Motivation for participating in phase 1 vaccine trials: Comparison of an influenza and an Ebola randomized controlled trial

Introduction/Hypothesis

Recruitment of participants into phase 1 vaccine clinical trials can be challenging since these vaccines have not been used in humans and there is no perceived benefit to the participant. Occasionally, as was the case with a phase 1 clinical trial of an Ebola vaccine in Halifax, Canada, during the 2014–2016 West African Ebola virus outbreak, recruitment is less difficult. In this study, we explored the motivations of participants in two phase 1 vaccine trials that were concurrently enrolling at the same centre and compared the motivations of participants in a high-profile phase 1 Ebola vaccine trial to those in a less high-profile phase 1 adjuvanted seasonal influenza vaccine study.

Is the driver drunk? Oculomotor sobriety testing

Recently a new test involving observation of ocular pursuit movements, end-point nystagmus and angle of lateral deviation at which nystagmoid movements begin has been used by law enforcement agencies to determine the blood alcohol level of suspected drunk drivers. When properly administered and scored, this test can correctly identify approximately 80% of drivers with alcohol levels of 0.10% or greater. The test is more accurate than the traditional coordination or mental computation tests previously used, but questions may be raised about the use of the test with suspects who have ocular problems such as high refractive errors, chronic nystagmus, etc.     

Are ADDH and ADHD the same or different?

To assess the relationship between the DSM-III criteria for attention deficit disorder with hyperactivity (ADDH) and the DSM-III-R criteria for attention-deficit hyperactivity disorder (ADHD), children from an inner city parochial school were evaluated using a 30-item teacher questionnaire consisting of the DMS-III and DSM-III-R criteria for these disorders, the revised Conners Parent and Teacher Questionnaires, and a continuous performance test. Diagnostic groups were established based on teacher ratings of the DSM items and evaluated in relation to the rating scale data and continuous performance test. While children who were identified by teachers as having ADDH almost always satisfied the criteria for ADHD, a new group of children who were hyperactive and impulsive but less clearly inattentive also met the criteria for ADHD. Implications of the change in diagnostic criteria are discussed.     

Work-related injuries in minors

Since 1938, federal child labor laws have restricted employment of persons under 18 years old, in part to protect them from hazardous occupations. Workers' compensation claims reported to the Supplementary Data System of the Bureau of Labor Statistics were examined to define the current status of occupational injuries among minors. Data tapes from 1980 to 1983 were searched to identify all current claims for injuries and illnesses occurring in 1980 in persons under age 18. Injury rates were calculated using information about employment in 1979 available from the 1980 census. In the 24 states included in this study, 23,823 claims were reported for persons less than 18 years old. Of these claims, approximately 10% were from persons under age 16. Rates of injuries in 16- and 17 year olds were 12.6 per 100 full-time male workers and 6.6 per 100 full-time female workers. Serious injuries included fractures, dislocations, and amputations, accounting for 5.8%, 0.7%, and 0.6% of cases, respectively. California, the only state that coded whether injuries resulted in fatalities, reported 12 deaths in this age group. Machines and vehicles, many of which are restricted under child labor laws, accounted for 8.3% and 5.8% of claims. These data suggest that persons under age 18 years are not adequately protected from occupational injury. Further attention and, possibly, new preventive strategies are needed.     

A groundless hypothesis, megaloblastic madness, and the founding of Duke University.

In a recent issue of Medical Hypotheses, Dr H L Newbold repeats the assertion that the cause of James B Duke's death in 1925 was pernicious anemia. Dr Newbold postulates that Mr Duke was neurologically impaired as a result of vitamin B-12 deficiency and that he suffered from depression. In an attempt to relieve this depression, Dr Newbold argues that James B Duke donated the money necessary to found Duke University. Had he been properly treated for pernicious anemia, James Duke might have not been depressed nor made his donation. The historical record does not substantiate this hypothesis. Dr George Minot, Novel Laureate for his work on pernicious anemia, was a consultant to Mr Duke's physicians, and felt that the patient did not have pernicious anemia. There is no independently verifiable evidence to demonstrate that Mr Duke ever suffered from depression. Duke made his first donations to Trinity College, later named Duke University, in 1900--25 years before his death. The available data discounts the hypothesis that depression related to pernicious anemia played any role in the founding of Duke University.     

Failure of tetracycline therapy in early Lyme disease

We describe the clinical courses of 5 patients with Lyme disease who developed significant late complications, despite receiving tetracycline early in the course of their illness. All 5 patients had been treated for erythema chronicum migrans with a course of tetracycline that met or exceeded current recommendations. The late manifestations of Lyme disease included arthritis, cranial nerve palsy, peripheral neuropathy, chronic fatigue, and changes in mental function. Our findings suggest that the use of tetracycline at a dosage of 250 mg, 4 times a day for 10 days, as a treatment for early Lyme disease should be reconsidered. To determine optimal therapy for early Lyme disease, a study that compares an increased dosage of tetracycline with alternative treatments is indicated.     

缺血性卒中或短暂性脑缺血发作患者的卒中预防指南

这份新声明旨在为缺血性卒中或短暂性脑缺血发作存活者的缺血性卒中预防提供全面和及时的循证推荐，循证推荐包括对危险因素的控制，动脉粥样硬化性疾病的干预措施，心源性栓塞的抗栓治疗以及非心源性卒中抗血小板药的应用。另外，还为其他多种特殊情况下复发性卒中的预防提供了推荐、包括动脉夹层分离、卵圆孔未闭、高同型半胱氨酸血症、高凝状态、镰状细胞病、脑静脉窦血栓形成、女性卒中（特别是与妊娠和绝经后激素替代治疗相关卒中），脑出血后肮凝药的应用，以及该指南在高危人群中执行和应用的特殊措施。     

Anterior interosseous nerve palsy following closed fracture of the proximal ulna. A case report and review of the literature

Complete paralysis of the anterior interosseous nerve was seen in 32-year-old army officer 5 weeks after he sustained a minimally displaced fracture of the proximal ulna. The fracture was immobilized in an arm cast. Thirteen weeks after injury, the cast was removed following evidence of bone union. Complete recovery of the flexor pollicis longus was noted 17 weeks after the injury, while recovery of the flexor profundus to the index finger to grade four lasted 10 months. To the best of our knowledge, this is the first case reported in the English language literature in which anterior interosseous nerve palsy follows isolated fracture of the proximal ulna.