Why quad bike safety is a wicked problem: an exploratory study of attitudes, perceptions, and occupational use of quad bikes in northern Queensland, Australia.

Quad bike safety represents the quintessential wicked problem. To address this wicked problem, this research explores the use of quad bikes in the northwestern region of outback Queensland, Australia, concentrating efforts on the pastoral industry. Focus groups and interviews were conducted with pastoralists, farmers, retailers, repairers, healthcare professionals, and regulators. The discussions revealed the diverse activities currently undertaken in the region's pastoral enterprises while riding a quad bike, and that attitudes toward the purchase and use of quad bikes vary and may be influenced by retailers. Perceptions of risk and safety in the use of quad bikes in occupational settings also varied. The findings from this study provide insight into the decisions of local pastoralists and agriculturalists to use quad bikes in their workplaces, and attitudes toward safety and injury prevention relating to quad bike use in these industries in northwestern outback Queensland. This study is the first step toward understanding quad bike use in this region, with the goal of reducing injury and death, and will be used in policy and legislation development regarding the use and safety of quad bikes in Australia.

The overall status in rheumatoid arthritis (OSRA) measure--further evidence to support its use in clinical practice.

OBJECTIVES: The overall status in rheumatoid arthritis (OSRA) instrument is a simple summary of health status, including disease activity (OSRA-A) and damage (OSRA-D) scores. Despite evidence of the validity of the OSRA, uptake has been low. This study aimed to assess the responsiveness and re-examine the validity of the OSRA using the measures from the British Rheumatoid Outcome Study Group (BROSG) randomized controlled trial of aggressive vs symptomatic treatment of rheumatoid arthritis (RA) patients. METHODS: 466 patients were recruited. Outcome measures included the OSRA, the OMERACT core set and the DAS28, and were collected at baseline and annually for the 3 yrs of the trial. X-rays of the hands and feet were taken at baseline and 3 yrs. Patients were assigned a Townsend score (a measure of social deprivation) according to area of residence. Construct validity was assessed by correlating the OSRA with a range of outcome measures, and testing for the known inequality in RA outcome between patients classified by social deprivation. Responsiveness to change was assessed against self-reported change over the first year of the trial. RESULTS: The OSRA-A and OSRA-D measures demonstrated construct validity, performing as hypothesized. The OSRA-A was the most responsive measure in the BROSG trial in detecting patient reported improvement and deterioration. The OSRA-D demonstrated similar responsiveness to alternative measures. CONCLUSIONS: Our results demonstrate the validity and responsiveness of the OSRA, and its potential for inclusion in clinical trials. More important, as the OSRA is quick and easily calculated, uses routinely collected information, and provides useful quantitative information about a patient's status and progress it is suitable for use in the routine clinic.

Corticosteroids do not alter the threshold for vertebral fracture.

Corticosteroid use is one of the most important secondary causes of osteoporosis. Generally, it has been believed that in addition to its effect on bone mineral density (BMD), it also causes an alteration in bone quality that means that fractures occur at a lower BMD than might be expected. To establish if this is the case, we have compared the relationship between BMD and vertebral fracture in patients receiving corticosteroids with that in patients who had never received such therapy. Information was gathered on those patients who had been referred to the participating centers and had both BMD measurements and lateral thoracolumbar radiographs. In all, 452 patients (391 female) were identified; of these 82 (63 female) were receiving corticosteroids. There was no significant difference in BMD between the patients on corticosteroids and those with other suspected causes of osteoporosis. Vertebral fractures were present in 53% of patients on steroids compared with 35% of those who had no such treatment (p = 0.0035). The fractures were more likely to be multiple in patients on corticosteroids (p = 0.0042). However, if the relationship between bone density and fracture is investigated by plotting the cumulative prevalence of fracture against the bone density, measured by T score, the median BMD for fractures actually was marginally lower in patients on steroids, -2.74 (95% confidence interval [CI], -2.77 to -2.70) compared with -2.65 (95% CI, -2.66 to -2.65) in those who had not received steroids. Our results fail to support the notion that the fracture threshold is altered in patients on long-term steroids and suggest that the same diagnostic criteria should be used for osteoporosis in patients whether or not they are taking corticosteroid therapy.

What date/acquaintance rape victims tell others: a study of college student recipients of disclosure.

The authors surveyed 828 college students and found that approximately one third (n = 282) of the respondents reported that one or more women had told them that they had been raped by their dates or acquaintances. The 282 respondents who knew 1 or more victims of date/acquaintance rape reported on a total of 396 victims. The number of victims identified by respondents ranged from 1 to 3 or more (1 = 73%; 2 = 19%, 3 = 5%, > or = 4 = 3%). Reactions to disclosure offered by these respondents were generally supportive of the victim. The respondents' reactions suggested that there is a continuing need to educate students about the incidence and risks associated with date/acquaintance rape and the possibility of disclosure, particularly by friends or dating partners, and brought out some possible helpful and some counterproductive reactions to such disclosures.

Exploring practical knowledge: a case study of an experienced senior tennis performer.

The purpose of the study was to explore sport-related practical knowledge through the perceptions and experiences of a senior adult competitive tennis performer. Practical knowledge was defined as goal oriented, experiential knowledge developed within particular physical activity settings. Data were collected through formal interviews and participant observation and analyzed through narrative inquiry and conventional coding techniques. The data suggest that the tennis environment was perceived in terms of the opportunities afforded by that environment. Specifically, the participant's practical knowledge centered on performance capabilities and strategic planning that revealed opponent limitations. This knowledge appeared to be developed and expressed within the relationships among individual capabilities, the task, and the situated context of game play.

A brief screening instrument for assessing parental alcoholism in college student populations.

The Children of Alcoholics Short Screening Instrument (CASSI), a four-item Likert-type scale, was developed to fulfill the need for a screening instrument to identify children of alcoholics (COAs) in college student populations. A sample of 369 college students was surveyed to assess the psychometric properties of the CASSI; the scale had a Cronbach alpha reliability coefficient of .94 and a 4-week test-retest reliability of .81. The CASSI correlated significantly with the Children of Alcoholics Screening Test (CAST), which supported its concurrent validity. The CASSI appears to be a promising research tool for identifying COAs, particularly among college student populations.

Designated-driver programs: college students' experiences and opinions.

We investigated the experiences and opinions of college students regarding the use of designated drivers. Although using designated drivers appeared to be common, results indicated that in many instances the designated driver did not abstain from drinking alcoholic beverages. The opinions of the participants indicated that the nondrivers in a drinking group may in fact drink more when there is a designated driver. Our findings lead us to question the overall value of currently practiced designated-driver programs for college student drinkers. Developing programs on how to be a designated driver are among our recommendations.

Gender-specific changes in students' sexual behaviors and attitudes at a southeastern university between 1973 and 1988.

This study investigated the gender-specific, self-reported sexual behaviors and attitudes of never-married college students attending a southeastern university in 1973 and 1988. Data were collected by means of a mailed questionnaire that remained essentially unchanged for both years. The authors found that both men and women reported an increase in heterosexual relationships that included sexual intercourse and a decrease in nonsexual relationships with the other gender. The majority of the students perceived themselves as adequately informed about sexuality and satisfied with their relationships, although the proportion of men who reported being satisfied with their relationships declined over the 15 years. The students indicated that sexuality education should focus primarily on information about AIDS and on preparation for marriage.

Children of alcoholics in the classroom: a survey of teacher perceptions and training needs.

Children of alcoholics (COAs) represent a population at risk for alcoholism as well as other physical, emotional, and social problems. This survey explored perceptions of North Carolina elementary and middle school teachers regarding roles and responsibilities in assisting COAs, their need for additional training specific to COAs, and their perceptions of school-based resources for helping COAs. Survey findings teachers generally are willing to assist COAs but need training regarding these children. Training is particularly appropriate for teachers who perceive a low incidence of COAs in their classrooms since these individuals' responses suggest the existence of barriers to effective COA assistance.

Risk factors for the transmission of diarrhoea in children: a case-control study in rural Malaysia.

In response to a recorded increasing incidence of diarrhoea in Tumpat District, Malaysia, a case-control study was performed to identify modifiable risk factors for the transmission of diarrhoea, in children aged 4-59 months. Ninety-eight pairs of children, matched on age and sex, were recruited prospectively from health centres. Exposure status was determined during a home visit. Interviewers were 'blinded' as to the disease status of each child. Odds ratios were measured through matched pair analysis and conditional logistic regression. Risk factors for diarrhoea identified were: reported--drinking of unboiled water, storage of cooked food before consumption and bottle feeding; and observations--animals inside the house and absence of washing water in latrines. Water quality, source of drinking water, reported hand washing behaviour, indiscriminate defecation by children, cup use and the absence of a functional latrine were not associated with diarrhoea. Nonsignificant associations were found for: accessibility of washing water source, type of water storage container and use of fly covers for food.

PIP: In February-March 1989, during home visits, health investigators collected data on 98 pairs of 4-59 month old children recruited from 5 government health centers in rural Tumpat District in Malaysia to identify the risk factors for transmission of diarrhea. The controls had acute respiratory infections. Households not boiling drinking water and children drinking that water were leading risk factors of diarrhea transmission (adds ration [OR]=15, p=.02 and OR=3.13, p.001, respectively). 80.3% of reported boiled drinking water samples did not have any fecal coliforms. Storage of cooked food for 2 hours before consumption was a risk factor OR of conditional logistic regression=3 for 2 hours, p=.02; 2.44 for 2 hours=1/2 day, p=.03; and 9.82 for 1.2 day, p=.03). Another risk factor was animals (cats and chickens) living inside the dwelling (OR=2.41, p=.06). Socioeconomic status could not account for these 2 risk factors. Even though having no latrine in the house was not associated with diarrhea (OR=1.7, p=5), no water available with which to wash the anus and hand in latrines located in those houses which had latrines was significantly associated with diarrhea (OR=2.8, p=.05). This may have reflected overall poor hygienic standards. Even though breast feeding did not have a strong protective effect against diarrhea, bottle feeding was significantly associated with diarrhea (OR=8.07, p=.06). The lack of negative association between breast feeding and diarrhea may have been due to the controls' had respiratory infections, and breast feeding does have a protective effect against them. These results can help health officials to develop intervention strategies to reduce the incidence of diarrhea in rural children in Malaysia.

Anaemia of chronic disease in rheumatoid arthritis: effect of the blunted response to erythropoietin and of interleukin 1 production by marrow macrophages.

Anaemia in rheumatoid arthritis (RA) is a common and debilitating complication. The most common causes of this anaemia are iron deficiency and anaemia of chronic disease. Investigations have suggested that interleukin 1 (IL-1) or tumour necrosis factor (TNF), or both, from monocytes associated with chronic inflammation are responsible for the anaemia of chronic disease. On bone marrow examination anaemia of chronic disease is characterised by the diversion of iron from the erythropoietic compartment into marrow macrophages. This phenomenon is termed failure of iron utilisation. In this study, CFU-E (colony forming unit erythroid; late red cell precursors) and BFU-E (burst forming unit erythroid; early red cell precursors) stem cells were cultured from 10 normal marrow samples and 12 marrow samples from patients with RA with iron deficiency anaemia and 10 samples from patients with RA with failure of iron utilisation. All patients with RA were anaemic (haemoglobin less than 100 g/l), Potential accessory or inhibitory cells of erythropoiesis (CD4, CD8, or CD14 positive cells) were removed before culture. Control marrow samples were studied in a similar manner. Normal marrow samples yielded 377 (17) CFU-E and 133 (6) BFU-E (mean (SD)) colonies for each 2 x 10(5) light density cells plated. CD4 ablation caused reductions of 62 and 100% in CFU-E and BFU-E colonies respectively. CD14 removal resulted in considerable but lesser reductions of 46% for CFU-E and 25% for BFU-E. In both groups of patients with RA, CFU-E colony numbers were significantly lower than those seen in normal control subjects, 293 (17) for patients with iron deficiency anaemia and 242 (35) for patients with failure of iron utilisation. BFU-E colony numbers were 102 (13) and 108 (20) respectively. In patients with RA, CD4 removal caused a significantly greater loss of CFU-E colonies compared with normal control subjects. Cytolysis of CD14 positive cells caused a reduction in CFU-E colonies in the two RA groups which was similar to that seen in normal subjects. In conclusion, patients with RA seem to have fewer CFU-E progenitors but essentially normal numbers of BFU-E stem cells. Our data suggest a stimulatory role for marrow CD4 and CD14 cells in erythropoiesis in patients with RA. Monocytes-macrophages (CD14 positive) are known to be producers of IL-1 or TNF, or both, however, the predicted increase in the CFU-E colonies on removal of CD14 cells is not seen. Therefore, if IL-1 or TNF, or both, are responsible for the impairment of erythropoiesis in patients with RA, marrow macrophages are unlikely to be the source. Moreover, these results indicate the probability of erythropoietin resistance on the basis of diminished CFU-E colony formation in patients with RA.

Increase in neutrophil Fc gamma receptor I expression following interferon gamma treatment in rheumatoid arthritis.

The therapeutic potential of interferon gamma (IFN gamma) in a number of disease states is still being explored, but progress is hampered by the lack of a suitable measure of in vivo biological activity. To assess the in vivo biological effects of recombinant human IFN gamma (rhIFN gamma), 14 patients were studied in a randomised, prospective, double blind, placebo controlled trial of this cytokine for the treatment of rheumatoid arthritis. The levels of Fc gamma receptors on peripheral blood neutrophils were measured at baseline and after 21 days of once daily, subcutaneous injections of rhIFN gamma or placebo. An induction of neutrophil Fc gamma receptor type I (Fc gamma RI) was seen in the group of patients receiving recombinant human rhIFN gamma but not in those receiving placebo. No change in the expression of Fc gamma RII or Fc gamma RIII was detected. The amount of induction of Fc gamma RI detected on the neutrophils of patients receiving rhIFN gamma did not correlate with clinical measures of response at either 21 days or at the end of the study (24 weeks). No significant clinical responses were observed in the rhIFN gamma group at these times. These data confirm that the reported in vitro effect of IFN gamma on human neutrophil Fc receptor expression can be reproduced in vivo.

Molecular analysis of the fragile X syndrome.

The molecular analysis of human X-linked disease has progressed rapidly over the last few years owing to advances in power of mapping techniques. Physical DNA maps covering more than 5 million base pairs have been constructed for several chromosomal regions. Many of these regions have now also been cloned into overlapping cosmid and YAC contigs facilitating the search for disease genes. The recent identification of the mutation in the fragile X syndrome is such an example of the power of YAC technology in the characterization of human genetic disease mutations.

Cloning and characterization of the genes for the two homocysteine transmethylases of Escherichia coli.

We have cloned the genes for the two homocysteine transmethylases of Escherichia coli K12. The vitamin B12-independent enzyme is encoded by the metE gene while the metH gene codes for the vitamin B12-requiring enzyme. Overexpression of the gene products and Tn1000 mutagenesis have enabled the metE and metH gene products to be identified as 99 kDa and 130 kDa polypeptides, respectively. The truncated polypeptides generated by Tn1000 insertion were used to determine the direction of transcription of the metE and metH genes. Negative complementation suggests that the MetH enzyme exists as an oligomer. Investigation of the expression of the chromosomal- and plasmid-encoded gene products confirms that metE is subject to negative control by vitamin B12 and methionine, and that metH is under positive control by the cofactor and negative control by methionine. For vitamin B12 and methionine to act as regulatory effectors in metE control, functional metH and metJ genes are required, respectively. The use of stable Tn1000-generated fragments of the metE product as electrophoretic markers for the plasmid-encoded metE gene product demonstrated that the two regulatory proteins involved in negative control of metE are present in excess. Under conditions whereby both forms of negative metE control are non-functional, the metE gene product represented about 90% of the total protein, and cell growth was severely impaired.

18q deletion syndrome in a child with steroid-17,20-lyase deficiency.

The del (18q) syndrome is characterised by poor growth, variable mental retardation, facial dysmorphism, and abnormalities of the genitalia. In genetic males, genital abnormalities vary from testicular ectopia, and microphallus to severe hypospadias. Genetic females frequently have hypoplasia of the labia minora. We describe a child with del (18q) syndrome and severe ambiguous genitalia. Serum testosterone after 4 doses of hCG (5000 IU/m2/dose) was only 50 ng/dL (expected greater than 300 ng/dL). When testicular tissue was incubated with [1,2-3H]progesterone and 17-hydroxy-[4-14C]progesterone, there was synthesis of 17-hydroxy-[1,2-3H]progesterone but no further metabolism of 17-hydroxyprogesterone to androgens. These data suggested the presence of steroid-17,20-lyase deficiency. In order to determine if steroid-17,20-lyase deficiency was a common feature in del (18q) syndrome we examined 6 other patients (3 girls; 3 boys) with a deletion of the long arm of chromosome 18 distal to band q21. All 6 had dehydroepiandrosterone sulfate (DHEA-S) levels which were lower than those of age-matched controls. Four had delayed puberty. Serum testosterone levels were also low in 2 of the 3 affected boys. These results together with the findings in the index case suggest that a structural or regulatory gene for steroid-17,20-lyase may be located on the long arm of chromosome 18, distal to band q21.