Comparing growth of pork- and venison-reared Phormia regina (Diptera: Calliphoridae) for the application of forensic entomology to wildlife poaching.

Laboratory rearing of Phormia regina Meigen larvae on pork and venison was conducted as part of a study to determine whether forensic entomology approaches can be used in wildlife poaching investigations. Larvae were reared at 30 degrees C, 75% relative humidity, and a photoperiod of 14:10 (L:D) h on pork or venison diets, and samples were collected every 8 h until >90% of the maggots reached the third-instar wandering or prepupal stage. Significant differences were found in the distribution of lengths of the third instar and combined instars for maggots reared on the two different meat sources. Maggots reared on venison reached the prepupal wandering stage significantly faster (approximately 6 h) compared with maggots on the pork diet. Mean adult weight and wing length of venison-reared flies were significantly greater than for flies reared on pork. The lower crude fat content of venison appears to make this meat source a more suitable medium than pork for larvae of P. regina. The difference in growth rate could introduce error into PMImin estimations from third-instar maggots in deer poaching cases if estimates are based on data from studies in which maggots were reared on pork.

CD8+ lymphocyte depletion without SIV infection does not produce metabolic changes or pathological abnormalities in the rhesus macaque brain.

BACKGROUND: Simian immunodeficiency virus (SIV) infection and persistent CD8(+) lymphocyte depletion rapidly leads to encephalitis and neuronal injury. The objective of this study is to confirm that CD8 depletion alone does not induce brain lesions in the absence of SIV infection. METHODS: Four rhesus macaques were monitored by proton magnetic resonance spectroscopy ((1) H-MRS) before and biweekly after anti-CD8 antibody treatment for 8 weeks and compared with four SIV-infected animals. Post-mortem immunohistochemistry was performed on these eight animals and compared with six uninfected, non-CD8-depleted controls. RESULTS: CD8-depleted animals showed stable metabolite levels and revealed no neuronal injury, astrogliosis or microglial activation in contrast to SIV-infected animals. CONCLUSIONS: Alterations observed in MRS and lesions in this accelerated model of neuroAIDS result from unrestricted viral expansion in the setting of immunodeficiency rather than from CD8(+) lymphocyte depletion alone.

Diagnostic conscious pain mapping using laparoscopy under local anaesthetic and sedation in general surgical patients.

BACKGROUND: Patients in whom extensive investigations have failed to identify the cause of abdominal pain present a challenge to surgeons. We present our initial experience of using laparoscopy under local anaesthetic and sedation in the diagnosis of chronic abdominal pain. METHODS AND PATIENTS: Nine patients with chronic abdominal pain and multiple normal investigations underwent laparoscopy under local anaesthetic and sedation. By touching and grasping intra-abdominal viscera and peritoneum, an attempt was made to reproduce the patient's pain. RESULTS: Two patients were found to have pain arising from the gall bladder and subsequently underwent laparoscopic cholecystectomy with resolution of their symptoms. A third patient had a clinical presentation of chronic acalculous cholecystitis and a normal laparoscopy. She decided to undergo laparoscopic cholecystectomy, which cured her pain. Another patient had pain arising from the appendix, which resolved after an appendicectomy. Three patients had pelvic adhesions, which caused chronic abdominal pain. After adhesiolysis, one is pain free; the others declined surgery for adhesions and their pain resolved. Conscious pain mapping was negative in two patients. CONCLUSION: Laparoscopy can be carried out in the conscious patient, who is then usually able to collaborate with the surgeon in establishing the source of the pain experienced during conscious pain mapping. Long-term effectiveness and diagnostic accuracy has not yet been established.

Avoiding problems: evidence-based selection of medical gloves.

Allergenic contact reaction to glove proteins and residual chemicals increased from 1980 onwards; circumstantial and technical evidence indicates that change from reusable to disposable latex gloves was a causative factor. Several protein fractions are potentially allergenic; if low protein gloves contain a dominant protein fraction, people with sensitivity may still have an adverse reaction. Use of chlorinated powder-free gloves reduces risk of allergenic reaction; other powder-free gloves may still pose a contact risk to patients. Adverse comparative tests of vinyl vs latex medical gloves may, in some cases, have used non-medical gloves without assessment of initial quality or involved an unrealistic test method; these have discouraged use of a non-allergenic alternative to latex gloves. Vinyl medical glove properties are reviewed. Nitrile examination gloves offer better protection than latex types when handling lipid-soluble substances and chemicals. Properties of medical gloves made from other materials are described.

Mortality hazard associated with prescription hypnotics.

BACKGROUND: The American Cancer Society's Cancer Prevention Study II was a large survey designed primarily to examine cancer risks such as cigarette smoking. From the same survey and methods, data on usage of "prescription sleeping pills" in 1982 were examined. METHODS: Standardized mortality ratios were computed. Because sleeping pill use could be a proxy for other risk factors, cox proportional hazards models were computed to control for possible confounding factors as extensively as the data permitted. RESULTS: Men and women who reported taking prescription sleeping pills 30+ times in the past month had standardized mortality ratios of 3.18 and 2.82, respectively; controlling for 10-year age groups (p < 0.001). The standardized mortality ratios for usage 1-29 times/month were 1.8 and 1.48, respectively (p < 0.001). In proportional hazards models that controlled for 30 other risk factors and comorbidities simultaneously, the excess mortality risk associated with usage 30+ times per month remained significant, but hazard ratios were reduced to 1.35 for men and 1.22 for women. CONCLUSIONS: Use of hypnotics was associated with excess mortality. This methodology could not determine if hypnotic compounds caused the risks associated with their use, nor could the risks of individual compounds be determined. Since millions of Americans are currently taking hypnotics, long-term controlled trials are urgently needed to further guide both patients and physicians.

Variations in circadian rhythms of activity, sleep, and light exposure related to dementia in nursing-home patients.

We measured 24-hour circadian-rhythm patterns of activity and sleep/wake activity in a group of nursing-home patients (58 women and 19 men with a mean age of 85.7 years). Severely demented patients were contrasted with a composite group of moderate y, mild, or not-demented patients. Sleep/wake activity and light exposure were recorded with the Actillume recorder. Cosinor analyses were computed to determine the mesor, amplitude, acrophase, and circadian quotient of the activity rhythms. The diagnosis of dementia was based on the Mini Mental Examination and on examination of medical records. Sleep was extremely fragmented in both groups of nursing-home patients. Severely demented patients slept more both at night and during the day, but there were no significant differences in the number of awakenings during the night or in the number of naps during the day when compared to the composite group of moderate, mild, or no-dementia patients. The severely demented group had lower activity mesor, more blunted amplitude, and were more phase delayed (i.e. had later acrophases) than the other group. In addition, the severely demented patients spent less time exposed to bright light. These results confirm that circadian rhythms in nursing-home patients are disturbed with more disturbance in the severely demented. Much of the disturbance may be related not just to age but to mental status.

Use of wrist activity for monitoring sleep/wake in demented nursing-home patients.

Actigraphy is applicable for studying sleep in populations who are unable to tolerate traditional sleep-recording techniques, such as nursing-home patients who are infirm and demented. This study examined whether actigraphy can accurately reflect sleep/wake activity in this population by testing the reliability of a wrist-activity monitor, the Actillume, against traditional sleep measurements and against observations of nursing-home patients. Data from the Actillume are presented as two variables, the sum (total of all activity movements within the prescribed epoch) and the maximum activity (the largest or maximum movement recorded during the prescribed epoch), and by electroencephalogram (EEG). One difficulty in making comparisons was that the EEG records showed diffuse slowing, making it extremely difficult to score sleep/wake activity and making it difficult to use the EEG as a "gold standard". Nevertheless, the correlation for total sleep time from EEG and Actillume was r = 0.91 (p < 0.001) for sum activity and r = 0.81 for maximum activity (p < 0.005). Correlations for percent sleep were r = 0.78 (p < 0.01) for maximum activity and r = 0.61 for sum activity. The comparison of sleep/wake determined by the Actillume vs. observations resulted in a sensitivity of 87% and specificity of 90%. We conclude that the Actillume is the most feasible technique for studying sleep and wake activity in demented nursing-home patients.

Validity of specific subscales of the positive and negative symptom scales in older schizophrenia outpatients.

We investigated the construct validity of subscales of the Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS) along with other measures of psychopathology in 109 schizophrenia outpatients aged 45-84 years. Scores on subscales of the SAPS, SANS and Brief Psychiatric Rating Scale (BPRS) and on the Hamilton Depression Scale (HAM-D) were subjected to a principal components analysis and orthogonal rotation followed by an extension analysis. In both analyses, three of four SAPS subscales had their highest loading on the positive symptom factor and four of five SANS subscales had their highest factor loading on the negative symptom factor. The SAPS bizarre behavior subscale, however, had a much higher loading on the depressive symptom factor than on the positive symptom factor, and the SANS avolition-apathy subscale had moderate loadings on both the negative symptom factor and the depressive symptom factor. The use of SAPS and SANS subscales to represent two constructs was largely (but not entirely) validated among middle-aged and elderly schizophrenia outpatients. The SAPS bizarre behavior subscale and, to a lesser extent, the SANS avolition-apathy subscale appear to represent in this older population a separate construct which may be related to depressive symptoms.

Passive tension in rat hindlimb during suspension unloading and recovery: muscle/joint contributions.

Muscle/joint stiffness associated with disuse conditions or weightlessness may seriously impair movement and work capacity. The purposes of this study were 1) to develop a noninvasive model to measure rat hindlimb passive tension, 2) to describe changes in passive tension (i.e., flexibility) during whole body suspension and weight-bearing recovery, and 3) to determine relative contributions of the posterior hindlimb to passive tension. Male Sprague-Dawley rats were suspended (14 days) and reloaded (14 days). On days 0, 7, 14, 17, 21, and 28, animals were anesthetized and hindlimb passive tension was measured during ankle dorsiflexion. Seven days of suspension significantly increased passive tension. Recovery of passive tension occurred by 14 days of weight bearing. In suspended animals, increased passive tension was due to musculotendinous units (75%) rather than to the joint (25%). Increased passive tension did not appear to be due to a shorter muscle, but changes in muscle architecture, cytoskeletal proteins, or viscoelastic properties of the muscle and its connective tissue elements cannot be excluded.

Morbidity, mortality and sleep-disordered breathing in community dwelling elderly.

A population-based probability sample of elderly individuals (n = 426), who were originally studied between 1981 and 1986 (mean age at initial study was 72.5 years), were followed for mortality. Those with > or = 30 respiratory disturbances per hour of sleep had significantly shorter survival (p = 0.0034), but the respiratory disturbance index (RDI) was not an independent predictor of death. When Cox proportional hazards analysis was done, only age (the strongest predictor), cardiovascular disease and pulmonary disease were independent predictors of death. It may be that factors that are secondary to or associated with sleep-disordered breathing (SDB), such as cardiovascular or pulmonary disease, predispose these elderly to death.

Validating specific psychopathology scales in older outpatients with schizophrenia.

To our knowledge, there have been no published studies validating commonly used psychopathology rating scales in older outpatients with schizophrenia. We studied specific psychopathology rating scales (three subscales of the Brief Psychiatric Rating Scale: positive symptoms, negative symptoms, and depression subscales; the Scale for Assessment of Positive Symptoms; the Scale for the Assessment of Positive Symptoms; the Scale for the Assessment of Negative Symptoms; and the Hamilton Depression Rating Scale) in 101 (age > 45 years) DSM-III-R-diagnosed schizophrenia outpatients. We found high interrater reliability (intra-class correlated coefficient > or = .77) on these scales. Using principal components analysis, we demonstrated satisfactory construct validity, suggesting three factors-positive symptoms, negative symptoms, and depressive symptoms.

Sleep-disordered breathing in African-American elderly.

Although sleep-disordered breathing (SDB) has been shown to be very prevalent in the elderly, little has been done to examine differences between the elderly of different racial groups. It has been well documented that SDB often results in hypertension and that hypertension is more common in African-Americans than in Caucasians. Therefore, one might suspect that SDB might be more common in African-Americans. Caucasians (n = 346) and African-Americans (n = 54) older than 65 yr of age were studied. African-Americans reported less satisfaction with sleep (p = 0.017), more difficulty falling asleep (p < 0.001), more daytime sleepiness (p = 0.0014), and more frequent morning headaches (p = 0.0043). African-Americans napped 0.8 times more frequently per evening (p = 0.05) and 11 min longer per nap (p = 0.019) than did Caucasians, and they showed a trend toward more total sleep time (428 versus 408 min). Of greater interest was the fact that more African-Americans had severe SDB with a relative risk twofold as great (relative risk = 2.13) as that for Caucasians, which was confirmed in a logistic regression analysis where race was associated with the presence of SDB (RDI > or = 30) independently of age, sex, and body mass index. The mean RDI for those African-Americans with severe SDB was significantly higher than that for Caucasians (72.1 versus 43.3; p = 0.014).

Risk of tardive dyskinesia in older patients. A prospective longitudinal study of 266 outpatients.

BACKGROUND: Neuroleptic-induced tardive dyskinesia (TD) is a major iatrogenic disorder that is more prevalent among older patients. The objective of this study was to determine the incidence of and risk factors for TD in neuroleptic-treated patients over age 45 years. METHODS: We studied 266 middle-aged and elderly outpatients with a median duration of 21 days of total lifetime neuroleptic exposure at study entry. Most patients were treated throughout the study with either a high-potency or a low-potency neuroleptic and maintained on relatively low doses. The patients were followed up at 1- to 3-month intervals with "blind" assessment of psychopathologic condition, clinically as well as instrumentally (ie, using electromechanical sensors with computerized data reduction, including spectral analysis) evaluated movement disorder, and global cognitive function. RESULTS: Cumulative incidence of TD was 26%, 52%, and 60% after 1, 2, and 3 years, respectively. The principal risk factors for TD were duration of prior neuroleptic use at baseline, cumulative amount of high-potency neuroleptics, history of alcohol abuse/dependence, borderline or minimal dyskinesia, and tremor on instrumental assessment. CONCLUSION: Use of higher amounts of neuroleptics, particularly high-potency ones, should be avoided in older patients, patients with alcohol abuse/dependence, or patients with a subtle movement disorder at baseline; these patients are at a higher risk of developing TD.

Translocation of two glucose transporters in heart: effects of rotenone, uncouplers, workload, palmitate, insulin and anoxia.

Our previous studies on the acute regulation of glucose transport in perfused rat hearts were extended to explore further the mechanism of regulation by anoxia; to test the effects of palmitate, a transport inhibitor; and to compare the translocation of two glucose transporter isoforms (GLUT1 and GLUT4). Following heart perfusions under various conditions, glucose transporters in intracellular membranes were quantitated by reconstitution of transport activity and by Western blotting. Rotenone stimulated glucose uptake and decreased the intracellular contents of glucose transporters. This indicates that it activates glucose transport via net outward translocation, similarly to anoxia. However, two uncouplers of oxidative phosphorylation produced little or no effect. Increased workload (which stimulates glucose transport) reduced the intracellular contents of transporters, while palmitate increased the contents, indicating that these factors cause net translocation from or to the intracellular pool, respectively. Relative changes in GLUT1 were similar to those in GLUT4 for most factors tested. A plot of changes in total intracellular transporter content vs. changes in glucose uptake was roughly linear, with a slope of -0.18. This indicates that translocation accounts for most of the changes in glucose transport, and the basal pool of intracellular transporters is five times as large as the plasma membrane pool.

The "mini-Bier's block": a new technique for prevention of tourniquet pain during axillary brachial plexus anaesthesia.

Tourniquet cuff pain is a significant cause of morbidity following regional anaesthesia of the upper limb. We describe a simple new technique for effectively anaesthetizing the area under a pneumatic tourniquet (the "mini-Bier's block"), which permits comfortable surgery under axillary block anaesthesia even if the local block is incomplete. We report a controlled study of 40 patients in whom statistically significant tourniquet cuff pain relief was obtained in patients receiving an additional low-dose intravenous injection of local anaesthetic localized beneath the cuff. This technique ensures that the safe axillary approach to the brachial plexus can always be used with avoidance of pain from the pressure of the tourniquet cuff.

Low illumination experienced by San Diego adults: association with atypical depressive symptoms.

We explored the illumination exposure of middle-aged adults to determine normal values and to explore several correlates of daily light exposures. Subjects aged 40-64 years in San Diego, CA were recruited by random telephone dialing. Subjects completed a demographic interview and the Center for Epidemiologic Studies Depression self-rating scale (the CES-D) supplemented with eight questions related to seasonal affective disorders (SAD). Data were analyzed for 106 volunteers who wore a device that monitors illumination exposures and activity. The median subject was exposed to illumination > or = 1000 lux for only 4% of the time observed, that is, only about 58 min per day were spent in daylight. Subjects scoring higher on the atypical SAD mood symptoms spent less time in bright illumination rs = -0.266, p = 0.003. The CES-D depression score was similarly correlated with illumination but of borderline significance (rs = -0.150, p = 0.063). These results suggest the hypothesis that many Americans may be receiving insufficient light exposure to maintain optimal mood.

Pharmacoeconomic analysis of cefmenoxime dual individualization in the treatment of nosocomial pneumonia.

OBJECTIVE: To determine if dual individualization of cefmenoxime dosing is cost-effective. DESIGN: Retrospective, pharmacoeconomic decision analysis of two consecutively conducted prospective clinical studies. PATIENTS: Patients with documented gram-negative nosocomial pneumonia were evaluated. Thirty-three patients received cefmenoxime at standard dosing and 28 patients received doses according to dual individualization methodology. MAIN OUTCOME MEASURE: Antibiotic and infection-related costs were compared between groups. The number of hospital antibiotic days and costs incurred on those days were also evaluated. A decision model was constructed to characterize differences in treatment outcome. Probabilities within the decision tree were derived from 61 evaluable patients. Cost-effectiveness and incremental cost-effectiveness ratios were calculated. Sensitivity analysis was performed by varying outcome probabilities, antibiotic prices, and hospital room costs. RESULTS: Antibiotic and infection-related costs (mean +/- SEM) were $848 +/- 78 for standard cefmenoxime dosing and $1123 +/- 128 for dual individualization (p < 0.05). Total hospital costs were $10,660 +/- 1432 for standard dosing and $11,709 +/- 1900 for dual individualization (p > 0.05). Median antibiotic length of stay (ALOS) was 15.2 and 12.7 days for standard and dual individualization methodologies, respectively (p > 0.05). Incremental analysis of cost-effectiveness indicated that a similar reduction in length of stay for 259 dual individualization patients would save $321,808 annually. CONCLUSIONS: Sensitivity analysis indicates that, by reducing ALOS, dual individualization could be a cost-effective method of beta-lactam dosing for patients with pneumonia. A prospective study should be conducted to validate these findings.

Early course of new-onset tardive dyskinesia in older patients.

The risk of neuroleptic-induced tardive dyskinesia (TD) in older patients is known to be high, yet the course of TD in older patients has not been systematically studied. We followed 69 middle-aged and elderly outpatients newly diagnosed with TD in a naturalistic, longitudinal, prospective fashion. Standardized assessment instruments were administered to measure psychopathology, cognitive impairment, and abnormal movements. We observed a highly fluctuating early course of TD. Although the cumulative proportion of patients whose TD partially remitted was quite high (56% at 3 months, and 80% at 6 months), the cumulative proportion of patients whose TD relapsed (post-remission) was also high (33% at 3 months and 54% at 6 months). These findings may have clinical as well as theoretical implications for TD in older subjects.

Natural history of sleep disordered breathing in community dwelling elderly.

Mild sleep disordered breathing is very common in the elderly, but little is known about the course of the disorder over time. Twenty-four elderly people from a population-based study were recorded three times over an 8.5-year period. There were no significant changes in either apnea index or in respiratory disturbance index (RDI) over time, even when controlled for body mass index. For most subjects, there was great variability over time in the number of respiratory disturbances. The sensitivity of RDI > or = 15 at visit 1 predicting RDI > or = 15 at visit 3 was only 20%. The predictive value was 50%. Sleep disordered breathing measured at a single point in time is rather weakly predictive of the severity of breathing disorder 4-8 years later.