Failure of accommodation in patients with HIV infection

PURPOSE

The principal objective was to test the hypothesis that HIV-positive patients have significantly reduced amplitudes of accommodation compared with controls. The secondary objective was to investigate accommodative impairment in relation to factors such as age of susceptibility, CD4 count, viral load and current antiretroviral therapies.

METHOD

The study was a single-center open prospective study involving a subject population of 43 HIV-positive men aged from 26 to 39 years with no previous history of eye problems and 21 age-matched healthy male controls. The main outcome measure was the amplitude of accommodation, as measured monocularly with a standard push-up technique.

RESULTS

Amplitudes of accommodation were significantly smaller in the HIV-positive group compared with controls for age groups 25-29 (p = 0.016) and 30-34 years (p = 0.030) but not in the older group. In total, 30% (8/27) of patients aged between 25 and 34 years had reduced amplitudes of accommodation below age-expected norms. Accommodative failure was not related to current or lowest CD4 count, viral load or specific antiretroviral therapies.

CONCLUSION

This study has identified accommodative failure in a significant proportion of HIV-positive patients aged between 26 and 35 years. This problem may be under-recognised, and further studies are warranted to investigate possible causes.

Advanced life support skills undertaken by nurses--UK survey

Many nurses successfully complete the Resuscitation Council (UK), European Resuscitation Council, advanced life support (ALS) Provider Course. Acquiring ALS provider status is not necessarily a licence to practice and individual hospital policy determines which skills these nurses can then perform without direct medical supervision. This postal survey aimed to determine which ALS skills are utilised by nurse ALS providers working in a variety of clinical areas within acute hospitals in the UK. A questionnaire was sent to the Resuscitation Officer or Nursing Director of all acute hospital groups in the UK. Almost 261 (87%) of the questionnaires were completed and returned. Nurse ALS providers in 99% of coronary care units, 89% of intensive care units, and 88% of accident and emergency departments undertook manual defibrillation. The majority of hospitals ran compulsory in-house training sessions for intravenous cannulation. Laryngeal mask insertion by nurse ALS providers was permitted in 19% of coronary care units and in the wards of 16% of the responding hospitals. Tracheal intubation by nurse ALS providers working in coronary care units, intensive care units and emergency departments was permitted by 11% of the responding hospitals. This survey has demonstrated that many acute hospitals do not permit nurse ALS providers to use a number of the skills taught on the ALS provider course. General ward-based nurse ALS providers, in particular, are restricted in the ALS skills, they are permitted to use. It would be more efficient for nurses to be trained and assessed specifically in skills they are then permitted to use. Having been assessed in a given skill and achieved a nationally recognised standard, nurse ALS providers should be permitted to use it in clinical practice.

Carers' and Users' Expectations of Services--User version (CUES-U): a new instrument to measure the experience of users of mental health services

BACKGROUND

No existing instrument measures all or even most of the issues considered important by users of mental health services.

AIMS

To develop and test a self-assessment instrument to enable users of mental health services to rate their experience across the range of domains that they consider to be important.

METHOD

Relevant domains were identified and a new instrument was drafted and field tested to examine its psychometric properties.

RESULTS

The 17-item, self-rated Carers' and Users' Expectations of Services--User version (CUES-U) appears acceptable to most service users. Its items have reasonable test-retest reliability and a 'total CUES-U score' correlates significantly with a total score of the Health of the Nations Outcome Scales (Spearman's rho=0.42; P < 0.01).

CONCLUSIONS

The development and testing of CUES-U suggest that it might be feasible to apply a self-rated measure of the expectations and experience of users of mental health services.

A weekend camp for bereaved siblings

PURPOSE

The purpose of this article is to describe a weekend bereavement camp for children age 6 to 18 years who have lost a brother or sister to cancer. A description of the planning for the camp and the weekend program is included.

OVERVIEW

Camp New Horizons is a weekend camp for children age 6 to 18 years who have lost a sibling to cancer. At the camp, the children are divided into age-appropriate groups and spend time, through various activities, learning about the grief process to reduce their feelings of isolation, to express grief appropriately, and to move forward in the grief process. Similar programs, as well as the uniqueness of this program, are discussed.

CLINICAL IMPLICATIONS

Camp New Horizons has met many of the educational and support needs of bereaved siblings. Networks of support and friendship have formed that allow the children to reach out to one another when needed. Parents and children have increased their communication about the death in their family, thus accepting their feelings and increasing support in the family system. Continued collaboration between centers will create ongoing support for the healthcare professionals and the programs they provide.

Genetic engineering of the Trichoderma reesei endoglucanase I (Cel7B) for enhanced partitioning in aqueous two-phase systems containing thermoseparating ethylene oxide--propylene oxide copolymers

Endoglucanases (endo-1,4-beta-D-glucan-4-glucanohydrolase, EC 3.2.1.4) are industrially important enzymes. In this study endoglucanase I (EGI or Cel7B) of the filamentous fungi Trichoderma reesei has been genetically engineered to investigate the influence of tryptophan rich peptide extensions (tags) on partitioning in an aqueous two-phase model system. EGI is a two-domain enzyme and is composed of a N-terminal catalytic domain and a C-terminal cellulose binding domain, separated by a linker. The aim was to find an optimal tag and fusion position, which further could be utilised for large scale extractions. Peptide tags of different length and composition were attached at various localisations of EGI. The fusion proteins were expressed from T. reesei with the use of the gpdA promoter from Aspergillus nidulans. Variations in secreted levels between the engineered proteins were obtained. The partitioning of EGI in an aqueous two-phase system composed of a thermoseparating ethylene oxide-propylene oxide random copolymer (EO(50)PO(50)) and dextran, could be significantly improved by relatively minor genetic engineering. The (Trp-Pro)(4) tag added after a short stretch of the linker, containing five proline residues, gave in the highest partition coefficient of 12.8. The yield in the top phase was 94%. The specific activity was 83% of the specific activity of unmodified EGI on soluble substrate. The efficiency of a tag fused to a protein is shown by the tag efficiency factor (TEF). A hypothetical TEF of 1.0 would indicate full tag exposure and optimal contribution to the protein partitioning by the fused tag. The location of the fusion point after the sequence of five proline residues in the linker of EGI is the most beneficial in two-phase separation. The highest TEF (0.97) was obtained with the (Trp-Pro)(2) tag at this position, indicating full exposure and intactness of the tag. However, the peptide tag composed of (Trp-Pro)(4) improved the partition properties the most but had lower TEF in comparison to (Trp-Pro)(2).

Homocysteine, folate, and cardiovascular disease

Cardiovascular disease (CVD) continues to be one of the main causes of mortality in the western world, however approximately only two-thirds of all episodes can be attributed to traditional environmental and genetic risk factors. Over the past decade it has emerged that a moderate elevation in plasma concentrations of the amino acid homocysteine (tHcy) constitutes a risk factor for atherosclerotic vascular disease in the coronary, cerebral and peripheral vessels. Furthermore, this association is a graded one with no apparent threshold and is independent of, but may enhance the effect of conventional risk factors. Plasma homocysteine is determined by both genetic and nutritional factors. The B-vitamins folate, B-12 and B-6 all play a key role in homocysteine metabolism and in fact it has been proposed that about two-thirds of all cases of hyperhomocysteinemia are due to an inadequate status of one or all of these vitamins. Of the three, folate appears to be the most important determinant and has been shown to significantly lower homocysteine concentration when administered at doses ranging from 0.2 to 10 mg/d in both healthy and hyperhomocysteinemia subjects. There is considerable variation in the rate of CVD mortality between northern and southern European countries. A common dietary element in regions with lower CVD incidence i.e. southern European countries appears to be the higher consumption of fruit and vegetables. In the past this protective effect of fruit and vegetables has been primarily attributed to antioxidants. Fruit and vegetables are however also one of the main sources of folate in the diet, contributing to more than 30% of total dietary folate intake (even in countries where consumption of fruit and vegetables is low). Thus, in light of the evidence that folate may play a role in primary prevention of CVD via homocysteine-lowering the protective effect of fruit and vegetables may be partly explained by folate.

Low-dose vitamin B-6 effectively lowers fasting plasma homocysteine in healthy elderly persons who are folate and riboflavin replete

BACKGROUND

Current data suggest that physiologic doses of vitamin B-6 have no significant homocysteine-lowering effect. It is possible that an effect of vitamin B-6 was missed in previous trials because of a much greater effect of folic acid, vitamin B-12, or both.

OBJECTIVE

The aim of this study was to investigate the effect of low-dose vitamin B-6 supplementation on fasting total homocysteine (tHcy) concentrations in healthy elderly persons who were made replete with folate and riboflavin.

DESIGN

Twenty-two healthy elderly persons aged 63-80 y were supplemented with a low dose of vitamin B-6 (1.6 mg/d) for 12 wk in a randomized, double-blind, placebo-controlled trial after repletion with folic acid (400 microg/d for 6 wk) and riboflavin (1.6 mg/d for 18 wk); none of the subjects had a vitamin B-12 deficiency.

RESULTS

Folic acid supplementation lowered fasting tHcy by 19.6% (P < 0.001). After folic acid supplementation, baseline tHcy concentrations ranged from 6.22 to 23.52 micromol/L and 10 subjects had suboptimal vitamin B-6 status (plasma pyridoxal-P < 20 nmol/L). Two-way analysis of variance showed that the significant improvement in vitamin B-6 status in response to vitamin B-6 supplementation (on the basis of both pyridoxal-P: and the erythrocyte aspartate aminotransferase activation coefficient) was reflected in a significant reduction in plasma tHcy of 7.5%.

CONCLUSIONS

Low-dose vitamin B-6 effectively lowers fasting plasma tHcy in healthy subjects who are both folate and riboflavin replete. This suggests that any program aimed at the treatment or prevention of hyperhomocysteinemia should include vitamin B-6 supplementation.

Genetically engineered peptide fusions for improved protein partitioning in aqueous two-phase systems. Effect of fusion localization on endoglucanase I of Trichoderma reesei

Genetic engineering has been used for fusion of the peptide tag, Trp-Pro-Trp-Pro, on a protein to study the effect on partitioning in aqueous two-phase systems. As target protein for the fusions the cellulase, endoglucanase I (endo-1,4-beta-Dglucan-4-glucanohydrolase, EC 3.2.1.4, EGI, Cel7B) of Trichoderma reesei was used. For the first time a glycosylated two-domain enzyme has been utilized for addition of peptide tags to change partitioning in aqueous two-phase systems. The aim was to find an optimal fusion localization for EGI. The peptide was (1) attached to the C-terminus end of the cellulose binding domain (CBD), (2) inserted in the glycosylated linker region, (3) added after a truncated form of EGI lacking the CBD and a small part of the linker. The different constructs were expressed in the filamentous fungus T. reesei under the gpdA promoter from Aspergillus nidulans. The expression levels were between 60 and 100 mg/l. The partitioning behavior of the fusion proteins was studied in an aqueous two-phase model system composed of the thermoseparating ethylene oxide (EO)-propylene oxide (PO) random copolymer EO-PO (50:50) (EO50PO50) and dextran. The Trp-Pro-Trp-Pro tag was found to direct the fusion protein to the top EO50PO50 phase. The partition coefficient of a fusion protein can be predicted with an empirical correlation based on independent contributions from partitioning of unmodified protein and peptide tag in this model system. The fusion position at the end of the CBD, with the spacer Pro-Gly, was shown to be optimal with respect to partitioning and tag efficiency factor (TEF) was 0.87, where a fully exposed tag would have a TEF of 1.0. Hence, this position can further be utilized for fusion with longer tags. For the other constructs the TEF was only 0.43 and 0.10, for the tag fused to the truncated EGI and in the linker region of the full length EGI, respectively.

Middle school reform through data and dialogue. Collaborative evaluation with 17 leadership teams

This report describes a 2-year, longitudinal study of one school district's effort to link site-based, collaborative evaluation with formal, centralized program evaluation. Participants formed a research team in partnership with a local university. Team members assisted leadership teams in identifying issues for informal, site-based assessments and then used the information to monitor progress toward established goals. Participants collaborated in designing and conducting informal assessments of student achievement, school climate and safety, discipline, and parent involvement. Leadership teams used these data in developing their school improvement plans. Researchers and administrators used these data to revise the districtwide survey. At the end of the 2-year cycle, analysis of school improvement plans showed that collaborative evaluation is creating a connection between dialogue and data. These 17 middle schools are approaching school improvement in a more integrated fashion by actively involving key stakeholders (students, parents, and teachers) in the evaluation process.

Utility of mechanical rheolysis as an adjunct to rescue angioplasty and platelet inhibition in acute myocardial infarction and cardiogenic shock: a case report

We describe the value of mechanical rheolysis as an adjunct to rescue angioplasty and platelet glycoprotein IIb/IIIa receptor inhibition in a patient with acute myocardial infarction and cardiogenic shock in whom the severity of the intracoronary thrombus burden precluded restoration of antegrade coronary flow by conventional balloon angioplasty and stenting.

Cross-species identification of novel Candida albicans immunogenic proteins by combination of two-dimensional polyacrylamide gel electrophoresis and mass spectrometry

We have previously reported the usefulness of two-dimensional gel electrophoresis followed by Western blotting with sera from patients with systemic candidiasis in the detection of the major Candida albicans antigens (Pitarch et al., Electrophoresis 1999, 20, 1001-1010). The identification of these antigens would be useful for the characterization of good markers for the disease, and for the development of efficient diagnostic strategies. In this work we have used nanoelectrospray tandem mass spectrometry to obtain amino acid sequence information from the immunogenic proteins previously detected. We report here the cross-species identification of these antigens by matching of tandem mass spectrometry data to Saccharomyces cerevisiae proteins. Using this approach, we unambiguously identified the four C. albicans immunogenic proteins analyzed, namely aconitase, pyruvate kinase, phosphoglycerate mutase and methionine synthase. Furthermore, we report for the first time that aconitase, methionine synthase and phosphoglycerate mutase have antigenic properties in C. albicans.

Opiate-related deaths in Dublin

BACKGROUND

Intravenous drug misuse, principally heroin, occurs primarily in the Greater Dublin area. Methadone maintenance treatment has been an important part of the response to opiate misuse in Dublin since 1992.

AIMS

To determine the number of opiate-related deaths in Dublin City and County during 1999, to establish the number of methadone-related deaths and determine the proportion of deaths associated with methadone prescribed according to guidelines.

METHODS

A retrospective review of all coroners' inquest files in Dublin City and County during 1999 was undertaken.

RESULTS

There were 84 opiate-related deaths. Seventy-eight (92.9%) were male. Seventy-three (86.9%) had two or more drugs identified toxicologically. There were 45 methadone-related deaths, of which 15 (33.3%) were receiving methadone prescribed according to guidelines.

CONCLUSION

Opiate-related deaths occur primarily in males in the 25-34 year age group and are associated with a high level of polydrug use. Diverted methadone accounted for the majority of deaths involving

The value and limitations of the arm cephalic and basilic vein for arteriovenous access

The National Kidney Foundation has identified the use arteriovenous grafts (AVG) and the interventions required to maintain their patency as two major causes of increased expenditure in the management of hemodialysis access in end-stage renal disease patients. They have issued an appeal for the increased use of native arteriovenous fistulae (AVF). Although the radialcephalic AVF is considered to be the procedure of choice for these patients, other veins should be sought after to maintain an all-autogenous AVF policy. We examined our experience of using arm veins that were transposed to the brachial artery. Over the last 2.5 years, 109 brachiocephalic AVF (BCAVF) and 63 brachiobasilic AVF (BBAVF) were placed in 163 patients with chronic renal failure. In each group, 40 and 25 patients were males, respectively. Ages ranged from 29 to 88 years (mean 67+/-1.4 years) and 37 to 84 years (mean 69+/-2.0 years) in each group. Diabetic patients comprised 56 and 65% of each group and hypertensive patients comprised 73 and 75% of each group. Data collection was via chart review, personal interviews, and review of the dialysis records. Patency was assessed by life-table analysis. The log-rank test was performed in conjunction with Kaplan-Meier survival analysis. Our results showed that the use of BCAVF and BBAVF appears to be a viable alternative to prosthetic arteriovenous grafts. On the basis of our experience, an algorithm for placement of AVF is suggested.

Effect of supplemental methionine on plasma homocysteine concentrations in healthy men: a preliminary study

Hyperhomocysteinaemia is an established risk factor for vascular disease. The only source of homocysteine in humans is the amino acid methionine found in dietary protein. In an 8-week study, fasting plasma homocysteine concentrations were examined in a group of healthy male subjects (n = 6) under usual dietary conditions (weeks 1-4) and in response to weekly graded (25, 50 and 75 mg/kg/d) supplementary methionine (weeks 5, 6, 7). Nutrient intakes, including methionine, were calculated from 4 x 3 day food records. Under usual dietary conditions (mean methionine intake; 0.95 +/- 0.51 mg/d) weekly mean plasma homocysteine concentrations for the group were not significantly different (ANOVA) from each other ranging from 6.82 +/- 1.77 to 9.42 +/- 2.73 mumol/l. Doubling (supplementing with 25 mg/kg/d; + 2.04 g/d) or quadrupling (50 mg/kg/d; + 4.08 g/d) methionine intakes did not result in a significant increase in plasma homocysteine (8.56 +/- 3.68 mumol/l and 13.37 +/- 5.09 mumol/l respectively). A significant increase, however, was achieved when diets were supplemented with methionine at the highest level of 75 mg/kg/d (+6.14 g/d) resulting in a mean plasma homocysteine concentration of 18.05 +/- 11.8 mumol/l. Mean plasma homocysteine concentration returned to baseline (8.76 +/- 3.42 mumol/l), 10 days post-supplementation. The results of this study indicate that an increased dietary methionine will only cause elevated fasting homocysteine concentrations if ingested at intakes equivalent to five times usual intake. Because it is very unlikely that such levels could be achieved through dietary means alone we conclude that plasma homocysteine is unlikely to be affected by longer-term changes in food methionine intake.

Psychiatric Inpatients' Experience of Nursing Observation

1. Nursing observation is a key component of psychiatric inpatient nursing care. 2. Patients' experiences of being observed are strongly influenced by the attitudes and behaviors of the observing nurses. 3. Patients prefer to be observed by nurses they know and who talk to them.

Fluctuations in dietary methionine intake do not alter plasma homocysteine concentration in healthy men

A moderate elevation in plasma total homocysteine (tHcy) has been established as an independent risk factor for vascular disease. An important exogenous source of homocysteine is methionine found in foods rich in animal protein. We investigated the response of tHcy to fluctuations in methionine intake in a cross-over intervention trial (two arms). Healthy men (n = 52; 19-29 y) were screened for habitual methionine intake using a food-frequency questionnaire. Subjects in the top quartile for methionine intake (n = 13), with a baseline fasting tHcy of 7.01 +/- 1.84 micromol/L (mean +/- SD), were randomly assigned to receive either a low-methionine intervention diet for 1 wk followed by a control diet for 1 wk or vice-versa. Simultaneously, those in the bottom quartile for methionine intake (n = 11), with a fasting plasma tHcy of 9.79 +/- 7. 20 micromol/L (mean +/- SD), received either a high methionine intervention diet for 1 wk followed by a control diet or vice-versa. All subjects had serum folate, red-cell folate, serum vitamin B-12 and plasma pyridoxal phosphate (PLP) concentrations within normal ranges. During the intervention, subjects in the top quartile for methionine intake reduced their daily methionine intake 79%, from 1969 +/- 639 to 407 +/- 83 mg/d (P: </= 0.001), and those in the bottom quartile almost doubled their methionine intake, from 1155 +/- 401 to 2112 +/- 379 mg/d (P: </= 0.001). Despite these changes in methionine intake, no corresponding changes in plasma tHcy were observed. These results suggest that in the absence of an obvious deficiency of relevant B-vitamins, fasting plasma tHcy is unaffected by intermediate-term fluctuations (up to 100% of usual intake) in dietary methionine.

What happens to special hospital patients admitted to medium security?

This article describes the outcome of all the Special Hospital patients admitted to and discharged from the Norvic Clinic over a period of ten years since its opening in 1984. This study identified 23 patients. Of those transferred, 56% had a legal classification of mental illness. A much higher percentage (91%) were restricted under the powers of s.41 of the Mental Health Act 1983, compared to 69% in the West Midlands study (Cope and Ward, 1993). There appears to be a significant difference between the mental disorder groups for age on admission to Special Hospital when considering all patients (males and females). This difference is not maintained when males and females are looked at separately, although the result for males is nearly significant (p = 0.0606). The number of female patients is small (five) and so the tests will hardly be reliable for the female sample. No significant differences were demonstrated for any of the other variables considered. Like the West Midlands study, minor reconvictions were completely absent. This was an unusual finding within the West Midlands study and not replicated from any of the previous Special Hospital studies. In this study, failure constituted an unsuccessful transfer with return to Special Hospital and reconviction. The percentage of those returned to Special Hospital without reaching the community was slightly lower than the West Midlands study, for both the mentally ill and those classified as suffering from psychopathic disorder.

A proteomic approach for the study of Saccharomyces cerevisiae cell wall biogenesis

In fungi, cell shape is determined by the presence of a rigid cell wall which separates the cell from the extracellular medium. This highly dynamic structure is essential for the maintenance of cell integrity and is involved in several phenomena such as flocculation, adherence and pathogenicity. The composition of the fungal cell wall is well known, but issues such as the assembly and remodeling of its components remain poorly understood. In an attempt to study the de novo construction of the yeast cell wall, we have undertaken a large-scale proteomic approach to analyze the proteins secreted by regenerating protoplasts. Upon incubation of protoplasts in regenerating conditions, numerous proteins are secreted into the culture medium. These presumably include proteins destined for the cell wall, comprising both structural proteins as well as enzymes involved in cell wall biogenesis. This work reports the establishment of a reference map of proteins secreted by regenerating protoplasts by means of two-dimensional polyacrylamide gel electrophoresis (2-D PAGE) and their identification by mass spectrometry. Thirty-two different proteins have been identified, including known cell wall proteins, glycolytic enzymes, heat shock proteins, and proteins involved in several other processes. Using this approach, novel proteins possibly involved in cell wall construction have also been identified. This reference map will allow comparative analyses to be carried out on a selected collection of mutants affected in the cell wall.

Geographic information systems. A new tool in environmental epidemiology

PURPOSE: Geographic Information Systems (GIS) are useful tools for identifying populations with potential exposure to environmental contaminants. Using a GIS, features of the local environment around an individual's home, work, or school can be described. We present two examples illustrating methods and issues in identifying populations potentially exposed to agricultural pesticides and to toxic releases from the Toxic Release Inventory (TRI).METHODS: We used USDA Farm Service Agency records as ground reference data to classify a late summer 1984 satellite image into crop species in 3 counties in Nebraska. We located residences from a case-control study of non-Hodgkin's lymphoma (NHL) on the crop maps and calculated the distance to crop fields. Residences from a 4-center study of NHL were mapped and the distance to TRI sites was determined.RESULTS: Twenty-two percent of residences had crop fields within 500 meters of the home, an intermediate distance for the range of drift effects from pesticide applications. After accounting for the extent of primary drift from ground applications of pesticides, we estimated that 30 percent of residences were potentially exposed to crop pesticides. In the 4-center study, residence locations determined by address-matching methods and by a global positioning system were compared; the population 1 mile from specific TRI sites is described.CONCLUSIONS: These examples demonstrate the utility of a GIS in environmental epidemiology studies. A GIS can be a useful addition to questionnaire and other methods of exposure assessment in health studies.

Experimental study of the effects of Optison concentration on sonoporation in vitro

Lethal sonoporation and reparable sonoporation were observed in Jurkat lymphocytes in suspension with the addition of varying amounts of Optison, a commercially available bubble-based contrast agent. For given ultrasound (US) exposure conditions (spatial peak-pressure amplitude of 0.2 MPa, duty cycle 10% and 2-MHz frequency), sonoporation was directly related to the bubble-to-cell ratio (in a range from 0 to 230). It was found that the nearest bubble-cell spacing was also related to the occurrence frequency of bioeffects. A constant bubble-to-cell ratio often provided very different results for two different initial cell concentrations (200,000 cells/mL and 600,000 cells/mL), with the higher cell concentration generally exhibiting higher levels of sonoporation. In contrast, a constant bubble-to-cell spacing provided similar results between the two initial cell concentrations. The frequency of reparable and lethal sonoporation was seen to decay as the inverse-cube power of the nearest bubble-cell spacing. Significant reparable sonoporation was observed at a bubble-cell spacing that was 10 microm larger than the minimum spacing at which significant lethal sonoporation was observed. Preliminary analysis also suggests the possibility of a step-wise increase in lethal sonoporation as spacing decreases; further experiment is needed.