Twenty years of WIC: a review of some effects of the program.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began in 1974 after a 2-year pilot program. WIC links food assistance and nutrition education to health care for at-risk persons. The program had approximately 344,000 participants in 1975 and has grown to provide services to nearly 6 million participants. Infants born to women who participate in WIC during pregnancy tend to have a slightly higher mean birth weight than those born to women who were eligible but did not participate in WIC. Higher birth weight has been associated with a slightly higher mean gestational age. The prevalence of low birth weight and very low birth weight among infants and the prevalence of iron deficiency anemia among toddlers and preschool children is lower for those participating in WIC than for those not participating in WIC.

Factors affecting the in vivo precision of broad-band ultrasonic attenuation.

The in vivo precision of broad-band ultrasonic attenuation (BUA) was measured in one normal male volunteer over periods of one day and six weeks and in a group of 10 volunteers over a period of two weeks using a Walker Sonix UBA 1001 bone mineral analyser in which the foot is immersed in a water tank. Coefficients of variation ranged from 1-3% and, in general, there was no difference in BUA variance between right and left feet. However, right foot BUA values were consistently greater than those of the left, but there was no difference between mediolateral and lateromedial transmission. The use of preboiled water improved precision and reduced measurement time. In addition, factors affecting BUA precision were investigated in the individual volunteer. Equipment stability and conditions of immersion (immersion time, water depth, water temperature and concentration of a detergent wetting agent) had comparatively little effect on BUA values. On the other hand, the effects of foot positioning were more pronounced: rotation about the long axis of the foot, translation across the water tank and foot movement in the dorsal-plantar direction each contributed a maximum of 1.5-2.0% variation in BUA. However, both rotation about the long axis of the leg and foot movement in the heel-toe direction could change BUA by as much as 9%. It is likely that foot positioning will limit the precision achievable with this technique.

Optical coherence microscopy in scattering media.

We describe a novel technique, based on optical coherence tomography, for enhanced optical sectioning in confocal microscopy. Confocal imaging deep into highly scattering media is demonstrated and compared with the predictions of a single-backscatter theory.

Temporal instabilities associated with a planar high purity germanium detector.

Experiments have been performed which show that a grooved planar high purity germanium semiconductor detector may give rise to time variant counting rates in energy regions below prominent spectral peaks. It is postulated that this effect is due to prolonged or incomplete charge collection in the vicinity of the bottom of the groove, and is caused by distortions in the applied electric field in this region. Such effects may lead to changes in the minimum detectable count rate in x-ray fluorescence measurements; these can be reduced by collimating incident photons on the central region of the detector but the resulting reduction in efficiency lowers the overall sensitivity.

A theoretical analysis of the accuracy of single-energy CT bone-mineral measurements.

A relationship has been derived between the in vivo concentration of calcium hydroxyapatite and the in vitro concentration of K2HPO4 solution in a single-energy quantitative computed tomography (QCT) bone-mineral determination. Under certain simplifying assumptions this relationship is linear. The gradient term has been calculated as a function of scanner effective energy using the measured variation of solvent water density with K2HPO4 concentration; it ranges from 1.17 at 60 keV to 1.21 at 80 keV. The intercept term has been calculated as a function of effective energy, patient age and trabecular bone volume (TBV) by modelling the constituents of whole trabecular bone and using published normal composition data. It varies from about 15 to 25 mg cm-3 at an effective energy of 70 keV and within a TBV range of 5 to 20%. This intercept term may be used as an additive correction which improves the accuracy of single-energy QCT results without significant loss of precision. However, the method is limited by the uncertainties of tissue composition in an individual patient.

For better, for worse: nursing in higher education.

In this paper the recently proposed developments in nursing education within the United Kingdom are discussed within a historical context. Since a number of nursing departments already exist within the higher education sector (comprising universities, polytechnics and colleges of technology), it is suggested that use should be made of the experience already gained by nurses working within higher education. The pros and cons of nurse education being provided in or associated with higher education are discussed. Theoretical perspectives from change theory are applied. The importance of educating the practitioner for a holistic and community-based role is stressed.

Struma ovarii: a case report.

A patient with struma ovarii and hyperthyroidism is described. She was treated for Graves' hyperthyroidism at age 22 and received thyroxine for post-operative hypothyroidism. Twenty years later she became thyrotoxic and was treated with antithyroid drugs and radioiodine. Diagnosis of struma ovarii was made by radioiodine profile scanning and an ovarian tumour was removed. This had the pathological features of struma ovarii and autoradiographic evidence of pre-operatively administered 125I was seen in the lesion. The patient had positive results for long acting thyroid stimulator (LATS) and LATS-protector (LATS-P) pre- and post-operatively. Bioassays for thyroid stimulators were positive post-operatively but radioreceptor assays for TsAb were consistently negative. It is suggested that profile scanning is an appropriate investigation for diagnosis. It is not clear whether the lesion was autonomous or being stimulated by circulating thyroid stimulators.

Interaction of the infant formula industry with the academic community.

The infant formula industry and the academic community have developed and maintained significant educational and research interactions over the past four decades. A third partner in the enterprise is government. These cooperative efforts have led to the development of quality formula products to meet the needs of healthy infants and the special needs of infants with various medical disorders.

The influence of enamel prism orientation on leakage of resin-bonded restorations.

A new method is described for the quantification of leakage between etched enamel and restorative resin. A significant correlation was demonstrated between the plane of enamel section prior to etching and subsequent leakage. It is suggested that these findings will be of value in the design of cavities for use with the acid-etch technique; when possible, enamel should be prepared to expose prisms transversely prior to etching and bonding.

Daily multivitamin supplementation and vitamin blood levels in the elderly: a randomized, double-blind, placebo-controlled trial.

Despite the many questions being raised about multivitamin use by the elderly, it has not been proven that consuming an oral multivitamin alters vitamin blood levels in the aged. To address this question, we performed a randomized, prospective, placebo-controlled study of daily multivitamin supplementation in 101 noninstitutionalized ambulatory elderly persons (median age, 64 years). Vitamin levels were assayed at baseline, and at two and four months of supplementation. At four months, those taking multivitamins had statistically significant increased levels of water soluble vitamins (C, B2, B12, plasma, and erythrocyte folate) that were greater than changes noted for the placebo group. This was not true for fat soluble vitamins A and E. Greater storage pools of fat soluble vitamins help explain this discrepancy. We conclude that in the ambulatory elderly, oral multivitamins can raise levels of water soluble vitamins but the effect on fat soluble vitamins remains uncertain.

Effect of lithium on the metabolic response to parathyroid hormone.

Blood and urine samples were collected at timed intervals for up to 120 min after the start of a 30-min infusion of 30 IU bovine parathyroid hormone (PTH) into 6 normal male subjects. Infusions were performed before and after 7 days' treatment with lithium carbonate. A highly significant increase in the maximum renal tubular reabsorption capacity for calcium (TmCa/GFR) from 2.02 +/- 0.04 to 2.17 +/- 0.07 mmol/l (p less than 0.02) produced a significant rise in plasma calcium. Lithium had no effect on basal fasting PTH or nephrogenous cyclic AMP (cAMP). Changes in nephrogenous cAMP and TmP/GFR in response to PTH were not altered by lithium. The absorption of 47Ca following an oral calcium load was increased in 5 out of 6 subjects also treated for 1 week with lithium. These results suggest that lithium has a direct effect on calcium transport, both at the level of the renal tubule and the gut, which is not mediated by stimulation of parathyroid activity or via modification of PTH-stimulated adenylate cyclase.

Prediction of outcome in Graves' disease after carbimazole treatment.

In a prospective study to determine which factors would predict remission or relapse, 65 patients with hyperthyroid Graves' disease were treated for six months with a blocking replacement regimen of carbimazole, 40 mg daily, and triiodothyronine (T3). They were followed for one year after stopping treatment, by which time 32 (49 per cent) had relapsed. Although the treatment protocol, relapse rate and frequency of the HLA-DR3 antigen in this population were similar to those of a regionally separate Graves' population investigated previously, the predictive value of HLA-DR3 status together with thyroid stimulating antibody (TSAB) levels was strikingly different. In the present study there was no significantly abnormal distribution of any HLA antigen in the relapse group compared with those patients who achieved remission. Thyroid stimulating antibodies were detected in 62 patients (95 per cent) and fell significantly (p less than 0.05) after carbimazole treatment, irrespective of DR3 status or outcome; TSAB levels only became undetectable in nine patients (28 per cent) who subsequently relapsed and in nine patients (30 per cent) who maintained remission. T3-suppressed 20 min 123I uptake fell equally after treatment in the relapse and remission groups but continued to fall thereafter in the group which maintained remission. In these patients, 123I uptake was significantly lower at the end of the study period than at the end of treatment (p less than 0.05). Serum free T4 levels were higher before treatment in the patients who later relapsed than in those whose disease remitted (p less than 0.02). This proved the only significant marker associated with outcome but was of little predictive value in any patient. This study highlights the problem in predicting the outcome of antithyroid drug treatment, since even within the same country under similar conditions, divergent results have been obtained. It appears that the loci controlling the immune response in Graves' disease are likely to include genes lying outside the HLA-DR region. The results also suggest that the immunological effects of antithyroid drugs are maintained after stopping treatment in those patients whose disease remits.

Duplex scanning of the thyroid.

High resolution ultrasound scanners are used to image nodular thyroid glands and in the study of thyroid malignancy. There are no specific ultrasonic characteristics of malignant lesions to distinguish them from benign conditions. Preliminary results using a Duplex ultrasound scanner shows that the detection of a high frequency Doppler-shift signal from the superior thyroid artery is indicative of an overactive thyroid. In a study of 23 consecutive patients who were being investigated for possible hyperthyroidism, 15 were found to have normal thyroid function and 8 to be overactive. The normals had a mean systolic peak frequency of 1.77 +/- 1.75 kHz, and the hyperthyroid group 4.08 +/- 1.5 kHz. This result is highly significant, having a p value less than 0.0002 (Mann-Whitney U Test). In another 10 patients with solid lesions, one was diagnosed as follicular carcinoma. High frequency Doppler shift signals, similar to those found in carcinoma of the breast, were detected in the periphery of the lesion but were not found in nine cases of adenoma. Duplex scanning may assist in the investigation of hyperthyroidism and in the differential diagnosis of benign and malignant lesions.

Post-arterial reconstruction edema, are lymphatic channels to blame?

Edema which follows successful arterial reconstruction of a previously ischemic lower limb is a common observation. Most patients have no long term difficulty, but this side effect requires considerable attention to leg care and frequently delays resumption of normal activity. Earlier studies suggested various causes. This study looked into lymphatic causes. 125I RIHSA clearance was monitored in 4 patients who developed edema following femoropopliteal bypass, and 5 patients who did not develop edema following other vascular procedures. In the edematous limbs following successful femoropopliteal bypass grafting, the mean T 1/2 was 18.4 hours when compared to 52.7 hrs. in other procedures (p less than .025). This indicates increased lymphatic flow of the distal superficial lymphatics. It is concluded that post reconstruction edema is not due to lymphatic disruption but is instead of multifactorial origin.