PURPOSE: Previous research has confirmed the inability of flight nurses in an airborne BO-105 helicopter to hear breath sounds using normal or amplified transthoracic stethoscopy. The purpose of this study was to determine whether esophageal stethoscopy enabled effective auscultation of breath sounds in a simulated in-flight environment. METHODS: The cabin-sound environment of an in-flight BO-105 was recorded and recreated in an audiology laboratory, where five flight nurses were evaluated listening to taped breath sounds via an esophageal stethoscope. This audiotape model, validated in a previously published study, used a tape consisting of 24 20-second segments. Each segment, the beginning of which was marked with a beep signal, consisted of 20 seconds of silence or breath sounds. The distal (esophageal) end of the esophageal stethoscope was attached to the tape recorder; the intensity level of breath sounds heard at the stethoscope earpiece was calibrated to equate the sound level of actual esophageal breath sounds recorded on a volunteer. RESULTS: All nurses correctly identified the 24 taped segments as silent or including breath sounds 100% of the time. CONCLUSION: In the simulated environment tested, esophageal stethoscopy enabled 100% accuracy in identification of breath sounds, as compared with previously reported 0% efficacy for standard transthoracic auscultation. Study in the actual patient-care environment is indicated to confirm the usefulness of esophageal stethoscopy in the in-flight setting.

Air Ambulances↗

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Susceptibility of Anopheles quadriannulatus Theobald (Diptera: Culicidae) to Plasmodium falciparum.

Anopheles quadriannulatus, the cattle-feeding member of the An. gambiae complex, was fed human blood which contained cultured gametocytes of Plasmodium falciparum, using a membrane feeding system. After 7 days, 33-80% of the mosquitoes that took a blood meal contained developing oocysts. In 7 out of 12 females sporozoites were found in the salivary glands 14 days after the infectious blood meal. Control groups of An. gambiae s.s. and An. stephensi became readily infected with > 90% developing oocysts. All of the An. gambiae dissected 14 days after the infectious blood meal had sporozoites in their salivary glands. The results demonstrate that An. quadriannulatus is susceptible to infections with P. falciparum.

Animals↗

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T-cell-mediated enhancement of host-versus-graft reactivity in mice fed a diet enriched in vitamin A acetate.

Retinol (vitamin A) and some of its derivatives have an important role in: (1) regulating growth, proliferation and differentiation of various tissues and (2) maintaining reproduction and visual function in man and higher animals. Vitamin A and retinoids are also known as potent immunoregulatory and antineoplastic agents. Their ability to increase reactivity to histoincompatible tissues is well documented but the mechanism of this action is unclear. Here we report that mice fed on an otherwise conventional diet supplemented with vitamin A acetate (VAA) respond to 10(5) semiallogeneic cells (a suboptimal dose) in a host-versus-graft (HvG) reaction, whereas mice on a conventional diet do not. It is possible to transfer this enhanced immune reactivity by injecting lymphoid cells from VAA-fed animals into those syngeneic mice maintained on the conventional diet. Using a positive selection technique, we demonstrate that the phenotype of the cell probably responsible for this phenomenon is Lyt 1+ 2-.

Animals↗

PubMedDate not supplied

Social competence and behavioral problems of pediatric survivors of burns.

Sixty children (35 boys, 25 girls) with burns were surveyed at least 1 year after burn injury to assess the behavior problems and difficulties with competency that they were having. The Child Behavior Checklist, the Youth Self Report, and the Teacher Report Form developed by Achenbach were administered to obtain standardized measures of behavior and competence. The mean values for these scales were in the normal range for each age and sex. However, the Child Behavior Checklist revealed a statistically significant (p < 0.05) increase in problems and decrease in competency for most age groups and both sexes when compared with the reference population. In contrast, the Teacher Report Form and the Youth Self Report revealed very few differences from the reference population. The burn size (15% to 20% total body surface area, 35% to 50% total body surface area, and > 70% total body surface area) did not account for any of the group differences. Further studies involving detailed clinical interviews and other standardized measures are needed to understand the discrepancies between the Child Behavior Checklist and the other scales.

Adolescent↗

PubMedDate not supplied

Parental stress as a cause and effect of pediatric burn injury.

The current study reports assessments of stress for parents of children with acute burns at the time of hospital admission and during the first 5 years after injury. At each assessment, parents of children with burns report neither more nor less stress than a normal population. At the time of admission, parents of children with acute burns do not differ from the normal sample on any of the measures of parenting stress. Parents of recovering children with burns do report significant changes. They report significantly higher depressive symptoms at year 2 after the child's burn injury and lower than normal levels of depression in years 4 and 5 after the child's injury. During the recovery period, these parents also attribute their stress more often to the child with burns, whereas other parents more evenly divide blame among their children and their personal characteristics.

Acute Disease↗

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Visible scars and self-esteem in pediatric patients with burns.

The supposition of often made that visible scarring is more psychologically damaging than are "hidden" burn scars, but little evidence exists to support that idea. We compared the self-evaluations of 28 male and 21 female pediatric patients with burns to the amount and visibility of scars. Males were 6 to 18 years old at the time of burn and sustained 15% to 99% total body surface area burns. They were evaluated 1 to 6 years after their burn injury. Females constituted a similar group. They were 5 to 18 years old at the time of burn, sustained 15% to 94% total body surface area burns, and were evaluated 1 to 7 years after their burn injury. All of the children underwent evaluation with the Piers-Harris Children's Concept Scale, evaluating themselves on intellectual and school status, physical appearance, anxiety, happiness and satisfaction, and behavior and popularity. Scores from these parameters were compared against each child's "visible" scars as seen on the face, head, neck, and hands. Also, comparisons were made with the numbers of reconstructive needs in these areas. Significant inverse correlations were found in the males. As the number of scars increased in these areas, the patient's scores for "physical appearance" and "happiness and satisfaction" decreased (p < 0.001). Other psychologic parameters were not affected. There was no effect by age of patient, and no significant correlations were found for the female group. The results emphasize the importance of the burn team's awareness that pediatric survivors of burns may appear superficially to be adjusting well, while harboring grave self-deprecating feelings. Those with "visible" scars will need special support to enhance self-esteem.

Adaptation, Psychological↗

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Physical activity, glucose tolerance, and diabetes mellitus: the Whitehall Study.

In the Whitehall Study, 6,672 men aged 40-64 years completed a questionnaire concerning leisure time physical activity and had a capillary blood glucose measurement on a sample taken 2 h after a 50 g glucose load. An activity score was calculated by grouping subjects into three broad categories: inactive, moderately active, and active. In both univariate and multiple regression analysis no significant association between blood glucose level and activity score could be found. There were 49 previously diagnosed non-insulin-dependent diabetic men and 25 men with 2 h blood glucose levels exceeding 11.1 mmol/l. The proportion of men in each of these groups did not differ significantly between the three activity categories. In a 1:10 sub-sample (n = 1,650) of the whole Study population there was no relationship between glucose tolerance distribution and a measure of energy expenditure (kcal/kg body weight). In this population there is no evidence for relationship between glucose tolerance or non-insulin-dependent diabetes and reported leisure time physical activity, or between glucose tolerance and energy expenditure.

Adult↗

PubMedDate not supplied

Examinee strategies for increasing test scores.

Explore the source record for details and available documents.

Educational Measurement↗

PubMedDate not supplied

Cost effectiveness of alternative Helicobacter pylori eradication strategies in the management of duodenal ulcer.

Published data and techniques for decision analysis were used to construct a model to estimate the cost effectiveness of nine alternative strategies for the management of patients diagnosed with uncomplicated duodenal ulcer. Two strategies of intermittent therapy with either ranitidine or omeprazole, one strategy of continuous maintenance treatment with ranitidine, and six strategies for ulcer healing and eradication of Helicobacter pylori infection were considered. Healing time curves were estimated by using published data, allowing for estimation of expected time for acute healing episodes. The expected number of weeks to heal per patient, in a one-year period, was estimated by combining healing time data with probability of ulcer recurrence. It was found that patients that underwent any of the six H pylori eradication regimens had fewer days with ulcer per year than those who underwent maintenance or intermittent ranitidine. Four eradication regimens had lower costs and better outcomes than ranitidine therapy. In comparing H pylori strategies, the two strategies of omeprazole plus one antibiotic (either amoxicillin or clarithromycin) are most costly than omeprazole plus two antibiotics (specifically amoxicillin and metronidazole or clarithromycin and metronidazole) and result in similar outcomes. Although omeprazole-based eradication regimens are more costly than ranitidine bismuth triple therapy, they are associated with fewer recurrences of ulcer and days of symptoms. A limitation of the analysis is that it did not incorporate issues of compliance and metronidazole resistance; however, the former concern may be less of an issue as H pylori regimens become simpler and shorter in duration.

Amoxicillin↗

PubMedDate not supplied

Evaluation of salivary antibodies to detect infection with Helicobacter pylori.

Helicobacter pylori infection is an important cause of peptic ulcer disease and chronic gastritis. Infection with this bacterium stimulates the production of immunoglobulin (Ig) G antibody. Salivary IgG antibody tests to detect H pylori infection offer a convenient and noninvasive method of diagnosis. To evaluate an IgG salivary antibody kit, saliva was collected from 157 out-patients with dyspepsia referred for endoscopy to a tertiary centre. A salivary IgG ELISA antibody assay was performed using the Helisal Helicobacter pylori (IgG) assay kit, and at least four gastric biopsies were obtained. H pylori infection was confirmed by demonstration of the organism on Warthin-Starry silver stain (sensitivity 85%, specificity 55%). The prevalence of infection with H pylori was 30%. When the analysis was redone, excluding those treated with eradication therapy, the results were similar (sensitivity 86%, specificity 58%). The positive predictive value of the assay was 45% and the negative predictive value was 90%. Despite the ease of sampling, the assay used has limited diagnostic utility, lacking the predictive value to indicate which patients referred with dyspeptic symptoms to a tertiary care setting are infected with H pylori.

Adolescent↗