UNASSIGNED

The acute respiratory distress syndrome (ARDS) is a condition with a high mortality and morbidity. Mechanical ventilation prevents immediate mortality but may further damage patients' lungs. Low tidal volume lung-protective strategies have been shown to increase survival by reducing this iatrogenic damage. Current guidelines recommend tidal volumes of 6-8 ml kg -1 of predicted body weight. We used data from three large randomized controlled trials of treatments for ARDS to determine compliance with these recommendations.

UNASSIGNED

We used the tidal volume recorded at randomization for all patients in the OSCAR, HARP-2, and BALTI-2 studies. In addition, we used the ventilation data for control arm patients in OSCAR and all patients in HARP-2 at days 1 and 7 after randomization.

UNASSIGNED

The three trials enrolled 1660 patients, with tidal volume data available at least at one time point in 1412 patients. Compliance with the 6-8 ml kg -1 recommendation for tidal volume ranged from 20 to 39% of patients across all time points in all three trials.

UNASSIGNED

Poor compliance with the guidelines for tidal volume in patients with ARDS has been demonstrated before in case series, but not in clinical trials where the patient population is specifically selected against standard ARDS diagnostic criteria and the investigators were encouraged to use low tidal volumes. This study may indicate a need to improve implementation and compliance with protective lung ventilation.

Daily variations of pineal and plasma melatonin and plasma thyroid hormones were measured in harp seals (Phoca groenlandica), grey seals (Halichoerus grypus), and hooded seals (Cystophora cristata), ranging in age from newborn to 14 days. In newborn harp seals the mean mass of the pineal gland was 273 mg (+/- 45 SEM, n = 11), containing 49 ng (median) melatonin. In newborn, 4- and 10-day-old grey seals, the pineal mass was similar, weighing on average 337 mg (+/- 74, n = 6) and containing 90 ng melatonin. Two newborn hooded seal pups had pineals weighing 520 and 1289 mg, with 254 and 7600 ng melatonin, respectively. There were no day-night differences in the pineal contents of melatonin or in the number of pineal beta-adrenergic receptors measured in newborn harp seals, and, in newborn, 4- and 10-day-old grey seals, there were no day-night or age differences in pineal melatonin content. Plasma melatonin levels were 10 times higher in newborn seals than in two 10-day-old grey seals and one 14-day-old harp seal pup. In all seal pups, the levels exhibited a 24-hr rhythmicity, with increasing night- and decreasing daytime concentrations. Plasma levels of thyroxine (T4) and triiodothyronine (T3) were generally higher in newborn seals than in 10- and 14-day-old seals or in adult females. There was no apparent 24-hr rhythmicity, but the thyroid hormone levels generally declined throughout each sampling sequence. High pineal and thyroid activities may play a thermoregulatory role in newborn seals, but the results do not indicate a stimulatory action of melatonin in the peripheral conversion of T4 to T3. It is speculated that the large and active pineal gland, particularly in newborn seals, may be related to aspects of their diving habit.

Various brominated flame retardants (BFRs), including polybrominated diphenyl ethers (PBDEs) and current-use, non-PBDE BFRs, as well as organochlorine (OC) pesticides and polychlorinated biphenyls (PCBs), were measured in winter flounder, harp and hooded seals, and North Atlantic right whales from the Eastern United States and Canada. The concentrations of PBDEs in winter flounder and right whales were similar in magnitude to the levels of PCBs, which was unlike the pattern observed in seals. In these marine mammals, the levels of PBDEs were orders of magnitude lower than the levels of OCs and PCBs detected. Evidence existed for the accumulation of methoxylated (MeO)-PBDEs of natural origin in seals and right whales. Current-use, non-PBDE BFRs (including hexabromocyclododecane, pentabromoethylbenzene, hexabromobenzene, and pentabromotoluene) were detected in winter flounder and marine mammals. Future research should focus on monitoring PBDEs, current-use, non-PBDE BFRs, and MeO-BDEs of natural origin in marine organisms from Massachusetts and Cape Cod Bays.

Polychlorinated dibenzo-p-dioxins (PCDD), dibenzofurans (PCDF) and non-ortho substituted biphenyls (PCB, CB) were determined in 6 polar bear milk samples from Svalbard (Norway). For these compounds, no data for polar bears have been reported before from this region. Most of the PCDD/PCDF congeners were found at detectable levels. Concentrations expressed as 2,3,7,8-TCDD equivalents (Nordic model) were in the order of 1-3 pg/g(-1) fat (0.2-1.6 pg ml(-1) milk) which is comparable with ringed and harp seal blubber from the same region. On whole milk basis, concentrations were similar to those found in human milk. An estimation of the daily uptake via milk showed that the intake is lower for polar bears compared to humans. As in human milk, relatively high levels of OCDD were found in some polar bear milk samples. The PCDD/PCDF congener pattern in the milk was different to that found in polar bear fat from the Canadian Arctic. Non-ortho substituted PCB levels in polar bear milk were similar to those found in polar bear fat from the Canadian North. However, CB 77 or 169 dominated in the milk while CB 126 was the most abundant congener in fat. PCDD/PCDF levels expressed as 2,3,7,8-TE were highly correlated with the fat content of the milk. No correlation between CB and PCDD/PCDF concentrations was found. Some data indicate that PCDD/PCDF concentrations in polar bear milk decrease with increasing time after delivery.

The levels of polychlorinated dibenzo-p-dioxins (PCDD), dibenzofurans (PCDF), biphenyls (PCB) and compounds of the DDT group were determined in individual seal blubber and brain samples from ten male and one female harp seals caught in the Greenland Sea. No data from this region and from harp seals have been reported before. The age of the animals varied between 1 and 18 years. PCDD/PCDF concentrations in the blubber (4-10 pg/g TEQ wet weight (w.w.), Nordic model) were somewhat lower than in ringed seals from the Arctic. Non-ortho substituted PCB (CB 77,126 and 169) showed TEQ levels in the blubber which were about 4-10-times higher. CB 77 dominated in most samples, but in a few cases CB 169 was the most abundant congener. p,p'-DDE (average 760 ng/g w.w.) and di-ortho substituted PCB concentrations (2560 ng/g w.w. expressed as sigma PCB) in the blubber were comparable to those found in ringed seals from the European and Canadian Artic. Levels of PCDD/PCDF in brain correspond to the detection limit (about. 0.1-0.6 pg/g w.w.) for most congeners. With one exception, PCB amounts in brain (w.w.) were one to two orders of magnitude lower. A highly significant correlation was found between age, p,p-DDE and di-ortho PCB as well as between single PCDD and coplanar PCB congeners. No relationship was observed between levels of PCDD/PCDF, age and di-ortho-PCB.

BACKGROUND

Transplantation is the only treatment offering long-term benefit to patients with chronic kidney failure. Live donor nephrectomy is performed on healthy individuals who do not receive direct therapeutic benefit of the procedure themselves. In order to guarantee the donor's safety, it is important to optimise the surgical approach. Recently we demonstrated the benefit of laparoscopic nephrectomy experienced by the donor. However, this method is characterised by higher in hospital costs, longer operating times and it requires a well-trained surgeon. The hand-assisted retroperitoneoscopic technique may be an alternative to a complete laparoscopic, transperitoneal approach. The peritoneum remains intact and the risk of visceral injuries is reduced. Hand-assistance results in a faster procedure and a significantly reduced operating time. The feasibility of this method has been demonstrated recently, but as to date there are no data available advocating the use of one technique above the other.

METHODS

The HARP-trial is a multi-centre randomised controlled, single-blind trial. The study compares the hand-assisted retroperitoneoscopic approach with standard laparoscopic donor nephrectomy. The objective is to determine the best approach for live donor nephrectomy to optimise donor's safety and comfort while reducing donation related costs.

CONCLUSIONS

This study will contribute to the evidence on any benefits of hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy.

BACKGROUND

Dutch Trial Register NTR1433.

The purpose of this study was to answer the question of whether dehydrated harp seals (Phoca groenlandica) are able to obtain a net gain of water from the intake of seawater. Following 24 h of fasting, three subadult female harp seals were dehydrated by intravenous administration of the osmotic diuretic, mannitol. After another 24 h of fasting, the seals were given 1,000 ml seawater via a stomach tube. Urine and blood were collected for measurement of osmolality and osmolytes, while total body water (TBW) was determined by injections of tritiated water. In all seals, the maximum urinary concentrations of Na(+) and Cl(-) were higher than in seawater, reaching 540 and 620 mM, respectively, compared to 444 and 535 mM in seawater. In another experiment, the seals were given ad lib access to seawater for 48 h after mannitol-induced hyper-osmotic dehydration. In animals without access to seawater, the mean blood osmolality increased from 331 to 363 mOsm kg(-1) during dehydration. In contrast, the blood osmolality, hematocrit and TBW returned to normal when the seals were permitted ad lib access to seawater after dehydration. In conclusion, this study shows that harp seals have the capacity to gain net water from mariposa (voluntarily drinking seawater) and are able to restore water balance after profound dehydration by drinking seawater.

BACKGROUND

Genomes of lower organisms have been observed with a large amount of horizontal gene transfers, which cause difficulties in their evolutionary study. Bacteriophage genomes are a typical example. One recent approach that addresses this problem is the unsupervised clustering of genomes based on gene order and genome position, which helps to reveal species relationships that may not be apparent from traditional phylogenetic methods.

RESULTS

We propose the use of an overlapping subspace clustering algorithm for such genome classification problems. The advantage of subspace clustering over traditional clustering is that it can associate clusters with gene arrangement patterns, preserving genomic information in the clusters produced. Additionally, overlapping capability is desirable for the discovery of multiple conserved patterns within a single genome, such as those acquired from different species via horizontal gene transfers. The proposed method involves a novel strategy to vectorize genomes based on their gene distribution. A number of existing subspace clustering and biclustering algorithms were evaluated to identify the best framework upon which to develop our algorithm; we extended a generic subspace clustering algorithm called HARP to incorporate overlapping capability. The proposed algorithm was assessed and applied on bacteriophage genomes. The phage grouping results are consistent overall with the Phage Proteomic Tree and showed common genomic characteristics among the TP901-like, Sfi21-like and sk1-like phage groups. Among 441 phage genomes, we identified four significantly conserved distribution patterns structured by the terminase, portal, integrase, holin and lysin genes. We also observed a subgroup of Sfi21-like phages comprising a distinctive divergent genome organization and identified nine new phage members to the Sfi21-like genus: Staphylococcus 71, phiPVL108, Listeria A118, 2389, Lactobacillus phi AT3, A2, Clostridium phi3626, Geobacillus GBSV1, and Listeria monocytogenes PSA.

CONCLUSIONS

The method described in this paper can assist evolutionary study through objectively classifying genomes based on their resemblance in gene order, gene content and gene positions. The method is suitable for application to genomes with high genetic exchange and various conserved gene arrangement, as demonstrated through our application on phages.

Three trained young seals, one harp seal, Pagophilus groenlandicus, and two hooded seals, Cystophora cristata, have been used to study the effect of hypercapnia on respiratory characteristics and diving behaviour. The seals were allowed free movements within a circular pool, while diving and respiratory behaviour were recorded. During the experiments the alveolar CO2 tension was continually recorded. There was a significant decrease in duration of dives with increasing Paco2 for all animals. Ve increased significantly with increasing Paco2. This increase was caused by more frequent surfacing rather than by a higher respiratory frequency during the breathing periods. Tidal volume increased from 3 to 43% when inspired CO2 was increased from 0.03 to 9 vol%. The seals were all found to be less sensitive to CO2 than man. A decreased sensitivity to CO2 with age is suggested from the results.

Formalin-fixed paraffin-embedded tissues from one Caspian seal (Phoca caspica), one harp seal (Phoca groenlandica), one hooded seal (Cystophora cristata), and one harbor seal (Phoca vitulina vitulina) were used to compare the utility of immunohistochemistry (IHC) versus that of a novel seminested reverse transcriptase polymerase chain reaction (RT-PCR) to detect and differentiate canine distemper virus (CDV) and phocine distemper virus (PDV). Four antibodies made against PDV were able to detect both viruses. Two antibodies made against cetacean morbillivirus (CMV) did not label antigens from either CDV or PDV. A third anti-CMV antibody inconsistently stained CDV antigens but did not label PDV antigens. The seminested RT-PCR was able to detect RNA of the phosphoprotein gene in all positive cases. Nucleotide sequence analyses of seminested RT-PCR products were used to differentiate CDV RNA from PDV RNA. From these data, it was determined that IHC using antibodies generated against PDV provided a rapid means of detection for both CDV and PDV antigens; however, differentiation between CDV and PDV was achieved only with the RT-PCR assay.

OBJECTIVE

Anxiety disorders are the most common group of psychiatric disorders in adults. In addition to high prevalence, anxiety disorders are associated with significant functional impairment, and published research has consistently found them to have a chronic course. To date, very little research has explored the clinical characteristics and prospective course of anxiety disorders in racial and ethnic minority samples. The aims of this article are to present clinical and demographic characteristics at intake and prospective 2-year course findings in a sample of African American adults.

METHODS

Data are presented from 152 African Americans diagnosed with generalized anxiety disorder (GAD, n = 94), social anxiety disorder (SAD, n = 85), and panic disorder with agoraphobia (PDA, n = 77) who are participating in the Harvard/Brown Anxiety Research Project-Phase II (HARP-II). HARP-II is an observational, prospective, longitudinal study of the course of anxiety disorders. Participants were interviewed at intake and annually for 2 years of follow-up. Probabilities of recovery over 2 years of follow-up were calculated using standard survival analysis methods.

CONCLUSIONS

Survival analyses revealed a chronic course for all anxiety disorders, with rates of recovery of 0.23, 0.07, and 0.00 over 2 years for GAD, SAD, and PDA, respectively. These rates of recovery were lower than those reported in predominantly non-Latino White longitudinal samples, especially for SAD and PDA, suggesting that anxiety disorders may have a more chronic course for African Americans, with increased psychosocial impairment and high rates of comorbid Axis-I disorders. Clinical implications of these findings are discussed.

This paper examines factors associated with suicidal behavior in patients with anxiety disorders. HARP is a naturalistic, prospective, longitudinal follow-up study. This paper examines 527 subjects with panic disorder (with or without agoraphobia). 9% of the subjects reported past suicidal behavior. Factors associated with suicidal behavior were depressive disorders, substance abuse, eating disorders, PTSD and personality disorders as well as having early onset of the first anxiety or depressive disorder. Subjects had a 4.5% P of suicidal behavior during the first 30 months of follow-up. All prospectively recorded suicidal behavior occurred in subjects with depressive disorders. In these panic disorder patients, suicidal behavior rarely occurred in the absence of affective disorders. Certain nondepressive disorders also substantially increased the risks of suicide attempts/gestures.

Optimizing a living kidney donation program is important to guarantee a high grade of acceptance among potential donors. Hand-assisted retroperitoneoscopic donor nephrectomy (HARP) is an alternative to the open anterior approach (AA) technique. Problems associated to the learning curve could hinder a transition. 3D display technique seems to ease minimally invasive surgery. Aim of this study was to evaluate the learning curve during the transition from AA to HARP and the influence of the 3D display system on the established technique.

Observational study (n = 207) during transition to HARP and introduction of 3D display technique.

Operation time (OT), warm ischemia time (WIT) and blood loss (BL) of HARP decreased during transition. Pairwise group comparison for OT showed a significant learning effect for the first 30 out of 50 HARPs without influence on graft function. Between AA and HARP no significant difference in OT (133 ± 24 vs. 127 ± 19 min, p = 0.25) but for WIT (23 ± 28 vs. 126 ± 40 s, p < 0.005) and BL (328 ± 207 vs. 54 ± 35 ml, p < 0.005) was seen. There was neither a significant difference in donors' nor recipients' eGFR. OT (98 ± 16 vs. 106 ± 19 min, p = 0.036) and WIT (97 ± 37 vs. 120 ± 57 s, p = 0.023) were significantly shorter for the 3D technique compared to 2D.

A transition to HARP is possible without additional risk for the donor or loss of quality for the recipient. The learning curve for HARP is steep and short. The introduction of 3D display technique after transition facilitates the surgical preparation and could further help to optimize HARP.

The purpose of this study was to determine if elevated myocardial glycogen content could obviate Ca(2+) overload and subsequent myocardial injury in the setting of low oxygen and diminished exogenous substrate supplies. Isolated harp seal cardiomyocytes, recognized as having large glycogen stores, were incubated under conditions simulating ischemia (oxygen and substrate deprivation) for 1 h. Rat cardiomyocytes were used for comparison. Freshly isolated seal cardiomyocytes contained approximately 10 times more glycogen than those from rats (479 +/- 39 vs. 48 +/- 5 nmol glucose/mg dry weight (dry wt), mean +/- S.E., n = 6), and during ischemia lactate production was significantly greater in seal compared to rat cardiomyocytes (660 +/- 99 vs. 97 +/- 14 nmol/mg dry wt), while glycogen content decreased both in seal (from 479 +/- 39 to 315 +/- 58 nmol glucose/mg dry wt) and rat cardiomyocytes (from 48 +/- 5 to 18 +/- 5 nmol glucose/mg dry wt). Cellular ATP was well maintained in ischemic seal cardiomyocytes, whereas it showed a 65% decline (from 31 +/- 3 to 11 +/- 1 nmol ATP/mg dry wt) in rat cardiomyocytes. Similarly, total seal cardiomyocyte Ca(2+) content was not affected by ischemia, while Ca(2+) increased from 8.5 +/- 2.0 to 13.3 +/- 2.0 nmol/mg dry wt in ischemic rat myocytes. Rat cardiomyocytes also showed a notable decline in the percentage of rod-shaped cells in response to ischemia (from 66 +/- 4% to 30 +/- 3%), and cell morphology was unaffected in seal incubations. Addition of iodoacetate (IAA, an inhibitor of glycolysis) to seal cardiomyocytes, on top of substrate and oxygen deprivation, reduced the cellular content of ATP by 52.9 +/- 4.4% (from 25 +/- 4 to 11 +/- 2 nmol ATP/mg dry wt) and the percentage of rod-shaped myocytes from 51 +/- 3% to 28 +/- 4%, while total Ca(2+) content was unchanged by these conditions. Seal cardiomyocytes thus tolerate low oxygen conditions better than rat cardiomyocytes. This finding is most likely due to a higher glycolysis rate in seals, fueled by larger myocardial glycogen stores.

Glioblastoma is the most common primary brain tumor in human adults. Since existing treatments are not effective enough, novel therapeutic targets must be sought. The heparin-binding growth factor, heparin affin regulatory peptide (HARP), also known as pleiotrophin (PTN), could potentially represent such a target. We have previously shown that a mutant protein, HARPDelta111-136, which lacks HARP's C-terminal 26 amino acids, acts as a dominant negative HARP effector by heterodimerizing with the wild-type growth factor. The aim of our study was to evaluate the potential inhibitory activity of HARPDelta111-136 on the U87 MG human glioblastoma cell line. By overexpressing the truncated form of HARP in stably established clones of U87 MG cells, we observed an inhibition of proliferation under both anchorage-dependent and anchorage-independent conditions. We confirmed these results in an in vivo subcutaneous tumor xenograft model. In addition, we found that HARPDelta111-136 inhibited cell proliferation in a paracrine manner. Analysis of key cellular pathways revealed a decrease of cell adhesion in U87 MG cells that overexpressed the mutant protein, which could explain this inhibitory effect. A replication-defective adenovirus model that encoded HARPDelta111-136 supported a putative antiproliferative role for the truncated protein in vitro and in vivo. Interestingly, HARPDelta111-136 was also able to abolish angiogenic activity in HUVEC proliferation and in a Matrigel plug assay. These results demonstrate that considering its antiproliferative and angiostatic effects, HARPDelta111-136 could be of great interest when used in conjunction with standard treatments.

Music is a method nurses can use to help relieve pain, however little is known about its effectiveness across cultures. In this study, Western music was tested for its effectiveness in reducing postoperative pain in 38 Taiwanese patients, and its acceptability was explored. A pretest and post-test experimental design was used with visual analogue scales to measure sensation and distress of pain. Before surgery, subjects were randomly assigned to receive tape recorded music or the usual care. Those who were assigned to the music group chose among 5 types of sedative music. On postoperative Day 1 and Day 2, the effectiveness of the tape-recorded music was investigated during 15 minutes of rest in bed. Patients were interviewed on Day 3 to determine their liking for the music, its calming effects, and the helpfulness of the music. Repeated measures analysis of variance showed a significant interaction between time and group in the distress of pain on Day 1, but not on Day 2, and in pain sensation on Day 2, but not Day 1. Subjects from Taiwan were similar to subjects in a previous study in the United States in their liking for the music, and in reports of the helpfulness of the music for pain sensation and distress, but fewer Taiwanese found the music calming, and they had different choices: more chose harp music and fewer chose jazz than subjects in the U.S. study, and some would prefer Buddhist hymns or popular songs heard in Taiwan. Findings support the use of culturally acceptable music in addition to analgesic medication for the sensation and distress of postoperative pain.

This report prospectively examines the course of body dysmorphic disorder (BDD) for up to 8 years in a sample of 514 participants in the Harvard/Brown Anxiety Research Project, a naturalistic, longitudinal study of anxiety disorders. Diagnostic and Statistical Manual of Mental Disorders (4th ed.) BDD was assessed with a reliable semi-structured measure. For participants with BDD, severity of BDD symptoms was assessed with the Longitudinal Interval Follow-up Evaluation Psychiatric Status Rating scale. At the initial assessment, 17 participants (3.3%; 95% confidence interval = 1.8%-4.8%) had current BDD; 22 (4.3%; 95% confidence interval = 2.6%-6.1%) had lifetime BDD. Participants with BDD had significantly lower Global Assessment Scale scores than those without BDD, indicating poorer functioning. The probability of full recovery from BDD was 0.76, and probability of recurrence, once remitted, was 0.14 over the 8 years. In conclusion, among individuals ascertained for anxiety disorders, the probability of recovering from BDD was relatively high and probability of BDD recurrence was low.

Aim of this study is to demonstrate the advantages of oblique 3D tags in cardiac magnetic resonance imaging (MRI) and the potential to accurately describe the complex motion of the myocardial wall. 3D cardiac Cine data were densely tagged with 3D oblique tags. The latter were tracked using Gabor analysis and active geometries. From the tag intersections, common 2D parameters such as long axis shortening, radial shortening and rotation were evaluated on a global as well as detailed local level. Finally, the same data were used to estimate left ventricular volume change and myocardial stress/strain. We have successfully tracked dense 3D tags and evaluated common parameters on a detailed local level. In addition, inherently 3D parameters could be estimated. Global motion data are in accordance with previously published data. Oblique tags allow for unambiguous localization of the tag plane in all MRI slices and in any time frame. In contrast to HARP, our tag tracking methodology allows for tracking of the tags even when they are dense. Motion parameters can be extracted in greater detail. Moreover, the intersections of dense oblique 3D tags provide a natural basis for a finite element model of the heart. Straight forward access to the 3D characteristics of the cardiac motion is provided.

Data on the geographic distribution and host specificity of Cryptosporidium spp. are critical for developing an understanding of likely transmission patterns in nature. During a molecular-based survey of fecal samples from 293 terrestrial and aquatic animals in Maine, USA, we detected Cryptosporidium sp. in 11 harbor seals (Phoca vitulina), 1 hooded seal (Cystophora cristata), and 1 harp seal (Pagophilus groenlandicus). None of the terrestrial or freshwater mammal fecal samples or bird samples tested positive for Cryptosporidium sp. However, the sequencing results of the small subunit (ssu) rRNA gene indicate that the seals were infected with an undescribed species of Cryptosporidium , previously isolated only from ringed seals (Phoca hispida) in northern Quebec, Canada. In addition, the Cryptosporidium sp. detected in the harp seal is significantly different from the previously observed Cryptosporidium sp. in other seals. We confirmed the genetic distinctiveness of this Cryptosporidium genotype and the identity of the other Cryptosporidium sp. seal ssu rRNA sequences by using data from the 70-kDa heat shock protein gene. Based on phylogenetic reconstructions of both genes, it seems that either Cryptosporidium canis or C. felis are sister species to the seal associated Cryptosporidium spp. Our findings extend the range of " Cryptosporidium sp. seal" well south of the 55th parallel, add other species to the list of seals affected by Cryptosporidium sp., and highlight the presence of unrecognized population and potentially species level variation in Cryptosporidium.

The careHPV assay is a test for high-risk (HR) human papillomaviruses (HPV) detection designed to be affordable in resource-poor settings. We evaluated the performance of careHPV screening among 1052 women living with HIV/AIDS included in the HARP (HPV in Africa Research Partnership) study in Burkina Faso (BF) and South Africa (SA).

Cervical samples were tested for HR-HPV by the careHPV and the INNO-LiPA HPV genotyping Extra assays. All women had Pap smear testing, visual inspection with acetic acid/Lugol's iodine (VIA/VILI) and colposcopy. Cervical biopsies were obtained for participants who were HR-HPV DNA positive by careHPV or who had abnormalities detected on cytology, VIA/VILI or colposcopy.

Overall, 45.1% of women had a positive careHPV test (46.5% in BF, 43.8% in SA). The careHPV positivity rate increased with the grade of cytological lesions. Sensitivity and specificity of careHPV for the diagnosis of CIN2+ (n=60, both countries combined) were 93.3% (95% confidence interval (CI): 83.8-98.2) and 57.9% (95% CI: 54.5-61.2), respectively. Specificity increased with CD4 count. careHPV had a similar clinical sensitivity but higher specificity than the INNO-LiPA assay for detection of CIN2+.

Our results suggest that careHPV testing is a reliable tool for cervical cancer screening in HIV-1-infected women in sub-Saharan Africa.

BACKGROUND

The harp seal (Phoca groenlandica) is one of the most important predators in the Northeastern Atlantic ecosystem. Establishing biochemical reference intervals is important for evaluating the health status of harp seals kept in captivity and for evaluating the effects of environmental changes on the health of populations in the wild.

OBJECTIVE

The purpose of this study was to determine reference values for serum biochemical parameters in wild adult harp seals using readily available current methods.

METHODS

Blood samples were obtained from 14 adult female harp seals and 9 suckling pups on the pack ice of the Greenland Sea in early March 1998. Seven seals were humanely killed on the ice by permission of the Norwegian Directory of Fisheries and in conjunction with several other research projects. The seals were sampled within 15 minutes postmortem. Remaining seals were captured alive and sampled via the extradural intravertebral vein. Serum biochemical parameters were measured using a Technicon Axon analyzer and included electrolytes (sodium, chloride, potassium, magnesium, and calcium), substrates (free fatty acids, triglycerides, fructosamine, and glucose), end products (urea and uric acid), and proteins (total protein, globulins, and albumin). Serum protein electrophoresis also was done. Data were tested for normality and reference limits were calculated as mean +/- 1.96 X SD. Results between groups were compared using 2-tailed t-tests.

RESULTS

Serum levels of glucose and triglycerides were lower, but serum levels of urea were higher in dead animals than in animals that were captured alive. Serum levels for 7 of 17 parameters were significantly different in pups compared with adults. Separate reference intervals were calculated for adult seals and seal pups.

CONCLUSIONS

Both sampling method and age should be considered when evaluating the results of future analysis of serum parameters in wild and captive harp seals.

This study reports the findings of an integrated, comprehensive analysis of lactation energetics in harp seals conducted using longitudinal measurements of mass, body composition and milk composition from mother-pup pairs in conjunction with water flux measurements in pups. The nursing period of harp seals is a short, intense and relatively efficient period of energy transfer from mothers to pups. The average daily milk intake for pups was 3.65 +/- 0.24 kg which is equivalent to 79.5 MJ of energy. Eighty-one per cent of the energy received in the milk was metabolisable and 66% of the energy was stored by the pups as body tissue. The field metabolic rate of pups was 3.9 +/- 0.4 time basal metabolic rate. The pups were growing at a rate of 2.2 kg per day during the nursing period. The distribution of this mass gain varied in terms of tissue composition, depending on the age of the pups, but over the whole nursing period approximately half of the tissue was stored as fat. Harp seal mothers lost an average of 3.1 kg per day during lactation which was composed of 37% water, 50% fat, 11% protein and 2% ash. Mothers spent half of their time during the lactation period actively diving and only one-third of their time on the surface of the ice. Milk compositional changes followed the normal phocid pattern with increasing fat content and decreasing water content as lactation progressed. The mean mass transfer efficiency was 73%. However, this value cannot be used without qualification because female harp seals in this study fed to varying degrees, consuming an estimated 0-4.8 kg of fish per day. Feeding does not appear to be required in order to achieve the energy requirements for lactation, given the energy stores possessed by females, and some females do fast through the entire period so feeding may be considered opportunistic in nature.

Blubber samples from harbour (Phoca vitulina) and grey seals (Halichoerus grypus) captured in the St Lawrence Estuary were analysed for PCBs and OC pesticides. Concentrations of sigma PCB, sigma DDT, sigma CHLOR and mirex were higher in harbour than in grey seals, while sigma HCH and HCB were similar in the two species. Age vs. concentration plots showed that sigma PCB, sigma DDT and sigma CHLOR concentrations increased with age in males, but plateaued at sexual maturity in females. Concentrations of sigma HCH decreased and mirex increased with age for post-weaning animals, regardless of gender. HCB did not show age-related trends. PCB congener and OC pesticide patterns varied within harbour seals (based on gender and maturity) and between harbour and grey seals. PCB and OC concentrations in harbour seals were lower than those seen in a sample of significantly older beluga whales. Both species remain in the Estuary year-round. PCB and OC pesticide concentrations were higher in resident harbour seals than in either grey or harp seals that visit the Estuary seasonally. PCB and OC pesticide concentrations in harbour seals from the Estuary were generally higher than in harbour seals from other regions of North America. They were comparable to, or higher than those from the NE Atlantic Ocean and the North Sea, and lower than those from the Wadden and Baltic Seas.

We have developed a novel highly articulated robotic probe (HARP) that can thread through tightly packed volumes without disturbing the surrounding tissues and organs. We use cardiac surgery as the focal application of this work. As such, we have designed the HARP to enter the pericardial cavity through a subxiphoid port. The surgeon can effectively reach remote intrapericardial locations on the epicardium and deliver therapeutic interventions under direct control. Our device differs from others in that we use conventional actuation and still have great maneuverability. We have performed proof-of-concept clinical experiments to give us preliminary validation of the ideas presented here.