Bee Fauna and Floral Abundance Within Lawn-Dominated Suburban Yards in Springfield, MA.

Private yards comprise a significant component of urban lands, with managed lawns representing the dominant land cover. Lawns blanket > 163,000 km2 of the United States, and 50% of urban and suburban areas. When not treated with herbicides, lawns have the capacity to support a diversity of spontaneous (e.g., not planted) flowers, with the potential to provide nectar and pollen resources for pollinators such as native bees. In order to determine the extent to which suburban lawns support these important species, we surveyed lawns in 17 suburban yards in Springfield, MA, between May and September 2013 and 2014. Householders participating in the study did not apply chemical pesticides or herbicides to lawns for the duration of the study. We collected 5,331 individual bees, representing 111 species, and 29% of bee species reported for the state. The majority of species were native to North America (94.6%), nested in soil (73%), and solitary (48.6%). Species richness was lower for oligolectic (specialists on a single plant; 9.9%) and parasitic species (12.6%). Abundance percentages for number of individuals were similar. We documented 63 plant species in the lawns, the majority of which were not intentionally planted. The most abundant lawn flowers were dandelion (Taraxacum officinale) and clover (Trifolium sp.). Nearly 30% of the spontaneous plant species growing in the lawns were native to North America. Our study suggests that the spontaneous lawn flowers could be viewed as supplemental floral resources and support pollinators, thereby enhancing the value of urban green spaces.

Frailty and Constellations of Factors in Aging HIV-infected and Uninfected Women--The Women's Interagency HIV Study.

BACKGROUND: Biological similarities are noted between aging and HIV infection. Middle-aged adults with HIV infection may present as elderly due to accelerated aging or having more severe aging phenotypes occurring at younger ages. OBJECTIVES: We explored age-adjusted prevalence of frailty, a geriatric condition, among HIV+ and at risk HIV- women. DESIGN: Cross-sectional. SETTING: The Women's Interagency HIV Study (WIHS). PARTICIPANTS: 2028 middle-aged (average age 39 years) female participants (1449 HIV+; 579 HIV-). MEASUREMENTS: The Fried Frailty Index (FFI), HIV status variables, and constellations of variables representing Demographic/health behaviors and Aging-related chronic diseases. Associations between the FFI and other variables were estimated, followed by stepwise regression models. RESULTS: Overall frailty prevalence was 15.2% (HIV+, 17%; HIV-, 10%). A multivariable model suggested that HIV infection with CD4 count<200; age>40 years; current or former smoking; income ≤$12,000; moderate vs low fibrinogen-4 (FIB-4) levels; and moderate vs high estimated glomerular filtration rate (eGFR) were positively associated with frailty. Low or moderate drinking was protective. CONCLUSIONS: Frailty is a multidimensional aging phenotype observed in mid-life among women with HIV infection. Prevalence of frailty in this sample of HIV-infected women exceeds that for usual elderly populations. This highlights the need for geriatricians and gerontologists to interact with younger 'at risk' populations, and assists in the formulation of best recommendations for frailty interventions to prevent early aging, excess morbidities and early death.

Parental stress increases body mass index trajectory in pre-adolescents.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Rates of childhood obesity have increased since the mid-1970s. Research into behavioural determinants has focused on physical inactivity and unhealthy diets. Cross-sectional studies indicate an association between psychological stress experienced by parents and obesity in pre-adolescents. WHAT THIS STUDY ADDS: We provide evidence of a prospective association between parental psychological stress and increased weight gain in pre-adolescents. Family-level support for those experiencing chronic stress might help promote healthy diet and exercise behaviours in children. OBJECTIVE: We examined the impact of parental psychological stress on body mass index (BMI) in pre-adolescent children over 4 years of follow-up. METHODS: We included 4078 children aged 5-10 years (90% were between 5.5 and 7.5 years) at study entry (2002-2003) in the Children's Health Study, a prospective cohort study in southern California. A multi-level linear model simultaneously examined the effect of parental stress at study entry on the attained BMI at age 10 and the slope of change across annual measures of BMI during follow-up, controlled for the child's age and sex. BMI was calculated based on objective measurements of height and weight by trained technicians following a standardized procedure. RESULTS: A two standard deviation increase in parental stress at study entry was associated with an increase in predicted BMI attained by age 10 of 0.287 kg m(-2) (95% confidence interval 0.016-0.558; a 2% increase at this age for a participant of average attained BMI). The same increase in parental stress was also associated with an increased trajectory of weight gain over follow-up, with the slope of change in BMI increased by 0.054 kg m(-2) (95% confidence interval 0.007-0.100; a 7% increase in the slope of change for a participant of average BMI trajectory). CONCLUSIONS: We prospectively demonstrated a small effect of parental stress on BMI at age 10 and weight gain earlier in life than reported previously. Interventions to address the burden of childhood obesity should address the role of parental stress in children.

Thermal defense of extremely low gestational age newborns during resuscitation: exothermic mattresses vs polyethylene wrap.

OBJECTIVE: The purpose of this study was to assess the effectiveness of thermal warming mattresses compared with wrapping in a polyethylene sheet during resuscitation in extremely low gestational age newborns (ELGANs) in preventing admission hypothermia in the neonatal intensive care unit. STUDY DESIGN: Patients delivered between 24 and 28 weeks gestation and ≤1250 g were eligible for this prospective, randomized study. In the delivery room, the resuscitation team opened a sealed opaque envelope for treatment group assignment to either the wrap or the sodium acetate mattress group. Resuscitation followed protocols recommended by the Neonatal Resuscitation Program. The primary outcome for this study was comparison of axillary temperatures recorded at the time of neonatal intensive care unit admission between the two groups. RESULT: Thirty-nine patients were enrolled in the study. The mattress group's mean admission temperature was 36.5±0.67, whereas the plastic wrap group's was 36.1±0.66 (P=0.0445). CONCLUSION: Thermal mattresses improved admission temperature for ELGANs over plastic wrap. Although both plastic wrap and thermal mattresses improve the thermal status of ELGANs, all current interventions fall short of truly protecting all these vulnerable patients from thermal stress.

Educational intervention to control cockroach allergen exposure in the homes of hispanic children in Los Angeles: results of the La Casa study.

BACKGROUND: Cockroach allergy is common among inner city children with asthma, and exposure to cockroach allergen is associated with more severe disease. However, there has been little evaluation of educational approaches for controlling cockroach infestations and reducing allergen exposure. OBJECTIVE: An educational intervention to reduce cockroach allergen exposure in the homes of Hispanic children in Los Angeles was implemented and evaluated. METHODS: Caretakers of 150 children with asthma were randomly assigned to an in-home intervention or comparison group. In the intervention group, peer health educators trained the caretaker to control cockroaches by reducing harbourage and access to food and by applying boric acid, and to reduce allergen exposure by cleaning. Allergen impermeable covers were placed on the child's mattress and pillows. Knowledge, reported and observed behaviour, cockroach counts, and cockroach allergen (Bla g 1) in dust samples from the kitchen and the child's bedding were assessed at study entry and at follow-up 4 months later. RESULTS: There was improvement in knowledge and in observed and reported behaviour hypothesized to be associated with cockroach control. The geometric mean cockroach number in the intervention homes at the follow-up visit was 60% lower than in the non-intervention homes (95% confidence interval (CI) 14%, 81%). Geometric mean total cockroach allergen collected from the child's bedding was 64% lower in the intervention group (95% CI 12%, 85%). In homes with heavier initial cockroach infestation, there was a larger reduction in total kitchen dust allergen and concentration associated with the intervention than in homes with fewer initial cockroaches. CONCLUSIONS: We conclude that reduction in number of cockroaches and in total allergen in bedding dust can be achieved by caretakers of asthmatic children following a single home educational intervention by peer educators.

The complete sequence of the zebrafish (Danio rerio) mitochondrial genome and evolutionary patterns in vertebrate mitochondrial DNA.

We describe the complete sequence of the 16,596-nucleotide mitochondrial genome of the zebrafish (Danio rerio); contained are 13 protein genes, 22 tRNAs, 2 rRNAs, and a noncoding control region. Codon usage in protein genes is generally biased toward the available tRNA species but also reflects strand-specific nucleotide frequencies. For 19 of the 20 amino acids, the most frequently used codon ends in either A or C, with A preferred over C for fourfold degenerate codons (the lone exception was AUG: methionine). We show that rates of sequence evolution vary nearly as much within vertebrate classes as between them, yet nucleotide and amino acid composition show directional evolutionary trends, including marked differences between mammals and all other taxa. Birds showed similar compositional characteristics to the other nonmammalian taxa, indicating that the evolutionary trend in mammals is not solely due to metabolic rate and thermoregulatory factors. Complete mitochondrial genomes provide a large character base for phylogenetic analysis and may provide for robust estimates of phylogeny. Phylogenetic analysis of zebrafish and 35 other taxa based on all protein-coding genes produced trees largely, but not completely, consistent with conventional views of vertebrate evolution. It appears that even with such a large number of nucleotide characters (11,592), limited taxon sampling can lead to problems associated with extensive evolution on long phyletic branches.

A java-based application for differential diagnosis of hematopoietic neoplasms using immunophenotyping by flow cytometry.

We describe the implementation of a Java-based application for differential diagnosis of hematopoietic neoplasms using immunophenotyping by flow cytometry. The current version of this Java applet includes the knowledge-base for 33 hematopoietic neoplasms and 43 diagnostic immunophenotyping markers. Java, a new object-oriented computing language, helps facilitate development of this applet, a platform-independent module that can be implemented on the World Wide Web. As the Web rapidly becomes more accessible to users around the world, Web-based software may eventually form the core of decision-support systems in clinical settings. Java-based applications, such as the one described in this paper, are expected to contribute significantly in this area.

Perceived invulnerability and cigarette smoking among adolescents.

Adolescent perceptions of invulnerability toward smoking and nonsmoking-related health risks were examined among 442 continuation high school students. Smokers were less likely than nonsmokers to report feeling invulnerable to both smoking and nonsmoking-related health risks. Among the smokers, those who reported feeling invulnerable to smoking-related health risks, compared to those who reported feeling vulnerable, smoked fewer cigarettes, were less addicted, were less likely to intend to smoke more in the future, attempted to quit fewer times in the past, valued their health more, and reported higher public body awareness. In a multiple logistic regression model, only high public body awareness, fewer previous attempts to quit, and being in the action stage of change (compared to being in the precontemplation stage of change) remained significant independent concurrent predictors of being in the invulnerable group. These results suggest, contrary to some previous work, that perceived invulnerability may be predictive of quitting tobacco use and may reflect relative invulnerability; that is, lighter use of tobacco.

A relational database for diagnosis of hematopoietic neoplasms using immunophenotyping by flow cytometry.

A relational database was developed to facilitate the diagnosis of hematopoietic neoplasms using results of immunophenotyping by flow cytometry. This database runs on personal computers and uses backward-chaining search to arrive at conclusions. Results of immunologic marker studies are processed by the database to obtain a set of differential diagnoses. The current version of this database includes diagnostic immunophenotyping pattern for 33 hematopoietic neoplasms. We tested this database using 92 clinical cases from 2 tertiary care medical centers. The database ranked the actual diagnosis as 1 of the top 5 differential diagnoses in 93% of the cases tested. The user can modify the database contents to suit individual needs. This database has been posted on the World Wide Web for direct access. We propose that this user-friendly database is a potential tool for computer-assisted diagnosis of hematopoietic neoplasms.

Practice parameter for the use of red blood cell transfusions: developed by the Red Blood Cell Administration Practice Guideline Development Task Force of the College of American Pathologists.

A practice parameter has been developed to assist physicians in the therapeutic use of red blood cell transfusions. The developers of this parameter used the best available information from the medical literature, as well as clinical experience and the extensive reality testing required by the College of American Pathologists for approval. In acute anemia, a fall in hemoglobin values below 6 g/dL or a rapid blood volume loss of more than 30% to 40% requires red blood cell transfusions in most patients. However, tissue oxygenation provides a better indication of physiologic need in situations where invasive monitoring provides this information. When these data are not available, heart rate and blood pressure measurements and the nature of bleeding (active, controlled, uncontrolled) supplement the hemoglobin value in guiding the transfusion decision. In sickle cell disease and thalassemias, red blood cells are transfused to prevent acute or chronic complications. Red blood cell transfusions are used in chronic anemias unresponsive to pharmacologic agents based on the patient's symptoms. Guidelines must be altered for neonates who require an increase in hematocrit to above 0.30 to 0.35 when respiratory distress is present. Indications for red blood cell transfusion for the pregnant or postpartum patient are similar to those for the nonpregnant patient. Risks of transfusion, particularly transmissible disease and incompatibility, remain but have been reduced. Thus, red blood cell transfusion continues to be a powerful therapeutic tool when used judiciously and carries less risk than in the recent past.

Pseudosarcomatous fibromyxoid tumor of the bladder: biphasic contrast-enhanced helical CT findings.

We report a case of pseudosarcomatous fibromyxoid tumor of the bladder in a 23-year-old man with a 2 month history of painless gross hematuria, which was studied by biphasic contrast-enhanced helical CT. CT demonstrated a 2 cm diameter polypoid enhancing mass in the anterior bladder wall. The lesion measured 103 and 91 HU on early and delayed images, respectively. Increased contrast enhancement was attributed to a histologically highly vascular myxoid stroma.

Fellowship training programs in blood banking and transfusion medicine: results of a national survey.

This report details the results of a 1995 survey of the 40 fellowship training programs in blood banking and transfusion medicine in the United States approved by the Accreditation Council for Graduate Medical Education. Fellows primarily enter transfusion medicine training after completing a pathology residency, and are subsequently employed in an academic or university setting, or a blood donor center. Program directors indicated that either the current level, or fewer, transfusion medicine specialists will be needed in the future. The educational content of fellowship training was examined, as well as aspects of proficiency and competency in several areas. Research is an important part of most fellowship programs, and a majority of program directors felt that some formal training in clinical medicine should be a part of fellowship training in transfusion medicine. The information obtained from this survey should be helpful to both fellowship applicants and program directors in delineating important aspects of fellowship training in blood banking and transfusion medicine.

Case reports: delayed hemolytic transfusion reaction in sickle cell disease.

This article reports the details of delayed hemolytic transfusion reactions in four patients with sickle cell disease. These cases demonstrate the characteristics of the reactions, the significant risks involved, and the principles useful in diagnosis and treatment. Patients with sickle cell disease are at particular risk for delayed hemolytic transfusion reactions because they may be transfused at intervals over many years; they frequently form alloantibodies because of antigenic differences from the donor population; and they may receive emergency care in different hospitals where transfusion records are not available. In addition, exchange transfusions, which are often used for patients with sickle cell disease and which were given in three of these cases, raise the risks through increased exposure to foreign erythrocyte antigens and through an increased volume of erythrocytes susceptible to hemolysis. It was concluded that the hazards of these transfusion reactions justify preventive measures, such as extended erythrocyte phenotyping of patients with sickle cell disease and extended phenotypic matching of transfused cells.

A rule-based expert system for laboratory diagnosis of hemoglobin disorders.

OBJECTIVE: To illustrate the utility of a rule-based expert system in diagnosing hemoglobin disorders. DESIGN: A rule-based expert system was developed for diagnosing hemoglobin disorders. This expert system runs on IBM-compatible personal computers and uses a backward-chaining search strategy to draw conclusions. Laboratory data (ie, results of hemoglobin electrophoresis, quantitative measurements of hemoglobin F and hemoglobin A2 levels, and result of a sickle cell screen) are processed by the system using defined rules to obtain a set of differential diagnoses. Additional data, such as hematologic parameters, ethnicity of the patient, and the presence or absence of certain clinical signs and symptoms, aid in making a final diagnosis. The rules in the current version of this expert system include diagnostic criteria for 71 hemoglobin disorders. SETTING: Regional academic medical center. PATIENTS: We tested the system by using 58 survey sample cases offered by the College of American Pathologists during the period of January 1989 through December 1994. MAIN OUTCOME MEASURE: The established diagnosis for a given case must be included in the list of differential diagnoses suggested by the expert system. RESULTS: The expert system included the actual diagnosis as one of the top four differential diagnoses in 90% of the cases, whereas all the laboratories participating in the survey included it in 84% (mean) of the cases. CONCLUSION: We propose that this user-friendly expert system is a potential tool for computer-assisted diagnosis of hemoglobin disorders.

Laboratory medicine parameter. Utilizing monospecific antihuman globulin to test blood-group compatibility.

When using polyspecific antihuman globulin (AHG) reagents to detect unexpected antibodies or for crossmatching, reactivity in the AHG phase may be due exclusively to the AHG anticomplement component. A lengthy evaluation may be needed to prove that the reactivity is caused by a "nuisance" antibody, one that is clinically insignificant. Clinically significant transfusion intolerance is rare when caused by blood group alloantibodies, which are detected only with AHG sera that contain anticomplement activity. Using monospecific anti-IgG AHG reagents to detect unexpected antibodies offers reliability while avoiding interference from some common and clinically insignificant IgM complement-fixing antibodies, and thereby saves time and expense.

Biomechanical performance of new vascular sutures and needles for use in polytetrafluoroethylene grafts.

Two new cardiovascular monofilament sutures attached to taper point needles have been developed for use in expanded polytetrafluoroethylene (PTFE) grafts. One monofilament suture made of PTFE has a microporous structure that allows it to be channel swaged to a needle that closely approximates its suture diameter. The other suture is a monofilament polypropylene suture that has been extruded to produce a tapered swage end, which was significantly smaller than that of the remainder of the suture in order to be channel swaged to smaller diameter needles. On the basis of comprehensive biomechanical performances, the performance of the new needle suture products with needle/suture diameter ratios approaching 1:1 was superior to needle suture products with 2:1 needle/suture diameter ratios for use in PTFE vascular grafts, regardless of the suture material.

Serial maternal blood donations for intrauterine transfusion.

Because of concern regarding viral disease transmission, 21 pregnant women who had been alloimmunized to various red-cell antigens donated 77 units of blood (range two to six donations) for intrauterine transfusion to their anemic fetuses. Patients received supplemental iron and vitamin therapy throughout the blood donation period. Before the first donation, the mean (+/- SD) maternal hematocrit was 34.4 +/- 2.8%, whereas at delivery it was 33.4 +/- 3.5%. Maternal hematocrit was noted to decline slightly between the first and second donations but returned to pre-donation values with subsequent donations. No adverse maternal or fetal effects occurred secondary to repeated donations. Use of maternal designated-donor red cells for intrauterine transfusion offers potential advantages over the use of random allogeneic red blood cell units.

Cardiovascular surgery in patients with congenital plasma coagulopathies.

From 1978 to 1986, fifteen cardiovascular operations were performed on 13 patients with known congenital bleeding disorders. The patients (10 men and 3 women) had a mean age of 51.1 +/- 3.4 years. Four were seen with cardiovascular lesions and documented hemophilia A (Factor VIII deficiency); 3 had hemophilia B (Factor IX deficiency); 3 had Factor XI deficiency; 2 had von Willebrand's disease, and 1 had dysfibrinogenemia. All patients had a history of major hemorrhage after dental extractions or general surgical procedures, and had clearly documented coagulation disorders on hematological evaluation. Elective cardiovascular procedures performed in these patients included aortocoronary bypass grafting (eight), cardiac valve replacement or repair (five), aortic graft placement (one), and carotid endarterectomy (one). The mainstay of perioperative management included appropriate replacement therapy with blood components. Coagulation factor levels were measured routinely to guide therapy. There were no deaths. Two hemorrhagic complications necessitated reexploration. We conclude that in patients known to have congenital coagulation disorders, cardiovascular operations using systemic heparinization can be performed with minimal morbidity and mortality when carried out with preoperative and perioperative support from the hematology service, adequate replacement therapy using blood components, and careful monitoring of the coagulation status.