Longitudinal associations of experiences of adversity and socioeconomic disadvantage during childhood with labour force participation and exit in later adulthood.

The Extending Working Lives (EWL) agenda seeks to sustain employment up to and beyond traditional retirement ages. This study examined the potential role of childhood factors in shaping labour force participation and exit among older adults, with a view to informing proactive interventions early in the life-course to enhance individuals' future capacity for extending their working lives. Childhood adversity and socioeconomic disadvantage have previously been linked to ill-health across the life-span and sickness benefit in early adulthood. This study builds upon previous research by examining associations between childhood adversity and self-reported labour force participation among older adults (aged 55). Data was from the National Child Development Study - a prospective cohort of all English, Scottish, & Welsh births in one week in 1958. There was evidence for associations between childhood adversity and increased risk of permanent sickness at 55 years - which were largely sustained after adjustment for educational disengagement and adulthood factors (mental/physical health, qualifications, socioeconomic disadvantage). Specifically, children who were abused or neglected were more likely to be permanently sick at 55 years. In addition, among males, those in care, those experiencing illness in the home, and those experiencing two or more childhood adversities were more likely to be permanently sick at 55 years. Childhood factors were also associated with part-time employment and retirement at 55 years. Severe childhood adversities may represent important distal predictors of labour force exit at 55 years, particularly via permanent sickness. Notably, some adversities show associations among males only, which may inform interventions designed to extend working lives.

Impact of childhood and adulthood psychological health on labour force participation and exit in later life.

BACKGROUND: Adulthood psychological health predicts labour force activity but few studies have examined childhood psychological health. We hypothesized that childhood psychological ill-health would be associated with labour force exit at 55 years. METHOD: Data were from the 55-year follow-up of the National Child Development Study (n = 9137). Labour force participation and exit (unemployment, retirement, permanent sickness, homemaking/other) were self-reported at 55 years. Internalizing and externalizing problems in childhood (7, 11 and 16 years) and malaise in adulthood (23, 33, 42, 50 years) were assessed. Education, social class, periods of unemployment, partnership separations, number of children, and homemaking activity were measured throughout adulthood. RESULTS: Childhood internalizing and externalizing problems were associated with unemployment, permanent sickness and homemaking/other at 55 years, after adjustment for adulthood psychological health and education: one or two reports of internalizing was associated with increased risk for unemployment [relative risk (RR) 1.59, 95% confidence interval (CI) 1.12-2.25; RR 2.37, 95% CI 1.48-3.79] and permanent sickness (RR 1.32, 95% CI 1.00-1.74; RR, 1.48, 95% CI 1.00-2.17); three reports of externalizing was associated with increased risk for unemployment (RR 2.26, 95% CI 1.01-5.04), permanent sickness (RR 2.63, 95% CI 1.46-4.73) and homemaking/other (RR 1.95, 95% CI 1.00-3.78). CONCLUSIONS: Psychological ill-health across the lifecourse, including during childhood, reduces the likelihood of working in older age. Support for those with mental health problems at different life stages and for those with limited connections to the labour market, including homemakers, is an essential dimension of attempts to extend working lives.

Acid-base balance and ventilation during sternal and lateral recumbency in field immobilized black rhinoceros (Diceros bicornis) receiving oxygen insufflation: a preliminary report.

Posture, ventilation, and acid-base balance using auricular venous blood values (pH, lactate, base excess [BE], HCO(3)(-), PO(2), SO(2), and PCO(2)), oxygen saturation of hemoglobin (SpO(2)), and end-tidal carbon dioxide (P(ET)CO(2)) were compared between sternal (STE) and lateral (LAT) recumbency in free-ranging black rhinoceros (Diceros bicornis bicornis) receiving oxygen insufflation. Data are reported as median, minimum, and maximum (median [minimum, maximum]). Thirty-six desert-adapted black rhinoceros (20 male, 16 female; age 8 [1.5, 33] yr) were immobilized in Namibia in March and April of 2008, from a helicopter, by remote intramuscular injection with etorphine HCl, azaperone, and hyaluronidase. Time from darting to recumbency was 6.0 (3, 15.5) min. Data were organized into two sampling periods: sample period 1 (P1, collected within 0-20 min postdarting; 13 [6.5, 19] min) and sample period 2 (P2, collected between 20-40 min postdarting; 32 [22.3, 39] min). All animals were acidemic (pH 7.24 [7.07, 7.32]) and hypoxemic (PO(2) 51 [38, 95.2]; SO(2) 78 [64, 96] mmHg) after capture. Lactate at P1 was 7.2 (3.2, 16.8) mmol/l and decreased (P=0.01) to 4.6 (1.2, 10.9) mmol/l at P2. At P2, lactate was less (P=0.06) in LAT 3.5 (1.2, 8.6) mmol/l than in STE posture 7.4 (3.1, 10.9) mmol/l. In P2, PO(2), SO(2), and SpO(2) were higher (P=0.02, 0.10, and 0.01, respectively) in STE than in LAT. End-tidal carbon dioxide in LAT was 38 (26, 47) mmHg and increased (P<0.001) rapidly to 48 (37, 55) mmHg when animals were moved into STE; no corresponding change in PCO(2) was observed. These preliminary findings suggest that STE posture in recumbent black rhinoceros reduces dead-space ventilation and improves oxygenation. Lateral posture was associated with lower blood lactate, quicker lactate recovery, or both. It is possible that the posture of recumbent rhinoceros after capture affects lactate accumulation and clearance, or both, and procedures should consider positioning in order to enhance perfusion.

Solution structure of the coiled-coil trimerization domain from lung surfactant protein D.

Surfactant protein D (SP-D) is one of four known protein components of the pulmonary surfactant lining the lung alveoli. It is involved in immune and allergic responses. SP-D occurs as a tetramer of trimers. Trimerization is thought to be initiated by a coiled coil domain. We have determined the solution structure of a 64-residue peptide encompassing the coiled coil domain of human SP-D. As predicted, the domain forms a triple-helical parallel coiled coil. As with all symmetric oligomers, the structure calculation was complicated by the symmetry degeneracy in the NMR spectra. We used the symmetry-ADR (ambiguous distance restraint) structure calculation method to solve the structure. The results demonstrate that the leucine zipper region of SP-D is an autonomously folded domain. The structure is very similar to the independently determined X-ray crystal structure, differing mainly at a single residue, Tyr248. This residue is completely symmetric in the solution structure, and markedly asymmetric in the crystalline phase. This difference may be functionally important, as it affects the orientation of the antigenic surface presented by SP-D.

Reduction of peak inspiratory pressure using high frequency jet ventilation and pressure control ventilation following pneumonectomy.

High peak inspiratory pressure (PIP) during mechanical ventilation is associated with increased risk of barotrauma. High frequency jet ventilation (HFJV) and pressure control ventilation (PCV) have been advocated for the reduction of PIP. The Food and Drug Administration has approved HFJV, respiratory frequency as high as 150 breaths per minute (bpm); however, bpm greater than 150 are still considered for experimental use. At less than 40 bpm, the point where HFJV is no longer considered to be high frequency, PCV is substituted which then becomes the mode of choice because of the ability to control ventilating pressures by setting the PIP. We present a case in which we used these two forms of ventilation for reducing the risk of stump blowout and barotrauma following pneumonectomy.

Reduction of peak inflation and positive end-expiratory pressure using pressure control with inverse-ratio ventilation: a case report.

Pressure control with inverse-ratio ventilation (PcIRV) has been shown to reduce peak inspiratory pressure (PIP) and positive end-expiratory pressure while providing adequate oxygenation and ventilation. This case of a 39-year-old man with a perforated colon who required high PIP after surgery demonstrates the effectiveness of PcIRV in reducing PIP from 72 cm H2O to 44 cm H2O and reducing positive end-expiratory pressure from 24 cm H2O to 6 cm H2O. A maximum inverse ratio of 3:1 was established to achieve a PaO2 of 105 mm Hg and PaCO2 of 37 mm Hg. In this case, the mean airway pressure rose from 32 cm H2O with assist-control ventilation to 39 cm H2O with PcIRV at 3:1. Cardiac output decreased from 9.11 L/min to 8.35 L/min with PcIRV at a 3:1 inspiratory/expiratory ratio.

Pressure control inverse ratio ventilation as a method to reduce peak inspiratory pressure and provide adequate ventilation and oxygenation.

Nineteen patients with ARDS or pneumonia who were ventilated with PcIRV on the Siemens-Elema Servo 900 C were retrospectively reviewed. The PcIRV reduced peak airway pressure, PEEP, increased Paw, and improved ventilation and oxygenation in these patients. When these patients were compared with themselves on prior conventional IPPV, all had a decrease in PIP, an increase in Paw and most had a decrease in VE, with no change in PaCO2 and an increase in PaO2. The increase in Paw may have contributed to this improved arterial oxygenation. High levels of PIP and PEEP during IPPV have been identified as risk factors in the development of barotrauma and residual parenchymal pulmonary damage. We propose that PcIRV allows for adequate ventilation and oxygenation with decreases in PIP, extrinsically added PEEP and inspired O2 concentration. This mode of ventilation may decrease the morbidity associated with IPPV utilizing high PIP and PEEP.

Single arterial puncture vs arterial cannula for arterial gas analysis after exercise. Change in arterial oxygen tension over time.

In an attempt to find the least invasive, safest, easiest, and cheapest method of obtaining resting and exercise samples of arterial blood, a comparison was made between samples from an arterial needle puncture and an arterial cannula. This study demonstrated that samples of arterial blood may be obtained by radial arterial puncture both at rest and during exercise in practically all cases without morbidity. Samples from arterial needle puncture provide the same results as those from arterial cannulas. In the very rare patient in whom arterial puncture during maximal exercise is unsuccessful, the arterial oxygen pressure (PaO2) measured at 10 seconds after exercise correlates very well with the PaO2 at maximal exercise, and the 15-second value correlates nearly as well. Arterial cannulas are needed in the infrequent case when arterial puncture is not accomplished during maximal exercise and the 10-second or 15-second PaO2 decreases from the resting value. In this instance, determination of the exact extent of the hypoxemia requires an exercise sample obtained by cannula; however, the decrease in PaO2 obtained by arterial needle puncture at 10 or 15 seconds will be all that is needed many times to make a clinical decision. Values obtained at 20 seconds after maximal exercise reflect less of the exercise measurement and cannot be used; however, all episodes of significant hypoxemia (PaO2 less than 60 mm Hg) were captured by the analysis at 20 seconds after exercise.

Giant cell arteritis of the legs. Clinical isolation of severe disease with gangrene and amputations.

Giant cell arteritis rarely presents as clinically advanced extra-ocular ischemia or gangrene. Clinically isolated leg involvement with amputation is even more unusual. A 69-year-old woman is described who had giant cell arteritis necessitating bilateral leg amputations. No other clinical sequelae have ensued during a four-year follow-up period. Temporal artery biopsy subsequent to the amputations revealed no arteritis. Disparities between the usual patterns of clinical and anatomic involvement in giant cell arteritis underlie the potential diagnostic difficulties in this disease. Although typically diagnostic, temporal artery biopsy does not always bridge the clinical and anatomic disparities.

Comparison of diflunisal and piroxicam in the management of patients with osteoarthritis.

An open-label comparison of diflunisal, a nonacetylated salicylate nonsteroidal anti-inflammatory drug (NSAID), and piroxicam, an NSAID belonging to the oxicam family, was conducted in patients with osteoarthritis. Efficacy assessments were made biweekly by the physician and patients during a 12-week treatment and observation period. The physician's evaluations showed that both drugs resulted in significant reductions in knee pain, tenderness, swelling, stiffness, and difficulty walking. A greater number of statistically significant differences were noted with diflunisal than with piroxicam, but there were no statistically significant differences between the two treatment groups. Patients' efficacy ratings tended to favor diflunisal, and diflunisal was significantly more effective than piroxicam in relieving night pain. Seventy-five percent of patients receiving diflunisal and 40% of those receiving piroxicam considered their condition improved after treatment; however, the proportion of good to excellent drug ratings was similar for the two drugs. Both drugs were generally well tolerated. Adverse effects were encountered in five (28%) of 18 patients given diflunisal and in four (33%) of 12 patients given piroxicam. Six patients were withdrawn from the study because of side effects, four from the piroxicam group and two from the diflunisal group. In this study, diflunisal was found to be an effective and well tolerated drug for use in the management of osteoarthritis.

Immune complex vasculitis as a cause of ascites and pleural effusions in systemic lupus erythematosus.

A patient is described with systemic lupus erythematosus and large painless ascites and pleural effusions. Pleural and peritoneal fluid complement levels were depressed, and DNA binding was elevated in the presence of normal serum values. Immunoglobulin and complement deposits were demonstrated in vessels of the pleura, peritoneum, and skin, along with histologic evidence of vasculitis. The relation of the ascites and pleural effusions to the presence of widespread vasculitis and local immune complex formation is discussed. These complications responded poorly to corticosteroid therapy but slowly resolved following the addition of an immunosuppressive agent.