'What vision?': experiences of Team members in a community service for adults with intellectual disabilities.

BACKGROUND: In the UK, the closure of 'long-stay' hospitals was accompanied by the development of community teams (CTs) to support people with intellectual disabilities (IDs) to live in community settings. The self-reported experiences of staff working in such teams have been neglected. METHODS: Focusing on a single county-wide service, comprising five multi-disciplinary and inter-agency CTs, we measured perceptions among the health care and care management Team members of (1) their personal well-being; (2) the functioning of their team; and (3) the organisation's commitment to quality, and culture. RESULTS: Almost three-quarters of the questionnaires were returned (73/101; 72%). The scores of health care practitioners and care managers were very similar: (1) the MBI scores of more than half the respondents were 'of concern'; (2) similarly, almost four in ten respondents' scores on the Vision scale of the TCI were 'of concern'; (3) the perceived commitment to quality (QIIS-II Part 2) was uncertain; and (4) the organisational culture (QIIS-II, Part 1) was viewed as primarily hierarchical. DISCUSSION: The perceived absence of a vision for the service, combined with a dominant culture viewed by its members as strongly focussed on bureaucracy and process, potentially compromises the ability of these CTs to respond proactively to the needs of people with IDs. Given the changes in legislation, policy and practice that have taken place since CTs were established, it would be timely to revisit their role and purpose.

Microbes, molecular mimicry and molecules of mood and motivation.

The hypothesis proposed is that functional disorders, such as irritable bowel syndrome, chronic fatigue syndrome and anorexia nervosa are caused by auto-antibodies to neuronal proteins induced by molecular mimicry with microbial antigens. The age incidence of these conditions, the marked female excess, increase with economic and technological advance, precipitation by infection, and the paucity of histological changes are all consistent with the hypothesis. It can be tested directly using human sera to search for cross reaction with brain proteins in model systems such as Drosophila melanogaster. The conditions might be amenable to treatment using pooled immunoglobulin. Identification and elimination from the microbial flora of the bacteria that express the cross reacting antigens should be possible.

Hypothalamic-pituitary-adrenal (HPA) axis activity in adults with intellectual disabilities: a preliminary investigation.

BACKGROUND: Cortisol is a marker of physiological arousal, exhibiting a characteristic pattern of diurnal activity. The daily cortisol profile has been xamined extensively and is atypical in a number of clinical disorders. However, there are very few studies focussing on the cortisol profile in adults with intellectual disabilities (ID). This paper reports a preliminary investigation into the nature of the cortisol profile in adults with mild or moderate ID and provides reflections on the challenges of psychophysiological research in this population. METHODS: On two consecutive days, 39 adults with mild or moderate ID each donated saliva samples for cortisol analysis, at multiple times between waking and evening. A comparison between these data and the published literature permitted a descriptive assessment of the cortisol awakening response (CAR) and diurnal profile. A variety of psychometric measures and an assessment of behavioural history were also collected in order to describe aspects of the participants' emotional and behavioural states. RESULTS: Individuals with ID exhibit a diurnal cortisol secretion profile, qualitatively similar to that of the typical, healthy, adult population. However, the findings also suggested a blunted CAR, warranting further investigation. There was also some evidence that cortisol secretion was affected by anxiety and a recent history of aggression. CONCLUSION: While further work is required to characterise the CAR fully, there was no indication that the diurnal cortisol profile among people with ID differs from that of the typical population. This study also demonstrates that, although challenging, it is feasible, and acceptable to participants, to collect repeated physiological measures from men and women with mild and moderate ID.

Five Years Experience of Ureterovaginal Fistulae Following Obstetric or Gynecological Intervention in Ethiopia

To study the etiology; presentation and outcome of women presenting to the Addis Ababa Fistula Hospital with an ureterovaginal fistula. Patients and Methods Women presenting with ureterovaginal fistulae following obstetric or gynecological intervention. The operating register from June 2004 to July 2009 was studied to identify women who had undergone ureteric re-implantation. Patient files were reviewed and only women with fistulae resulting from iatrogenic injury were included. Results Ureterovaginal fistulae were found in 89 women; 64 after Caesarean section; of which 43 were for a stillborn baby; 12 women have uterine rupture; 6 with instrumental delivery and only 7 with abdominal hysterectomy. The left ureter was most frequently injured (54). The number of patients seen has doubled over the past two years. Using one of four methods of repair; 88 women were continent at discharge from hospital. One died from a suspected pulmonary embolism. conclusion The incidence of iatrogenic ureteric injury is increasing in Ethiopia and most result from Caesarean section. The reasons should be studied. Using a variety of repair techniques; all patients can be cured. However; surgeons undertaking this surgery should have a wide range of urological training

Potential new insecticides for the control of western flower thrips (Thysanoptera: Thripidae) on sweet pepper, tomato, and lettuce.

New pesticides are required to maintain effective resistance management strategies for control of western flower thrips, Frankliniella occidentalis (Pergande) (Thysanoptera: Thripidae). We tested the efficacy of acetamiprid, and thiamethoxam, two neonicotinoids that represent a newer class of insecticides for the control of thrips. We also tested chlorfenapyr, a pyrrol compound, and a lower than registered rate of the biopesticide spinosad. Laboratory bioassays were used to predict the relative efficacy of insecticides against F. occidentalis and to forecast likely field rates. Two doses within the calculated LC99.99 range were used to predict field rates and trial rates of 0.5 g and 1.0 active ingredient (AI)/liter acetamiprid, 0.025 and 0.05 g (AI)/liter chlorfenapyr, 0.3 and 0.6 g (AI)/liter thiamethoxam, and 0.01 g (AI)/ liter spinosad were tested in the greenhouse against pepper, lettuce, and tomato. With the exception of acetamiprid, field trial doses predicted from laboratory bioassay translated to effective field efficacy. All products controlled F. occidentalis at the rates trialed and so have potential to augment current chemical controls. Increasing mortality correlated with increasing acetamiprid concentration in a greenhouse lettuce trial, suggesting that the higher trial rate (1.0 g [AI]/liter) may be required in some lettuce crops. The lower than registered (0.01 g [AI]/liter) rate of spinosad also significantly reduced F. occidentalis numbers and is a viable control option that may be useful in specific integrated pest management programs. The implications of introducing neonicotinoids into existing insecticide resistance management strategies for F. occidentalis are discussed.

Diminished lung function, RSV infection, and respiratory morbidity in prematurely born infants.

BACKGROUND: Diminished lung function appears to be a risk factor for respiratory syncytial virus (RSV) infection/bronchiolitis in term born infants. AIMS: To determine if diminished lung function prior to neonatal unit discharge was associated with subsequent symptomatic RSV lower respiratory tract infection (LRTI) and respiratory morbidity in prematurely born infants. METHODS: Of 39 infants in a tertiary neonatal intensive care unit (median gestational age 28 weeks, range 23-31), 20 had bronchopulmonary dysplasia. Lung function (compliance and resistance of the respiratory system (C(rs) and R(rs)) and functional residual capacity (FRC)) was measured on the neonatal unit at 36 weeks postmenstrual age (PMA). Following neonatal unit discharge, nasopharyngeal aspirates were obtained on every occasion, at home or in hospital, an infant had an LRTI. RSV was identified by immunofluorescence and/or culture. RESULTS: The 15 infants who suffered a symptomatic RSV LRTI had a higher mean R(rs) and suffered more wheeze at follow up than the rest of the cohort. Regression analysis showed that a high R(rs) was significantly associated with a symptomatic RSV LRTI; significant factors for cough were a high R(rs) and a symptomatic RSV LRTI, and for wheeze were a high R(rs). CONCLUSION: Prematurely born infants, who had a symptomatic RSV LRTI and/or respiratory morbidity at follow up, had worse lung function prior to neonatal unit discharge.

Prospective study of healthcare utilisation and respiratory morbidity due to RSV infection in prematurely born infants.

BACKGROUND: A study was undertaken to determine the impact of respiratory syncytial virus (RSV) infection, both in hospital and the community, on healthcare utilisation and respiratory morbidity in prematurely born infants and to identify risk factors for symptomatic RSV infection. METHODS: A hospital and community follow up study was undertaken of 126 infants born before 32 weeks of gestational age. Healthcare utilisation (hospital admissions and general practitioner attendances) in the first year, respiratory morbidity at follow up (wheeze and cough documented by parent completed diary cards), and RSV positive lower respiratory tract infections (LRTIs) were documented. Nasopharyngeal aspirates were obtained for immunofluorescence and culture for RSV whenever the infants had an LRTI, either in the community or in hospital. RESULTS: Forty two infants had an RSV positive LRTI (RSV group), 50 had an RSV negative LRTI (RSV negative LRTI group), and 32 infants had no LRTI (no LRTI group). Compared with the RSV negative LRTI and the no LRTI groups, the RSV group required more admissions (p=0.392, p<0.001) and days in hospital (p=0.049, p=0.006) and had more cough (p=0.05, p=0.038) and wheeze (p=0.003, p=0.003) at follow up. Significant risk factors for symptomatic RSV LRTI were number of siblings (p=0.035) and maternal smoking in pregnancy (p=0.005), for cough were number of siblings (p=0.002) and RSV LRTI (p=0.02), and for wheeze was RSV LRTI (p=0.019). CONCLUSION: RSV infection, even if hospital admission is not required, is associated with increased subsequent respiratory morbidity in prematurely born infants.

Dampened ventilatory response to added dead space in newborns of smoking mothers.

BACKGROUND: Term newborns can compensate fully for an imposed dead space (tube breathing) by increasing their minute ventilation. OBJECTIVE: To test the hypothesis that infants of smoking mothers would have an impaired response to tube breathing. DESIGN: Prospective study. SETTING: Perinatal service. PATIENTS: Fourteen infants of smoking and 24 infants of non-smoking mothers (median postnatal age 37 (11-85) hours and 26 (10-120) hours respectively) were studied. INTERVENTIONS: Breath by breath minute volume was measured at baseline and when a dead space of 4.4 ml/kg was incorporated into the breathing circuit. MAIN OUTCOME MEASURES: The maximum minute ventilation during tube breathing was determined and the time constant of the response calculated. RESULTS: The time constant of the infants of smoking mothers was longer than that of the infants of non-smoking mothers (median (range) 37.3 (22.2-70.2) v 26.2 (13.8-51.0) seconds, p = 0.016). Regression analysis showed that maternal smoking status was related to the time constant independently of birth weight, gestational or postnatal age, or sex (p = 0.018). CONCLUSIONS: Intrauterine exposure to smoking is associated with a dampened response to tube breathing.

Developing an evidence-based procedure: maintenance of central venous catheters.

This article describes the creation of an evidence-based guideline as part of a learning experience of a group of clinical nurse specialists. The guideline was the product of a utilization-focused integrated review of the literature conducted with the guidance of a nurse researcher. Key aspects of the evidence-based recommendations, as well as factors that facilitated or hindered this effort, are shared.

The effectiveness of tonsillectomy in diagnosing lymphoproliferative disease in pediatric patients after liver transplantation.

OBJECTIVE: To determine the effectiveness of diagnosing forms of lymphoproliferative disease by performing tonsillectomy in pediatric patients who develop symptomatic or asymptomatic tonsillar hypertrophy during immunosuppressive therapy after liver transplantation. DESIGN: Retrospective chart and pathological review. SETTING: Urban tertiary referral children's hospital. MAIN OUTCOME MEASURES: The presence of a pathological stage of lymphoproliferative disease or Epstein-Barr virus (EBV) diagnosed using tonsillar specimens, resulting in a change in therapy. RESULTS: Of 275 pediatric patients who underwent liver transplantation, 13 had tonsillectomy performed with histopathological review of the tonsillar specimens. The specimens from 5 patients (39%) demonstrated pathological changes thought to be consistent with EBV-related changes or a form of lymphoproliferative disease. Histological changes ranged from tonsillar hyperplasia associated with EBV infection to large cell lymphoma. Immunosuppressive therapy was reduced or discontinued, and antiviral therapy was initiated. CONCLUSION: Children who have undergone liver transplantation and develop tonsillar hypertrophy should undergo a diagnostic tonsillectomy, regardless of the clinical presentation, to rule out a form of posttransplant lymphoproliferative disease. Arch Otolaryngol Head Neck Surg. 2000;126:1444-1447

Women with learning disabilities: risk behaviours and experiences of the cervical smear test.

This paper reports the findings of a study on the views and experiences of women with learning disabilities regarding the cervical smear test. The experience and opinions of the carers were also taken into account. The study was carried out between 1997 and 1999 in Cambridgeshire. The factors that influenced whether women with a learning disability had a smear test included: sexual activity; number of sexual partners; pregnancy; and a past history of smoking. Women with a learning disability who had a cervical smear test most often experienced pain and difficulty with the procedure. Factors that enable women with a learning disability to undergo a cervical smear test, according to their experiences, will be discussed in this paper. These include: the importance of prolonged preparation; issues surrounding communication; the giving of information; and support from the carers. The implications of these findings for collaborative working between learning disability nurses and primary healthcare professionals in clinical practice are highlighted.

Using communicative action in the primary prevention of cancer.

The primary prevention of disease, including cancer, has been a major part of health promotion and health education for decades. However, the long-term results of these strategies have been mixed, and primary prevention as an instrument of cancer control continues to fail to live up to either public or professional expectations. The authors identify and critique two possible factors contributing to this failure and then offer a model for the development and implementation of primary prevention strategies that addresses these factors. The model used is based on Habermas's theory of communicative action and recognizes the importance of a critical dialogue in health education and health promotion. The primary prevention programs currently being conducted by the Cancer Centre for the Southern Interior are presented as an example of the model in action.

Plateletpheresis efficiency: a comparison of the spectra LRS and AMICUS separators.

BACKGROUND: Optimizing the yields of plateletpheresis by increasing collection efficiencies may provide several benefits: to patients, by increasing the dose in single-donor platelet (SDP) units; to the collection center, by increasing the percentage of components that may be split into double units; and/or to the donor, by reducing the duration of donation. STUDY DESIGN AND METHODS: A prospective, randomized study was undertaken to compare the efficiency of platelet collection in paired donations by 21 donors on two cell separators (Spectra LRS, version [v] 5.1; and AMICUS, v2.37). The order of donation was randomly assigned; donations were performed at least 2 weeks apart. A fixed blood volume (4000 mL) was processed by utilizing standard protocols. Findings were confirmed in a retrospective, matched study that compared the two separators by using fixed collection times (90 min). RESULTS: The AMICUS and Spectra LRS separators consistently produced white cell-reduced (<1 x 10(6) white cells) components. The AMICUS harvested 32 percent more platelets on average (median, 4.9 x 10(11); range, 1.5-8.7 x 10(11)) than the Spectra LRS (median, 3.7 x 10(11); range, 2.1-7.7 x 10(11)) (p = 0.03), with mean times of 71.5 and 66.0 minutes (p = 0.03), respectively, to process 4000 mL. Mild donor reactions tended to be more common on the AMICUS separator, which used significantly more ACD (median 482 mL vs. 389 mL; p<0.0001) than on the Spectra LRS. CONCLUSIONS: The AMICUS separator harvested more platelets per unit of blood volume processed than the Spectra LRS. Possible benefits include increased dose in each single-donor unit, increased double-unit harvests, and/or shorter donation time.

Disseminated lymphangiosarcoma in a dog.

This case is unusual due to its extended clinical course. Clinical, histopathological, and immunohistochemical findings are presented.

Transport of CaM kinase along processes elicited by neuronal contact evokes an inhibition of arborization and outgrowth in D. melanogaster cultured neurons.

Transgenic Drosophila strains expressing an inhibitory peptide of Ca2+/calmodulin dependent protein kinase II (CaM kinase), or a constitutively activated CaM kinase, show altered neuronal process morphology compared to wild type in scanning electron microscopy (SEM) of cultured mature neurons from embryonic neuroblasts. We observed significantly enhanced process growth in cells with inhibited enzyme, and reduced process growth in cells with activated enzyme, suggesting that active CaM kinase is involved in the inhibition of neurite growth during development. The subcellular distribution of CaM kinase in wild type neuronal cultures was determined using a gold particle labeling procedure which allowed the mapping of the enzyme directly in the scanning electron microscope (SEM). Before neuronal contact there was little labeling of processes, but after connections had been made the processes were heavily labeled. Our results suggest that the major transport of CaM kinase to the terminals does not occur until after or during the formation of neuronal connections when a functional synapse might be formed. Taken together, these results suggest a target-dependent transport of the enzyme along processes and an inhibitory role for CaM kinase on neurite branching.

Endogenously inhibited protein kinase C in transgenic Drosophila embryonic neuroblasts down regulates the outgrowth of type I and II processes of cultured mature neurons.

Embryonic neurons were cultured from transgenic Drosophila melanogaster expressing a highly specific pseudosubstrate inhibitor of protein kinase C (PKC). Flies homozygous for this transgene, which is under the control of the yeast UAS promoter, were crossed to flies homozygous for the yeast heat shock inducible transcription factor GAL 4. Following heat shock, the progeny express the pseudosubstrate inhibitor at high levels. This strategy, which has the advantage of avoiding the non-specific effects of drugs, was used to study the role of PKC in process growth of cultured, differentiating neuroblasts. An external gold particle labeling procedure using a cell surface antigen expressed by mature neurons and processes was used to visualize neuronal processes directly in the scanning electron microscope. We observed that cell cultures expressing a low concentration of the pseudosubstrate inhibitor showed a significant decrease in the number of type I and II processes as compared to control cultures, while the proportions of neuroblasts, ganglion mother cells (GMCs), and mature neurons in the clusters were little affected.