High Schools Struggle to Adopt Evidence Based Practices for the Management of Exertional Heat Stroke.

CONTEXT: Exertional heat stroke (EHS) deaths can be prevented by adhering to best practices. OBJECTIVE: We investigated the adoption of policies and procedures for the recognition and treatment of EHS and the factors influencing the adoption of a comprehensive policy. DESIGN: Cross Sectional. SETTING: Online questionnaire. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers (ATs) practicing in the high school (HS) setting. MAIN OUTCOME MEASURE(S): Using the NATA Position Statement: Exertional Heat Illness, an online questionnaire was developed and distributed to ATs to ascertain their schools' current written policies for the use of rectal temperature and cold-water immersion (CWI). The Precaution Adoption Process Model (PAPM), allowed for responses to be presented across the various health behavior stages ("Unaware if have the policy", "Unaware for the need for the policy", "Unengaged", "Undecided", "Decided Not to Act", "Decided to Act", "Acting", and "Maintaining"). Additional questions included perceptions of facilitators and barriers. Data are presented as proportions. RESULTS: A total of 531 ATs completed this questionnaire. Overall, 16.9% (n=62) report adoption of all components for proper recognition and treatment of EHS. The policy component with the highest adoption was "cool first transport second" with 74.1% (n=110) of ATs reporting "Acting" or "Maintaining." The most variability in the PAPM responses was for a rectal temperature policy, with 28.7% (n=103) of ATs reporting "Decided not to Act" and 20.1% (n=72) reporting "Maintaining." The most commonly reported facilitator and barrier for rectal temperature included state mandate from state HS athletics association (n=274,51.5%) and resistance or apprehension from parents or legal guardians (n=311,58.5%), respectively. CONCLUSIONS: ATs in the HS setting appear to be struggling to adopt a comprehensive EHS strategy, with rectal temperature continuing to appear as the biggest undertaking. Tailored strategies based on health behavior, facilitators and barriers may aid in changing this paradigm.

Comparative weight loss in obese patients restarting a supplemented very-low-calorie diet.

Successive weight losses were compared for 21 patients restarting a very-low-calorie diet (VLCD) after weight regain. Patients broke VLCD2 sooner (3.8 vs 9.8 wk) and lost less (9.4 vs 19.1 kg), but weight-loss rates did not differ significantly (0.83 vs 0.71 kg/wk). Net loss post-VLCD2 was 12.0 kg. Restart patients had difficulty adhering to the repeat VLCD, which resulted in lower losses. However, similar weight-loss rates and significant net weight loss suggest repeat VLCDs can be effective.

Expression of essential B cell development genes in horses with common variable immunodeficiency.

Common variable immunodeficiency (CVID) is a heterogeneous disorder of B cell differentiation or function with inadequate antibody production. Our laboratory studies a natural form of CVID in horses characterized by late-onset B cell lymphopenia due to impaired B cell production in the bone marrow. This study was undertaken to assess the status of B cell differentiation in the bone marrow of CVID-affected horses by measuring the expression of genes essential for early B cell commitment and development. Standard RT-PCR revealed that most of the transcription factors and key signaling molecules that directly regulate B cell differentiation in the bone marrow and precede PAX5 are expressed in the affected horses. Yet, the expression of PAX5 and relevant target genes was variable. Quantitative RT-PCR analysis confirmed that the mRNA expression of E2A, PAX5, CD19, and IGHD was significantly reduced in equine CVID patients when compared to healthy horses (p<0.05). In addition, the PAX5/EBF1 and PAX5/B220 ratios were significantly reduced in CVID patients (p<0.01). Immunohistochemical analysis confirmed the absence of PAX5-BSAP expression in the bone marrow of affected horses. Our data suggest that B cell development seems to be impaired at the transition between pre-pro-B cells and pro-B cells in equine CVID patients.

Species-restriction of rat lymphoid cell migration inhibitory factor.

Migration inhibitory factor (MIF) was produced by lymphoid cells of Lewis rats in response to infection with Bacille Calmette Guérin (BCG), mixed lymphocyte reaction or concanavalin A stimulation. It was found that rat lymphokine-containing supernatants demonstrate a definite species specificity, in that MIF activity is observed only when rat indicator cells and not when guinea-pig indicator cells are used. A comparative study of MIF activities, using rat peritoneal exudate cells, revealed that all three methods stimulated MIF production by either spleen or lymph node cells. Only infection with BCG induced peripheral blood leukocytes to elaborate MIF. In all cases, rat MIF inhibited rat peritoneal exudate cells but not guinea-pig peritoneal exudate cells. Possible explanations for the species specificity of rat MIF including a role for receptor carbohydrate moieties and fibronectin are discussed.