A workplace colorectal cancer screening program in firefighters: lessons learned.

BACKGROUND: Although colorectal cancer (CRC) screening is widely recommended, screening rates remain low. Workplace interventions have the potential to increase rates of screening. AIMS: To evaluate the impact of a workplace CRC screening program targeting active duty and retired firefighters. METHODS: A letter, a fecal immunochemical test (FIT) kit and a survey were mailed to all active duty and retired San Francisco firefighters aged 40 and older during 2008-09. The survey included questions about CRC risk factors and prior CRC screening tests. The primary outcome was return of the completed FIT. RESULTS: FIT kits and surveys were sent to 1203 firefighters. In total, 445 individuals (37%) completed the survey, and 400 (33%) completed the FIT. Forty-five per cent of respondents had had a stool test for blood at some time, although few (8%) had had it within the past year. Thirty-six per cent of respondents said they had had a sigmoidoscopy at some time, although only 15% had had it within the past 5 years and 37% within the past 10 years. Among those aged 50 and older, 59% had had a test for colon cancer at some time. CONCLUSIONS: A workplace intervention can increase CRC screening rates in firefighters. Future studies should focus on the long-term sustainability of this type of program.

The Experience of Anaemia and Ingesting Oral Iron Supplementation in Pregnancy: A Qualitative Study.

INTRODUCTION: The objective of this study was to understand the experience of iron deficiency anaemia requiring oral iron in pregnancy and the factors affecting compliance with oral iron supplementation. Participants' understanding regarding the possible consequences of anaemia in pregnancy was also explored. Feedback on a proposed randomised controlled trial of daily versus alternate day oral iron in pregnancy was sought. MATERIALS & METHODS: Following ethical approval, fourteen semi-structured one-to-one interviews were carried out using an interview tool with open-ended questions. Recruitment was carried out through social media and from an antenatal out-patient setting. Interviews were audio-recorded, transcribed and analysed thematically. RESULTS: Fatigue emerged as a predominant and troubling symptom. Awareness was often highlighted through friends/family and from healthcare professionals, particularly in first pregnancies. Knowledge surrounding the potential short-term and long-term adverse consequences of untreated anaemia however was limited. Gastro-intestinal side-effects, a previous experience of poor tolerance and forgetfulness all negatively impacted compliance with oral iron supplementation in pregnancy. Routine, a perceived improvement in fatigue with supplementation and reduced dose frequency recurred as themes which positively affected compliance. Pregnancy as a motivating factor recurred as a theme in analysis. The role of diet was felt to be important. Knowledge of iron-rich foods and absorption aids and inhibitors was good, but practice on optimal ingestion of oral iron supplementation varied. Feedback on trial acceptability was positive with the benefit of extra supportive care noted. Incorporating study visits with routine care was advised in view of time constraints. This area of research was perceived as important. CONCLUSION: In order to successfully reduce the rates of iron deficiency anaemia in pregnancy, it is crucial that all factors affecting compliance with oral iron are considered. Providing women with the important information on the possible consequences of sub optimally treated anaemia may help to improve this public health issue.

Design, synthesis, and biological evaluation of aryl piperazines with potential as antidiabetic agents via the stimulation of glucose uptake and inhibition of NADH:ubiquinone oxidoreductase.

The management of blood glucose levels and the avoidance of diabetic hyperglycemia are common objectives of many therapies in the treatment of diabetes. An aryl piperazine compound 3a (RTC1) has been described as a promoter of glucose uptake, in part through a cellular mechanism that involves inhibition of NADH:ubiquinone oxidoreductase. We report herein the synthesis of 41 derivatives of 3a (RTC1) and a systematic structure-activity-relationship study where a number of compounds were shown to effectively stimulate glucose uptake in vitro and inhibit NADH:ubiquinone oxidoreductase. The hit compound 3a (RTC1) remained the most efficacious with a 2.57 fold increase in glucose uptake compared to vehicle control and micromolar inhibition of NADH:ubiquinone oxidoreductase (IC50 = 27 µM). In vitro DMPK and in vivo PK studies are also described, where results suggest that 3a (RTC1) would not be expected to provoke adverse drug-drug interactions, yet be readily metabolised, avoid rapid excretion, with a short half-life, and have good tissue distribution. The overall results indicate that aryl piperazines, and 3a (RTC1) in particular, have potential as effective agents for the treatment of diabetes.

An evaluation of selected oral fluid point-of-collection drug-testing devices.

Point-of-collection oral fluids drug-testing devices are being marketed for a variety of medico-legal purposes where they may complement existing technologies and be used to detect drugs following recent ingestion. To assess the utility of these devices for use in drugged-driving investigations, we performed a laboratory evaluation of four devices and those results were published previously. In the study reported here, two more devices, Oratect(R) (Branan) and Uplink(R) (OraSure), were evaluated for their ability to detect amphetamines, cocaine, opiates, and cannabinoids. An additional device, Drugwipe (Securtec), was evaluated for the detection of cocaine and cannabinoids. Each of the devices was assessed for their ability to meet the manufacturers' claimed cutoff concentrations and to meet cutoffs proposed for federal workplace programs. In general, the Branan and OraSure devices detected amphetamine, methamphetamine, opiates, and cannabinoid metabolite (THC-COOH) well in the concentration ranges approximating those proposed by the Substance Abuse and Mental Health Services Administration (SAMHSA), but all three devices performed poorly in detecting Delta9-tetrahydrocannabinol (THC) at the proposed SAMHSA cutoff. The ability to accurately and reliably detect cocaine was dependent on the individual device, and the Branan and Securetec devices were more effective than OraSure at detecting parent cocaine.

Impact of maternal diet on neonatal anthropometry: a randomized controlled trial.

OBJECTIVE: Large for gestational age infants are at increased risk of childhood obesity and maternal nutrition impacts birthweight. The aim of this study was to assess the impact of a maternal low glycaemic index (GI) diet on neonatal anthropometry. METHODS: The ROLO (Randomised Control Trial of Low Glycaemic Index Diet in Pregnancy) study was a randomized controlled trial to assess the impact of a low GI diet versus usual diet on birthweight. It took place in a tertiary maternity hospital in Ireland and women were randomized to receive either a low GI diet or no dietary intervention from early pregnancy to term. Two hundred sixty-five neonates had anthropometric measurements on day 1-2 of life, 126 in the intervention group and 139 in the control group. Measurements included birthweight, length and circumferences of the head, chest, abdominal, thigh and mid-upper arm. A subgroup of 219 (82%) neonates also had skin-fold measurements. RESULTS: Neonates whose mothers had a low GI diet in pregnancy had lower thigh circumference (15.9 ± 1.7 cm vs. 16.6 ± 1.5 cm, P = 0.04). There was no difference between the intervention and control groups in head, chest abdominal or mid-upper arm circumferences. No difference was noted between the two groups for any skin-fold measurements (subscapular, thigh, biceps and triceps). CONCLUSION: Neonatal thigh circumference was altered by maternal low GI diet in pregnancy. These findings suggest that maternal low GI diet is safe in pregnancy and may positively impact infant adiposity.

Unsuspected hemodynamic alterations during endotracheal suctioning.

Endotracheal suctioning of intubated patients is associated with hemodynamic complications including arterial hypoxemia, cardiac arrhythmias, hypotension and even death. Prior investigations of this subject focus primarily on arterial hypoxemia. Our observations of ETS revealed significant falls in the mixed SvO2 and we postulated that alterations in VO2 or CO must be occurring. This study was then designed to determine the alterations in CO, VO2, SaO2 and the resulting effect on SvO2 during ETS. Ten critically ill intubated patients with pulmonary artery catheters in place, were studied during routine ETS by the nursing staff. We found that ETS produced a significant decrease in SvO2 which was predominantly due to an increased VO2 accompanied by an inadequate rise or even fall in CO. Alterations in SaO2 appeared to be modest and were insensitive indicators of alterations in SvO2.

Magnesium sulfate potentiates several cardiovascular and metabolic actions of terbutaline.

beta-Adrenergic agonists are useful for the emergency treatment of asthma. Recently, magnesium sulfate (MgSO4) has also been shown to be efficacious in this situation. beta-Agonists have unwanted cardiovascular and metabolic actions: increased systolic blood pressure, corrected QT interval (QTc), serum glucose and insulin, and decreased RR interval, diastolic blood pressure, serum potassium, phosphate, and calcium. As beta-agonists and MgSO4 quite possibly will be used in combination, we sought to determine how MgSO4 would affect these actions. Healthy young male adults were administered two doses of terbutaline sulfate, 0.25 mg subcutaneously, 30 min apart on two separate occasions, in a randomized, double-blind fashion. On one occasion, 4 g of MgSO4 was administered intravenously over the same 30-min period. On the other, normal saline solution was given as a placebo. Cardiovascular and metabolic variables were measured sequentially for 2 h. Data at 60 min with p values given for a summation of all time points are as follows: MgSO4 increased terbutaline's effects on the RR interval by 0.09 s, p < 0.0001; QTc interval by 0.01 s, p < 0.0007; diastolic blood pressure by 8 mm Hg, p = 0.0001; serum calcium by 0.13 mg/dl, p = 0.01; and glucose by 9 mg/dl, p < 0.0001. MgSO4 also mitigated the systolic blood pressure elevating the effect of terbutaline by 5 mm Hg (p = 0.007). The magnitude of the response potentiations was modest. We conclude that combining terbutaline and MgSO4 is unlikely to result in serious short-term adverse events, if used acutely in patients with relatively normal cardiac and metabolic function. MgSO4 may act by potentiating the effect of beta-agonists on magnesium requiring enzymes such as adenyl cyclase.

Incidence of phrenic neuropathy after isolated lung transplantation. The Loyola University Lung Transplant Group.

BACKGROUND: Isolated lung transplantation is a viable therapeutic option for many patients with end-stage pulmonary disease. Other intrathoracic surgical procedures have a well documented incidence of phrenic nerve dysfunction, although the incidence after lung transplantation has not been studied. METHODS: Thirty-one patients who underwent lung transplantation were evaluated for evidence of phrenic nerve dysfunction and subsequent recovery. Risk factors contributing to the incidence of injury were examined. Phrenic nerve injury was defined by two separate diagnostic tests (Transcutaneous Phrenic Nerve Conduction Studies and Fluoroscopic evaluation of diaphragmatic movement) used in combination. RESULTS: Of the 27 patients who were completely evaluated after the operation, eight had defining criteria for nerve injury--an incidence of 29.6%. Of those affected, the majority of injuries (89%) resulted in complete paralysis of the affected hemidiaphragm. The highest incidence of injury occurred in patients who underwent bilateral single lung transplantation (41%), with the right phrenic nerve being injured most often (78%). Fortunately, no significant postoperative morbidity was attributable to the occurrence of phrenic nerve injury when compared with those patients who did not sustain injury. CONCLUSIONS: The analysis of possible risk factors resulted in the hypothesis that the likely mechanism of injury in these patients was due to stretching or direct instrumentation of the nerve, and thus measures should be instituted to minimize the possibility of injury.

Comparison of diaphragmatic EMG power spectra: spontaneous contractions vs. evoked compound action potentials.

The electromyogram (EMG) power spectrum from spontaneous diaphragm contractions has been used to identify the development of fatigue. However, power spectral analysis of the spontaneous diaphragmatic EMG signal is limited and subject to error. In contrast, power spectral analysis of the compound diaphragm action potential (CDAP) may be superior. The aim of the present study was to determine whether the EMG power spectra of evoked CDAPs correlate with those of spontaneous diaphragm contractions. Four anesthetized mechanically ventilated dogs with spontaneous isometric diaphragm contractions were studied using a mechanically isolated in situ diaphragm preparation. CDAPs were elicited via phrenic nerve stimulation, and intramuscular wire electrodes recorded EMG. Diaphragm temperature was changed from 40 to 30 degrees C to elicit changes in the EMG power spectra. The EMG signal from 10 spontaneous contractions and 10 CDAPs were acquired at 1 degrees C intervals. Fast Fourier transform was applied to both spontaneous and CDAP data yielding the power spectra, which were represented by their center frequencies (fc). The CDAP fc correlated well with the EMG fc obtained from spontaneous contractions (r = 0.99). We conclude that evoked CDAPs may provide an accurate alternative to spontaneous contractions for EMG power spectral analysis of the diaphragm.

Influence of isometric loading on biceps EMG dynamics as assessed by linear and nonlinear tools.

The summed electrical discharges generated by a contracting skeletal muscle constitute a dynamic system conveying electromyographic (EMG) information indicative of muscle physiological status. "Steady states" of activity can be achieved with light loads, but with heavy loads the dynamic system experiences continuous status transitions that culminate in task failure. The present study was designed to assess the applicability of two mathematical tools, one linear and the other nonlinear, in addressing the time course of EMG alterations under different loading challenges. Surface EMGs of the biceps brachii muscle were recorded from 14 healthy human volunteers during light and heavy loadings, and task failure occurred at varying times among the subjects. Digitized EMG signals were analyzed by linear spectral analysis (fast Fourier transform) and nonlinear recurrence-plot analysis. With light loading, computed variables from both analyses gave "quasi-steady-state" values over time, with recurrence-plot analysis having the higher variance. With heavy loading, the nonlinear variable (%determinism) increased sooner and exhibited larger changes from control values than decreases in the linear variable (spectral center frequency). Experimental results support the conclusion that both analyses can be combined to give a fuller assessment of the biceps EMG during light or heavy loading. Implications for the detection of muscular fatigue are discussed.

Structural change of the thorax in chronic obstructive pulmonary disease.

This study examines structural changes of the thorax in hyperinflated subjects with chronic obstructive pulmonary disease (COPD). Age-matched normal subjects were used for comparison. Thoracic dimensions were determined using anteroposterior and lateral chest radiographs performed at total lung capacity, functional residual capacity, and residual volume. Rib cage dimensions (lateral diameter, rib angle, anteroposterior diameter) and diaphragm position were determined at each lung volume. There were no significant differences in rib cage dimension between the COPD and normal subjects for all lung volumes. In contrast, the diaphragm was significantly lower in the COPD subjects. The change of rib cage dimensions in the COPD subjects (for a similar volume change) was not different from that in normal subjects, whereas the change of diaphragm position in the COPD subjects (for a similar volume change) was reduced. In conclusion, the primary structural change of the thorax in COPD with chronic hyperinflation is confined to the diaphragm, with no appreciable structural change in the rib cage.

Prevention training and medical residency.

We developed a questionnaire to assess training and perceived competence in prevention skills during medical residency. We asked residents at a university training program about 20 prevention interventions recommended by the U.S. Preventive Services Task Force. Primary care and categorical medicine residents rated the adequacy of training and the perceived relevance to clinical practice of these interventions as well as basic skill and knowledge areas (such as patient education) on five-point Likert-type scales (1 = very inadequate or very unimportant and 5 = very adequate or very important). Fifty-eight residents (n = 19 primary care and 39 categorical medicine) completed the questionnaire (response rate = 63%). Primary care residents felt significantly (P < .05) more competent than categorical medicine residents in 14 of the 20 prevention interventions. Primary care residents rated the adequacy of training in eight of 10 basic skill and knowledge areas significantly (P < .05) higher than did categorical medicine residents. For both groups of residents, mean relevance scores significantly exceeded mean perceived competence scores in 18 of 20 prevention interventions and in all 10 skill and knowledge areas. Primary care residents felt more competent than categorical medicine residents in performing most prevention interventions. However, residents in both training programs rate the relevance of several basic skill and knowledge areas as higher than their perceived competence, suggesting training underemphasis. Both primary care and categorical medicine training programs could use this instrument to assess the adequacy of their training in these areas.

Exercise counseling by primary care physicians in the era of managed care.

BACKGROUND: Recommendations from the Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) advise all adults to accumulate at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week, but many U.S. adults engage in no leisure-time physical activity. Since primary care providers can play an important role in exercise counseling and prescription, we wanted to assess the proportion of primary care physicians from four hospitals who asked about exercise habits, counseled about exercise, and prescribed exercise; and the factors that were associated with their counseling and prescription habits. DESIGN: Survey of 326 internists, family practitioners, and internal medicine and family practice residents. RESULTS: One hundred seventy-five physicians completed the questionnaire (54% response rate). Two thirds of physicians reported asking more than half of their patients about exercise, 43% counseled more than half of their patients about exercise, but only 14% prescribed exercise for more than half of their patients. Only 12% of physicians were familiar with the new ACSM recommendations. Physicians aged 35 and over were more likely than physicians less than 35 year old to ask about (82% versus 60%), counsel about (58% versus 37%), and prescribe (30% versus 8%) exercise. Family practitioners were more likely to ask about (85% versus 62%) and counsel about (59% versus 39%) exercise than internists. Physicians who felt they had adequate exercise knowledge were more likely to ask about (72% versus 49%) and counsel about (48% versus 29%) exercise than those who felt their knowledge was inadequate. Finally, physicians who felt that they were successful in changing behavior were more likely to ask about and counsel about exercise. The most important barriers to exercise counseling were not having enough time and needing more practice in effective counseling techniques. CONCLUSION: Many primary care physicians are not asking about, counseling about, or prescribing exercise for their patients. Since primary care physicians are in the best position to provide individualized exercise prescriptions for their patients, future research should focus on training physicians in effective counseling techniques that can be done as brief interventions.

Reduction of the behavioral effects of delta9-tetrahydrocannabinol by hyperbaric pressure.

Delta9-tetrahydrocannabinol in doses of 0.5, 1.0, 2.0 and 4.0 mg/kg was administered to rats under normal (1 ATA) and increased (3, 5 and 7 times normal) atmospheric pressure. Behavior was maintained by a food-reinforced differential-reinforcemnet-of-low-rate (DRL) schedule. Dose-dependent decrements in performance was observed at the 1 ATA conditions, in which response rates increased and the well-established temporal discrimination disintegrated. Under the elevated pressure conditions, however, a reversal of behavioral toxicity occurred during which performance improved as a function of pressure. The behavioral disruptions occurring at the 5- and 7-ATA pressures were minimal compared with those occurring at 1 ATA under equivalent doses of the drug. The present experiment has demonstrated that delta9-tetrahydrocannabinol produces significant behavioral changes at 1 ATA pressure, but when atmospheric pressure is increased the drug effects are reduced.

Behavioral effects of morphine on free-operant avoidance under hyperbaric pressure.

Morphine sulfate was tested under hyperbaric pressure to assess its effects on behavior. Four male hooded rats were trained to avoid brief electric shocks under a free-operant unsignalled avoidance procedure. Using an individual organism design, we injected each rat subcutaneously with morphine sulfate (2.0, 4.0, 6.0, 8.0 mg/kg body wt.) or saline (0.1 ml/100 g body wt.). Rats were tested at 1.0 and 7.1 atmospheres absolute (ATA) in a dry hyperbaric chamber while breathing a mixture of helium and oxygen. Each session lasted 60 min. Overall, the analgesic effects of morphine at 1.0 and 7.1 ATA were found to be similar. Shock avoidance by a rat was found to be a monotonic function of the drug dose; the fewest shocks were associated with the 2.0 mg/kg dose. Increased pressure did not significantly affect the number of shocks received by a rat across doses. Total responding remained stable throughout the study, but the temporal pattern of responding was differentially influenced by drug dose.

The effect of investment material and ceramming regime on the surface roughness of two castable glass-ceramic materials.

OBJECTIVE: To assess the surface roughness (R(a)) of two castable glass-ceramic materials, cast using four different investment materials and employing different ceramming regimes. METHODS: Forty discs, each 12 mm diameter and 2 mm thick were produced from two castable glass-ceramic materials, one a glass ionomer derivative based on 1.5SiO(2)-1Al(2)O(3)-0.53P(2)O(5)-1CaO-0.67CaF(2) (LG112), the other a fluorcanasite material based on 0.60SiO(2)-0.05K(2)O-0.10Na(2)O-0.15CaO-0.10CaF(2) (SG3). The discs were made using four dental investments, two gypsum-bonded (Whip-Mix Cristobalite (WMC), Degussa California (DC)) and two phosphate-bonded (Fujivest Super (FS), Techceram Glass (TG)). A Ni-Cr metal/ceramic alloy (Wiron 99) was also used as a control. Each investment was used to produce 10 discs for each glass-ceramic material, five left in the as-cast, glass state, the other five cerammed. Ceramming was carried out either within the investment mold or after de-vesting from the investment mold. The discs had their surface roughness values measured using a stylus, surface contact measuring instrument. RESULTS: For the Ni-Cr alloy the phosphate-bonded investments produced discs significantly smoother than those produced by the two gypsum-bonded investments (p<0.05). The FS investment produced the smoothest discs (p<0.05), but there was no significant difference between the discs produced by the two gypsum-bonded investments (p>0.05). For the SG3 material no significant differences were seen between the as-cast glass and cerammed discs (p>0.05), with the WMC investment producing the smoothest discs (p<0.05), and the TG investment the roughest (p<0.05). The LG112 material showed a significant difference between glass and cerammed discs for the gypsum-bonded investments (p<0.05) but not when using phosphate-bonded investments (p>0.05). With LG112 the WMC investment produced smoother discs than the DC and TG investments (p<0.05). The DC investment produced rougher discs than the two phosphate-bonded investments (p<0.05). SIGNIFICANCE: The selection of investment material can have a significant effect on the as-cast surface finish of castable glass-ceramic materials. A gypsum-bonded investment material gave smoother surface finishes compared to phosphate-bonded investments. The ceramming process significantly increases surface roughness.

Effect of furnace type and ceramming heat treatment conditions on the biaxial flexural strength of a canasite glass-ceramic.

OBJECTIVE: To assess the effect of different heat treatment conditions when using two different furnace types on the biaxial flexural strength (BFS) of a fluorcanasite castable glass-ceramic. METHODS: Two furnace types, one a programmable furnace (PF), the other a dental laboratory burnout furnace (DLF), were used with various ceramming times to determine their effect on the BFS of a fluorcanasite castable glass-ceramic. The glass-ceramic material was cast to produce discs of 12 mm diameter and 2 mm thickness using the lost wax casting process (n = 80). After casting, both furnace types were used to ceram the discs. Half the discs were not de-vested from the casting ring before ceramming but cerammed in situ (DLF) and half were de-vested before ceramming (PF). All the discs were given a nucleation heat treatment at 520 degrees C for 1 h and then cerammed at 860 degrees C using four heat soak times (0.5, 1, 2 and 3 h). The DLF furnace had a rate of climb of 13 degrees C/min and the PF furnace had a rate of climb of 5 degrees C/min to 520 degrees C and 3 degrees C/min to 860 degrees C. After ceramming the discs were de-vested and the BFS determined using a Lloyd 2000R tester. RESULTS: The maximum BFS values seen for both furnace types were almost identical (280 MPa), but were achieved at different heat soak times (1 h DLF, and 2 h PF). The only significant differences in BFS values for the two furnaces were between the 0.5 and 2 h heat soak times (p < or = 0.05). Individual differences were seen between results obtained from each furnace type/heat soak times evaluated (p < or = 0.05). SIGNIFICANCE: Already available dental laboratory burnout furnaces can be used to ceram fluorcanasite glass-ceramic castings to the same BFS values as more expensive and slower specialist programmable furnaces.

The effect of casting conditions on the biaxial flexural strength of glass-ceramic materials.

OBJECTIVE: To assess the effect of mould and glass casting temperatures on the biaxial flexural strength (BFS) of two different types of castable glass-ceramic, using existing laboratory equipment and techniques. METHODS: Two castable glass-ceramic materials were evaluated. One glass (LG3) is based on SiO2-Al2O3-P2O5-CaO-CaF2, and is similar in composition to glasses used in the manufacture of glass-ionomer cements. The other glass (SG3) is based on SiO2-K2O-Na2O-CaO-CaF2, and is a canasite-based material. Both materials were used to produce discs of 12 mm diameter and 2 mm thickness using the same lost-wax casting process as used for metal castings. Mould temperatures of between 500 degrees C and 1000 degrees C and glass casting temperatures of between 1100 degrees C and 1450 degrees C were evaluated. The cast discs were cerammed and the biaxial flexural strength determined with a Lloyd 2000 R tester. RESULTS: A significant difference was found for the BFS in the range of mould temperatures evaluated, with the optimum investment mould temperature being 590 degrees C for LG3 and 610 degrees C for SG3 (p = 0.0002 and p = 0.019, respectively). No significant differences were seen between any of the glass casting temperatures evaluated. SIGNIFICANCE: The mould temperature for castable glass-ceramic materials produced using the lost-wax casting process can have a significant effect on BFS. The optimum mould temperature may differ slightly depending on the type of material being used. The glass casting temperature of these materials does not appear to have a significant effect on BFS.