pathologists individually viewed the radiographs on two separate occasions; wound locations were provided for the second viewing (Group 2). Differences in opinion regarding direction of fire were resolved by consensus review. A trauma radiologist independently made two sets of interpretations in the same way. Comparisons of these groups of interpretations were made with the actual bullet direction determined at autopsy. Of 21 cases included in the study, only three (14.3%) did not require consensus resolution in either group. Accuracy of pathologists' interpretation improved from 38.1% (8/21) to 76.2% (16/21) with provision of wound locations (p = 0.012). The radiologist achieved similar improvement, from 28.6% (6/21) to 47.6% (10/21). The rate of agreement between radiologist and pathologists increased from 42.9% (9/21) to 61.9% (13/21) between Groups 1 and 2. Both the pathologists and radiologist interpreted several cases the same way in both groups; of those cases interpreted differently, the second interpretation was occasionally incorrect after correct interpretation in Group 1. We conclude that bullet direction for perforating centerfire rifle wounds cannot be accurately determined from postmortem radiographs. When wound location is known, the ability to predict bullet direction improves but is still subject to error, including a lack of consistency between observers.

Effect of pallidotomy on postural control and motor function in Parkinson disease.

OBJECTIVE: To investigate the effects of pallidotomy on postural reactions and other motor parkinsonian deficits. DESIGN: Comparison of performance by patients before and after pallidotomy on tests of balance and function. SETTING: A Parkinson disease Center of Excellence and Center for Human Performance Testing at a university hospital and research center. PARTICIPANTS: Twenty-nine patients with Parkinson disease undergoing pallidotomy. MAIN OUTCOME MEASURES: Performance results on the United Parkinson's Disease Rating Scale (UPDRS), activities of daily living and motor subscales (parts II and III). and posturography (sensory organization test), which were collected before and 3 and 6 months after surgery with patients in the practically defined off state (medication withheld for at least 12 hours). RESULTS: Data were analyzed with a paired Wilcoxon and Spearman correlation. There was a significant improvement in mean +/- SD UPDRS motor subscale score after pallidotomy (before surgery, 52.43+/-13.46; after surgery, 43.93+/-15.15; z= 3.63; P=.003). There were no significant changes in the UPDRS activities of daily living subscale or average stability scores when the group was examined as a whole. However, examination of individual data revealed that 9 (56%) of 16 patients who could stand independently before surgery showed improvement in either the number of falls or the average stability score. No patient who was unable to stand independently before surgery was able to stand independently after it. CONCLUSION: Pallidotomy helped improve overall motor function in patients with parkinsonism and, for some patients, also improved postural stability.

New pharmacotherapy for Parkinson's disease.

OBJECTIVE: To summarize the development, pharmacology, pharmacokinetics, efficacy, and safety of five investigational antiparkinsonian drugs that are in or have recently completed Phase III trials: three dopamine agonists, pramipexole, ropinirole, and cabergoline; and two catechol-O-methyltransferase (COMT) inhibitors, entacapone and tolcapone. The pathophysiology and the role of dopamine in Parkinson's disease are also reviewed. DATA SOURCES: A MEDLINE search of relevant English-language literature, clinical studies, abstracts, and review articles pertaining to Parkinson's disease was conducted. Manual searches of 1996/1997 meeting abstracts published by the American Academy of Neurology and the Movement Disorders Society were also performed. Manufacturers provided unpublished Phase III trial efficacy and pharmacokinetic data. STUDY SELECTION AND DATA EXTRACTION: Clinical trial investigations selected for inclusion were limited to human subjects. Interim analyses after 6 months for long-term clinical studies in progress were included. Pharmacokinetic data from animals were cited if human data were unavailable. Statistical analyses for all studies were evaluated. DATA SYNTHESIS: By selectivity targeting D2 receptors, the newer dopamine agonists (i.e., cabergoline, pramipexole, ropinirole) may delay the introduction of levodopa and thus the occurrence of levodopa-induced dyskinesias. In addition, they are efficacious as adjunctive therapies in patients with advanced Parkinson's disease. Unlike the currently available dopamine agonists, pramipexole and ropinirole are non-ergot derivatives and do not cause skin inflammation, paresthesias, pulmonary infiltrates, or pleural effusion. The COMT inhibitors, tolcapone and entacapone, improve the pharmacokinetics of levodopa by preventing its peripheral catabolism and increasing the concentration of brain dopamine; thus, these agents may reduce the incidence of "wearing-off" effects associated with the short half-life of levodopa and the progression of Parkinson's disease. CONCLUSIONS: Interim 6-month analyses of pramipexole, ropinirole, and cabergoline for symptomatic treatment of early Parkinson's disease have shown these drugs to be efficacious and relatively well-tolerated when used as monotherapy. Their role in delaying the development of motor fluctuations and delaying the addition of levodopa is the subject of long-term clinical studies. In advanced stages of Parkinson's disease, these medications were also efficacious; however, the main adverse effects included dyskinesias, somnolence, and hallucinations. The COMT inhibitors, entacapone and tolcapone, have also demonstrated efficacy in improving on-time in patients with stable disease. Tolcapone has also demonstrated efficacy in patients with motor fluctuations. Both drugs are relatively well-tolerated, with the exception of dyskinesias that require reduction of the levodopa dosage and occasional diarrhea.

Roadblocks encountered in recruiting patients for a study of sleep disruption in Alzheimer's disease.

Recruitment strategies and the roadblocks encountered in a clinical trial are described. A four-group, repeated measures design was used to test the effects of three sleep-related behavioral interventions on sleep disruption and related variables in Alzheimer's disease patients and their primary caregivers. Despite extensive recruitment efforts, enrollment did not meet expectations. Data analysis revealed three types of roadblocks to recruitment: caregiver resistance, provider resistance, and a mismatch of the disease characteristics with protocol requirements. Recommendations are made to help others solve recruitment problems.

Sensory perception in Parkinson disease.

OBJECTIVE: To determine whether there is a complex sensory disturbance that may be contributing to the motor deficit in patients with Parkinson disease. DESIGN: Comparison of performance by patients and healthy, age- and sex-matched subjects in tests of various sensory functions. SETTING: The Center for Human Performance and Testing at a university hospital and research center. PARTICIPANTS: Ten subjects with Parkinson disease and 10 control subjects matched for age and sex. MAIN OUTCOME MEASURE: Performance on 4 subjects of the Sensory Integration and Praxis Test: finger identification, graphesthesia, localization of tactile stimuli, and kinesthesia. RESULTS: Data were analyzed using paired t tests for ratio data and the paired Wilcoxon test for ordinal data. Patients with Parkinson disease performed significantly worse (P = .001) than the control patients on the test of kinesthesia. There were no significant differences between the 2 groups on the other subtests. CONCLUSIONS: Without visual guidance, patients with Parkinson disease had more difficulty in perceiving the extent of a movement made to a target away from the body, a task requiring reliance on proprioceptive feedback. Parkinsonian patients had no more difficulty than controls in making movements to a target on the surface of the body when they could use tactile sensations. Movement difficulties in patients with Parkinson disease may relate in part to a decrease in proprioception. Activities that enhance kinesthetic awareness may be an important adjunct to the treatment of these patients.

Symptom management of auditory hallucinations in schizophrenia. Results of 1-year follow up.

1. The majority of participants reported that they were still using behavioral strategies to manage their auditory hallucinations throughout the 12-month follow-up period and that they had experienced a decrease in symptom severity. 2. The answers to managing the symptom of auditory hallucinations are as individual as the symptom itself. All of the behavioral management strategies worked for at least one participant, but no strategy worked for everyone. 3. Practicing strategies in a group and at home seemed to promote long-term use of the behavioral strategies.

Sleep in older women with Parkinson's disease.

The sleep status of twenty-one women with Parkinson's disease (PD) was compared to that of twenty-two women without PD (controls). Variables measured included the 24-hour sleep-wake cycle, self-reported night-time sleep, mood, functional status and, in PD subjects, levodopa exposure and disease duration. Results indicated that, in general, the women with PD were more sleepy than the controls during the day and less sleepy at night. Both groups exhibited sleepiness rhythms with 12 and 24 hour periodicities and similar nighttime sleep characteristics. Women with PD exhibited more mood disturbance consistent with borderline clinical depression and were significantly more impaired in their ability to carry out the activities of daily living. Early nursing assessment and interventions addressing these potential problems may significantly reduce their incidence and/or severity.