Children from low-SES and ethnic minority backgrounds are at heightened risk for overweight, yet are underrepresented in the pediatric obesity literature.
The current paper describes strategies employed to minimize barriers to recruitment and retention of African-American families receiving WIC services in a longitudinal study examining caregiver feeding and child weight.
Seventy-six families enrolled in the study over 3.5 years, and 50% of the families completed the study.
Implications for Practice
Despite effortful planning, unanticipated barriers likely contributed to lengthy recruitment and a modest retention rate. Future research should incorporate lessons learned to modify and develop effective strategies for increasing engagement of low-SES and ethnic minority families in research.
Childhood obesity rates have reached epidemic proportions. Excessive weight gain in infancy is associated with persistence of elevated weight status and later obesity. In this review, we make the case that weight gain in the first 6 mo is especially predictive of later obesity risk due to the metabolic programming that can occur early postpartum. The current state of knowledge regarding the biological determinants of excess infant weight gain is reviewed, with particular focus on infant feeding choice. Potential mechanisms by which different feeding approaches may program the metabolic profile of the infant, causing the link between early weight gain and later obesity are proposed. These mechanisms are likely highly complex and involve synergistic interactions between endocrine effects and factors that alter the inflammatory and oxidative stress status of the infant. Gaps in current knowledge are highlighted. These include a lack of data describing 1) what type of infant body fat distribution may impart risk and 2) how maternal metabolic dysfunction (obesity and/or diabetes) may affect milk composition and exert downstream effects on infant metabolism. Improved understanding and management of these early postnatal determinants of childhood obesity may have great impact on reducing its prevalence.
Tibolone has estrogenic, progestogenic, and androgenic effects. Although tibolone prevents bone loss, its effects on fractures, breast cancer, and cardiovascular disease are uncertain.
In this randomized study, we assigned 4538 women, who were between the ages of 60 and 85 years and had a bone mineral density T score of −2.5 or less at the hip or spine or a T score of −2.0 or less and radiologic evidence of a vertebral fracture, to receive once-daily tibolone (at a dose of 1.25 mg) or placebo. Annual spine radiographs were used to assess for vertebral fracture. Rates of cardiovascular events and breast cancer were adjudicated by expert panels.
During a median of 34 months of treatment, the tibolone group, as compared wit h the placebo group, had a decreased risk of vertebral fracture, with 70 cases versus 126 cases per 1000 person-years (relative hazard, 0.55; 95% confidence interval [CI], 0.41 to 0.74; P<0.001), and a decreased risk of nonvertebral fracture, with 122 cases versus 166 cases per 1000 person-years (relative hazard, 0.74; 95% CI, 0.58 to 0.93; P = 0.01). The tibolone group also had a decreased risk of invasive breast cancer (relative hazard, 0.32; 95% CI, 0.13 to 0.80; P = 0.02) and colon cancer (relative hazard, 0.31; 95% CI, 0.10 to 0.96; P=0.04). However, the tibolone group had an increased risk of stroke (relative hazard, 2.19; 95% CI, 1.14 to 4.23; P = 0.02), for which the study was stopped in February 2006 at the recommendation of the data and safety monitoring board. There were no significant differences in the risk of either coronary heart disease or venous thromboembolism between the two groups.
Tibolone reduced the risk of fracture and breast cancer and possibly colon cancer but increased the risk of stroke in older women with osteoporosis. (ClinicalTrials. gov number, NCT00519857.)
To evaluate the rate of seropositivity to hepatitis B and C and Human Immunodeficiency Virus (HIV) infections among children with β-thalassemia major receiving multiple transfusions in Ahmedabad, India, compared with healthy controls.
Materials and Methods:
The study was performed during January 2007 to January 2009 on multi-transfused children suffering with β-thalassemia major registered in the Prathama Blood Centre, Ahmedabad; Jeevandeep hospital, Ahmedabad; and Red Cross Blood Centre, Ahmedabad, and investigated for the prevalence and development of transfusion-transmitted infections. Hepatitis B surface Antigen (HBsAg), anti-Hepatitis C Virus (HCV) Antibodies (Ab), and HIV Ab were checked using a fourth-generation Enzyme-Linked Immunosorbent Assay (ELISA). Positive tests were confirmed by western blots. Healthy blood donors were used for the control group.
Hepatitis B surface antigen, anti-HCV Ab, and HIV Ab were positive in one of 96 (1.04%; 95% Confidence Interval (CI) = 0.17–1.3), 24 of 96 (25%; 95% CI = 11.4–14.2), and one of 96 (1.04%; 95% CI = 0.12–1.3), respectively. The rate of anti-HCV Ab was significantly higher in multi-transfused children suffering with β-thalassemia major. In thalassemia patients, the rate of positive anti-HCV Ab was significantly higher than that for positive HBsAg (P<0.001) and HIV Ab (P<0.001).
It is concluded that HCV is the current major problem in multi-transfused children with thalassemia major and more careful pretransfusion screening of blood for anti-HCV must be introduced in blood centers.
Hepatitis B; hepatitis C; Human immunodeficiency virus; β-thalassemia major; seroprevalence
Human desire for sweet taste spans all ages, races, and cultures. Throughout evolution, sweetness has had a role in human nutrition, helping to orient feeding behavior toward foods providing both energy and essential nutrients. Infants and young children in particular base many of their food choices on familiarity and sweet taste. The low cost and ready availability of energy-containing sweeteners in the food supply has led to concerns that the rising consumption of added sugars is the driving force behind the obesity epidemic. Low-calorie sweeteners are one option for maintaining sweet taste while reducing the energy content of children’s diets. However, their use has led to further concerns that dissociating sweetness from energy may disrupt the balance between taste response, appetite, and consumption patterns, especially during development. Further studies, preferably based on longitudinal cohorts, are needed to clarify the developmental trajectory of taste responses to low-calorie sweeteners and their potential impact on the diet quality of children and youth.
Apomixis in Hieracium subgenus Pilosella initiates in ovules when sporophytic cells termed aposporous initial (AI) cells enlarge near sexual cells undergoing meiosis. AI cells displace the sexual structures and divide by mitosis to form unreduced embryo sac(s) without meiosis (apomeiosis) that initiate fertilization-independent embryo and endosperm development. In some Hieracium subgenus Pilosella species, these events are controlled by the dominant LOSS OF APOMEIOSIS (LOA) and LOSS OF PARTHENOGENESIS (LOP) loci. In H. praealtum and H. piloselloides, which both contain the same core LOA locus, the timing and frequency of AI cell formation is altered in derived mutants exhibiting abnormal funiculus growth and in transgenic plants expressing rolB which alters cellular sensitivity to auxin. The impact on apomictic and sexual reproduction was examined here when a chimeric RNAse gene was targeted to the funiculus and basal portions of the ovule, and also when polar auxin transport was inhibited during ovule development following N-1-naphthylphthalamic acid (NPA) application. Both treatments led to ovule deformity in the funiculus and distal parts of the ovule and LOA-dependent alterations in the timing, position, and frequency of AI cell formation. In the case of NPA treatment, this correlated with increased expression of DR5:GFP in the ovule, which marks the accumulation of the plant hormone auxin. Our results show that sporophytic information potentiated by funiculus growth and polar auxin transport influences ovule development, the initiation of apomixis, and the progression of embryo sac development in Hieracium. Signals associated with ovule pattern formation and auxin distribution or perception may influence the capacity of sporophytic ovule cells to respond to LOA.
Apomixis; auxin; gametophyte; ovule; seed
Lymphocytic choriomeningitis virus (LCMV) exhibits natural tropism for dendritic cells and represents the prototypic infection that elicits protective CD8+ T cell (cytotoxic T lymphocyte (CTL)) immunity. Here we have harnessed the immunobiology of this arenavirus for vaccine delivery. By using producer cells constitutively synthesizing the viral glycoprotein (GP), it was possible to replace the gene encoding LCMV GP with vaccine antigens to create replication-defective vaccine vectors. These rLCMV vaccines elicited CTL responses that were equivalent to or greater than those elicited by recombinant adenovirus 5 or recombinant vaccinia virus in their magnitude and cytokine profiles, and they exhibited more effective protection in several models. In contrast to recombinant adenovirus 5, rLCMV failed to elicit vector-specific antibody immunity, which facilitated re-administration of the same vector for booster vaccination. In addition, rLCMV elicited T helper type 1 CD4+ T cell responses and protective neutralizing antibodies to vaccine antigens. These features, together with low seroprevalence in humans, suggest that rLCMV may show utility as a vaccine platform against infectious diseases and cancer.
Reproductive or neotenic soldiers of the Archotermopsid Zootermopsis nevadensis nevadensis (Hagen) are compared to sterile soldiers and primary male reproductives. Several head capsule morphometrics correlate significantly with gonad size across all forms and both sexes of soldiers. The easily observed field character of ratio of mandible length to labrum length is a consistent and reliable feature of head capsule external morphology for predicting gonad development and reproductive potential of soldier forms regardless of age, sex, or live weight.
evolution of soldier caste; reproductive soldier; neotenic soldier; Zootermopsis; morphometrics
Moderate to severe premenstrual syndrome (PMS) affects 8%–20% of premenopausal women and causes substantial levels of impairment, but few modifiable risk factors for PMS have been identified. Adiposity may impact risk through the complex interaction of hormonal and neurochemical factors, but it is not known if adiposity increases a woman's risk of developing PMS. We have addressed these issues in a prospective study nested within the Nurses' Health Study 2.
Participants were a subset of women aged 27–44 and free from PMS at baseline, including 1057 women who developed PMS over 10 years of follow-up and 1968 controls. Body mass index (BMI), weight change and weight cycling were assessed biennially via questionnaire.
We observed a strong linear relationship between BMI at baseline and risk of incident PMS, with each 1 kg/m2 increase in BMI associated with a significant 3% increase in PMS risk (95% confidence interval [CI] 1.01-1.05). After adjustment for age, smoking, physical activity, and other factors, women with BMI ≥27.5 kg/m2 at baseline had significantly higher risks of PMS than women with BMI <20 kg/m2 (ptrend = 0.003). A large weight change between age 18 and the year 1991 was significantly associated with PMS risk, whereas weight cycling during this period was not. BMI was positively associated with specific symptoms, including swelling of extremities, backache, and abdominal cramping (all p < 0.001).
Our findings suggest that maintaining a healthy body mass may be important for preventing the development of PMS. Additional studies are needed to assess whether losing weight would benefit overweight and obese women who currently experience PMS.
Visual presentation of food provides considerable information such as its potential for palatability and availability, both of which can impact eating behavior.
We investigated the subjective ratings for food appeal and desire to eat when exposed to food pictures in a fed sample (n = 129) using the computer paradigm ImageRate. Food appeal and desire to eat were analyzed for the effects of food group, portion size and energy density of the foods presented as well as by participant characteristics.
Food appeal ratings were significantly higher than those for desire to eat (57.9 ± 11.6 v. 44.7 ± 18.0; p < 0.05). Body mass index was positively correlated to desire to eat (r = 0.20; p < 0.05), but not food appeal. Food category analyses revealed that fruit was the highest rated food category for both appeal and desire, followed by discretionary foods. Additionally, overweight individuals reported higher ratings of desire to eat large portions of food compared to smaller portions (p < 0.001), although these effects were relatively small. Energy density of the foods was inversely correlated with ratings for both appeal and desire (r's = - 0.27; p's < 0.01).
Results support the hypothesis that individuals differentiate between food appeal and desire to eat foods when assessing these ratings using the same type of metric. Additionally, relations among food appeal and desire to eat ratings and body mass show overweight individuals could be more responsive to visual foods cues in a manner that contributes to obesity.
liking; wanting; food appeal; desire to eat; intake; hedonic; obesity; portion size
Strategies to prevent adult chronic diseases, including obesity, must start in childhood. Because many preschool-aged children spend mealtimes in child care facilities, staff should be taught supportive feeding practices for childhood obesity prevention. Higher obesity rates among low-income children suggest that centers providing care to these children require special attention. We compared self-reported feeding practices at child care centers serving low-income children on the basis of whether they received funding and support from the Child and Adult Care Food Program (CACFP), which suggests supportive feeding practices. We also assessed training factors that could account for differences among centers.
Eligible licensed child care centers (n = 1600) from California, Colorado, Idaho, and Nevada received surveys. Of the 568 responding centers, 203 enrolled low-income families and served meals. We analyzed the responses of 93 directors and 278 staff for CACFP-funded centers and 110 directors and 289 staff from nonfunded centers. Chi square analyses, pairwise comparisons, t tests, and multiple linear regressions were used to compare CACFP-funded and nonfunded centers.
Significant differences were noted in 10 of 26 feeding practices between CACFP-funded and nonfunded centers. In each case, CACFP-funded centers reported practices more consistent with a supportive feeding environment. Forty-one percent of the variance could be explained by training factors, including who was trained, the credentials of those providing training, and the type of training.
Our findings suggest that when trained by nutrition professionals, child care staff learn, adopt, and operationalize childhood obesity prevention feeding guidelines, thereby creating a supportive mealtime feeding environment.
Ordinary variations in human infants’ attachment behaviors – their proclivity to seek and accept comfort from caregivers – are associated with a wide range of individual differences in psychological functioning in adults. The current investigation examined variation in the oxytocin receptor (OXTR) gene as one possible source of these variations in infant attachment. One hundred seventy-six infants (77 Caucasian, 99 non-Caucasian) were classified as securely or insecurely attached based on their behavior in the Strange Situation (Ainsworth et al., 1978). The A allele of OXTR rs2254298 was associated with attachment security in the non-Caucasian infants (p < 0.005). These findings underscore the importance of oxytocin in the development of human social behavior and support its role in social stress-regulation and the development of trust.
attachment; trust; development; oxytocin; polymorphisms
To evaluate the efficacy and safety of a carbohydrate restricted versus a low fat diet on weight loss, metabolic markers, body composition, and cardiac function tests in severely obese adolescents.
Subjects were randomized to one of two diets: a high protein, low carbohydrate (20 g/day) diet (HPLC) or low fat (30% of calories) (LF) regimen for 13 weeks; close monitoring was maintained to evaluate safety. After the intervention, no clinical contact was made until follow-up measurements were obtained at 24 and 36 weeks from baseline. The primary outcome was change in BMI-Z-score at 13, 24, and 36 weeks.
Forty-six subjects (24 HPLC, 22 in LF) initiated and 33 subjects completed the intervention; follow-up data were available on approximately half of the subjects. Significant reduction in BMI-Z-score (BMI-Z) was achieved in both groups during intervention, and was significantly greater for the HPLC group (p=0.03). Both groups maintained significant BMI-Z reduction at follow-up; changes were not significantly different between groups. Loss of lean body mass was not spared in the HPLC group. No serious adverse effects were observed related to metabolic profiles, cardiac function, or subjective complaints.
The HPLC diet is a safe and effective option for medically supervised weight loss in severely obese adolescents.
Obesity; obesity treatment; body composition; hyperlipidemia; insulin resistance; satiety
Relatively little is known about factors that influence the initial development of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), although these conditions are common in reproductive age women and are associated with substantial impairment. Previous studies have observed higher alcohol use in prevalent PMS/PMDD patients compared with controls, but it is unknown if drinking predisposes women to developing these disorders or is instead influenced by symptom experience.
To address this, we conducted a case-control study nested within the prospective Nurses' Health Study II (NHS2). Participants were a subset of women aged 27–44 and free from PMS at baseline (1991), including 1057 women who developed PMS over 10 years of follow-up, 762 of whom also met criteria consistent with PMDD, and 1968 control women. Alcohol use at various time periods, before and after onset of menstrual symptoms, was assessed by questionnaire.
Overall, alcohol use was not strongly associated with the incidence of PMS and probable PMDD. Relative risks (RR) for women with the highest cumulative alcohol use vs. never drinkers were 1.19 (95% confidence interval [CI] 0.84-1.67) for PMS and 1.28 (95% CI 0.86-1.91) for PMDD, although results did suggest a positive relationship in leaner women (p trend = 0.002). Women who first used alcohol before age 18 had an RR of PMS of 1.26 (95% CI 0.91-1.75) compared with never drinkers; the comparable RR for PMDD was 1.35 (95% CI 0.93-1.98).
These findings suggest alcohol use is not strongly associated with the development of PMS and PMDD, although early age at first use and long-term use may minimally increase risk.
Early growth monitoring may not identify infants at-risk for later growth faltering because it is difficult for the provider to recognize how large of a negative shift might be problematic.
The aim of this study was to determine whether a slowing in early weight-for-age could be used to identify children at increased risk of later growth faltering.
Longitudinal data for infants aged birth to two years were analyzed for 1978 healthy, term infants born between 1999-2001. Logistic regression techniques were used to determine whether a negative change in weight-for-age, across well-child visit intervals, can identify infants at risk for growth faltering.
The period prevalence of underweight was 24%. The odds ratio (OR) for infants with a negative shift in z-scores ≥ -0.85 between four and six months was 2.4 (95% CI 1.5, 3.9) compared to those without this shift, holding birth weight constant. Sensitivity analyses revealed the model was significant when either the 2000 CDC growth charts (p<.0001) or the 2006 WHO growth charts (p<.0001) were used as the reference, although the prevalence of underweight was lower (14.7%) when the 2006 WHO growth charts were the reference.
The findings support the hypothesis that a downward shift in weight-for-age of this magnitude during early infancy when well-child visits are most frequent can be used to identify children at-risk of later poor growth.
Early Intervention; Failure-to-thrive; Growth; Infant; Weight; Sensitivity
The Emotion Focused Therapy-Therapist Fidelity Scale (EFT-TFS) is introduced as a scale to measure a therapist's fidelity to the EFT model. The rationale and conceptual development of the scale are presented. Members of an EFT electronic mailing list who participated in a survey (n=130) rated all of the items as highly important for the practice providing support for the content validity of the scale. Finally, the 13 items of the EFT-TFS are presented. Future research directions for the EFT-TFS are presented.
couples therapy; therapist rating scales; emotion focused therapy; supervision; psychotherapy research
The purpose of this study was to examine the predictors of intensification of antihyperglycemic therapy in patients with type 2 diabetes; its impact on A1C, body weight, symptoms of anxiety/depression, and health status; and patient characteristics associated with improvement in A1C.
RESEARCH DESIGN AND METHODS
We analyzed survey, medical record, and health plan administrative data collected in Translating Research into Action for Diabetes (TRIAD). We examined patients who were using diet/exercise or oral antihyperglycemic medications at baseline, had A1C >7.2%, and stayed with the same therapy or intensified therapy (initiated or increased the number of classes of oral antihyperglycemic medications or began insulin) over 18 months.
Of 1,093 patients, 520 intensified therapy with oral medications or insulin. Patients intensifying therapy were aged 58 ± 12 years, had diabetes duration of 11 ± 9 years, and had A1C of 9.1 ± 1.5%. Younger age and higher A1C were associated with therapy intensification. Compared with patients who did not intensify therapy, those who intensified therapy experienced a 0.49% reduction in A1C (P < 0.0001), a 3-pound increase in weight (P = 0.003), and no change in anxiety/depression (P = 0.5) or health status (P = 0.2). Among those who intensified therapy, improvement in A1C was associated with higher baseline A1C, older age, black race/ethnicity, lower income, and more physician visits.
Treatment intensification improved glycemic control with no worsening of anxiety/depression or health status, especially in elderly, lower-income, and minority patients with type 2 diabetes. Interventions are needed to overcome clinical inertia when patients might benefit from treatment intensification and improved glycemic control.
By the end of the first year, infants are able to recognize both goal-directed and perceptually guided behavior in the actions of non-human agents, even faceless ones. How infants derive the relevant orientation of an unfamiliar agent in the absence of familiar markers such as eyes, ears, or face is unknown. The current studies tested the hypothesis that infants’ calculate an agent’s “front” from the geometry of its behavior in the spatial environment. In the first study, 14- to 15-month-old infants observed a symmetrical, faceless agent either interact contingently with a confederate or act randomly. It then turn toward one of two target objects. Infants were more likely to look in the direction the agent turned than the opposite direction, but only in the contingent condition. In the second study, the location of the confederate and target objects was varied, which in turned influenced which end of the agent infants interpreted as the front. Finally, implications for infants’ early gaze-following behaviors with humans are tested and implications for theory of mind development more broadly are discussed.
Moderate to severe premenstrual syndrome (PMS) affects as many as 20% of premenopausal women. Although smoking may be more common in women with PMS, it is unknown whether smoking is involved in PMS etiology. In 1991–2001, the authors conducted a case-control study nested within the prospective Nurses’ Health Study II. Participants were US women aged 27–44 years and free of PMS at baseline, including 1,057 who developed PMS over 10 years and 1,968 reporting no diagnosis of PMS and only minimal menstrual symptoms during this time. Smoking at various ages was assessed by questionnaires. After adjustment for oral contraceptives and other factors, current smokers were 2.1 times as likely as never smokers to develop PMS over the next 2–4 years (95% confidence interval: 1.56, 2.83). Total pack-years and smoking during adolescence and young adulthood were also independently associated with a higher risk of PMS. For example, the relative risk for women who started smoking before age 15 years, compared with never smokers, was 2.53 (95% confidence interval: 1.70, 3.76). Results suggest that smoking, especially in adolescence and young adulthood, may increase risk of moderate to severe PMS. These findings may provide an additional incentive for young women to avoid cigarette smoking.
case-control studies; cohort studies; menstrual cycle; premenstrual syndrome; smoking
CD40L on CD4+ T cells has been shown to license dendritic cells (DC) via CD40 to prime CTL responses. Surprisingly, we found that the converse (CD40L on DC) was also important. Anti-CD40L treatment decreases endogenous CTL responses to both OVA and influenza infection even in the absence of CD4+ T cells. DC express CD40L upon stimulation with agonists to TLR 3 and 9. Moreover, influenza infection, which stimulates CTL without help upregulates CD40L on DC, but herpes simplex infection, which elicits CTL through help, does not. CD40L−/− DC are suboptimal both in vivo in bone marrow chimera experiments and in vitro in mixed lymphocyte reactions. In contrast, CD40L−/− CD8+ T cells kill as effectively as wildtype. We conclude that CD40L upregulation on DC promotes optimal priming of CD8+ T cells without CD4+ T cells, providing a mechanism by which pathogens may elicit helper-independent CTL immunity.
Twelve-month-old infants attribute goals to both familiar, human agents and unfamiliar, non-human agents. They also attribute goal-directedness to both familiar actions and unfamiliar ones. Four conditions examined information 12-month-olds use to determine which actions of an unfamiliar agent are goal-directed. Infants who witnessed the agent interact contingently with a human confederate encoded the agent's actions as goal-directed; infants who saw a human confederate model an intentional stance toward the agent without the agent's participation, did not. Infants who witnessed the agent align itself with one of two potential targets before approaching that target encoded the approach as goal-directed; infants who did not observe the self-alignment did not encode the approach as goal-directed. A possible common underpinning of these two seemingly independent sources of information is discussed.
A practical workshop on ‘Immunohematology’ was conducted in conjunction with the Indian Society of Blood Transfusion and Immunohaematology annual scientific program. The participants, from many parts of India, were able to obtain valuable practice in key areas of blood group serology and by the end of the workshop were able to carry out ‘tube’ techniques for antibody detection and identification. Column agglutination methods were also demonstrated. A preliminary questionnaire was completed by participants. Results showed a wide variety in types of pretransfusion (serologic) testing being performed. Less than half of the participants had encountered hemolytic transfusion reactions. The program was rated as excellent by most participants in response to a postworkshop evaluation questionnaire, with requests for longer and more frequent workshops. Safety of blood for transfusion depends on maintenance of high standards of both microbiological and immunohematological performance by the blood bank staff.
Blood group serology; education; immunohematology
The mucosa-associated microflora is increasingly considered to play a pivotal role in the pathogenesis of inflammatory bowel disease. This study explored the possibility that an abnormal mucosal flora is involved in the etiopathogenesis of granulomatous colitis of Boxer dogs (GCB). Colonic biopsy samples from affected dogs (n = 13) and controls (n = 38) were examined by fluorescent in situ hybridization (FISH) with a eubacterial 16S rRNA probe. Culture, 16S ribosomal DNA sequencing, and histochemistry were used to guide subsequent FISH. GCB-associated Escherichia coli isolates were evaluated for their ability to invade and persist in cultured epithelial cells and macrophages as well as for serotype, phylogenetic group, genome size, overall genotype, and presence of virulence genes. Intramucosal gram-negative coccobacilli were present in 100% of GCB samples but not controls. Invasive bacteria hybridized with FISH probes to E. coli. Three of four GCB-associated E. coli isolates adhered to, invaded, and replicated within cultured epithelial cells. Invasion triggered a “splash”-type response, was decreased by cytochalasin D, genistein, colchicine, and wortmannin, and paralleled the behavior of the Crohn's disease-associated strain E. coli LF 82. GCB E. coli and LF 82 were diverse in serotype and overall genotype but similar in phylogeny (B2 and D), in virulence gene profiles (fyuA, irp1, irp2, chuA, fepC, ibeA, kpsMII, iss), in having a larger genome size than commensal E. coli, and in the presence of novel multilocus sequence types. We conclude that GCB is associated with selective intramucosal colonization by E. coli. E. coli strains associated with GCB and Crohn's disease have an adherent and invasive phenotype and novel multilocus sequence types and resemble E. coli associated with extraintestinal disease in phylogeny and virulence gene profile.
This paper reviews a recent set of behavioural studies that examine the scope and nature of the representational system underlying theory-of-mind development. Studies with typically developing infants, adults and children with autism all converge on the claim that there is a specialized input system that uses not only morphological cues, but also behavioural cues to categorize novel objects as agents. Evidence is reviewed in which 12- to 15-month-old infants treat certain non-human objects as if they have perceptual/attentional abilities, communicative abilities and goal-directed behaviour. They will follow the attentional orientation of an amorphously shaped novel object if it interacts contingently with them or with another person. They also seem to use a novel object's environmentally directed behaviour to determine its perceptual/attentional orientation and object-oriented goals. Results from adults and children with autism are strikingly similar, despite adults' contradictory beliefs about the objects in question and the failure of children with autism to ultimately develop more advanced theory-of-mind reasoning. The implications for a general theory-of-mind development are discussed.
A sample survey of 3622 patients attending the emergency department at Toronto's North York General Hospital was conducted during July 1970. The objectives were to study the increasing use of this department, especially by non-urgent patients, to discover reasons for this trend, and to recommend possible ways of reversing or at least coping with the increasing usage.
Over 80 percent of the sample said they had a family physician; however, less than 40 percent reported phoning him before coming to the department. The results show that the family physician can be effective (over the telephone) in screening prospective emergency patients.
Dr. Bain concludes that it's time to educate the public to use family physicians and emergency departments more effectively. Should public education be ineffective, it will be necessary to develop, construct and staff facilities to handle non-urgent, non-traumatic patients.