Distribution and possible sources of polycyclic aromatic hydrocarbons (PAHs) and metals in marine surface sediments off northern Mozambique.

Liquid natural gas (LNG) exploration has started off the coast of northern Mozambique, in the Rovuma Basin, East Africa. In advance of gas production, we collected in 2018 over 100 samples of surface sediments from 40 locations in the pristine and exploration areas at water depths of 5-2000 m. We have determined the levels of hydrocarbons (total hydrocarbon contents (THC) and 49 individual PAHs), heavy metals, arsenic, grain size and total organic carbon. While sediment composition varied strongly from coarse sediment to high mud contents (<63 µm), background levels of hydrocarbons and metals were found in most samples. We found anthropogenic contamination at one site in Pemba harbor. We observed no petroleum-related contamination, including the Palma area with numerous exploration wells. Elevated concentrations of barium and THC at some locations in this area are attributed to drilling activities but are not considered to be of environmental concern.

The First Record of Aedes vittatus (Diptera: Culicidae) in the Dominican Republic: Public Health Implications of a Potential Invasive Mosquito Species in the Americas.

Aedes vittatus Bigot is distributed throughout Africa, tropical Asia, and southern Europe and occurs in sylvatic as well as peridomestic environments where it readily feeds on humans. Although the vectorial capacity of Ae. vittatus is not well understood, this species is known to play a role in the maintenance and transmission of yellow fever, Zika, chikungunya, and dengue virus within its native range. In October 2019, after a routine inspection of mosquito-breeding containers in Jarabacoa, Dominican Republic, two Ae. vittatus females were captured via human landing catch method. After this finding, a CDC miniature light trap was deployed at the point of initial detection from 18:00 to 08:00 h, 2 d/wk from 3 to 31 October 2019. Potential larval habitats were also sampled via traditional dip method once per week spanning a 150 m radius from point of initial detection. In addition to the 2 adult females, 10 female and 2 male Ae. vittatus were captured. One Ae. vittatus larva also was found in a small puddle formed by an animal hoof print. Conventional PCR and Sanger sequencing were used to confirm morphological identification of collected specimens. This is the first detection of Ae. vittatus in the Dominican Republic as well as the Americas. Therefore, enhanced surveillance is needed to better understand the range and public health risks this potential invasive mosquito species may pose in the Dominican Republic, other Caribbean Islands, and/or the Americas.

A comparison of pre-operative nerve stimulator-guided femoral nerve block and fascia iliaca compartment block in patients with a femoral neck fracture.

We undertook a randomised, controlled trial to compare the analgesic efficacy and opioid sparing effect of nerve stimulator-guided femoral nerve block with fascia iliaca compartment block in patients awaiting surgery for fractured neck of femur. Ten-centimetre visual analogue pain scores were measured before and 2 h after the block and opioid consumption was recorded in the 12-h period after the block. One hundred and ten patients were randomly assigned. Femoral nerve block provided superior pre-operative analgesia for fractured neck of femur compared with fascia iliaca compartment block. The difference in the mean reduction of pain score after the block was 0.9 (95% CI 0-1.8); p = 0.047. Patients receiving a femoral nerve block required less morphine after the block than those receiving fascia iliaca compartment block (p = 0.041).

Encephalitis and neuronal necrosis in a 3-month-old suckled beef calf.

A 3-month-old suckled beef calf from the west coast of Scotland showed neurologic clinical signs for 1 week and was euthanized after failing to respond to treatment. Blood and tissue samples, including the brain, were submitted for diagnosis. Histologic examination of the brain showed neuronal chromatolysis and necrosis in the hind brain and loss of Purkinje cells in the cerebellum, accompanied by mild nonsuppurative encephalitis in the hind brain with a striking lack of inflammation in the cerebellar layers. Other microscopic lesions present were mild nonsuppurative meningitis with perivascular cuffs, diffuse hypergliosis, and occasional foci of neuronophagia. Polymerase chain reaction amplification of viral nucleic acids and specific immunohistochemical labeling allowed the identification of louping ill virus, and serology showed high titers of immunoglobulin M, indicating a recent infection.

Prevalence of upper-body symptoms following breast cancer and its relationship with upper-body function and lymphedema.

This investigation describes the prevalence of upper-body symptoms in a population-based sample of women with breast cancer (BC) and examines their relationships with upper-body function (UBF) and lymphedema, as two clinically important sequelae. Australian women (n=287) with unilateral BC were assessed at three-monthly intervals, from six to 18 months post-surgery (PS). Participants reported the presence and intensity of upper-body symptoms on the treated side. Objective and self-reported UBF and lymphedema (bioimpedance spectroscopy) were also assessed. Approximately 50% of women reported at least one moderate-to-extreme symptom at 6- and at 18-months PS. There was a significant relationship between symptoms and function (p < 0.01), whereby perceived and objective function declined with increasing number of symptoms present. Those with lymphedema were more likely to report multiple symptoms, and presence of symptoms at baseline was associated with an increased risk of lymphedema (ORs > 1.3, p = 0.02), although presence of symptoms explained only 5.5% of the variation in the odds for lymphedema. Upper-body symptoms are common and persistent following breast cancer and are associated with clinical ramifications, including reduced UBF and increased risk of developing lymphedema. However, using the presence of symptoms as a diagnostic indicator or prognosticator of lymphedema has its limitations.

A controlled study of risk factors for enamel hypoplasia in the permanent dentition.

PURPOSE: The purpose of this study was to investigate risk factors for enamel hypoplasia (EH) and enamel opacity (EO) in the permanent teeth of healthy schoolchildren from a nonfluoridated community in Australia. METHODS: Children with EH (N=104) or EO (N=104) were compared with matched controls without enamel defects (N=105). Subjects who previously resided in on optimally fluoridated town provided data on the effects of drinking fluoridated water. RESULTS: The main risk factors for EH were low socioeconomic status (P < .04), respiratory infections (P < .001), exposure to cigarette-smoking (P = .001), asthma (P = .007), otitis media (P = .01), urinary tract infection (UTI; P = .03) and chickenpox (P = .001). Combinations of either chickenpox and UTI or chickenpox and exposure to cigarette-smoking were associated with relatively high numbers of EH. While use of adult toothpaste (1000 ppm) at 0 to 3 years old increased risks for EH, there were less EO in children who used child toothpaste (300 ppm fluoride, 86% vs. 95%; P = .02) or who drank optimally fluoridated water compared to those who did not (4% vs. 29%; P < .001). CONCLUSIONS: Children with low socioeconomic status, histories of respiratory or chickenpox infections, exposure to cigarette-smoking, urinary tract infections, otitis, and use of adult toothpaste are predisposed to enamel hypoplasia. By contrast, drinking optimally fluoridated water at 0 to 3 years old reduces the risk for enamel opacities.

Neurologic abnormalities in HTLV-I- and HTLV-II-infected individuals without overt myelopathy.

BACKGROUND: Human T-lymphotropic virus (HTLV) type I is the causative agent of HTLV-associated myelopathy (HAM)/tropical spastic paraparesis, and a number of HAM cases with HTLV-II infection have also been reported. However, despite some reports, it is unclear whether HTLV-I or -II infection is associated with other neurologic manifestations. METHODS: An analysis of medical histories and screening neurologic examinations from a prospective cohort of 153 HTLV-I, 388 HTLV-II, and 810 HTLV-seronegative individuals followed up for means of 11.5, 12.0, and 12.2 years was performed. Participants diagnosed with HAM were excluded. We calculated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, sex, race or ethnicity, income, educational attainment, body mass index, alcohol and cigarette consumption, injection drug use, diabetes, and hepatitis C virus status, using generalized estimating equations for repeated measures. RESULTS: HTLV-I and -II participants were more likely than seronegative participants to have leg weakness (ORs 1.67 [95% CI 1.28-2.18] and 1.44 [1.16-1.78]), impaired tandem gait (ORs 1.25 [95% CI 1.07-1.47] and 1.45 [1.27-1.64]), Babinski sign (ORs 1.54 [95% CI 1.13-2.08] and 1.51 [1.18-1.93]), impaired vibration sense (ORs 1.16 [95% CI 1.01-1.33] and 1.27 [1.14-1.42]), and urinary incontinence (ORs 1.45 [95% CI 1.23-1.72] and 1.70 [1.50-1.93]). For both HTLV-I and -II participants, higher odds of sensory neuropathy by monofilament examination were no longer significant after adjustment for confounding. CONCLUSIONS: These results provide strong evidence that human T-lymphotropic virus (HTLV)-I and -II are associated with a spectrum of predominantly motor abnormalities in patients without overt HTLV-associated myelopathy. Further investigation of the clinical course and etiology of these abnormalities is warranted.

Clinical detection of caries in the primary dentition with and without bitewing radiography.

BACKGROUND: Inadequate detection of caries in the primary dentition due to non-use of bitewing radiography is commonly encountered in paediatric practice. The present study investigated the increased benefits of using bitewing radiography in addition to the visual-tactile examination technique for detection of primary dentition caries in a non-fluoridated community, and determined the prevalence of "hidden" occlusal caries in the primary dentition. METHODS: Primary teeth were scored for caries at the restorative threshold using a visual-tactile technique followed by bitewing radiographic examination in a sample of 611 schoolchildren aged 6.4 +/- 0.5 yrs to 12.1 +/- 0.8 yrs residing in a non-fluoridated city. RESULTS: Overall, at the restorative threshold, the visual-tactile technique could detect 62 per cent of occlusal caries compared to 74 per cent for bitewing radiography (p < 0.001). The prevalence of "hidden" occlusal caries was 12 per cent. In contrast, for primary molar proximal surface caries, the visual-tactile technique could detect only 43 per cent of caries compared with 91 per cent for bitewing radiography (p < 0.001). CONCLUSIONS: In the primary dentition, use of bitewing radiography increases the detection rate of proximal surface caries substantially. It is recommended that bitewing radiography be included as part of the routine examination of children with proximal surfaces that cannot be visualized.

Treatment for upper-limb and lower-limb lymphedema by professionals specializing in lymphedema care.

Up to 60% of patients with cancer of the vulva, and between 20 and 30% of patients with breast or abdominal cancers may develop lymphedema following treatment. The aims of this study were to assess health professionals' knowledge about treatment, diagnostic procedures, advice and confidence in treatment of patients with either upper-limb (ULL) or lower-limb lymphoedema (LLL), and whether these differed by health professionals' background or for patients with ULL compared with LLL. A cross-sectional telephone interview was undertaken in 2006, of 63 health professionals (response rate 92.6%) known to treat lymphedema. Sixty-three per cent of the health professionals were physiotherapists; the majority were university-trained, with 20 years' experience or more. Ninety-five per cent of health professionals used circumferential measurements to establish lymphedema status, and most health professionals advised avoiding scratches and cuts (100%), insect bites (98.4%), sunburn (98.4%) and excessive exercise (65.1%) on the affected limb. Health professionals reported that compared with patients with LLL, patients with ULL were more likely to present within the first 3 months of being symptomatic (P < 0.01). Patients with LLL were more likely to present with swelling (P = 0.001), heaviness (P = 0.003), tightness (P = 0.007) and skin problems (P < 0.001) compared with patients with ULL. Treatment and advice differed according to health professionals' background, but not location of lymphedema (ULL vs. LLL). Assessment, treatment and advice for lymphedema vary across professional groups. Our results suggest that improvements should be attempted in the early detection of lymphedema, in particular of LLL among cancer patients.

Lymphedema secondary to breast cancer: how choice of measure influences diagnosis, prevalence, and identifiable risk factors.

Research on secondary lymphedema primarily uses indirect methods for diagnosis. This paper compares prevalence and cumulative burden following breast cancer surgery, as well as personal, treatment, and behavioral characteristics associated with lymphedema, using different assessment techniques. Lymphedema status was assessed at three-monthly intervals between six- and 18-months post-surgery in a population-based sample of Australian women with recently diagnosed, unilateral, invasive breast cancer, using three methods: bioimpedance spectroscopy (BIS), difference between sum of arm circumferences (SOAC) and self-report. Depending on the method, point prevalence ranged between 8 to 28%, with 1 in 5 to 2 in 5 women experiencing lymphedema at some point in time. Of those with lymphedema defined by BIS, almost 40%-60% went undetected, and 40%-12% were misclassified as having lymphedema, based on self-report and SOAC, respectively. The choice of measure also had significant implications for identified risk factors. Over 10 characteristics were associated with lymphedema, however only one, experiencing other upper-body symptoms at baseline, influenced odds of lymphedema across all three methods. These findings highlight that secondary lymphedema poses a significant public health problem. Utilizing the most accurate and reliable method for assessment is crucial to advance our understanding of preventive and treatment strategies.

Spontaneous resolution of acute cranial subdural hematomas.

Acute cranial subdural hematoma (SDH) represents a common consequence of traumatic brain injury. The vast majority of acute SDHs larger than 10mm in thickness require immediate surgical evacuation. In rare occasions, however, spontaneous resolution may occur. In our current communication, we present four cases of spontaneous resolution of acute cranial SDH. Further more, the proposed theories explaining spontaneous resolution of acute SDH, as well as, clinical parameters and imaging characteristics that might predict such phenomenon, are also reviewed. The possibility of spontaneous resolution of an acute SDH, although remote, may impact the decision making process regarding the management of these patients under certain conditions.

Economic analysis of a community-based falls prevention program.

OBJECTIVES: To undertake a cost-benefit analysis of 'Stay on Your Feet', a community-based falls prevention program targeting older people at all levels of risk in New South Wales, Australia. Hospital separations were monitored in the intervention region, a control region and for the state of New South Wales as a whole. Changing admission patterns over the intervention period were used to assess the impact of the program. METHODS: Cost-benefit analysis compared the costs of the program with two estimates of savings from avoided hospital admissions. The first compared the cost of hospital admissions in the intervention region to a control region of similar demographics, while the second compared hospital utilization in the intervention region with the state of New South Wales as a whole using falls-related hospital diagnosis related group (DRG) codes. RESULTS: The total direct costs of the program were estimated at A dollars 781,829. Both methods identified clear overall net benefits ranging from A dollars 5.4 million for avoided hospitalizations alone to A dollars 16.9 million for all avoided direct and indirect costs. The confidence intervals around these estimates were small. The average overall benefit to cost ratio for the intervention as a whole was 20.6:1. CONCLUSIONS: These findings suggest that well-designed community-based interventions targeting falls prevention among older people are highly cost effective and a wise investment for all levels of government. The models used are conservative and are likely to underestimate the real benefit of the intervention, which may have lasted for some time beyond the life of the program.

Donor reactions in high-school donors: the effects of sex, weight, and collection volume.

BACKGROUND: The high incidence of donor reactions in first-time, 17-year-old Caucasian whole-blood donors makes this group ideal for the study of donor reactions. STUDY DESIGN AND METHODS: Donor reaction rates were retrospectively evaluated in 7274 first-time, 17-year-old Caucasian whole-blood donors based on observations recorded at the collection sites. The effect of sex and weight on donor reactions was determined. In addition, a model was developed to estimate how different blood collection volumes would affect donor reaction rates. RESULTS: The donor reaction rate was 12.0 percent (870/7274). Female donors overall had a higher donor reaction rate than male donors (16.7% vs. 7.3%) and also had a higher donor reaction rate than male donors at each 20-lb weight interval in the range from 110 to 189 lb. A model suggested that a change in the blood-unit volume from 450 to 500 mL would increase donor reaction rates by 18 percent in either female or male donors, whereas a reduction in the blood-unit volume from 500 to 400 mL would decrease donor reaction rates by 29 and 27 percent in female and male donors, respectively. CONCLUSION: First-time, 17-year-old Caucasian female donors had a higher donor reaction rate than male donors overall and at equivalent donor weights. In the range of present US blood-unit volumes, a change in collection of as little as 50 mL could have a significant impact on blood donor reaction rates in high-school students.

The median whole-blood donation time in the best-case scenario: findings at one blood center.

BACKGROUND: Whole-blood donation times in a donor population when there are no impediments to blood donation at any point can be used to determine the shortest median whole-blood donation time. This statistic is relevant to blood donors and collection staff. STUDY DESIGN AND METHODS: Small, over-staffed blood drives in August 2004 were evaluated via operation records and supervisor interviews to determine if there were any impediments to whole-blood donation at any point in the process. Four-hundred ninety-two whole-blood donations from 33 blood drives were not impeded and were evaluated for whole-blood donation times. Registration records (entry time) and blood donor records (phlebotomy start and end time) provided three objective time points for the process, the median post-phlebotomy interval at the phlebotomy station was estimated, and 10 minutes was assigned for the refreshment period. RESULTS: The median donation time for the whole-blood donation process was 50 minutes. The 25 to 75 percent range was 46 to 56 minutes, and the 10 to 90 percent range was 42 to 64 minutes. First-time blood donors had blood donation times that were 5 to 6 minutes longer than in repeat blood donors (55.5 min vs. 50 min), and women had slightly longer donation times than men (51 min vs. 49 min). Five percent of the donors had donation times that exceeded 69 minutes. CONCLUSION: The median whole-blood donation time and range under the best circumstances was defined based on the process in place in our blood center in August 2004.

Estimating the probability of a blood donation adverse event based on 1000 interviewed whole-blood donors.

BACKGROUND: Estimating the probability that a donor will have or not have an adverse event is useful for staff knowledge to give blood donors reassurance upon request. STUDY DESIGN AND METHODS: One-thousand donors from the general donor pool were interviewed for seven potential adverse events 3 weeks after a 525-mL whole-blood phlebotomy. The four most common adverse events were bruise (22.7%), sore arm (10.0%), fatigue (7.8%), and donor reaction (7.0%). A stepwise logistic regression analysis was performed based on five donor characteristics that were studied: age, weight, sex, race, and first-time donor status. The contribution of each significant or marginally significant factor to each adverse event was quantified. RESULTS: For donor reaction, weight (p < 0.0001) and age (p = 0.015) were significant contributors, and first-time donor status (p = 0.054) was a marginally significant contributor. An equation was derived, and the donor reaction rate can be estimated for a group based on the donor's weight, age, and first-time donor status. Similar analyses were performed for fatigue, sore arm, and bruise. CONCLUSION: Based on the derived formulas and with the use of a spreadsheet, data can be entered and the probability that a donor will have (or not have) a donor reaction, fatigue, sore arm, or bruise can be estimated.

Health-related quality of life one month after thrombolysis or primary PCI in patients with ST-elevation infarction. A DANAMI-2 sub-study.

OBJECTIVES: To evaluate the health-related quality of life (HRQoL) following Primary percutaneous coronary intervention (PCI) or thrombolytic treatment for ST-elevation myocardial infarction (STEMI). DESIGN: A questionnaire based study on patients randomised in the DANAMI-2 study to Primary PCI or thrombolysis for STEMI. A total of 1 351 patients (93.2% response rate) randomised in the DANAMI-2 study completed the HRQoL questionnaire one month after the infarction. RESULTS: With respect to the primary end-points (SF-36 physical component score, angina pectoris, and dyspnoea), patients randomised to primary PCI scored better on the SF-36 physical component score (PCS) (p=0.007), and reported significantly less angina pectoris (p=0.010) and dyspnoea (p=0.010). Higher scores among PCI patients were also found on the SF-36 scales physical functioning (p=0.015), role-physical (p=0.017), and general health (p=0.009). CONCLUSION: The results in this study support the hypothesis that primary PCI is superior to thrombolysis in treating STEMI, not only in clinical outcome, but also in quality of life outcome.

Program sustainability of a community-based intervention to prevent falls among older Australians.

Multi-strategy interventions have been demonstrated to prevent falls among older people, but studies have not explored their sustainability. This paper investigates program sustainability of Stay on Your Feet (SOYF), an Australian multi-strategy falls prevention program (1992-1996) that achieved a significant reduction in falls-related hospital admissions. A series of surveys assessed recall, involvement and current falls prevention activities, 5 years post-SOYF, in multiple original SOYF stakeholder groups within the study area [general practitioners (GPs), pharmacists, community health (CH) staff, shire councils (SCs) and access committees (ACs)]. Focus groups explored possible behavioural changes in the target group. Surveys were mailed, except to CH staff and ACs, who participated in guided group sessions and were contacted via the telephone, respectively. Response rates were: GPs, 67% (139/209); pharmacists, 79% (53/67); CH staff, 63% (129/204); SCs, 90% (9/10); ACs, 80% (8/10). There were 73 older people in eight focus groups. Of 117 GPs who were practising during SOYF, 80% recalled SOYF and 74% of these reported an influence on their practice. Of 46 pharmacists operating a business during SOYF, 45% had heard of SOYF and 79% of these reported being 'somewhat' influenced. Of 76 community health staff (59%) in the area at that time, 99% had heard of SOYF and 82% reported involvement. Four SCs retained a SOYF resource, but none thought current activities were related. Seven ACs reported involvement, but no activities were sustained. Thirty-five focus group participants (48%) remembered SOYF and reported a variety of SOYF-initiated behaviour changes. Program sustainability was clearly demonstrated among health practitioners. Further research is required to assess long-term effect sustainability.