Randomized controlled pilot trial with ion-exchange water softeners to prevent eczema (SOFTER trial).

BACKGROUND: Observational studies suggest an increased risk of eczema in children living in hard versus soft water areas, and there is, therefore, an interest in knowing whether softening water may prevent eczema. We evaluated the feasibility of a parallel-group assessor-blinded pilot randomized controlled trial to test whether installing a domestic ion-exchange water softener before birth in hard water areas reduces the risk of eczema in infants with a family history of atopy. METHODS: Pregnant women living in hard water areas (>250 mg/L calcium carbonate) in and around London UK, were randomized 1:1 antenatally to either have an ion-exchange water softener installed in their home or not (ie to continue to receive usual domestic hard water). Infants were assessed at birth and followed up for 6 months. The main end-points were around feasibility, the primary end-point being the proportion of eligible families screened who were willing and able to be randomized. Clinical end-points were evaluated including frequency of parent-reported doctor-diagnosed eczema and visible eczema on skin examination. Descriptive analyses were conducted, and no statistical testing was performed as this was a pilot study. RESULTS: One hundred and forty-nine families screened were eligible antenatally and 28% (41/149) could not have a water softener installed due to technical reasons or lack of landlord approval. Eighty of 149 (54%) were randomized, the primary end-point. Two participants withdrew immediately after randomization, leaving 39 participants in each arm (78 total). Attrition was 15% (12/78) by 6 months postpartum. All respondents (n = 69) to the study acceptability questionnaire reported that the study was acceptable. Fifty-six of 708 (7.9%) water samples in the water softener arm were above the hard water threshold of 20 mg/L CaCO3 . At 6 months of age 27/67 infants (40%) developed visible eczema, 12/36 (33%) vs. 15/31 (48%) in the water softener and control groups, respectively, difference -15% (95% CI -38, 8.3%), with most assessments (≥96%) remaining blinded. Similarly, a lower proportion of infants in the water softener arm had parent-reported, doctor-diagnosed eczema by 6 months compared to the control arm, 6/17 (35%) versus 9/19 (47%), difference -12% (95% CI -44, 20%). CONCLUSION: A randomized controlled trial of water softeners for the prevention of atopic eczema in high-risk infants is feasible and acceptable. TRIAL REGISTRATION: NCT03270566 (clinicaltrials.gov).

Evaluation of starter dietary digestible lysine level on broilers raised under a sex-separated or straight-run housing regime, part 2: Economics of sex separation and digestible lysine level for maximum returns.

The objective of this experiment was to determine the maximum net returns digestible lysine (dLys) levels (MNRL) when maintaining the ideal amino acid ratio for starter diets of broilers raised sex separate or comingled (straight-run). A total of 3,240 Ross 708 chicks was separated by sex and placed in 90 pens by 2 rearing types: sex separate (36 males or 36 females) or straight-run (18 males + 18 females). Each rearing type was fed 6 starter diets (25 d) formulated to have dLys levels between 1.05 and 1.80%. A common grower diet with 1.02% of dLys was fed from 25 to 32 days. Body weight gain (BWG) and feed intake were assessed at 25 and 32 d for performance evaluation. Additionally, at 26 and 33 d, 4 birds per pen were sampled for carcass yield evaluation. Data were modeled using response surface methodology in order to estimate feed intake and whole carcass weight at 1,600 g live BW. Returns over feed cost were estimated for a 1.8-million-broiler complex of each rearing system under 9 feed/meat price scenarios. Results indicated that females needed more feed to reach market weight, followed by straight-run birds, and then males. At medium meat and feed prices, female birds had MNRL at 1.07% dLys, whereas straight-run and males had MNRL at 1.05%. As feed and meat prices increased, females had MNRL increased up to 1.15% dLys. Sex separation resulted in increased revenue under certain feed and meat prices, and before sex separation cost was deducted. When the sexing cost was subtracted from the returns, sex separation was not shown to be economically viable when targeting birds for light market BW.

Straight-run vs. sex separate rearing for two broiler genetic lines Part 2: Economic analysis and processing advantages.

The objective of this analysis was to evaluate the effects of raising broilers under sex separate and straight-run conditions for 2 broiler genetic lines. One-day-old Ross 308 and Ross 708 chicks (n = 1,344) were sex separated and placed in 48 pens according to rearing type: sex separate (28 males or 28 females) or straight-run (14 males + 14 females). There were 3 dietary phases: starter (zero to 17 d), grower (17 to 32 d), and finisher (32 to 48 d). Bird individual BW and group feed intakes were measured at 12, 17, 25, 32, 42, and 48 d to evaluate performance. At 33, 43, and 49 d 4 birds per pen (straight-run pens 2 males + 2 females) were sampled for carcass yield evaluation. Data were analyzed using linear and non-linear regression in order to estimate feed intake and cut-up weights at 3 separate market weights (1,700, 2,700, and 3,700 g). Returns over feed cost were estimated for a 1.8 million broiler complex for each rearing system and under 9 feed/meat price scenarios. Overall, rearing birds that were sex separated resulted in extra income that ranged from ${\$}$48,824 to ${\$}$330,300 per week, depending on the market targeted and feed and meat price scenarios. Sex separation was shown to be especially important in disadvantageous scenarios in which feed prices were high. Gains from sex separation were markedly higher for the Ross 708 than for the Ross 308 broilers. Bird variability also was evaluated at the 3 separate market ages under narrow ranges of BW that were targeted. Straight-run birds decreased the number of birds present in the desired range. Depending on market weight, straight-run rearing resulted in 9.1 to 16.6% fewer birds than sex separate rearing to meet marketing goals. It was concluded that sex separation can result in increased company profitability and have possible beneficial effects at the processing plant due to increased bird uniformity.

Straight-run vs. sex separate rearing for 2 broiler genetic lines Part 1: Live production parameters, carcass yield, and feeding behavior.

The objective of this experiment was to evaluate the effects of raising broilers under sex separate and straight-run conditions for 2 broiler strains. Day-old Ross 308 and Ross 708 chicks (n = 1,344) were separated by sex and placed in 48 pens according to the rearing type: sex separate (28 males or 28 females) or straight-run (14 males + 14 females). There were 3 dietary phases: starter (zero to 17 d), grower (17 to 32 d), and finisher (32 to 48 d). Birds' individual BW and feed intakes were measured at 12, 17, 25, 32, 42, and 48 d to evaluate performance. At 33, 43, and 49 d, 4 birds per pen were sampled for carcass yield evaluation. Additionally, from 06:00 to 06:30, 13:00 to 13:30, and 22:00 to 22:30, video records were taken to assess behavior at 45 days. Data were analyzed as CRD with a 2 × 3 factorial arrangement of treatments over time. Throughout the experiment Ross 308 were heavier than the 708, and after 17 d, male pens had the heavier birds, followed by straight-run and then females. Straight-run pens had higher BW CV in comparison with sex separate pens. Sex separate male BW was negatively impacted from 17 to 32 days. On the other hand, females raised sex separate were heavier than females raised straight-run with lower CV from 25 to 41 days. Post 25 d, FCR was the lowest in male pens whereas feed intake was the highest for these pens after 17 days. Overall, males had total carcass cut-up weights higher than straight-run and females at the 3 processing times. The Ross 708 had higher white meat yields, whereas 308 had higher yields for dark meat. Feeding behavior results were not consistent over time. However, from 13:00 to 13:30, birds in female pens spent more time eating, followed by straight-run and then males. In conclusion, raising females in a straight-run system negatively impacted performance and CV, whereas males benefited from straight-run rearing, with the differences being possibly related to feeder space competition.

Assessment of Advanced Life Support competence when combining different test methods--reliability and validity.

UNLABELLED: Robust assessment of Advanced Life Support (ALS) competence is paramount to the credibility of ALS-provider certification and for estimating the learning outcome and retention of ALS competence following the courses. The European Resuscitation Council (ERC) provides two sets of MCQs and four Cardiac Arrest Simulation Test (CASTest) scenarios for the assessments according to guidelines 2005. AIMS: To analyse the reliability and validity of the individual sub-tests provided by ERC and to find a combination of MCQ and CASTest that provides a reliable and valid single effect measure of ALS competence. METHODS: Two groups of participants were included in this randomised, controlled experimental study: a group of newly graduated doctors, who had not taken the ALS course (N=17) and a group of students, who had passed the ALS course 9 months before the study (N=16). Reliability in terms of inter-rater agreement and generalisability across skills scenarios were estimated. Validity was studied in terms of equality of test difficulty and ability to discriminate performance between the groups. RESULTS: Inter-rater agreement on checklist scores were generally high, Intraclass Correlation Coefficients between 0.766 and 0.977. Inter-rater agreements on pass/fail decisions were not perfect. The one MCQ test was significantly more difficult than the other. There were no significant differences between CASTests. Generalisability theory was use to identify a composite of MCQ and CASTest scenarios that possessed high reliability, equality of test sets, and ability to discriminate between the two groups of supposedly different ALS competence. CONCLUSIONS: ERC sub-tests of ALS competence possess sufficient reliability and validity. A combined ALS score with equal weighting of one MCQ and one CASTest can be used as a single measurement of ALS competence.

Gold catalysis: on the phenol synthesis.

[reaction--see text] For the gold-catalyzed phenol synthesis an intramolecular migration of the oxygen atom was proven. Several other late transition metals with d(8) configuration allow this conversion, providing evidence for Au(III) being a catalytically active species. On the other hand gold was still the most active catalyst and gives the cleanest conversion. With additional alkynyl substituents another ring could be closed to provide doubly annellated arenes.

Two isomorphous benzenesulfonamide crystal structures determined by intermolecular C-H...O, C-H...pi and C-H...Cl interactions.

The title compounds, N-[5-(4-chlorophenyl)furan-2-ylmethyl]-4-methyl-N-(prop-2-ynyl)benzenesulfonamide, (Ia), and N-[5-(2-chlorophenyl)furan-2-ylmethyl]-4-methyl-N-(prop-2-ynyl)benzenesulfonamide, (Ib), both C(21)H(18)ClNO(3)S, have isomorphous crystal structures. The crystal packing is mainly determined by intermolecular C-H...O and C-H...pi interactions. These interactions are very similar in (Ia) and (Ib). Additional intermolecular C-H...Cl interactions appear less important and are different in (Ia) and (Ib). The different positions of the Cl atoms result in small variations of the crystal packing of the two compounds.

The relation between mortality from malignant melanoma and early detection in the Cancer Research Campaign Mole Watcher Study.

Between 1987 and 1989 the Cancer Research Campaign funded a health education programme for the early detection of cutaneous malignant melanoma in the general population in 6 health districts of England and 1 health board in Scotland (population of 3 million). The intervention was evaluated by studying its effects on annual and cumulative mortality rates for melanoma. Population-based data on mortality from melanoma were collected in the intervention areas, the health regions covering those areas, and 5 other health regions of England from 1981 to 1996. Deaths from melanoma in cases diagnosed after the start of the intervention were used to study cumulative mortality rates. The annual mortality rates for melanoma, 1981 to 1996, showed no significant difference in their trends between the intervention areas, and other areas of England and Wales. After adjustment for pre-intervention rates, there was also no significant reduction in cumulative mortality from melanoma in the intervention areas compared with the non-intervention areas: rate ratio 1.2 (95% Cl 0.9-1.7) in men, 0.9 (95% Cl 0.7-1.3) in females. The lack of a significant reduction in melanoma mortality associated with the intervention raises questions about this approach to early detection and emphasises the need for new strategies.

Competing with giants. Survival strategies for local companies in emerging markets.

The arrival of a multinational corporation often looks like a death sentence to local companies in an emerging market. After all, how can they compete in the face of the vast financial and technological resources, the seasoned management, and the powerful brands of, say, a Compaq or a Johnson & Johnson? But local companies often have more options than they might think, say the authors. Those options vary, depending on the strength of globalization pressures in an industry and the nature of a company's competitive assets. In the worst case, when globalization pressures are strong and a company has no competitive assets that it can transfer to other countries, it needs to retreat to a locally oriented link within the value chain. But if globalization pressures are weak, the company may be able to defend its market share by leveraging the advantages it enjoys in its home market. Many companies in emerging markets have assets that can work well in other countries. Those that operate in industries where the pressures to globalize are weak may be able to extend their success to a limited number of other markets that are similar to their home base. And those operating in global markets may be able to contend head-on with multinational rivals. By better understanding the relationship between their company's assets and the industry they operate in, executives from emerging markets can gain a clearer picture of the options they really have when multinationals come to stay.

Thermal preference behavior following clonidine, norepinephrine, isoproterenol, and ephedrine.

A thermal gradient (temperature range 7-45 degrees C) was used to assess ambient temperature (Ta) preferences of rats following treatment with clonidine (25 microg/kg), norepinephrine (NE, 250 microg/kg), isoproterenol (ISO, 50 microg/kg), and ephedrine (EPH, 10 mg/kg). Clonidine produced a preference for a temperature (31.5 degrees C) slightly warmer than that preferred after saline (28.3 degrees C), but this resulted in no significant change in posttest colonic temperature (Tc). NE, ISO and EPH produced a preference for a colder region of the gradient (20-22 degrees C) compared to saline (24.5-28.9 degrees C). Posttest Tc was reduced significantly from 37.7-37.9 degrees C after saline to 37.2 degrees C (NE), 37.3 degrees C (ISO), and 36.8 degrees C (EPH). Thus, given the opportunity to select an environmental temperature, the animals selected a Ta that resulted in significantly lower body temperatures after NE, ISO, and EPH. This suggests that paradoxical thermoregulatory effects of these thermogenic adrenergic agonists are due, at least in part, to a preference for a lower body temperature.

Bond strength and clinical efficiency for two light guide sizes in orthodontic bracket bonding.

The purpose of this study was to establish a possible increase in efficiency in bracket bonding with light-cured adhesive by using a larger size on the light transmitting unit. Two light guides were compared, a standard-sized 11-mm light guide and a 19-mm elliptical extra broad light guide, the latter designed to allow simultaneously curing of two adjacent brackets. Fifty extracted human premolars mounted in five phantom maxillary arches were bonded according to a standard procedure with Mini Uni-Twin stainless steel brackets. The two light guides were randomly chosen for each half of the maxillary arch. After bonding, all teeth were tested for tensile bond strength to failure. In the clinical study 30 patients were bonded according to a split mouth technique with the two light guides alternatively used randomly for each side of the jaw. Time for bonding and the occurrence of bracket failures were recorded. The results showed no statistically significant differences between the standard and elliptical light guides regarding tensile bond strength, or bracket failure frequency. However, with the larger light guide size a significantly shorter total bonding time for each patient was required. It is therefore concluded that the elliptical light guide in combination with a light transmitting unit of sufficient quality gave a similar bonding result as the standard light guide, offering the clinician a reduction in chair side time during the bonding procedure.

High response rates with short infusional 2-chlorodeoxyadenosine in de novo and relapsed low-grade lymphoma. Australian and New Zealand Lymphoma Study Group.

Thirty-five patients (eight de novo, 27 relapsed disease) with low-grade non-Hodgkin's lymphoma (diffuse small lymphocytic, follicular small cleaved cell, follicular mixed cell, and lymphoplasmacytoid) were treated with 2-chlorodeoxyadenosine (2CdA) at a daily dose of 0.14 mg/kg for 5d (2 h infusion) for an average of three cycles. Minor treatment delays, generally due to haematological toxicities, occurred in nine of 105 cycles. Major toxicities were lymphopenia, neutropenia and thrombocytopenia. Opportunistic infections occurred in seven patients. Overall response rate was 69% (five complete, 19 partial) reaching 88% for de novo patients (two complete, five partial). Elevated beta 2-microglobulin level was negatively predictive of response (P = 0.0014). Eight of 24 responders relapsed, with a median follow-up of 13 months. 2CdA administered as an intermittent infusion shows considerable single-agent activity in low-grade lymphomas achieving high response rates of prolonged duration. Consideration of schedules where 2CdA is alternatively administered with combination chemotherapy appears warranted.

Using qualitative research in community nurse casework.

This paper explores how methods and skills frequently employed in qualitative research can be used by community nurses to promote an interpretation of the setting that is valid and client-focused. It discusses the construction and use of casenotes, the development of theoretical sensitivity, employing native-language terms, and looks at the importance of a critical awareness of additional documentary evidence.

The influence of the dialysate flow rate on hollow fiber hemodialyzer performance.

The clearance characteristics of two sizes of hemodialyzers (0.9 m2 and 1.5 m2) from the same range of products have been studied over the dialysate flow range of 500-3,000 ml/min to establish the device's overall mass transfer resistance characteristics. The results obtained demonstrate a difference in the overall mass transfer resistance which is most marked at the commonly used dialysate flow rate of 500 ml/min. This difference suggests that the increase in size results in the introduction of flow imperfections which reduces the benefit that might be gained by the use of a larger surface area. Results established indicate a reduction in the overall mass transfer resistance with an increasing dialysate flow rate. This reduction is attributed to the presence of turbulence in the dialysate pathway at higher flow rates. The presence of such turbulence was confirmed by visual inspection of the dialyzer after the completion of the study when it was noted that the original well-ordered configuration present in a new dialyzer had been substantially disturbed. Correlation of the dialysate flow rate with overall mass transfer resistance by the use of a Wilson plots indicates a nonlinear relationship. This nonlinearity is attributed to a nonfully developed turbulent flow profile in the dialysate pathway.

Problems with registration of cutaneous malignant melanoma in England.

The aim of the study was to assess the completeness and accuracy of cancer registration for cutaneous malignant melanoma. The study was conducted in seven health districts in England and one health board in Scotland from 1987 to 1989 with a total resident population of 3.6 million. Records from pigmented lesion clinics and pathology laboratories collected during the Cancer Research Campaign's health education programme to promote the early detection of melanoma were matched with cancer registrations from a total of five regional cancer registries. In England 74% out of a total of 642 cases of invasive malignant melanomas (ICD 172) and 44% out of a total of 155 in situ melanomas (ICD 232) had been registered compared with 96% and 100% respectively in Scotland. A significantly higher proportion of late-stage cases was found among registered than among non-registered cases in England (P < 0.001). In all registries the majority of superficial spreading in situ melanomas were miscoded as invasive cases. The annual incidence of invasive malignant melanoma in the English study areas was found to be seven per 100,000 in men and 11 per 100,000 in women, similar to that reported in Scotland. The registries are best at recording thick or late-stage melanomas. As the skin cancer target for Health of the Nation depends on monitoring trends in the incidence of malignant melanoma, future improved ascertainment of cases and changes in the type of cases being registered must be taken into account.

Cytogenetic response to alpha-interferon is predicted in early chronic phase chronic myeloid leukemia by M-bcr breakpoint location.

Alpha-interferon (alpha-IFN) therapy is an effective agent in early chronic phase (ECP) chronic myeloid leukemia (CML), achieving hematologic control in the majority and major cytogenetic response (MCR) (reduction in Ph' +ve metaphases to < 35%) in a substantial minority. Currently no pretreatment markers exist to ascertain likelihood of meaningful response. The site of breakpoint in M-bcr and relationship to prognosis is controversial. Studies have been hampered by variation in definition of breakpoint and difference in treatment protocols. In this study of ECP CML patients, Southern analysis and reverse transcription polymerase chain reaction (RT-PCR) were used to determine breakpoint location. Patients received alpha-IFN (9 x 10(6) units/day) and dose-adjusted hydroxyurea (HU) to maintain granulocyte count between 1.0-2.0 x 10(9)/l for 6 months or more. Twelve of 31 patients entered on the study achieved a MCR. The Sokal index did not predict for cytogenetic response to alpha-IFN. Eight of 11 patients with 5' breakpoint achieved MCR compared to only four of 20 patients with 3' breakpoint (P = 0.007). These results suggest site of M-bcr rearrangement may be predictive of response to alpha-IFN therapy. If verified by further study, this may allow more appropriate use of alpha-IFN with respect to other modalities such as allogeneic transplant.

Cancer Research Campaign health education programme to promote the early detection of cutaneous malignant melanoma. I. Work-load and referral patterns.

From 1987 to 1989 a campaign to promote the early detection of cutaneous malignant melanoma was conducted in the areas of seven health authorities in England and Scotland (total population 3.6 million). Data were collected on 17,155 patients attending pigmented lesion clinics (PLCs) in each study area during the campaign. After a dramatic rise in PLC referral rates in the first month of the campaign the average monthly referral rate among the target population in the study period settled to an average of 13 per 10(5), a twofold increase compared with the pre-campaign period. Over 85% of patients at all PLCs were seen within 4 weeks of referral from their general practitioners. The melanoma to non-melanoma detection ratio was (1:33). The organization of future early detection initiatives needs careful review and planning, in order to improve their effectiveness in all sections of the population, and to enable health services to cope with the increased work-load.