Author Correction: Mice lacking NF-κB1 exhibit marked DNA damage responses and more severe gastric pathology in response to intraperitoneal tamoxifen administration.

Following the publication of this article [1], it was noted that the author list was incomplete and was missing the following author.

How do we cultivate in England? Tillage practices in crop production systems.

Reducing tillage intensity offers the possibility of moving towards sustainable intensification objectives. Reduced tillage (RT) practices, where the plough is not used, can provide a number of environmental and financial benefits, particularly for soil erosion control. Based on 2010 harvest year data from the nationally stratified Farm Business Survey and drawing on a sub-sample of 249 English arable farmers, we estimate that approximately 32% of arable land was established under RT, with 46% of farms using some form of RT. Farms more likely to use some form of RT were larger, located in the East Midlands and South East of England and classified as 'Cereals' farms. Application of RT techniques was not determined by the age or education level of the farmer. Individual crops impacted the choice of land preparation, with wheat and oilseed rape being more frequently planted after RT than field beans and root crops, which were almost always planted after ploughing. This result suggests there can be limitations to the applicability of RT. Average tillage depth was only slightly shallower for RT practices than ploughing, suggesting that the predominant RT practices are quite demanding in their energy use. Policy makers seeking to increase sustainable RT uptake will need to address farm-level capital investment constraints and target policies on farms growing crops, such as wheat and oilseed rape, that are better suited to RT practices.

Cleaning-induced arsenic mobilization and chromium oxidation from CCA-wood deck: Potential risk to children.

Concern about children's exposure to arsenic (As) from wood treated with chromated-copper-arsenate (CCA) led to its withdrawal from residential use in 2004. However, due to its effectiveness, millions of American homes still have CCA-wood decks on which children play. This study evaluated the effects of three deck-cleaning methods on formation of dislodgeable As and hexavalent chromium (CrVI) on CCA-wood surfaces and in leachate. Initial wipes from CCA-wood wetted with water showed 3-4 times more dislodgeable As than on dry wood. After cleaning with a bleach solution, 9.8-40.3µg/100cm(2) of CrVI was found on the wood surface, with up to 170µg/L CrVI in the leachate. Depending on the cleaning method, 699-2473mg of As would be released into the environment from cleaning a 18.6-m(2)-deck. Estimated As doses in children aged 1-6 after 1h of playing on a wet CCA-wood deck were 0.25-0.41µg/kg. This is the first study to identify increased dislodgeable As on wet CCA-wood and to evaluate dislodgeable CrVI after bleach application. Our data suggest that As and CrVI in 25-year old CCA-wood still show exposure risks for children and potential for soil contamination.

Development of a pulsed uniform supersonic gas expansion system based on an aerodynamic chopper for gas phase reaction kinetic studies at ultra-low temperatures.

A detailed description of a new pulsed supersonic uniform gas expansion system is presented together with the experimental validation of the setup by applying the CRESU (French acronym for Cinétique de Réaction en Ecoulement Supersonique Uniforme or Reaction Kinetics in a Uniform Supersonic Flow) technique to the gas-phase reaction of OH radicals with 1-butene at ca. 23 K and 0.63 millibars of helium (carrier gas). The carrier gas flow, containing negligible mixing ratios of OH-precursor and 1-butene, is expanded from a high pressure reservoir (337 millibars) to a low pressure region (0.63 millibars) through a convergent-divergent nozzle (Laval type). The novelty of this experimental setup is that the uniform supersonic flow is pulsed by means of a Teflon-coated aerodynamic chopper provided with two symmetrical apertures. Under these operational conditions, the designed Laval nozzle achieves a temperature of (22.4 ± 1.4) K in the gas jet. The spatial characterization of the temperature and the total gas density within the pulsed uniform supersonic flow has also been performed by both aerodynamical and spectroscopic methods. The gas consumption with this technique is considerably reduced with respect to a continuous CRESU system. The kinetics of the OH+1-butene reaction was investigated by the pulsed laser photolysis/laser induced fluorescence technique. The rotation speed of the disk is temporally synchronized with the exit of the photolysis and the probe lasers. The rate coefficient (k(OH)) for the reaction under investigation was then obtained and compared with the only available data at this temperature.

Nosocomial infections in immunocompromised children.

Within the last decade several advances in medicine have resulted in extended longevity of children with cancer, cystic fibrosis, certain congenital immunodeficiency disorders, chronic renal diseases and aplastic anemia. Forthwith, the population of such immunocompromised children has increased and accounts for a greater portion of the hospital census than heretofore. To avoid emotional, infectious and financial burdens of hospitalization, efforts have been successful in developing ambulatory outpatient programs within specialized centers. Although infection control policies have been reasonably well-established for the hospitalized inpatient, policies for the hospital outpatient are lacking. Investigations into the problems of "nosocomial outpatient infections" are needed. Accomplishments in recent years in the control of nosocomial infections include the development of preparations for passive immunization for varicella-zoster virus and hepatitis B virus exposures and the application of certain antibiotic regimens for prophylaxis. Currently a vaccine is under study for active immunization to varicella with possible efficacy for exposed susceptible persons. It is obvious that the proportion of children at increased risk for infection in the hospital environment will continue to increase.

Seroepidemiology of hepatitis B virus infection in the United States. 1976 to 1980.

The prevalence of hepatitis B virus (HBV) infection was determined using sera from persons participating in the second National Health and Nutrition Examination Survey, conducted from 1976 to 1980. Of 14,488 scientifically selected participants aged 12 to 74, 821 had evidence of past or present infection with HBV. In the white population, the weighted estimate of hepatitis B infection was 3.2 percent (95 percent confidence interval, 3.1 to 4.2). A steady increase with age was seen; by ages 65 to 74, the prevalence was 6.9 percent (95 percent confidence interval, 5.2 to 8.5). In the black population, the overall weighted estimate of prevalence was 13.7 percent (95 percent confidence interval, 11.6 to 15.8). In this racial group, there was a dramatic increase with age, with the oldest age groups having a prevalence of 39.6 percent (95 percent confidence interval, 29.1 to 50.0). In both racial groups, there was a low prevalence of infection in young children that began to rise between ages 12 and 18. In a multivariate analysis of factors associated with infection, there was an interaction of race with age; therefore, the odds ratio for race is presented for four ages. This ratio ranged from 3.0 (95 percent confidence interval, 1.8 to 4.2) for a 15-year-old to 8.2 (95 percent confidence interval, 6.5 to 10.3) for a 70-year-old. These relative odds estimates were not substantially affected by adjustment for the available information on risk factors for HBV infection. The results of this study in a representative sample of the United States population show that adult black Americans are at high risk for hepatitis B infection. Other independent predictors of HBV positivity include male sex; residing in the South, Northeast, or West; residing in a city of 250,000 or more people; serving in the armed forces; living below the poverty level; and having a positive treponemal test for syphilis. These data suggest that the immunization practices for controlling this disease should be re-examined.

Use of antimicrobial drugs in general hospitals: IV. Infants and children.

The use of antimicrobial drugs was studied among 933 randomly selected infants and children who were hospitalized in 20 short-stay general hospitals in Pennsylvania. Twenty-two percent of pediatric patients received antimicrobial drugs: 5% of neonates and 57% of patients aged 12 to 18 months. Sixty-eight percent of the 265 antimicrobial courses administered to these children consisted of a penicillin or a penicillin analogue. Ampicillin was the single drug most frequently administered and was given in 32% of all courses. In contrast to the findings in older children, penicillin or penicillin analogues and aminoglycosides were the only antimicrobial drug groups administered to neonataes. Seventy-nine percent of courses were initiated for proved or suspected infections and 17% were initiated to prevent infections associated with surgical or nonsurgical invasive procedures. Cultures were associated with the initiation of 84% of courses among neonates and 39% of courses among children 6 to 9 years of age. This study provides the initial information, from data derived from randomly selected general hospitals, to permit a statement of norms of practice with respect to use of antimicrobial drugs in pediatric populations.

Are surveillance of resistant enteric bacilli and antimicrobial usage among neonates in a newborn intensive care unit useful?

From March 1976 through December 1978, the prevalence of ampicillin- and gentamicin-resistant enteric bacilli was monitored in fecal cultures of neonates in an intensive care unit. Substantial fluctuations in colonization rates were observed which did not correlate with the occurrence of sepsis due to these organisms nor with variations in antibiotic use. This experience suggests that the availability of these surveillance data did not result in more effective control of neonatal sepsis due to enteric bacilli.

Differences in antibody response to whole-cell pertussis vaccines.

It has been assumed that whole-cell pertussis vaccines (WCVs) commercially distributed in the United States are of comparable immunogenicity, as all must comply with established standards for licensure. However, we have recently noted significant differences in antibody responses between groups of infants receiving the two WCVs commercially available in the United States. In separate studies performed concurrently under similar protocols at Vanderbilt and Johns Hopkins universities, infants were randomized to receive either an acellular pertussis vaccine or WCV. The acellular pertussis vaccine used at the two sites was identical, but the WCVs were from different manufacturers. Antibody responses to acellular pertussis vaccine did not differ between the two studies; responses to WCV differed dramatically, with infants receiving the Lederle WCV producing a 46-fold increase in antibody to pertussis toxin, compared with a 2.4-fold increase for infants receiving the Connaught WCV (P = .00003). Evaluation of other comparative data sets that were available provided further support for the conclusion that the two commercially available WCVs consistently differed in their ability to induce antibody to pertussis toxin. These findings have important implications for the design and interpretation of clinical trials comparing acellular and WCV products.

Characterization of methanogenic and methanotrophic assemblages in landfill samples.

A greater understanding of the tightly linked trophic groups of anaerobic and aerobic bacteria residing in municipal solid waste landfills will increase our ability to control methane emissions and pollutant fate in these environments. To this end, we characterized the composition of methanogenic and methanotrophic bacteria in samples taken from two regions of a municipal solid waste landfill that varied in age. A method combining polymerase chain reaction amplification, restriction fragment length polymorphism analysis and phylogenetic analysis was used for this purpose. 16S rDNA sequence analysis revealed a rich assemblage of methanogens in both samples, including acetoclasts, H2/CO2-users and formate-users in the newer samples and H2/CO2-users and formate-users in the older samples, with closely related genera including Methanoculleus, Methanofollis, Methanosaeta and Methanosarcina. Fewer phylotypes of type 1 methanotrophs were observed relative to type 2 methanotrophs. Most type 1 sequences clustered within a clade related to Methylobacter, whereas type 2 sequences were broadly distributed among clades associated with Methylocystis and Methylosinus species. This genetic characterization tool promises rapid screening of landfill samples for genotypes and, therefore, degradation potentials.

Clinical trial of cefamandole, cefazolin, and cefuroxime for antibiotic prophylaxis in cardiac operations.

A relatively large number of comparative trials of antibiotic prophylaxis in cardiac surgery have been published, many of which have serious design flaws. Despite the large number of studies, no single antibiotic regimen has emerged as clearly superior in preventing postoperative site infections. To determine if a superior regimen could be identified with a study designed to avoid flaws found in previous studies, we undertook a randomized, double-blind clinical trial of three cephalosporins. From March 1987 to February 1990, 2759 adults underwent median sternotomies: 1641 completed study participation, 203 were enrolled but were dropped from the study for protocol violations, and 815 were excluded. The characteristics of all 2759 patients were recorded with respect to case mix and infection risk factors, and the patients were followed-up by the same nurse throughout hospitalization and for 6 weeks after discharge for the assessment of infection outcome status. Of the 1641 participants, 141 (8.6%) had one or more operative site infections: 46 of 549 (8.4%) cefamandole recipients, 46 of 547 (8.4%) cefazolin recipients, and 49 of 545 (9.0%) cefuroxime recipients (p = 0.92). The sites of infection and the depth of tissue involvement were not significantly different across groups. Because no differences in effectiveness in preventing postoperative site infections were demonstrated in a rigorously designed trial, the costs of the drugs, including the costs of their preparation and delivery, may be the only variables by which to choose among these three antibiotic prophylaxis regimens.

Response of preterm infants to diphtheria-tetanus-pertussis vaccine.

The American Academy of Pediatrics recommendation that immunization of preterm infants with diphtheria-tetanus-pertussis (DTP) vaccine should begin at 2 months after birth, regardless of gestational age, is based on limited data. A prospective study was conducted to determine the immunogenicity and safety of DTP vaccine in preterm infants. One hundred ten preterm and 146 full term infants received doses of DTP at 2, 4 and 6 months after birth. Adjusted analysis of the antibody responses indicated that after three doses mean titers among preterm infants to each vaccine component were comparable to those of full term infants. Adjusted analysis of the incidence of adverse events indicated that the risk of adverse events in preterm infants was not significantly higher than that in full term infants. DTP vaccine is immunogenic and safe in preterm infants when the series is initiated at 2 months after birth, and this study supports the current recommendation of the American Academy of Pediatrics.

Comparison of nasal brush and nasopharyngeal aspirate techniques in obtaining specimens for detection of respiratory syncytial viral antigen by immunofluorescence.

Diagnosis of respiratory syncytial virus by antigen detection is dependent on obtaining adequate respiratory epithelial cells. Two specimen collection methods, nasopharyngeal aspiration (NPA) and nasal brushing (NB), were compared. Thirty-two pediatric patients with presumed viral pneumonia or bronchiolitis (34 episodes) had both NPA and NB performed. Of 34 specimens 15 were culture-positive for respiratory syncytial virus. Of these 12 NPA samples and 10 NB samples had viral inclusions by immunofluorescent antibody staining (IFA). Of culture-negative samples, 1 of 17 NB was positive by IFA. One specimen obtained by NB had too few cells to read by the IFA method. Sensitivity and specificity were 80 and 100% for NPA and 67 and 94% for NB. Total respiratory cells and IFA-positive cells (classified as few, moderate, or many) were greater with NPA; however, NB was also an effective procedure and was better tolerated by children, less expensive and easier to perform.

Reducing the rate of nosocomially transmitted respiratory syncytial virus.

BACKGROUND: A large number (17) of nosocomial respiratory syncytial virus cases led to the development of control measures to prevent transmission of respiratory syncytial virus (RSV) within the Johns Hopkins Hospital's Children's Center. METHODS: The control plan is based on a 2-stage process. In stage 1, the staff are notified that RSV is in the community, and information is distributed through a communication tree. Stage 2 requires that nasopharyngeal aspirates be obtained from all children <3 years of age who have respiratory symptoms. The aspirates are tested directly for RSV antigen and cultured for RSV. The children are placed on pediatric droplet precautions pending those results. RESULTS: The proportion of nosocomial RSV cases dropped from 16.5% before the use of RSV control measures to 7.2% after the initiation of the control program. A case of RSV identified in the hospital was 2.6 times more likely to be nosocomially acquired before the intervention compared with after the intervention. Approximately 14 cases of RSV are prevented each year, which results in a savings of 56 hospital-days and more than $84,000 in direct hospital-related charges alone. CONCLUSIONS: The nosocomial spread of RSV can be reduced by a specific and feasible control plan that includes early identification and rapid isolation of potential RSV cases.

Mediastinal infection after cardiac surgery.

Mediastinitis is an uncommon complication after cardiac surgery; however, its associated morbidity and mortality demand early recognition and emergency therapy. This review is intended to emphasize certain features of the incidence, pathogenesis, and bacteriology of this complication in patients undergoing cardiopulmonary bypass through a median sternotomy. The diagnosis and treatment of mediastinitis after cardiac surgical procedures, as well as methods of prevention, are also reviewed.

Goals and strategies for teaching death and dying in medical schools.

Teaching medical students to respond to needs of the dying represents an important challenge for medical educators. This article describes the goals and objectives that should be identified before medical schools can meet this challenge, as well as strategies that, when implemented, will provide students with the necessary knowledge, skills, and attitudes to meet the needs of the dying patients. The goals and objectives were identified through a modified group consensus process developed during Choice In Dying's 5-year project "Integrating Education on Care of the Dying into Medical Schools." The authors have diverse experiences and backgrounds and are actively involved in death and dying teaching at 11 medical schools. They conclude that after accepting the goals and objectives, key medical school faculty can work cooperatively to develop strategies to integrate them into the school's curriculum. Without first establishing a set of goals and objectives and developing evaluation methods, medical schools could miss their mark in fostering the student's ability to care for the dying.

Speech intelligibility through communication headsets for general aviation.

Word discrimination was measured on eight general aviation pilots listening alternately through each of three communication headsets and an aircraft loudspeaker in the presence of light aircraft noise. Each subject listened at the speech intensity designated by him as yielding optimal intelligibility. Performance varied directly with the degree of attenuation provided by the headset. Mean intelligibility scores ranged from 73% through the loudspeaker to 92% through two of the headsets, although retesting through the loudspeaker at a higher signal level improved mean scores to 85%. Articulation functions obtained on four normally hearing listeners tested under the same conditions as the pilots revealed that, for situations when little or no attenuation was available (loudspeaker and one headset), greater signal-to-noise ratios were necessary to allow discrimination equivalent to that obtained under conditions of greater noise attenuation (two headsets). Although good intelligibility could be achieved through the loudspeaker given sufficient signal intensity (greater than 100 dB SPL) some pilots preferred lower levels even though discrimination was reduced.

Effects of phase manipulation on speech intelligibility through communication headsets.

A masking level difference (MLD) paradigm was established by rewiring the earphones of a communications headset out-of-phase. Essentially no release from masking could be measured, however, on a crew of listeners in the cabin of light aircraft. The experiment was replicated in the laboratory so that the exact phase of the aircraft noise masker could be controlled. The substantial MLD obtained in this environment led to the conclusion that the noise reaching the ear in the cockpit was of random phase, which almost eliminates the MLD. Therefore, rewiring headsets out-of-phase provides no advantage in intelligibility.

Occurrence of organic pollutants in recovered soil fines from construction and demolition waste.

The objective of this study was to characterize recovered soil fines from construction and demolition (C&D) waste recycling facilities for trace organic pollutants. Over a period of 18 months, five sampling trips were made to 14 C&D waste recycling facilities in Florida. Screened soil fines were collected from older stockpiles and newly generated piles at the sites. The samples were analyzed for the total concentration (mg/kg) of a series of volatile organic compound (VOCs) and semi-volatile organic compounds (semi-VOCs). The synthetic precipitation leaching procedure (SPLP) test was also performed to evaluate the leachability of the trace organic chemicals. During the total analysis only a few volatile organic compounds were commonly found in the samples (trichlorofluoromethane, toluene, 4-isopropyltoluene, trimethylbenzene, xylenes, and methylene chloride). A total of nine VOCs were detected in the leaching test. Toluene showed the highest leachability among the compounds (61.3-92.0%), while trichlorofluoromethane, the most commonly detected compound from both the total and leaching tests, resulted in the lowest leachability (1.4-39.9%). For the semi-VOC analysis, three base-neutral semi-VOC compounds (bis(2-ethylhexyl)phthalate, butyl benzyl phthalate, and di-n-butyl phthalate) and several PAHs (acenaphthene, pyrene, fluoranthene, and phenanthrene) were commonly detected in C&D fines samples. These compounds also leached during the SPLP leaching test (0.1-25%). No acid extractable compounds, pesticides, or PCBs were detected. The results of this study were further investigated to assess risk from land applied recovered soil fines by comparing total and leaching concentrations of recovered soil fines samples to risk-based standards. The results of this indicate that the organic chemicals in recovered soil fines from C&D debris recycling facilities were not of a major concern in terms of human risk and leaching risk to groundwater under reuse and contact scenarios.

Doesn't everyone grieve in the abortion choice?

PIP: Brown, Elkins, and Larson's article on prolonged grieving after induced abortion properly alerts physicians to the need for vigilance to emotional difficulties following this procedure. However, the authors appear to have an implicit political agenda in publishing their material, and the absence of scientific method in the presentation of this material is reckless given the political volatility surrounding the abortion issue. The article is based on an analysis of 61 letters solicited by the pastor of a Protestant church in Florida known for its anti-abortion activities; only negative experiences were sought. Cited are long-term negative sequelae such as anger, loss, depression, masking of emotion, regret, shame, guilt, fantasizing, and suicidal ideation. It is impossible for the authors to make psychiatric diagnoses on the basis of letters alone. More importantly, these same reactions can be found, to an even greater extent, among women suffering forced continuation of an unwanted pregnancy and subsequent nonvoluntary parenthood. Feelings of guilt and loss can be expected both among women who choose to abort and those who opt to continue with an unplanned pregnancy. The very fact that abortion is legal in the US allows physicians to help those women who do experience emotional difficulties after the procedure.^ieng