Obesogenic island: the financial burden of private transport on low-income households

BACKGROUND

The physical and social environment influences access to a healthy lifestyle, of which transport is one determining factor. This paper estimates the cost of transport on the island of Ireland.

METHODS

Budget standards were developed on the basis of costs of baskets of core goods and services required for daily living. The transport budget was based on the needs of an urban living family. Financial capacity of the family relative to transport basket costs was determined.

RESULTS

Transport costs vary depending on family type and car ownership. The motoring costs for a family with two unemployed adults, with a weekly financial capacity of 388.28 euros and 427.70 euros, respectively, for the Republic of Ireland and Northern Ireland, amount to 94.78 euros and 74.68 euros, representing 18 and 10% of the family's weekly income.

CONCLUSION

The prohibitive costs of private transport present an opportunity for policy makers to consider creating supportive environments incorporating the more cost-effective and environmentally friendly options of public transport. Without such measures, dependence on private transport will exacerbate the incidence of food poverty and the health inequalities consequent upon it.

The potential of a store and forward tele-behavioral platform for effective treatment and research of autism

This paper describes the justification and the design principles of a behavioral medicine store & forward telemedicine platform to facilitate the capturing and communication of spontaneous patient behaviors for the improved evaluation, diagnosis and ongoing treatment of people with autism. This Tele-Behavioral Health platform will allow families and other caregivers to readily capture spontaneous patient behaviors for subsequent evaluation by appropriate medical specialists. A unique feature of the system is its capability to archive and index the data for access as well as comparison over time by clinicians and other researchers. Such a system may serve as a precursor to further advances in other health information technology applications leading to more effective treatment and a better understanding of this disability.

Development of homogeneous high-affinity agonist binding assays for 5-HT2 receptor subtypes

The serotonin (5-hydroxytryptamine) 5-HT2 receptor subfamily consists of three members, 5-HT2A, 5-HT2B, and 5-HT2C. These receptors share high homology in their amino acid sequence, have similar signaling pathways, and have been indicated to play important roles in feeding, anxiety, aggression, sexual behavior, mood, and pain. Subtype-selective agonists and antagonists have been explored as drugs for hypertension, Parkinson's disease, sleep disorders, anxiety, depression, schizophrenia, and obesity. In this study, we report the development of homogeneous agonist binding assays in a scintillation proximity assay (SPA) format to determine the high-affinity binding state of agonist compounds for the human 5-HT2C, 5-HT2A, and 5-HT2B receptors. The 5-HT2 agonist 1-(4- [125I]iodo-2,5-dimethoxyphenyl)-2-aminopropane ([125I]DOI) was used to label the high-affinity sites for the 5-HT2A and 5-HT2C receptors. The high-affinity sites for the 5-HT2B receptor were labeled with [3H]lysergic acid diethylamide. Total receptor expression was determined with the 5-HT2 antagonist [3H]mesulergine for the 5-HT2B and 5-HT2C receptors, and [3H]ketanserin for the 5-HT2A receptor. The agonist high-affinity binding sites accounted for 2.3% (5-HT(2C) receptor), 4.0% (5-HT2A receptor), and 22% (5-HT2B receptor) of the total receptor population. Competition binding studies using known agonists indicated high Z' values of the agonist binding assays in SPA format (Z' > 0.70). The Ki values of 5-HT, (R)(-)DOI, and VER-3323 for the 5-HT2A, 5-HT2B, and 5-HT2C receptors by SPA format were equivalent to published data determined by filtration binding assays. These results indicate that agonist binding assays in SPA format can be easily adapted to a high throughput assay to screen for selective 5-HT2C receptor agonists, as well as for selectivity profiling of the compounds.

Outgrowth of a transformed cell population derived from normal human BM mesenchymal stem cell culture

BACKGROUND

Human mesenchymal stem cells (hMSC) have been isolated and characterized extensively for a variety of clinical applications. Yet it is unclear how the phenomenon of hMSC plasticity can be safely and reasonably exploited for therapeutic use.

METHODS

We have generated mesenchymal stem cells (MSC) from normal human BM and identified a novel cell population with a transformed phenotype. This cell population was characterized by morphologic, immunophenotypic, cytogenetic analyzes and telomerase expression. Its tumorigenicity in NOD/SCID mice was also studied.

RESULTS

A subpopulation of cells in hMSC culture was noted to appear morphologically distinct from typical MSC. The cells were spherical, cuboidal to short spindle in shape, adherent and exhibited contact independent growth. Phenotypically the cells were CD133(+), CD34(-), CD45(-), CD90(low), CD105(-), VEGFR2(+). Cytogenetic analysis showed chromosome aneuploidy and translocations. These cells also showed a high level of telemerase activity compared with typical MSC. Upon transplantation into NOD/SCID mice, multiple macroscopic solid tumors formed in multiple organs or tissues. Histologically, these tumors were very poorly differentiated and showed aggressive growth with large areas of necrosis.

DISCUSSION

The possible explanations for the origin of this cell population are: (1) the cells represent a transformed population of MSC that developed in culture; (2) abnormal cells existed in the donor BM at rare frequency and subsequently expanded in culture. In either case, the MSC culture may provide a suitable environment for transformed cells to expand or propagate in vitro. In summary, our data demonstrate the potential of transformed cells in hMSC culture and highlight the need for karyotyping as a release criteria for clinical use of MSC.

Ex vivo expansion of mafosfamide-purged PBPC products

BACKGROUND

Multiple studies have demonstrated that 'purging' of autografts with 4-hydroperoxycyclophosphamide (4HC) or the related compound mafosfamide (Mf), to eradicate residual leukemia, produces the best results associated with autologous blood and marrow transplantation for AML. However, 4HC purging results in prolonged aplasia. Therefore, we evaluated the potential of ex vivo expansion of Mf-treated CD34+ cells from mobilized PBPC.

METHODS

CD34+ cells were isolated from PBPC products and treated with 30 microg/mL Mf. The Mf-treated CD34+ cells were washed and cultured for 14 days in StemLine II-defined media containing recombinant human (rh) SCF, G-CSF and thrombopoietin (Tpo).

RESULTS

Treatment with Mf resulted in 90% killing of progenitor cells (GM-CFC) but maintenance of SCID-repopulating cells (SRC). Ex vivo culture of the Mf-treated CD34+ cells resulted in decreased cell numbers (10-20% of the starting cell dose) during the first week. Nevertheless, in the second week of culture the total cell numbers expanded to approximately 20-fold above starting cell numbers and progenitor cells returned to approximately pre-treatment levels.

DISCUSSION

These studies demonstrate the potential of ex vivo culture to expand both total cell numbers and progenitor cells following treatment of PBPC CD34+ cells with Mf. Clinical studies are currently being initiated to evaluate the engraftment potential of these purged and expanded products.

Ex vivo expansion of cord blood mononuclear cells on mesenchymal stem cells

BACKGROUND

Cord blood (CB) cells are being used increasingly as a source of hematopoietic cells to support high dose chemotherapy. However, CB units contain low numbers of cells, including CD34+ cells, and thus their use is associated with significant delays in engraftment of neutrophils and platelets. Exvivo expansion of CB has been proposed to increase the numbers of cells available. We and others have reported the requirement of CD34 selection for optimal expansion of CB products'; however, the selection of frozen CB products in clinical trials results in significant loss of CD34+ cells, with a median recovery of 50, but less than 40% recovery in more than one-third of products. In the present studies we evaluated the potential of mesenchymal stem cells (MSC) to support ex vivo expansion of unselected CB products.

METHODS

Mononuclear cells (MNC) from CB products were isolated and cultured on preformed MSC layers in T150 flasks containing 50 mL Stemline II media plus hematopoietic growth factors. Various culture conditions were compared for optimal expansion of the CB MNC.

RESULTS

Ex vivo expansion of CB MNC on MSC resulted in 10- to 20-fold expansion of total nucleated cells, seven- to 18-fold expansion of committed progenitor cells, two- to five-fold expansion of primitive progenitor cells and 16- to 37-fold expansion of CD34+ cells.

DISCUSSION

These studies demonstrated significant expansion of CB products without CD34 cell selection using culture conditions that are clinically applicable. Our current focus is to initiate clinical trials to evaluate the in vivo potential of CB cells expanded with these conditions.

How great is the risk of abuse in infants born to drug-using mothers?

This prospective, cohort study reports early child protection and surveillance process markers for children born to self-proclaimed drug-using mothers.

BACKGROUND

A strong association is reported between maternal drug use and child abuse in North American studies. There are no systematic data describing this association for the UK population. Given the heterogeneous nature of drug cultures and associated behaviour it is difficult to generalize from US data to the UK population.

METHODS

The study group consisted of all women referred to a hospital-based antenatal clinic for pregnant drug users. Infants of non-drug users were matched for social class and gestational age. At 18 months the Bristol and surrounding area child protection registers and child health surveillance records were searched. Infants were coded as to whether they were the subject of an enquiry, case conference, registration, registration with subsequent deregistration, or taken into care.

RESULTS

There were 68 infants of drug users and 127 infants of non-drug users. Most (81%) of drug users were heroin and/or methadone users; half were using/had used intravenously. Child health surveillance uptake for both groups is lower than that reported for the Avon population as a whole during the study period, consistent with the relatively deprived populations represented. There is no statistically significant difference between the drug users and non-drug users. The overall risk of child protection proceedings was higher in children of drug users than in children of non-drug users. However, closer inspection of the data shows most of the excess risk is explained by the small group taken into care and the much larger group for whom the concerns were relatively shortlived as shown by their subsequent deregistration during the study period.

CONCLUSIONS

Maternal drug use does not necessarily lead to unacceptable standards of parenting. More UK-based research is needed to inform the risk assessment process for child protection.

Social diversity of Irish adults nutritional intake

OBJECTIVE

The first health and lifestyle survey of Irish adults was carried out in 1998 and aimed to describe the health-related lifestyle behaviours of a cross-section of various population strata residing in the Republic of Ireland. This paper reports on the social variation in nutrient intake.

DESIGN

A self-administered postal questionnaire, including a 149 food item semiquantitative food frequency section, from which nutrient intakes were estimated based on McCance and Widdowson food composition tables.

SETTING

Community-based adults aged 18 years and over residing in the Republic of Ireland on the Register of Electors.

SUBJECTS

A stratified sample of adults on the Register of Electors received the questionnaire, of which 6539 (62%) were returned.

RESULTS

The contribution of fat to total energy intake increased with decreasing socioeconomic grouping, a finding reflective of the higher consumption levels of foods high in fat by respondents from socially disadvantaged groups. Energy from carbohydrates was greatest among those from socially advantaged groups, and was close to the recommended 50% of the total energy intake. Conversely, energy from protein decreased with increasing social status group. The mean intake of vitamins and minerals was generally close to or above the recommended values. Significant variation was observed among females across the different levels of education, whereas living with someone appeared to influence the micronutrient intake of males. The reported diets of males and females over the age of 65 years were lacking in vitamin D. Mean calcium levels among males were borderline and females over the age of 65 years had mean dietary iron levels below the recommended intake.

CONCLUSIONS

For the first time, quantification of nutrient intake in the different social groups in Ireland has been undertaken. A healthy balance of energy derived from fat, protein and carbohydrate is best achieved among respondents from higher social positions. The positive relation observed with healthy food intake and increasing education level was also present in macronutrient intake and a clear gender and social support interplay was seen in the nutrient intake levels.

Outcome of patients undergoing ileal pouch-anal anastomosis for left-sided chronic ulcerative colitis

Chronic ulcerative colitis is not a uniform disease entity because the clinical pattern and disease characteristics differ on the basis of the anatomic location of the inflammation. The aim of this study was to compare the preoperative characteristics, postoperative complications, and long-term functional outcome of ileal pouch-anal anastomosis (IPAA) in patients with left-sided colitis to those same characteristics in patients with pancolitis. Between 1990 and 1996, a total of 565 patients underwent IPAA for chronic ulcerative colitis at our institution. Of these, 111 patients were determined to have left-sided involvement, whereas 283 patients had pancolitis. The mean age at surgery was greater in the patients with left-sided colitis (37 years vs. 34 years, P = 0.01), and the mean duration of disease (8.7 years vs. 7.7 years, P = 0.05) tended toward a significant difference between the left-sided colitis and pancolitis groups. The complication rates were similar with the exception of small bowel obstructions, for which there was a higher incidence in the group with left-sided colitis (27% vs. 13%, P = 0.002) at 5 years. The incidence of pouchitis (43% vs. 39%) at 5 years was comparable. Long-term functional results and quality-of-life assessment did not show any significant differences between the two groups. We were unable to detect any correlation between the extent of colon involvement and the subsequent incidence of pouchitis, long-term pouch function, and quality of life. Patients with left-sided colitis were older, had a relatively longer duration of disease, and were at increased risk for postoperative small bowel obstruction as compared to patients with pancolitis.

Effects of age, size and condition of elephant seals (Mirounga leonina) on their intravenous anaesthesia with tiletamine and zolazepam

Southern elephant seals (Mirounga leonina) were caught as part of a long-term demographic study on Macquarie Island. Over 18 months, 1033 seals were caught by hand and anaesthetised intravenously with a 1:1 mixture of tiletamine and zolazepam. Assessments were made of the effects of variations in the body condition and age at capture of the seals on the characteristics of their anaesthesia, including induction time and weighted recovery time. The size and condition of the seals were assessed by morphometric and ultrasound measurements. Weighted recovery times decreased as the body condition and age of the seals increased, but there were no residual effects of sex. There were no fatalities, and no periods of apnoea longer than five minutes were recorded. In individual seals there was a significant increase in weighted recovery time with successive captures.

Measures of self-reported morbidity according to age, gender and general medical services eligibility in the national survey of lifestyles, attitudes and nutrition

BACKGROUND

The survey of lifestyles, attitudes and nutrition (SLAN) is a national representative sample of 6,539 adults.

AIMS

To report on both global and disease specific measures of self-reported morbidity according to age, gender and medical card status.

METHODS

Reported rates of morbidity are given for angina, heart attack, stroke, raised blood pressure, cholesterol, diabetes mellitus and for other general conditions as well as difficulty with hearing and glasses/contact lens use. Stratified chi-squared analysis of categorical variables was conducted and logistic age adjusted regression model with general medical services (GMS) eligibility as the dependent variable.

RESULTS

All conditions were more prevalent after the age of 45 years and showed a continuing age gradient. There were highly statistically significant inverse morbidity patterns according to GMS status among both men and women. Only reported raised cholesterol level was higher among the more affluent (13.5% males and 13.3% females over 45 years without a medical card, compared with 7.3% and 9.5% card holders respectively), one suggested explanation is the lack of access to means-tested screening.

CONCLUSIONS

There is considerable morbidity in the Irish population, particularly among GMS card holders.

The relation between vertebral endplate shape and lumbar disc herniations

STUDY DESIGN

Blinded review of selected and un-selected computed tomographic myelograms.

OBJECTIVE

To determine whether shape of the vertebral body endplate margins is a risk factor for the development of symptomatic lumbar disc herniations. The law of LaPlace for a fluid-filled tube suggests that anular tension could be related to endplate shape and a propensity for disc herniation.

SUMMARY OF BACKGROUND DATA

It was hypothesized that the law of Laplace could apply to the lumbar spine because of to the cylindrical shape of the lumbar disc and its high water content in nonelderly individuals. It was further hypothesized that differences in the radius of the curvature could place stresses on the anulus that would make posterior disc herniations more likely with "rounder" endplates.

METHODS

Ninety-seven contrast computed tomography scans were reviewed at transitional L4-L5 and L5-S1 in patients under 60 years of age, without previous spine surgery and without spondylolisthesis. Determinations of disc herniations and measurements of endplates were performed by blinded observers. A ratio of these measurements was used to determine the relative circularity of the endplate. Height, weight, body mass index, and disc endplate size and shape were related to the presence of disc herniation.

RESULTS

By multiple logistic regression, only endplate shape was strongly related to disc herniations. Endplate area was a less significant factor in men.

CONCLUSIONS

The shape of the vertebral body margin at the endplate is an important factor contributing to the development of disc herniations at L4-L5 and L5-S1.

Reading aloud begins when the computation of phonology is complete

Naming latency experiments in which monosyllabic items are read aloud are based on the assumption that the vocal response is not initiated until the phonology of the entire syllable has been computed. Recently, this assumption has been challenged by A. H. Kawamoto, C. T. Kello, R. Jones, and K. Bame (1998), who argued instead that the reading-aloud response begins as soon as the initial phoneme is computed. This view would be refuted by evidence of anticipatory coarticulation effects on the initial phoneme due to the nature of the following vowel in the speeded reading-aloud task. The authors provide such evidence.

A pilot study of the relationship between problem-solving skills and outcome in major depressive disorder

Three methods of assessing problem-solving skills are described in the literature: questionnaires, self-report inventories and verbal assessment of the resolution of problem scenarios. These three approaches were used to assess problem-solving ability in a sample of 20 patients with unipolar major depressive disorder, who were treated with antidepressant medication alone at a hospital out-patient clinic. It was found that baseline deficits in problem-solving skills were significantly associated with prognosis at 3- and 6-month follow-up. Self-ratings of perceived self-control and confidence rather than subjective problem-solving effectiveness were important predictors of final outcome. Differences in perceived and actual problem-solving ability emerged over time. The reasons for these differences in subjective and observer assessments are unclear. The data appear to demonstrate that problem-solving deficits in depression represent both state and trait phenomena.

Reading aloud begins when the computation of phonology is complete

Naming latency experiments in which monosyllabic items are read aloud are based on the assumption that the vocal response is not initiated until the phonology of the entire syllable has been computed. Recently, this assumption has been challenged by A. H. Kawamoto, C. T. Kello, R. Jones, and K. Bame (1998), who argued instead that the reading-aloud response begins as soon as the initial phoneme is computed. This view would be refuted by evidence of anticipatory coarticulation effects on the initial phoneme due to the nature of the following vowel in the speeded reading-aloud task. The authors provide such evidence.

Acoustic evidence for dynamic formant trajectories in Australian English vowels

The extent to which it is necessary to model the dynamic behavior of vowel formants to enable vowel separation has been the subject of debate in recent years. To investigate this issue, a study has been made on the vowels of 132 Australian English speakers (male and female). The degree of vowel separation from the formant values at the target was contrasted to that from modeling the formant contour with discrete cosine transform coefficients. The findings are that, although it is necessary to model the formant contour to separate out the diphthongs, the formant values at the target, plus vowel duration are sufficient to separate out the monophthongs. However, further analysis revealed that there are formant contour differences which benefit the within-class separation of the tense/lax monophthong pairs.

Management of acquired rectourinary fistulas: outcome according to cause

PURPOSE

Acquired rectourinary fistulas, an infrequent complication of pelvic conditions, remain a therapeutic problem for which neither a widely accepted classification nor long-term outcome data are available. This study was designed to provide a new etiologic classification system and examine the success of various surgical therapies. It also looked at the need for permanent fecal or urinary diversion or radical excision depending on the cause of the fistula, i.e., benign vs. malignancy-related.

METHODS

A retrospective analysis was made of 41 patients treated for acquired rectourinary fistulas between 1980 and 1995. Acquired rectourinary fistulas were classified as 1) benign but caused by Crohn's disease, trauma, perirectal sepsis, or iatrogenic injury; and 2) malignancy-related fistulas secondary to neoplasm, radiation, surgery, or combined tumor and treatment effects. Surgical interventions were classified as repair, excision, fecal diversion, and urinary diversion.

RESULTS

Thirty-seven males and 4 females with acquired rectourinary fistula were identified with a mean age of 62 (range, 28-90) years. Nineteen patients had fistulas involving their urethras, and 22 patients had fistulas involving the bladder. Eight patients were not treated surgically; one was not treated because of an advanced malignancy, three because of patient preference, three because of sepsis, and one because of a poor general condition. Of the remaining 33 patients, nine had benign fistulas of which two were the result of Crohn's disease, two were the result of trauma, two were from an iatrogenic response, and three were from perirectal sepsis. Twenty-four patients had malignancy-related fistulas, and five patients had neoplasm at their fistula sites. The remaining 19 patients had malignancy-related fistulas that were the result of cancer treatments. Of the 19 malignancy-related fistulas, 5 were from radiation, 9 were from surgical trauma, and 5 were from radiation and surgical trauma. Forty-nine percent of the patients had undergone attempts at fistula treatment before referral. A resolution of symptoms after initial and reoperative surgery occurred more often in patients with benign fistulas (44 and 100 percent; mean, 1.8 surgeries per patient) compared with malignancy-related fistulas (21 and 88 percent; mean, 2.1 surgeries per patient). The rates of permanent fecal, urinary, and fecal plus urinary diversion were also lower for benign fistulas (11, 0, and 33 percent) compared with malignancy-related fistulas (13, 8, and 54 percent). Permanent diversion was avoided in 56 percent of the benign fistulas but in only 25 percent of the malignancy-related fistulas. The rates of excisional and radical (ileal conduit) surgery were lower for benign fistulas than for malignancy-related fistulas (44 and 11 percent vs. 50 and 54 percent).

CONCLUSION

Successful management of rectourinary fistulas typically requires aggressive reoperative therapy with permanent diversion more often required for malignancy-related fistulas. Better outcomes can be anticipated for benign fistulas.

The Andover Working Group--accelerating the implementation of standards

The Andover Working Group was formed with the objective to accelerate and broadly deliver standards-based solutions for healthcare which feature plug and play interoperability across the continuum of care. In this paper, organization and processes used by the Andover Working Group are discussed. A description of how multilateral message profiles, combined with object-oriented component middleware supporting application developments, systems integration and systems operation remove many of the barriers to deployment of systems of standards based applications is also given.

Individual risk factors for early repetition of deliberate self-harm

This study investigated individual factors associated with repetition of deliberate self-harm (DSH) within three months of a first-ever episode. Individuals from an 'at risk' population who repeated DSH (N = 25) were compared with a socio-demographically matched group of 'at risk' individuals who did not engage in a further episode of DSH (N = 18). In comparison with the 'single DSH' individuals, those in the 'repeated DSH' group demonstrated significantly higher levels of depression and hopelessness, were significantly less skilled at problem solving, were significantly less likely to report the availability of a confidante and significantly more likely to identify that the reason for their DSH was to communicate their desperation. The implications of these findings for risk assessment and interventions are noted.

Fluorescence in situ hybridization studies on the sex chromosome constitution of human sperm

More males are conceived than females and more males are born as a result of in vitro fertilization (IVF) and donor insemination procedures. All donor sperm samples are frozen for a minimum of 6 months before they are used. The ratio of more boys to girls has been consistently reported over the years. A similar finding has been noted in the Galway Fertility Unit at University College Hospital Galway, Ireland. Traditionally, it has been accepted that the reason for this excess is that a Y chromosome-bearing sperm swims faster than the X-bearing sperm because it contains less DNA and is therefore "lighter." To test this hypothesis, semen samples were collected at the Galway Fertility Unit from men presenting for routine semen assessments. Each sample was divided into a number of aliquots. The first aliquot was assessed as the "raw" ejaculate to measure the initial ratio of X to Y. The second aliquot was prepared using Percoll density gradients, which allows for greater recovery of sperm with higher motility and improved sperm function. The final aliquot was frozen. The frozen sample was later thawed and prepared using Percoll. The prepared sperm were kept for 48 h and sampled at the time of preparation and at 24 h and 48 h to establish if there was any differential survival over time. The X:Y ratio was analyzed using the technique of fluorescence in situ hybridization (FISH). This allowed the sex chromosomes to be specifically stained and identified simultaneously. No difference was found in the X:Y ratio of the sperm. Therefore, any selection for the Y sperm must take place at some later stage.

Significance of individual point mutations, T202C and C314T, in the human Lewis (FUT3) gene for expression of Lewis antigens by the human alpha(1,3/1,4)-fucosyltransferase, Fuc-TIII

The Lewis alpha(1,3/1,4)-fucosyltransferase, Fuc-TIII, encoded by the FUT3 gene is responsible for the final synthesis of Lea and Leb antigens. Various point mutations have been described explaining the Lewis negative phenotype, Le(a-b-), on erythrocytes and secretions. Two of these, T202C and C314T originally described in a Swedish population, have not been found as single isolated point mutations so far. To define the relative contribution of each of these two mutations to the Lewis negative phenotype, we cloned and made chimeric FUT3 constructs separating the T202C mutation responsible for the amino acid change Trp68 --> Arg, from the C314T mutation leading to the Thr105 --> Met shift. COS-7 cells were transfected and the expression of Fuc-TIII enzyme activity and the presence of Lewis antigens were determined. There was no decrease in enzyme activity nor of immunofluorescence staining on cells transfected with the construct containing the isolated C314T mutation compared with cells transfected with a wild type FUT3 allele control. No enzyme activity nor immunoreactivity for Lewis antigens was detected in FUT3 constructs containing both mutations in combination. The T202C mutation alone decreased the enzyme activity to less than 1% of the activity of the wild type FUT3 allele. These results demonstrate, that the Trp68 --> Arg substitution in human Fuc-TIII is the capital amino acid change responsible for the appearance of the Le(a-b-) phenotype on human erythrocytes in individuals homozygous for both the T202C and C314T mutations.

Insulin secretion and DNA synthesis of cultured islets of Langerhans are influenced by the matrix

To compare the effect of matrix on glucose-stimulated insulin release, we cultured neonatal (3- to 5-day-old) rat islets of Langerhans, devoid of mesenchymal cell, on fibronectin, Cell-Tak, or endothelial basement membranes, free-floating, or dispersed into single cells. We also examined the rate of DNA synthesis during the culture period. Compared to free-floating islets [0.386 +/- 0.03 (SEM) ng per 24 h/ng total], single-cell cultures had the lowest basal insulin release (0.159 +/- 0.03 ng per 24 h/ng total; p < 0.0001), which was also low in islets attached to endothelial basement membrane (0.294 +/- 0.02 ng per 24 h/ng total; p = 0.01). The spontaneous insulin release (1 h in medium with 2.7 mM glucose) was lowest in islets attached to endothelial basement membrane (0.003 +/- 0.00023 ng per h/ng total; p < 0.0001 vs. free-floating) and highest in single-cell cultures (0.01153 +/- 0.00259 ng per h/ng total; p = 0.039 vs. free-floating). The ability to increase insulin release following a glucose challenge (16.1 mM for 1 h) was highest in islets grown on endothelial basement membranes (16.4-fold) and fibronectin (12.6-fold) compared to free-floating islets (8.7-fold), Cell-Tak (7.9-fold), and single-cell cultures (5.4-fold).(ABSTRACT TRUNCATED AT 250 WORDS)

Lagging strand DNA synthesis at the eukaryotic replication fork involves binding and stimulation of FEN-1 by proliferating cell nuclear antigen

The 5'-->3'-exonuclease domain of Escherichia coli DNA polymerase I is required for the completion of lagging strand DNA synthesis, and yet this domain is not present in any of the eukaryotic DNA polymerases. Recently, the gene encoding the functional and evolutionary equivalent of this 5'-->3'-exonuclease domain has been identified. It is called FEN-1 in mouse and human cells and RTH1 in Saccharomyces cerevisiae. This 42-kDa enzyme is required for Okazaki fragment processing. Here we report that FEN-1 physically interacts with proliferating cell nuclear antigen (PCNA), the processivity factor for DNA polymerases delta and epsilon. Through protein-protein interactions, PCNA focuses FEN-1 on branched DNA substrates (flap structures) and on nicked DNA substrates, thereby stimulating its activity 10-50-fold but only if PCNA can functionally assemble as a toroidal trimer around the DNA. This interaction is important in the physical orchestration of lagging strand synthesis and may have implications for how PCNA stimulates other members of the FEN-1 nuclease family in a broad range of DNA metabolic transactions.

In vitro growth of neonatal rat islet cells is stimulated by adhesion to matrix

We examined DNA synthesis in non-enzymatically isolated neonatal rat pancreatic islets sub-cultured to eliminate fibroblast contamination, which was excluded both by demonstrating no effect of fibroblast growth factor (FGF) on 3H-thymidine incorporation and by immunofluorescence of attached islets using a mouse anti-fibroblast monoclonal antibody. 3H-thymidine incorporation in islets increased with increasing glucose up to a concentration of 21.1 mM in both free-floating islets (11,789 cpm/micrograms DNA +/- 1,610 SEM) and islets attached to fibronectin coated plastic (43,043 cpm/micrograms DNA +/- 9,203 SEM). These values were significantly higher when compared to 3H-thymidine incorporation in medium containing 11.1 mM glucose (p < 0.007, and p < 0.0001 for free-floating and attached islets respectively). 3H-thymidine incorporation was significantly higher in attached islets than in free-floating islets at all glucose concentrations tested (p < 0.005 at 11.1 mM, 16.1 mM, and 21.1 mM; and p < 0.01 at 26.1 mM). 5-bromo-2'-deoxyuridine (BrDU) staining of islets showed an increased number of positive nuclei in cells localised within attached islets (37.6 nuclei per islet +/- 5.1 SEM) compared to free-floating islets (7.62 nuclei per islet +/- 1.04 SEM, p < 0.001), indicating that attachment influenced proliferation of islet cells not physically in contact with the matrix. No difference in glucose-stimulated insulin release was observed between attached and free-floating islets. In conclusion, a fibroblast free islet culture was used to document the stimulatory effect of islet attachment on DNA synthesis, which was greater than the stimulation exerted by glucose alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Healthcare Information Framework

CEN committee TC 251 Medical Informatics, has set up a project team charged with producing a European pre-standard ENV on Healthcare Information Framework (HIF). The HIF is based on abstraction from a specific information system architecture to a reference architecture and further to a conceptual architectural framework based on serving open, distributed and heterogeneous healthcare enterprises. To specify the suitable healthcare information system architecture modelling of the healthcare enterprise is required. As there is no one method serving all needs, the HIF gives guidance on what aspects to look at in selecting a suitable modelling method. It is expected that the work will be completed by early 1995.

The contribution of the murmur and vowel to the place of articulation distinction in nasal consonants

Recent studies have shown that the acoustic relationship between the murmur and the vowel at the nasal-vowel boundary is highly informative for the [m]-[n] distinction. In the present paper, the contribution of relational information is reassessed by classifying 1946 syllable-initial and 2848 syllable-final nasal consonants taken from continuous speech data. Relational information in the acoustic waveform is based on difference spectra, in which spectral information in the vowel is subtracted from spectral information in the murmur, and on combined spectra in which classifications are made from combinations of murmur and vowel spectra. These two kinds of relational spectra are compared with static spectra, in which single spectral slices are taken in either the murmur or the vowel. Contrary to recent theoretical predictions, difference spectra are shown to perform more poorly than some kinds of static spectra. However, since classification scores from combined spectra are better than from either static or difference spectra, cues to nasal place of articulation can nevertheless be defined as relational. In the best scoring combined spectra, classification scores on open tests are just under 94% correct for syllable-initial nasals and just under 82% correct for syllable-final nasals. The high classification scores show that there is considerable information in the acoustic waveform for identifying nasal place of articulation from continuous speech data.

Asthma severity and morbidity in a population sample of Sydney school children: Part I--Prevalence and effect of air pollutants in coastal regions

BACKGROUND

In two regions of Sydney where sewage treatment facilities with high temperature sludge burning incinerators are installed, there was concern that the resultant emissions were causing a local increase in symptoms of asthma and other allergic diseases.

AIM

To investigate whether living in a region with high temperature sludge burning incinerators was associated with an increased prevalence of childhood asthma or allergy.

METHODS

We studied 713 children aged eight-12 years in two regions close to incinerators and 626 children in a control region with no sludge burning incinerator. We measured respiratory illness in the previous year by questionnaire, airway hyper-responsiveness (AHR) by histamine inhalation test, and atopy by skin prick tests. 'Current asthma' was defined as AHR and recent wheeze.

RESULTS

Recordings of oxides of nitrogen and sulphur, hydrogen sulphide, ozone and particulates during the study period showed that the level of pollutants did not vary in any major way between the study regions and the control region. The prevalence of current asthma, atopy, symptom frequency or any category of severity of asthma illness was not significantly different between the control and study regions.

CONCLUSIONS

This suggests that factors other than intermittent or industrial air pollutants are responsible for the high prevalence of asthma symptoms, asthma medication use, asthma morbidity and AHR in the study of children.

Recommendations for an object oriented healthcare information model

The need for a healthcare information model as a component in a framework of standards for healthcare data interchange is identified. Key requirements for a method to support development of a healthcare information model are defined and recommendations for development of an Object Oriented Healthcare Information Model are presented.

Analysis of the defect in DNA end joining in the murine scid mutation

Murine severe combined immune deficiency (scid) is marked by a 5,000-fold reduction in coding joint formation in V(D)J recombination of antigen receptors. Others have demonstrated a sensitivity to double-strand breaks generated by ionizing radiation and bleomycin. We were interested in establishing the extent of the defect in intramolecular and intermolecular DNA end joining in lymphoid and nonlymphoid cells from scid mice. We conducted a series of studies probing the ability of these cells to resolve free ends of linear DNA molecules having various biochemical end configurations. We find that the stable integration of linear DNA into scid fibroblasts is reduced 11- to 75-fold compared with that in normal fibroblasts. In contrast, intramolecular and intermolecular end joining occur at normal frequencies in scid lymphocytes and fibroblasts. This normal level of end joining is observed regardless of the type of overhang and regardless of the requirement for nucleolytic activities prior to ligation. The fact that free ends having a wide variety of end configurations are recircularized normally in scid cells rules out certain models for the defect in scid. We discuss the types of DNA end joining reactions that are and are not affected in this double-strand break repair defect in the context of a hairpin model for V(D)J recombination.

Cerebral blood flow response to PaCO2 during hypothermic cardiopulmonary bypass in rabbits

Differences in cerebral blood flow (CBF) between alpha-stat and pH-stat management depend on preserved responsiveness of the cerebral vasculature to changes in arterial carbon dioxide tension (PaCO2). We tested the hypothesis that hypothermia-induced reductions in CBF would decrease the CBF response to changing PaCO2 (delta CBF/delta PaCO2). Anesthetized New Zealand white rabbits were randomly assigned to one of three temperature groups--group 1 (37 degrees C, n = 9); group 2 (31 degrees C, n = 10); or group 3 (25 degrees C, n = 10)--and were cooled using cardiopulmonary bypass. After esophageal temperature equilibration (approximately 40 min), oxygenator gas flows were serially varied to achieve PaCO2 values of 20, 40, and 60 mm Hg (temperature-corrected). All animals were studied at all three PaCO2 levels in random order. At each level of PaCO2, CBF and masseter blood flow were determined using radiolabeled microspheres. There were no significant differences between groups with respect to mean arterial pressure (approximately 80 mmHg), central venous pressure (approximately 4 mmHg), or hematocrit (approximately 22%). Prior normothermic studies have found delta CBF/delta PaCO2 to be proportional to CBF. Nevertheless, in this study, with hypothermia-induced reductions in CBF, delta CBF/delta PaCO2 was not significantly different between temperature groups. Thus, hypothermia either increased the sensitivity of the cerebral vasculature to carbon dioxide and/or increased the effective level of cerebrospinal fluid respiratory acidosis produced by each increment of temperature-corrected PaCO2.(ABSTRACT TRUNCATED AT 250 WORDS)

Haptoglobin typing in canine bloods

Haptoglobin typing by vertical electrophoresis in a discontinuous polyacrylamide gel was conducted on 47 dog blood samples, of which 19 were from Doberman pinschers, 20 from German shepherds, and 8 from pit bullterriers. Two phenotypes were common in the three breeds and could not be used to differentiate between them. Canine haptoglobin phenotypes were, however, sufficiently different from those of humans to warrant using haptoglobin typing as a method for determining the origin of bloodstains.

Differences in cerebral blood flow between alpha-stat and pH-stat management are eliminated during periods of decreased systemic flow and pressure. A study during cardiopulmonary bypass in rabbits

Prior reports suggest cerebral blood flow (CBF) responses to changing bypass (systemic) flow rates may differ between alpha-stat and pH-stat management. To compare the effect of blood gas management upon CBF responses to changing systemic flow and pressure, 15 New Zealand White rabbits, anesthetized with fentanyl and diazepam, underwent nonpulsatile cardiopulmonary bypass at 25 degrees C. One group of animals (n = 8) was randomized to alpha-stat blood gas management that maintained arterial carbon dioxide tension (PaCO2) approximately 40 mmHg when measured at 37 degrees C. A second group (n = 7) was managed with pH-stat technique, maintaining PaCO2 approximately 40 mmHg when corrected to the animal's actual temperature. Bypass was initiated at a flow rate of 100 ml.kg-1.min-1 and, after approximately 20 min, control hemodynamic and CBF measurements (radioactive microspheres) were made. Thereafter, bypass flow rate was changed in random order at 15-min intervals to 50, 70, and 100 ml.kg-1.min-1. CBF and hemodynamic measurements were repeated at the end of each period of altered bypass flow. Groups differed significantly with respect to both pHa and PaCO2. There were no significant differences between groups with respect to bypass flow rate, mean arterial pressure (MAP), central venous pressure, temperature, hematocrit, arterial oxygen tension (PaCO2), or bypass duration at any measurement point. MAP decreased significantly, from approximately 80 to approximately 65 mmHg with decreasing bypass flow (P = 0.0001). Over the entire range of bypass flows, CBF decreased with decreasing bypass flow (P = 0.001), and the degree of change was equivalent among regions and between groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Symptomatic bipartite sesamoids

The great toe sesamoids have been well reported in the literature, in every aspect. Much has been written about the normal anatomic variation of partite metatarsophalangeal sesamoids. It is the purpose of this article to present a theory explaining the common occurrence of a symptomatic partite sesamoid. The authors believe there is a high rate of occurrence of symptomatic partite sesamoids, especially when associated with hallux abducto valgus. Presented is information concerning the internal and external structural components of a bipartite metatarsal sesamoidal joint, which may inherently lead it to symptomatology.

The networking standards evolution: toward a real electronic medical record. Interview by Carolyn Dunbar

While converging networking standards have created short- and long-term options for healthcare IS planners, one strong goal is a "life-long, longitudinal electronic medical record" that includes data of all types--text, wave forms, voice, images and other pictorial data. Jack Harrington of Hewlett-Packard says these complex efforts are shaped by major forces that now speed progress toward multilateral acceptance of a uniform standard.

Cyclic AMP-dependent melatonin production in Y79 human retinoblastoma cells

Melatonin is rhythmically synthesized in some vertebrate retinas and has been implicated in the regulation of key rhythmic events in the photoreceptor-pigment epithelial complex. In human retina, melatonin is present; however, no information exists on the cellular regulation of this hormone. We report here that the established human retinoblastoma cell line Y79 synthesizes and releases melatonin. Treatments that elevate cyclic AMP (cAMP) levels (forskolin, 8-Br-cAMP, and the phosphodiesterase inhibitor 3-isobutyl-1-methylxanthine) all stimulate melatonin release from static cultures of Y79 cells. Other 8-bromo nucleotide analogues (cyclic GMP, ATP, and AMP) are not effective. These results suggest that Y79 human retinoblastoma cells require a cAMP-dependent mechanism for melatonin biosynthesis similar to that described previously in other vertebrates. This is the first demonstration of melatonin release from a cultured human cell line. These results support the idea that human retinal cells share homologies with pineal cells, as suggested by the condition trilateral retinoblastoma.