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Household insecticides: evaluation and assessment of inhalation toxicity: a workshop summary.

Particularly in tropical countries household insecticides are used on a day-by-day basis to control mosquitoes, other crawling and flying insects to prevent the spread of vector-borne diseases. The products used most often are spray-cans, oil-sprays, mosquito coils as well as slow-release vaporising systems such as mats and liquid vaporiser. The extent and duration of exposure of humans is highly dependent on the type of product used. The objective of this workshop was to analyse the necessity and feasibility of inhalation studies with household insecticides taking into account the specific constrains associated with each type of end-use product. The standardisation of inhalation studies with regard to the generation of test atmospheres, mode and duration of exposure, and selection of adequate toxicological endpoints were addressed. Due to the complex nature of exposure atmospheres generated by some household insecticides, viz. mosquito coils, it is scientifically challenging to characterise the pathomechanism of most concern, since irritant combustion gases, volatile and semi-volatile organic substances, particulates (soot), condensation aerosols and re-condensed substances onto particulates may act independently, synergistically or mixture specific. It has been concluded that for the comparative safety evaluation and risk assessment of indoor insecticide end-use products generally recognised guidance for harmonised inhalation testing is required: 1) For high-dose release products, such as spray-cans, acute inhalation testing appears to be most relevant. 2) For low-dose, slow-release devices, subchronic inhalation studies of 13-weeks, duration of exposure 6 hours/day for 5 consecutive days per week, should be performed on rats preferably with the end-use product. A dose-range finding study of 2-weeks duration, daily exposure, should be available for the justification of dose selection and to demonstrate that the findings of 5 days/week exposure is not different from that utilising a daily exposure. 3) In certain instances, inhalation testing of shorter duration, for example 2 or 4 weeks, may be appropriate if the inhalation toxicity of the basic formula has already been characterised or the major constituents contained in the formulation have been examined in extant studies. The duration of study should also depend on actual use and exposure pattern, the accumulation potential and the mode of action of the ingredients of concern. 4) Particularly for mosquito coil smokes, the possible physico-chemical interactions of particulates, potentially irritant water soluble or nonsoluble vapours and aerosol or vapours of the active ingredient(s) are virtually impossible to predict without appropriate inhalation testing. 5) Physiological measurements may be useful for the detection and quantification of the respiratory tract sensory irritation potency. Biochemical endpoints in lung lavage and conventional histopathology of the lungs and extrathoracic airways are considered to be important. 6) It has been agreed that the nose-only exposure technique provides the most cost-effective and controlled means to expose small laboratory animals to well defined atmospheres as long as the limitations of this technique are taken into account.

Air Pollution, Indoor↗

Cancer imaging informatics workshop report from the Biomedical Imaging Program of the National Cancer Institute.

A group of experts on very large databases, quantitative imaging, data format standards development, image management and communications, and related technologies for cancer imaging met at a recent workshop sponsored by the BIP and discussed the key issues confronting this field. The BIP received recommendations regarding steps that can be taken to advance the technology and take advantage of the opportunities to improve collaboration and utility in cancer imaging. There are tremendous opportunities to change radically the way we use image information. These opportunities are most obvious in clinical research, in which we seek to advance the dissemination and use of cancer image data in research and practice. Important opportunities and new modes of information use are provided by supporting the entire "information cycle" of creation, dissemination, and collaboration in addition to image organization, access, presentation, and preservation. To learn more, visit the BIP Web site at www3 .cancer.gov/bip/steer_iasc.htm and join the image archive listserver at the NIH (ARCHIVE-COMM-L, available online at list.nihgov). These resources are open and available to all.

Diagnostic Imaging↗

Oral mucosal melanomas: the WESTOP Banff workshop proceedings. Western Society of Teachers of Oral Pathology.

A workshop to discuss primary oral melanomas was convened at the annual Western Society of Teachers of Oral Pathology meeting in Bannf, Alberta, Canada. Fifty oral melanomas, identified from the files of the participants, were reviewed in order to better understand the clinical features, histologic spectrum, and natural history of these perplexing lesions. Results confirmed that oral melanomas occur in adults almost three times more frequently in men than women and have a decided predilection for the palate and gingiva. Some lesions exhibit a clinically detectable and prolonged in situ growth phase, whereas others seem to lack this property and exhibit only or predominantly invasive characteristics. Recurrences, metastases, and death from tumor were characteristic of the follow-up of a limited number of patients. Until definitive prospective data are collected that elucidate natural history, oral mucosal melanomas should be tracked separately from cutaneous lesions. All oral pigmented lesions that are not clinically diagnostic should be biopsied. Lesions with equivocal histopathologic features might be referred to as "atypical melanocytic proliferation" and should be excised. Recognition of lesions in an early in situ phase and aggressive treatment should have a favorable effect on prognosis. To enhance future or prospective study of these rare neoplasms, guidelines for reporting oral melanomas are suggested.

Adult↗

Enhancing efficacy, safety, and convenience of immunotherapy: a workshop presentation.

OBJECTIVE: To discuss issues in delivering appropriate allergen immunotherapy. DATA SOURCES: Review of Immunotherapy Collegium II workshop presented at the 2005 Annual Meeting of the American College of Allergy, Asthma and Immunology. STUDY SELECTION: Topics discussed during Immunotherapy Collegium II. RESULTS: In the past, dosage schedules, levels, and rates of acceleration were linked to skin test results. The most recent published schedules for administration of immunotherapy do not reflect the initial reaction to the skin test, but leave it to the treating physician to factor in the results of testing with plans for administration in both increments and frequency. However, there are no official recommendations for physicians relevant to using a skin test to gauge patient sensitivity. Rather, allergists are advised to set up a maintenance concentrate and then make suitable dilutions when immunotherapy is initiated. CONCLUSION: Although recommendations are lacking regarding the use of a skin test to gauge patient sensitivity, official recommendations are clear in other areas of immunotherapy, such as the use of premedication. It is important that standard terms be adopted by all physicians who prescribe allergen immunotherapy and that modified allergens and/or oral immunotherapy be explored in the future to make immunotherapy more comfortable.

Desensitization, Immunologic↗

Biological monitoring of young workers exposed to polycyclic aromatic hydrocarbons in engine repair workshops.

Several polycyclic aromatic hydrocarbons (PAHs) are carcinogenic in rodents, while exposure to these compounds has been associated with various types of human cancer. Engine exhaust and used engine oils are major PAH sources in engine repair workshops. Urinary 1-hydroxypyrene (1-OHP) levels and some genotoxicity parameters (sister-chromatid exchange, SCE; micronucleus, MN) have been compared among engine repair workers (n = 61, age: between 13 and 18) and workers not occupationally exposed to PAH (n = 30, age: between 13 and 19). The mean value (+/- S.E.) of urinary 1-OHP excretions of workers was 4.71 +/- 0.53 micromol/mol creatinine and also mean urinary 1-OHP for controls was found to be as 1.55 +/- 0.28 micromol/mol creatinine. The mean values (+/- S.E.) of SCE frequency per cell in peripheral lymphocytes from the workers and controls were 4.47 +/- 0.09 and 4.06 +/- 0.16, respectively (p < 0.05). The mean (+/- S.E.) MN (per thousand) frequencies in peripheral lymphocytes from the workers and controls were 1.87 +/- 0.04 and 1.56 +/- 0.06, respectively (p < 0.0001). The effect of smoking for the above parameters were also evaluated.

Adolescent↗

Breaking bad news--development of a hospital-based training workshop.

The skills required to break bad news have been written about extensively and are taught in medical schools. Recent initiatives have concentrated on improving the skills of doctors and nurses in senior positions, who act as role models for their junior colleagues. A multiprofessional learning situation can be a threatening environment, in which colleagues may worry about exposing some of the weaknesses in their knowledge and skills regarding communication with patients. We describe the initiation, running, and evaluation of successful training workshops on breaking bad news in a large British district hospital.

Humans↗

Iron bioavailability: UK Food Standards Agency workshop report.

The UK Food Standards Agency convened a group of expert scientists to review current research investigating factors affecting iron status and the bioavailability of dietary iron. Results presented at the workshop show menstrual blood loss to be the major determinant of body iron stores in premenopausal women. In the presence of abundant and varied food supplies, the health consequences of lower iron bioavailability are unclear and require further investigation.

Biological Availability↗

Scanning the horizon for emerging health technologies. Conclusions from a European Workshop.

To share the existing, albeit limited, experience among nations and to explore the feasibility of international collaboration on the identification and early evaluation of health care technologies, an workshop was arranged in September 1997. Twenty-seven policy makers and researchers from twelve countries attended the meeting and concluded that: the policy environment in most European countries is characterized by insufficient data on safety, effectiveness, and cost-effectiveness of health care innovations; that an early warning system is perceived as an essential mechanism for facilitating communication among policy makers, technology experts, and health professionals; and that collaboration on early warning activities might be even more useful than traditional collaboration in health technology assessment.

Diffusion of Innovation↗

Strategic planning workshop on research needs for neutron capture therapy.

The workshop 'Research Needs for Neutron Capture Therapy', held in Williamsburg, VA, May 9-12. 1995 addressed key issues and questions related to optimization of boron neutron capture therapy (BNCT), in general, and to the possibility of success of the present BNCT trials at the Brookhaven National Laboratory (BNL) and Massachusetts Institute of Technology (MIT), in particular. Both trials use nuclear fission reactors as neutron sources for BNCT of glioblastoma multiforme (BNL) and of deep seated melanoma (MIT). Presentations and discussions focussed on optimal boron-labeled compounds, mainly for brain tumors such as glioblastoma multiforme, and the best mode of compound delivery to the tumor. Also, optimizing neutron irradiation with dose delivery to the tumor cells and the issues of dosimetry of BNCT especially in the brain were discussed. Planning of treatment and of follow-up of patients, coordination of BNCT at various treatment sites, and the potential of delivery BNCT to various types of cancer with an appropriately tailored protocol were additional issues. The need for multicentric interdisciplinary cooperation among the different medical specialties was highlighted.

Boron Neutron Capture Therapy↗

Current views on the pathogenesis of testicular germ cell tumours and perspectives for future research: highlights of the 5th Copenhagen Workshop on Carcinoma in situ and Cancer of the Testis.

This review article highlights the most important contributions presented at the 5th Copenhagen Workshop on Carcinoma in situ and Cancer of the Testis, which was held in Denmark, August 29-31, 2002. The major themes that emerged at the meeting are critically discussed and perspectives for future research in this field are presented.

Animals↗

Research on adherence, behavior change, and mental health: a workshop overview.

The National Institute of Mental Health sponsored a research workshop in 1999 to examine the potential of various theoretical approaches for enhancing adherence and behavior change, with special attention to mental disorders as mediators and outcomes. Complementary, multiple levels of analysis--including individual, small-group, community, and cultural perspectives--were considered. Working groups identified problems and gaps in knowledge that if addressed would transform adherence and behavior change from overlooked or nuisance variables to critical variables in research on mental and medical disorders.

Behavior Therapy↗

A workshop for receptionists in mental health settings.

This article addresses an area which has received little attention in the mental health field--the education and training needs of receptionists. Factors that can assist or impede the contribution of this important position are identified. The authors describe the process used to design and deliver a one-day workshop to enhance receptionists' interpersonal skills, and to increase their understanding of mental health issues. The benefits of this experience for the individual and for mental health organizations are described.

Education↗

Hematopoietic stem cell transplants after reduced intensity conditioning regimen (RI-HSCT): report of a workshop of the European group for Blood and Marrow Transplantation (EBMT).

Allogeneic minitransplants are being increasingly used for the treatment of hematologic malignancies. Eligibility criteria usually include age over 60 years and/or major clinical problems concomitant with the hematologic disorder. This report summarizes a workshop which was held in 1999 under the auspices of EBMT: the issues discussed included stem cell sources and mobilization techniques, stem cell engraftment, accessory cells, mixed chimerism, graft-versus-tumor effect and ongoing clinical trials. There are many questions which still need to be answered, but this area of transplantation seems very promising and will certainly develop in the coming years.

Europe↗

Third EBMT/AMGEN Workshop on reduced-intensity conditioning allogeneic haemopoietic stem cell transplants (RIC-HSCT), and panel consensus.

The Third Workshop on reduced intensity conditioning allogeneic stem cell transplants (RIC-HSCT) was convened by EBMT/AMGEN in Zurich in February 2003. Three general issues were addressed: the age effect, graft-versus-host disease (GvHD) and donor lymphocyte infusions (DLI). An age effect is seen and has a negative impact on survival; GvHD remains an issue that needs to be addressed, and DLI were shown to be a powerful tool against minimal residual disease, but not with rapidly progressing leukemia. The role of host antigen-presenting cells in the development of acute GvHD was outlined and discussed in the animal model. The emerging importance of Epstein Barr Virus infections was also discussed. Retrospective and prospective studies from the EBMT, national groups and single institutions included over 1800 patients: the incidence of acute GvHD grade III-IV was 11% extensive chronic GvHD 22% and TRM 20%. Most conditioning regimens include fludarabine in association with a reduced dose of a myeloablative agent (busulfan, TBI, thiotepa or melphalan). Most transplants were from HLA-identical siblings (77%), and used peripheral blood (90%) as a stem cell source. A consensus discussion on current evidence in RIC transplants is reported in this paper.

Age Factors↗

Hohenheim consensus workshop: copper.

Copper (Cu) is an essential trace element with many physiological functions. Homeostatic mechanisms exist to allow Cu to act as a cofactor in enzymatic processes and to prevent accumulation of Cu to toxic levels. The aim of this commentary is to better understand the role of dietary Cu supply in deficiency and under physiological and pathological conditions. The essentiality of Cu can be attributed to its role as a cofactor in a number of enzymes that are involved in the defence against oxidative stress. Cu, however, has a second face, that of a toxic compound as it is observed with accumulating evidence in hepatic, neurodegenerative and cardiovascular diseases. The destructive potential of Cu can be attributed to inherent physico-chemical properties. The main property is its ability to take part in Fenton-like reactions in which the highly reactive and extremely deleterious hydroxyl radical is formed. Diseases caused by dietary Cu overload could be based on a genetic predisposition. Thus, an assessment of risk-groups, such as infants with impaired mechanisms of Cu homeostasis regarding detoxification, is of special interest, as their Cu intake with resuspended formula milk may be very high. This implies the need for reliable diagnostic markers to determine the Cu status. These topics were introduced at the workshop by the participants followed by extensive group discussion. The consensus statements were agreed on by all members. One of the conclusions is that a re-assessment of published data is necessary and future research is required.

Cardiovascular Diseases↗

From birth to adolescence: Vienna 2005 European Childhood Obesity Group International Workshop.

BACKGROUND: In the last 15 y there has been a tremendous increase in the number of studies on pediatric obesity looking at epidemiology, health-related risks, etiology, methodology and treatment. During the early 1990s, the European Childhood Obesity Group (ECOG) was born as a group of scientists' expert in the field of pediatric obesity. ECOG this year celebrates the approach to early maturity with an excited and omni-comprehensive program developing through eight different tracks. METHODS: Comments on different 'key' papers in each of the eight tracks. RESULTS: The eight tracks were (1) Nutrition requirements and food habits, (2) physical activity, (3) prevention and political actions/strategies, (4) diabetes, (5) metabolism, (6) psychology, (7) pathology, and (8) treatment with emphasis on drugs. CONCLUSION: Looking at the overall picture of the ECOG workshop we could conclude that despite the fact that childhood obesity is a crisis facing worldwide youth, it is necessary that action to control it must be taken now. All the six relevant levels (ie, family, schools, health professionals, government, industry and media) could be involved in prevention of child and adolescent obesity.

Adolescent↗

Training and retaining of underrepresented minority physician scientists - a Hispanic perspective: NICHD-AAP workshop on research in neonatology.

In a workshop organized by NICHD and the AAP in January 2004, we addressed and discussed issues related to a Hispanic perspective in Training and Retaining of underrepresented minority physician scientists in the United States. A review of the literature related to training of underrepresented minority physicians in the United States (US) was performed, giving emphasis to those related to the Hispanic population. Success and failure in training and retention of Hispanic physician scientists and trainees was examined. An underrepresentation of Hispanic minorities in medical research workforce was found. This fact has recently resulted in efforts to increase their recruitment and there is a mandate by the National Institute of Health (NIH) for their inclusion. The Hispanic population in the US has increased rapidly, with diversity among the Hispanics in their personal and professional behavior. Significant disparities in health, health risk factors and access to health care manifested by an increased burden of illness and death have been documented. There in an undersupply of academic Hispanic neonatologist. Factors such as availability of academic employment, limited research funding in pediatrics, managed care and large debt burden of the US medical graduates interfere with recruitment of Hispanic trainees and academic physician scientist. Possible solutions, including recognition research awards, revision of NIH policies in awarding funds for neonatology, establishing strategies to improve minorities' acceptance, participation in research and increase accrual of Hispanic population in clinical trials should be given priority.

Biomedical Research↗

Hematologic malignancies with t(4;11)(q21;q23)--a cytogenetic, morphologic, immunophenotypic and clinical study of 183 cases. European 11q23 Workshop participants.

A total of 183 hematologic malignancies with t(4;11)(q21;q23), including five variant translocations, were collected by the Workshop. Clinical, morphologic and immunophenotypic features were compiled, and karyotypes with variant t(4;11) or secondary chromosomal aberrations were reviewed. All cases were acute leukemias (AL): 173 acute lymphoblastic leukemias (ALL), six acute myeloid leukemias (AML), three unclassifiable AL, and one biphenotypic AL. Ten patients had treatment-associated AL. Females were overrepresented (104 vs 79) and the age distribution was clearly nonrandom; 34% of the cases occurred in infants below the age of 12 months. The remaining AL were evenly distributed among the other age groups, with the oldest patient being 79 years old. An increased white blood cell count (WBC) was reported in more than 90% of the cases, with hyperleukocytosis (> or =100 x 10(9)/l) in 64%. Additional chromosomal changes were detected in 55 (30%) cases, most often gain of the X chromosome, i(7)(q10), and trisomy 8, with frequent breakpoints in 1p36, 1q21, 7q10, 11p15, 12p13, 17p11, and 17p10. All recurrent secondary changes resulted in genomic imbalances, in particular gains of 1q, 7q, 8, and X and losses of 7p and 17p. Event-free and overall survival (EFS and OS) could be ascertained in 170 and 171 patients, respectively. Kaplan-Meier estimates of EFS and OS showed no differences with regard to gender, WBC, or presence of secondary chromosomal abnormalities, and there was no increase of EFS or OS among the 55 cases that had undergone bone marrow transplantation. However, age had an important prognostic impact, with significantly (P < 0.0001) longer EFS and OS in children 2-9 years old than among infants and younger children, patients aged between 10 and 39 years and older adults.

Acute Disease↗