Alcohol and drug use among bartenders: An at risk population?

INTRODUCTION: The current study explored the prevalence of hazardous alcohol and drug consumption within bartenders and the impact of working more than 40 h a week on levels of alcohol and drug use. METHODS: Three hundred and ninety bartenders (247 females), recruited via social media, took part in a cross-sectional online survey. The study recorded units of alcohol and hours worked per week among participants. The team measured hazardous drinking using the Alcohol Use Disorders Identification Test (AUDIT) and drug use by the Drug Abuse Screening Test (DAST). RESULTS: According to AUDIT scores, 39% of participants were classed as having harmful alcohol consumption and 43.6% reported moderate/severe alcohol use that might indicate alcohol dependence. According to DAST scores, 21.8% of participants were classed as intermediate risk, 6.5% as substantial risk, and 0.5% as severe risk for drug use problems. Male bartenders reported drinking significantly more units of alcohol per week and scored significantly higher on the AUDIT compared to females. Bartenders aged 26-30 and 31-40 reported drinking significantly more alcohol per week than bartenders aged 18-25. Additionally, bartenders aged 26-30 scored significantly higher on the AUDIT than ages 41-55. A high workload (more than 40 h per week) had a significant effect on units of alcohol drunk per week. CONCLUSION: This research indicates that hazardous alcohol and drug use is highly prevalent among this sample of bartenders. Working more than 40 h a week increases the amount of alcohol consumed, with males reporting higher use of alcohol and more problematic use than females. Additionally, those aged between 26 and 30 and 31 and 40 reported higher and more problematic use of alcohol compared to those in other age groups. These findings are important for public health because they describe a population that may be at risk of developing alcohol and substance use problems, and highlight the importance of adopting the brief, preventative interventions that we have suggested. Further research must help us to better understand the risk factors and causality involved in hazardous alcohol and drug use among bartenders.

Acyl Peptide Enzyme Hydrolase (APEH) activity is inhibited by lipid metabolites and peroxidation products.

Acyl Peptide Enzyme Hydrolase (APEH) activity is decreased in certain diseases but the mechanism and impact behind this loss in activity is not well understood. We hypothesized that lipid metabolites and lipid peroxidation products produced in inflammatory diseases may bind to and inhibit APEH activity. In vitro studies carried out in mammalian cell lysates, as well as with purified APEH protein, support our hypothesis that cellular lipid metabolites and lipid peroxidation products significantly decrease APEH activity. Enzymatic assays and molecular docking in silico analysis suggest that larger lipid metabolites are the best APEH inhibitors. APEH activity was measured in vivo in mice exposed to chronic e-cigarette vapor, as e-cigarettes are known to increase reactive oxygen species and lipid peroxidation products. In support of our in vitro findings, APEH activity in our mouse model demonstrates decreased APEH activity in the brains of mice exposed to e-cigarette vapor. These results provide a novel mechanism by which APEH activity may be inhibited in disease states. Furthermore, APEH inhibition may contribute to disease development and progression in pathologies associated with redox imbalances and can potentially act as biomarker for oxidative stress in disease.

Inviting ASPPB to address systemic bias and racism: Reply to Turner et al. (2021).

Turner et al. (2021) subtly relapse in conceptualizing the Examination for Professional Practice in Psychology (Part 2-Skills) exam as a competency evaluation despite Association of State and Provincial Psychology Boards' (ASPPB) prior concession that Part 2 measures only the knowledge of skills (not skill competency). They do not address the purpose of redundant evaluation or the other concerns raised in Callahan et al. (2020). Instead, Turner et al. remain narrowly focused on defense of content validity and a reliance on outdated standards that fail to meet contemporary expectations for assessment of health care professionals. The adopted processes and procedures, albeit time consuming and effortful, are known to be methodologically inadequate. ASPPB's methods demonstrably foster linguistic biases and systemic racism that constricts licensure of diverse individuals as psychologists. Specific suggestions are offered, and ASPPB is urged to take drastic corrective action. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Expedited SARS-CoV-2 screening of donors and recipients supports continued solid organ transplantation.

Universal screening of potential organ donors and recipients for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now recommended prior to transplantation in the United States during the coronavirus disease 19 (COVID-19) pandemic. Challenges have included limited testing capacity, short windows of organ viability, brief lead time for notification of potential organ recipients, and the need to test lower respiratory donor specimens to optimize sensitivity. In an early U.S. epicenter of the outbreak, we designed and implemented a system to expedite this testing and the results here from the first 3 weeks. The process included a Laboratory Medicine designee for communication with organ recovery and transplant clinical staff, specialized sample labeling and handoff, and priority processing. Thirty-two organs recovered from 14 of 17 screened donors were transplanted vs 70 recovered from 23 donors during the same period in 2019. No pretransplant or organ donors tested positive for SARS-CoV-2. Median turnaround time from specimen receipt was 6.8 hours (donors), 6.5 hours (recipients): 4.5 hours faster than daily inpatient median. No organ recoveries or transplantations were disrupted by a lack of SARS-CoV-2 testing. Waitlist inactivations for COVID-19 precautions were reduced in our region. Systems that include specialized ordering pathways and adequate testing capacity can support continued organ transplantation, even in a SARS-CoV-2 hyperendemic area.

"If somebody just showed me once how to do it": How are workplace cultures and practice development conceptualised and operationalised for early career nurses?

BACKGROUND: An imminent nursing shortage mandates attention to retention of early career nurses. One factor that impacts on intention to stay in the profession is the ability to do the work. Early career nurses rely on supportive cultures to develop the practical skills and knowledge specific to particular workplaces. OBJECTIVES: This study was conducted to determine the impact of workplace culture on practice development for early career nurses. METHODS: We undertook a qualitative study using semi-structured interviews conducted with eleven early career nurses at a single metropolitan hospital in Melbourne, Australia. Interviews were transcribed verbatim and analysed using thematic analysis techniques. RESULTS: Themes identified were learning in the moment, active welcome, confidence, ambiguities in the culture of learning, bullying and navigating the space. CONCLUSIONS: Early career nurses conceive practice development as the acquisition of skills and knowledge particular to the immediate needs of their patients, which they learnt by asking questions. Developing confidence was integral to all aspects of practice development. Complexity and risk on the wards could negatively impact on confidence. Where welcome was explicit and overt the nurses felt that practice development was facilitated. Transition to practice programs supported nurses and some individual nurses were active in assisting nurses to develop. However, workplace cultures were at times indifferent to the learning needs of the early career nurses and some experienced poor workplace behaviour and bullying.

Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study.

BACKGROUND: Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. OBJECTIVE: This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. METHODS: We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. RESULTS: We enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with persistent health problems. CONCLUSIONS: mHealth equipment is feasible with potential to improve patient-centered outcomes and increase self-management in older adults with HF.

Integration of family planning services into a sexually transmitted disease clinic setting.

BACKGROUND: Sexually transmitted diseases (STDs) and unintended pregnancy are significant and costly public health concerns. Integrating family planning services (FPS) into STD visits provides an opportunity to address both concerns simultaneously. Our objectives were to create an electronic eligibility reminder to identify male and female patients eligible for FPS during an STD clinic visit and measure FPS use, additional cost of integrated services, and patient/provider satisfaction and to explore the impact on incident pregnancy and STDs. METHODS: Quasi-experimental design compared enrollment and patient/provider satisfaction before (2008) and after implementation (2010). Incident pregnancy and STD 12 months after the initial visit before and after were explored. Time and cost were calculated. Quantitative and qualitative analyses were performed. RESULTS: A total of 9695 clients (male, 5842; female, 3853) in 2008 and 10,021 clients (male, 5852; female, 4169) in 2010 were eligible for FPS. Enrollment in FPS increased (2008: 51.6%, 2010: 95.3%; P < 0.01). Total additional cost was US$29.25/visit, and additional staff time was 4.01 minutes for integrated visits. Staff satisfaction increased and client satisfaction remained high. Among women returning within 12 months (39.6% in 2008, 37.1% in 2010), pregnancies were lower among enrolled versus nonenrolled women for 2008 (7.7% vs. 19.5%, P < 0.01) and 2010 (13.1% vs. 25.9%, P = 0.05). Incident STDs did not differ. DISCUSSION: An electronic eligibility reminder of FPS increased FPS use. Integration of FPS with STD services is feasible, is well accepted, and increases costs minimally. Integration may reduce pregnancy rates without increasing STD rates.

Worlds apart: training in rural South Africa.

BACKGROUND: Reforms in the delivery of surgical and anaesthetic services in the UK have reduced the opportunity for trainees to acquire 'hands-on' training. These problems are seen in other European countries and in North America. CONTEXT: Surgical and anaesthetic services within developed health care systems tend to be specialised, and are often consultant led. In rural South Africa there is a shortage of surgeons and anaesthetists to service the population, and the public health care system is vastly over-burdened. Trauma accounts for a large percentage of the surgical and anaesthetic workload. INNOVATION: This report compares the anaesthetic and surgical training experience of two first-year registrars during a 6-month training period in rural South Africa and a 6-month training period in the UK. IMPLICATIONS: Surgical and anaesthetic trainees from countries such as the UK can spend an out-of-programme training period in rural South Africa, thereby broadening their experience and exposure to trauma. They have the opportunity to take on a higher level of responsibility at an earlier stage of training, gaining 'hands-on' experience. Similarly, South African anaesthetic and surgical trainees can spend an out-of-programme training period in the UK, where they can learn the specialist procedures needed in their home country.

Poly-helminth Infection in East Guatemalan School Children.

BACKGROUND: Soil transmitted helminths (STH) remain a global public health concern in spite of occasional dosing campaigns. AIMS: To determine baseline prevalence and intensity of STH infection in east Guatemalan school children, and describe the associated epidemiology of anemia, stunting, and wasting in this population. SETTING AND DESIGN: Ten schools in Izabal province (eastern Guatemala) were identified, and 1,001 school children were selected for this study. Half of the schools were used as clinical testing sites (blood and stool). MATERIALS AND METHODS: Anthropometric measures were collected from all children. Over 300 children were tested for anemia and 229 for helminth infection. Ova and parasite specimens were examined via Direct, Kato Katz, and McMaster techniques. Hemoglobin was measured from venipuncture following the hemacue system. STATISTICAL ANALYSIS: Correlation between infection intensities and growth indicators were examined. Chi Square or t tests were used for bivariate analysis. Multiple logistic regression was performed on significant variables from bivariate techniques. RESULTS: Over two-thirds of school children were positive for infection by any STH. Prevalence of Hookworm was 30%; Ascaris, 52%; and Trichuris, 39%, most as low-intensity infection. Over half of the children were co-infected. In bivariate analysis, anemia was significantly associated with polyparasitism. CONCLUSIONS: For a Guatemalan child who experiences a unit decrease in hemoglobin, one expects to see a 24% increase in the odds of being infected with STH, controlling for age, sex, lake proximity, and growth characteristics. Infection with more than one STH, despite low intensity, led to a significant decrease in hemoglobin.

Topical mupirocin/sodium hypochlorite reduces peritonitis and exit-site infection rates in children.

BACKGROUND AND OBJECTIVES: Peritoneal dialysis (PD) is a common maintenance renal replacement modality for children with ESRD frequently compromised by infectious peritonitis and catheter exit site and tunnel infections (ESI/TI). The effect of topical mupirocin (Mup) and sodium hypochlorite (NaOCl) solution was evaluated as part of routine daily exit site care on peritonitis and ESI/TI rates, causative microorganisms, and catheter survival rates. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Retrospective chart review of children on home continuous cycling PD between April 1, 2001 and June 30, 2007 was performed. Infection rates were examined based on exit site protocol used in two different periods: Mup alone, April 1, 2001 to November 17, 2004; and Mup and NaOCl (Mup+NaOCl), November 18, 2004 to June 30, 2007. RESULTS: Eighty-three patients (mean PD initiation age: 12.1 +/- 5.8 yr) received home PD over 2009 patient months. Annualized rates (ARs) for peritonitis decreased from 1.2 in the Mup period to 0.26 in the Mup+NaOCl period (P < 0.0001). ARs for ESI/TI decreased from 1.36 in the Mup period to 0.33 in the Mup+NaOCl period (P < 0.0001). No infections with Mup-resistant organisms were observed when either Mup or Mup+NaOCl was used for prophylaxis. Gram-negative-organism associated peritonitis decreased from an AR of 0.31 in the Mup period to 0.07 in the Mup+NaOCl period (P < 0.001). Infection-related catheter removal rates decreased from 1 in 38.9 catheter-months in the Mup period to 1 in 94.2 in the Mup+NaOCl period (P = 0.01). Catheter survival rates were longer in the Mup+NaOCl period (Kaplan-Meier, P < 0.009). CONCLUSIONS: The combination Mup+NaOCl in daily exit site care was very effective to reduce PD catheter-associated infections and prolong catheter survival in pediatric patients.

Pneumocystis jiroveci pneumonia and pneumomediastinum in an anti-TNFalpha naive patient with ulcerative colitis.

We report the case of a 21-year-old man who was noted to have pneumomediastinum during an admission for an acute flare of ulcerative colitis. At that time, he was on maintenance treatment with azathioprine at a dose of 1.25 mg/kg per day, and had not received supplementary steroids for 9 mo. He had never received anti-tumor necrosis factor (TNF)alpha therapy. Shortly after apparently effective treatment with intravenous steroids and an increased dose of azathioprine, he developed worsening colitic and new respiratory symptoms, and was diagnosed with Pneumocystis jiroveci (carinii) pneumonia (PCP). Pneumomediastinum is rare in immunocompetent hosts, but is a recognized complication of PCP in human immunodeficiency virus (HIV) patients, although our patient's HIV test was negative. Treatment of PCP with co-trimoxazole resulted in resolution of both respiratory and gastrointestinal symptoms, without the need to increase the steroid dose. There is increasing vigilance for opportunistic infections in patients with inflammatory bowel disease following the advent of anti-TNFalpha therapy. This case emphasizes the importance of considering the possibility of such infections in all patients with inflammatory bowel disease, irrespective of the immunosuppressants they receive, and highlights the potential of steroid-responsive opportunistic infections to mimic worsening colitic symptoms in patients with ulcerative colitis.

A double-blind randomized controlled trial of electromagnetic stimulation of the pelvic floor vs sham therapy in the treatment of women with stress urinary incontinence.

OBJECTIVE: To compare the efficacy of extracorporeal electromagnetic stimulation (ES) of the pelvic floor for treating stress urinary incontinence (SUI) vs sham ES. PATIENTS AND METHODS: In all, 70 women with urodynamically confirmed SUI were randomized to receive active (35) or sham (35) ES. The NeoControl chair (NeoTonus, Marietta, GA, USA) was used, and treatment consisted of three sessions per week for 6 weeks. data were collected before and after treatment on all women, including a 20-min provocative pad-test with a predetermined bladder volume (primary outcome measure), a 3-day bladder diary and 24 h pad-test. Circumvaginal muscle (CVM) rating score, perineometry using two separate instruments and video-urodynamics were also used, and the Urinary Incontinence Quality of Life Scale (I-QOL) and King's Health Questionnaires. Patients were fully re-evaluated 8 weeks after treatment, and the bladder diary, pad-test and questionnaires were repeated at 6 months. The urotherapist and physician were unaware to which treatment group the patient was assigned. RESULTS: In the overall group of 70 patients there were significant improvements in each of the primary and secondary outcome measures at 8 weeks. There were also significant improvements in primary and secondary outcome measures in the active treatment group when compared with baseline measures. At 8 weeks, there were improvements in the mean (sd) values for the 20-min pad-test, of 39.5 (5.1) vs 19.4 (4.6) g (P < 0.001); the 24-h pad-test, of 24.0 (4.7) vs 10.1 (3.1) g (P < 0.01); the number of pads/day, of 0.9 (0.1) vs 0.6 (0.1) (P < 0.01), the I-QOL score, of 63.7 (2.8) vs 71.2 (3.3) (P < 0.001); and King's Health Questionnaire score, of 9.6 (0.8) vs 6.9 (0.7) (P < 0.001). However, these improvements were not statistically significant when compared with the sham-treatment group. In those patients on active treatment who had a poor pelvic floor contraction at the initial assessment (defined by the CVM score and perineometry), there was a significant reduction (P < 0.05) in the 20-min pad-test leakage when compared with the sham-treatment group. CONCLUSIONS: ES was no more effective overall than sham treatment in this patient group. However, in those women who were unable to generate adequate pelvic floor muscle contractions, there was an objective improvement in provocative pad testing when compared to sham treatment.

An adjustable continence therapy device for treating incontinence after prostatectomy: a minimum 2-year follow-up.

OBJECTIVE: To evaluate the efficacy and safety of the ProACT (Uromedica, Inc., MN, USA) balloon device, an alternative for the surgical management of incontinence after prostatectomy. PATIENTS AND METHODS: The initial patients who received this device at our institution were evaluated, using urodynamics at baseline and at 6 months. Perioperative variables were recorded and pad usage, volume adjustments, an estimate of Incontinence Quality of Life (I-QoL) and adverse events were recorded at baseline, and 1, 3, 6, 12 and 24 months after surgery. RESULTS: In all, 37 patients were treated on this protocol between November 2001 and March 2005. Of these, 30 had had radical prostatectomy and seven holmium laser enucleation of the prostate. The mean (range) pad usage decreased from 2.81 (1-12) at baseline to 0.7 (0-4) pads at 24 months, and the I-QOL increased from 49.7 (4.5-77) to 81.3 (13.6-100) over the same period. At 24 months, 62% of 34 men were pad-free and 81% required one pad or less. Bilateral explantation was required in three patients (11%) for infection (one) and balloon migration (two). All other adverse events were mild and transient. CONCLUSIONS: The ProACT balloon device is an acceptable therapy for the surgical management of incontinence after prostatectomy.

Leukemia stem cells in a genetically defined murine model of blast-crisis CML.

Myeloid leukemia arises from leukemia stem cells (LSCs), which are resistant to standard chemotherapy agents and likely to be a major cause of drug-resistant disease and relapse. To investigate the in vivo properties of LSCs, we developed a mouse model in which the biologic features of human LSCs are closely mimicked. Primitive normal hematopoietic cells were modified to express the BCR/ABL and Nup98/HoxA9 translocation products, and a distinct LSC population, with the aberrant immunophenotype of lineage(-), Kit(+/-), Flt3(+), Sca(+), CD34(+), and CD150(-), was identified. In vivo studies were then performed to assess the response of LSCs to therapeutic insult. Treatment of animals with the ABL kinase inhibitor imatinib mesylate induced specific modulation of blasts and progenitor cells but not stem- cell populations, thereby recapitulating events inferred to occur in human chronic myelogenous leukemia (CML) patients. In addition, challenge of leukemic mice with total body irradiation was selectively toxic to normal hematopoietic stem cells (HSCs), suggesting that LSCs are resistant to apoptosis and/or senescence in vivo. Taken together, the system provides a powerful means by which the in vivo behavior of LSCs versus HSCs can be characterized and candidate treatment regimens can be optimized for maximal specificity toward primitive leukemia cells.

Two types of recollection-based monitoring in younger and older adults: Recall-to-reject and the distinctiveness heuristic.

People often use recollection to avoid false memories. At least two types of recollection-based monitoring processes can be identified in the literature. Recall-to-reject is based on the recall of logically inconsistent information (which disqualifies the false event from having occurred), whereas the distinctiveness heuristic is based on the failure to recall to-be-expected information (which is diagnostic of non-occurrence). We attempted to investigate these hypothetical monitoring processes in a single task, as a first step at delineating the functional relationship between them. By design, participants could reject familiar lures by (1) recalling them from a to-be-excluded list (recall-to-reject) or (2) realising the absence of expected picture recollections (the distinctiveness heuristic). Both manipulations reduced false recognition in young adults, suggesting that these two types of monitoring were deployed on the same test. In contrast, older adults had limited success in reducing false recognition with either manipulation, indicating deficits in recollection-based monitoring processes. Depending on how a retrieval task is structured, attempts to use one monitoring process might interfere with another, especially in older adults.

Ovarian cancer is a heterogeneous disease.

The purpose of this study was to systematically evaluate the molecular profiles of different histologic types of epithelial ovarian cancer before the disease has metastasized beyond the ovary. Stage 1 epithelial ovarian cancers were chosen for analysis of early genetic events associated with different cell types. Allelotyping of 47 cases was performed using 224 polymorphic markers. Analysis with Fisher's exact test found markers specific for grade 3 tumors and clear cell histology. Hierarchal clustering analysis using dChip software revealed that the pattern of allele loss in eight regions on four chromosomes led to grouping of grade 3 tumors, endometrioid (grades 1 and 2) tumors, and clear cell tumors. We conclude that ovarian cancer is a heterogeneous disease in which histologic phenotypes correlate with distinct genetic patterns.

Specific- and partial-source memory: effects of aging.

Normal aging can be associated with impairments in source memory (recollecting an event's context). This study examined the effects of aging on specific-source memory (e.g., remembering which of 4 people spoke a word) and partial-source memory (e.g., remembering the gender of the person who spoke the word). When young and older adults were matched in terms of old-new recognition, age-related deficits were observed on both specific- and partial-source recollection. When the groups were matched on partial-source performance, no disproportionate specific-source impairment was seen. The results suggest that aging does not differentially affect specific- versus partial-source memory.

Stem cells, aging, and cancer: inevitabilities and outcomes.

Given the unique abilities of a stem cell to self-renew, differentiate, and proliferate, it is no wonder that they are critically important to an organism during development and to maintain homeostasis. Likewise, when something goes awry within a stem cell, it is likely to have far-reaching effects, since stem cells persist throughout the lifetime of the individual. Two significant biological phenomena that involve stem cells are the inevitable process of aging and a major health issue whose incidence increases with aging: cancer. In this review, we summarize evidence and theories concerning these two stem cell processes. The inability of stem cells to be passaged indefinitely in mice and the data supporting regular replication of the quiescent stem cell pool are discussed. Further, the current evidence indicating a stem cell origin of acute myeloid leukemia, including examples from both experimental mouse models and human clinical samples, is evaluated. Finally, we propose a model in which aging of the stem cell population of the hematopoietic system in particular can create conditions that are permissive to leukemia development; in fact, we suggest that aging is a secondary event in leukemogenesis.

Polymorphisms in the MLL breakpoint cluster region (BCR).

The MLL gene is involved in many chromosomal translocations leading to both acute myeloid and lymphoid leukemia. Some patients treated for primary malignancies with chemotherapeutic agents that inhibit DNA topoisomerase II (topo II) develop treatment-related leukemia (t-AML) caused by MLL gene rearrangement. Whether these patients are unusually susceptible to anti-topo II drugs, or whether this is a random adverse event is unknown. To discover genetic polymorphisms that may predispose patients to t-AML development, we sequenced the 8.3-kb MLL breakpoint cluster region (BCR) from 22 patients who had been treated with topo II inhibitors and who developed t-AML and from 37 patients who did not, and from eight infants and 20 normal individuals. Four polymorphic sites within Alu repetitive elements were identified; three affected the length of poly-A tracts and one altered the size of a trinucleotide repeat. The three poly-A tract polymorphisms occurred with equal frequency in leukemic patients and controls and hence are not predictors of risk. The trinucleotide GAA repeat has three alleles: (GAA)4, (GAA)5, and (GAA)6. The (GAA)6 allele is very rare. The adult t-AML patients are almost exclusively (GAA)4/5 heterozygotes (83%), whereas the normal population is only 55% (GAA)4/5 heterozygotic and is represented equally by (GAA)4 and (GAA)5 homozygotes (20% each). Only certain trends could be established because of the small sample size of these leukemic groups. Whereas adult t-AML patients are more likely to be (GAA)4/5 heterozygotes, this is not statistically significant, and this polymorphism within the MLL BCR has only a suggestive association with t-AML development.