The potential for bluetongue virus serotype 16 to cause disease in sheep in New South Wales, Australia.

BLUETONGUE VIRUS SEROTYPE 16 DETECTION IN NSW: In coastal New South Wales (NSW), bluetongue virus (BTV) serotypes 1 and 21 are endemic and transmitted in most years without evidence of disease. However, serotype 16 (BTV-16) infection was detected for the first time in NSW in November 2016 in cattle undergoing testing for export. Retrospective testing of blood samples collected from sentinel cattle as part of the National Arbovirus Monitoring Program (NAMP) established that the first detected transmission of BTV-16 in NSW occurred in April 2016 in sentinel cattle on the NSW North Coast. Subsequently, until 2022, BTV-16 has been transmitted in most years and was the predominant serotype in the 2018-2019 transmission season. The data available suggests that BTV-16 may have become endemic in NSW. EXPERIMENTAL STUDIES: During experimental infection studies with BTV-16, all sheep were febrile, with the peak of viremia occurring 6-10 days after inoculation. There was nasal and oral hyperaemia in most sheep with several animals developing a nasal discharge and nasal oedema. All sheep developed coronitis of varying severity, with most also developing haemorrhages along the coronary band. There was a high incidence of haemorrhage in the pulmonary artery, epicardial petechiae, extensive pericardial haemorrhages and moderate body cavity effusions including pericardial effusions. CONCLUSION: Overall, experimental pathogenicity findings suggest moderate disease may occur in sheep in the field. These findings, when combined with climatic variability that could result in an expansion of the range of Culicoides brevitarsis into major sheep-producing areas of the state, suggest that there is an increasing risk of bluetongue disease in NSW.

Improving drug delivery to primary and metastatic brain tumors: strategies to overcome the blood-brain barrier.

Brain tumor diagnosis has an extremely poor prognosis, due in part to the blood-brain barrier (BBB) that prevents both early diagnosis and effective drug delivery. The infiltrative nature of primary brain tumors and the presence of micro-metastases lead to tumor cells that reside behind an intact BBB. Recent genomic technologies have identified many genetic mutations present in glioma and other central nervous system (CNS) tumors, and this information has been instrumental in guiding the development of molecularly targeted therapies. However, the majority of these agents are unable to penetrate an intact BBB, leading to one mechanism by which the invasive brain tumor cells effectively escape treatment. The diagnosis and treatment of a brain tumor remains a serious challenge and new therapeutic agents that either penetrate the BBB or disrupt mechanisms that limit brain penetration, such as endothelial efflux transporters or tight junctions, are required in order to improve patient outcomes in this devastating disease.

A comparison of multimedia and standard advanced cardiac life support learning.

OBJECTIVES: To compare student performance after Multimedia ACLS Learning System (MM) education compared with that after standard (ST) ACLS education. METHODS: Final-year medical students were divided into 2 groups based on convenience scheduling and given ACLS instruction either in a standard format or with the MM course. The sizes of the small groups and the times in small-group instruction were identical. All students were evaluated with the same 50-item multiple-choice written examination, a structured evaluation immediately after the management of a mock cardiac arrest, and a second structured evaluation of the same mock arrest (videotaped) by an instructor blinded to the education method. Students were assigned a mark from 1 to 5 in each of 4 domains: assessment, immediate priorities, continual assessment, and leadership. RESULTS: 75 students took the MM and 38 took the ST course. The mean +/- SD mark for the multiple-choice test was 89.3 +/- 4.9% (MM) vs 89.3 +/- 4.8% (ST); the on-site mock arrest evaluation mark (20 maximum) was 14.1 +/- 2.5 (MM) vs 14.1 +/- 2.0 (ST); and the blinded mock arrest evaluation was 13.1 +/- 2.9 (MM) vs 14.4 +/- 2.9 (ST) (p = 0.024). 1/75 (MM) vs 0/38 (ST) did not successfully complete the on-site mock arrest evaluation. More students in the MM group (46% vs 25%) required multiple attempts to successfully complete the mock arrest evaluation (p < 0.02). CONCLUSION: In medical students with no previous ACLS training, structured access to the multimedia ACLS Learning System provides immediate educational outcomes similar to those of a standard ACLS course. Multimedia computer-interactive learning should be enhanced with a short period of hands-on practice.

Intergeneric coaggregation of oral Treponema spp. with Fusobacterium spp. and intrageneric coaggregation among Fusobacterium spp.

A total of 22 strains of Treponema spp. including members of all four named human oral species were tested for coaggregation with 7 strains of oral fusobacteria, 2 strains of nonoral fusobacteria, and 45 strains of other oral bacteria, which included actinobacilli, actinomyces, capnocytophagae, eubacteria, porphyromonads, prevotellae, selenomonads, streptococci, and veillonellae. None of the treponemes coaggregated with any of the latter 45 oral strains or with the two nonoral fusobacteria. All treponemes, eight Treponema denticola strains, eight T. socranskii strains, four oral pectinolytic treponemes, one T. pectinovorum strain, and one T. vincentii strain coaggregated with at least one strain of the fusobacteria tested as partners. The partners consisted of one strain of Fusobacterium periodonticum, five F. nucleatum strains including all four subspecies of F. nucleatum, and a strain of F. simiae obtained from the dental plaque of a monkey. In the more than 100 coaggregations observed, the fusobacterial partner was heat inactivated (85 degrees C for 30 min), while the treponemes were unaffected by the heat treatment. Furthermore, the fusobacteria were usually inactivated by proteinase K treatment, and the treponemes were not affected. Only the T. denticola coaggregations were inhibited by lactose and D-galactosamine. None were inhibited by any of 23 other different sugars or L-arginine. Intragenic coaggregations were seen among the subspecies of F. nucleatum and with F. periodonticum, and none were inhibited by any of the sugars tested or by L-arginine. No intrageneric coaggregations were observed among the treponemes. These data indicate that the human oral treponemes show a specificity for oral fusobacteria as coaggregation partners. Such cell-to cell contact may facilitate efficient metabolic communication and enhance the proliferation of each cell in the progressively more severe stages of periodontal disease.

A rapid method for extraction and purification of DNA from dental plaque.

A rapid method based on previously described DNA extraction procedures was developed for the isolation of DNA from dental plaque samples. The isolated DNA is suitable for use in the PCR. Freeze-thawing, cell wall-degrading enzymes, and guanidine isothiocyanate were used to lyse cells and release DNA. The released DNA was adsorbed onto diatomaceous earth and purified by washing with guanidine isothiocyanate, ethanol, and acetone. The purified DNA was released from the diatomaceous earth into an aqueous buffer and analyzed by PCR with 16S rDNA primers (rDNA is DNA coding for rRNA). As judged from studies with pure cultures of a number of bacterial species, gram-negative and gram-positive organisms were lysed equally well by this procedure. The amount of PCR product was proportional to the number of cells analyzed over the range tested, 500 to 50,000 cells. On the basis of studies with plaque samples that were spiked with known quantities of the oral bacterium Treponema denticola, the DNA prepared from plaque was free of substances inhibitory to PCR. This method should have utility in molecular genetic studies of bacterial populations not only in uncultured plaque samples but also in other complex bacterial assemblages.

Relationship between age and drinking patterns and drinking problems among Japanese, Japanese-Americans, and Caucasians.

Comparing alcohol consumption patterns by age and gender among Japanese in Japan and Japanese-Americans and Caucasians in the United States, this study examined the associations between age and both heavy drinking and social problems using logistic regression for each ethnic group of male current drinkers. As reported in previous studies of Caucasians, men drink more alcohol than women, older respondents are more likely than younger ones to be abstainers, and the percentages of heavier drinkers and problem drinkers are higher among the young than among older people. Although Japanese-Americans reported consuming less alcohol than Caucasians, their drinking patterns by age were similar: among both United States populations, younger respondents are at higher risk for drinking problems than older respondents, even when alcohol consumption and sociodemographic variables are controlled by logistic regression. However, this association of age and drinking patterns and drinking problems is not universal. Japanese men consumed more alcohol and had a higher proportion of heavier drinkers in the middle age groups; the association between age and drinking problems also varied in this group. In addition to aging, sociocultural factors such as drinking norms probably account for the differences in drinking behavior among different age groups. This study may stimulate further cross-cultural comparison of drinking patterns and problems.

Effect of changes in maternal age, parity, and birth weight distribution on primary cesarean delivery rates.

OBJECTIVE: To examine the effect of maternal age on cesarean delivery risk and to quantify the impact of demographic changes since 1970 on primary cesarean delivery rates. DESIGN: A cohort study. SETTING: Nonfederal short-stay hospitals in Washington State. PARTICIPANTS: All women who delivered live singletons with linked birth certificate and hospital discharge data from 1987 through 1990. MAIN OUTCOME MEASURES: Maternal age-, birth weight-, and parity-specific primary cesarean delivery rates, Mantel-Haenszel relative risk estimates for primary cesarean delivery by 5-year age category stratified by parity, and direct standardization of 1987 through 1990 primary cesarean rates to 1970 Washington State maternal age, birth weight, and parity distribution. RESULTS: Primary cesarean rates ranged from 3.2% for multiparous teenage women who delivered infants weighing 3500 g through 3999 g to 58.9% for primiparous women 40 years of age or older who delivered infants weighing 4000 g or more. After adjustment, the risk of cesarean delivery increased with each 5-year age increment among women 20 years of age or older. We estimated that if the maternal age, parity, and birth weight distribution from 1987 through 1990 were identical to what existed in 1970, Washington State's primary cesarean rate from 1987 through 1990 would have been 12.2%, compared with the observed rate of 14.8%. CONCLUSION: The lower adjusted primary cesarean rate reflects the demographic changes in the childbearing population, which may be responsible for 18% of the 1987 through 1990 cesarean delivery rates. These findings suggest the importance of using maternal age-, birth weight-, and parity-specific primary cesarean delivery rates to compare populations and study temporal trends.

Increased alcohol-related oesophageal cancer mortality rates in Japanese men.

Age-adjusted oesophageal cancer mortality rates for Japanese women declined by 58% between 1960 and 1989, whereas corresponding rates for Japanese men have shown no decline. We speculate that alcohol-related oesophageal cancer mortality rates have been increasing in Japanese men replacing non-alcohol related oesophageal cancer deaths. Specifically, male birth cohorts, which experienced increased alcohol-related cirrhosis mortality rates, would also experience a rise in oesophageal cancer mortality rates. To test this hypothesis, we compared male to female ratios of oesophageal cancer mortality rates by birth cohort with those of liver cirrhosis mortality rates. We calculated the attributable risk of alcohol consumption and smoking to oesophageal cancer in Japanese men using oesophageal cancer mortality rates in Japanese women as a baseline, i.e. non-alcohol and non-smoking related oesophageal cancer deaths. We applied this method to head and neck cancer deaths to test its feasibility. Male birth cohorts born after 1926, which experienced male to female cirrhosis mortality ratios, also experienced increased oesophageal cancer mortality ratios. Overall, drinking and smoking accounted for 86% of all oesophageal cancer deaths and 85% of head and neck cancer deaths among Japanese men.

Average daily alcohol consumption during adult life among decedents with and without cirrhosis: the 1986 National Mortality Followback Survey.

The relationship of alcohol consumption and cirrhosis mortality was examined by sampling 1% of deaths in the U.S. using the 1986 National Mortality Followback Survey. Quantity and frequency of decedent's alcohol consumption was obtained from next of kin through mailed questionnaire. The percentage of decedents with cirrhosis increased sharply with the increasing number of drinks per day. Three drinks per day was associated with a significantly higher percentage of cirrhosis deaths compared with lifetime abstainers for both whites and blacks. Although blacks had a significantly higher percentage of abstainers than whites, of those persons who were reported to drink every day, blacks were more likely to be heavier drinkers (5 or more drinks per day). Blacks did not have a higher risk of cirrhosis mortality than whites for each drinking category. Although Native Americans were oversampled, the number of deaths was too small for statistical comparisons.

Variations in the accuracy of obstetric procedures and diagnoses on birth records in Washington State, 1989.

The authors abstracted a sample of 7,536 hospital medical records to validate the accuracy of the coding of obstetric information on 1) birth certificates, 2) a statewide computerized hospital discharge abstract data system, and 3) a linked file merging birth certificates and the hospital abstract data for Washington State deliveries occurring in 1989. Measures of accuracy of coding of delivery method and obstetric procedures varied greatly among the 23 hospitals that participated in the study. Computerized hospital discharge data were generally more complete and accurate than were birth certificate data. The linked file was more likely to identify obstetric procedures than was either source alone. For example, only 84.1% of cesarean deliveries noted in the hospital charts were identified on birth certificates (range among hospitals, 37-100%). Using the linked file, the authors identified 99.8% of cesarean deliveries (range, 97-100%). Linked birth certificate-hospital abstract files may become an excellent source of data for epidemiologic and health care studies; however, further training of medical record personnel and standardization of coding are needed to improve the quality of computerized data on obstetric events.

StORQS: Washington's Statewide Obstetrical Review and Quality System: overview and provider evaluation.

The Foundation for Health Care Quality (Washington) used three administrative public databases and indicators recommended by the Joint Commission and the American College of Obstetrics and Gynecology to build algorithms to measure quality of obstetric care in the state of Washington. Analyses demonstrated a high degree of variability across hospitals for major processes of care such as cesarean section, vaginal birth after cesarean section, and forceps deliveries. Eighty-five percent of the participating hospitals concluded that important aspects of care were being measured. Ninety-four percent found the information useful in describing their performance compared with other hospitals. Sixty-two percent believed the information was useful for initiating quality improvement projects. Of the 25 indicators tested in the project, indicators rated as most useful were the same 10 obstetric indicators chosen by the Joint Commission after alpha testing.

Alcoholics with eating disorders: prevalence and clinical course. A study from Japan.

Investigation of the prevalence of eating disorders among a large sample of Japanese alcoholics admitted for hospital treatment revealed a strong association between eating disorders and alcohol abuse and alcohol dependence among young women. That association was not apparent in young men. The results of this study of the clinical courses of eating disorders and alcohol abuse and alcohol dependence suggest that women with eating disorders, especially bulimia nervosa, are at high risk of becoming alcoholic.

Alcohol-related problems encountered by Japanese, Caucasians, and Japanese-Americans.

Using population-based survey data, personal-problematic and socioproblematic factors were examined among Japanese in Japan, Japanese-Americans in Hawaii, and Japanese-Americans; Caucasians in California were analyzed as a control group. Caucasian males were more likely to exhibit drinking-related social problems, whereas Japanese males showed more personal-problematic symptoms. Japanese-American men, both in Hawaii and California, were least likely among the three ethnic groups to have personal-problematic symptoms and were more likely to have socioproblematic symptoms than Japanese men. These differences might be explained by differences in the perception of social problems.

The relationship between three subtypes of the flushing response and DSM-III alcohol abuse in Japanese.

This study examined the relationship between the flushing response and drinking patterns and DSM-III alcohol abuse among Japanese using data collected in the joint U.S.-Japan collaborative study. The flushing response was classified into the following three subtypes: typical flushing (always flushed in the face after drinking), atypical flushing (sometimes) and nonflushing (never). This study of male current drinkers showed that typical flushers drank less alcohol than did atypical and nonflushers, but there was no observed difference between the drinking patterns of atypical flushers and nonflushers. Although the relationship was less pronounced, a similar association was found for female current drinkers. The 12-month prevalence of DSM-III alcohol abuse was estimated to be highest among atypical flushers and lowest among typical flushers, with nonflushers in between for both genders. When daily alcohol consumption and other pertinent sociodemographic variables were controlled, logistic regression analyses revealed that the risk for alcohol abuse by men was approximately 3.0 times higher among atypical flushers and 1.7 times higher among nonflushers than among typical flushers. The corresponding risks for abuse by women were 7.8 (atypical flushers) and 2.8 (nonflushers) times higher. Possible explanations for these differences in drinking patterns and the risk for alcohol abuse among the three flushing subtypes and between genders are discussed.

The effect of acculturation on drinking attitudes among Japanese in Japan and Japanese Americans in Hawaii and California.

Data from a joint Japan-U.S. collaborative study were examined to determine the relationship of acculturation to drinking attitudes among Japanese in Japan and Japanese Americans in Hawaii and California. Drinking attitudes (i.e., self-reported acceptable or appropriate levels of drinking) among ethnic groups differed significantly for the nine situations studied: (1) at a bar with friends, (2) at a party at someone else's house, (3) as a parent, spending time with small children, (4) during working hours, (5) visiting in-laws, (6) with friends at home, (7) with friends after work, (8) with people at sports events and (9) before driving a car. Factor analysis was used to determine the differences in drinking attitudes among these ethnic groups. Japanese and Japanese Americans differentiated drinking situations into different categories. The major difference between the two groups was that the Japanese associated spending time with small children with a situation appropriate for drinking, such as being with friends at home, whereas Japanese Americans associated spending time with small children with a situation inappropriate for drinking, such as before driving.

Cysts of the mandible and maxilla.

Mandibular and maxillary cysts originate from elements of the teeth (odontogenic), or from epithelial remnants trapped in fusion lines during development (nonodontogenic). Both types can be clinically asymptomatic and must be treated surgically. The specific diagnosis of a jaw cyst and its recurrence depends upon the anatomical location, the radiographic appearance, and the pathological diagnosis.

The association of drinking levels and drinking attitudes among Japanese in Japan and Japanese-Americans in Hawaii and California.

This study examined cross-cultural differences in drinking attitudes and drinking levels and their correlation among Japanese in Japan and Japanese-Americans in Hawaii or California. In most situations, an increase in drinking levels was associated with more tolerant drinking attitudes in all three groups. Abstainers were less likely to say that getting drunk is sometimes all right, whereas the reverse was true for heavier drinkers. Drinking levels among Japanese, especially among Japanese women, were not highly associated with how much drinking was perceived as acceptable in each situation, whereas among Japanese-Americans, drinking levels were highly associated with drinking attitudes. Although the Japanese had generally tolerant attitudes toward drinking, they indicated higher abstention rates before driving than Japanese-Americans regardless of their drinking levels. This may reflect the impact of public education on drunken driving in Japan.

A method for estimating alcohol-related liver cirrhosis mortality in Japan.

In Japan, per capita alcohol consumption increased sharply during the post World War II period followed by an increase in cirrhosis mortality. The prevalence of alcoholic cirrhosis among hospitalized patients also increased, from 11% in 1969 to 18% in 1985. Despite an increase in the percentage of drinkers among young women, over 80% of women in Japan are still abstainers or light drinkers. Thus, female cirrhosis mortality rates can be used as a proxy measure of non-alcohol-related cirrhosis mortality rates to estimate alcohol-related cirrhosis deaths among Japanese men. Employing this method, we conclude that two-thirds of cirrhosis deaths among men between 24 and 85 years of age and half of all cirrhosis deaths were attributable to alcohol. Two factors are probably responsible for the differences in proportional morbidity and proportional mortality of alcohol-related cirrhosis: differences in survival rates between alcoholic and non-alcoholic cirrhosis patients and detection bias toward post-hepatic cirrhosis. The synergistic effect of alcohol on viral hepatitis may in part explain excess cirrhosis deaths among Japanese men.

Effect of active management of labor on the incidence of cesarean section for dystocia in nulliparas.

The hypothesis that introduction of a defined policy of managing labor in nulliparas, active management of labor, would reduce the incidence of cesarean section (CS) for dystocia was examined by the introduction of active management at Hermann Hospital, the University of Texas affiliated hospital in Houston. The study was conducted over four consecutive 6-month periods. Observational data were accumulated for the year preceding introduction of active management, which served as the control period. The overall incidence of CS in nulliparas in the two control periods was 23 and 25%, and declined significantly to 20 and 17.7% in the intervention periods. The incidence of CS for dystocia fell significantly from 13 and 15% to 10 and 8.1%, whereas the incidence for other indications was unchanged. There were no significant differences in perinatal outcome judged by incidence of fetal death in labor, neonatal death associated with asphyxia, rate of admission to neonatal care with a diagnosis of asphyxia, or incidence of neonatal seizure. The data suggest that active management of labor reduces the incidence of cesarean section significantly and that these results can be achieved without detriment to mother or child.