Evaluation of the Test-mate ChE (cholinesterase) field kit in acute organophosphorus poisoning

STUDY OBJECTIVE: Measurement of acetylcholinesterase (AChE) is recommended in the management of organophosphorus poisoning, which results in 200,000 deaths worldwide annually. The Test-mate ChE 400 is a portable field kit designed for detecting occupational organophosphorus exposure that measures RBC AChE and plasma cholinesterase (PChE) within 4 minutes. We evaluate Test-mate against a reference laboratory test in patients with acute organophosphorus self-poisoning. METHODS: This was a cross-sectional comparison study of 14 patients with acute organophosphorus poisoning between May 2007 and June 2008. RBC AChE and PChE were measured in 96 and 91 samples, respectively, with the Test-mate ChE field kit and compared with a reference laboratory, using the limits of agreement method (Bland and Altman), κ statistics, and Spearman's correlation coefficients. RESULTS: There was good agreement between the Test-mate ChE and the reference laboratory for RBC AChE. The mean difference (Test-mate-reference) was -0.62 U/g hemoglobin, 95% limits of agreement -10.84 to 9.59 U/g hemoglobin. Good agreement was also observed between the categories of mild, moderate, and severe RBC AChE inhibition (weighted κ 0.85; 95% confidence interval [CI] 0.83 to 0.87). Measurement of PChE also showed good agreement, with a mean difference (Test-mate-reference) of +0.06 U/mL blood, 95% limits of agreement -0.41 to 0.53 U/mL blood. Spearman's correlation coefficients were 0.87 (95% CI 0.81 to 0.91) for RBC AChE and 0.76 (95% CI 0.66 to 0.84) for PChE. Analysis for within-subject correlation of subjects did not change the limits of agreement. CONCLUSION: The Test-mate ChE field kit reliably provides rapid measurement of RBC AChE in acute organophosphorus poisoning.

Persisting side-to-side differences in bone mineral content, but not in muscle strength and tendon stiffness after anterior cruciate ligament reconstruction

Tendon stiffness may be involved in limiting peak musculoskeletal forces and thus may constitute an upper limit for bone strength. The patellar tendon bone (PTB) graft, which is harvested from the patellar tendon during surgical reconstruction of the anterior cruciate ligament (ACL), is an ideal scenario to test this hypothesis. Eleven participants were recruited who had undergone surgical reconstruction of the ACL with a PTB graft 1-10 years prior to study inclusion. As previously reported, there was no side-to-side difference in thigh muscle cross-sectional area, in maximum voluntary knee extension torque, or in patellar tendon stiffness, suggesting full recovery of musculature and tendon. However, in the present study bone mineral content (BMC), assessed by peripheral quantitative computed tomography, was lower on the operated side than on the control side in four regions studied (P = 0·0019). Differences were less pronounced in the two sites directly affected by the operation (patella and tibia epiphysis) when compared to the more remote sites. Moreover, significant side-to-side differences were found in BMC in the trabecular compartment in the femoral and tibial epiphysis (P = 0·004 and P = 0·047, respectively) with reductions on the operated side, but increased in the patella (P = 0·00016). Cortical BMC, by contrast, was lower on the operated side at all sites except the tibia epiphysis (P = 0·09). These findings suggest that impaired recovery of BMC following ACL reconstruction is not because of lack of recovery of knee extensor strength or patellar tendon stiffness. The responsible mechanisms still remain to be determined.

Towards a "non-didactic didacticism" of the sociopolitical: assemblages and the event in surface tension and shame

To write sociopolitical fiction is to be caught in an odd double bind. The term itself, ‘sociopolitical’ (hyphenated or not), implies an ‘assemblage’, and the terms it combines—‘the social’ and ‘the political’—each suggest complex, worldly assemblages. However, the more the writer attempts to express the assembled complexity of the sociopolitical domain, the more he/she feels a tug in the other direction: towards the version of ideas that might best explain the sociopolitical world and motivate political action. This article engages with the aesthetic and political challenges that arise in writing within a genre in which, to some extent at least, a moral content is desired by readers as an explanation for sociopolitical issues, only to be resisted when, as it often does, it becomes didactic. Co-author Cathryn Perazzo’s sociopolitical novel-in-progress, Surface Tension, is, we suggest, a laboratory of an assemblage in action. In it, we test and elaborate our hypothesis of the ‘assembled idea’ or ‘assembled morality’ of the sociopolitical novel. We conclude with a look at a published short story, ‘Shameʼ, by co-author Patrick West, which similarly deals with the sociopolitical, with how ‘non-didactic didacticisms’ might be germinated, and, most explicitly, with the ‘event’, following Deleuze’s use of this term.

Do ENSO and coastal development enhance coastal burial of terrestrial carbon?

Carbon cycling on the east coast of Australia has the potential to be strongly affected by El Niño-Southern Oscillation (ENSO) intensification and coastal development (industrialization and urbanization). We performed paleoreconstructions of estuarine sediments from a seagrass-dominated estuary on the east coast of Australia (Tuggerah Lake, New South Wales) to test the hypothesis that millennial-scale ENSO intensification and European settlement in Australia have increased the transfer of organic carbon from land into coastal waters. Our data show that carbon accumulation rates within coastal sediments increased significantly during periods of maximum millennial-scale ENSO intensity ("super-ENSO") and coastal development. We suggest that ENSO and coastal development destabilize and liberate terrestrial soil carbon, which, during rainfall events (e.g., La Niña), washes into estuaries and becomes trapped and buried by coastal vegetation (seagrass in this case). Indeed, periods of high carbon burial were generally characterized as having rapid sedimentation rates, higher content of fine-grained sediments, and increased content of wood and charcoal fragments. These results, though preliminary, suggest that coastal development and ENSO intensificationboth of which are predicted to increase over the coming centurycan enhance capture and burial of terrestrial carbon by coastal ecosystems. These findings have important relevance for current efforts to build an understanding of terrestrial- marine carbon connectivity into global carbon budgets.

Engaging patients, clinicians and health funders in weight management: the Counterweight Programme

Background. The Counterweight Programme provides an evidence based and effective approach for weight management in routine primary care. Uptake of the programme has been variable for practices and patients.

Aim. To explore key barriers and facilitators of practice and patient engagement in the Counterweight Programme and to describe key strategies used to address barriers in the wider implementation of this weight management programme in UK primary care.

Methods. All seven weight management advisers participated in a focus group. In-depth interviews were conducted with purposeful samples of GPs (n = 7) and practice nurses (n = 15) from 11 practices out of the 65 participating in the programme. A total of 37 patients participated through a mixture of in-depth interviews (n = 18) and three focus groups. Interviews and focus groups were analysed for key themes that emerged.

Results. Engagement of practice staff was influenced by clinicians’ beliefs and attitudes, factors relating to the way the programme was initiated and implemented, the programme content and organizational/contextual factors. Patient engagement was influenced by practice endorsement of the programme, clear understanding of programme goals, structured proactive follow-up and perception of positive outcomes.

Conclusions. Having a clear understanding of programme goals and expectations, enhancing self-efficacy in weight management and providing proactive follow-up is important for engaging both practices and patients. The widespread integration of weight management programmes into routine primary care is likely to require supportive public policy.