Evaluating an adapted reverse categorisation task to assess cognitive flexibility in young children with Down syndrome.

BACKGROUND: Accurate measurement of cognitive skills is necessary to advance both developmental and intervention science for individuals with Down syndrome (DS). This study evaluated the feasibility, developmental sensitivity and preliminary reliability of a reverse categorisation measure designed to assess cognitive flexibility in young children with DS. METHODS: Seventy-two children with DS ages 2.5-8 years completed an adapted version of a reverse categorisation task. Twenty-eight of the participants were assessed again 2 weeks later for retest reliability. RESULTS: This adapted measure demonstrated adequate feasibility and developmental sensitivity, and preliminary evidence for test-retest reliability when administered to children with DS in this age range. CONCLUSIONS: This adapted reverse categorisation measure may be useful for future developmental and treatment studies that target early foundations of cognitive flexibility in young children with DS. Additional recommendations for use of this measure are discussed.

Invasive micropapillary carcinoma of the breast: eighty cases of an underrecognized entity.

Eighty cases of infiltrating duct carcinoma of the breast with a pure or partial micropapillary component are reported. The cases were analyzed using various parameters, including age at presentation, tumor size, tumor grade, presence of lymphatic invasion, and axillary lymph node status. The patients' age at presentation ranged from 36 to 92 years (mean, 58.8 years). Tumor size ranged from 0.1 to 10 cm (mean, 2.0 cm); 67.5% (54 of 80) were poorly differentiated, and 32.5% (26 of 80) were moderately differentiated; 62.5% (50 of 80) of the cases had lymphatic invasion; 72.3% (47 of 65) of cases with axillary dissections had positive lymph nodes; and 25% (20 of 80) of the tumors were < or = 1.0 cm and 7.5% (6 of 80) were < or = 0.5 cm. The characteristics of these small tumors with an invasive micropapillary component have not previously been reported. Despite their minute size, these small micropapillary carcinomas seem to show the same proclivity for lymphatic spread and nodal dissemination as larger tumors with this unique histologic pattern.

Spit (smokeless) tobacco use by high school baseball athletes in California.

OBJECTIVE: To describe the prevalence, patterns, and correlates of spit (smokeless) tobacco (ST) use in a sample of high school baseball athletes in California. DESIGN: This cross sectional study was a survey of 1226 baseball athletes attending 39 California high schools that were randomly selected from a list of all publicly supported high schools with baseball teams. At a baseball team meeting, athletes who agreed to participate and had parental consent completed the study questionnaire. To enhance the accuracy of self reported ST use status, a saliva sample was collected from each subject. The questionnaires and saliva samples were coded and salivary cotinine assay was performed on a random subsample of 5% of non-users who also were non-smokers. Biochemical assay indicated that 2% tested positive for cotinine inconsistent with self reported ST non-use. RESULTS: Overall, 46% had ever used ST and 15% were current users. Odds ratios and 95% confidence intervals (CI) suggested that, among high school baseball athletes, age, living in a rural area, being white, smoking cigarettes, drinking alcohol, not knowing about the adverse effects of ST, perceiving little personal risk associated with ST use, and believing that friends, role models, teammates, and same age baseball athletes in general used ST, increased the likelihood of being an ST user. CONCLUSION: The findings indicate that considerable experimentation with ST products occurs among high school baseball athletes in California, and many are current users. ST interventions targeting this population are needed to stop the transition from experimental ST use to tobacco dependence. Correlates of ST use for consideration in future intervention studies are identified.

Application of the human needs conceptual model to dental hygiene practice.

The Human Needs Conceptual Model is relevant to dental hygiene because of the need for dental hygienists to be client focused, humanistic, and accountable in practice. Application of the Human Needs Conceptual Model provides a formal framework for identifying and understanding the unique needs of the client that can be met through dental hygiene care. Practitioners find that the Human Needs Conceptual Model can not only help them in assessment and diagnosis, but also in client education, decision-making, care implementation, and the evaluation of treatment outcomes. By using the model, the dental hygienist is able to manage client care humanistically and holistically, and ensure that care is client-centered rather than task-oriented. With the model, a professional practice can be made operational.

Species-specific detection of hydrocarbon-utilizing bacteria.

Rapid detection and quantitative assessment of specific microbial species in environmental samples is desirable for monitoring changes in ecosystems and for tracking natural or introduced microbial species during bioremediation of contaminated sites. In the interests of developing rapid tests for hydrocarbon-degrading bacteria, species-specific PCR primer sets have been developed for Pseudomonas aeruginosa, Stentrophomonas (Xanthomonas) maltophilia, and Serratia marsescens. Highly variable regions of the 16S rRNA gene were used to design these primer sets. The amplification products of these primer sets have been verified and validated with hemi-nested PCR and with ligase chain reaction (LCR) techniques, and have been applied to the analyses of environmental water samples. These species-specific primer sets were also chosen to amplify in conjunction with a universal set of PCR primers chosen from highly conserved neighboring sequences in the same gene. These multiplex or competitive PCR procedures enable testing with an internal marker and/or the quantitative estimation of the relative proportion of the microbial community that any one of these species occupies. In addition, this universal PCR primer set amplified the same size amplicon from a wide spectrum of procaryotic and eucaryotic organisms and may have potential in earth biota analyses.

Smokeless tobacco cessation intervention for college athletes: results after 1 year.

OBJECTIVES: The purpose of this study was to determine the efficacy of a college-based smokeless tobacco cessation intervention targeting college athletes. METHODS: Sixteen colleges were matched for prevalence of smokeless tobacco use in their combined baseball and football teams and randomly assigned within college pairs to the intervention or the control group. One-year prevalence of cessation among smokeless tobacco users was determined by self-report of abstinence for the previous 30 days. Differences between groups were analyzed in a weighted version of the Fisher 1-sided permutation test for paired samples after adjustment for significant predictors of quitting other than the intervention (i.e., smokeless tobacco uses per week and most frequently used brand). RESULTS: Cessation prevalences were 35% in the intervention colleges and 16% in the control colleges when subjects with unknown quit status were defined as nonquitters. After adjustment for other significant predictors of quitting, the difference of 19% increased to 21%. The intervention effect increased with level of smokeless tobacco use. CONCLUSIONS: This intervention was effective in promoting smokeless tobacco cessation, especially among those who were more frequent users.

Epithelioid hemangioendothelioma of the liver mimicking Budd-Chiari syndrome.

A case of epithelioid hemangioendothelioma of the liver in a 34-year-old man with clinical and radiologic findings suggestive of Budd-Chiari syndrome is reported. Despite clinical and radiologic findings, percutaneous liver biopsy was suspicious for epithelioid hemangioendothelioma. The patient underwent liver transplantation 2 months later, and histologic examination confirmed this diagnosis. Unusual histopathologic features included extensive areas of capillary-thin vascular structures with open lumina, lack of significant cytologic atypia in the majority of neoplastic cells, and areas with Budd-Chiari-like features in the hepatic parenchyma surrounding the tumor. The neoplastic cells were focally immunopositive for endothelial markers, such as factor VIII-related antigen and CD34 antigen. The unusual clinical presentation may have been due to tumor invasion and fibrous obliteration of terminal hepatic venules and sublobular veins. Epithelioid hemangioendothelioma should be considered when evaluating patients with clinical features of Budd-Chiari syndrome or veno-occlusive disease.

Frequency and carrier risk associated with common BRCA1 and BRCA2 mutations in Ashkenazi Jewish breast cancer patients.

Based on breast cancer families with multiple and/or early-onset cases, estimates of the lifetime risk of breast cancer in carriers of BRCA1 or BRCA2 mutations may be as high as 85%. The risk for individuals not selected for family history or other risk factors is uncertain. We determined the frequency of the common BRCA1 (185delAG and 5382insC) and BRCA2 (6174delT) mutations in a series of 268 anonymous Ashkenazi Jewish women with breast cancer, regardless of family history or age at onset. DNA was analyzed for the three mutations by allele-specific oligonucleotide hybridization. Eight patients (3.0%, 95% confidence interval [CI] 1.5%-5.8%) were heterozygous for the 185delAG mutation, two (0.75%, 95% CI 0.20-2.7) for the 5382insC mutation, and eight (3.0%, 95% CI 1.5-5.8) for the 6174delT mutation. The lifetime risk for breast cancer in Ashkenazi Jewish carriers of the BRCA1 185delAG or BRCA2 6174delT mutations was calculated to be 36%, approximately three times the overall risk for the general population (relative risk 2.9, 95% CI 1.5-5.8). For the 5382insC mutation, because of the low number of carriers found, further studies are necessary. The results differ markedly from previous estimates based on high-risk breast cancer families and are consistent with lower estimates derived from a recent population-based study in the Baltimore area. Thus, presymptomatic screening and counseling for these common mutations in Ashkenazi Jewish women not selected for family history of breast cancer should be reconsidered until the risk associated with these mutations is firmly established, especially since early diagnostic and preventive-treatment modalities are limited.

Prevalence of spit tobacco use across studies of professional baseball players.

A review of published data, together with previously unpublished information, shows that the use of spit tobacco among professional baseball players continues to be alarmingly high. In spite of efforts to make players aware of the harmful effects, approximately 35 percent to 40 percent of professional baseball players still use spit tobacco, and about half of those have associated lesions. However, current efforts of the National Spit Tobacco Education Program, Major League Baseball, the Professional Baseball Athletic Trainers Society and the Major League Baseball Players Association are expected to result in a significant reduction in spit tobacco use in this population in the next decade.

A dental-based, athletic trainer-mediated spit tobacco cessation program for professional baseball players.

During 1997 spring training, the National Spit Tobacco Education Program provided a spit (smokeless) tobacco intervention program to 16 professional baseball clubs. The program consisted of an awareness-raising presentation and an opportunity to discuss quitting spit tobacco use with an expert cessation counselor. For two clubs, however, a more extensive intervention was pilot-tested for feasibility and acceptability among their major- and minor-league teams during their regularly scheduled health examinations at the beginning of spring training. The intervention included an oral exam by a dentist who advised spit tobacco users to stop and pointed out any spit tobacco-associated lesions in the player's mouth, brief cessation counseling by a specially trained dental hygienist, and ongoing support and follow-up by the certified athletic trainer to promote cessation. Findings from this pilot study indicate that this intervention, which is dependent upon involvement of dental professionals, was feasible to implement during spring training and appeared to be well-received by the athletes. Dental professionals are in an excellent position to advise and help spit tobacco users to quit and can have an important role in helping youth overcome this rapidly growing addiction.

Whole blood platelet function assay on the ICHOR point-of-care hematology analyzer.

The role of platelets as the initial defense against insult to the vasculature is well established. Moreover, platelets are now recognized as having a critical role in the acute care settings of cardiopulmonary bypass (CPB) procedures and cardiac catheterization. In the environment of CPB, both platelet count and function have been demonstrated as being markedly compromised during and following the procedure. Unfortunately, current assays that are used to evaluate the parameters of platelet count and function are limited in regard to their utility in a near patient format. Here, we describe a practical, rapid, and user-friendly whole blood platelet function assay that has been developed for the ICHOR point-of-care hematology analyzer. This analyzer is capable of performing an eight parameter blood profile including platelet count. In comparable studies, platelet aggregation in whole blood demonstrated good correlation (for ADP the values were n = 14, r2 = 0.81, p = 0.0001; for collagen, n = 10, r2 = 0.93, p = 0.0001; for ristocetin, n = 10, r2 = 0.89, p = 0.0001; and for epinephrine, n = 10, r2 = 0.81, p = 0.0003) with traditional platelet-rich aggregometry, which uses increased light transmission as an indication of platelet aggregation. Furthermore, early feasibility studies in CPB patients demonstrated both decreased platelet count and a marked reduction in platelet function peri-procedurally. This new assay of platelet function is extremely suitable for the clinical environment with rapid turnaround time and provides a full hematology profile to enhance transfusion decisions.

Effect of Dietary Supplementation with α-Tocopheryl Acetate on the Stability of Reformed and Restructured Low Nitrite Cured Turkey Products.

The objective of this study was to investigate the effects of sodium (Na) nitrite reduction on the oxidative and colour stability of reformed and restructured cured cooked turkey products manufactured from meat containing high and low levels of dietary α-tocopheryl acetate. Turkeys were randomly assigned to either a control group, fed a basal α-tocopheryl acetate diet (20mg/kg feed), or a treatment group fed a supplemented α-tocopheryl acetate diet (600mg/kg feed). Diets were fed ad libitum from day 1 until slaughter on day 147. Breast meat from control and treatment groups was used to manufacture cured reformed cooked turkey ham and cured restructured cooked turkey patties. Residual levels of 60 and 120mg Na nitrite/kg of meat were used. Turkey products were packaged in either overwrap or vacuum packaging and stored under refrigerated (4°C) illuminated display for 10 days. Results showed that dietary supplementation with α-tocopheryl significantly (p<0·05) improved the oxidative and colour stability of all low nitrite products produced when compared to non-supplemented controls.

Oral effects of smokeless tobacco use by professional baseball players.

This is a review of studies conducted from 1988-90 on the oral consequences of snuff and chewing tobacco use among professional baseball players. About half of the players studied were smokeless tobacco (ST) users, the majority of whom used snuff. Compared with non-users, players who used ST showed a significantly higher prevalence of leukoplakia, which was related to placement of the ST quid, and the frequency, amount, duration, and type of ST used. Sites adjacent to these mucosal lesions showed an increased prevalence of gingival recession with associated attachment loss, cervical abrasion, and root caries than did comparable sites in non-users. Extrinsic stain and occlusal attrition were also more frequent in ST users than in non-users. While ST use placed players at significantly increased risk for mucosal lesions and other oral problems, no differences were found between ST non-users and users in measurements of batting, fielding, and pitching performance during the baseball season.

A spit tobacco cessation intervention for college athletes: three-month results.

Sixteen colleges were matched on the baseline prevalence of spit tobacco (ST) use, and college pairs were randomized, one to the intervention and the other to the control group. Baseball and football athletes at each intervention college received: an oral examination by a dental professional who pointed out ST-related problems in the athlete's mouth and advised him to quit ST use; counseling by a dental hygienist on strategies to cope with cravings and triggers for use; and two follow-up telephone calls. At the three-month follow-up, quit rates were 24% and 16% for the intervention (n = 171) and control (n = 189) groups, respectively (p < 0.05). As the reported amount of ST used weekly increased, the percent of individuals who quit at 3 mos decreased (p < 0.05). Dental professionals appear to be effective in promoting spit tobacco cessation at 3 mos post-intervention in male college athletes, especially among those using lesser amounts of ST.

Smokeless tobacco use: how it affects the performance of major league baseball players.

The authors examined the effect of smokeless tobacco use on the athletic performance of major league baseball players during the 1988 season. They evaluated performance records of 158 players on seven major league teams who played or pitched at least 10 games or innings during the 1988 season. ST use, they concluded, is not related to player performance in major league baseball but does place players at significantly increased risk for mucosal lesions and other oral pathology.

Planning a spit tobacco cessation intervention: identification of beliefs associated with addiction.

We examine the relationship between beliefs regarding spit tobacco (ST) use and addiction among 473 male college athletes who currently use ST. Beliefs were assessed using methods prescribed by the Theory of Reasoned Action. Independent associations between beliefs and addiction, defined by self-reported amount of ST used per week, were found via multivariate polychotomous regression modeling. We found that with increasing addiction level, athletes were significantly more likely to believe that "ST helps me relax," "ST keeps me alert," "ST tastes good," and "ST is addicting." All athletes believed that clinicians, parents, and girlfriends do not approve of their ST use, but that male peers, coaches, and professional athletes are fairly indifferent about it. To increase quit rates, highly addicted ST users may require an intensive cessation program including nicotine replacement to overcome symptoms of withdrawal, oral substitutes for the enjoyable taste of ST, and the support of male peers and athletes who influence their social norms.

Prevalence, patterns, and correlates of spit tobacco use in a college athlete population.

We surveyed varsity athletes (N = 1,328) in 16 California colleges about their patterns of spit (smokeless) tobacco (ST) use, related habits, reasons for use, and preferred methods for quitting. Prevalence of use was analyzed by sport and demographic characteristics, and patterns of use in players using snuff exclusively, using chewing tobacco exclusively, and those using both were compared. Odds ratios and 95% confidence intervals were calculated, adjusting for ethnic group. Prevalence was highest in Whites (44%) and Native Americans (48%) and lowest in African Americans (11%), and higher in varsity baseball (52%) than varsity football players (26%), in players attending rural colleges, and among those who ever smoked cigarettes or used alcohol. Forty-one percent of ST users initiated regular use during their high school years. Athletes who used snuff exclusively used it more intensively and for more years than those who used chewing tobacco exclusively. Snuff users indicated a greater perceived need for ST, but also were more ready to quit. These data suggest ST programs with prevention and cessation components are appropriate for high school as well as college athletes. Such interventions should focus on baseball players, distinguish snuff from chewing tobacco users in planning quit strategies, integrate intervention programs for cigarette smoking and alcohol consumption, provide training in refusal skills, and attempt to change social norms in support of ST use by integrating popular peers and significant others (e.g., wives/girlfriends) to endorse nonuse of ST.

A program to help major league baseball players quit using spit tobacco.

There are few reports in the scientific literature that describe tested methods for helping people quit using spit (smokeless) tobacco. This paper reports data from a pilot study to determine the effectiveness of two dental-oriented interventions to promote cessation of ST use among major league baseball players. These preliminary findings suggest that interventions involving an oral examination and advice to quit, combined with behavioral counseling, may effectively decrease ST use among professional baseball players.

Application of the human needs conceptual model of dental hygiene to the role of the clinician : part II.

In summary, the theories of Maslow and of Yura and Walsh have been highlighted as background for understanding the human needs conceptual model of dental hygiene. In addition, 11 human needs have been identified and defined as being especially related to dental hygiene care, and a sample evaluation tool for their clinical assessment and a dental hygiene care plan have been presented. The four concepts of client, environment, health/oral health, and dental hygiene actions explained in terms of human need theory, and the 11 human needs related to dental hygiene care constitute the human needs conceptual model of dental hygiene. Within the framework of the human needs conceptual model of dental hygiene, the dental hygiene process is a systematic approach to dental hygiene care that involves assessment of the 11 human needs related to dental hygiene care; analysis of deficits in these needs; determination of the dental hygiene care plan based on identified deficits; implementation of dental hygiene interventions stated in the care plan; and evaluation of the effectiveness of dental hygiene interventions in achieving specific goals, including subsequent reassessment and revision of the dental hygiene care plan. This human needs conceptual model for dental hygiene provides a guide for comprehensive and humanistic client care. This model allows the dental hygienist to view each client (whether an individual or a group) holistically to prevent oral disease and to promote health and wellness. Dental hygiene theorists are encouraged to expand this model or to develop additional conceptual models based on dental hygiene's paradigm.