Cross-examination may be more detrimental to repeated-event children than single-event children.

Cross-examination is detrimental to the consistency and accuracy of children's reports and a re-direct interview may rehabilitate accuracy. We compared the effects of cross-examination on reports provided by single-event and repeated-event children. Children participated in one or five magic shows. One week later they were interviewed in a supportive manner (Interview 1). Next, a different interviewer cross-examined half the children or asked the other children all questions again (Interview 2). Finally, the initial interviewer re-directed the children by re-asking questions in a supportive manner (Interview 3). When defined narrowly (the instance children were asked to describe), cross-examination was more detrimental to single-event children and the re-direct interview rehabilitated correct responses for all children. When defined broadly (experienced details), cross-examination was more detrimental to repeated-event children and the re-direct did not rehabilitate correct responses for repeated-event children. Therefore when performance was off the floor, cross-examination was more detrimental to repeated-event children. The changes that repeated-event children make under cross-examination are explained by cognitive factors and social influences Ost et al., [2016]. Recall, verbatim memory and remembered narratives. In G. Oxburgh (Ed.), Communication in investigative and legal contexts: Integrated approaches from forensic psychology, linguistics and law enforcement (pp. 39-54). Wiley Blackwell).

Nonoperative management of blunt liver and spleen injury in children: evaluation of the ATOMAC guideline using GRADE

BACKGROUND: Nonoperative management of liver and spleen injury should be achievable for more than 95% of children. Large national studies continue to show that some regions fail to meet these benchmarks. Simultaneously, current guidelines recommend hospitalization for injury grade + 2 (in days). A new treatment algorithm, the ATOMAC guideline, is in clinical use at many centers but has not been prospectively validated. METHODS: A literature review conducted through MEDLINE identified publications after the American Pediatric Surgery Association guidelines using the search terms blunt liver trauma pediatric, blunt spleen trauma pediatric, and blunt abdominal trauma pediatric. Decision points in the new algorithm generated clinical questions, and GRADE [Grading of Recommendations, Assessment, Development, and Evaluations] methodology was used to assess the evidence supporting the guideline. RESULTS: The algorithm generated 27 clinical questions. The algorithm was supported by six 1A recommendations, two 1B recommendations, one 2B recommendation, eight 2C recommendations, and ten 2D recommendations. The 1A recommendations included management based on hemodynamic status rather than grade of injury, support for an abbreviated period of bed rest, transfusion thresholds of 7.0 g/dL, exclusion of peritonitis from a guideline, accounting for local resources and concurrent injuries in the management of children failing to stabilize, as well as the use of a guideline in patients with multiple injuries. The use of more than 40 mL/kg or 4 U of blood to define end points for the guideline, and discharging stable patients before 24 hours received 1B recommendations. CONCLUSION: The original American Pediatric Surgery Association guideline for pediatric blunt solid organ injury was instrumental in improving care, but sufficient evidence now exists for an updated management guideline.(AU)

British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults.

BACKGROUND: Irritable bowel syndrome (IBS) is a chronic debilitating functional gastrointestinal disorder. Diet and lifestyle changes are important management strategies. The aim of these guidelines is to systematically review key aspects of the dietary management of IBS, with the aim of providing evidence-based guidelines for use by registered dietitians. METHODS: Questions relating to diet and IBS symptom management were developed by a guideline development group. These included the role of milk and lactose, nonstarch polysaccharides (NSP), fermentable carbohydrates in abdominal bloating, probiotics and empirical or elimination diets. A comprehensive literature search was conducted and relevant studies from January 1985 to November 2009 were identified using the electronic database search engines: Cinahl, Cochrane Library, Embase, Medline, Scopus and Web of Science. Evidence statements, recommendations, good practice points and research recommendations were developed. RESULTS: Thirty studies were critically appraised. A dietetic care pathway was produced following a logical sequence of treatment and formed the basis of these guidelines. Three lines of dietary management were identified. first line: Clinical and dietary assessment, healthy eating and lifestyle management with some general advice on lactose and NSP. Second line: Advanced dietary interventions to improve symptoms based on NSP, fermentable carbohydrates and probiotics. Third line: Elimination and empirical diets. Research recommendations were also identified relating to the need for adequately powered and well designed randomised controlled trials. CONCLUSIONS: These guidelines provide evidence-based details of how to achieve the successful dietary management of IBS.

Elimination of beta-blockers in sewage treatment plants.

beta-Blockers are used to treat high blood pressure as well as patients recovering from heart attacks. In several studies, they were detected in surface water, thus indicating incomplete degradability of these substances in sewage treatment plants (STPs). In this study, we determined the sorption coefficients (K(D)) and degradation rates of the four beta-blockers sotalol, atenolol, metoprolol and propranolol in sludge from an STP operating with municipal wastewater. The sorption coefficients (K(D), standard deviations in brackets) were determined as 0.04(+/-0.035), 0.04(+/-0.033), 0.00(+/-0.023) and 0.32(+/-0.058) Lg(-1)(COD), and the pseudo-first-order degradation rate constants were estimated to be 0.29(+/-0.02), 0.69(+/-0.05), 0.58(+/-0.05) and 0.39(+/-0.07) Ld(-1)g(-1)(COD) for sotalol, atenolol, metoprolol and propranolol, respectively. These values translate into a typical elimination in STPs (sludge concentrations of 4g(COD)L(-1) and a hydraulic retention time of 6h) of 25%, 37%, 44% and 50% for sotalol, propranolol, metoprolol and atenolol, respectively. These results are also confirmed by measurements in two municipal STPs for atenolol, sotalol and propranolol. The estimated eliminations are slightly too high for metoprolol.

Comparison between the conventional anaerobic digestion of sewage sludge and its combination with a chemical or thermal pre-treatment concerning the removal of pharmaceuticals and personal care products.

Many novel treatment technologies, usually representing a pre-treatment prior to the biological degradation process, have been developed in order to improve the recycling and reuse of sewage sludge. Among all the methods available, a chemical (alkaline) and a thermal treatment have been considered in this study. The behaviour of 13 substances belonging to different therapeutic classes (musks, tranquillisers, antiepileptic, anti-inflammatories, antibiotics, X-ray contrast media and estrogens) has been studied during the anaerobic digestion of sewage sludge combined with these pre-treatments (advanced operation) in comparison with the conventional process. Two parameters have been analysed: the temperature (mesophilic and thermophilic conditions) and the sludge retention time. While organic matter solubilization was higher with the alkaline process (55-80%), no difference between both pre-treatments was observed concerning volatile solids solubilization (up to 20%). The removal efficiencies of solids and organic matter during anaerobic digestion ranged from 40-70% and 45-75%, respectively. The higher removal efficiencies of pharmaceuticals and personal care products were achieved for the antibiotics, Naproxen and the natural estrogens (>80%). For the other compounds, the values were in the range 20-70%, except for Carbamazepine, which was not removed at any condition tested.

Activation of p38 mitogen-activated protein kinases by endothelin and noradrenaline in small arteries, regulation by calcium influx and tyrosine kinases, and their role in contraction.

Small-artery responses to vasoconstrictor agonists are important for vascular function. To investigate the signaling pathways involved in contraction, we studied the activation and regulation of p38 mitogen-activated protein kinases (p38MAPKs) and heat shock protein (HSP) kinase by endothelin and noradrenaline in rat mesenteric arteries. Both vasoconstrictors activated p38alpha and/or p38beta but not p38gamma or p38delta, leading to increased HSP kinase activity. p38MAPK activation by noradrenaline was maximum between 2 and 10 minutes and was wholly dependent on calcium influx but insensitive to the tyrosine kinase inhibitor herbimycin A. In contrast, endothelin induced a biphasic response, with activation at 2 and 10 minutes. The early activity was wholly dependent on calcium influx and inhibited by herbimycin A. The later activity was only 50% calcium dependent, was insensitive to herbimycin A, but was 50% inhibited by genistein, a nonselective tyrosine kinase inhibitor. With both agonists, p38MAPK activity returned to basal by 30 minutes. SB203580, a p38MAPK inhibitor, blocked agonist-induced HSP kinase activity, and herbimycin A inhibited activation by endothelin but not by noradrenaline. In addition, SB203580 inhibited noradrenaline-induced contraction but had little effect on contraction to endothelin. These data show that vasoconstrictors use different upstream activators of p38MAPK in vascular tissue and that the p38MAPK pathway is selectively implicated in the contractile response to noradrenaline in small arteries.

Trace determination of fluoroquinolone antibacterial agents in urban wastewater by solid-phase extraction and liquid chromatography with fluorescence detection.

Fluoroquinolones (FQs) are among the most important antibacterial agents (synthetic antibiotics) used in human and veterinary medicine. An analytical method based on reversed-phase liquid chromatography with fluorescence detection was developed and validated for the simultaneous determination of nine FQs and the quinolone pipemidic acid in urban wastewater. Aqueous samples were extracted using mixed-phase cation-exchange disk cartridges that were subsequently eluted by ammonia solution in methanol. Recoveries were above 80% at an overall precision of better than 10%. Instrumental quantification limits varied between 150 and 450 pg injected. The presented method was successfully applied to quantify FQs in effluents of urban wastewater treatment plants. The two most abundant human-use FQs, ciprofloxacin and norfloxacin, occurred in primary and tertiary waste-water effluents at concentrations between 249 and 405 ng/L and from 45 to 120 ng/L, respectively. The identity of FQs in urban wastewater was confirmed by recording full fluorescence spectra and liquid chromatography directly coupled to tandem mass spectrometry. These results indicate that conventional environmental risk assessment overestimates FQ concentrations in surface waters by 1 to 2 orders of magnitude.

Primary DNA damage but not mutagenicity correlates with ciprofloxacin concentrations in German hospital wastewaters.

Recently, we showed for the wastewater of a large Swiss university hospital that primary DNA damage, assessed by a bacterial SOS repair assay (umuC test), could be largely assigned to a specific class of antibiotics, the fluoroquinolones (FQs) (Hartmann et al. [1998] Environ Toxicol Chem 17:377-382). In an attempt to confirm the significance of FQs for the bacterial DNA damaging effects in native hospital wastewaters, 25 samples from five German clinics were screened in this study by the umuC test. The results were compared to HPLC-derived concentrations of ciprofloxacin, an important member of the FQs. Ten samples (40%) were umuC-positive and ciprofloxacin concentrations ranged from 0.7 to 124.5 microg/L (n = 24). Primary DNA damage, as indicated by the umuC test, correlated strongly with ciprofloxacin concentrations in a logistic, dose-dependent manner (r2 = 0.896), almost irrespective of the use of S9 metabolic activation. The lowest observed effect concentration (LOEC) for ciprofloxacin was 5.2 microg/L (+S9) and 5.9 microg/L (-S9). Similar to our previous findings, these results indicate that positive umuC results in hospital wastewater are strongly dependent on the presence of fluoroquinolone antibiotics. In a second part of the study, previously generated Ames and V79 chromosomal aberration data of the same samples (Gartiser and Brinker [1995] in Umweltbundesamt Texte 74/95) were compared with the newly generated results. Neither the mutagenic effects detected by the Ames assay (8%, n = 25) nor the positive V79 results (46% n = 13) seemed to be caused by ciprofloxacin. Therefore, the Ames and V79 results suggest the presence of additional mutagens that are yet to be identified.

Determination of the quaternary ammonium surfactant ditallowdimethylammonium in digested sludges and marine sediments by supercritical fluid extraction and liquid chromatography with postcolumn ion-pair formation.

To study the phasing-out of the quaternary ammonium surfactant ditallowdimethylammonium cation (DTDMAC), concentrations of the cation in anaerobically stabilized sewage sludges were determined before and after its replacement by better degradable compounds. DTDMAC was quantitatively extracted from digested sludges using 380 atm of supercritical CO(2) modified with 30% methanol at 100 °C. Determination of DTDMAC was performed by normal-phase HPLC with postcolumn ion-pair formation and extraction with no sample cleanup. Mean concentrations of DTDMAC in sludges from five different municipal sewage treatment plants in Switzerland decreased from 3.67 g/kg (in 1991) to 0.96, 0.47, and 0.21 g/kg of dry sludge in 1992, 1993, and 1994, respectively. The precision of the method in digested sludge for 0.1-6.0 g/kg of dry matter, as indicated by the relative standard deviation, was typically 7%. The influence of the sample matrix was studied by performing supercritical fluid extraction (SFE) in coastal marine sediments. While SFE and a conventional liquid extraction method gave equal DTDMAC concentrations in sludges, the extraction of marine sediment samples yielded 30-40% higher DTDMAC values for SFE compared to those obtained by liquid extraction. The 94% drop in DTDMAC concentrations in digested sludges is due to the replacement of this substance and is a clear result of the producers' voluntary ban on its use in Europe.

Generalized pustular eruption associated with converting enzyme inhibitor therapy.

A 67-year-old man presented with a high fever and a generalized rash. His extended hospital stay was characterized by fever with repeated staphylococcal bacteremia and the appearance of axillary lymphadenopathy and splenomegaly. Skin lesions became hyperpigmented, dry, and atrophic with areas of exfoliation and uclers. Examination of skin and lymph node biopsy specimens showed findings consistent with mycosis fungoides. The patient unexpectedly recovered on discontinuation of captopril. A positive macrophage inhibiting factor response for both captopril and enalapril indicated that the non-sulfhydryl moiety was the antigenic stimulant for the lesion resembling mycosis fungoides.

Synthesis and aromatase inhibitory activity of novel 1-(4-aminophenyl)-3-azabicyclo[3.1.0]hexane- and -[3.1.1]heptane-2,4- diones.

The synthesis of 3-(cyclohexymethyl)-1-(4-aminophenyl)-3-azabicyclo[3.1.0]hexane-2, 4-dione (1h), with its optical enantiomers, and a series of novel achiral 1-(4-aminophenyl)-3-azabicyclo[3.1.1]haptane-2,4-diones (2a-i,k) is described. These compounds were tested in vitro for inhibition of human placental aromatase, a cytochrome-P450-dependent enzyme responsible for the conversion of androgens to estrogens. All of them displayed enzyme-inhibiting activity, and 3-cyclohexyl derivative 2g and 3-cyclohexylmethyl derivative 1h both proved more potent (greater than 140-fold) than the clinically effective agent aminoglutethimide [3-(4-aminophenyl)-3-ethylpiperidine-2,6-dione, AG]. As with AG and its derivatives, the 1R-(+)-enantiomer of 1h was responsible for the enzyme inhibitory activity. These novel compounds are of interest as potential drugs for endocrine therapy of hormone-dependent tumors, e.g. breast cancer.

Individual-differences assessment of the relationship between change in and initial level of adult cognitive functioning.

Methodological factors may have been partially responsible for the inconsistency in findings from previous investigations into the relationship between change in, and initial level of, adult cognitive functioning. An alternative data-analytic procedure is proposed and applied to data from 277 men (25-76 years of age at initial testing) over 3 measurement occasions (interwave intervals of 6.7 years). Performances on both the Benton Revised Visual Retention Test (BVRT) and the Wechsler Adult Intelligence Scale (WAIS) Vocabulary subtest were analyzed. The findings demonstrate that the significant negative relationships between change and initial status, found on both tests, were partially a function of measurement error. Once adjustments were made for errors of measurement, the previously significant negative relationship for the BVRT data became significantly positive, whereas for the WAIS the relationship remained significantly negative, although to a lesser degree. The importance of accounting for errors of measurement is discussed.

Activity and adaptation of nitrilotriacetate (NTA)-degrading bacteria: field and laboratory studies.

Adaptation of bacterial activity for the degradation of nitrilotriacetate (NTA) was studied using natural sediment samples and an NTA-degrading bacterium (strain ATCC 29600). Sediment samples from a river with persistent levels of NTA had much higher NTA-degradative activity than comparable samples from a less contaminated control site. When sediment from the control site was exposed to high levels of NTA a 5 day lag preceded an abrupt increase in NTA degradation while strain 29600 colonized on sand and grown in the absence of NTA became induced within eight hours. The induction of strain 29600 was compared between bacteria in suspension and cells attached to sand. The sand-associated bacteria became induced 4 to 5 h before the planktonic suspension and displayed over threefold greater specific activity. Suspensions of strain 29600 became adapted within 8 h when placed in membrane diffusion chambers that were immersed within a municipal wastewater reactor containing NTA. These findings support the concept that induction is a part of the process of bacterial adaptation to degrade NTA and sand-associated bacteria can adapt more quickly to and have a greater degradative activity for NTA than planktonic cells.

[Results and advantages of simultaneously measured peroperative arterial and central venous pressure]. / Ergebnisse und Vorteile gleichzeitiger peroperativer Messungen des arteriellen und zentralvenösen Drucks.

Central venous pressure and intravasal arterial pressure have been followed up during different operations in 80 patients of different age and sex. At the same time we have determined an exact fluid balance and blood gas analysis pre-, intra- and postoperatively. These examinations had some interesting results. In our view the most important result is that the anesthetist gets more suitable informations about intraoperative blood volume therapy by continuous measuring of central venous pressure than by the continuous following up of intravasal arterial pressure which is practised very often to-day.

["Narcose à distance" for pneumoencephalography using the x-ray apparatus neurocentrix (author's transl)]. / "Narcose à distance" bei dem Röntgengerät Neurocentrix für die Pneumoenzephalographie

A method of anesthesia for pneumoencephalography patients in combination with a modern automated x-ray apparatus (Neurocentrix, C.G.R.) is presented with all technical and apparatus details. The method was used in 62 patients.