Viability and dormancy of the Clematis vitalba aerial seed bank.

Old man's beard (Clematis vitalba L.) is a liana species that has become invasive in many areas of its introduced range. Seeds are produced in abundance and are both physiologically and morphologically dormant upon maturity. To understand the importance of seeds to its invasiveness, changes in viability and dormancy of the aerial seed bank were tracked throughout the after-ripening period and during storage. Seeds collected every second month for 2 years were subjected to germination tests. Other seeds stored in outdoor ambient conditions or in a dry, chilled state were dissected before, during, and after imbibition, as well as during incubation, to measure embryo size. Less than 72% of seeds on the mother plant were viable. Viable seeds remained completely morpho-physiologically dormant throughout autumn, even when treated with nitrate. Physiological dormancy declined in response to seasonal changes, yet morphological dormancy did not change until seeds had been exposed to appropriate germination conditions for several days. Fully dormant autumn seeds decayed at higher rates during incubation than partially or fully after-ripened seeds, which were also more germinable and less dormant. Furthermore, seeds incubated in complete darkness were more likely to decay or remain dormant than those exposed to light. This study demonstrates that fewer than three-quarters of seeds produced are viable and further decay occurs after dispersal, yet total fertility is still very high, with enormous propagule pressure from seeds alone. Viable seeds are protected with two forms of dormancy; morphological dormancy requires additional germination cues in order to break after seasonal changes break physiological dormancy.

Informing the delivery of cancer survivorship care in rural primary care practice.

PURPOSE: The cancer survivor population is projected to increase to 22.2 million by 2030, requiring improved collaboration between oncology and primary care practices (PCP). PCPs may feel ill-equipped to provide cancer survivorship care to patients without input from cancer specialists. Compared with nonrural cancer survivors, rural cancer survivors report experiencing worse treatment-related symptoms. The goal of this study was to gain a better understanding of the perspectives of PCP teams towards survivorship care and to develop and test an interdisciplinary training program to improve cancer survivorship care in rural practice. METHODS: This study was conducted in two phases. First, focus groups were conducted with rural PCP teams to gather information regarding beliefs, practices, and barriers related to cancer survivorship care delivery. A thematic analysis was completed using an iterative process of reviewing transcripts. Results from phase 1 were used to inform the development of a pilot intervention tested within seven rural PCPs (phase 2). Pre- and post-intervention knowledge changes were compared, and post-session interviews assessed planned or sustained practice changes. RESULTS: Seven PCPs participated in focus groups (phase 1). Cross-cutting themes identified included (1) organizational barriers affecting the delivery of cancer survivorship care, (2) challenges of role delineation with specialists and patients, (3) difficulty accessing survivorship care and resources, and (4) providers' lack of knowledge of cancer survivorship care. For phase 2, seven practices participated in four case-based educational sessions. Within and between practice changes were identified. CONCLUSION: This project explored cancer survivorship perspectives among PCP teams. Lack of familiarity with evidence-based guidelines and the inability to identify cancer survivors was apparent during discussions and led to the implementation of the phase 2 intervention, iSurvive. As a result, PCPs either changed or planned changes to improve the identification and evidence-based care of cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Address barriers to access cancer survivorship care in rural primary care practices.

Stratigraphy of stable isotope ratios and leaf structure within an African rainforest canopy with implications for primate isotope ecology.

The canopy effect describes vertical variation in the isotope ratios of carbon (δ13C), oxygen (δ18O) and partially nitrogen (δ15N) within plants throughout a closed canopy forest, and may facilitate the study of canopy feeding niches in arboreal primates. However, the nuanced relationship between leaf height, sunlight exposure and the resulting variation in isotope ratios and leaf mass per area (LMA) has not been documented for an African rainforest. Here, we present δ13C, δ18O and δ15N values of leaves (n = 321) systematically collected from 58 primate food plants throughout the canopy (0.3 to 42 m) in Côte d'Ivoire, West Africa. Besides leaf sample height and light availability, we measured leaf nitrogen and carbon content (%N, %C), as well as LMA (n = 214) to address the plants' vertical resource allocations. We found significant variation in δ13C, δ18O and δ15N, as well as LMA in response to height in combination with light availability and tree species, with low canopy leaves depleted in 13C, 18O and 15N and slightly higher in %N compared to higher canopy strata. While this vertical isotopic variation was not well reflected in the δ13C and δ15N of arboreal primates from this forest, it did correspond well to primate δ18O values.

Obesity and obesity-related secondary conditions in adolescents with intellectual/developmental disabilities.

BACKGROUND: To explore the prevalence of obesity and related secondary conditions associated with obesity in adolescents with intellectual/developmental disabilities (IDD). METHODS: In total, 461 parents of adolescents with IDD (M = 14.9 year, SD = 1.9) across 49 US states completed a web-based survey containing questions related to their child's health status, including body weight and existing health conditions. Results were compared with published data for youth without disabilities. RESULTS: Adolescents with autism and Down syndrome were two to three times more likely to be obese than adolescents in the general population. Secondary health conditions were higher in obese adolescents with IDD compared with healthy weight adolescents with IDD including high blood pressure, high blood cholesterol, diabetes, depression, fatigue, liver or gallbladder problems, low self-esteem, preoccupation with weight, early maturation and pressure sores. CONCLUSION: Obesity is as much of a health problem in youth with IDD as it is among youth without disabilities and, in certain disability groups, is a significantly greater health problem. Obese youth with IDD have a high number of obesity-related secondary conditions predisposing them to greater health problems as they transition into adulthood. Federal and local initiatives to reduce obesity among youth in the general population must recognise the need for interventions that are also relevant (i.e. accessible and effective) for youth with IDD.

A controlled trial of topical nitroglycerin in a New Zealand white rabbit model of brown recluse spider envenomation.

STUDY OBJECTIVES: Topical nitroglycerin has been reported to prevent skin necrosis from brown recluse spider bites, but this has never been scientifically tested. This study attempts to assess the effects of topical nitroglycerin on experimental Loxosceles reclusa envenomations. METHODS: We performed a randomized, blinded, controlled study in an animal care facility. Twenty-four New Zealand white rabbits were experimentally envenomated by means of subcutaneous injection with 20 microg of brown recluse spider venom. Rabbits were randomized to 1 of 2 experimental groups. The treatment group received 1 in of 2% topical nitroglycerin ointment every 6 hours for 3 days applied directly to the envenomation site. The control group received the vehicle without nitroglycerin. Gross examination of the lesions and measurements of the areas of the lesions were made daily. Creatine phosphokinase (CPK), blood urea nitrogen, creatinine, hemoglobin, and hematocrit levels were measured on days 0, 5, and 10. Lesions were excised after 10 days and examined by a blinded pathologist, who measured the area of necrosis and quantified inflammation and edema using a standard wound-healing score. For all values, mean values plus SD were determined. All comparisons made over multiple time points were assessed for significance by using a repeated-measures analysis of variance followed by Fisher least significant difference and Scheffé post hoc comparisons. A P value of.05 or less was used to determine significance. The Student's t test was used to compare the means of single measures. Significance was determined by using 95% confidence intervals. Comparisons of total area of necrosis were made with the nonparametric Mann-Whitney U test because of the heavy positive skew of the data. RESULTS: Skin necrosis developed in all animals. Mean values of the lesion area were not significantly different over time between the 2 groups of animals. At day 10, the median area of necrosis was 22.3 cm2 for the treatment group and 15.4 cm2 for the control group (P =.12). The inflammation score was 3.33+/-0.78 for the treatment group and 2.79+/-1.29 for the control group (P < .01). The edema score was 1.25+/-1.28 for the treatment group and 0.98+/-1.10 for the control group (not significantly different). CPK levels increased dramatically in both groups, with the greatest increase in the treatment group. In both groups hemoglobin and hematocrit levels decreased significantly, whereas WBC counts and platelet counts increased significantly, without significant differences between the 2 groups. CONCLUSION: At the dose used in this experiment, topical nitroglycerin did not prevent skin necrosis, increased inflammation score, and increased serum CPK levels. The results of this study do not support the use of topical nitroglycerin in the treatment of L reclusa envenomation and suggest that systemic toxicity could be increased.

The role of early colposcopy in the management of females with first episode anogenital warts.

212 females attending a genitourinary medicine (GUM) clinic with first episode anogenital warts were screened by cervical cytology and colposcopy/histology for the presence of cervical epithelial abnormalities in keeping with infection by the human papillomavirus (HPV infection) and/or cervical intraepithelial neoplasia (CIN). The prevalence of cervical epithelial abnormalities detected by cervical cytology alone was 32%, rising to 56% after colposcopic examination. However, the majority of cervical lesions detected by colposcopy alone were of low grade (HPV infection and/or CIN I). Histologically-confirmed high grade cervical lesions (CIN II or CIN III) were detected more frequently in those females in whom cervical cytological examination indicated dyskaryosis in keeping with any grade of CIN, compared to females without dyskaryotic changes on cervical smear (P < 0.05, chi-squared test with Yates' correction). Early colposcopy is indicated for females with anogenital warts in the presence of a cervical smear showing dyskaryosis in keeping with any grade of CIN, because of the statistically significant increased risk of detecting a potentially progressive high grade cervical lesion. In females without dyskaryotic changes on cervical smear, the value of early colposcopy is uncertain and warrants larger more long-term trials.

Adenovirus type 8 epidemic keratoconjunctivitis in an eye clinic: risk factors and control.

Epidemic keratoconjunctivitis (EKC) due to adenovirus type 8 affected 126 (7%) of 1870 ophthalmology clinic patients during an outbreak. Risk factors and mode of transmission were studied by comparing cases (n = 58) and controls (n = 200) for exposure to risk factors. Pneumotonometry (odds ratio [OR], 10.5; 95% confidence interval [CI], 4.0-27.7), multiple clinic visits (OR, 5.9; 95% CI, 3.3-10.6), and contact with an infected physician (OR, 3.3; 95% CI, 1.2-9.0) were significant risk factors for infection. The hands of 3 patients and 3 physicians with EKC were cultured before and after hand washing to assess adenovirus removal; 3 had hand cultures positive for adenovirus after hand washing. In conclusion, this outbreak appeared to be due to inadequate disinfection of instruments, especially pneumotonometers, and finger-to-eye transmission by health care workers. Hand washing did not reliably remove adenovirus from contaminated fingers. Gloving for exam of eyes with EKC may help prevent transmission. Ophthalmologists with EKC were a significant risk factor for patients and should be furloughed for the duration of communicability.

Viruses and heart disease: a problem in pathogenesis.

Identification of viral myocarditis offers problems; pathologists fail to agree on the definition of the disease and biopsy-proven cases documented in the English literature are still few in number. Though endomyocardial biopsy is becoming a standard procedure at many medical centers, tissue sampling, especially in cases of patchy myocarditis, can result in further diagnostic difficulties. While conventional wisdom holds dilated cardiomyopathy the end-stage of chronic viral myocarditis, a history of preceding viral infection is usually unobtainable. Some research suggests that myocardial necrosis is a cell-mediated immune process and chronic myocarditis an autoimmune disease. Understanding the true relationship between viruses and heart disease will require further research.

Localization of Legionella pneumophila in tissue using FITC-conjugated specific antibody and a background stain.

Lightly staining formalin-fixed or fresh tissue with Gram's crystal violet obviates interfering nonspecific fluorescence by acting as a metachromatic stain in ultraviolet light. Against the easily recognized background of tissues and cells fluorescein isothiocyanate-tagged Legionella pneumophila antibodies can then identify this bacterium in or on individual cells. This procedure can be run at room temperature in two hours and has the potential for further widespread applicability.