Probabilistic Multiple-Bias Modeling Applied to the Canadian Data From the Interphone Study of Mobile Phone Use and Risk of Glioma, Meningioma, Acoustic Neuroma, and Parotid Gland Tumors.

We undertook a re-analysis of the Canadian data from the 13-country case-control Interphone Study (2001-2004), in which researchers evaluated the associations of mobile phone use with the risks of brain, acoustic neuroma, and parotid gland tumors. In the main publication of the multinational Interphone Study, investigators concluded that biases and errors prevented a causal interpretation. We applied a probabilistic multiple-bias model to address possible biases simultaneously, using validation data from billing records and nonparticipant questionnaires as information on recall error and selective participation. In our modeling, we sought to adjust for these sources of uncertainty and to facilitate interpretation. For glioma, when comparing those in the highest quartile of use (>558 lifetime hours) to those who were not regular users, the odds ratio was 2.0 (95% confidence interval: 1.2, 3.4). After adjustment for selection and recall biases, the odds ratio was 2.2 (95% limits: 1.3, 4.1). There was little evidence of an increase in the risk of meningioma, acoustic neuroma, or parotid gland tumors in relation to mobile phone use. Adjustments for selection and recall biases did not materially affect interpretation in our results from Canadian data.

Early childhood caries: recurrence after comprehensive dental treatment under general anaesthesia.

AIMS: This was to assess the recurrence of dental caries and the affecting factors after dental surgery for early childhood caries (ECC). STUDY DESIGN: A retrospective study completed in a private dental practice with surgical facilities. METHODS: Dental charts were reviewed for 269 patients under 6-years-old who had comprehensive dental care under general anaesthesia (GA) between January 1, 2005 and December 31, 2007. The rate of new caries was evaluated by recording the new carious lesions at each follow-up appointment up to 24 months after the original dental surgery. RESULTS: Of the 269 patients, 62% had at least one recall appointment within 12 months after the GA; 24% of these had at least one new carious lesion. Of the 36 patients who attended recalls at 13 to 24 months following the GA, 53% had new carious lesions. Demographics, defs/deft before the GA, and number of extractions, pulpotomies, and preformed metal crowns (PMC) at the GA were not associated with relapse. Patients who had a previous dental GA were less likely to relapse in the short term (1-6 months after GA), but more likely to relapse in the longer term (19-24 months), as compared with those who had not had another GA. CONCLUSION: A previous dental GA experience may have an immediate impact on parents to promote healthy behaviours, but the challenges that they face may eventually mean failure of maintaining good oral health in the long term. A comprehensive and frequent preventive approach is required to reduce the relapse rate following a dental surgery for ECC.

Continuously apodized fiber-to-chip surface grating coupler with refractive index engineered subwavelength structure.

We demonstrate a fully etched, continuously apodized fiber-to-chip surface grating coupler for the first time (to our knowledge). The device is fabricated in a single-etch step and operates with TM-polarized light, achieving a coupling efficiency of 3.7 dB and a 3 dB bandwidth of 60 nm. A subwavelength microstructure is employed to generate an effective medium engineered to vary the strength of the grating and thereby maximize coupling efficiency, while mitigating backreflections at the same time. Minimum feature size is 100 nm for compatibility with deep-UV 193 nm lithography.

Determinants of mobile phone output power in a multinational study: implications for exposure assessment.

OBJECTIVES: The output power of a mobile phone is directly related to its radiofrequency (RF) electromagnetic field strength, and may theoretically vary substantially in different networks and phone use circumstances due to power control technologies. To improve indices of RF exposure for epidemiological studies, we assessed determinants of mobile phone output power in a multinational study. METHODS: More than 500 volunteers in 12 countries used Global System for Mobile communications software-modified phones (GSM SMPs) for approximately 1 month each. The SMPs recorded date, time, and duration of each call, and the frequency band and output power at fixed sampling intervals throughout each call. Questionnaires provided information on the typical circumstances of an individual's phone use. Linear regression models were used to analyse the influence of possible explanatory variables on the average output power and the percentage call time at maximum power for each call. RESULTS: Measurements of over 60,000 phone calls showed that the average output power was approximately 50% of the maximum, and that output power varied by a factor of up to 2 to 3 between study centres and network operators. Maximum power was used during a considerable proportion of call time (39% on average). Output power decreased with increasing call duration, but showed little variation in relation to reported frequency of use while in a moving vehicle or inside buildings. Higher output powers for rural compared with urban use of the SMP were observed principally in Sweden where the study covered very sparsely populated areas. CONCLUSIONS: Average power levels are substantially higher than the minimum levels theoretically achievable in GSM networks. Exposure indices could be improved by accounting for average power levels of different telecommunications systems. There appears to be little value in gathering information on circumstances of phone use other than use in very sparsely populated regions.

[Professional self concept]. / Le concept de soi professionnel.

With health care restructuring, nurses must constantly adapt to a changing work environment. Over time, these profound and sustained changes create a prolonged state of stress that can be detrimental to their health. Nurses who view themselves positively on a professional level seem to be better able to adapt to many changing work requirements. This professional self-concept seems to influence not only the nurse's capacity to adapt to these many work requirements, but also influences his or her health in the workplace. In this article, the authors undertake a critical analysis of the literature that enables them to highlight the main attributes of nurses' professional self-concept.

Complete reductive dehalogenation of brominated biphenyls by anaerobic microorganisms in sediment.

We sought to determine whether microorganisms from the polychlorinated biphenyl (PCB)-contaminated sediment in Woods Pond (Lenox, Mass.) could dehalogenate brominated biphenyls. The PCB dechlorination specificities for the microorganisms in this sediment have been well characterized. This allowed us to compare the dehalogenation specificities for brominated biphenyls and chlorinated biphenyls within a single sediment. Anaerobic sediment microcosms were incubated separately at 25 degrees C with 16 different mono- to tetrabrominated biphenyls (350 muM) and disodium malate (10 mM). Samples were extracted and analyzed by gas chromatography with an electron capture detector and a mass spectrometer detector at various times for up to 54 weeks. All of the tested brominated biphenyls were dehalogenated. For most congeners, including 2,6-dibromobiphenyl (26-BB) and 24-25-BB, the dehalogenation began within 1 to 2 weeks. However, for 246-BB and 2-2-BB, debromination was first observed at 7 and 14 weeks, respectively. Most intermediate products did not persist, but when 2-2-BB was produced as a dehalogenation product, it persisted for at least 15 weeks before it was dehalogenated to 2-BB and then to biphenyl. The dehalogenation specificities for brominated and chlorinated biphenyls were similar: meta and para substituents were generally removed first, and ortho substituents were more recalcitrant. However, the brominated biphenyls were better dehalogenation substrates than the chlorinated biphenyls. All of the tested bromobiphenyls, including those with ortho and unflanked meta and para substituents, were ultimately dehalogenated to biphenyl, whereas their chlorinated counterparts either were not dehalogenation substrates or were only partially dehalogenated. Our data suggest that PCB-dechlorinating microorganisms may be able to dehalogenate brominated biphenyls and may exhibit a relaxed specificity for these substrates.

Temperature determines the pattern of anaerobic microbial dechlorination of Aroclor 1260 primed by 2,3,4,6-tetrachlorobiphenyl in Woods Pond sediment.

Reductive dechlorination of the Aroclor 1260 residue in Woods Pond (Lenox, Mass.) sediment samples was investigated for a year at incubation temperatures from 4 to 66 degrees C. Sediment slurries were incubated anaerobically with and without 2,3,4,6-tetrachlorobiphenyl (2346-CB; 350 microM) as a primer for dechlorination of the Aroclor 1260 residue. Dechlorination of the Aroclor residue occurred only in live samples primed with 2346-CB and only at 8 to 34 degrees C and 50 to 60 degrees C. The extent and pattern of polychlorinated biphenyl (PCB) dechlorination were temperature dependent. At 8 to 34 degrees C, the dechlorination resulted in 28 to 65% decreases of the hexathrough nonachlorobiphenyls and corresponding increases in the tri- and tetrachlorobiphenyls. At 12 to 30 degrees C, 30 to 40% of the hexa- through nonachlorobiphenyls were dechlorinated in just 3 months. The optimal temperature for overall chlorine removal was 20 to 27 degrees C. We observed four different microbial dechlorination processes with different but partially overlapping temperature ranges, i.e., Process N (flanked meta dechlorination) at 8 to 30 degrees C, Process P (flanked para dechlorination) at 12 to 34 degrees C, Process LP (unflanked para dechlorination) at 18 to 30 degrees C, and Process T (a very restricted meta dechlorination of specific hepta- and octachlorobiphenyls) at 50 to 60 degrees C. These temperature ranges should aid in the development of strategies for the enrichment and isolation of the microorganisms responsible for each dechlorination process. The incubation temperature determined the relative dominance of the four PCB dechlorination processes and the extent and products of dechlorination. Hence, understanding the effects of temperature on PCB dechlorination at contaminated sites should assist in predicting the environmental fate of PCBs or planning bioremediation strategies at those sites.

Effect of Incubation Temperature on the Route of Microbial Reductive Dechlorination of 2,3,4,6-Tetrachlorobiphenyl in Polychlorinated Biphenyl (PCB)-Contaminated and PCB-Free Freshwater Sediments.

We studied the influence of temperature (4 to 66(deg)C) on the microbial dechlorination of 2,3,4,6-tetrachlorobiphenyl (2,3,4,6-CB) incubated for 1 year in anaerobic sediments from Woods Pond in Lenox, Mass., and Sandy Creek Nature Center Pond (SCNC) in Athens, Ga. Seven discrete dechlorination reactions were observed, four of which occurred in both sediments. These were 2,3,4,6-CB (symbl) 2,4,6-CB, 2,3,4,6-CB (symbl) 2,3,6-CB, 2,4,6-CB (symbl) 2,6-CB, and 2,3,6-CB (symbl) 2,6-CB. Three additional reactions occurred only in Woods Pond sediment. These were 2,4,6-CB (symbl) 2,4-CB, 2,4-CB (symbl) 2-CB, and 2,4-CB (symbl) 4-CB. The dechlorination reactions exhibited at least four different temperature dependencies in SCNC sediment and at least six in Woods Pond sediment. We attribute the discrete dechlorination reactions to different polychlorinated biphenyl (PCB)-dechlorinating microorganisms with distinct specificities. Temperature influenced the timing and the relative predominance of parallel pathways of dechlorination, i.e., meta versus para dechlorination of 2,3,4,6-CB and ortho versus para dechlorination of 2,4,6-CB and 2,4-CB. meta dechlorination of 2,3,4,6-CB to 2,4,6-CB dominated at all tested temperatures except at 18 and 34(deg)C, where para dechlorination to 2,3,6-CB dominated in some replicates. The dechlorination of 2,4,6-CB was restricted to (symbl)15 to 30(deg)C in both sediments. Temperature affected the lag time preceding the dechlorination of 2,4,6-CB in both sediments and affected the preferred route of its dechlorination in Woods Pond sediment. para dechlorination dominated at 20(deg)C, and ortho dechlorination dominated at 15(deg)C, but at 18 and 22 to 30(deg)C the relative dominance of ortho versus para dechlorination of 2,4,6-CB varied. These data indicate that field temperatures play a significant role in controlling the nature and the extent of the PCB dechlorination that occurs at a given site.

Influence of incubation temperature on the microbial reductive dechlorination of 2,3,4,6-tetrachlorobiphenyl in two freshwater sediments.

Volumn 62, no. 11, p. 4174, Abstract, lines 12 and 13: "para dechlorination was restricted from 18 to 34(deg)C" should read "para dechlorination was restricted to temperatures from 18 to 34(deg)C." [This corrects the article on p. 4174 in vol. 62.].

Influence of incubation temperature on the microbial reductive dechlorination of 2,3,4,6-tetrachlorobiphenyl in two freshwater sediments.

We studied the impact of incubation temperatures on the dechlorination of 2,3,4,6-tetrachlorobiphenyl (2346-CB) in two sediments from different climates: polychlorinated biphenyl (PCB)-free sediment from Sandy Creek Nature Center Pond (SCNC) in Athens, Ga., and PCB-contaminated sediment from Woods Pond (WP) in Lenox, Mass. Sediment slurries were incubated anaerobically with 350 (mu)M 2346-CB for 1 year at temperatures ranging from 4 to 66(deg)C. Most of the 2346-CB was dechlorinated between 12 and 34(deg)C in both sediments and, unexpectedly, between 50 and 60(deg)C in WP sediment. This is the first report of PCB dechlorination at thermobiotic temperatures. The data reveal profound differences in dechlorination rate, extent, and products as a function of sediment and temperature. The highest observed rate of dechlorination of 2346-CB to trichlorobiphenyls occurred at 30(deg)C in both sediments, but the rate was higher for WP than for SCNC sediment (46 versus 16 (mu)mol liter(sup-1) day(sup-1)). For SCNC sediment the rate of dechlorination dropped sharply below 30(deg)C, but for WP sediments it was near optimal from 20 to 34(deg)C and then dropped sharply below 20(deg)C. In WP sediment most of the meta chlorines were removed between 8 and 34(deg)C and between 50 and 60(deg)C. para dechlorination was restricted from 18 to 34(deg)C and was optimal at 20(deg)C. ortho dechlorination occurred between 8 and 30(deg)C, with optima around 15 and 27(deg)C, but the extent was highly variable. In SCNC sediment complete meta dechlorination occurred from 12 to 34(deg)C and para dechlorination occurred from 18 to 30(deg)C; both were optimal at 30(deg)C. No ortho dechlorination was observed. Dechlorination products were 246-CB, 236-CB, and 26-CB (both sediments) and 24-CB, 2-CB, and 4-CB (WP sediment). The data suggest that in SCNC sediment similar factors controlled meta and para PCB dechlorination over a broad temperature range (18 to 30(deg)C) but that in WP sediment there were multiple temperature-dependent changes in the factors controlling ortho, meta, and para dechlorination. We attribute the differences observed in the two sediments to differences in their PCB-dechlorinating communities.

Aerobic degradation of polychlorinated biphenyls by Alcaligenes sp. JB1: metabolites and enzymes.

In contrast to the degradation of penta- and hexachlorobiphenyls in chemostat cultures, the metabolism of PCBs by Alcaligenes sp. JB1 was shown to be restricted to PCBs with up to four chlorine substituents in resting-cell assays. Among these, the PCB congeners containing ortho chlorine substituents on both phenyl rings were found to be least degraded. Monochloro-benzoates and dichlorobenzoates were detected as metabolites. Resting cell assays with chlorobenzoates showed that JB1 could metabolize all three monochlorobenzoates and dichlorobenzoates containing only meta and para chlorine substituents, but not dichlorobenzoates possessing an ortho chlorine substituent. In enzyme activity assays, meta cleaving 2,3-dihydroxybiphenyl 1,2-dioxygenase and catechol 2,3-dioxygenase activities were constitutive, whereas benzoate dioxygenase and ortho cleaving catechol 1,2-dioxygenase activities were induced by their substrates. No activity was found for pyrocatechase II, the enzyme that is specific for chlorocatechols. The data suggest that complete mineralization of PCBs with three or more chlorine substituents by Alcaligenes sp. JB1 is unlikely.

Reductive ortho and meta Dechlorination of a Polychlorinated Biphenyl Congener by Anaerobic Microorganisms.

We used gas chromatography-mass spectrometry to study the metabolic fate of 2,3,5,6-tetrachlorobiphenyl (2356-CB) (350 muM) incubated with unacclimated methanogenic pond sediment. The 2356-CB was dechlorinated to 25-CB (21%), 26-CB (63%), and 236-CB (16%) in 37 weeks. This is the first experimental demonstration of ortho dechlorination of a polychlorinated biphenyl by anaerobic microorganisms.

Managing scarce services. A waiting list approach to cardiac catheterization.

Relatively little attention has been directed to the provision of health care services when demand exceeds availability. Since "waiting lists" are characteristic of the delivery of cardiovascular services in Manitoba, we hypothesized that the highest priority would be given to cases with the greatest urgency. This study examined the waiting lists for cardiac catheterization in one of two tertiary health care facilities offering comprehensive cardiovascular care to a population of slightly more than one million persons. Hospital records of all patients undergoing cardiac catheterization from May 1981 through December 1982 were abstracted retrospectively. For 871 patients entering a catheterization laboratory by two different routes (Elective Care, N = 557; Immediate Care, N = 314), patient need for immediate catheterization was assessed. Clinical differences between patients in the two groups were striking. Immediate Care patients more frequently had acute congestive heart failure, prior aortic valve surgery, and chronic obstructive pulmonary disease. Immediate Care patients were most frequently in Class 4 of the NYHA functional classification and were more often treated with triple medical therapy. These clinically ill individuals were more likely to enter the hospital via the Emergency Room; they were more likely to have long hospital stays and to die in hospital. As implemented in one Manitoba hospital, the waiting list process appears to have worked fairly well; cardiac arrest, acute myocardial infarction, and death among patients waiting for catheterization were all rare events. Both those patients needing immediate care and those who could wait with a low probability of a poor outcome were successfully identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of chroline substitution pattern on the degradation of polychlorinated biphenyls by eight bacterial strains.

We compared the metabolism of eight di- and trichlorobiphenyls by eight bacterial strains chosen to represent a broad range of degradative activity against polychlorinated biphenyls (PCBs). The PCB congeners used were 2,3-, 2,3'-, 2,4'-, 3,3'-, 2,3,3'-, 2,4,4'-, 2,5,3'-, and 3,4,2'-chlorobiphenyl. The bacterial strains used wereCorynebacterium sp. MB1,Alcaligenes strainsA. eutrophus H850 andA. faecalis Pi434, andPseudomonas strains LB400 and H1130,P. testosteroni H430 and H336, andP. cepacia H201. The results indicated that both the relative rates of primary degradation of PCBs and the choice of the ring attacked were dependent on the bacterial strain used. The bacterial strains exhibited considerable differences in their relative reactivity preferences for attack on mono- and dichlorophenyl groups and in the degree to which the attack was affected by the chlorine substitution pattern on the nonreacting ring. For MB1 the reactivity pattern was 3-≥4-≫2-chlorophenyl with no attack on 2,4- or 2,5-chlorophenyl groups. This strain was relatively insensitive to the chlorine substitution pattern on the nonreacting ring. Strains H1130, H430, H201, and Pi434 exhibited the same reactivity preferences as MB1, but for these strains (and for all others tested) the chlorination pattern on the nonreacting ring had a strong effect. For strain H336 the reactivity preference was 4-≥2->2,4-≥3-chlorophenyl, with no evidence of attack on 2,5-chlorophenyl rings. For strains H850 and LB400 the relative reactivity was 2->2,5->3-≫2,4->4-chlorophenyl. On this basis we propose that the eight bacterial strains represent four distinct classes of biphenyl/PCB-dioxygenase activity.The types of products formed were largely strain-independent and were determined primarily by the chlorine substitution pattern on the reacting ring. When the reacting ring was an unsubstituted phenyl or a 2-chlorophenyl group, the products were chlorobenzoic acids in high yields; for a 3-chlorophenyl ring, both chlorobenzoic acids and chloroacetophenones in moderate yields; and for a 4- or 2,4-chlorophenyl group, chlorobenzoic acids in low yields with an apparent accumulation ofmeta ring-fission product. Strains H850 and LB400 were able to degrade the 3-chlorobenzoic acid that they produced from the degradation of 2,3'-chlorobiphenyl. We conclude that despite differences among strains in the specificity of the initial dioxygenase, the specificities of the enzymes responsible for the subsequent degradation to chlorobenzoic acid and/or chloroacetophenone are quite similar for all strains.

[Stress fractures of the femoral neck]. / Fractures de fatigue du col fémoral.

Four young patients who developed a fatigue fracture of the femoral neck are presented. The clinical features of pain with movement are described. The role of nuclear medicine is discussed with emphasis on its importance in the early diagnosis of this entity. The radiologic stages based on the site and time of presentation are analyzed: 1) normal, 2) sclerotic bands perpendicular to the trabeculations, 3) incomplete fracture, 4) complete fracture.