Pyroclastic flows and surges generated by the 25 June 1997 dome collapse, Soufrière Hills Volcano, Montserrat

On 25 June 1997, an unsteady, retrogressive, partial collapse of the lava dome at Soufrière Hills Volcano lasted 25 minutes and generated a major pulsatory block-and-ash flow, associated pyroclastic surges and a surge-derived pyroclastic flow that inundated an area of 4 km2 on the north and NE flanks of the volcano. Three main pulses are estimated to have involved 0.78, 2.36 and 2.36 x 106m3 of debris and the average velocities of the fronts of the related block-and-ash flow pulses were calculated to be 15 ms-1, 16.1 ms-1 and 21.9 ms-1 respectively.

Deposits of block-and-ash flow pulses 1 and 2 partially filled the main drainage channel so that material of the third pulse spilled out of the channel at several places, inundating villages on the eastern coastal plain. Bends and constrictions in the main drainage channel, together with depositional filling of the channel, assisted detachment of pyroclastic surges from the pulsatory block-and-ash flow. The most extensive pyroclastic surge detached at an early stage from the third block-and-ash flow pulse, swept down the north flank of the volcano and then climbed 70 m in elevation before dissipating. Rapid sedimentation from this surge generated a high-concentration granular flow (surge-derived pyroclastic flow) that drained westwards into a valley not anticipated to be at high risk.

Observations support the hypothesis that the interior of the Soufrière Hills Volcano lava dome was pressurized and that pyroclastic surge development became more substantial as deeper, more highly pressurized parts of the dome were incorporated into the pyroclastic flow. Surge development was at times so violent that expanded clouds detached from the block-and-ash flow within a few tens of metres of the lava dome.

Economic impact of lupus

Current cost analyses that have been conducted on systemic lupus erythematosus (SLE) have not been thorough economic evaluations of the disease and treatment; they have not considered the broad treatment effects such as quality of life and productivity. They have however examined healthcare resource use (ie, direct costs) and time loss (ie, indirect costs) and at minimum provide some perspective on the societal impact of this disease. Incorporating all of the above factors into an analysis is extremely important in SLE and it is hoped that future analyses will include them. Also, any new economic analyses that are conducted will need to compare the cost of new or alternative SLE therapies with existing standard treatments because new treatments are on the horizon.

Influence of alpha-helices on the emulsifying properties of proteins

A peptide derived from apomyoglobin by cyanogen bromide cleavage was found to be an active emulsifier. This molecule, peptide 1-55, has two potential amphipathic alpha-helices and a hydrophilic C-terminal domain. The importance of each of these domains to the emulsifying properties of this molecule was investigated by testing the products of gene constructs based on the sequence of peptide 1-55, but lacking one of the three domains. The emulsifying activity of the peptides lacking either of the alpha-helices was correlated with the hydrophobic moments of their respective helices. The hydrophobic moment is a measure of the amphipathicity of alpha-helices; a hydrophobic moment analysis of other emulsifying peptides supports the hypothesis that a high hydrophobic moment contributes to good emulsifying properties in a molecule which contains alpha-helices.

The influence of formulation variables on the properties of pellets containing a self-emulsifying mixture

A method of converting self-emulsifying drug delivery systems to a pellet form has been studied. Formulations with varied relative quantities of an oil/surfactant mixture, water, microcrystalline cellulose (MCC), and lactose were chosen in a statistical design after preliminary ranging experiments. Pellets were produced by extrusion/spheronization. The characteristics of the pellets were studied by sieving, disintegration testing, diametral compression, image analysis, non-contact laser profilometry, and scanning electron microscopy. The effects of the formulation variables on pellet properties were evaluated by analysis of variance. It was possible to relate the formulation variables to all the quantified pellet properties except the shape. The relative quantities of oil/surfactant and water had an effect on the amount of liquid and oil/surfactant that could be incorporated into the powder, extrusion force, median diameter, size spread, disintegration time, tensile strength, and surface roughness. The relative quantities of lactose and MCC had an effect on the amount of liquid and oil/surfactant that could be incorporated into the powder, tensile strength, and roughness only. Water was an essential element of the formulations. The maximum quantity of the specific oil/surfactant combination studied that can be incorporated was 42% of the dry pellet weight.

Hirschsprung disease, mental retardation and dysmorphic facial features in five unrelated children

We report five patients with Hirschsprung disease, severe mental retardation and dysmorphic facial features including hypertelorism, prominent forehead and dysmorphic ears. All four boys had hypospadias. All had postnatally retarded growth. One of them had a de novo apparently balanced translocation 46,XY,t(2;11)(q22.2;q21). There are several reports on patients with Hirschsprung disease, mental retardation and various dysmorphic features. Some of them, especially those reported by Tanaka et al. [(1993) Pediatr Neurol 9:479-481], Lurie et al. [(1994) Genet Couns 5:11-14] and Mowat et al. [(1998) J Med Genet 35:617-623] closely resemble our patients suggesting that they have the same malformation syndrome.

Guidelines for reporting clinical features in cases with MECP2 mutations

An international group recommends that papers relating phenotypes to genotypes involving mutations in the X chromosome gene MECP2 should provide a minimum data set reporting the range of disturbances frequently encountered in Rett Syndrome. A simple scoring system is suggested which will facilitate comparison among the various clinical profiles. Features are described which should prompt screening for MECP2 mutations.

Length of stay. How short should hospital care be?

BACKGROUND

Reducing length of hospital stay (LOS) is a policy aim for many health care systems and is thought to indicate efficiency.

METHODS

A MedLine search was undertaken for articles relating to 'LOS', 'early discharge' or 'patient discharge' between 1983 and 1997 and a selective search was undertaken for material published before 1983.

RESULTS

Routine data showed that there were variations in LOS between countries, regions and hospitals. The trends in LOS showed a decrease over time in all regions. Research consistently fails to show an adverse effect on health outcomes of reducing LOS, but there may nevertheless be an ethical or moral minimum LOS. Two recent examples illustrate this. There has been an outcry at some ultrashort stays, for example 'drive-through mastectomy' and 'lunchtime abortion' and these are discussed in the review.

CONCLUSIONS

There are a number of reasons for the perceived lack of relationship between LOS and health outcomes. Clearly reducing days of care at the low-intensity end of a hospital stay may not necessarily affect health outcomes. There is a case to be made for tailoring care more exactly to an individual's needs by looking at the actual components of care rather than the place of care--within or outside hospital walls.

Managing the psychological aspects of altered appearance: the development of an information resource for people with disfiguring conditions

As the demand for health-related information grows, people are looking beyond health professionals, to patient-led organisations or support groups. The development of an information service is therefore a primary objective for such groups. Why information is needed, what kind of information people want, and who can provide it are central questions. These are discussed in the context of the development of a written information series, produced by a patient-led organisation, for people with facial disfigurement.

Psychosocial rehabilitation after disfiguring injury or disease: investigating the training needs of specialist nurses

AIM OF THIS STUDY

To investigate the training needs of specialist nurses working with patients who have disfiguring conditions.

BACKGROUND

As the psychosocial impact of disfiguring illness and disease becomes more widely recognized and understood, there are increasing issues about who can provide this kind of input. Whilst nurses have been identified as the health professionals who are often the most appropriate to fulfil this role, there is less evidence that they feel confident in their skills to provide it. The volume of requests from health professionals, particularly nurses, to a lay-led organization specializing in facial disfigurement suggested both an acknowledgement of the importance of providing psychosocial support to this population, together with a perceived lack of skill in this area. DESIGN/METHOD, STUDY 1: This study used a cross-section design. Two groups of nurses working either in burns or in head and neck cancer were surveyed by questionnaire. RESULTS, STUDY 1: Both the burns group and head and neck group rated their skills in the social rehabilitation of their patient group as significantly lower than their skills in physical rehabilitation. DESIGN/METHOD, STUDY 2: Using a multiple baseline design, a pilot intervention consisting of a specifically focused resource pack and 1-day training course was delivered to eight head and neck cancer nurses. RESULTS, STUDY 2: Postintervention, only the targeted skills (those concerned with social rehabilitation) were rated as significantly improved. Research continues to establish the extent to which these skills are implemented by nurses in the clinical setting and passed on to patients.

CONCLUSIONS

These findings suggest that although nurses do not feel as skilled in delivering psychosocial support to patients as they do in delivering more traditional aspects of physical nursing care, they can very easily take on this role when given simple training and access to appropriate resources. This training can be provided by a lay-led organization.

The relative influence of temperature and food on the metabolism of a marine invertebrate

Many benthic marine invertebrates exhibit a seasonal cycle in activities such as feeding, growth and reproduction. In temperate regions, this seasonality is typically correlated with coincident cycles in photoperiod, temperature and food availability and it can be difficult to determine which of these environmental factors is the key driver. Polar regions are characterised by greatly reduced seasonal variation in temperature, and an enhanced seasonality of food availability; they therefore form a natural laboratory for distinguishing the ecological effects of food from those of temperature. Here, we report a study of the common shallow water urchin Sterechinus neumayeri from Rothera Point, Antarctica. This species exhibits a marked seasonal variation in metabolic rate and feeding activity (which ceases completely in winter). In this study the metabolic rate of urchins collected in late winter and held in the laboratory without food was compared with that of wild urchins undertaking the transition to summer feeding and growth. Starved urchins showed a small rise in metabolic rate in summer which could be explained entirely by the small increase in temperature (Q(10)=2.5). At the same time, the wild population showed a much larger increase in metabolic rate related largely to the costs of feeding and growth. Rates of nitrogen excretion were also much larger in wild urchins, and the O:N atomic ratio indicated that starved urchins were depending to a greater extent on lipid and carbohydrate. Gut mass and test organic content showed no change in starved urchins, indicating that metabolic substrate was being provided by the gonad. The data suggest that in wild S. neumayeri only 15-20% of the summer increase in metabolism is caused directly by the temperature rise whereas 80-85% is caused by increased physiological activity associated with feeding, growth and spawning.

Trp203 mutation in GroEL promotes a self-association reaction: a hydrodynamic study

A combination of sedimentation equilibrium and sedimentation velocity in the analytical ultracentrifuge is used to investigate the hydrodynamic integrity and increased self-association interactions of the mutant GroEL Y203W when compared to the wild-type GroEL molecule, which may be derived from increased hydrophobic exposure caused by the mutation. Sedimentation velocity has revealed that three distinct species were present throughout the concentration ranges used, corresponding to 14-mer (GroEL "super monomer") and 28-mer ("super dimer") subunit compositions with a small amount of 42-mer ("super trimer"), which, from the relative concentration of each species, would give an estimated weight average molecular weight of (1.0 +/- 0.1) x 10(6) Da. Sedimentation equilibrium gave an apparent weight average molecular weight (Mw,app) of (910,000 +/- 5000) Da, which is in agreement with these findings. These results are in contrast to wild-type GroEL which, in excellent agreement with the previous findings of Behlke and co-workers, revealed a single species with an Mw,app of (805,000 +/- 5200) Da and a sedimentation coefficient s(0)20,w of (21.6 +/- 0.3) S. We therefore conclude that the tryptophan mutation at the Y203 location causes a significant degree of self-association of the GroEL 14-mer assembly (with dimer and trimer present). These findings would appear to correlate well with the findings of Gibbons et al., who showed an increase in hydrophobic exposure due to this mutation.

NO way back: nitric oxide and programmed cell death in Arabidopsis thaliana suspension cultures

Recent research has implicated nitric oxide (NO) in the induction of the hypersensitive response (HR) during plant-pathogen interactions. Here we demonstrate that Arabidopsis suspension cultures generate elevated levels of NO in response to challenge by avirulent bacteria, and, using NO donors, show that these elevated levels of NO are sufficient to induce cell death in Arabidopsis cells independently of reactive oxygen species (ROS). We also provide evidence that NO-induced cell death is a form of programmed cell death (PCD), requiring gene expression, and has a number of characteristics of PCD of mammalian cells: NO induced chromatin condensation and caspase-like activity in Arabidopsis cells, while the caspase-1 inhibitor, Ac-YVAD-CMK, blocked NO-induced cell death. A well-established second messenger mediating NO responses in mammalian cells is cGMP, produced by the enzyme guanylate cyclase. A specific inhibitor of guanylate cyclase blocked NO-induced cell death in Arabidopsis cells, and this inhibition was reversed by the cell-permeable cGMP analogue, 8Br-cGMP, although 8Br-cGMP alone did not induce cell death or potentiate NO-induced cell death. This suggests that cGMP synthesis is required but not sufficient for NO-induced cell death in Arabidopsis. In-gel protein kinase assays showed that NO activates a potential mitogen-activated protein kinase (MAPK), although a specific inhibitor of mammalian MAPK activation, PD98059, which blocked H2O2-induced cell death, did not inhibit the effects of NO.

The care of older people

This ongoing study examines the use of a biographical approach to enhance patient-centred care of older people.

Randomized trial of a specialist genetic assessment service for familial breast cancer

BACKGROUND

Because of the growing demand for genetic assessment, there is an urgent need for information about what services are appropriate for women with a family history of breast cancer. Our purpose was to compare the psychologic impact and costs of a multidisciplinary genetic and surgical assessment service with those of current service provisions.

METHODS

We carried out a prospective randomized trial of surgical consultation with (the trial group) and without (the control group) genetic assessment in 1000 women with a family history of breast cancer. All P: values are from two-sided tests.

RESULTS

Although statistically significantly greater improvement in knowledge about breast cancer was found in the trial group (P: =.05), differences between groups in other psychologic outcomes were not statistically significant. Women in both groups experienced statistically significant reductions in anxiety and found attending the clinics to be highly satisfying. An initial specialist genetic assessment cost pound 14.27 (U.S. $22.55) more than a consultation with a breast surgeon. Counseling and genetic testing of affected relatives, plus subsequent testing of family members of affected relatives identified as mutation carriers, raised the total extra direct and indirect costs per woman in the trial group to pound 60.98 (U.S. $96.35) over costs for the control subjects.

CONCLUSIONS

There may be little benefit in providing specialist genetics services to all women with a family history of breast cancer. Further investigation of factors that may mediate the impact of genetic assessment is in progress and may reveal subgroups of women who would benefit from specialist genetics services.

The psychological burden of peanut allergy as perceived by adults with peanut allergy and the parents of peanut-allergic children

BACKGROUND

Peanut-allergic patients are affected by a condition which forces them and their families to exercise extreme dietary vigilance and experience constant uncertainty throughout their lives.

OBJECTIVE

To compare the quality of life and family relations of children and adults with a peanut allergy to that of children and adults with a rheumatological disease.

METHODS

Patients with a confirmed diagnosis of peanut allergy or a rheumatological disease completed (for children less than 18 years, by proxy) self-report questionnaires regarding the impact of their condition on their quality of life and family relations. A vertical visual analogue scale and the Impact on Family Questionnaire (IFQ) served as outcome measures.

RESULTS

One hundred and fifty-three peanut-allergic children were compared with 69 children with a rheumatological disease while 37 peanut-allergic adults were compared with 42 adults with a rheumatological disease. The parents of peanut-allergic children, compared to the parents of children with a rheumatological disease, reported that their children had significantly more disruption in their daily activities. Furthermore, the parents of peanut-allergic children reported more impairment in the familial-social dimension of the IFQ. Conversely, adults with a chronic rheumatological disease reported more disruption in their family relations than peanut-allergic adults.

CONCLUSION

Given the considerable disruption in daily activities and family relations reported by the parents of peanut-allergic children, accurate diagnosis of peanut allergy is essential. Our work should make health care professionals dealing with children with confirmed peanut allergy more aware of the support that these families may require. Furthermore, we hope to motivate food industries to offer more 'peanut free' products to decrease the dietary restrictions of these patients while minimizing their potential for accidental ingestion.