Premature cardiovascular disease in chronic renal failure

There is a remarkable lack of reliable information about the determinants of risk of cardiovascular disease (CVD) among patients with chronic renal failure. Indeed, such patients have often been deliberately excluded from randomised trials of treatments of CVD, perhaps because of concerns about drug safety. But the absolute risk of CVD among them may be large, so the potential absolute benefits of treatments may also be large, and may well exceed any increased hazards. Hence, as well as further investigation of the underlying mechanisms of cardiac disease, it would be helpful to have some large-scale randomised trials in a wide range of renal patients of interventions (such as cholesterol-lowering drugs, antihypertensives, aspirin, B-vitamins, and antioxidant vitamins) that are of proven or suspected benefit in other settings. If safe and effective treatments can be identified, and started early in the natural history of renal failure, the exceptionally high risk of CVD experienced by these patients could be decreased before and after end-stage renal failure has occurred.     

Understanding the business versus care paradox in gambling venues: a qualitative study of the perspectives from gamblers,venue staff and counsellors

Background

In recent years, greater emphasis has been placed on gambling venues to identify potential problem gamblers, respond appropriately and refer to treatment. In seeking the perspectives of problem gamblers, venue staff and treatment providers, this qualitative study investigates how problem gamblers experience being identified and referred for treatment by venue staff.

Methods

A semi-structured interview guide focusing on experiences and perceptions of problem gambling identification and referral for treatment in gaming venues was used to conduct 4 focus groups and 9 semi-structured in-depth interviews. Participants comprised 22 problem gamblers, 10 gambling venue staff and 8 problem gambling counsellors. Audio recordings were transcribed verbatim, and an interpretive phenomenological analysis was conducted.

Results

‘Role conflict’ was identified as a considerable source of stress for venue staff who described conflicting priorities in responding to problem gamblers whilst maintaining employer profit margins. Problem gamblers described offers of help from venue staff as hypocritical and disingenuous. Venue staff also described reluctance to make moral judgements through the identification of and engagement with problem gamblers, and gamblers described resentment in being singled out and targeted as a problem gambler. Being approached and offered referral to a counselling service was a rare occurrence among problem gamblers. This corresponded with reports by gambling counsellors.

Conclusions

Role conflict experienced by gambling venue staff and patrons alike inhibits effective referral of potential problem gamblers into treatment. Reducing the need for gambling venue staff to make a perceived moral judgement about the gambling behaviours of specific patrons may improve the reception of responsible gambling information and promote help-seeking.

     

Genetic analysis reveals that both haemagglutinin and neuraminidase determine the sensitivity of naturally occurring avian influenza viruses to zanamivir in vitro.

The basis of differential sensitivity of replication of influenza viruses to the neuraminidase-specific inhibitor zanamivir was examined using four avian influenza viruses and reassortants produced between them. IC(50) values for inhibition of neuraminidase activity by zanamivir were similar for each of the four viruses, whereas the haemagglutinating activity of each of the viruses was relatively insensitive to zanamivir. However, the four viruses showed distinct zanamivir-sensitivity profiles in tissue culture. Analysis of the reassortant viruses showed that sensitivity was determined by the haemagglutinin gene (segment 4) and the neuraminidase gene (segment 6) and was independent of the remaining six RNA segments. Decreased sensitivity to zanamivir was associated with possession of a haemagglutinin that is released from cells with decreased dependence on neuraminidase and with possession of a neuraminidase that has a short stalk region.     

Scheuermann's disease. Clinical and radiological survey of 17 and 18 year olds

This is a study of the incidence and possible predisposing stress factors of Scheuermann's disease (S.D.). 500, 17 and 18 year old, students from the local larger schools, from one country town school and from the local Teachers' Training College, took part. Each student filled in a questionnaire, underwent a simple spinal examination including a clinical assessment of the available passive hamstring stretch, and had a lateral X-ray of the dorsal and upper lumbar spine. 56.3% of the males and 30.3% of the females had X-ray evidence of previous S.D., in varying degrees of severity. Dynamic stress, such as playing sports involving a lot of potential compression stress, weight lifting, and heavy lifting work in spare time and holidays, seem to play little if any part in the pathogenesis of S.D. Tall males and males who had spent more than 2 weeks in bed, due to sickness or injury, were more prone to S.D. Hamstring tightness showed a significant relationship to X-ray evidence for males. In the absence of possible dynamic stress factors it is suggested that prolonged sitting may be an important factor in the pathogenesis of end plate breakdown and thus S.D.     

Utilization of ileal digestible amino acids by growing pigs: effect of dietary lysine concentration on efficiency of lysine retention

Diets were formulated using sugar, soya-bean meal and free amino acids to contain 0.1-0.8 g lysine/MJ digestible energy (DE) and offered at three times maintenance to male and female pigs from 20 to 45 kg live weight. Growth responses and retentions of protein, fat, energy and lysine were assessed. Increasing the dietary lysine concentration resulted in significant (P less than 0.001) linear and curvilinear increases in growth rates and decreases in food conversion ratios. There was only a small effect of lysine concentration on total energy retention, but a substantial effect on the partitioning of energy deposition, with increases in the rate of protein deposition and decreases in fat retention. There was no difference in the efficiency of protein deposition between male and female pigs but males responded more to higher lysine concentrations than females (estimated 0.93 and 0.74 g lysine/MJ DE for males and females respectively). Lysine concentration in the protein deposited by the pigs increased linearly and curvilinearly (P less than 0.01) from 5.8 to 6.6 g lysine/16 g N with increasing dietary lysine concentration. There was a linear and quadratic response (P less than 0.001) in retention of ileal digestible lysine, with the minimum retention of 0.16 occurring at 0.1 g lysine/MJ DE and increasing to a maximum retention of 0.73 at a dietary concentration of 0.47 g lysine/MJ DE. The efficiency of lysine retained/ileal digestible lysine intake was 0.86 and the endogenous lysine loss was estimated at 0.94 g/d.