Simple objective measurement of the cutaneous delayed-type hypersensitivity reaction to tuberculin using spectrophotometry

BACKGROUND/AIMS

A number of subjective methods have been used to quantify the extent of the cutaneous delayed-type hypersensitivity (DTH) reaction. However, because of their subjective nature, significant differences in measurements may be seen between individual observers or laboratories unless thorough training is given to each observer.

METHODS

Objective measurement of the DTH reaction using a hand-held spectrophotometer is described. Guinea pigs were primed using inoculation with Mycobacterium bovis Bacille Calmette-Guerin and challenged five weeks later in the shaved flank with three doses of bovine purified protein derivative. The extent of the ensuing DTH reaction was measured 24 and 48 h later. Spectrophotometric measurement of the reaction site was compared with a control region of skin on each animal and expressed as the change within a standard colour space. Data obtained with the spectrophotometer was compared with the subjective measurement of the area of the DTH reaction by an experienced operator.

RESULTS

The measurements obtained with the spectrophotometer correlated very closely with conventional measurement of the reaction area by a trained operator. The reaction size in square mm and changes along the red/green colour axis was correlated most strongly.

CONCLUSION

Spectrophotometric measurement of the DTH reaction had advantages over conventional measuring techniques in terms of speed, reproducibility and reduced operator to operator variation. We conclude that the cutaneous DTH reaction may be simply and objectively quantified with the use of a hand-held spectrophotometer.

Electrophysiological behavior of the TolC channel-tunnel in planar lipid bilayers

Escherichia coli TolC assembles into the unique channel-tunnel structure spanning the outer membrane and periplasmic space. The structure is constricted only at the periplasmic entrance of the tunnel and this must be opened to allow export of substrates bound by cognate inner membrane complexes. We have investigated the electrophysiological behavior of TolC reconstituted into planar lipid bilayers, in particular the influence of the membrane potential, the electrolyte concentration and pH. TolC inserted in one orientation into the membrane. The resultant pores were stable and showed no voltage-dependent opening or closing. Nevertheless, TolC could adopt up to three conductance substates. The pores were cation-selective with a permeability ratio of potassium to chloride ions of 16.5. The single-channel conductance was higher when the protein was inserted from the side with negative potential. It showed a nonlinear dependence on the concentration of the electrolyte in the bulk solution and decreased as the pH was lowered. The calculated pK of the apparent closing was 4.5. The electrophysiological characterization is discussed in relation to the TolC structure, in particular the periplasmic entrance.

Substrate-triggered recruitment of the TolC channel-tunnel during type I export of hemolysin by Escherichia coli

A defining event in type I export of hemolysin by Escherichia coli is the substrate-triggered recruitment of the TolC channel-tunnel by an inner membrane complex. This complex comprises a traffic ATPase (HlyB) and the 478 residue adaptor protein (HlyD), which contacts TolC during recruitment. HlyD has a large periplasmic domain (amino acid residues 81-478) linked by a single transmembrane helix to a small N-terminal cytosolic domain (1-59). Export was disabled by deletion of the ca 60 amino acid residue cytosolic domain of HlyD, even though the truncated HlyD (HlyDDelta45) was, like the wild-type, able to trimerise in the cytosolic membrane, and interact with the traffic ATPase. The mutant HlyB/HlyDDelta45 inner membrane complex engaged the hemolysin substrate, but this substrate-engaged complex failed to trigger recruitment of TolC. Further analyses showed that HlyDDelta45 was specifically unable to bind the substrate. The result suggests that substrate engagement by the traffic ATPase alone is insufficient to trigger TolC recruitment, and that substrate binding to the HlyD cytosolic domain is essential. Analysis of three further N-terminal deletion variants, HlyDDelta26, HlyDDelta26-45 and HlyDDelta34-38, indicated that an extreme N-terminal amphipathic helix and a cytosolic cluster of charged residues are central to the cytosolic domain function. The cytosolic amphipathic helix was not essential for substrate engagement or TolC recruitment, but export was impaired without it. In contrast, when the charged amino acid residues were deleted, the substrate was still engaged by HlyD but engagement was unproductive, i.e. TolC recruitment was not triggered. Our results are compatible with the HlyD cytosolic domain mediating transduction of the substrate binding signal directly, presumably to the HlyD periplasmic domain, to trigger recruitment of TolC and assemble the type I export complex.

Acting nasty in the face of failure? Longitudinal observations of "hard-to-manage" children playing a rigged competitive game with a friend

Peer problems are almost universal among children with disruptive behavior disorders, and have been linked to social information processing deficits that lead to heightened threat responses. This 2-year longitudinal study uses direct observations to examine the real-life significance of this finding. Forty "hard-to-manage" children and 40 typically developing control children were filmed at ages 5 and 7 playing a rigged competitive game in which they experienced a clear threat of losing. Group differences in negative behavior (hard-to-manage > controls) were stable over time and independent of verbal ability. Predictors of individual differences in negative behavior were also examined. Previous studies with this sample have shown that at 4 years of age, the hard-to-manage children displayed elevated frequencies of violent pretend play, coupled with poor performance on tests of executive function and theory of mind. In this study, 4-year-olds whose pretend play indicated a preoccupation with violence were more likely to respond negatively to the threat of losing a competitive game at age 5 and at age 7. Four-year-olds who performed poorly on tests of theory of mind and executive function showed higher rates of negative behavior at age 5 but not age 7. These findings highlight just a few of the multiple paths leading to peer problems among children with disruptive behavior problems.

Transition to adulthood: supporting young adults to access social, employment, and civic pursuits

"Transition support" is a concept new to the field of secondary transition. This paper describes the development of a model of transition support as derived from the empirical literature (Hughes and Carter. [2000] The Transition Handbook. Baltimore, MD: Paul H. Brookes). The components of the Transition Support Model are both empirically based and field-tested among practitioners. The over 500 transition support strategies that compose the model have been used by practitioners in the field to improve educational and postschool outcomes for high school students. These strategies are grouped according to two main goals (i.e., "developing support in the environment" and "increasing students' competence") and corresponding components. Literature supporting the Transition Support Model is described as well as the use of the model in the transition planning process. Suggestions are made for application of transition support in high schools and the need for future research. MRDD Research Reviews 7:84-90, 2001. (c) 2001 Wiley-Liss, Inc.

Intraoperative plateletpheresis and autologous platelet gel do not reduce chest tube drainage or allogeneic blood transfusion after reoperative coronary artery bypass graft

Platelet-rich plasma (PRP) is postulated to decrease postoperative mediastinal chest tube drainage (MCTD) and allogeneic blood transfusions (ABT) after surgery with cardiopulmonary bypass. However, recent metaanalysis of the literature reveals that few good quality (therapeutic yield) trials that show a benefit have been published. The potential hemodynamic instability caused by plateletpheresis has not been emphasized. We studied the effect of plateletpheresis on MCTD, ABT, and hemodynamic stability in reoperative coronary artery bypass graft patients, a group perceived to be at high risk for ABT. Ninety patients were randomly assigned to Pheresis or Control groups. epsilon-Aminocaproic acid was given to all patients. Hemodynamic instability was assessed by degree of volume and inotrope resuscitation required. Part of the sequestered platelet volume was used to make autologous platelet gel, which was applied as a wound sealant. Mean pheresis yield was 30% +/- 7% of the circulating platelet mass or 6.4 +/- 2.2 allogeneic platelet unit equivalents. Total MCTD did not differ between the groups. There were no differences in mean packed red blood cell, platelet, and plasma transfusion rates. Overall, 52% of the Pheresis group received ABT, versus 55% of the Control group. Fifty-three percent of the Pheresis group patients exhibited significant hemodynamic instability, versus 27% of the Control group (P < 0.05). This study was unable to show any reduction in MCTD or ABT, although the plateletpheresis technique may offset platelet dysfunction caused by aspirin or increased blood exposure to nonbiologic surfaces, or it may compensate for lack of antifibrinolytic use. The significantly increased incidence of hemodynamic instability in the Pheresis group means that the risk/benefit ratio must be determined for individual cardiac surgical units.

Women's reluctance to seek help for stress incontinence during pregnancy and following childbirth

OBJECTIVE

to identify whether women were made aware of stress incontinence around the time of childbirth, whether symptomatic women sought help from professionals caring for them at this time, to look at what help they receive in the first instance and to understand why some of those experiencing it chose not to seek help.

DESIGN

a qualitative survey was conducted using semi-structured interviews.

SETTING

interviews were conducted in participants' own homes.

PARTICIPANTS

42 women who reported symptoms of stress incontinence at eight weeks postpartum, and 15 women who were symptomatic one year following the birth of their baby.

FINDINGS

women were reluctant to seek help, although they were often inconvenienced and troubled by the condition. This was predominantly due to the nature of the condition itself, although the relationship with their health care professionals was also a consideration in some cases. The majority of women were not provided with information on the condition but wanted health professionals to provide a warning that the condition could occur. They also wanted health professionals to seek out information about symptoms, rather than the women themselves having to broach the subject. The first line of treatment at this time was usually a recommendation to perform pelvic floor exercises.

IMPLICATIONS FOR PRACTICE

health professionals caring for women during pregnancy or following the birth of their baby need to raise awareness of the condition, the treatment available, and to be pro-active in seeking out those experiencing incontinence rather than expecting women to approach them for help.

Membrane interaction of Escherichia coli hemolysin: flotation and insertion-dependent labeling by phospholipid vesicles

The 1,024-amino-acid acylated hemolysin of Escherichia coli subverts host cell functions and causes cell lysis. Both activities require insertion of the toxin into target mammalian cell membranes. To identify directly the principal toxin sequences dictating membrane binding and insertion, we assayed the lipid bilayer interaction of native protoxin, stably active toxin, and recombinant peptides. Binding was assessed by flotation of protein-liposome mixtures through density gradients, and insertion was assessed by labeling with a photoactivatable probe incorporated into the target lipid bilayer. Both the active acylated hemolysin and the inactive unacylated protoxin were able to bind and also insert. Ca(2+) binding, which is required for toxin activity, did not influence the in vitro interaction with liposomes. Three overlapping large peptides were expressed separately. A C-terminal peptide including residues 601 to 1024 did not interact in either assay. An internal peptide spanning residues 496 to 831, including the two acylation sites, bound to phospholipid vesicles and showed a low level of insertion-dependent labeling. In vitro acylation had no effect on the bilayer interaction of either this peptide or the full-length protoxin. An N-terminal peptide comprising residues 1 to 520 also bound to phospholipid vesicles and showed strong insertion-dependent labeling, ca. 5- to 25-fold that of the internal peptide. Generation of five smaller peptides from the N-terminal region identified the principal determinant of lipid insertion as the hydrophobic sequence encompassing residues 177 to 411, which is conserved among hemolysin-related toxins.

Channel-tunnels

TolC and its many homologues comprise an alpha-helical transperiplasmic tunnel embedded in the bacterial outer membrane by a contiguous beta-barrel channel, providing a large exit duct for diverse substrates. The 'channel-tunnel' is closed at its periplasmic entrance, but can be opened by an 'iris-like' mechanism when recruited by substrate-engaged proteins in the cytosolic membrane.

Protein export and drug efflux through bacterial channel-tunnels

The bacterial protein TolC assembles into an alpha-helical trans-periplasmic tunnel, which is embedded in the outer membrane by a contiguous beta-barrel channel. TolC and its homologues thus provide large exit ducts for a wide range of substrates, including protein toxins and antibacterial drugs, that are engaged by specific recognition proteins in the cytosolic membrane.

Teaching students to self-regulate their behavior: the differential effects of student-vs. teacher-delivered reinforcement

The effects of selected student-directed learning strategies on the classroom behavior of six students with varying disabilities in general education were examined using a multiple baseline design across groups. Target behaviors included academic, study, and social skills. Results indicated increases in student target performance for all participants, however, differential effects were observed across groups and reinforcement conditions (student-vs. teacher-delivered). Additionally, anecdotal reports obtained from the cooperating teacher and students supported the study's findings. The implications of these findings are discussed.

Gait characteristics of patients with knee osteoarthritis

The knee kinematics and kinetics of 139 patients (47 males and 92 females) with Grade II knee osteoarthritis (OA) were measured during level walking, stair ascent and stair descent. There was no significant difference in knee motion between the patients and normal subjects. The patients with knee OA had a significantly reduced internal knee extensor moment compared to normal subjects. This difference reflects the patient's compensation to reduce the knee joint loading. Further, subjects with OA and a higher body mass index have a lower knee extensor moment. The female subjects had significantly greater knee flexion and a greater knee extensor moment. This gender difference may partially explain the increased prevalence of OA in females. Most tests of OA treatments are assessed by criteria that do not reflect functional activities. This study demonstrates that objective gait analysis can be used to document gait adaptations used by patients with knee OA.

Perceived barriers to receiving HIV services in groups of traditionally underserved individuals: empirical models

Persons living with HIV/AIDS face many issues that make them highly vulnerable to a number of health and social problems. As the demographics of the epidemic have shifted in recent years, many members of traditionally underserved groups have encountered barriers to entering the services system. This article uses data from seven national demonstration projects funded to enroll persons with HIV/AIDS who tend to "fall through the cracks" and help them access needed services. Data on the initial perceptions of the participants about barriers to accessing services were related to 17 indicators of traditionally underserved status including demographic characteristics and behavioral variables using the data modeling method of Exhaustive CHAID (Chi-squared Automatic Interaction Detector). Through the modeling methods, the groups most likely to experience a large number of barriers to service participation are identified. Having children needing care is particularly predictive of the level of barriers to care.

A guinea pig model of low-dose Mycobacterium bovis aerogenic infection

In order to develop a model of Mycobacterium bovis infection with pathogenetical relevance, a modified version of the Henderson apparatus was used to deliver infectious aerosols directly to the snouts of guinea pigs. Aerosols generated from 10(6), 10(7), 10(8)CFU/ml M. bovis suspensions established disease in every animal, with estimated retained doses of 10, 100, 1000 CFU, respectively. For comparison, other guinea pigs were inoculated with 100 CFU M. bovis intramuscularly (i.m.). Pathology and bacterial colonisation of lungs and spleen varied according to the dose and route of inoculation. Animals inoculated i.m. gave a significant cutaneous tuberculin hypersensitivity reaction earlier after testing than those infected aerogenically. A serological response to M. bovis antigens was detected in all infected animals. Intensity of antigen recognition was dose-dependent and although the range of antigens recognised varied between animals, a 25 kDa antigen present in the cell fraction was serodominant. Thus, a reproducible guinea pig model has been defined that may be suitable for virulence, vaccination, and immunological studies.

Smoking is associated with increased hepatic lipase activity, insulin resistance, dyslipidaemia and early atherosclerosis in Type 2 diabetes

We have studied the relationships between hepatic lipase activity, smoking, dyslipidaemia insulin resistance, and early atherosclerosis in 67 Type 2 diabetic subjects, 47 non-smokers and 20 smokers. Insulin resistance was measured using an insulin modified frequently sampled intravenous glucose tolerance test. Early atherosclerosis was assessed using high-resolution ultrasound to measure carotid intima media thickness (IMT) and an arterial ultrasonic score (AUS). Smokers had higher serum cholesterol and triglyceride, lower HDL and HDL2 cholesterol as well as increased hepatic lipase activity. They were also more insulin resistant than non-smokers. Smokers also had higher patient AUS scores. On multiple regression analysis, hepatic lipase activity emerged as the most significant variable affecting patient AUS. We suggest that smoking accentuates the dyslipidaemia of Type 2 diabetic subjects and this is associated with increased hepatic lipase activity. This may be one mechanism whereby smoking further increases the risk of cardiovascular disease in Type 2 diabetes.

Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care: a multicentre study in seven European countries

OBJECTIVE

This study aimed to measure the outcomes of a harmonised, structured pharmaceutical care programme provided to elderly patients (> or =65 years of age) by community pharmacists in a multicentre international study performed in 7 European countries.

DESIGN AND SETTING

The study was a randomised, controlled, longitudinal, clinical trial with repeated measures performed over an 18-month period. A total of 104 intervention and 86 control pharmacy sites participated in the research and 1290 intervention patients and 1164 control patients were recruited into the study.

MAIN OUTCOME MEASURES AND RESULTS

A general decline in health-related quality of life over time was observed in the pooled data; however, significant improvements were achieved in patients involved in the pharmaceutical care programme in some countries. Intervention patients reported better control of their medical conditions as a result of the study and cost savings associated with pharmaceutical care provision were observed in most countries. The new structured service was well accepted by intervention patients and patient satisfaction with the services improved during the study. The pharmacists involved in providing pharmaceutical care had a positive opinion on the new approach, as did the majority of general practitioners surveyed. The positive effects appear to have been achieved via social and psychosocial aspects of the intervention, such as the increased support provided by community pharmacists, rather than via biomedical mechanisms.

CONCLUSIONS

This study is the first large-scale, multicentre study to investigate the effects of pharmaceutical care provision by community pharmacists to elderly patients. Future research methodology and implementation will be informed by the experience gained from this challenging trial.