Interindividual and intraindividual variability in adolescent sleep patterns across an entire school term: A pilot study.

OBJECTIVES: This study aimed to investigate sleep patterns in adolescent males over a 12-week period (a 10-week school term and pre and post term holidays). DESIGN: Intensive longitudinal design, with sleep data collected daily via actigraphy for 81 consecutive days. SETTING: Five Secondary Schools in Adelaide, South Australia. PARTICIPANTS: Convenience sample of 47 adolescent males aged 14 to 17 years. MEASUREMENTS: Daily sleep duration, bedtimes, rise times, and sleep efficiency were collected via actigraphy with all (except sleep efficiency) also measured by sleep diary. Mood was measured weekly with Depression Anxiety Stress Scale-21 (DASS-21) and weekly wellbeing with the Satisfaction with Life Scale (SWLS). Age, body mass index, self-reported mood, life satisfaction, and chronotype preference assessed at baseline (pre-term holiday week) were included as covariates. RESULTS: Dynamic Structural Equation Modeling indicated significant but small fixed-effect and random-effect auto-regressions for all sleep variables. Collectively, these findings demonstrate day-to-day fluctuations in sleep patterns, the magnitude of which varied between individuals. Age, morningness, and mood predicted some of the temporal dynamics in sleep over time but other factors (BMI, life satisfaction) were not associated with sleep dynamics. CONCLUSIONS: Using intensive longitudinal data, this study demonstrated inter-individual and intra-individual variation in sleep patterns over 81 consecutive days. These findings provide important and novel insights into the nature of adolescent sleep and require further examination in future studies.

Young, vulnerable and uncertain: Young workers' perceptions of work health and safety.

BACKGROUND: Young workers are at an increased risk of work place injury, and are less likely to report hazards or injuries, or apply for workers' compensation even though they are over-represented in workers' compensation statistics in comparison with their older peers. OBJECTIVE: To identify young workers' perceptions of work health and safety (WHS), why and how they report (or do not report) hazards and injuries, and examine where they source WHS information. This paper reports on the first stage of a larger, mixed methods study on WHS and young workers in South Australia. METHODS: A total of 226 young South Australian workers aged between 12 and 25 years completed an online survey. Data were analyzed using chi-squared analysis for categorical variables and t-tests where the dependent variable was continuous. RESULTS: Three quarters of young workers identified stress at work, not being trained to do the job, fatigue from work and lifting heavy things at work as WHS issues, although not necessarily as issues that they have personally experienced. Most young workers obtained information about WHS through their employer although a sizable proportion sourced this information from friends and social media. Young workers identified that they lacked confidence to report WHS issues. When they did report issues, many young workers reported these issues to their parents, despite identifying that their parents were often unable to help. CONCLUSIONS: Our findings contribute to our understanding of young workers' perceptions of work health and safety. Although young workers could identify their concerns about particular health and safety related issues at work, they lacked the confidence to report their concerns and had limited information about where to go for help. The research suggests that there is a need to empower young people to report WHS concerns to their employer and provide structures and processes that encourage reporting.

Horse-keeping practices in Australia: findings from a national online survey of horse owners.

OBJECTIVE: To gain an understanding of general horse-keeping practices in Australia, including shelter, social contact, exercise, watering and supplementary feeding. METHODS: An online survey was conducted with 505 owners in relation to one 'representative' horse in their care. RESULTS: The majority (83%) of horses were managed at pasture. Approximately one-quarter of those horses were housed alone (26%) or with one companion animal (27%). If horses were confined to a stable or small yard, the most recorded means of exercise was riding (65%) at a daily frequency (60%). Over half of the horse owners provided water in a trough or drinker with an automatic refill system (58%) and most horse owners supplied hay to their horses (82%), most commonly in combination with grazing. Areas of potential concern included one-quarter of stabled horses being prevented from unmediated social and physical contact with conspecifics and one-fifth of stabled horses being exercised less than daily. CONCLUSION: The horse-keeping profile in this study should be considered in the public communication of guidelines as well as interactions between veterinarians and clients.

The phonological neighbourhood effect on short-term memory for order.

There is a growing body of literature that suggests that long-term memory (LTM) and short-term memory (STM) structures that were once thought to be distinct are actually co-dependent, and that LTM can aid retrieval from STM. The mechanism behind this effect is commonly argued to act on item memory but not on order memory. The aim of the current study was to examine whether LTM could exert an influence on STM for order by examining an effect attributed to LTM, the phonological neighbourhood effect, in a task that reduced the requirement to retain item information. In Experiment 1, 18 participants completed a serial reconstruction task where neighbourhood density alternated within the lists. In Experiment 2, 22 participants completed a serial reconstruction task using pure lists of dense and sparse neighbourhood words. In Experiment 3, 22 participants completed a reconstruction task with both mixed and pure lists. There was a significant effect of neighbourhood density with better recall for dense than sparse neighbourhood words in pure lists but not in mixed lists. Results suggest that LTM exerts an influence prior to that proposed by many models of memory for order.

Views on equine-related research in Australia from the Australian equestrian community: perceived outputs and benefits.

OBJECTIVES: The extension of research into public practice is enhanced by communication and behaviour change strategies that are consistent with consumer needs and perspectives. To gain support for equine research (or to appreciate the perspectives contributing to disagreement), it is necessary to determine how aware consumers are of research, what research means to them, how they perceive its benefits (if at all) and how they engage with (or resist) it. Because of a surprising dearth of research evaluating consumer perceptions of research in any sector, our aim was to identify the perceived outputs and benefits of research from the perspective of the Australian horse owner. METHODS: We analysed the data for 930 participants in an online survey. RESULTS: Participants' understanding of research was associated with a broad terminology. Slightly more than half were aware of equine research that had taken place in Australia, with almost half reporting gaining some benefit, notably in relation to equine health. Although comments demonstrated an awareness of the collective benefit of research, research was made meaningful in relation to local conditions and participants' own equestrian disciplines. CONCLUSION: There is a significant opportunity for increasing awareness of Australia-based equine research and its value to owners of horses. The critical engagement with research by some owners suggests the need for communicators to present research in terms suitable for an intelligent lay audience, with clear identification of the personal and collective benefits for owners, horses and the equestrian community.

Clinical management of patients with ASXL1 mutations and Bohring-Opitz syndrome, emphasizing the need for Wilms tumor surveillance.

Bohring-Opitz syndrome is a rare genetic condition characterized by distinctive facial features, variable microcephaly, hypertrichosis, nevus flammeus, severe myopia, unusual posture (flexion at the elbows with ulnar deviation, and flexion of the wrists and metacarpophalangeal joints), severe intellectual disability, and feeding issues. Nine patients with Bohring-Opitz syndrome have been identified as having a mutation in ASXL1. We report on eight previously unpublished patients with Bohring-Opitz syndrome caused by an apparent or confirmed de novo mutation in ASXL1. Of note, two patients developed bilateral Wilms tumors. Somatic mutations in ASXL1 are associated with myeloid malignancies, and these reports emphasize the need for Wilms tumor screening in patients with ASXL1 mutations. We discuss clinical management with a focus on their feeding issues, cyclic vomiting, respiratory infections, insomnia, and tumor predisposition. Many patients are noted to have distinctive personalities (interactive, happy, and curious) and rapid hair growth; features not previously reported.

Unique cerebrovascular anomalies in Noonan syndrome with RAF1 mutation.

Noonan syndrome is a common autosomal dominant neurodevelopmental disorder caused by gain-of-function germline mutations affecting components of the Ras-MAPK pathway. The authors present the case of a 6-year-old male with Noonan syndrome, Chiari malformation type I, shunted benign external hydrocephalus in infancy, and unique cerebrovascular changes. A de novo heterozygous change in the RAF1 gene was identified. The patient underwent brain magnetic resonance imaging, computed tomography angiography, and magnetic resonance angiography to further clarify the nature of his abnormal brain vasculature. The authors compared his findings to the few cases of Noonan syndrome reported with cerebrovascular pathology.

Clinical utility of the X-chromosome array.

Previous studies have limited the use of specific X-chromosome array designed platforms to the evaluation of patients with intellectual disability. In this retrospective analysis, we reviewed the clinical utility of an X-chromosome array in a variety of scenarios. We divided patients according to the indication for the test into four defined categories: (1) autism spectrum disorders and/or developmental delay and/or intellectual disability (ASDs/DD/ID) with known family history of neurocognitive disorders; (2) ASDs/DD/ID without known family history of neurocognitive disorders; (3) breakpoint definition of an abnormality detected by a different cytogenetic test; and (4) evaluation of suspected or known X-linked conditions. A total of 59 studies were ordered with 27 copy number variants detected in 25 patients (25/59 = 42%). The findings were deemed pathogenic/likely pathogenic (16/59 = 27%), benign (4/59 = 7%) or uncertain (7/59 = 12%). We place particular emphasis on the utility of this test for the diagnostic evaluation of families affected with X-linked conditions and how it compares to whole genome arrays in this setting. In conclusion, the X-chromosome array frequently detects genomic alterations of the X chromosome and it has advantages when evaluating some specific X-linked conditions. However, careful interpretation and correlation with clinical findings is needed to determine the significance of such changes. When the X-chromosome array was used to confirm a suspected X-linked condition, it had a yield of 63% (12/19) and was useful in the evaluation and risk assessment of patients and families.

Sporadic Salmonella enterica serotype Javiana infections in Georgia and Tennessee: a hypothesis-generating study.

From 1996 to 2004, the incidence of Salmonella Javiana infections increased in FoodNet, the U.S. national active foodborne disease surveillance programme. Contact with amphibians and consumption of tomatoes have been associated with outbreaks of S. Javiana infection. To generate and test hypotheses about risk factors associated with sporadic S. Javiana infections, we interviewed patients with laboratory-confirmed S. Javiana infection identified in Georgia and Tennessee during August-October 2004. We collected data on food and water consumption, animal contact, and environmental exposure from cases. Responses were compared with population-based survey exposure data. Seventy-two of 117 identified S. Javiana case-patients were interviewed. Consumption of well water [adjusted odds ratio (aOR) 4.3, 95% confidence interval (CI) 1.6-11.2] and reptile or amphibian contact (aOR 2.6, 95% CI 0.9-7.1) were associated with infection. Consumption of tomatoes (aOR 0.5, 95% CI 0.3-0.9) and poultry (aOR 0.5, 95% CI 0.2-1.0) were protective. Our study suggests that environmental factors are associated with S. Javiana infections in Georgia and Tennessee.

Case report. An unusual thoracic mass.

Intrathoracic renal ectopia is a rare congenital abnormality that is often discovered incidentally. Plain radiography of the chest is often indeterminate, particularly in cases where there may be more than one pathology. CT is the mainstay of diagnosis in such cases where malignant or benign features may be identified and, as in this case report, it can confirm confidently the diagnosis of a rare benign mass and negate the need for further investigation. Here, the clinical and radiological findings of intrathoracic kidneys are discussed, together with a review of the literature.

Respiratory-related quality of life: relation to pulmonary function, functional exercise capacity, and sputum biophysical properties.

One of the difficulties in assessing mucoactive therapy is selecting clinical outcome variables that reflect the impact of clearing airway secretions on quality of life (QOL). Petty and colleagues developed a questionnaire designed to evaluate the clinical impact of mucoactive therapy in patients with chronic bronchitis (CB). We evaluated this questionnaire in a multicenter study of a mucolytic medication used in patients with CB and hypothesized that spirometry, exercise capacity, and sputum clearability changes would correlate with QOL changes. This was a multicenter trial in 159 patients with stable CB (111 completed the 16-week study). Spirometry, plethysmography, the 6-minute walk test (6MWT), and Petty score as a measure of QOL were assessed at each visit. Sputum was collected at each visit. Cough transportability was measured in a cough machine, and mucociliary transportability was measured on the frog palate. Cohesivity was measured in a filancemeter, interfacial tension by de Noüy ring, and wettability by contact angle analysis. Within the entire data set of 694 evaluations, there was no correlation between pulmonary function and QOL. There was an inverse correlation with distance covered in a 6MWT (R(2) = 0.041, p < 0.0001). Sputum CTR was directly correlated with QOL (R(2) = 0.027, p < 0.0001). Change from baseline (mean of first three visits) was computed and compared the change in the mean of values at the 8- and 12-week visits (n = 108 sets of data pairs). This was analyzed as a percentage of change for continuous measurements, and as QOL is normative, we calculated the absolute change in QOL. There was no relation between QOL and 6MWT changes. There was an inverse relation between change in forced expiratory volume in 1 second and QOL (R(2) = 0.092, p = 0.0021) as well as between forced vital capacity and QOL (R(2) = 0.05, p = 0.024). There was a direct relation between CTR and QOL (R(2) = 0.039, p = 0.048). The relation between QOL and 6-minute walk distance was expected but weak. The consistent relation between CTR and QOL (suggesting that improved CTR of sputum is associated with decreased QOL) is difficult to explain. A change in forced expiratory volume in 1 second and forced vital capacity did correlate with a change in QOL. There is a need for a good QOL tool to evaluate mucus clearance devices or medications. The Petty questionnaire was designed specifically for this task, but the effect on sputum properties by current mucoactive agents may be too small to elicit a significant change in the Petty score.

Measurement of cortisol and lymphocyte subpopulations in depressed and conduct-disordered adolescents.

Lymphocyte subpopulations were analyzed in 11 adolescents with major depressive disorder, 11 with conduct disorder, and eight normal age-matched subjects. No significant differences were noted on any T or B cell measure between the groups. Further, no significant correlations were found between any cortisol measure (baseline cortisol, post-dexamethasone cortisol, urinary free cortisol) and any lymphocyte measure in either depressed or conduct-disordered adolescents. The negative findings in this small sample contrast with those reported in adult patients and suggest that an aging effect may be associated with the immunological changes reported in older depressed patients.

Retinal transplants and optic nerve bridges: possible strategies for visual recovery as a result of trauma or disease.

From the review of the current literature it is quite evident that some exciting prospects are on the horizon which will help to better explain the development and functioning of the visual system. In addition, the new technology of CNS tissue grafting coupled to other newly emerging technologies (i.e., microsurgical, microinjection, and micromanipulative techniques coupled with our knowledge of immunosuppressive methods) will allow for a realistic approach in exploring possible strategies for visual recovery as a result of trauma or disease within the near future. One specific area of research that hopefully will emerge from this new body of knowledge comes from the realization that at the present time there is no effective therapy for practically all types of hereditary retinal degenerative disorders in man. It would seem most appropriate to take advantage of the new neuronal transplantation technology mentioned in this article and the availability of hereditary retinal degeneration models in the hope of developing new methods for a therapeutic approach to this problem. Such an approach could involve replacing the abnormal, absent, and/or lost host retinal cells with tissue from healthy donors by means of a grafting technique with the goal of arresting and/or reversing the disease process. Of course, this is but one example of the many challenges in this area of research which increasingly appear to be within our grasp.

The effect of short term intensive insulin therapy in non-insulin-dependent diabetics who had failed on sulphonylurea therapy.

To determine the effect of short term intensive insulin therapy in non-insulin-dependent diabetes mellitus (NIDDM) we studied 10 patients who had been on maximal doses of sulphonylurea therapy, with a glycosylated haemoglobin value persistently above the normal range. All patients were non-ketonuric, had negative islet cell antibodies, and had been on sulphonylureas for a mean duration of 5.6 yr. Patients were maintained at euglycaemia (plasma glucose 4-7 mmol/l) for 24 hr using an open-loop intravenous insulin regimen, and then underwent a standard 75 g oral glucose tolerance test (OGTT). This was repeated after 3 months of treatment with insulin. Mean fasting plasma glucose and glycosylated haemoglobin were 10.1 mmol/l and 12.2% respectively before, and 7.1 mmol/l (p less than 0.001) and 8.4% (p less than 0.001) after treatment. There was no significant change in body weight. Plasma insulin and C-peptide responses to 75 g OGTT did not change significantly, but the total amount of intravenously infused insulin required for 24-hr euglycaemia fell from a mean value of 138 u before treatment to 87 u (p less than 0.001) at the end of insulin therapy. Remission, with glycosylated haemoglobin in the normal range for more than 3 months after stopping insulin, was observed in 5 out of the 10 patients. All 5 who failed to achieve remission had markedly blunted maximal insulin responses of less than 10 mu/l on both OGTT's. Our study shows that insulin treatment in NIDDM appears to exercise a beneficial effect by lowering insulin resistance. We suggest that this may be of advantage early on in patients with NIDDM in preserving B-cell reserve.

Motile curved bacilli. Isolation and investigation.

Motile curved bacilli seen in vaginal secretions have been isolated on Columbia agar supplemented with 5% human blood and vitamin K. Growth occurred both anaerobically and in 5% oxygen, but not under more aerobic conditions. There were two distinct groups of these organisms, distinguishable by morphology, biochemical activity, antigenic pattern and susceptibility to metronidazole. All isolates were sensitive to a wide range of antimicrobial agents, with the exception of nalidixic acid and polymyxin. One group was resistant to metronidazole.