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PubMed2003

Understanding the transition from alternative medicine to mainstream science: the homocysteine theory of heart disease and the crucial role of effective mentoring.

A deficiency of effective 'mentoring' may contribute to the relatively low quality of alternative medicine research and to the medical/scientific community's reluctance to consider even its most promising theories. This hypothesis derives from a case-study of the homocysteine theory of heart disease (HTSD), one of only a few recent theories to have made the transition from 'alternative' to 'mainstream'.

Animals↗

PubMed1998

Who cares for students with epilepsy in mainstream education?

RATIONALE: For children with specific healthcare needs, educational staff must be able to act in 'loco parentis', so that families can safely place their child in the school of choice. If a student has unstable epilepsy, staff must know its potential effects on the individual, and understand enough to manage this. Needs will vary from career advice to management issues such as administration of rectal medication. METHOD: A pilot study involved two primary school children with unstable epilepsy, whose medical treatment included intermittent rectal Diazepam. The study started in September 1994 and was undertaken by two senior nurses who worked with the school nurses to set up a protocol for each child, family and school respectively, that was clear, workable and safe. RESULTS: By September 1995 all school nurses in Leicester/Leicestershire had been trained in epilepsy awareness, the safe administration of rectal Diazepam and the legal implications of volunteers administering medicines in schools. In 1996 school nurses were caretaking the scheme and initiating the uninitiated. The conclusion was that it is possible to train staff in the mainstream educational environment in the special health needs of children with unstable epilepsy thereby supporting continued attendance at the school of choice.

Administration, Rectal↗

PubMedDate not supplied

Reported attitudes and beliefs toward soy food consumption of soy consumers versus nonconsumers in natural foods or mainstream grocery stores.

OBJECTIVE: To examine the attitudes and beliefs of soy foods consumers (SCs) versus nonconsumers (NCs). DESIGN: Seven focus groups were conducted. SETTING: Mainstream or natural foods grocery stores. PARTICIPANTS: Fifty-three participants, ages 18 to 91 years. VARIABLES MEASURED: Focus groups included discussions on lifestyle practices, beliefs about soy, conversion to soy consumption, and suggestions on how to increase soy consumption. ANALYSIS: Common themes were identified, coded, and compared using NVivo computer software. RESULTS: Barriers to soy consumption included soy's image, a lack of familiarity with how to prepare soy foods, and a perception that soy foods were an inadequate flavor substitute for animal-based products. SCs' conversion to regular consumption was initiated by food intolerances, an increased interest in health, or an adoption of a vegetarian or natural foods lifestyle and was sustained because they enjoyed the flavor. Many participants did not know why soy was considered healthful, whereas others identified it as "heart healthy," a source of protein, and good for women's health. Some SCs had become concerned regarding the controversy surrounding breast cancer and soy consumption. CONCLUSIONS AND IMPLICATIONS: Improving soy's image and educating consumers on its preparation could increase soy consumption.

Adolescent↗

PubMed2003

Simultaneous determination of five tobacco-specific nitrosamines in mainstream cigarette smoke by isotope dilution liquid chromatography/electrospray ionization tandem mass spectrometry.

Tobacco-specific nitrosamines (TSNAs) have been previously implicated as a source of carcinogenicity in tobacco and cigarette smoke. Accurate quantification of these chemicals is needed to help assess public health risk. We have developed and validated a specific and sensitive method to simultaneously measure five TSNAs in the particulate phase of mainstream tobacco smoke. Cigarette smoke particulate, produced using standardized machine smoking protocols, was collected on a Cambridge filter pad. The particulate matter was extracted using methylene chloride, back extracted into aqueous solution, further purified by solid-phase extraction, and analyzed by liquid chromatography/electrospray ionization tandem mass spectrometry using isotopically labeled analogues as internal standards. Limits of detection for this method ranged from 0.05 to 1.23 ng/mL using an injection volume of 20 microL. A linear calibration range spanning 2.5-2500 ng/mL was adequate to measure TSNA levels in cigarette smoke. The method achieved excellent reproducibility and accuracy. The identity of each TSNA was established by chromatographic retention time, analyte-specific fragmentation patterns, and relative peak area ratios of two product/precursor ion pairs. This new method provides higher sensitivity, specificity, and throughput than earlier methods for TSNA determination.

Calibration↗

PubMed2005

Application of time-of-flight mass spectrometry with laser-based photoionization methods for time-resolved on-line analysis of mainstream cigarette smoke.

The application of soft photoionization mass spectrometry methods (PIMS) for cigarette mainstream smoke analysis is demonstrated. Resonance-enhanced multiphoton ionization (REMPI) at 260 nm and vacuum ultraviolet light single-photon ionization (SPI) at 118 nm were used in combination with time-of-flight mass spectrometry (TOFMS). An optimized smoking machine with reduced memory effects of smoke components was constructed, which in combination with the REMPI/SPI-TOFMS instrument allows PIMS smoke analysis with a time resolution of up to 10 Hz. The complementary character of both PIMS methods is demonstrated. SPI allows the detection of various aliphatic and aromatic compounds in smoke up to approximately 120 m/z while REMPI is well suited for aromatic compounds. The capability of the instrument coupled to the novel sampling system for puff-by-puff resolved measurements is demonstrated. The feasibility of using the experimental system for intrapuff smoke measurements is also shown. Two main patterns of puff-by-puff behaviors are observed for different smoke constituents. The first group exhibits a constant increase in smoke constituent yield from the first to the last puff. The second group shows a high yield of the constituent in the first puff, with lower and constant or slowly increasing yields in the following puffs. A third group cannot be clearly classified and is a combination of both observed profiles.

Journal Article↗

PubMed2006

The detection of nitro pesticides in mainstream and sidestream cigarette smoke using electron monochromator-mass spectrometry.

Over the past decade, electron monochromator-mass spectrometry (EM-MS) has been shown to be a selective and sensitive technique for the analysis of a wide variety of electrophilic compounds in complex matrixes. Here, for the first time, three different dinitroaniline pesticides, flumetralin, pendimethalin, and trifluralin, have been shown to be present in both mainstream and sidestream tobacco smoke using an EM-MS system. A number of cigarettes were tested that included three pure-tobacco-type cigarettes, an experimental reference cigarette, and 11 commercial cigarettes. Due to the complexity of the smoke particulate matter, the pesticides were identified only after each sample was subjected to a multistep cleanup process that included phenyl solid-phase extraction; an acid wash; aminopropyl solid-phase extraction; and finally, normal phase LC fractionation. All cigarette types tested showed the presence of the three pesticides in the tobacco smoke, with flumetralin ranging from trace levels up to 37 (+/- 9) ng/cig, pendimethalin ranging from trace levels up to 10.4 (+/- 0.6) ng/cig, and trifluralin ranging from trace levels up to 47 (+/- 17) ng/cig. Acute toxicity information is presented for the three pesticides.

Aniline Compounds↗

PubMed2002

Acetaldehyde in mainstream tobacco smoke: formation and occurrence in smoke and bioavailability in the smoker.

A review is presented of the scientific literature on the effects of sugars (mono- and disaccharides), when used as tobacco additives, on the formation of acetaldehyde in mainstream (MS) smoke and the potential bioavailablity of MS smoke acetaldehyde derived from sugars to the smoker. The experimental data supports the following conclusions. Sugars, e.g., D-glucose, D-fructose, and sucrose, do not produce greater yields of acetaldehyde in MS smoke than are produced from tobacco itself on a weight-for-weight basis. A variety of studies suggests that natural tobacco polysaccharides, including cellulose, are the primary precursors of acetaldehyde in MS smoke. In a number of different studies using commercial cigarette brands, MS smoke yields of acetaldehyde correlate (r > 0.9) with both MS smoke "tar" and carbon monoxide. MS smoke acetaldehyde yields are affected more by cigarette design characteristics that influence total smoke production, such as filter ventilation, filtration, and paper porosity, than by reducing sugars. MS smoke acetaldehyde deposits primarily in the upper respiratory tract, including the mouth, of the smoker. Acetaldehyde is rapidly metabolized by aldehyde dehydrogenase in the blood and elsewhere in the body, including at the blood-brain barrier. Tobacco sugar-derived MS smoke acetaldehyde from commercial cigarettes is unlikely to result in direct central nervous system effects on the smoker.

Animals↗

PubMed2004

Delivery levels and behavior of 1,3-butadiene, acrylonitrile, benzene, and other toxic volatile organic compounds in mainstream tobacco smoke from two brands of commercial cigarettes.

Mainstream tobacco smoke (MTS) was collected from Camel and Marlboro cigarettes for the determination of the delivery levels and equilibrium gas/particle partitioning constants K(p) (m(3) microg(-)(1)) of 26 volatile organic compounds (VOCs) of toxicological interest. K(p) values are important for understanding the fractional distribution of each compound of interest between the gas and the particle phases of MTS. The experimental method involved (i) drawing a smoke sample into a Teflon sampling bag at 20 degrees C, (ii) allowing the smoke particulate matter (PM) to collect on the walls of the bag, (iii) sampling the bag to determine the initial gas phase concentration of each VOC, (iv) removing the gas phase from the bag, (v) refilling the bag with humidified nitrogen gas, (vi) reestablishing the gas/PM equilibrium, and (vii) redetermining the gas phase concentrations. For each smoke sample, a comparison of the initial and redetermined gas phase concentrations allowed calculation of the total (i.e., gas + particle) delivery level (= m(tot), ng cig(-)(1)) and K(p) value (= c(p)/c(g)) at 20 degrees C for each compound, where c(p) (ng microg(-)(1)) = concentration in the PM phase and c(g) (ng m(-)(3)) = concentration in the gas phase. Significant deliveries were observed for a number of carcinogenic VOCs. For the Camel cigarettes tested, the average m(tot) values for 1,3-butadiene, acrylonitrile, and benzene were 10(4.6), 10(4.4), and 10(4.8) ng cig(-)(1), respectively; for Marlboro, the m(tot) values were 10(5.0), 10(4.6), and 10(4.7) ng cig(-)(1), respectively. For each of the 26 VOCs, the smoke PM from the two brands yielded very similar K(p) values at 20 degrees C. In addition, the vapor pressure-dependent K(p) values of the 26 VOCs were in close agreement with predictions made by the Pankow theory of absorptive gas/particle partitioning [Pankow, J. F. (1994) Atmos. Environ. 28, 185-188]. These results can be used in general predictions of chemical behavior in tobacco smoke, including deposition mechanisms and rates in the respiratory tract from inhaled MTS. Example calculations are provided to illustrate how the gas phase fraction at equilibrium (f(g,e)) increases strongly with increasing compound vapor pressure and temperature and with dilution of the inhaled tobacco smoke total PM concentration (microg m(-)(3)).

Acrylonitrile↗

PubMed2006

Quantitative puff-by-puff-resolved characterization of selected toxic compounds in cigarette mainstream smoke.

Soft single photon ionization (SPI)-time-of-flight mass spectrometry (TOFMS) has been applied for the quantitative puff-by-puff-resolved characterization of selected toxic species in cigarette mainstream smoke, namely, nitric oxide (NO), acetaldehyde, butadiene, acetone, isoprene, benzene, toluene, ethyl benzene, and xylene. The 2R4F research cigarette was investigated for whole smoke (unfiltered) and gas phase (filtered). It has been demonstrated that the existing smoking regime for total smoke analysis (smoke from a complete cigarette) features deficiencies when applied to puff-resolved measurements. This is especially the case for analysis in which a glass fiber filter is used to separate the smoke particulate and gas phases because material is desorbed from the filter and influences succeeding puffs. Regarding whole smoke measurements, succeeding puffs are affected by contamination and memory effects of the smoking machine itself, but to a lower extent. Quantitative puff-resolved smoke profiles show that the puff yields of the various constituents can differ tremendously. Most species' concentrations increase gradually with puff number, which is mainly due to the reduction in length of the cigarette. However, high yields in the first puff are observed for butadiene and isoprene, suggesting different formation mechanisms for these compounds. First results are presented in which these high yields in the first puff are mainly associated with the gaseous fraction of the smoke.

Mass Spectrometry↗

PubMed2002

Mainstream and sidestream cigarette smoke exposure increases Ca2+-dependent phospholipid binding proteins in guinea pig alveolar type II cells.

We have earlier identified the presence of a 36 kDa Ca2+-dependent phospholipid-binding protein (PLBP) in guinea pig alveolar type II cells. PLBP has been suggested to act as a mediator in facilitating and regulating intracellular surfactant assembly and delivery to the plasma membrane of type II cells for secretion into alveolar space. It has been reported that cigarette smoke exposure (CSE) causes a decrease in the surfactant activity in bronchial washings. We have also reported earlier that mainstream (MS) and sidestream (SS) CSE causes desensitization of beta-adrenoreceptors in guinea pig alveolar type II cells. Since both Ca2+ and beta-adrenoreceptors are involved in surfactant secretion and PLBP is involved in surfactant delivery, it is important to know whether CSE causes any change in the PLBP level in alveolar type II cells. In the present study, we have demonstrated that MS and SS CSE causes a significant increase in the levels of PLBP in alveolar type II cells (107 and 150%, respectively) and in lung lavage (42 and 125%, respectively) in comparison to that in sham control (430 ng/mg protein in alveolar type II cells and 780 ng/mg protein in lung lavage). The mechanism by which smoke exposure causes an elevation in the levels of PLBP in alveolar type II cells and lung lavage remains to be investigated.

Animals↗

PubMed1989

Determination of formaldehyde and acetaldehyde in mainstream cigarette smoke by high-performance liquid chromatography.

A method is described for the determination of formaldehyde and acetaldehyde in mainstream cigarette smoke. This involved the collection and reaction of the aldehydes with 2,4-dinitrophenylhydrazine in aqueous acetonitrile. The high-performance liquid chromatographic separation and measurement of the various components directly in this reaction solution eliminated the need for a clean-up stage. Cigarette yields of greater than 5 micrograms of formaldehyde and 50 micrograms of acetaldehyde could be determined to estimated relative standard deviations of 0.07 and 0.05, respectively.

Acetaldehyde↗

PubMed2003

Straddling the pathway from paediatrician to mainstream health care: transition issues experienced in disability care.

OBJECTIVE: To identify the strengths and limitations of health care and related services provided to young adults with a disability during the period of transition from the care of a paediatrician to the mainstream health system. DESIGN: A descriptive design was used to address the study objectives. SETTING: Barwon and south-western region of Victoria. SUBJECTS: Twelve focus group discussions, with young adults with a disability, carers of young adults with a disability and health care service providers. Each focus group involved eight to 10 participants. RESULTS: The findings revealed a number of problems with the transition period. All participants acknowledged the supportive, coordinating role of the paediatrician. In the absence of this type of role, carers felt they lacked the knowledge and support to manage the adolescent with a disability. Communication problems between all service providers were identified as being problematical. The general lack of continuity of care between providers made it difficult for individuals to negotiate the transition period and increased the burden of care on carers. CONCLUSION: There is a need for policy makers to address these transition problems and develop appropriate services that improve the situation for young adults with a disability and their carers.

Adolescent↗

PubMed2004

A case study in mainstreaming flexible learning in health--perspectives from the bush.

Our mission is to inculcate an ethos of online learning and communicating, moving it from the margins to mainstream. A skilled health workforce is crucial to better practices. Face-to-face teaching still dominates learning across NSW Health, despite remarkable developments worldwide in using technology for learning. Health is slow to embrace this renaissance due partly to lack of exposure among educators and learners, and the fact of course that learning is not its core business. The three staff comprising New England Area Health Service (NEAHS) Learning Services extensively researched NEAHS staff attitudes to fexible learning (2001) and Information Technology skills (2003). Amalgamating these data, with that from the first ever across-NSW Health online course we ran (2002) determined the appropriateness of our decision to instigate an external web-based discussion facility previously not available in health, for supporting learning and for communicating within NEAHS and indeed across Area Health Services (AHS).

Certification↗

PubMedDate not supplied

Becoming a manual occupation? The construction of a therapy manual for use with language impaired children in mainstream primary schools.

BACKGROUND: The construction of therapy protocols for a large-scale randomized controlled trial comparing speech and language therapists and assistants, and group and individual therapy approaches for children aged 6-11 in mainstream schools is outlined. AIMS: The aim was to outline the decision-making processes that led to the construction of the research therapy manual, and to give a preliminary report on compliance with the manual. METHODS & PROCEDURES: A search of the research and professional literature and of published therapy materials was conducted to locate usable examples of effective language therapy for primary school children. Results were collated into a manual of therapy principles and activities to structure research intervention. The use of the manual with children (n=30) receiving individual or group direct therapy from a speech and language therapist in the first phase of intervention was audited. OUTCOMES & RESULTS: Very few high-level research studies were found, but the professional literature gave added information. Therapies for comprehension monitoring, vocabulary development, later grammar and narrative were adapted for the research intervention, and procedures compiled into a manual to guide research speech and language therapists and assistants. The audit of direct therapy suggested that the manual was useable, providing a suitable range of activities and materials for therapy intervention. Its use helped to record the therapy offered to research children, and formed a sound basis for discussion amongst speech and language therapists and between speech and language therapist/assistant pairs. CONCLUSIONS: The construction and use of a therapy manual allowed the provision of replicable therapy within the research project whilst maintaining flexibility.

Child↗

PubMedDate not supplied

A review of chronic inhalation studies with mainstream cigarette smoke, in hamsters, dogs, and nonhuman primates.

This paper is the continuation of previously published work, a review limited to studies on rats and mice. This paper makes an identical evaluation as before, but, restricting the species being evaluated to representative studies of smoke-exposed hamsters, dogs (both by tracheostomy and by direct inhalation), and nonhuman primates. As was seen previously, no statistically significant increase in the incidence of malignant tumors of the respiratory tract was found in any of the 3 species, even though very long exposures and high doses of smoke were used. All 5 of the species of laboratory animals commonly used to evaluate carcinogenic potential produce results with mainstream cigarette smoke that are at variance with the epidemiological evidence in smokers.

Administration, Inhalation↗

PubMedDate not supplied

Residential therapeutic communities in the mainstream: diversity and issues.

Not all residential drug abuse treatment programs are therapeutic communities (TCs), not all TCs are in residential settings, and not all programs that call themselves TCs employ the same social and psychological models of treatment. The term "therapeutic community" is widely used to represent a distinct approach in almost any setting, including community residences, hospital wards, prisons, and homeless shelters. One effect of this labeling has been to cloud understanding of the TC as a drug abuse treatment approach, how well it works, where it works best, and for which clients it is most appropriate. This article attempts to further a general understanding of residential TCs. Distinctions are drawn between residential drug abuse treatment and residential TCs. The diversity of programs within the TC modality is described in terms of modifications of the model and applications to special populations; and the essential elements of the TC program model are briefly outlined. Finally, movement into the mainstream has surfaced issues for the TC in terms of policy and practice, several of which are highlighted.

Humans↗

PubMed2002

A minireview of chronic animal inhalation studies with mainstream cigarette smoke.

This work was performed to verify whether or not the inhalation response to cigarette smoke in animal species for assessing carcinogenic potential in humans reflects the strong epidemiological evidence in human smokers. Significant increases in the numbers of malignant tumors of the respiratory tract were not seen in rats, mice, hamsters, dogs, or nonhuman primates exposed for long periods of time to very high concentrations of mainstream cigarette smoke. The results are clearly at variance with the epidemiological evidence in smokers, and it is difficult to reconcile this major difference between observational studies in humans and controlled laboratory studies.

Administration, Inhalation↗

PubMed2003

Evaluation of relationships between mainstream smoke acetaldehyde and "tar" and carbon monoxide yields in tobacco smoke and reducing sugars in tobacco blends of U.S. commercial cigarettes.

Mainstream (MS) smoke acetaldehyde (AA), carbon monoxide (CO), and "tar" yields and percentage total reducing sugars in the tobacco blends from a Philip Morris USA database of a large number of commercial U.S. cigarettes were analyzed. MS smoke acetaldehyde is significantly correlated with "tar" yield and also with MS smoke carbon monoxide. These correlations are consistent with recently available data, including the 1999 Massachusetts Benchmark Study. MS smoke acetaldehyde yield is not correlated with reducing sugar (RS) concentration in the tobacco blend. For the available data over the time period 1985-1993, the concentration of reducing sugars (mean values for the brands tested) decreased. The correlations found between MS smoke acetaldehyde yield and "tar" and MS smoke carbon monoxide, and the percentage of the variance in AA yield explained by "tar" and MS smoke CO, coupled with the lack of correlation between "tar" normalized MS smoke AA and RS, plus related pyrolysis studies, support the hypothesis that MS smoke acetaldehyde yields are affected more by cigarette design characteristics influencing total smoke production than by tobacco reducing sugars.

Acetaldehyde↗