The 3-year evolution of a preschool physical activity intervention through a collaborative partnership between research interventionists and preschool teachers.

Despite evidence that preschoolers spend the majority of their time in sedentary activities, few physical activity interventions have focused on preschool-age children. Health promotion interventions that can be integrated into the daily routines of a school or other setting are more likely to be implemented. The Study of Health and Activity in Preschool Environments employed a flexible approach to increasing physical activity opportunities in preschools' daily schedules through recess, indoor physical activity and physical activity integrated into academic lessons. Eight preschools were randomly assigned to receive the study's physical activity intervention. Teachers in these schools partnered with university-based interventionists across 3 years to design and implement a flexible and adaptive intervention. The intervention approach included trainings and workshops, site visits and feedback from intervention personnel, newsletters, and physical activity equipment and materials. Teachers reported a high acceptability of the intervention. The purpose of this article is to describe the evolution of a multi-component physical activity intervention in preschools, including (i) a description of the intervention components, (ii) an explanation of the intervention process and approach, and (iii) a report of teachers' perceptions of barriers to implementation.

Physical activity behaviours of highly active preschoolers.

BACKGROUND: Understanding the physical activity behaviour of young children who are highly active may provide important guidance for promoting physical activity in preschools. OBJECTIVES: The objective of this study was to describe the movement characteristics of high-active (HA) children during attendance at preschools. METHODS: Children in 20 preschools (n = 231) wore accelerometers and were classified into tertiles of moderate-to-vigorous physical activity. Children's movement characteristics were observed using the Observational System for Recording Physical Activity in Children-Preschool Version. Mixed-model analyses compared movement types between HA children and lower-active (LA) children during the total school day. RESULTS: HA (n = 77) children were observed to be more active than LA children (n = 154) indoors (P < 0.001), but no differences were observed outdoors. HA children were more frequently observed running, crawling, climbing, jumping, skipping, swinging and throwing across the total school day than LA children. Outdoors, HA children participated in more swinging and throwing and less jumping or skipping than LA children. Indoors, HA children spent more time pulling, pushing and running, and less time walking than LA children. CONCLUSIONS: HA children have unique activity patterns. Further interventions to increase physical activity of all preschoolers should increase the time spent outside and include varied activity types throughout the entire school day.

Prevalence of HTLV-I Tax in a subset of patients with rheumatoid arthritis.

OBJECTIVE: In regions of the world where the human T cell lymphotropic virus type I (HTLV-I) is endemic, it is recognized that infection with this virus is associated with autoimmune diseases such as rheumatoid arthritis (RA). Moreover, mice transgenic for the HTLV-I Tax gene develop a disease akin to RA. The observation that about 8% of healthy American blood donors carry HTLV-I Tax in their lymphocytes (1) prompted studies to determine whether Tax positivity is more prevalent among patients with RA and if so, whether its sequence is homologous with prototypic HTLV-I Tax. This proved to be the case. Of 102 patients with RA tested, one was a carrier of HTLV-I and 25 had the Tax sequences in their mononuclear cells and antibodies to p40 Tax in their sera, while being negative for antibodies to the structural proteins of the virus. METHODS: Blood was collectedfrom 102 RA patients. Lysates of their mononuclear cells were assayed for HTLV-I Tax by PCR/Southern analysis, and in some positive cases Tax sequence analysis was performed. Antibodies to p40 Tax, the gene product of the Tax sequence, were detected by western blot assay using recombinant p40 Tax as antigen. Results Of the 102 patients tested, one proved to be a carrier of the virus, having antibodies and sequences for the viral structural proteins, gag and env in addition to p40 Tax. Twenty-five of the 101 HTLV-I/II seronegative patients carried both HTLV-I Tax sequences in their mononuclear cells and had antibodies to p40 Tax. Sequence analysis confirmed homology with HTLV-I Tax. CONCLUSION: The data show that the prevalence of HTLV-I Tax positivity among patients with RA is -3 times higher than among healthy blood donors. Since Tax is known to be involved in the development of numerous autoimmune diseases, the possibility that it is responsible for the development of RA in a subpopulation of patients with this disease is not remote.

Accuracy of movement tracking with a miniaturized second-generation Moiré device.

The availability of a Nanoform 600, a machine used in the contouring of optical components, with movement capabilities of 12.5 A, made it possible to determine the sensitivity, accuracy and movement tracking ability of a high-resolution measuring device using the principle of Moiré magnification. The Nanoform 600 was programmed to make a series of movements measured by the Moiré device. Comparison of the Moiré measurement with the programmed movements verified that the Moiré device is capable of reliably tracking movements as small as 0.05 microm. Increasing the rate of movement had little effect on linearity. Tracking movements over a 350 microm distance at rates of up to 340 microm per second resulted in a 0.23% error. Intentionally defocusing the Moiré signal did not appreciably affect sensitivity.

Brucellosis in adult beef cattle of Mexican origin shipped direct-to-slaughter into Texas.

OBJECTIVE: To compare prevalence estimates of brucellosis (BR) in adult beef cattle that originated from different states and regions of Mexico and that were shipped direct-to-slaughter into Texas during 1995. DESIGN: Epidemiologic survey. ANIMALS: About 65,000 adult beef cattle. PROCEDURE: Blood samples were collected during postmortem examinations and were tested for serum antibodies to Brucella abortus, using the particle concentration fluorescence immunoassay and automated complement-fixation test. Prevalence estimates and 95% confidence intervals of BR were calculated by state of origin in Mexico. The difference among prevalence estimates of BR in cattle from different states and regions was tested for significance (P < 0.05), using the proportion test. RESULTS: On the basis of serologic test results, the overall prevalence estimate of BR was 0.32%. The prevalence estimate of BR in cattle from the state of Chihuahua (0.10%) was significantly different than that in cattle from the states of Nuevo Leon (0.23%), Zacatecas (0.34%), Durango (0.47%), Chiapas (1.81%), Tamaulipas (2.71%), Aguascalientes (7.89%), and Campeche (12.24%). In addition, prevalence estimates of BR in cattle were significantly different among the northern (0.22%), south-central (3.18%), and south coastal (9.42%) regions of Mexico. CLINICAL IMPLICATIONS: Results of this study indicate that the number of cattle exposed to B abortus may be significantly different among states and regions of Mexico. Current import sanitary requirements should continue to mitigate potential risk of transmission of BR from sexually intact cattle of Mexican origin to Texas cattle.

Tuberculosis in adult beef cattle of Mexican origin shipped direct-to-slaughter into Texas.

OBJECTIVE: To evaluate differences in prevalence of tuberculosis (TB) in adult beef cattle that originated from different states in Mexico and were shipped direct-to-slaughter into Texas in 1995. DESIGN: Epidemiologic survey. ANIMALS: Approximately 65,000 adult beef cattle. PROCEDURES: Postmortem examinations of carcasses for detection of Mycobacterium bovis infection were conducted at slaughter plants in Texas. Specimens were collected from cattle with granulomatous lesions, stored in neutral-buffered 10% formalin or saturated sodium borate solution, and processed for histologic and bacteriologic diagnosis. Prevalence and 95% confidence intervals were estimated by state of origin. Difference between prevalences for different states was tested for significance (P < 0.05), using the proportion test. RESULTS: Overall prevalence of TB at slaughter in adult beef cattle that originated from Mexico was approximately 0.5/1,000 (34/65,233). Prevalence of TB in cattle that originated from Chihuahua (0.07) was significantly lower than that in cattle from Coahuila (0.80), Nuevo Leon (1.27), and Tamaulipas (1.81). CLINICAL IMPLICATIONS: Prevalence of M bovis infection in adult beef cattle may be significantly different between states in the northern border region of Mexico. On the basis of disease prevalence and numbers of exported cattle and provided safeguards such as TB testing are continued, cattle from Chihuahua may pose a lower risk of TB transmission to Texas cattle than do cattle from Coahuila, Nuevo Leon, and Tamaulipas. To allow interstate/international movement of cattle from northern border states of Mexico, TB testing requirements should be continued. In the context of international trade, southern border states of the United States should continue collaborating with northern border states of Mexico to control and eradicate this disease.

The application of Moire magnification to high-resolution studies of human premolar eruption.

The optical phenomenon of Moire magnification can be used to provide real-time measurements of the position of an erupting human premolar, with a resolution of 0.1 micron or better. A new instrument for this purpose, which allows repeated measurements in the same individual, is described. Cyclic changes in the position of the erupting tooth in concert with the heartbeat, with a magnitude of 0.05-0.35 micron, can be discerned. An unusual cyclic rhythm, with a period of 20-50 s, was observed.

Strategies and tactics for promoting generalization and maintenance of young children's social behavior.

Employing a conceptual framework of generalization strategies proposed by Stokes and Osnes (1986), the authors selectively reviewed the research literature concerning interventions to improve young children's social behavior and strategies for promoting generalization and maintenance of young children's social responding. Three basic strategies are discussed: (a) taking advantage of natural communities of reinforcement, (b) training diversely, and (c) incorporating functional mediators, along with several accompanying tactics, to improve children's social interactions. Pragmatic recommendations for proactive programming of generalization and maintenance of young children's social behavior are included. In addition, the authors argue for the continued development of a technology (or technologies) of generalization and maintenance for young children's social competence interventions.

Magnetostrictive calibration of a precision optical measurement device for studies of tooth eruption.

In order to calibrate a precision-measuring instrument for studies of tooth eruption, a calibration device capable of repositioning an optical grating in steps accurate to at least 0.02 microns was required. At this level, piezoelectric and similar pushers encounter problems. A new calibration device based on the magnetostrictive properties of nickel was developed. Accuracy better than 0.02 microns was verified by relating its movements to the wavelength of the green line of mercury, and the device was successfully used to calibrate the instrument for establishing tooth position. Magnetostriction offers a way to calibrate precision measurement instruments for other applications.

Wheat straw or alfalfa hay in diets with 30% neutral detergent fiber for lactating Holstein cows.

Twenty-four Holstein cows near peak lactation were fed diets formulated to contain 30% NDF with forage NDF from chopped wheat straw or chopped alfalfa hay in proportions of 0:3, 1:2, 2:1, and 3:0 in an 8-wk trial to evaluate effects of fiber source on lactational performance. Concentrate was based on highly degradable carbohydrate in steam-flaked sorghum grain. Forage to concentrate ratio decreased from 49:51 to 28:72 when straw was substituted for alfalfa hay. Milk yield (38.4 kg/d) and DMI (23.1 kg/d) were not influenced by forage source. Milk fat percentage decreased and milk protein percentage increased linearly with increasing straw. Yields of 3.5% FCM and fat showed linear and quadratic responses, because they appeared to be reduced only on the 0:3 diet, and protein yield showed a quadratic response and was highest for the 1:2 diet. Digestibility of NDF averaged 43.5, 45.4, 40.7, and 31.2%, and acetate to propionate ratio was 3.0, 2.4, 2.2, and 1.9 with increasing dietary straw. Passage rates were not influenced by diet and averaged 9.3, 7.6, 6.1, and 4.7%/h for fluid, grain, alfalfa hay, and wheat straw, respectively. It is suggested that the ratio of forage NDF to ruminally degradable starch be maintained greater than or equal to 1:1 when diets based on low quality forage are fed to cows in early lactation.

The plasma collection system: a new concept in autotransfusion.

We have used the Haemonetics Cell-Saver autotransfusion technique in over 6,500 cases since 1979, salvaging more than 11,000 units of packed red blood cells. Major utilization has been in cardiac, vascular, and orthopedic cases. Coagulopathy associated with hypothermia, shock, multiple transfusions, and the autotransfusion technique, which removes clotting factors and platelets, often necessitated use of fresh-frozen plasma and platelet packs postoperatively to control bleeding and clotting problems. However, this defeats the prevention of disease transmission, transfusion reaction, and autoimmunization. Haemonetics has recently developed a plasma collection system which salvages up to 1,000 cc of platelet-rich plasma. Early experience suggests this technique will not only decrease the incidence of postoperative bleeding but further decrease the use of homologous (bank) blood and components. A step-by-step guide to the plasma collection system is discussed. The plasma collection system augments the present autotransfusion technique that conserves red blood cells, thus making complete autologous blood transfusion a reality.

Heparin-induced white clot syndrome.

Heparin-induced thrombocytopenia and thrombosis (white clot syndrome) is a devastating clinical problem as illustrated by the case presented. A high index of suspicion is required to make the diagnosis. Management included discontinuing heparin and administering alternative forms of anticoagulation. Surgery on both the arterial and venous systems may be required. Fibrinolytic therapy as well as antiplatelet therapy may at times be necessary. The mortality rate is high and prevention is of key importance.

Ductus diverticulum aneurysm and coronary stenosis: repair using circulatory arrest.

The case of a 68-year-old man with advanced symptomatic coronary artery disease and large aneurysm of the diverticulum of the ductus arteriosus is presented. Both the coronary artery disease and the aneurysm were successfully repaired at the same time via median sternotomy using cardiopulmonary bypass and a brief period of profound hypothermic circulatory arrest. To our knowledge, this is the 27th reported case of such an aneurysm in an adult.

Effects of group socialization procedures on the social interactions of preschool children.

We investigated the effects of group socialization procedures on the social behavior of preschool children in two studies. Group socialization procedures consisted of teachers using antecedent and consequent events to promote social interaction during children's games. During intervention, teachers discussed friendship with the children and then prompted and praised child-child social responding within the context of games. Children's social behavior was assessed during two sessions, group game periods (i.e., intervention sessions) and nonintervention play periods (i.e., generalization sessions). In both studies, a multiple baseline design across two target children and peers in their respective group was used to evaluate the effects of group socialization procedures. During group game periods, after intervention, target children increased their rates of both prompted and unprompted social interactions with peers. Also, in nonintervention play periods, target children improved both the rate and the duration of their social responding with peers. Results indicated that group socialization procedures were a practical and effective method for improving young children's social interaction during both structured games and unstructured play activities.

The cell-saver and autologous transfusion: an underutilized resource in vascular surgery.

The vascular surgeon's best resource for blood transfusion is the patient's own blood. It is readily available for recycling, already precisely typed and crossmatched, and without the risk of transfusion-related diseases such as hepatitis and AIDS. The relative ease, safety, and cost-effectiveness of autologous blood transfusions, intraoperative autotransfusions, and postoperative autotransfusions has been shown in our hospital experience with 320 cases and in the literature. We predict that autologous donor blood and autotransfusion will soon be widely accepted and utilized as the best and safest method of blood replacement.

Traumatic subarachnoid-pleural fistula.

Traumatic subarachnoid-pleural fistulas are rare. We found nine cases reported since 1959. Seven have been secondary to trauma and two following thoracotomy. One patient's death is thought to be directly related to the fistula. The diagnosis should be suspected in patients with a pleural effusion and associated vertebral trauma. The diagnosis can usually be confirmed with contrast or radioisotopic myelography. Successful closure of the fistula will usually occur spontaneously with closed tube drainage and antibiotics; occasionally, thoracotomy is necessary to close the rent in the dura.

Arterial thromboembolism. A 20-year perspective.

Our experience with 739 patients with lower extremity thromboembolism since the advent of the balloon catheter has led us to several important observations: As the etiology has shifted from rheumatic to atherosclerotic, we treat a more complex group of patients, one fourth of whom have severe, preexisting peripheral occlusive disease. Early diagnosis and treatment is essential to decrease the mortality and morbidity, which has ranged about 25% +/- 10%. Anticoagulation must be continued in the postoperative period, accepting wound hematomas as a fair "trade-off" to prevent recurrent embolus and distal thrombosis in areas inaccessible to the catheter. Postoperative use of heparin "buys time" to further assess marginal results of embolectomy allowing arteriography and careful planning of secondary operations to assure not only a viable but a functional limb. There is little mention in the literature to emphasize this approach, which we think is essential for long-term salvage. Early in the series, patients were treated with heparin or embolectomy alone. There were 161 secondary operations in 135 patients following embolectomy consisting of repeated thromboembolectomy, popliteal exploration, sympathectomy, bypass graft(s), angioplasty, and endarterectomy. Additionally, 44 patients had a direct attack correcting the cardiac source of their embolism. Our overall mortality (12%) and limb salvage (95%) shows marked improvement compared with earlier reports. Therefore, we recommend combined embolectomy and heparin as the primary choice of therapy.

The treatment of the expectant mother with deep venous thrombosis.

Experience with 12 expectant mothers with DVT from 1978 to 1983 supports heparin therapy. After early experience with four patients with various doses of intravenous and subcutaneous mini-heparin both in and out of the hospital, we have selected a program of outpatient, self-administered adjusted subcutaneous heparin. There has been no maternal or fetal mortality. There have been no serious bleeding or post-phlebitic complications, although two patients have had flare-ups of superficial phlebitis during the follow-up over the last four-and-a-half years. There have been three subsequent pregnancies, two of which were first trimester miscarriages and one uneventful term delivery of a normal infant.