Acute gastrointestinal illness following a prolonged community-wide water emergency.

The drinking water infrastructure in the United States is ageing; extreme weather events place additional stress on water systems that can lead to interruptions in the delivery of safe drinking water. We investigated the association between household exposures to water service problems and acute gastrointestinal illness (AGI) and acute respiratory illness (ARI) in Alabama communities that experienced a freeze-related community-wide water emergency. Following the water emergency, investigators conducted a household survey. Logistic regression models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for self-reported AGI and ARI by water exposures. AGI was higher in households that lost water service for ⩾7 days (aPR 2·4, 95% CI 1·1-5·2) and experienced low water pressure for ⩾7 days (aPR 3·6, 95% CI 1·4-9·0) compared to households that experienced normal service and pressure; prevalence of AGI increased with increasing duration of water service interruptions. Investments in the ageing drinking water infrastructure are needed to prevent future low-pressure events and to maintain uninterrupted access to the fundamental public health protection provided by safe water supplies. Households and communities need to increase their awareness of and preparedness for water emergencies to mitigate adverse health impacts.

Multimodal Regulation Orchestrates Normal and Complex Disease States in the Retina.

Regulation of biological processes occurs through complex, synergistic mechanisms. In this study, we discovered the synergistic orchestration of multiple mechanisms regulating the normal and diseased state (age related macular degeneration, AMD) in the retina. We uncovered gene networks with overlapping feedback loops that are modulated by nuclear hormone receptors (NHR), miRNAs, and epigenetic factors. We utilized a comprehensive filtering and pathway analysis strategy comparing miRNA and microarray data between three mouse models and human donor eyes (normal and AMD). The mouse models lack key NHRS (Nr2e3, RORA) or epigenetic (Ezh2) factors. Fifty-four total miRNAs were differentially expressed, potentially targeting over 150 genes in 18 major representative networks including angiogenesis, metabolism, and immunity. We identified sixty-eight genes and 5 miRNAS directly regulated by NR2E3 and/or RORA. After a comprehensive analysis, we discovered multimodal regulation by miRNA, NHRs, and epigenetic factors of three miRNAs (miR-466, miR1187, and miR-710) and two genes (Ell2 and Entpd1) that are also associated with AMD. These studies provide insight into the complex, dynamic modulation of gene networks as well as their impact on human disease, and provide novel data for the development of innovative and more effective therapeutics.

Studying the peripheral sympathetic nervous system and neuroblastoma in zebrafish.

The zebrafish serves as an excellent model to study vertebrate development and disease. Optically clear embryos, combined with tissue-specific fluorescent reporters, permit direct visualization and measurement of peripheral nervous system formation in real time. Additionally, the model is amenable to rapid cellular, molecular, and genetic approaches to determine how developmental mechanisms contribute to disease states, such as cancer. In this chapter, we describe the development of the peripheral sympathetic nervous system (PSNS) in general, and our current understanding of genetic pathways important in zebrafish PSNS development specifically. We also illustrate how zebrafish genetics is used to identify new mechanisms controlling PSNS development and methods for interrogating the potential role of PSNS developmental pathways in neuroblastoma pathogenesis in vivo using the zebrafish MYCN-driven neuroblastoma model.

Seasonal and dose-dependent effects of intracerebroventricular leptin on lh secretion and appetite in sheep.

The role of leptin in neuroendocrine appetite and reproductive regulation remains to be fully resolved. A series of three experiments was conducted using adequately nourished oestradiol-implanted castrated male sheep. In a cross-over design (n=6), responses to a single i.c.v. (third ventricle) injection of leptin (0.5, 1.0 and 1.5 mg ovine leptin (oLEP) and 1.0 mg murine leptin (mLEP)), N-methyl-D-aspartate (NMDA, 20 micro g) or 0.9% saline (control) were measured in terms of LH secretion (4 h post-injection compared with 4 h pre-injection) and appetite (during 2 h post-injection) in autumn (Experiment 1). NMDA and 1.0 mg oLEP treatments were repeated in the same sheep in the following spring (Experiment 2). With an additional 12 sheep (n=18 in cross-over design), responses to low-dose 'physiological' i.c.v. infusion of leptin (8 ng/h for 12 h daily for 4 days), insulin (0.7 ng/h) and artificial cerebrospinal fluid were measured in the next spring (Experiment 3). LH was studied over 8 h and appetite over 1 h on days 1 and 4 of infusion. In Experiment 1 (autumn), oLEP overall increased LH pulse frequency by up to 110% (P<0.05), decreased LH pulse amplitude (P<0.05) and decreased appetite (P<0.05). mLEP reduced LH pulse amplitude (P<0.05) without significant effect on appetite, while NMDA reduced appetite (P<0.05) but had no effect on LH. In Experiment 2 (spring), LH responses were 'surge-like' with highly significant increases in the moving average LH concentration after 1.0 mg oLEP (P<0.001) and after NMDA (P<0.001). Compared with similar analysis of experiment 1 results, the LH response in spring was greater than that in autumn for both 1.0 mg oLEP (P<0.05) and NMDA (P<0.005). Conversely, unlike in autumn (Experiment 1), there was no effect of 1.0 mg oLEP or NMDA on appetite in the spring (Experiment 2). In Experiment 3 (spring), 'physiological' i.c.v. infusion of oLEP or insulin increased LH pulse frequency by up to 100% (P<0.001) compared with the control infusion on both days 1 and 4, but there were no effects on appetite. These results indicate that intracerebral leptin both stimulates reproductive neuroendocrine output and decreases appetite in adequately nourished sheep. However, the responses of these two axes were dose-dependent and differentially affected by the time of year, suggesting dissociation of the neural pathways involved.

Pyruvate ingestion for 7 days does not improve aerobic performance in well-trained individuals.

The purposes of the present studies were to test the hypotheses that lower dosages of oral pyruvate ingestion would increase blood pyruvate concentration and that the ingestion of a commonly recommended dosage of pyruvate (7 g) for 7 days would enhance performance during intense aerobic exercise in well-trained individuals. Nine recreationally active subjects (8 women, 1 man) consumed 7, 15, and 25 g of pyruvate and were monitored for a 4-h period to determine whether blood metabolites were altered. Pyruvate consumption failed to significantly elevate blood pyruvate, and it had no effect on indexes of carbohydrate (blood glucose, lactate) or lipid metabolism (blood glycerol, plasma free fatty acids). As a follow-up, we administered 7 g/day of either placebo or pyruvate, for a 1-wk period to seven, well-trained male cyclists (maximal oxygen consumption, 62.3 +/- 3.0 ml. kg(-1). min(-1)) in a randomized, double-blind, crossover trial. Subjects cycled at 74-80% of their maximal oxygen consumption until exhaustion. There was no difference in performance times between the two trials (placebo, 91 +/- 9 min; pyruvate, 88 +/- 8 min). Measured blood parameters (insulin, peptide C, glucose, lactate, glycerol, free fatty acids) were also unaffected. Our results indicate that oral pyruvate supplementation does not increase blood pyruvate content and does not enhance performance during intense exercise in well-trained cyclists.

The potassium/sodium ratio in the demonstration of sudden ischemic cardiac death: a critical appraisal.

The practical value of measuring the ratio of potassium ion (K+) to sodium ion (Na+) in myocardium as an indicator of early inapparent infarction in sudden cardiac death was assessed using a series of 29 human hearts from selected coroner's autopsies together with experimental material from dogs, including infarcts of 5 min to 4 h duration. Samples for electrolyte analysis were derived from a transverse slice of each heart, taken through both ventricles midway between base and apex, all slices being completely subdivided into a numbered sequence of blocks. Ratios were mapped and compared with macroscopic enzyme staining and histological stains for injured muscle. Detailed examination of coronary arteries was performed on all human cases. Measurement of the K+/Na+ ratio did not detect all human cases of proven acute coronary occlusion and did not unequivocally demonstrate experimental infarcts less than 2 h old. Moreover, all ratios fell with increasing duration of autolysis, emphasizing the need for multiple sampling so that each heart may serve as its own control. As a routine test, therefore, the method is both impracticable and unreliable and as previously used has been subject to misinterpretation.

Infant feeding practices in East Harlem.

Infant feeding practices among low-income infants in East Harlem were surveyed prior to undertaking a nutrition education program. Data were obtained from 24-hr. recalls on 153 infants seen in a well-baby clinic. Intakes of energy, protein, fat, ascorbic acid, iron, and sodium showed wide variations among infants of similar ages. Nutrient intakes were similar for black and Puerto Rican infants, although some ethnic differences were observed in the types of milk and solid foods consumed. Black infants received formula for a longer period, while Puerto Rican infants were transferred to whole cow's milk at a younger age. In contrast black infants were introduced to table foods earlier.

Influence of a nutrition education program (EFNEP) on infant nutrition in East Harlem.

An assessment of the effectiveness of aides working in the Expanded Food and Nutrition Education Program (EFNEP) to improve the nutritional status of infants was conducted with a group of 118 infants attending a well-baby clinic in a low-income area of New York City. In addition to clinic care, the fifty-seven study infants received home visits from a nutrition aide whose role was to reinforce nutritional advice received at the clinic. The sixty-one control infants received only regular clinic care. The benefits of having an aide were suggested by three observations: Reduction in the practice of introducing whole cow's milk to young infants, familiarizing older infants with a variety of foods, and reducing the prevalence of iron-deficiency anemia. Few of the differences between study and control infants achieved statistical significance, although trends consistently indicated that the presence of aides was beneficial. The problems of assessing the effectiveness of nutrition education programs with healthy infants are discussed.

Psychiatric issues of adolescent chemical dependence.

Pediatricians, as well as other health care professionals, must always consider psychoactive drug use by adolescents as possible causes of general health or emotional problems, such as poor appetite, insomnia, problem behavior, academic underachievement, and loss of energy and motivation. Early diagnosis and intervention with youth can result in enormous benefits for the lives of the youth, families, and society. The physician must be alert to the adolescent who manifests such signs of abuse. This article details the recognition and management of these problems.

Identification of ninhydrin-positive caprolactam metabolites in the rat.

Caprolactam (2-oxohexamethylenimine) is metabolized in the rat partly to 4-hydroxycaprolactam or the corresponding free acid. The 4-hydroxy metabolite rearranges spontaneously in acidic aqueous medium to an equilibrium mixture of which 6-amino-gamma-caprolactone is the major component and 6-amino-4-hydroxyhexanoic acid is a minor component. Approximately 16% of the caprolactam ingested daily by rats fed a diet containing 3% caprolactam was excreted as the 4-hydroxy metabolite and a small amount was excreted as the non-hydroxylated acid, 6-aminohexanoic acid. The metabolites were isolated by ion-exchange chromatography and identified by gas chromatography-mass spectroscopy and infra-red and nuclear magnetic resonance spectroscopy.

Supervised versus independent student laboratories.

The purpose of this study was to determine if classroom laboratory time could be reduced in a basic physical agents course. Fifty-seven junior physical therapy students were randomly assigned to three laboratory sections. All students received identical lectures, demonstrations, course materials, and laboratory manuals. The control group, Section 1, received supervision and assistance during laboratory practice. Students in Section 2 and Section 3 worked independent of instructor supervision but could receive assistance from the instructor in an adjacent room. Students in Section 2 were provided with feedback following periodic assessment by the instructor. Attitudinal questionnaire responses indicated that the students preferred the supervised laboratory section. The presence of the instructor during classroom laboratory practice of basic physical agents did not affect student performance. Comparison of written and practical examination results indicated no significant differences in student performance. Classroom laboratory time for faculty and students was reduced when students worked independently.

Comparison of textbook and self-instructional learning methods.

Physical therapists have voiced their concern that independent study units, self-assessment tools, and refresher courses be made available. In response, we developed a series of self-instructional units in radiology, gross anatomy, and applied anatomy. To evaluate two of the units (hip and knee), we compared the self-instructional method with a traditional method using assigned textbook readings. We found no significant differences in performance levels between physical therapists and physical therapy students using self-instruction and those using textbook methods of reviewing anatomy. It took less time for the participants to do self-instruction reviews than textbook reviews, and the six-month retention rate was higher for those using self-instruction. Results of an attitude questionnaire, however, indicated approval of the self-instructional method of review as being more acceptable and enjoyable than the textbook method.

Follow-up of the graduates of one curriculum. 1956-1980.

A questionnaire was developed to obtain information from the graduates of the Marquette University Program in Physical Therapy from 1956, the year the program was established, to 1980. The response rate was 65 percent, with 433 graduates from 25 classes returning the questionnaire. The profile derived from the responses is of a graduate who remains employed in physical therapy full time or part-time, is satisfied with the undergraduate preparation received, and is a member of the American Physical Therapy Association. Compared with other studies, this survey reveals that lower percentages of physical therapy graduates are employed in hospital settings, higher percentages are earning graduate credits, and the dropout rate from the profession has decreased significantly. Other information obtained from the questionnaire is presented relating ti demographics, continuing education, and participation in professional organizations.

Comparison of serum and salivary cotinine measurements by a sensitive high-performance liquid chromatography-tandem mass spectrometry method as an indicator of exposure to tobacco smoke among smokers and nonsmokers.

Exposure to tobacco smoke, both from active smoking and from passive exposure to environmental tobacco smoke, can be monitored by measuring cotinine, a metabolite of nicotine, in a variety of biological sources including blood, urine, and saliva. Previously, a sensitive atmospheric-pressure ionization, tandem mass spectrometric (LC-API-MS-MS) method for cotinine measurements in serum was developed in support of a large, recurrent national epidemiologic investigation. The current study examined the application of this LC-API-MS-MS method to both serum and saliva cotinine measurements in a group of 200 healthy adults, including both smokers and nonsmokers. The primary objective of this study was to evaluate the relationship between serum and saliva cotinine concentrations to facilitate the linking of results from epidemiologic studies using salivary cotinine measurements to existing national data based on serum cotinine analyses. The results indicate that a simple, linear relationship can be developed to describe serum and saliva cotinine concentrations in an individual, and the expression describing this relationship can be used to estimate with reasonable accuracy (approximately +/- 10%) the serum cotinine concentration in an individual given his or her salivary cotinine result. It was further confirmed that saliva cotinine samples are generally quite stable during storage after collection, even at ambient temperatures, and this sample matrix appears to be well-suited to the requirements of many epidemiologic investigations.

At war in the fields of play: current perspectives on the nature and treatment of adolescent chemical dependency.

While the numbers of adolescents entering drug abuse treatment are not increasing dramatically, those entering treatment are getting sicker, according to clinical reports. Adolescents are entering treatment with multiple problems, including severe learning disorders, borderline personality disorders, multiple diagnoses of addiction, mental health and physical problems (including HIV/AIDS), and issues arising from child abuse and incest. A case study in client-therapist interaction is presented, highlighting the concept of the wounded healer. The disease model of addiction is discussed as it applies to adolescents, as is their need for habilitation, not rehabilitation. Current abuse trends and the drugs involved are also discussed. Multiple diagnoses, physiologic disorders, HIV testing and counseling, surgical problems, and maternal/neonatal complications are reviewed.

The psychometric properties of the Homonegativity Scale.

This research details the psychometric properties of an instrument designed to measure negative attitudes toward gay men and lesbians (the Homonegativity Scale-HS). Four studies were conducted using adolescents (N = 1078), university students (N = 343), and members of the general population (N = 146). Results suggest that the HS possesses a unidimensional factor structure and a high degree of internal consistency for both male and female participants. As predicted, scores on the HS were positively correlated with machismo, authoritarianism, political conservatism, religiosity, and modern sexism. In addition, responses on the HS did not appear to be contaminated by social desirability bias. The usefulness of this measure in survey research is discussed.