Evaluating the Health of the Nation Outcome Scales. Reliability and validity in a three-year follow-up of first-onset psychosis

BACKGROUND

The HoNOS has been developed as a routine measure of outcomes in mental health.

AIMS

To explore the validity and interrater reliability of HoNOS in a first-onset psychosis follow-up study.

METHOD

Between 1992 and 1994 we ascertained a cohort of all persons with first-onset psychosis. We re-assessed these people at 3 years (n = 166) with several outcome scales, including HoNOS. Patients' keyworkers also completed the HoNOS. We estimated concurrent validity by calculating correlations between HoNOS and other scales, and interrater reliability.

RESULTS

Researcher HoNOS correlated highly with other scales (0.46 < p < 0.86; P < 0.001). Keyworker HoNOS correlations were lower (0.41 < p < 0.51; P < 0.05), but still significant for all scores except the HoNOS-social subscale (0.12 < p < 0.28). Agreements between researcher and keyworker HoNOS were modest (0.47 < ICC < 0.85).

CONCLUSIONS

In this research cohort HoNOS correlates well with established outcome scales. Keyworker ratings show similar, but weaker, relationships; its use in routine settings may require further training for calibration of severity.

HIV-1 Gag shares a signature motif with annexin (Anx7), which is required for virus replication

Genetic and biochemical analyses of the Gag protein of HIV-1 indicate a crucial role for this protein in several functions related to viral replication, including viral assembly. It has been suggested that Gag may fulfill some of the functions by recruiting host cellular protein(s). In our effort to identify structural and functional homologies between Gag and cellular cytoskeletal and secretory proteins involved in transport, we observed that HIV-1 Gag contains a unique PGQM motif in the capsid region. This motif was initially noted in the regulatory domain of synexin the membrane fusion protein of Xenopus laevis. To evaluate the functional significance of the highly conserved PGQM motif, we introduced alanine (A) in place of individual residues of the PGQM and deleted the motif altogether in a Gag expression plasmid and in an HIV-1 proviral DNA. The proviral DNA containing mutations in the PGQM motif showed altered expression, assembly, and release of viral particles in comparison to parental (NL4-3) DNA. When tested in multiple- and single-round replication assays, the mutant viruses exhibited distinct replication phenotypes; the viruses containing the A for the G and Q residues failed to replicate, whereas A in place of the P and M residues did not inhibit viral replication. Deletion of the tetrapeptide also resulted in the inhibition of replication. These results suggest that the PGQM motif may play an important role in the infection process of HIV-1 by facilitating protein-protein interactions between viral and/or viral and cellular proteins.

Ethanol inhibits G-protein-mediated glucose uptake by C6 glioma cells

The mechanism of ethanol inhibition of glucose uptake was investigated using C6 glioma cells. Basal [3H]2-deoxy-D-glucose (2DG) uptake by C6 cells was inhibited by ethanol in a concentration-dependent manner. Fifty, 75 and 100 mM ethanol significantly inhibited basal 2DG uptake by 12, 20 and 23%, respectively (p < 0.05). Carbachol (an agonist acting via G protein-coupled receptors) stimulated the uptake by 26% (p < 0.05). In the presence of 100 mM ethanol, the ability of carbachol to stimulate 2DG uptake was abolished. In contrast, ethanol did not inhibit the ability of insulin to stimulate 2DG uptake. These results suggest that ethanol inhibits 2DG uptake by selectively interfering with G protein-mediated signal transduction pathway.

Nickel uptake by Pseudomonas aeruginosa: role of modifying factors

Pseudomonas aeruginosa cells growing in minimal medium were 40-fold more sensitive to Ni2+ than cells growing in enriched medium, suggesting a possible protective role of medium ingredients. Likewise, cells pre-grown in enriched medium showed a high Km (6.15 mM) and increased Ni2+ uptake (950 nmol mg-1 protein, 1h) over cells pre-sown in minimal medium (Km, 0.48 mM; 146 nmol mg-1 protein, 1 h). The overall pattern indicates that cells pre-grown in enriched medium were characterized by having lowered affinity towards Ni2+ than those with minimal medium background. The enhanced Ni2+ uptake by enriched medium-grown cells can be correlated with the improved metabolic state of the cells. Ni2+ uptake was optimum at neutrality (pH 7.0). A major Ni2+ transport system was competitively inhibited by Mg2+, Zn2+, Cd2+, or Co2+ (400 microM each). Noticeably, a minor Ni2+ transport pathway was still operative even in the higher concentration range of Mg2+ (4 mM and 40 mM). The stimulation of Ni2+ uptake monitored in the presence of different carbon sources (0.5% wt/vol, each) showed the sequence: glucose (1.6-fold) > phenol = gallic acid (1.5-fold). Succinate, in comparison, reduced Ni2+ uptake (0.5-fold) possibly because of its acting as a metal chelator as well. Sensitivity of Ni2+ transport towards methyl viologen, azide, 2-4 DNP, and DCCD suggested that transport was energy-linked.

Respiratory pressures in normal Indian subjects

Regression equations for the prediction of maximum inspiratory pressures (MIP) in North Indian adults are reported, based on observations in 120 females and 153 males. Age and sex were the only significant predictor variables. MIP was significantly related to vital capacity, FEV1 and peak flow rate. The MIP observed in the present study are similar to those reported earlier in Caucasians and Chinese. The lower lung volumes and flow rates in Indians are not explained by differences in MIP.

Aortic coarctation diagnosed after hypertension in pregnancy

Coarctation of the aorta is an unusual cause of hypertension in pregnancy because the disorder in adults is often unrecognized by obstetricians or general practitioners managing antenatal clinics. We report 3 women with adult coarctation of the aorta that was diagnosed in the hypertension clinic after hypertensive pregnancies where the diagnosis had been missed.

Role of microtubules in glucose uptake by C6 glioma cells

Drugs that influence tubulin function were used to investigate the role of microtubules in hexose uptake by C6 glioma cells. In C6 cells, colchicine and vinblastine (which inhibit tubulin polymerization) inhibited radioactive [3H]2-deoxy-D-glucose uptake by about 30%. Paclitaxel (which promotes tubulin polymerization) stimulated hexose uptake by about 25%. To further demonstrate that microtubules play a role in hexose uptake, C6 cells were transfected with GLUT1 cDNA and then challenged with 100 nM paclitaxel. In GLUT1-transfected cells paclitaxel stimulated 2-deoxy-D-glucose uptake by about 35%. To study the role of tubulin in agonist-stimulated hexose uptake, the effect of colchicine on carbachol-induced uptake was next examined. Hexose uptake was increased with carbachol in concentration-dependent manner which was abolished by pretreatment with colchicine. To examine the specificity of the inhibitory effect of colchicine on G protein-mediated signal transduction pathway, the influence of colchicine on insulin (which acts via tyrosine kinase pathway) stimulation of 2-deoxy-D-glucose uptake was investigated. Hexose uptake was increased by insulin in a concentration-dependent manner which was unaffected by pretreatment with colchicine. These results suggest that microtubules are involved in basal and carbachol-stimulated glucose uptake by C6 cells.

Coagglutination test: a simple and rapid immunodiagnostic test for parvovirus infection in dogs

The coagglutination test (COAT) was developed and standardized to detect canine parvovirus (CPV) antigen in faeces of infected dogs. Anti-parvovirus serum was raised in dogs for coating protein-A containing Staphylococcus aureus Cowan I strain. Agglutination of antibody coated bacteria invariably occurred within 2-3 min when mixed with standard CPV antigen or faecal supernatants of dogs having 8 or more haemagglutination (HA) titre of parvovirus antigen. The test had a perfect correlation with HA test and was found to be slightly more sensitive than agar gel precipitation test (AGPT) in detecting CPV antigens. As COAT is easy and needs no specific equipment or much technical know how to perform, it can be used as a field test for rapid clinical diagnosis of parvovirus infection in dogs.

Perinatal influence of Chlorella vulgaris (E-25) on hepatic drug metabolizing enzymes and lipid peroxidation

This study evaluates the potential for the perinatal transfer of active constituents and/or metabolites of Chlorella vulgaris (E-25) via modulating the hepatic level of drug metabolizing enzymes and lipid peroxidation. E-25 (100, 300 or 500 mg/kg b.w./day) induced a significant increase in the hepatic levels of glutathione S-transferase (GST) and sulfhydryl (-SH) in fetal and neonatal systems after 14 days treatment to gestating or lactating mice. E-25 (500 mg/kg b.w./day)-modulated inhibition of cytochrome b5 (Cyt. b5), cytochrome P-450 (Cyt. P-450) and malondialdehyde (MDA) level was observed in the fetal and neonatal hepatic tissue following the transplacental or translactational exposure. The observed modulation in the levels of hepatic drug metabolizing enzymes and lipid peroxidation suggest the chemopreventive potential of E-25 via perinatal passage of active constituents and/or metabolites.

Loss or altered subcellular localization of p27 in Barrett's associated adenocarcinoma

The cyclin-dependent kinase inhibitor p27 is a negative regulator of the cell division cycle. It is expressed at the highest levels during the quiescent (G0) and prereplicative (G1) phases, and its degradation is required for entry into the S phase. Because lack of p27 is associated with aggressive behavior in a variety of tumors of epithelial and lymphoid origin, we used immunohistochemistry and in situ hybridization to evaluate the expression of p27 in metaplastic and dysplastic Barrett's epithelium and to assess its prognostic significance in Barrett's associated adenocarcinoma (BAA) of the esophagus. In metaplastic Barrett's epithelium, p27 protein and mRNA were restricted to the superficial third of glands in all cases and extended to the lower third in 4 cases. In contrast, expression of p27 message and protein was both increased and full-thickness, in the 23 cases with high-grade dysplasia adjacent to BAA and in carcinoma in situ. Although all invasive carcinomas had elevated levels of p27 mRNA, 45 (83%) of 54 invasive carcinomas had low p27 protein levels (<50% positive tumor cells). Low p27 protein correlated with higher histological grade (P < 0.0001), depth of invasion (P = 0.0120), presence of lymph node metastasis (P = 0.05), and survival (P = 0.0197). In addition to the nuclear staining, cytoplasmic staining of p27 was noted in 11 of 23 (48%) of cases of dysplasia and in 14 of 54 (26%) adenocarcinomas and confirmed, in a subset of cases, by subcellular fractionation of protein lysates obtained from fresh tumor tissues. Cytoplasmic localization of p27 was also associated with decreased survival (P = 0.0239). Loss of p27 conferred poor prognosis independently of proliferative index, as assessed by Ki-67 (MIB-1) immunostaining, which was not significantly different in survivors versus nonsurvivors. These results show that: (a) distribution of p27 message and protein parallel one another in metaplastic and dysplastic Barrett's epithelium, suggesting transcriptional regulation of the gene in the nonneoplastic setting; (b) p27 is inactivated in the majority of BAA as a result of either post-transcriptional modification or altered subcellular localization; and (c) loss of the cell cycle inhibitor p27 is associated with parameters of aggressive behavior and unfavorable outcome in BAA.

Radioprotective effects of DNA ligands Hoechst-33342 and 33258 in whole body irradiated mice

Radioprotective effects of bisbenzimidole derived DNA ligands Hoechst-33342 (H-342) and Hoechst-33258 (H-258) have been investigated in whole body irradiated stain-A and Balb/c mice (Co-60 Gamma-ray, absorbed doses of 2.5 to 10 Gy delivered at dose rates of 0.01 to 0.50 Gy/min). Biodistribution of Hoechst dyes (2 or 5 mg/kg, body wt., i.v.) and their effects on cell cycle kinetics in bone marrow were studied by flow cytometry. Protection against radiation-induced chromosomal aberrations, micronuclei formation, alterations in DNA content dispersion, inhibition of erythropoiesis and animal lethality were investigated. Significant amount of DNA bound Hoechst could be observed in liver, intestine, kidney and brain for more than 14 days after its administration, while in the bone marrow cells, a reduction in the bound Hoechst was noticed after 7 days. H-342 significantly reduced the radiation-induced chromosome aberrations mainly due to a decrease in the frequency of acentrics (nearly 30%), while a marginal decrease (10%) in the dicentrics was observed at all the dose rates studied. Both H-342 and H-258 reduced the radiation-induced micronuclei formation in a dose dependent manner (2-10 mg/kg body wt.) and this protective effect was observed up to 6 days after the administration. Neither of the two compounds induced any cytogenetic damage in the bone marrow cells of unirradiated animals nor induced tumours at the doses used here (< 5 mg/kg, body wt. i.v.). Reduction in cytogenetic damage of bone marrow cells led to a faster recovery of erythropoesis as observed by increased PCE/NCE ratio in the peripheral blood erythrocytes of the animals which received Hoechst before irradiation. H-258 (5 mg/kg body wt.) given 18 hr before irradiation reduced radiation-induced animal death (5-9 Gy), while no significant effect was observed at higher doses (10 Gy). However, H-342, which has a higher cell permeability, even at a lower dose (2 mg/kg body wt.) showed significant protection at 10 Gy. The protective effects could be enhanced further, by combining these DNA binding agents with the glucose analogue, 2-deoxy-D-glucose (2-DG) which has been shown earlier to protect bone marrow cells against radiation damage.

In vivo antigenotoxic effects of dietary agents and beverages co-administered with urethane: assessment of the role of glutathione S-transferase activity

Antigenotoxic effects and changes in glutathione S-transferase (GST) activity were assessed in mice after oral co-administration of urethane (URE) with aqueous extracts of dietary vegetables (carrot, spinach and cabbage), spices (cinnamon, pepper, cumin, clove and cardamom), tea and coffee. The results of the genotoxicity assay (micronucleus test) demonstrated dose-related antigenotoxic effects after URE was co-administered with aqueous extracts of vegetables, spices, tea and coffee. Inhibition of GST activity was observed 4 h after treatment with URE alone. Co-administration of URE with extracts of vegetables, coffee and spices resulted in dose-related attenuation of the inhibitory effect of URE on GST activity. However, tea had no effect on inhibition of GST activity by URE. Hence an association between antigenotoxicity and GST activity could not be established.

9 trends creating a ripple effect. New directions in information technology must advance with changes in managed care

Managed care is no longer a neatly packaged alternative to fee-for-service healthcare. Today's health plans come in a variety of shapes and sizes, from traditional staff model HMOs to point-of-service and out-of-network plans. As managed care continues to evolve, information is at the crux of these developments. New directions in information technology must advance with the changes in managed care.

Changing the attitudes of 'tomorrow's doctors' towards mental illness and psychiatry: a comparison of two teaching methods

The General Medical Council's document 'Tomorrow's Doctors' (1993, GMC, London) recommended major changes in the undergraduate curricula of UK medical schools. In Nottingham, the fourth-year psychiatric attachment became shorter in duration, and interactive, problem-oriented, workshop-based learning replaced lectures. We compared the efficacy of this new teaching style in changing medical students' attitudes towards psychiatry and mental illness with that of old-style, didactic, lecture-based teaching. On the first and last days of their psychiatric attachment, 110 fourth-year-medical students (45 old curriculum; 65 new curriculum) completed two self-administered attitudinal measures: the Attitude to Psychiatry Questionnaire (ATP-30) and the Attitude to Mental Illness Questionnaire (AMI). We found that students had favorable attitudes towards psychiatry and mental illness before the attachment. These attitudes became more positive after the attachment in students from both curricula, with no significant difference between the groups and no gender difference. Students found patient contact rewarding, become more accepting of community care, and had greater appreciation of the therapeutic potential of psychiatric interventions. The interactive, student-centred, problem-oriented teaching of the shortened new curriculum appeared as effective in changing medical student' attitudes as a longer attachment with traditional teaching.

Greater sciatic notch in sex differentiation in Nigerian skeletal samples

A total of 150 X-ray films (A-P view) of the pelvis of adult (90 male and 60 female) Nigerians were used to measure the width, depth, posterior segment, total and posterior angles of the greater sciatic notch. Index 1 was calculated by dividing the greatest depth OC by the greatest width AB and multiplying by 100. Index 2 was calculated by diving the posterior segment OB by the greatest width (AB) and multiplying by 100. These indices were used to study the sex differences in the hip bones of these Nigerians. Demarking points of these parameters and indices were worked out to determine sex. The width, depth, total angle and index 1 were insignificant in sex determination. Posterior angle and index 2 were found to be the most useful assigning sex to 74.5% of the male and 90% of the female bones.

Overproduction of beta-glucosidase in active form by an Escherichia coli system coexpressing the chaperonin GroEL/ES

beta-Glucosidase from Cellvibrio gilvus was successfully overproduced in soluble form in Escherichia coli, with the coexpression of GroEL/ES. Without the GroEL/ES protein, the beta-glucosidase overexpressed in E. coli constituted a huge amount (80%) of the total cellular protein, but was localized in the insoluble fraction, and little activity was detected in the soluble fraction. Coexpression of the E. coli GroEL/ES had a drastic impact on the proper folding of the beta-glucosidase; 20% of the overexpressed enzyme was recovered in the soluble fraction in active form. In addition, the synergistic effect of GroEL/ES and the low induction temperature led to 70% solubilization of the total expressed target protein and more than a 20-fold increase in activity. Similar effects of GroEL/ES were also observed on the overexpressed beta-glucosidase from Agrobacterium tumefaciens.

Momordica charantia (Bitter Gourd) peel, pulp, seed and whole fruit extract inhibits mouse skin papillomagenesis

The present study was designed to elucidate the inhibitory potential of Momordica charantia (Bitter Gourd) peel, pulp, seed and whole fruit extract on mouse skin papillomagensis with the modulatory influence of biotransformation system enzymes. Topical application of Momordica whole fruit extract (100 microl/animal per day) during the peri-initiation stage (1 week before and 2 weeks after initiation) by 7,12-dimethylbenz[a]anthracene (DMBA) and/or during the tumor promotion stage reduced the (i) tumor burden to 4.26, 3.72 and 3.11 (positive control value: 5.42); (ii) cumulative number of papillomas to 81, 67 and 53 (positive control value: 103); and (iii) percent incidence of mice bearing papillomas to 100, 94 and 94, respectively (positive control value: 100). In a comparison of the anticarcinogenic efficacy of Momordica peel, pulp, seed and whole fruit extract (100 microl/animal per day), after topical treatment during the peri-initiation and during the tumor promotion stage, revealed the modulation of the (i) tumor burden (tumors/mouse) to 3.06, 3.61, 3.17 and 3.11; (ii) cumulative number of papillomas to 49, 65, 54 and 53; and (iii) percent incidence of mice bearing papillomas to 84, 100, 94 and 94, respectively. Significant elevation in the sulfhydryl (-SH) level was observed in the liver and skin tissues by the topical treatment of Momordica peel, pulp, seed and whole fruit extract. Elevation in the hepatic levels of cytosolic glutathione S-transferase (GST) and microsomal cytochrome b, was also observed by the topical treatment of Momordica peel, seed and whole fruit extract. The results suggest the maximum chemopreventive potential is in the Momordica peel. Equivocal efficacy is in the Momordica seed and whole fruit extract. Biotransformation system enzymes may be the cause of this reduced papillomagenesis.

Postnatal efficacy of Momordica charantia peel, pulp, seed and whole fruit extract in the detoxication pathway of suckling neonates and lactating mice

The present study evaluates the postnatal efficacy of Momordica charantia peel, pulp, seed and whole fruit extract via assessing the modulation in the biotransformation system enzymes of suckling neonates and lactating mice. The peel, seed or whole fruit extract of Momordica (100 microl/animal/day) independently induced a significant increase in the hepatic levels of glutathione S-transferase (GST) and acid soluble sulfhydryl (-SH) after 14 or 21 days treatment in lactating dams (P < 0.01) and translactationally exposed neonates (P < 0.05). However, the elevation (P < 0.05) in hepatic cytochrome b5 (Cyt. b5) and cytochrome P-450 (Cyt. P-450) levels was observed only in the lactating dams treated with the respective extracts of peel, seed or whole fruit of Momordica. In lactating dams and suckling neonates the modulated levels of biotransformation system enzymes suggest the potential for the translactational passage of active principle(s) and/or metabolites of Momordica.

Postnatal effect of smokeless tobacco on phytic acid or the butylated hydroxyanisole-modulated hepatic detoxication system and antioxidant defense mechanism in suckling neonates and lactating mice

The present study evaluates the potential of smokeless tobacco to translactationally modify the chemopreventive efficacy of phytic acid and butylated hydroxyanisole (BHA) via modulation of the hepatic xenobiotic detoxication system and antioxidant defense mechanism in the murine system. Phytic acid (1000 mg/kg b.w./day) by gavage while BHA (1% w/w) in diet induced a significant increase in the levels of glutathione-S-transferase (GST), acid soluble sulfhydryl (-SH), cytochrome b5 (Cyt. b5) and cytochrome P-450 (Cyt. P-450) in lactating dams and suckling pups. The hepatic levels of GST and -SH were significantly depressed whereas microsomal Cyt. b5, Cyt. P-450 and MDA levels were elevated in groups treated with smokeless tobacco (50 or 100 mg/kg b.w./day). The data reveals the inhibitory potential of smokeless tobacco on phytic acid-induced GST/GSH system efficiency besides the significant augmentation by smokeless tobacco on phytic acid or BHA-induced microsomal phase I enzymes. The direct or translactational modulation in the levels of xenobiotic detoxication system enzymes suggests the potential of smokeless tobacco to modify the chemopreventive efficacy of phytic acid or BHA.

Glucose uptake by C6 glioma cells is mediated by G(q alpha)

The role of G proteins in glucose uptake was investigated using C6 glioma cells. Carbachol (an agonist acting via G protein coupled receptors) and 5'-guanylylimidodiphosphate (Gpp(NH)p; a nonhydrolysable guanine nucleotide analog which bypasses the receptors and directly activates G proteins) stimulated [3H]2-deoxy-D-glucose (2DG) uptake by C6 cells, suggesting that hexose uptake is a G protein-mediated process. To identify the G protein involved in glucose uptake by C6 cells, the effect of carbachol on 2DG uptake was examined in the presence of pertussis toxin. Pertussis toxin treatment did not alter the ability of C6 cells to respond to carbachol, ruling out the involvement of G(i alpha) in 2DG uptake. C6 cells were transfected with G(q alpha) or GLUT1 cDNA for 48 h, exposed to 1 mM carbachol for 2 h, and processed for 2DG uptake. Carbachol stimulated 2DG uptake in both G(q alpha) and GLUT1-transfected cells. Gpp(NH)p, also stimulated 2DG uptake in G(q alpha) and GLUT1-transfected cells. These results suggest that muscarinic receptor coupling to G(q alpha) regulates hexose uptake in C6 cells.