Keep it simple: comparing functional assessments in individuals with Down syndrome.

BACKGROUND: A number of assessments exist that evaluate function in ambulatory adults. However, these assessments take for granted the cognitive abilities required for the participant to understand what is being asked of them in order to demonstrate their functional abilities. It has been shown that individuals with Down syndrome (DS) demonstrate lower functional levels when asked to perform additional tasks while walking. Therefore, measurements of function may not be reflective of actual function if the assessment requires additional tasks in those with DS. It is for these reasons the current investigation sought to evaluate four common functional assessments, two with [modified Berg balance test (mBERG) and Functional Gait Assessment (FGA)] and two without [Timed Up and Go (TUG) and Established Populations for Epidemiologic Study in the Elderly (EPESE)] complex tasks. METHODS: Adults with DS (n = 19) completed four functional assessments, which were later compared using bivariate Pearson correlation coefficients. RESULTS: There were large associations between simple assessments (TUG-EPESE: r = -0.525, P = 0.021) and complex assessments (FGA-mBERG: r = 0.612, P = 0.005), respectively. The TUG also inversely correlated with the FGA (r = -0.476, P = 0.039), and the EPESE had a large association with mBERG (r = 0.508, P = 0.027). CONCLUSIONS: The mBERG may be the best test to replicate real-world scenarios through its tasks, although it may also be confounded by the cognitive load required to perform the movements as asked. The TUG and EPESE may be more appropriate as mobility assessments because they require very little cognitive attention when completing the tasks. True assessments of mobility ought to err on the side of simple so to not confuse the outcomes with executive functionality.

Prostate Specific Membrane Antigen Positron Emission Tomography May Improve the Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging in Localized Prostate Cancer.

PURPOSE: Positron emission tomography using ligands targeting prostate specific membrane antigen has recently been introduced. Positron emission tomography imaging with (68)Ga-PSMA-HBED-CC has been shown to detect metastatic prostate cancer lesions at a high rate. In this study we compare multiparametric magnetic resonance imaging and prostate specific membrane antigen positron emission tomography of the prostate with whole mount ex vivo prostate histopathology to determine the true sensitivity and specificity of these imaging modalities for detecting and locating tumor foci within the prostate. MATERIALS AND METHODS: In a prospective clinical trial setting 20 patients with localized prostate cancer and a planned radical prostatectomy were recruited. All patients underwent multiparametric magnetic resonance imaging and positron emission tomography before surgery, and whole mount histopathology slides were directly compared to the images. European Society of Urogenital Radiology guidelines for reporting magnetic resonance imaging were used as a template for regional units of analysis. The uropathologist and radiologists were blinded to individual components of the study, and the final correlation was performed by visual and deformable registration analysis. RESULTS: A total of 50 clinically significant lesions were identified from the whole mount histopathological analysis. Based on regional analysis the sensitivity, specificity, positive predictive value and negative predictive value for multiparametric magnetic resonance imaging were 44%, 94%, 81% and 76%, respectively. With prostate specific membrane antigen positron emission tomography the sensitivity, specificity, positive predictive value and negative predictive value were 49%, 95%, 85% and 88%, respectively. Prostate specific membrane antigen positron emission tomography yielded a higher specificity and positive predictive value. CONCLUSIONS: A significant proportion of cancers are potentially missed and underestimated by both imaging modalities. Prostate specific membrane antigen positron emission tomography may be used in addition to multiparametric magnetic resonance imaging to help improve local staging in those patients undergoing retropubic radical prostatectomy.

A comparison of the physical demands associated with various right-angle direct-current power tools.

This work examined the physical demands associated with 4 commercially available direct current right-angle power tools along with their computer controlled fastening strategies. Physical demands were measured via an external instrumented handle that could also control the trigger of each tool. Data revealed that forces recorded by the external handle for each of the 4 tools differed. Independent of Joint-Hardness and Target Torque the Atlas Copco TurboTight® and Cleco Low Torque Reaction fastening strategies, both using a rapid spindle-head rotation strategy, produced the lowest peak and impulse force, respectfully, when compared to the 2 tools that were designed to fasten with a longer duration. This work has shown that short duration fastening strategies provide an ergonomics benefit to the users as it requires less force to operate, such force reduction in previous research has been linked to reduced handle displacement and lower muscle effort.

Physical demands associated with right-angle direct-current power-tools: An evaluation of current technology.

The purpose of this work was to evaluate the physical demands associated with three direct current powered right-angle power tool tightening strategies at various fastener-location-orientations, target torques and joint-hardness. Physical demands were measured using surface electromyography, handle force and upper body kinematics. Results identified TurboTight®, a rapid and short duration fastening strategy, to produce lower handle force impulse, less joint angle displacement, and lower EMG magnitudes when compared to the longer duration fastening strategies tested. The reduced magnitudes associated with TurboTight®, independent of fastener-location-orientations, target torques and joint-hardness, indicate a lower physical demand on power tool operators, providing a significant ergonomic benefit when compared to the slower fastening strategies.

Use of water-based foam to depopulate ducks and other species.

Current control strategies for avian influenza virus, exotic Newcastle disease, and other highly virulent poultry diseases often include surveillance, quarantine, depopulation, disposal, and disinfection. On-farm depopulation and disposal methods reduce potential movement of virus and improve biosecurity. Water-based foam depopulation was developed as a potential alternative mass emergency poultry depopulation procedure. The use of water-based foam is conditionally approved by the USDA Animal and Plant Health Inspection Service for use with floor-reared birds. This study reports on the use of water-based foam to depopulate other species including call ducks, chukars, Pekin ducks, and Japanese quail. Foam caused a rapid onset of airway occlusion. Although all species tested were depopulated with water-based foam, the time to cessation of activity varied by species, with quail being faster than chukars, broilers, and ducks.

Application of in-house mortality composting on viral inactivity of Newcastle disease virus.

This paper summarizes the results from 3 simulated in-house catastrophic mortality composting experiments. Experiment 1 evaluated the impact of water-based foam mass depopulation on in-house composting of the carcasses and litter and showed that water-based foam improved windrow temperatures. Experiment 2 evaluated the impact of freezing samples on virus recovery from windrow compost tissue and the choice of tissue for virus sampling within the bird. Experiment 2 documented that freezing the samples had minimal impact on processing and that virus recovery was more consistent among inoculated breast meat than inoculated tracheas. Experiment 3 evaluated the impact of sawdust, straw, and sawdust-straw base layer litter material on in-house mortality composting. All litter materials were able to reach and maintain temperatures in excess of 60 degrees C for multiple days. No viral hemagglutination activity was observed after d 2 during any of the 3 experiments.

Foam-based mass emergency depopulation of floor-reared meat-type poultry operations.

Current control strategies for avian influenza and other highly contagious poultry diseases often include quarantine, depopulation, and disposal of infected birds. For biosecurity reasons, on-farm depopulation and disposal methods are preferred. The options for mass depopulation are limited, as reported by the "2000 Report of the AVMA Panel on Euthanasia." Current depopulation techniques may have excessive labor requirements, are not appropriate for all house types, and may not be suitable for large-scale emergency implementation. A procedure has been developed that uses foam to rapidly form a blanket over the birds. The procedure requires relatively few people, can be performed in a variety of house types, and is compatible with in-house composting. Results from 2 experiments using foam for depopulation are presented in this paper. These studies have shown that foams are comparable to the CO(2) polyethylene tent procedure in time to death in small groups and that the foam is faster as group size increases. Adding CO(2) to the foam does not enhance its efficacy. Based on corticosterone levels, the study also showed that the foams are no more stressful than the CO(2) depopulation method. Necropsy and histological examination of birds indicated that blood was present to some degree in the trachea, syrinx, and bronchial tree in broilers subjected to foam with CO(2), foam without CO(2), and CO(2) polyethylene tent methods of depopulation. Foam caused a rapid onset of airway occlusion. In both foam- and CO(2)-euthanized broilers, lesions are consistent with anoxia or hypoxia. This suggests that foam acts by physically induced hypoxia, whereas CO(2) causes chemically induced hypoxia.

Differential diagnosis of palinacousis in a psychiatric patient.

Palinacousis is a relatively rare neurological phenomenon that may be misdiagnosed in psychiatric patients if it is not differentiated from the auditory hallucinations of psychotic illness. The authors present a case of palinacousis that responded to phenytoin.

Psychosis after neuroleptic withdrawal in a manic-depressive patient.

The authors present a case of neuroleptic-induced supersensitivity psychosis in a manic-depressive patient. They discuss the clinical differentiation of such a withdrawal psychosis from schizophrenic decompensation.

Antibodies to HIV in Israeli hemophiliacs: relationship between serological profile and disease development.

We studied 66 Israeli hemophiliacs for antibodies to HIV in blood samples collected between 1978 and 1985. By May 1985, 2 had AIDS, 2 had ARC, 4 had lymphadenopathy with some immunologic dysfunction, and 58 were asymptomatic. Antibodies to HIV were detected in 40 (60.6%) patients, including all 8 with disease. Presence of HIV antibodies was significantly associated with receipt of non-heat-treated commercial factor VIII concentrates (NHT fac VIII) between 1980 and 1983. Thirty-eight of 45 (84.44%) patients treated with NHT fac VIII developed antibodies to HIV, compared to 1 of 16 (6.25%) treated with cryoprecipitates and fresh plasma only. Of 40 seropositive patients, 1 (2.5%) had antibodies by 1980, 4 (10%) by 1982, 14 (35%) by 1983, 10 (25.0%) by 1984, and 11 (27.5%) by May 1985. The decline in the rate of seroconversion can be attributed to the replacement of NHT fac VIII concentrate with heat-inactivated factor VIII (HT fac VIII) concentrate by November 1983. As of January 1984 only HT fac VIII was administered. Twenty-nine multitransfused thalassemia patients as well as 20 healthy Israeli blood donors were seronegative to HIV. All 40 (100%) seropositive hemophiliacs had antibodies to viral env gene encoded gp120/gp160 antigens. Twenty-four (60.05%) also had antibodies to viral gag gene encoded p24 and/or p55 antigens. While antibodies to gp120/160 persisted during the follow-up time, a loss of antibodies to p24/55 was observed in 5 of 16 (31.25%) seropositive patients from whom multiple samples were available. gp120/160 positive, p24/55 negative hemophiliacs had significantly lower absolute T-helper cell counts and reversed Th/Ts ratios when compared to gp120/160 p24/55 seropositive patients. Four of the 16 (25.0%) asymptomatic gp120/160 positive, p24/55 negative patients developed overt disease within 15 months of the last blood collection. The data suggest that exposure to HIV antigens is widespread among hemophiliacs in Israel, and can be attributed to receipt of NHT fac VIII concentrates prior to 1984. Antibodies to gp120/160 are of the most important diagnostic value while loss of antibodies to p24/p55 may be of prognostic value.

PCR amplification of 40-year-old paraffin-embedded tumor-tissues - comparison of 4 different DNA extraction and purification methods.

Four different methods of DNA extraction from formalin-fixed, paraffin-embedded tissues were compared for their ability to produce DNA suitable as a template for polymerase chain reaction (PCR). Seven paraffin-embedded rhabdomyosarcoma tissue blocks from the 1950s and one from 1960 were treated with the following extraction methods: 1. Proteinase K digestion and phenol/chloroform extraction; 2. Proteinase K digestion followed by boiling to inactivate the enzyme; 3. Proteinase K digestion, addition of Chelex-100, followed by boiling; and 4. Proteinase K digestion and Prep-A-Gene purification. DNA extracted by methods 1 and 2 was degraded, but DNA of high molecular weight was recovered in every sample extracted by methods 3 and 4 - even though some degradation was observed. Extracted DNA was used as a template for PCR amplification of exon 4 of the PAX-3 gene. PCR was successful in 7 out of 8 samples prepared using methods 3 and 4, producing levels of amplified product equivalent to those obtained with control DNA obtained from fresh lymphocytes. Only very weak products were found in samples prepared by methods 1 (2 out of 8) and 2 (4 out of 8). These results indicate that chelation of polyvalent ions (Chelex-100 method) or obviating the need for boiling (Prep-A-Gene) may protect DNA during extraction.

The mutation status of PAX3 and p53 genes in medulloblastoma.

The p53 and PAX3 genes were examined by PCR, SSCP and DNA sequencing methods in 50 and 58 paraffinembedded medullablastoma tissues, respectively. Four novel mutations were identified among these samples in exon 5 of the p53 gene. Two tumours showed a G to A transition. One heterozygous mutation was located on codon 158 which changed the encoded amino acid from Arg (CGC) to His (CAC). Another was located on codon 174 and replaced AGG (Arg) with AAG (Lys). There was a single base deletion of guanine located on codon 160 in another two samples, causing a frameshift. This is the first study of mutation status of PAX gene in medulloblastoma wherein only one polymorphism was identified in the gene. The polymorphism changed codon 43 from GGC to GGT but both encoded glycine.

Methods for screening in cystic fibrosis.

Cystic fibrosis (CF) is the most common lethal autosomal recessive disorder in Whites, with an incidence of approx 1 m 2500 live births and a carrier frequency of approx 1 in 25. Since the discovery of the cystic fibrosis transmembrane conductance regulator (CFTR) gene m 1989 (1-3), molecular genetics laboratories throughout the world have endeavored to identify the mutations present in their population of CF-bearing chromosomes. Since the entire CFTR gene and its intron-exon boundaries have been sequenced, mutation analysis in CF has become relatively simple, although time consuming. Generally, a number of different methods are applied to mutation analysis, but all involve an imtial step of amplification of part of the gene by polymerase chain reaction (PCR) (4), or a derivative of it, such as amplification refractory mutation system (ARMS) (5).

Effect of litter treatment on broiler performance and certain litter quality parameters.

Litter-Aid, a product consisting primarily of ferrous sulfate but also containing propionic acid and magnesium and copper sulfate was incorporated into litter at three application rates (0, .73, and 1.46 kg/m2) to determine its effects on broiler chicken performance and various aspects of litter quality. In Trial 1, litter treatments were applied to litter used for two previous flocks with a 10-week layout period. In Trial 1, there were 10 replicate pens of 175 birds per treatment. In Trial 2, litter used in Trial 1 was retreated, after a 26-week layout period, at the same application rates as Trial 1 with five replicate pens of 175 birds per treatment. This product in Trial 1 at .73 kg/m2 and in Trial 2 at 1.46 kg/m2 significantly (P less than .05) increased body weight without affecting feed conversion or mortality. The product did not significantly (P less than .05) affect litter moisture or litter nitrogen levels, but significantly (P less than .05) decreased litter pH. However, even at the application rate of 1.46 kg/m2, litter pH values rose above 8 as the birds reached 7 weeks of age. This product had no effect on bacteria counts and significantly (P less than .05) increased mold counts. These data indicate that Litter-Aid can be used without detrimental effects on broiler performance or litter quality.

Quick tests for the determination of ammonia in poultry litter.

The objective of this work was to test the ability of various available quick tests to determine ammonia concentration of poultry litters. A total of 136 samples was collected from brood chambers of poultry houses. Samples were equally divided between surface samples (top 25 mm) and core samples. Samples were frozen until analysis but received no further processing. Samples were analyzed for ammonia by autoanalyzer (standard) and several quick tests (conductivity, Quantofix N-Volumeter, and Reflectoquant). In addition, samples were analyzed by near-infrared spectroscopy by scanning samples using a large-sample transport device on a FOSS-NIRSystems model 6500 (64 co-added scans from 400 to 2,498 nm). Results showed that, although ammonia could be determined with reasonable accuracy by near-infrared spectroscopy using data in the 1,100 to 2,498 nm spectral range (final calibration R2 of approximately 0.90), none of the quick tests, including near-infrared, worked as well as previously found with dairy manures. The best results were found using the Quantofix or Reflectoquant (R2 of approximately 0.75), and conductivity worked only with the core samples (R2 of approximately 0.75). It is believed that interferences due to the presence of uric acid (spectroscopy, Quantofix, and Reflectoquant) and sodium bisulfate used to treat the litter (conductivity) were the cause of the decreased accuracies as compared to results achieved previously with dairy manures.

Genetics of the buttercup plumage pattern.

Genetic analysis of the Buttercup breed of chickens indicates that they carry the buttercup allele (ebc) at the E locus, modified by the columbian-like primary pattern mutation Db and a secondary pattern gene resulting in autosomal barring. The interactions between ebc and the Db alleles are clarified by both F2 and testcross data. Homozygous ebc in the absence of Db results in a modified stripe pattern, whereas the light parallel back stripes are irregular and wider than those of wild type chicks. The dorsal head stripe is also broken and irregular, while the ground color is of a lighter shade of tan. Adult ebc/ebc db+/db+ males are typical black-breasted wild types as suggested previously by Brumbaugh and Hollander (1965). Adult females closely resemble the brown (eb/eb) phenotype. Further proof that the buttercup gene is an allele at the E locus is provided by F2 segregation data for crosses between Buttercup (ebc/cbc db+/db+) and Light Brown Leghorns (e+/e+ db+/db+) and Black Langshans (E/Edb+/db+).

The effect of floor type on the development of breast blisters and feather follicle infections in broilers.

The effect of floor types on the incidence of feather follicle infection and breast blisters in caged broilers was investigated in two trials. Broilers were reared on corn-soybean meal diets with warm-room brooding. Floor types included litter (control), wire, wire covered with various types of plastic mats, and wire woven with surgical tubing. In trial 1, the effect of a coccidiostat (Monensin, 120 mg/kg of feed) was investigated for broilers not on litter, and in trial 2, the effect of supplemental zinc was investigated. Broilers were processed in the laboratory processing plant when they were 51 (trial 1) and 53 days old (trial 2). Carcasses were evaluated for the occurrence of fleshing downgrades, crooked keels, feather follicle infection, and breast blisters. Incidence of feather follicle infection was low for broilers on litter or wire floor and high for broiler reared on plastic mats. Breast blisters incidence was low for broilers on litter and plastic mats and was high for broilers on the wire floor. Overall carcass quality for litter (control) was superior to any of the cage treatments. Neither the coccidiostat nor supplemental zinc affected the incidence of breast blisters or feather follicle infection.

Relationship of pen height to bone strength of broilers.

Broilers reared in cages have a high incidence of wing breakage during processing. Three trials were conducted to determine the effects of cage dimensions and floor types on bone breaking strength and wing breakage during processing. Broilers were fed commercial-type diets and processed through the pickers at a commercial processing plant or a research facility. Broken bones were detected by palpation, and humeri and tibia were removed. Breaking strength was determined for the humeri and tibia with a testing instrument. Incidence of breast blisters, crooked keels, follicle infection, fleshing downgrades, and slabsidedness were determined in one trial. Cage height was the major factor affecting wing breakage and humerus strength. Incidence of wing breakage for broilers on wire floors with cages .64 m high was not significantly different from that of control broilers reared on litter with ceiling 2.54 m high. Humerus breaking strength was significantly reduced in two of three trials by the .64-m-high ceiling. Cage rearing increased the incidence of crooked keels and feather follicle infections.

Active cascade testing for carriers of cystic fibrosis gene.

OBJECTIVE: To examine the acceptability, practicability, efficiency, and application of active screening for carriers of the cystic fibrosis gene in the extended families of those in whom the disease is present (Cascade screening). DESIGN: Paediatricians and physicians provide details of their affected patients, pedigrees are drawn up, and relatives offered tests after initial contact by the affected nuclear families. Affected patients are genotyped in a laboratory with a special interest in the genetics of cystic fibrosis. SETTING: North Western health region. SUBJECTS: Relatives and partners of 607 people with cystic fibrosis. INTERVENTIONS: Genetic counselling by letter for people found to be carriers; formal genetic counselling and when indicated arrangements for prenatal diagnosis for couples discovered to be carriers. MAIN OUTCOME MEASURES: Number of carrier couples detected; action in pregnancy of detected carrier couples; extent of the uptake of screening by relatives. RESULTS: Of 1563 relatives or partners tested, 15 carrier couples were detected; of nine pregnancies undertaken by these 15, eight had prenatal tests and three terminated pregnancies. An average of 16 people per family have come forward for testing so far. CONCLUSIONS: Cascade screening for carriers of cystic fibrosis is well accepted by relatives, especially on the mother's side of the family; it is 10 times more efficient in detecting carrier couples than unfocused screening. Detected carrier couples make practical use of the information in pregnancy. Active cascade screening for carriers is effective in cystic fibrosis and widespread application is recommended. These principles could be applied to other recessive disorders.

Pro-patient partnerships.

The degree to which nurses and physicians collaborate greatly impacts patient care. These elements of effective partnerships and strategies can help you achieve mutual benefits.