Penultimate Day Research Articles

Comparison of Waterlow and Braden scores for predicting pressure ulcer development in intensive care unit patients: A prospective observational cohort study

Abstract Background and Objectives: Intensive care unit (ICU) patients are highly vulnerable to the development of pressure ulcers (PUs). Risk score scale that would efficiently predict the formation of PU in such patients includes the Waterlow Scale and the Braden Scale. Our objective was to determine the cutoff values of these scores for predicting PU formation in the ICU. Materials and Methods: A prospective observational study was conducted in the ICU of tertiary care center with 74 admitted patients. Inclusion criteria were Braden score ≤18 and Waterlow score >15 at admission to ICU and without preexistent ulcer. Assessment was done at 24-h intervals, after admission using Braden and Waterlow Scales till the patient reached a predefined endpoint development of PU, discharge, or transfer from ICU or death. Results: Thirty-nine patients developed PUs during their ICU stay. Waterlow score on the penultimate day for those who developed ulcers had a lower coefficient of variance (13.30) and greater area under receiver operating characteristic (0.977) than that of Braden (14.20; 0.888). A Waterlow score >20 (sensitivity 97.4%, specificity 88%, and accuracy 93.75%) and Braden score of <12 (sensitivity 97.4%, specificity 60%, and accuracy 82.81%) were predictors of impending ulcer formation in ICU patients. Conclusion: A Waterlow score >20 (19.5) may be taken as a cutoff for predicting impending ulcer formation for ICU patients. Whenever Braden scores are used instead of Waterlow, a cutoff of <12 (12.5) is indicative of higher chances of ulceration.

Expression of enzymes involved in the urea cycle and muscle and mammary gland development of Holstein × Gyr heifers in a rotational grazing system supplemented with increasing protein levels

Studies evaluating the crude protein (CP) supplementation strategies across the year for grazing cattle and its association with the enzymes involved in the urea cycle and muscle and mammary gland developments are scarce. Thus, we aimed to evaluate the effect of supplementation with different levels of CP on the expression of genes involved in the urea cycle and muscle and mammary gland development of Holstein × Gyr crossbreed heifers grazing intensively managed Brachiaria decumbens throughout the year. Thirty-eight heifers with average initial BW of 172.5 ± 11.15 kg (mean ± SE) and 8.2 ± 0.54 mo of age were randomly assigned to 1 of 4 treatments: 3 protein supplements (SUP) fed at 5g/kg of body weight, plus a control group (CON, non-supplemented animals). The supplement CP levels evaluated were: 12, 24, and 36%. The study was divided into 4 seasons: rainy, dry, rainy-dry transition (RDT), and dry-rainy transition (DRT). On the penultimate day of each season, ultrasound images of the carcass and mammary gland were taken. Five animals from each treatment were randomly chosen on the last day of each season, and liver and muscle tissue biopsies were performed. The target genes were the mammalian target of rapamycin (mTOR) and adenosine monophosphate-activated protein kinase (AMPK) in the muscle samples. Carbamoyl phosphate synthetase (CPS), ornithine transcarbamylase (OTC), argininosuccinate synthetase (ASS), arginosuccinate lyase (ASL), and arginase (ARG) were evaluated in the liver samples. Data were analyzed using PROC GLIMMIX of the SAS with repeated measures. We observed a greater rib eye area (cm2) and fat thickness (mm) in SUP animals than in non-supplemented animals. However, we did not observe differences among SUP levels for both variables. No effects of supplementation were detected on mammary gland development. Nevertheless, seasonal effects were observed, where the RDT and dry season had the most and least accumulated fat in the mammary gland. In muscle, we observed greater expression of AMPK in non-supplemented animals than SUP animals. On the other hand, no differences were observed in gene expression between SUP and non-supplemented animals and among SUP animals for mTOR. Season affected both AMPK and mTOR; heifers had a greater AMPK gene expression on rainy than RDT. For mTOR, we observed greater gene expression in RDT and DRT than in rainy. No differences were observed among RDT, dry, and DRT, and between dry and rainy seasons for mTOR. We observed greater CPS, ASL, and ARG gene expression in SUP animals than in non-supplemented animals. Among SUP animals, supplement CP linearly affected CPS. In conclusion, the supplementation strategy did not affect mammary gland development and mTOR expression in muscle tissue. However, we observed a seasonal effect on mammary gland development and AMPK and mTOR expression. The CP supplementation increased the rib eye area and fat thickness, directly affecting AMPK expression in the muscle. Moreover, the CP supplementation increased urea cycle enzyme expression, indicating greater urea production in the liver.

Dissipation kinetics and distribution of fipronil and its toxic metabolites in Banana, cv. Nendran (AAB)

In the study under taken to analyze the dissipation, metabolism and persistence of fipronil in banana, cv. Nendran (AAB), in red loam soils (AEU 8-southern laterites) of Trivandrum, Kerala, India, with treatments as, absolute control (No application of fipronil), recommended practice of soil application of 30 mg a.i. of fipronil per plant per application, applied 3 times on 0, 60 and 150 days of planting and double dose of fipronil, in samples viz., leaves, fingers bunches and flower bud, central core of pseudo-stem and corm sampled and analyzed for residue at definite time intervals revealed that QuEChERS method can be conveniently applied for extracting the residue from various parts of banana plant and has resulted in satisfactory values for validation parameters. Residue of fipronil and their toxic metabolites in the 1st, 2nd and 3rd leaves of banana on penultimate day of completion of pre-bunching application was found to be below the detectable levels (BDL) throughout the period of sampling and this may be attributed to low absorption, very fast metabolism of very low levels of absorbed molecule and mobility. However, on 40th day the fipronil was detected in the 4th leaf to the extent of 0.034 μg g-1 and was not detectable (i.e., BDL) on 50th day indicating safety from residue of harvested produce for consumption especially at recommended dose. Sample matrices of blossom bud, flower bract alone, bunch on 15th day of emergence, bunch on 30th day of emergence, peel, bunch on harvest, pseudo stem and corm were below detectable level of fipronil and their metabolites and even with an additional application of treatment on the day of bunching also did not register any detectable level of fipronil and their metabolites.

Benefit of climatic summer camps for children with asthma bronchiale

Two-week long climate camps for asthmatic children have been organised since 1999 in Ludvikov, Jeseniky Mountains (altitude 620 m) by Department of Pediatrics at University Hospital Olomouc together with parents‘ association. During the stay, children gradually increase their physical activity under medical guidance. Between 1999 and 2019, a total of 915 children aged 8-18 years participated in the recondition stays. All of them had moderate asthma and were treated IKS/LABA. We checked correct application of drugs, educated patients and recorded the values of morning and evening peak expiratory flow (PEF). The program included indoor and outdoor (forest) games and physical activities. Daily agenda of the camp and continuous supervision of children was a responsibility of medical students, who in return observed patients’ reaction to physical burden. Thanks to sponsorship, children from socially disadvantaged families or unbalanced family conditions could also participate. During the 14-day stays, children increase their physical fitness and are able to walk 24 – 26 km trip on the penultimate day. In 60% of children, supervision of proper drug administration increased patients’ compliance and reduced the need for rescue medication (salbutamol spray). Summer recondition camps combine the advantages of mountain climate with the availability of education, treatment supervision and evaluation of the clinical condition. Dosing physical load under medical guidance gradually increases physical fitness of children with asthma and enables them to undertake equal sporting activities as their healthy peers. Medical students gain valuable experience through contact with asthma bronchiale in everyday life.

Blunted Nocturnal Salivary Melatonin Secretion Profiles in Military-Related Posttraumatic Stress Disorder.

Background: Sleep disturbances are a hallmark of posttraumatic stress disorder (PTSD), yet few studies have evaluated the role of dysregulated endogenous melatonin secretion in this condition. Methods: This study compared the sleep quality and nocturnal salivary melatonin profiles of Canadian Armed Forces (CAF) personnel diagnosed with PTSD, using the Clinician Administered PTSD Scale (CAPS score ≥50), with two healthy CAF control groups; comprising, a “light control” (LC) group with standardized evening light exposure and “normal control” (NC) group without light restriction. Participants were monitored for 1-week using wrist actigraphy to assess sleep quality, and 24-h salivary melatonin levels were measured (every 2h) by immunoassay on the penultimate day in a dim-light (< 5 lux) laboratory environment. Results: A repeated measures design showed that mean nocturnal melatonin concentrations for LC were higher than both NC (p = .03) and PTSD (p = .003) with no difference between PTSD and NC. Relative to PTSD, NC had significantly higher melatonin levels over a 4-h period (01 to 05 h), whereas the LC group had higher melatonin levels over an 8-h period (23 to 07 h). Actigraphic sleep quality parameters were not different between healthy controls and PTSD patients, likely due to the use of prescription sleep medications in the PTSD group. Conclusions: These results indicate that PTSD is associated with blunted nocturnal melatonin secretion, which is consistent with previous findings showing lower melatonin after exposure to trauma and suggestive of severe chronodisruption. Future studies targeting the melatonergic system for therapeutic intervention may be beneficial for treatment-resistant PTSD.

Primary Osteosarcoma of the Breast

Editor's Note.-RadioGraphics continues to publish radiologic-pathologic case material selected from the "best case" presentations of the American Institute for Radiologic Pathology (AIRP), a program of the American College of Radiology. The AIRP conducts a 4-week Radiologic Pathology Correlation Course, which is offered five times per year. On the penultimate day of the course, the best case presentation is held at the American Film Institute Silver Theater and Cultural Center in Silver Spring, Md. The AIRP faculty identifies the best cases, from each organ system, brought by the resident attendees. One or more of the best cases from each of the five courses are then solicited for publication in RadioGraphics. These cases emphasize the importance of radiologic-pathologic correlation in the imaging evaluation and diagnosis of diseases encountered at the institute and its predecessor, the Armed Forces Institute of Pathology (AFIP).

Evaluation of Microbial Communities Associated With the Liquid and Solid Phases of the Rumen of Cattle Offered a Diet of Perennial Ryegrass or White Clover.

Rumen microbiota plays an important role in animal productivity, methane production and health. Several different locations have been used to obtain rumen samples (i.e., liquid-phase samples, solid-phase samples, buccal swabs) in previous studies. Here we assess differences in the rumen microbiota between solid- and liquid-phases of the rumen under differing dietary conditions (white clover vs. perennial ryegrass); there were 4 sample types: liquid-associated/grass (LG), solid-associated/grass (SG), liquid-associated/clover (LC), and solid-associated/clover (SC). Four Holstein-Friesian cows were strip grazed on pure stands of perennial ryegrass or white clover in a change-over design experiment with 3 periods (each lasting for 3 weeks). Solid- and liquid- phase microbes were obtained following total rumen evacuation on the penultimate day of each period. DNA was extracted and multiplexed libraries sequenced using 16S next generation sequencing (Illumina MiSeq). Demultiplexed sequences underwent quality control and taxonomic profiles were generated for each sample. Statistical analysis for the effects of diet and phase was conducted both overall [using non-metric multidimensional scaling (NMDS) and diversity indices] and for individual taxa. Separation of both diet and phase was observed NMDS, with significant effects of diet (P < 0.001) and phase (P < 0.001) being observed. Regardless of diet, Prevotella was most abundant in the liquid samples. When assessing differences between phases, the majority of statistically significant taxa (predominantly from Archaea and the order Clostridiales) were found at higher relative abundances in solid-phase samples. Diversity (Shannon Index) was lower in the liquid-phase samples, possibly because of the higher relative abundance of Prevotella. A presence vs. absence approach, followed by Chi-squared testing, was adopted. Differences between phases (LG vs. LC, LC vs. LG, SG vs. SC, and SC vs. SG) and differences between phases for the clover diet (LC vs. SC and SC vs. LC) were significant (P < 0.001); differences between phases for the grass diet were non-significant. Sampling technique has a profound impact on reported microbial communities, which must be taken into consideration, particularly as archaea may be underestimated in the liquid-phase.

THE AMERICAN WAR FOR THE GREATER MIDDLE EAST: FROM DIPLOMACY TO MILITARY INTERVENTION

Emblazoned across the front page of The New York Times on Sunday, 15 November 1981 was a large photograph of hundreds of US soldiers from the army's 82nd Airborne Division parachuting into the vast western desert of the Sinai Peninsula. The photo was eerily reminiscent of the images from October 1956 when Israeli soldiers dropped into the same desert as part of their effort, along with British and French forces, to topple the government of Egyptian President Jamal ʿAbd al-Nasir. But the American soldiers were on a much different mission. Rather than attempting to bring down Egypt's government, they were there to participate, alongside Egyptian forces, in “Operation Bright Star,” the largest American military exercise in the Middle East since World War II. During the next ten days, more than 6,000 US soldiers participated in the “war games,” which stretched from Egypt to Sudan, Somalia, and Oman, at an estimated cost of more than 50 million dollars (157 million dollars in current figures). On 25 November, the penultimate day of the operation, a half dozen American B-52s flying from North Dakota dropped a cluster of bombs over the Egyptian desert and then returned home on a thirty-two-hour journey without stopping, demonstrating the vast reach of the American military.

Identification of drug- and drug-metabolite immune responses originating from both naive and memory T cells

Identification of drug- and drug-metabolite immune responses originating from both naive and memory T cells

Plasma metabolite abundances are associated with urinary enterolactone excretion in healthy participants on controlled diets.

Enterolignans, products of gut bacterial metabolism of plant lignans, have been associated with reduced risk of chronic diseases, but their association with other plasma metabolites is unknown. We examined plasma metabolite profiles according to urinary enterolignan excretion in a cross-sectional analysis using data from a randomized crossover, controlled feeding study. Eighty healthy adult males and females completed two 28-day feeding periods differing by glycemic load, refined carbohydrate, and fiber content. Lignan intake was calculated from food records using a polyphenol database. Targeted metabolomics was performed by LC-MS on plasma from fasting blood samples collected at the end of each feeding period. Enterolactone (ENL) and enterodiol, were measured in 24 h urine samples collected on the penultimate day of each study period using GC-MS. Linear mixed models were used to test the association between enterolignan excretion and metabolite abundances. Pathway analyses were conducted using the Global Test. Benjamini-Hochberg false discovery rate (FDR) was used to control for multiple testing. Of the metabolites assayed, 121 were detected in all samples. ENL excretion was associated positively with plasma hippuric acid and melatonin, and inversely with epinephrine, creatine, glycochenodeoxycholate, and glyceraldehyde (P < 0.05). Hippuric acid only satisfied the FDR of q < 0.1. END excretion was associated with myristic acid and glycine (q < 0.5). Two of 57 pathways tested were associated significantly with ENL, ubiquinone and terpenoid-quinone biosynthesis, and inositol phosphate metabolism. These results suggest a potential role for ENL or ENL-metabolizing gut bacteria in regulating plasma metabolites.

Efficacy of vancomycin extended-dosing regimens for treatment of simulated Clostridium difficile infection within an in vitro human gut model.

Effects of two vancomycin extended-dosing regimens on microbiota populations within an in vitro gut model of simulated Clostridium difficile infection (CDI) were evaluated. Two chemostat gut models were inoculated with faecal emulsion and clindamycin instilled to induce CDI. Simulated CDI was treated with vancomycin (125 mg/L four times daily, 7 days) followed by different vancomycin dosing extensions totalling 7 g (lower dose) or 9.5 g (higher dose) over 6 weeks in Model A and Model B, respectively. Microbiota populations, C. difficile vegetative cells and spores, cytotoxin, antimicrobial concentrations and vancomycin-tolerant enterococci (VTE) were measured every 1-2 days. In both models, vancomycin instillation caused a rapid decline in vegetative cells and cytotoxin, and declines in the Bacteroides fragilis group, bifidobacteria and clostridia populations to the lower limit of detection. Bifidobacteria failed to recover for the remainder of the experiment. B. fragilis group populations recovered to pre-dosing levels during the dosing extension in Model A and after dosing ceased in Model B. Recurrent CDI was observed on the penultimate day of Model B, but not Model A. VTE were observed throughout the experiment in both models, but populations increased during vancomycin instillation and post-vancomycin instillation. The two vancomycin extended-dosing regimens were efficacious in initial treatment of simulated CDI. Both had a prolonged deleterious effect on the indigenous gut microbiota, a factor that may contribute to recurrence; recurrence was observed only in Model B, although the potential for vegetative regrowth within Model A cannot be excluded. Vancomycin exposure appeared to select for VTE populations.

On a so‐Called Solution to a Paradox

AbstractThe mooronic solution to the surprise quiz paradox says students know there will be a surprise quiz one day this week but they lose this knowledge on the penultimate day. This is because ‘there will be a surprise quiz one day this week’ then becomes an instance of Moore's paradox. This view has surprising consequences. Furthermore, even though the surprise quiz announcement becomes an instance of Moore's paradox on the penultimate day, this does not prevent the students from knowing the quiz is coming. I conclude that the first stage of the paradoxical argument succeeds and the mooronic solution fails.

Methane emission, digestive characteristics and faecal archaeol in heifers fed diets based on silage from brown midrib maize as compared to conventional maize

The aim of the present experiment was to compare silage prepared from maize having a brown midrib (BMR) mutation with control (CTR) maize to identify their effects on enteric methane emission, digesta mean retention time (MRT), ruminal fermentation and digestibility. In addition, the utility of archaeol present in faecal samples was validated as a proxy for methane production. Seven German Holstein heifers were fed total mixed rations with a maize-silage proportion (either BMR or CTR) of 920 g/kg dry matter (DM) in a change-over design. Heifers were fed boluses with markers to measure MRT; faeces were collected for 7 days and rumen fluid was collected on the penultimate day. Methane emission was measured in respiration chambers on one day. Data were analysed by t-test and regression analysis. DM intake did not differ between the two diets. The apparent digestibility of DM and most nutrients was unaffected by diet type, but apparent digestibility of neutral and acid detergent-fibre was higher in those heifers fed BMR than in those fed CTR. Comparisons between diets revealed no difference in particle or solute MRT in the gastro-intestinal tract and the reticulorumen. Concentrations of short-chain fatty acid and ammonia in rumen fluid and its pH were not affected by silage type. Independent of the mode of expression [l/d, l/kg DM intake, l/kg digested organic matter], methane emissions were not affected by maize-silage type, but with BMR, there was a trend towards lower methane production per unit of digested neutral detergent fibre than there was with CTR silage. Results of the present study show that feeding heifers BMR silage does not increase methane emissions despite a higher fibre digestibility as compared to CTR silage. Therefore, it is assumed that improvements in animal productivity achieved by feeding BMR silage, as some studies have reported, can be obtained without extra environmental cost per unit of milk or meat. Neither faecal archaeol content [µg/g] nor daily amount excreted [mg/d] is suitable to predict methane production in absolute terms [l per day]. However, faecal archaeol content has a certain potential for predicting the methane yield [l per kg DM intake] of individual animals.

Sleep and the endogenous melatonin rhythm of high arctic residents during the summer and winter

The seasonal extremes of photoperiod in high latitudes place particular strain on the human circadian system. Arctic residence has been associated with poor sleep in both summer and winter. The goal of the work reported here was to study the circadian rhythms of individuals living in the high Arctic by measuring sleep variables and the timing of melatonin production. Two research trials were conducted in the built environment of CFS Alert (82° 29′ 58″ N). Participants wore motion logging devices (actigraphs), which measure ambient light as well as motion, for 1week to provide data on sleep quantity, quality and light exposure. On the penultimate day of each trial, the participants were maintained together in a gymnasium with lounge chairs and saliva was collected at regular intervals to measure melatonin and assess the dim light melatonin onset (DLMO), offset (MelOFF), 50% rise and fall times of the whole profile and total production. In general, sleep duration was found to be significantly different between the January and June data collections at CFS Alert, with participants in June sleeping 50min on average less each day compared to their January counterparts. In June sleep was mistimed in many subjects relative to circadian phase as evidenced by the melatonin rhythm. Exposure to bright evening light was the most likely causal factor and should be avoided in the Arctic summer. The Arctic summer represents a particularly challenging environment for obtaining sufficient sleep. This has implications for the cognitive performance of staff during work hours.

Effect of superstimulation protocols on nuclear maturation and distribution of lipid droplets in bovine oocytes.

Our objective was to study the effect of superstimulation protocols on nuclear maturation of the oocyte and the distribution of lipid droplets in the ooplasm. Heifers (n=4 each group) during the luteal phase were either treated with FSH for 4 days (Short FSH), FSH for 4 days followed by 84h of gonadotropin free period (FSH Starvation) or for 7 days (Long FSH) starting from the day of wave emergence. In all groups, LH was given 24h after induced luteolysis (penultimate day of FSH) and cumulus-oocyte complexes were collected 24h later. Oocytes were stained for nuclear maturation (Lamin/chromatin) and lipid droplets (Nile red). The Long FSH group had a greater proportion of mature oocytes (metaphase II) compared with heifers in the Short FSH and FSH Starvation groups (59/100 vs 5/23 and 2/25, respectively; P<0.01). On average across all groups, oocytes contained 22pL of lipids (3.3% of ooplasm volume) distributed as 3000 droplets. Average volume of individual lipid droplets was higher in the FSH Starvation (11.5±1.5 10(-3) pL, P=0.03) compared with the Short and Long FSH groups (7.2±0.6 10(-3) and 8.0±0.8 10(-3) pL, respectively). In conclusion, both FSH Starvation and Short FSH treatments yielded a lower proportion of mature oocytes compared with the Long FSH treatment. Furthermore, FSH starvation led to an accumulation of larger lipid droplets in the ooplasm, indicating atresia. Our results indicate that a longer superstimulation period in beef cattle yields higher numbers and better-quality oocytes.

Effect of Chronic DL-Amphetamine Exposure on Brain Volume, Anxiogenic, Locomotor, and Social Behaviors in Male SD Rats

Research examining the long-term effects of drugs such as AdderallTM, a mixed DL-amphetamine, as a first-line treatment strategy for those diagnosed with attention deficit hyperactivity disorder (ADHD), is very much lacking. In order to address this, the present study sought to examine possible behavioral and neuroanatomical effects of chronic oral exposure to DL-amphetamine administered at a relatively low dose to the developing male Sprague Dawley rat. Animals were administered a mixture of chocolate drink and DL-amphetamine at a dose of 1.6 mg/kg for 36 days, beginning at PD 24 and ending at PD 60. Anxiety, a potential side effect of stimulant treatment, was assessed using three paradigms: The open field test (OF), the social interaction test (SI), and the elevated plus maze (EPM). The OF and SI were conducted using repeated testing over the course of five weeks. Testing occurred immediately after drug administration on a given day. The EPM was used only once on the penultimate day of treatment, before the drug was administered. Following drug treatment on PD 60, brain-to-body weight ratios were obtained. Results indicated that there were no group differences in brain-to-body weight ratios nor were differences in locomotor and social behaviors observed. However, rats treated with DL-amphetamine did show an anxiogenic response in the EPM. This was represented as a significant reduction in open arm entries. Overall our findings suggest that while chronic drug treatment fails to alter multiple measures of behavior, or reliable changes in brain volume, such treatment may impact a behavioral index of anxiety. Future research should seek to examine the implications of this heightened anxiogenic response in animals treated chronically with oral, low-dose DL-amphetamine.

Abstract P6-08-07: Out-of-pocket spending, dermatologic quality of life, and treatment satisfaction in breast cancer radiotherapy patients

Abstract Objective: Skin toxicity is one of the most common acute side effects of breast cancer radiotherapy (RT). Past research has largely neglected non-medical out-of-pocket (OOP) spending associated with this side effect. We therefore developed a Skin Toxicity Costs (STC) questionnaire to assess such spending. The primary goal of the present study was to use the STC to estimate non-medical out-of-pocket spending associated with acute skin toxicity in breast cancer RT patients. Secondary goals included exploration of the associations between the STC, dermatologic quality of life, and satisfaction with RT. Methods: 185 consecutive female breast cancer RT patients (Stage 0-III) participated in the research from 2008 to 2013. All participants received a course of standard fractionated external beam RT. Demographics: mean age = 55.4; 74% White, 10% African American, 16% Other; and 10% Latina. In regard to employment, 46% reported working full-time, 12% part-time, and 42% were not employed. 68% had at least a college degree and 66% reported a household income of ≥ $60,000/year. On their penultimate day of RT, participants completed the STC, the Dermatologic Life Quality Index (DLQI), and a Patient Satisfaction Questionnaire (PSQ). Patients also completed a demographics questionnaire and an Importance of Appearance Scale (IAPP) at the commencement of RT. Note: all patients were provided with skin creams free of charge through the clinic. Results: Analyses revealed no differences in the STC, DLQI, or PSQ based on recruitment site (all ps &amp;gt; .45). Results revealed that 83% of the sample reported OOP spending associated with skin toxicity. Mean STC spending was $245.11 (95% CI: 135.34 to 354.87; Median = $75.00). Multiple regression of demographic factors (ethnicity, race, marital status, employment, education, income) and IAPP revealed that IAPP and marital status uniquely predicted STC spending (ps &amp;lt; .02; total model R2 = .24), such that increased STC was associated with increased importance of appearance and being unmarried. Controlling for IAPP and marital status, STC was significantly associated with DLQI (p&amp;lt;.001), such that increased STC was associated with decreased dermatologic quality of life. Lastly, we examined whether the STC was associated with treatment satisfaction controlling for IAPP, marital status, and DLQI. Results revealed that only STC was uniquely associated with patient satisfaction (p&amp;lt;.001; total model R2 = .39), such that patients with higher STC scores were less satisfied with their RT. Discussion: Results are consistent with recent research suggesting that OOP spending can be considered a “financial toxicity” of cancer treatment, and is associated with lower levels of satisfaction with cancer care. However, the present study is the first to examine this issue with a focus on skin toxicity-related spending in breast cancer patients. The results suggest that OOP spending is linked to patient satisfaction with care. OOP may be a marker of skin toxicity. Future research seeking to manage skin toxicity may have the beneficial downstream consequence of reducing OOP spending and improving overall satisfaction with RT. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-08-07.

Hatching Vocalisations in Free-Living Rockhopper Penguins

We analysed the vocalisation behaviour of Rockhopper Penguin chicks Eudyptes chrysocome during hatching. Hatching vocalisation rates (in number per minute) were not consistently influenced by ambient air temperature. They did not differ between chicks hatching from first-laid eggs (which are smaller, hatch second, and usually suffer brood reduction) and chicks hatching from second-laid eggs (which usually develop into fledglings). Hatchlings did not show significantly different vocalisation rates in the presence of a sibling during hatching. Hatching vocalisation rates also did not increase between the penultimate day and the last day before hatching. These results suggest that Rockhopper Penguin chicks might gain little benefit (parental care) from increased vocal behaviour at the late incubation stage.

Consumption of c9,t11–18:2 or t10,c12–18:2 Enriched Dietary Supplements Does Not Influence Milk Macronutrients in Healthy, Lactating Women

Substantial research suggests that the t10,c12-18:2, but not the c9,t11-18:2, isomer of conjugated linoleic acid (CLA) reduces milk fat synthesis in lactating bovine and rodent species. Because fat is the major energy-yielding component in human milk, we were interested in whether this is true for women as well. Thus, the effects of c9,t11-18:2 and t10,c12-18:2 on milk fat were examined in breast-feeding women (n = 12) in a double-blind, placebo-controlled, crossover study with latin-square design. The study was divided into six periods: baseline (3 days), three intervention periods (5 days each), and two washout periods (9 days each). During each intervention period, women consumed 750 mg/day of a supplement containing predominantly c9,t11-18:2, t10,c12-18:2, or 18:1 (olive oil placebo). Milk was collected by complete breast expression on the final day of each period. Infant milk consumption was estimated by 24 h weighing on the penultimate day of each intervention and washout period, and maternal adiposity (% body fat) was determined at baseline using dual energy X-ray absorptiometry. Milk c9,t11-18:2 and t10,c12-18:2 concentrations were greater (P < 0.05) during the corresponding CLA treatment periods as compared to the placebo period, providing strong evidence of subject compliance. Both CLA isomers were transferred into milk fat at relatively high efficiency; average transfer efficiency was estimated to be 23.3%. Compared to the placebo treatment, milk fat content was not reduced during either CLA treatment. Data indicate that body fatness did not modify any putative effect of isomeric CLA consumption on milk fat concentration. The evidence from this study suggests that the sensitivity of lactating women's mammary tissue to an anti-lipogenic effect of the t10,c12-18:2 isoform of CLA may be less than previously hypothesized.

The Politics of Policing the Anti-WTO Protests in Hong Kong

The confrontations between anti-World Trade Organisation (WTO) protestors and Hong Kong police proved that their earlier encounters brought about uncompromising attitudes and escalating activities on both sides. As a result, riots on the penultimate day of the WTO meeting were inevitable. Applying David Waddington's flashpoint model, this article shows that other factors at the structural, political/ideological, cultural, contextual and situational levels were at play, creating an environment conducive to violence. Waddington's model provides a useful framework for us to comprehend the interactional dynamics of the anti-WTO protests in Hong Kong. However, it has neglected the possibility of an interactive bond between protestors and the public. The contextual uniqueness of forging a dynamic relationship between protestors and the public can enrich Waddington's analytical framework.