Effectiveness of maternal counseling in reducing caries in Cree children.

This cluster-randomized pragmatic (effectiveness) trial tested maternal counseling based on Motivational Interviewing (MI) as an approach to control caries in indigenous children. Nine Cree communities in Quebec, Canada were randomly allocated to test or control. MI-style counseling was delivered in test communities to mothers during pregnancy and at well-baby visits. Data on outcomes were collected when children were 30 months old. Two hundred seventy-two mothers were recruited from the 5 test and 4 control communities. Baseline characteristics were comparable but not equivalent for both groups. At trial's end, 241 children had follow-up. The primary analysis outcome was enamel caries with substance loss (d2); no statistically significant treatment effect was detected. Prevalence of treated and untreated caries at the d2 level was 76% in controls vs. 65% in test (p = 0.17). Exploratory analyses suggested a substantial preventive effect for untreated decay at or beyond the level of the dentin, d3 (prevalences: 60% controls vs. 35% test), and a particularly large treatment effect when mothers had 4 or more MI-style sessions. Overall, these results provide preliminary evidence that, for these young, indigenous children, an MI-style intervention has an impact on severity of caries (clinical trial registration ISRCTN41467632).

Effective count rates for PET scanners with reduced and extended axial field of view.

We investigated the relationship between noise equivalent count (NEC) and axial field of view (AFOV) for PET scanners with AFOVs ranging from one-half to twice those of current clinical scanners. PET scanners with longer or shorter AFOVs could fulfill different clinical needs depending on exam volumes and site economics. Using previously validated Monte Carlo simulations, we modeled true, scattered and random coincidence counting rates for a PET ring diameter of 88 cm with 2, 4, 6, and 8 rings of detector blocks (AFOV 7.8, 15.5, 23.3, and 31.0 cm). Fully 3D acquisition mode was compared to full collimation (2D) and partial collimation (2.5D) modes. Counting rates were estimated for a 200 cm long version of the 20 cm diameter NEMA count-rate phantom and for an anthropomorphic object based on a patient scan. We estimated the live-time characteristics of the scanner from measured count-rate data and applied that estimate to the simulated results to obtain NEC as a function of object activity. We found NEC increased as a quadratic function of AFOV for 3D mode, and linearly in 2D mode. Partial collimation provided the highest overall NEC on the 2-block system and fully 3D mode provided the highest NEC on the 8-block system for clinically relevant activities. On the 4-, and 6-block systems 3D mode NEC was highest up to ∼300 MBq in the anthropomorphic phantom, above which 3D NEC dropped rapidly, and 2.5D NEC was highest. Projected total scan time to achieve NEC-density that matches current clinical practice in a typical oncology exam averaged 9, 15, 24, and 61 min for the 8-, 6-, 4-, and 2-block ring systems, when using optimal collimation. Increasing the AFOV should provide a greater than proportional increase in NEC, potentially benefiting patient throughput-to-cost ratio. Conversely, by using appropriate collimation, a two-ring (7.8 cm AFOV) system could acquire whole-body scans achieving NEC-density levels comparable to current standards within long, but feasible, scan times.

Protein-membrane interactions: blood clotting on nanoscale bilayers.

The clotting cascade requires the assembly of protease-cofactor complexes on membranes with exposed anionic phospholipids. Despite their importance, protein-membrane interactions in clotting remain relatively poorly understood. Calcium ions are known to induce anionic phospholipids to cluster, and we propose that clotting proteins assemble preferentially on such anionic lipid-rich microdomains. Until recently, there was no way to control the partitioning of clotting proteins into or out of specific membrane microdomains, so experimenters only knew the average contributions of phospholipids to blood clotting. The development of nanoscale membrane bilayers (Nanodiscs) has now allowed us to probe, with nanometer resolution, how local variations in phospholipid composition regulate the activity of key protease-cofactor complexes in blood clotting. Furthermore, exciting new progress in solid-state NMR and large-scale molecular dynamics simulations allow structural insights into interactions between proteins and membrane surfaces with atomic resolution.

Measured count-rate performance of the Discovery STE PET/CT scanner in 2D, 3D and partial collimation acquisition modes.

We measured count rates and scatter fraction on the Discovery STE PET/CT scanner in conventional 2D and 3D acquisition modes, and in a partial collimation mode between 2D and 3D. As part of the evaluation of using partial collimation, we estimated global count rates using a scanner model that combined computer simulations with an empirical live-time function. Our measurements followed the NEMA NU2 count rate and scatter-fraction protocol to obtain true, scattered and random coincidence events, from which noise equivalent count (NEC) rates were calculated. The effect of patient size was considered by using 27 cm and 35 cm diameter phantoms, in addition to the standard 20 cm diameter cylindrical count-rate phantom. Using the scanner model, we evaluated two partial collimation cases: removing half of the septa (2.5D) and removing two-thirds of the septa (2.7D). Based on predictions of the model, a 2.7D collimator was constructed. Count rates and scatter fractions were then measured in 2D, 2.7D and 3D. The scanner model predicted relative NEC variation with activity, as confirmed by measurements. The measured 2.7D NEC was equal or greater than 3D NEC for all activity levels in the 27 cm and 35 cm phantoms. In the 20 cm phantom, 3D NEC was somewhat higher ( approximately 15%) than 2.7D NEC at 100 MBq. For all higher activity concentrations, 2.7D NEC was greater and peaked 26% above the 3D peak NEC. The peak NEC in 2.7D mode occurred at approximately 425 MBq, and was 26-50% greater than the peak 3D NEC, depending on object size. NEC in 2D was considerably lower, except at relatively high activity concentrations. Partial collimation shows promise for improved noise equivalent count rates in clinical imaging without altering other detector parameters.

Expanding SimSET to include block detectors: performance with pseudo-blocks and a true block model.

We present a study that introduces two approaches to implementing block detectors into SimSET and compares their performance. SimSET is a photon tracking simulation package, which currently incorporates only detectors made of a solid annulus of scinitillator material. A pseudo-block approximation has been imposed on the solid annulus of conventional SimSET by discarding interactions in annulus segments that span the angular block gap. This yields blocks that are annulus segments, not rectangles. This is a quick and easy approximation of block structure, which brings SimSET results closer to actual scanner measurements. Even better agreement is expected with a deeper modification of the SimSET code that implements true rectangular blocks in the detector module (to be released late 2007/early 2008). This approach enables the greatest amount of variability and trueness to detail.We compare results from both block structure implementations to the conventional SimSET results and to measurements from a GE DSTE PET/CT scanner. Differences are evaluated in terms of sensitivities, crystal maps, and energy spectra, as well as in benchmark time tests of the simulation runs and their ease of use.Either implementation of block structure can aid in improving simulation accuracy by ameliorating one known cause of discrepancies, the geometric nature of the block detectors.

Change in parental oral health practices following a child's dental treatment under general anaesthesia.

AIMS: This qualitative study explored parental beliefs and behaviours that place their child at risk to caries relapse and parental readiness to adopt and maintain preventive behaviours following their child's general anaesthesia (GA). METHODS: Participants were parents whose children had had dental rehabilitation under GA. Data was collected by semi-structured, open-ended interviews scheduled at the post-operative appointment. Interviews were audio-taped, transcribed, checked and coded into a qualitative software program for analysis. RESULTS: Parents knew about the importance of diet and oral hygiene in the prevention of dental caries, but they were not aware of the role of bacteria. However, many parents perceived their ability to control their child's oral hygiene and eating habits to be limited. The main barriers to healthy baby teeth reported by parents were related to the child (uncooperative behaviour, eating habits, social interactions), the family (poor understanding by other caregivers, mother's self-efficacy, concerns about the cost of treatment), and external events (access to dental services for very young children and advertising of unhealthy commercial products). CONCLUSION: Although the GA experience had a profound emotional effect on parents that motivated them to take immediate action and implement changes in oral health behaviours, they were overwhelmed by the difficulties of applying these behaviours in the long term.

A qualitative look at parents' experience of their child's dental general anaesthesia.

OBJECTIVES: Caries relapse after treatment of early childhood caries (ECC) under general anaesthesia (GA) has been frequently reported. This research used a qualitative method of inquiry to explore parents' experience of their child's treatment under GA, and their perception of the impact of this treatment on their child. METHODS: The participants were parents whose children had recently undergone dental rehabilitation under GA. Data was collected by semistructured, open-ended interviews scheduled at the postoperative appointment. Interviews were audio-taped, transcribed, checked and coded into a qualitative computer software program for analysis. Data collection and analysis were done simultaneously, and the interview guide was modified based on responses. RESULTS: Parents were troubled that their child needed a GA and appeared aware of the complications. While some parents felt 'guilty' and struggled to accept this mode of treatment for their child, others felt 'blameless', and were convinced that the GA was 'preferable' for their child and superior to conventional treatment. Nonetheless, all parents reported some levels of anxiety during the GA; they expressed their emotions with 'fear', 'worry' and 'concern'. After the GA, improvement was reported by most parents in their child's amount of dental pain, sleeping pattern, eating habits and acceptance of parental toothbrushing. The most common changes in their child's behaviour mentioned by parents were increased toothbrushing and decreased consumption of sugary foods. Several children who had had primary teeth extracted were distressed as a result of this 'loss'. CONCLUSION: The general anaesthetic experience was troubling in a variety of ways for both parents and children. However, an 'early' and positive outcome of the GA was a reported improvement in dental health practices. Parents were more positive about maintaining the health of primary teeth and now knew how to take care of their child's teeth. Future exploration is required to reveal if and how the GA experience will affect long-term preventive behaviours.

Evaluation of 1-octen-3-ol, carbon dioxide, and light as attractants for mosquitoes associated with two distinct habitats in North Carolina.

Field studies were conducted in North Carolina to determine the responses of mosquitoes found in salt marsh and inland creek flood plain areas to 1-octen-3-ol (octenol), carbon dioxide (CO2), and light in various combinations with Centers for Disease Control (CDC) light traps. Over 56,000 adult mosquito specimens of 12 species in 4 genera were collected in the salt marsh. They exhibited a general response pattern of octenol + CO2 + light > CO2 + light = octenol + CO2 > octenol + light > octenol alone. Significantly, more Aedes sollicitans, Ae. taeniorhynchus, Anopheles bradleyi, and Culex salinarius were attracted to octenol + CO2 + light than to CO2 + light. Over 19,000 specimens of 24 species in 7 genera were collected in the inland creek flood plain. Although the response patterns to the attractants were similar to those in the salt marsh area, there was no significant difference between octenol + CO2 + light and CO2 + light. Aedes vexans, An. crucians, and An. punctipennis were attracted nearly equally to these two attractant combinations. These studies demonstrate that responses to combinations of these attractants are species specific. However, different combinations of attractants can significantly increase the collection of targeted species important in arbovirus transmission. The use of these combinations would be very beneficial in mosquito-borne virus surveillance studies. The use of octenol by itself or in conjunction with light was found the least useful for collecting mosquitoes in both habitats.

Asymptomatic intraventricular lipid leak from a primary pineal teratoma.

We present a case of pineal teratoma in a symptomatically stable 6-year-old child in which MRI revealed intraventricular lipid accumulation in the absence of any primary tumour growth, metastatic disease or tumour degeneration.

Vetting requests for body computed tomography.

The aim of this study was to assess the process and outcome of hospitalised patients (inpatients) for whom whole-body CT was requested but not performed. For 6 months the reasons why CT was not performed were recorded, together with relevant discussions with clinicians. Subsequent referrals for alternative investigations were noted. The eventual outcome of the patients was monitored via the patients' records. Eighty-three (8%) of 1001 inpatient requests were identified for which body CT was not performed after an electronically generated request. Fifty-five requests were not accepted by the radiology department during the vetting process for a variety of reasons (often more than one): criteria used for rejection often overlapped and included referrals outside national guidelines (n = 20), better alternative investigations (n = 29), time constraints (n = 19), over-zealous requests (n = 17) and clinicians' erroneous interpretation of preceding imaging investigations (n = 9). Sixteen CT exams were cancelled by a clinician. An additional 12 exams were not performed for miscellaneous non-medical reasons. In no case could a patient's death be ascribed to CT not being performed. Most (981 of 1001, 98%) CT requests comply with current guidelines, disproving a perception that many radiological referrals are inappropriate. In our health care system radiologists have to turn down some appropriate CT referrals due to a lack of CT capacity. Although lack of CT contributed to delay in diagnosis, no patient died as a direct result of not having CT.

Can we be sure about a radiological diagnosis of fat necrosis of the breast?

AIMS: We performed a review of the clinical, mammographic and sonographic findings of fat necrosis in a group of patients who presented with a lump in the breast. We aimed to show that, in the light of a non-specific combination of findings, an ultrasound-guided core-biopsy (CB) is a safe, quick and useful test to confirm the diagnosis. The procedure makes it possible to reassure the patient of the true identity of the lesion, thus avoiding the need for surgical excision or follow-up investigations. MATERIALS AND METHODS: We undertook a retrospective review of the clinical presentation, imaging findings and subsequent management of 23 histologically proven cases of fat necrosis. All patients had presented to a specialist breast clinic with a breast lump. RESULTS: Only 52% of patients had a definite history of trauma. Clinical examination intimated that the lump was possibly malignant in 22%, while 4.5% were probably malignant. Fifty-seven per cent of mammograms were completely normal, however ultrasound showed an abnormality in 100%. Of these 100%, 74% were interpreted as possibly malignant. The diagnosis of fat necrosis was histologically confirmed by ultrasound-guided needle core biopsy, performed at the time of initial presentation. All patients were subsequently discharged. The mean time interval from investigation and biopsy to final diagnosis and discharge of the patient was 5.9 days. CONCLUSION: We show that fat necrosis often has a confusing clinical presentation. Imaging by either mammography or ultrasound is often inconclusive and ultrasound-guided core biopsy will confirm the diagnosis sparing patients unnecessary radiological follow-up or surgical excision.

Persistent value of air-augmented radiograph in neonatal high gastrointestinal obstruction, despite more modern techniques.

Air is a safe and effective natural contrast agent in neonatal high gastrointestinal (GIT) obstruction. Successful early decompression often results in plain abdominal radiographs of low diagnostic yield. We present a series of neonates with high GIT obstruction in whom air-augmented abdominal radiographs (AAAR) were performed instead. Fourteen neonates presented with suspected high GIT obstruction. In 12 sick babies, obstruction was confirmed and the level of obstruction was determined. The other two neonates required additional positive contrast upper GIT studies. These confirmed small bowel malrotation. For neonatal high GIT obstruction an AAAR can provide a rapid and accurate diagnosis. Positive contrast agent studies should be performed when the AAAR is non-diagnostic.

Mutations within the Autographa californica nucleopolyhedrovirus FP25K gene decrease the accumulation of ODV-E66 and alter its intranuclear transport.

Previous reports indicate that mutations within the Autographa californica nucleopolyhedrosis virus FP25K gene (open reading frame 61) significantly reduce incorporation of enveloped nucleocapsids into viral occlusions. We report that FP25K is a nucleocapsid protein of both the budded virus (BV) and occluded virus (ODV), and we describe the effects of two FP25K mutations (480-1 [N-terminal truncation] and FP-betagal [C-terminal fusion]) on the expression and cellular localization of ODV-E66 and ODV-E25. Significantly decreased amounts of ODV-E66 are detected in cells infected with 480-1 or FP-betagal viral mutants, even though during FP-betagal infection, steady-state levels of ODV-E66 transcripts remain unchanged. While ODV-E66 is normally detected in intranuclear microvesicles and ODV envelopes by 24 h postinfection (p.i.), ODV-E66 remains cytosolic throughout infection in cells infected with 480-1 virus (up to 96 h p.i.), and its intranuclear localization is not detected until 96 h p.i. in cells infected with the FP-betagal mutant virus. The nuclear localization of ODV-E25 is not affected during infection by the FP-betagal mutant; however, its trafficking is significantly delayed during infection by the 480-1 mutant. Temporal Western blot analyses of cell lysates show that both 480-1 and FP-betagal mutant virus infections result in altered accumulation patterns of several structural proteins, including gp67, BV/ODV-E26, and the major capsid protein p39. In addition to BV/ODV-E26, ODV-E66 and gp67 may interact with FP25K, and ODV-E25 and p39 may also be components of a protein complex containing ODV-E66 and FP25K. Together, these data suggest that FP25K and its associated protein complex(es) may play an important role in the targeting and intracellular transport of viral proteins during infection.

Electroporation-mediated gene transfer in cardiac tissue.

Delivery of genes or macromolecules to cardiovascular tissues provides new therapeutic opportunities for the treatment of many acquired and inherited diseases. To investigate electroporation as a delivery method in cardiac tissue, embryonic chick hearts were studied for uptake of propidium iodide (PI) or DNA encoding either green fluorescent protein (GFP) or luciferase following electrical shock. PI uptake increased monotonically from 6% of heart tissue after 3 shocks to 77% with 12 shocks. GFP and luciferase expression varied in proportion to shock number, with detectable levels in all electrically treated hearts. Thus, electroporation promotes uptake of PI and DNA in cardiac tissue, suggesting further application of this method for therapeutic genes.

Spirituality and hope: nursing implications for people with HIV disease.

The article describes the historical influence of holistic nursing theorists on the integration of spirituality into nursing care. Assessment and interventions for spiritual distress are suggested based on the conceptual model for holistic nursing practice of Dossey and colleagues. Research concerning the influence of hope, a dimension of spirituality, on men with human immunodeficiency virus disease is reported. Practice implications for increasing hope and facilitating spirituality are discussed.

Dislocation of the pituitary gland by sphenocavernous meningiomas.

BACKGROUND: Dislocation of the pituitary gland from the sella turcia by tumor has only very rarely been described. To date, only two cases have appeared in the neurosurgical literature. METHODS: After intraoperative identification of pituitary dislocation in five patients with cavernous sinus meningiomas, a review of our most recent 20 patients with cavernous sinus meningiomas was performed. A subgroup of sphenocavernous meningiomas was identified, as were the associations between pituitary dislocation and the patient's endocrinologic status. RESULTS: Of 20 consecutive patients with cavernous sinus meningiomas, seven tumors could be subclassified as sphenocavernous meningiomas due to the significant amount of tumor extension into the sphenoid sinus. At the time of surgery, dislocation of the pituitary gland from the sella into the suprasellar cistern was observed in five of seven of these patients. Four of the five patients with pituitary dislocation had evidence of hypopituitarism, whereas there was no evidence of this condition in the two patients with sphenocavernous meningiomas without pituitary dislocation. CONCLUSIONS: Pituitary dislocation in these patients is likely due to the physical dislocation of the pituitary gland from the sella, through an incompetent diaphragma sella, and by the tumorous extension in the sphenoid sinus. The extension of a cavernous sinus meningioma into the sphenoid sinus, and specifically the sella turcica, may be via the intercavernous venous sinuses. The lack of endocrinologic improvement suggests that the hypopituitarism noted in these patients is likely due to disturbance of the pituitary microcirculation with subsequent pituitary ischemia. The possibility of pituitary dislocation in patients with sphenocavernous meningiomas, especially those with panhypopituitarism, should be considered and searched for at the time of surgery.