The safer choices project: methodological issues in school-based health promotion intervention research

Randomized trials of school-based health promotion programs present unique design and analytical issues not widely discussed in the research literature. This article describes the Safer Choices study--a school-based program for prevention of HIV, other sexually transmitted diseases, and pregnancy--to illustrate critical methodological issues involved in large-scale, school-based intervention trials, particularly those evaluating interventions with a school-wide focus. The issues presented are: 1) comparability of the intervention and control groups even when few units are randomized; 2) factors that affect the decision to use a cohort or cross-sectional design; and 3) appropriate analysis strategy when the unit of randomization and intervention is at the school level, but observations are at the student level.     

A highway in state space for reactors with minimum entropy production

Thousands of numerical solutions of an optimal control problem for plug flow reactors were found to give, what we call a “highway in the reactors’ state space”. The problem was to find the heat transfer strategy which minimise the entropy production in reactors with fixed chemical conversion. The control variable was always the temperature of the heating/cooling medium along the reactor. The highway represents the most energy efficient way to travel far in state space. Such highways were studied for five reactor systems, endothermic and exothermic ones. Numerical analysis showed that the reactor highway is characterised by approximately constant thermodynamic driving forces/local entropy production for reasonable process intensities. Each solution represents a compromise between the entropy production of reactions, heat transfer and frictional flow (pressure drop). The solutions enter and leave the highway at different positions depending on how far from the highway their initial and final destinations are. Knowledge about the nature of the highway, e.g. when the reactor operates in a reaction mode or a heat transfer mode, may be important for energy efficient reactor design. The theoretical formulation of the optimisation problem is valid for plug flow as well as batch reactors. We showed that important results in literature like the Spirkl-Ries quantity, the theorems of equipartition of entropy production and equipartition of forces are contained in our general formulation. The numerical results showed that the analytical results are good approximations to the optimum also in problems where they do not apply in a strictly mathematical sense.     

Neurorehabilitation/geriatric rehabilitation--goals achieved and aims from the viewpoint of the so-called "Vorarlberg Model"

Together with building up a first neurological department in one of the Austrian states we could introduce and organize the 1st scientific institute in literature for neuro-rehabilitation and -prophylaxis. 80% of the neuro-rehabilitation-patients are geriatrics. Hence overlapping of neuro-rehabilitation with rehabilitation in old age is to be postulated. "Rehabilitation of old age groups" as well has been named by us for the 1st time in scientific literature. Moreover we operate such activities on a large scale within a practical and social medical context. As worldover (at least within the civilized countries of high standards) the problem of old age groups is a steadily increasing and important, we are working on a very important scientific sector. Our slogan: "Holistic and permanent" is practically operated as follows: 1. Fluent transition of rehabilitation-adequate acute treatment towards a systematic specialized rehabilitation. 2. Schooling of relatives and follow up rehabilitation service. 3. Introducing rehabilitative thoughts as well in university, teaching as (by separate schoolings) within medical profession and all the other health professions. 4. We emphasize a plurality of methods; to be named here as main examples: integrated physiotherapy as well as integrated psychotherapy. Emphasizing more scientific values for (high age-)rehabilitation, we emphasize as well that it must not be banned into "high age ghettos". Contrarely rehabilitation adapted thinking must be integrated within all the health professions. 5. Innovation, phantasy and pleasure must be introduced into our work. We report of work with lay-groups, animal-visits, hippo-therapy, music, etc. This forms a large interesting territory for an upraising young generation in health professions.     

Ex vivo staining of metastatic lymph nodes by class I major histocompatibility complex tetramers reveals high numbers of antigen-experienced tumor-specific cytolytic T lymphocytes

Characterization of cytolytic T lymphocyte (CTL) responses to tumor antigens has been impeded by a lack of direct assays of CTL activity. We have synthesized reagents ("tetramers") that specifically stain CTLs recognizing melanoma antigens. Tetramer staining of tumor-infiltrated lymph nodes ex vivo revealed high frequencies of tumor-specific CTLs which were antigen-experienced by surface phenotype. In vitro culture of lymph node cells with cytokines resulted in very large expansions of tumor-specific CTLs that were dependent on the presence of tumor cells in the lymph nodes. Tetramer-guided sorting by flow cytometer allowed isolation of melanoma-specific CTLs and confirmation of their specificity and their ability to lyse autologous tumor cells. Our results demonstrate the value of these novel reagents for monitoring tumor-specific CTL responses and for generating CTLs for adoptive immunotherapy. These data also indicate that strong CTL responses to melanoma often occur in vivo, and that the reactive CTLs have substantial proliferative and tumoricidal potential.     

The course of geriatric depression with "reversible dementia": a controlled study

OBJECTIVE: The goals of this longitudinal investigation were 1) to study the rate of development of irreversible dementia in elderly depressed patients with a dementia syndrome that subsided after improvement of depression and 2) to compare it with that of depressed, never-demented patients. METHOD: The subjects were 57 elderly patients consecutively hospitalized for major depression. At entry into the study, 23 subjects also met criteria for "reversible dementia," while 34 were without dementia. After a systematic clinical evaluation, the subjects were followed up at approximately yearly intervals for an average of 33.8 months. RESULTS: Irreversible dementia developed significantly more frequently in the depressed group with reversible dementia (43%) than in the group with depression alone (12%). Survival analysis showed that the group with reversible dementia had a 4.69-times higher chance of having developed dementia at follow-up than the patients with depression alone. No clinical characteristics at entry into the study were found to discriminate the subjects who developed irreversible dementia during the follow-up period from those who remained nondemented. CONCLUSIONS: These findings suggest that geriatric depression with reversible dementia is a clinical entity that includes a group of patients with early-stage dementing disorders. Therefore, identification of a reversible dementia syndrome is an indication for a thorough diagnostic workup and frequent follow-ups in order to identify treatable neurological disorders.     

Plasma somatomedin activity in normal and scoliotic children

In a study of plasma somatomedin activity in childhood scoliosis a group of five patients with congenital scoliosis was found to have significantly lower plasma somatomedin levels compared with a group of 20 normal children. A group of 52 patients with "idiopathic" scoliosis had normal plasma somatomedin levels. There is no apparent difference in the plasma somatomedin activity between the sexes, and no change in plasma somatomedin activity with chronologic age in these children, suggesting that normal adult somatomedin levels have been reached.     

Psychophysiological studies in the pre-school children

The behavior of 24 children, aged 3-6 years, was recorded on video-tape. Simultaneously the ECG was recorded telemetrically. These observations were made during two pre-school educational programs lasting 90 minutes each: "Didactic games" and "Elementary music and movement program". For each child a scale was developed to show the correlation of mean heart-rate and well defined motor-activity. It was evident that the mean heart-rate was higher during the music program than during the didactic program, corresponding to the higher motor-activity. But it was found that in the didactic program the variation of the heart-rate within short intervals was higher due to the more frequent occurrence of respiratory arrhythmias. It was also seen that during the music program the children showed no signs of exertion as they did towards the end of the didactic program. Respiratory arrhythmias were not seen in children who according to the Schellong-test were classified as stable in their cardiovascular system. The arrhythmias occurred mainly when the children showed signs of fatigue.     

On the use of laboratory ocean circulation models to simulate mesoscale (10–100 km) spreading

The development of hydrodynamic numerical models for environmental studies depends on good benchmarks to calibrate and validate the physics and numerical codes. Laboratory models of non-linear and coupled physics in topography for which no analytical solutions are available can provide such valuable benchmarks. Although field data are necessary for a final validation, they are often of less value for developing numerical models, since a truly synoptic coverage of a scenario is seldom found, knowledge of the forcing conditions is imperfect and average conditions of a non-linear system are seldom obtained by applying average boundary conditions.The role of laboratory models and experiments for providing information on turbulence in complicated topography is indisputable. The high topographical resolution of these models reveals how narrow and filamentous many of the flow features can be, as often seen in satellite images. Such filaments enhance diffusion through a process known as shear dispersion. The filaments are also of concern for the interpretation of sparse field measurements and for computing the mesoscale (10–100 km) spreading characteristics. Time histories of dye clouds and clusters of particles in laboratory simulations of ocean currents, without wind, show much larger spreading than particle spreading due to strong winds. The results demonstrate that numerical models need high resolution and/or good parametrization of the spreading characteristics, which vary both in space and time, to achieve their goals. It is proposed that the differences between numerical and laboratory simulations of dispersion, with identical forcing, be parametrized as a size-dependent, or time-dependent random walk diffusion in the numerical code.The laboratory results amply show that spreading is greatly enhanced by shear dispersion, and that assessments of the consequences of accidental oil spills or releases of radionuclides, for example, must take this into account. Island communities in tidally active regions are particularly prone to the consequences of a rapid dispersion of contaminants.