Successful bone marrow transplantation for severe aplastic anemia following orthotopic liver transplantation: long-term follow-up and outcome.

Severe aplastic anemia (SAA) is well described in children following liver transplantation for fulminant hepatic failure (FHF) secondary to non-A, non-B, non-C hepatitis, and is associated with a high mortality rate. Successful immunosuppressive treatment of SAA following liver transplantation has been reported, but death from infectious complications is not uncommon. We report the 8-year follow-up of a 3.5-year-old boy who underwent successful HLA-identical sibling donor bone marrow transplant for SAA 7 months following orthotopic liver transplant for non-A, non-B, non-C hepatitis. His post-bone marrow transplantation course was uneventful with no evidence of liver toxicity. Eight months following BMT he developed renal cell carcinoma metastatic to lymph nodes which was treated surgically. Six years following BMT he developed a mucoepidermoid carcinoma of the parotid gland also treated surgically. Despite these malignancies, he is currently well 8 years following liver and bone marrow transplantation, without signs of GVHD, growth failure or liver graft rejection. This is the first report of long-term follow-up of bone marrow transplantation for SAA following liver transplantation. The occurrence of two subsequent malignancies in this child underscores the need for close follow-up of future similar cases.

Noise-induced hearing loss among U.S. Air Force cryptolinguists.

BACKGROUND: Occupational noise-induced hearing loss remains epidemic in the U.S. Air Force (USAF) and aircrew members continue to be affected. This study examines noise-induced hearing loss (NIHL) observed among USAF cryptolinguists that is attributable to radio noise and attempts to determine whether the current USAF Hearing Conservation Program (HCP) adequately identifies NIHL. METHODS: Audiograms from 120 ground-based cryptolinguists were examined. Comparisons were made between 1998 audiograms and either the reference audiogram or the enlistment audiogram. To determine HCP effectiveness, results were compared with the USAF standard of 3% or fewer permanent threshold shifts (PTS) per year. RESULTS: Some 13.3% of the cryptolinguists experienced standard threshold shifts (STS) between their enlistment audiogram and their initial occupational (reference) audiogram; 9.2% experienced STS in 1998 as compared with their initial enlistment audiogram but only 6 of the 11 (54%) were detectable using the reference audiogram as the baseline. The frequency pattern of changes in hearing thresholds was characteristic for NIHL. CONCLUSIONS: The NIHL that occurs among cryptolinguists prior to performance of the reference audiogram, and the hearing threshold shifts that occur between the enlistment audiogram and the reference audiogram, may obscure future hearing loss in the population. The incidence of PTS appeared to exceed 3% when the enlistment audiogram was used. While this result was not significantly different from 3%, sample size limitations and data accuracy concerns warrant that this population be closely watched in the future.

Validity of a modified aerobic fitness test for adults with mental retardation.

PURPOSE: The purpose of this study was to determine whether further modifications to the Rockport Fitness Walking Test (RFWT) protocol produces similar results to the previously modified protocol (Rintala et al., 1992) used for adults with mental retardation (MR). A second purpose of this study was to evaluate prediction equations developed to estimate aerobic capacity from the 1:5RFWT. METHODS: In an effort to make the RFWT more efficient for testing adults with MR the one pacer to one walker protocol (1:1RFWT) was further modified to one pacer to five walkers (1:5RFWT). Ten healthy men and 13 women (21.7 +/- 2.6 yr) with MR (IQ = 42-68) performed graded maximal treadmill tests, one 1:1RFWT and two 1:5RFWT. RESULTS: The end times (P = 0.326) and end heart rates (P = 0.457) did not significantly differ between the 1:1RFWT, the first 1:5RFWT, and the second 1:5RFWT. Separate Bland and Altman plots indicated that both end time and end heart rate had good agreement between protocols and also had good repeatability between the two 1:5RFWT. The main predictor variable, end time, from the 1:1RFWT and the 1:5RFWT was highly (and similarly) associated with the measured aerobic capacity (VO2peak), indicating a high predictive value for the 1:5RFWT end time. Bland and Altman plots of predicted and measured VO2peak for the prediction equations of Kline et al. (1987) and Rintala et al. (1987) indicated a general overestimation of measured values. CONCLUSIONS: The 1:5RFWT provides similar end times and end heart rates as the 1:1RFWT along with similar associations of end times to measured VO2peak. The 1:5RFWT could be used to predict aerobic capacity; unfortunately, the present prediction equations overpredict VO2peak for adults with MR and need to be revised.

Influence of prepartum body condition score change on reproduction in multiparous beef cows calving in moderate body condition.

Multiparous, spring-calving beef cows (n = 250) were used to determine whether large changes in body energy reserves during mid- to late gestation influenced subsequent reproductive performance of cows calving in moderate body condition. In three states, cows were blocked by BW and body condition score (BCS; 1 = emaciated to 9 = obese) then allotted to receive either a high or low plane of nutrition from late summer to early winter over a 3-yr period. This generated an array of BCS by the beginning of the last trimester of pregnancy when cows were grouped by BCS as follows: Group 1, BCS < or = 4; Group 2, BCS of 5 or 6; and Group 3, BCS > or = 7. Each group was managed so that individual cows would calve with a BCS of 5 to 6. At the time of group assignment, mean BW and BCS differed (P < .01) among groups and were 480 kg and 3.6, 541 kg and 5.5, and 594 kg and 7.1 for Groups 1 to 3, respectively. Within 28 d before calving, BW and BCS were similar (P > .20) among groups averaging 555 kg and 5.1. Prepartum BCS changes averaged 1.4, -.4, and -2.0 units for Groups 1 to 3, respectively (P < .01). Cows were managed as a single group after calving in each state. Location effect was significant for the prepartum and postpartum BW and BCS changes but not for postpartum reproductive performance. Significant location x BCS group interactions were found for the 90-d prepartum BW, BCS at calving, and prepartum changes in BW, but were caused by differences in magnitude among locations. The percentage of cows with luteal activity at the start of a subsequent breeding season was not affected (P > .20) by either location or BCS group, and averaged 66%. Mean pregnancy rates at 20, 40, and 60 d of a subsequent breeding season were 55, 76, and 89% for Group 1; 51, 67, and 82% for Group 2; and 64, 79, and 89% for Group 3 (P > .30). Mean days to conception were 89, 87, and 85 for Groups 1 to 3, respectively (P = .70). Neither calf birth weight (x = 38.6 kg) nor adjusted 205-d weight (x = 223.6 kg) were affected by prepartum BW and BCS changes. We conclude that reproductive performance of cows calving in moderate body condition is not influenced by large changes in body energy reserves during the last trimester of pregnancy.

Batch lot variability in permeation through nitrile gloves.

Many factors should be considered in the selection of chemical protective clothing, but the majority of selections are based on manufacturers' permeation data composed of average results for three replicates; usually no information about variability is provided. It was hypothesized that variability across batch lots might be considerable, and that variability may be due to cure factors that may vary from one site to another within the same company. Glass transition temperature (Tg) has been demonstrated to be an indicator of cure, and so its relationship to permeation parameters was examined. Steady state permeation rate, breakthrough detection time (BDT), cumulative permeation at 125 minutes (ASTM F1407), and Tg (ASTM E1356) were measured for two makes of nitrile gloves presumably in four batches. Tg was not related to any of the permeation parameters even though batch-to-batch variability was statistically significant for all parameters except BDT. A comparison with recent ASTM round-robin results indicates that some of the variability may be due to the method; however, manufacturer quality control must be suspected as the major source of variability based on the results of this study.

The use of implantable venous access devices (IVADs) in children with hemophilia.

PURPOSE: Implantable venous access devices (IVADs), either centrally or peripherally implanted, have become increasingly popular in children with hemophilia to assist in the early treatment of bleeding episodes and in the prevention of arthropathy. Their use has been associated with complications including thrombosis, thrombophlebitis, and infection. We attempted to better define whether the benefits associated with IVADs in this population outweight the associated risks. PATIENTS AND METHODS: We studied the medical records of 35 children from the University of Minnesota's Comprehensive Hemophilia Center who received IVADs between 1992 and 1996. RESULTS: There was no bleeding or thrombophlebitis associated with IVADs in our population. One patient required removal of a central IVAD due to thrombosis. The central IVADs were associated with local infection and bacteremia rates of 3% and 33%, respectively. The rates of local infection and bacteremia associated with peripheral IVADs were both 25%. The majority of infections were cleared with antibiotics, and ports remained intact. Both types of IVADs were associated with a high patient/parent satisfaction. CONCLUSION: Despite being associated with a significant incidence of infection, we believe the benefits of IVADs for children with hemophilia and their families outweigh the risks. Possible explanations for the observed infection rates are discussed.

Performance traits, hoof mineral composition, and hoof characteristics of bulls in a 112-day postweaning feedlot performance test.

OBJECTIVE: To evaluate relations between hoof and performance data from bulls fed in a 112-day standardized postweaning feedlot performance test. ANIMALS AND DESIGN: Breeds included were Angus (n = 20), Brangus (n = 19), Hereford (n = 31), and Simmental (n = 53). Hoof measurements, scores, and a 0.5-g hoof tissue sample were obtained from the right forefoot of bulls on days 1 and 112 of 4 tests conducted in 3 locations in Arkansas. Data were analyzed, using least squares ANOVA. The model used included an overall mean, breed, farm of origin within breed, initial age, and initial weight within breed and residual. Residual and canonical correlations of the traits studied were calculated. RESULTS: Residual correlations were found between some hoof minerals. Canonical correlations between performance traits and hoof minerals, between hoof characteristics and hoof minerals, and between hoof characteristics and performance traits were 0.62 and 0.45 (P < 0.005), 0.54 and 0.40 (P < 0.05), and 0.56 (P < 0.01) and 0.26 (P > 0.05), respectively. CONCLUSIONS: These data suggest that a relation exists between performance traits and hoof mineral composition and hoof characteristics and mineral composition. The visual scoring system for these data did not genetically separate bulls on the basis of claw quality. CLINICAL IMPLICATIONS: By selecting bulls with high claw quality, cattle producers are decreasing the chances of premature culling because of hoof laminitis. Therefore, by obtaining hoof measurements and mineral composition in a feedlot performance test, producers should have the tools to select bulls for increased lifetime performance.

Predicting temperature effects on chemical protective clothing permeation.

Although the polymer literature contains many references to the effects of temperature on diffusion coefficients of gases and vapors, little attention has been paid to the effect of temperature on permeation of liquids in either the polymer or industrial hygiene literature. Nevertheless, it is an important problem in the selection and use of chemical protective clothing (CPC) because most permeation tests are conducted at 20-25 degrees C, but actual polymer/solvent systems are often at higher temperatures in field use. A simple relationship between temperature and permeation rate does not exist; this may be the reason that little effort has been made at factoring temperature into CPC selection and use. In this study, five polymer/solvent systems were tested at 25, 37, and 50 degrees C. An Arrhenius relationship was used to relate temperature and permeation for these and 11 other data sets from the literature. Constants from the Arrhenius equations were calculated with excellent correlation and were used to construct equations for estimating temperature effects. With knowledge of steady-state permeation rate or breakthrough detection time at 25 degrees C and thickness for any polymer/solvent combination, the equations allow one to predict a new permeation rate or breakthrough detection time at any other temperature within a range of approximately 25-65 degrees C.

Identification of faceseal leak sites on a half-mask respirator.

A method has been developed to identify the location and shape of respirator faceseal leak sites by the deposition of a fluorescent tracer. An aerosol generation, conditioning, and exposure system to provide a test environment with stable aerosol concentration and size distribution of 4-methyl-7-diethylaminocoumarin was designed and tested. Faceseal leak sites on a respirator mounted on a mannequin and worn by human subjects were identified by deposition of the tracer aerosol and subsequent observation under long-wave ultraviolet lighting. Test parameters were identified for the optimal definition of leaks. Photographic techniques were developed to document the identified leak sites.

Doctoral preparation of nursing faculty.

Is the doctorate necessary for all nurse educators? Should nurse educators hold a doctorate or is a non-nursing doctorate acceptable? The authors report on a survey which looked at information concerning the number of doctorally prepared nursing faculty and the institutional requirement of a doctorate as the terminal degree in nursing.

Changes in pelvic conformation and peripheral estrone concentrations in pre- and post-partum beef cows.

An experiment was conducted to investigate the temporal relationship of peripheral estrone (E1) concentration to changes in the size of the pelvic opening preceding and immediately following parturition. Twenty-six multiparous beef cows were observed from approximately 50 d prepartum to 7 d postpartum. Blood samples were collected at 7 d intervals preceding calving and at 1, 3 and 7 d following for E1 quantitation. Estimates of pelvic opening area were made at the time of blood sampling. Peripheral E1 concentrations were elevated beginning at approximately 25 d prepartum. Dams bearing male fetuses had greater (P less than 0.01) concentrations of E1 than did dams with female fetuses. Calf birth weight was correlated (r = 0.44, P less than 0.01) with E1 levels from 10 d prepartum through parturition. Postpartum pelvic area was greater for cows giving birth to male calves, with no significant differences for calf birth weights by sex. Correlations were observed between E1 concentration, and pelvic area measured from 50 d prepartum to 7 d postpartum (r = 0.26, P less than 0.01), 10 d prepartum to calving (r = 0.42, P less than 0.01), and from calving to 7 d postpartum (r = 0.33, P less than 0.01). Percentage increase in E1 concentration from 50 d prepartum to calving was significantly correlated (r = 0.75, P less than 0.01) to percentage pelvic area increase over the same period. A correlation also exists between maternal E1 concentrations and fetal sex and pelvic area. In summary, the increased estrogen concentrations in cows with male calves may facilitate pelvic spread, resulting in a larger pelvic opening.

Skin protection, Viton, and solubility parameters.

Permeation is a function of diffusion and solubility of the solvent/polymer system. A physical-chemical constant that has been used previously to predict solubility is the three-dimensional solubility parameter (3-DSP). This paper reports a method for calculating the 3-DSP for the polymer Viton, new permeation data for Viton and 14 solvents, and the application of the 3-DSP to a model for predicting permeation parameters. The 3-DSP values for Viton (J/cc)1/2 were dispersion = 17.0, polar = 10.6, and hydrogen bonding = 6.1. A correlation coefficient of 0.65 was obtained when the natural log of breakthrough time for 19 solvents was regressed against the differences of the 3-DSP's for these 19 solvents and Viton. A value of 0.69 was obtained for the natural log of the permeation rate vs 16 solvent-Viton 3-DSP differences. While the variance unaccounted for in these regression tests does not allow quantitative prediction of permeation parameters, qualitative prediction of polymer suitability is possible.

Formaldehyde exposure in a gross anatomy laboratory.

A gross anatomy laboratory for medical students was evaluated for formaldehyde levels throughout its eight-week term. Results indicated that exposures for students and instructors were below the 3-ppm permissible exposure limit (assuming a maximum of five hours of daily exposure) established by the Occupational Safety and Health Administration. However, about one third of the eight-hour time-weighted-average exposures were greater than 1 ppm under the same assumptions. Exposure levels for students and instructors did not differ. Exposures tended to decrease over the term unless internal cadaver cavities were being dissected. These exposures are significant in light of the recent implication of formaldehyde as an animal carcinogen and the trend to reduce permissible levels to 1 ppm or lower.

Use of three-dimensional solubility parameter to predict glove permeation.

This paper describes the permeation process as related to protective clothing materials and some new applications of physical-chemical tools which may help to furnish the industrial hygienist with some predictive techniques. Values for the three-dimensional solubility parameter (3-DSP) for ten polymers are reported, and new developments regarding this parameter and its relation to glove selection are discussed. Limitation of the use of 3-DSP and future attempts to resolve the problem of proper protective clothing selection are also discussed.

Occupational health priorities for health standards: the current NIOSH approach.

Government agencies responsible for protecting the public from the adverse effects of toxic chemicals must set priorities for research, regulatory action, protocol testing, and monitoring due to the vast number of toxic chemicals and the limited resources available to these agencies. The National Institute for Occupational Safety and Health (NIOSH) must set priorities for research on hazards encountered in the workplace. Priorities are also utilized by NIOSH in preparing criteria for recommended occupational standards which are forwarded to the Occupational Safety and Health Administration (OSHA), U.S. Department of Labor, for possible promulgation. For various reasons, including rapidly changing conditions in the American workplace, NIOSH has instituted a revised priorities program. In the future, NIOSH research and recommended standards activities will focus not only on individual chemicals, but also on industries, occupations, chemical classes, and general industrial processes. NIOSH has also implemented a new program which will allow recommended control procedures for certain chemicals to be forwarded to OSHA in a shorter time period than has been experienced previously.

Inhibition of LH release as influenced by LRF infusion.

Four ovariectomized ewes were infused with LRF (10 mug/hr for 20 hr. Jugular vein blood samples were taken at 30 min intervals. After 16 hr of LRF infusion each animal was given a 1 mg iv injection of LRF. At the end of the 20 hr infusion period, the animals were sacrificed and the pituitary removed. Pituitary and plasma samples were analyzed for LH. Plasma LH concentration reached a peak level of 73 ng/ml, 1.5 hr after starting the LRF infusion. A rapid decline in LH concentration occured for the next 3 hr. The plasma LH concentration declined slowly to preinfusion levels over the next 15.5 hr. A small insigificant rise in plasma LH concentration occured when the animals were given 1 mg of LRF after 16 hr of LRF infusion. At the end of the treatment period pituitary LH concentration varied from 369 to 1360 ng/mg. Two of the four ewes had pituitary LH concentrations similar to untreated ovariectomized ewes. The pituitarys' refractoriness to LRF apparently is not due to depletion of pituitary LH.