Fresh Kids: the efficacy of a Health Promoting Schools approach to increasing consumption of fruit and water in Australia

The Fresh Kids programme utilized the Health Promoting Schools (HPSs) framework to design a whole-of-school, multifaceted intervention targeting specific behaviours to promote healthy eating and reduce the risk factors associated with childhood obesity. The aim of the programme was to evaluate the effectiveness of the HPS framework to increase fruit and water consumption among primary school-aged children over a 2-year period. The study design was an interrupted time series. Four primary schools in the inner west of Melbourne, Australia, participated in the programme intervention. Baseline data were collected using a lunch box audit to assess the frequency of children with fresh fruit, water and sweet drinks, either brought from home or selected from canteen lunch orders. The lunch box audit was repeated periodically for up to 2 years following programme implementation to assess the sustainability of dietary changes. Across all participating schools, significant increases between 25 and 50% were observed in the proportion of children bringing fresh fruit. Similarly, all schools recorded increases between 15 and 60% in the proportion of students bringing filled water bottles to school and reductions between 8 and 38% in the proportion of children bringing sweet drinks. These significant changes in dietary patterns were sustained for up to 2 years following programme implementation. Targeting key nutrition behaviours and using the HPS framework is an effective and simple approach which could be readily implemented in similar childhood settings. Effective strategies include facilitating organizational change within the school; integrating curriculum activities; formalizing school policy and establishing project partnerships with local community nutrition and dietetic services.

Evaluation of agrobacterium-mediated transformation of Agaricus bisporus using a range of promoters linked to hygromycin resistance

There is interest in establishing genetic modification technologies for the cultivated mushroom Agaricus bisporus, both for improved crop characteristics and for molecular pharming. For these methods to be successful, it is necessary to establish a set of transformation systems that include robust and reliable vectors for gene manipulation. In this article, we report the evaluation of a series of promoters for driving expression of the Escherichia coli hph gene encoding hygromycin phosphotransferase. This was achieved using the Aspergillus nidulans gpdA and the A. bisporus gpdII and trp2 promoters. The Coprinus cinereus beta-tubulin promoter gave contrasting results depending on the size of promoter used, with a 393-bp region being effective, whereas the longer 453-bp fragment failed to yield any hygromycin-resistant transformants. The C. cinereus trp1 and the A. bisporus lcc1 promoters both failed to yield transformants. We also show that transformation efficiency may be improved by careful selection of both appropriate Agrobacterium strains, with AGL-1 yielding more than LBA1126 and by the choice of the binary vectors used to mobilize the DNA, with pCAMBIA vectors appearing to be more efficient than either pBIN19- or pGREEN-based systems.

Patient burden, resource utilization, and treatment outcomes of grade 3/4 chimeric or humanized monoclonal antibody-associated infusion reactions

18544

Background: Treatment with chimeric and humanized monoclonal antibodies (MAb) is associated with infusion reactions that may limit their usage. Despite growing use and importance of MAb regimens, there is a dearth of information describing MAb-associated infusion reactions (MAb-IRs) outside of clinical trials. The purpose of this study is to describe the patient burden, resource utilization, and treatment outcomes of grade 3 and 4 chimeric or humanized MAb-IRs in a community sample. Methods: We obtained a convenience sample of charts from 8 US outpatient oncology practices for patients who were treated between Feb 2004 to Dec 2005 with bevacizumab, cetuximab, or rituximab and experienced a grade 3 or 4 MAb-IR during their treatment. Results: Data were abstracted for 30 (n = 3 bevacizumab, 4 cetuximab, 23 rituximab) adult cancer patients who experienced a grade 3 (26, 87%) or grade 4 (4, 13%) MAb-IR. Of these, 63% (19) of patients were male; the mean age was 62 yrs. Twenty (67%) of these patients received premedication before experiencing their grade 3/4 MAb-IR. Twenty (67%) MAb-IRs occurred during the first cycle, 6 (20%) occurred at or beyond cycle 4. The most common MAb-IRs were rigors/chills (13, 43%), bronchospasms (5, 17%), and dyspnea (6, 20%). Grade 4 MAb-IRs were sinus bradycardia (2), severe pain (1), and apnea, seizure, ventricular arrhythmia (1). The consequences of MAb-IRs required increased utilization of resources as shown in the table . Additionally, 9 (30%) required antihistamines, 19 (63%) corticosteroids, 1 (3.3%) an H2 blocker, 3 (10%) an H3 blocker, 4 (13%) epinephrine, 14 (47%) intravenous fluids, 4 (13%) antiemetics, 10 (33%) narcotics, and 17 (57%) oxygen. Conclusions: Grade 3 and 4 chimeric or humanized MAb-IRs result in substantial patient symptom burden, numerous clinical interventions, and changes to subsequent MAb treatment. Further analyses will be required to estimate the direct medical costs and long term consequences of MAb-IRs, and the impact of less severe infusion reactions.

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Measuring safety climate in health care

AIM

To review quantitative studies of safety climate in health care to examine the psychometric properties of the questionnaires designed to measure this construct.

METHOD

A systematic literature review was undertaken to study sample and questionnaire design characteristics (source, no of items, scale type), construct validity (content validity, factor structure and internal reliability, concurrent validity), within group agreement, and level of analysis.

RESULTS

Twelve studies were examined. There was a lack of explicit theoretical underpinning for most questionnaires and some instruments did not report standard psychometric criteria. Where this information was available, several questionnaires appeared to have limitations.

CONCLUSIONS

More consideration should be given to psychometric factors in the design of healthcare safety climate instruments, especially as these are beginning to be used in large scale surveys across healthcare organisations.

Effect of pramlintide on satiety and food intake in obese subjects and subjects with type 2 diabetes

AIMS/HYPOTHESIS

Long-term trials in insulin-treated subjects with type 2 diabetes have shown that adjunctive treatment with the amylin analogue pramlintide reduces HbA(1)c levels and elicits weight loss. While amylin reduces food intake in rodents, pramlintide's effect on satiety and food intake in humans has not yet been assessed.

METHODS

In this randomised, double-blind, placebo-controlled crossover study, 11 insulin-treated men with type 2 diabetes (age 60+/-9 years, BMI 28.9+/-4.8 kg/m(2)) and 15 non-diabetic obese men (age 41+/-21 years, BMI 34.4+/-4.5 kg/m(2)) underwent two standardised meal tests. After fasting overnight, subjects received single subcutaneous injections of either pramlintide (120 microg) or placebo, followed by a preload meal. After 1 h, subjects ate an ad libitum buffet meal. Energy intake and meal duration were measured, as were hunger ratings (using visual analogue scales), and plasma cholecystokinin, glucagon-like peptide-1 and peptide YY concentrations over time.

RESULTS

Compared with placebo, pramlintide reduced energy intake in both the type 2 diabetes (Delta-202+/-64 kcal, -23+/-8%, p<0.01) and obese (Delta-170+/-68 kcal, -16+/-6%, p<0.02) groups, without affecting meal duration. Hunger and hormonal analyte profiles provided evidence that pramlintide may exert a primary satiogenic effect, independently of other anorexigenic gut peptides.

CONCLUSIONS/INTERPRETATION

The results indicate that enhanced satiety and reduced food intake may explain the weight loss observed in long-term pramlintide trials.

Efficient GFP expression in the mushrooms Agaricus bisporus and Coprinus cinereus requires introns

We have developed a "Molecular Toolkit" comprising interchangeable promoters and marker genes to facilitate transformation of homobasidiomycete mushrooms. We describe the evaluation of a range of promoters in the homobasidiomycetes Agaricus bisporus and Coprinus cinereus using green fluorescent protein (GFP) as a reporter gene; the C. cinereus trp1 promoter and A. bisporus trp2 and gpdII promoters proving successful in driving expression in C. cinereus, with the gpdII promoter also functioning in A. bisporus. Our investigations demonstrate that a prerequisite for GFP expression in C. cinereus and A. bisporus is the presence of an intron. This is the first reported expression of GFP in either C. cinereus or A. bisporus.

Intranasal sumatriptan in post-ECT headache: results of an open-label trial

BACKGROUND

Significant headaches occur in up to 45% of patients receiving electroconvulsive therapy (ECT) as a result of treatment. Headaches may at times be severe and affect patient compliance with this treatment modality. The 5-HT(1B/1D) receptor agonist sumatriptan has been reported to be effective for post-ECT headache in several case reports. The aim of the present open-label study was to assess the efficacy and tolerability of intranasal sumatriptan for post-ECT headache.

METHOD

Patients undergoing ECT who experienced moderate-to-severe post-ECT headache were enrolled in the study. Patients were asked to rate their headache severity and describe headache characteristics using a standard headache diary. Headaches rated as severe or moderate were treated with 20 mg of intranasal sumatriptan. Additional headache ratings were recorded at 0.25, 0.5, 1.0, 1.5, and 2 hours after sumatriptan administration and compared with baseline values.

RESULTS

Eight female patients (ages 34-45 years old) participated in the trial and experienced a total of 13 post-ECT headaches, which were treated with intranasal sumatriptan. Of the headaches treated, six (46.2%) were described as severe and seven (53.8%) were characterized as moderate in severity. Twelve (92.3%) of the treated headaches responded by the 2 hour posttreatment time point and 11 (84.6%) had responded within 1 hour. Comparisons made at the 1- and 2-hour time point revealed a statistically significant improvement from baseline (p = 0.002). Of the 12 headaches that responded, 6 (50%) were reported as no pain and 5 (38.5%) were reported as only mild pain at 1 hour following treatment. At the 2-hour assessment, an additional headache, which had previously not responded, was rated at mild resulting in six (50%) headaches with complete resolution of pain and six (50%) with a decrease in pain symptoms from moderate or severe to mild. Overall, sumatriptan treatment was well tolerated, and no significant adverse effects or changes in vital signs were recorded. In no case was a second dose of sumatriptan given. The most common complaint was the taste of the medication (n = 4), which was not treatment limiting. No patient withdrew from the study due to an adverse event.

CONCLUSION

Intranasal sumatriptan spray may be an effective, well-tolerated, and prompt treatment for patients experiencing moderate-to-severe post-ECT headache. Preventing post-ECT headache may contribute to patient compliance with the ECT treatment modality. Additionally, the known pharmacologic effects of sumatriptan and the generally positive results found in the present study suggest that ECT-induced headache is vascular in origin. Further placebo-controlled, double-blind studies are needed to confirm our open-label results.

Identifying predictors of high quality care in English general practice: observational study

OBJECTIVES

To assess variation in the quality of care in general practice and identify factors associated with high quality care.

DESIGN

Observational study.

SETTING

Stratified random sample of 60 general practices in six areas of England.

OUTCOME MEASURES

Quality of management of chronic disease (angina, asthma in adults, and type 2 diabetes) and preventive care (rates of uptake for immunisation and cervical smear), access to care, continuity of care, and interpersonal care (general practice assessment survey). Multiple logistic regression with multilevel modelling was used to relate each of the outcome variables to practice size, routine booking interval for consultations, socioeconomic deprivation, and team climate.

RESULTS

Quality of clinical care varied substantially, and access to care, continuity of care, and interpersonal care varied moderately. Scores for asthma, diabetes, and angina were 67%, 21%, and 17% higher in practices with 10 minute booking intervals for consultations compared with practices with five minute booking intervals. Diabetes care was better in larger practices and in practices where staff reported better team climate. Access to care was better in small practices. Preventive care was worse in practices located in socioeconomically deprived areas. Scores for satisfaction, continuity of care, and access to care were higher in practices where staff reported better team climate.

CONCLUSIONS

Longer consultation times are essential for providing high quality clinical care. Good teamworking is a key part of providing high quality care across a range of areas and may need specific support if quality of care is to be improved. Additional support is needed to provide preventive care to deprived populations. No single type of practice has a monopoly on high quality care: different types of practice may have different strengths.

Array-based ELISAs for high-throughput analysis of human cytokines

In this report, we describe the development of a mini-array system suitable for high-throughput quantification of proteins. This mini-array is a multiplexed, sandwich-type ELISA that measures the concentration of seven different human cytokines--TNF-alpha, IFN alpha, IFN gamma, IL-1 alpha, IL-1 beta, IL-6, and IL-10--from a single sample in each well of a 96-well plate. The mini-array is produced by spotting monoclonal antibodies (mAbs) in a 3 x 3 pattern in the bottom of the wells of 96-well polystyrene plates. Cytokines that are captured by the arrayed mAbs are detected by using biotinylated mAbs, followed by the addition of a streptavidin-horseradish peroxidase (HRP) conjugate and a chemiluminescent substrate. The light produced from the HRP-catalyzed oxidation of the substrate is measured at each spot in the array by imaging the entire plate with a commercially available CCD camera. Here, we demonstrate that these 96-well-plate format mini-arrays have performance characteristics that make them suitable for the high-throughput screening of anti-inflammatory compounds.

Redefining critical incidents: a preliminary report

This pilot study was conducted to describe how some traumatic events become "critical incidents" and to generate a new understanding of the term critical incident. The qualitative research design utilized content analysis of structured interviews of six emergency nurses. The nurses were interviewed regarding the ways they think about certain patient care events, the reasons that specific events are remembered and the changes that occurred following the experience of an event they considered to be critical. The definitions of a critical incident as described in the literature--as an event, as a professional's reaction and as a professional's performance--are included in the nurses' comments. None of them, however, offers a comprehensive way of describing a critical incident. The results of this pilot study suggest one, two or all three elements may be present when a traumatic event is experienced. The interaction of these elements helps to produce a fourth "critical" component, the meaning a nurse gives to an event, which can trigger cognitive, affective and/or behavioral changes. This study acknowledges the importance of all the definitions of a critical incident and proposes a more comprehensive definition that results from the interaction among the other components and the generation of personal meaning and change.

The public's response to the obesity epidemic in Australia: weight concerns and weight control practices of men and women

OBJECTIVE

: To assess weight perceptions, weight concerns and weight control behaviours and related beliefs in a representative sample of adults.

DESIGN

: Cross-sectional postal survey.

SETTING

: The survey was conducted between October and December 1997 in the state of Victoria, Australia.

SUBJECTS

: A total of 2500 subjects were selected at random from the Australian electoral roll; 900 provided usable responses.

RESULTS

: At the time of the survey, 2.7% of respondents were trying to gain weight, 26.6% were trying to avoid gaining weight, 22.9% were trying to lose weight and 47.9% were not doing anything for their weight. Men (47.2%) were less likely than women (55.3%) to be attempting any form of weight control. Watching the type of food eaten (95.6%), reducing dietary fat intake (87.3%) and engaging in physical activity or exercise (84.4%) were the most common weight control strategies used. Potentially harmful strategies, such as self-induced vomiting and smoking, were used by relatively few respondents. Many adults believed that vigorous activity (26.8%) and total omission of fat from the diet (35.3%) are necessary in order to lose weight.

CONCLUSIONS

: Attempts at weight control are common in the community. However, many men, including men who are already overweight, appear to be unconcerned about their weight. Obesity prevention initiatives should attempt to influence individuals' weight-related beliefs and behaviours, as well as seeking to change policies and environments to better support weight control.

The measurement of IgA and IgG transglutaminase antibodies in celiac disease: a comparison with current diagnostic methods

Celiac disease (CD) is an inflammatory disorder of the small intestine induced by cereal prolamins. The demonstration of IgA endomysial antibodies (EMA) is currently the most reliable serological screen for CD. The antigenic target is transglutaminase. The aim of this study was to develop an ELISA assay for the detection of antibodies to transglutaminase (TGA), and to assess the sensitivity and specificity of TGA for the detection of celiac disease against the benchmarks of jejunal biopsy, antigliadin antibodies (AGA) and EMA. Sera from 57 patients with celiac disease were tested for IgA and IgG TGA, IgA EMA, IgA and IgG AGA, and the total IgA level. The sensitivity, specificity, predictive value and concordance of AGA, EMA and TGA were assessed against the gold-standard biopsy result. IgG plus IgA TGA offered 100% sensitivity in CD patients for whom no dietary intervention had been commenced, with a specificity of 61%. The sensitivity of TGA dropped from 100 to 79% after dietary restriction. In patients on no gluten restriction, there was 100% agreement between TGA and EMA, and 100% agreement between TGA and AGA for the IgA isotype. The false-positive rate for TGA was 53% in Down's syndrome patients and 25% in patients with systemic autoimmune disorders. We conclude that testing for TGA is a reliable diagnostic serology for celiac disease, with improved sensitivity compared with established methods. The results suggest that serial TGA measurements may be a more and accurate marker for dietary compliance than AGA, but prospective studies are required.

Effect of some electrical stimulation variables on wing flapping, post-mortem glycolysis and eating quality characteristics of broiler pectoralis major muscle

1. The influence of different rates of wing flapping on the rate of post-mortem glycolysis in the Pectoralis major (PMI) muscles of commercially-processed broilers was investigated. This was achieved by applying 300 pulses of low voltage electrical stimulation (ES) shortly after slaughter at various frequencies and pulse widths. The rate of post-mortem glycolysis was assessed by measuring muscle pH values at 20 min post mortem (pH(20 min)). 2. ES gave a mean pH(20 min) value of 6.01, significantly lower than that of the control carcases which had a mean value of 6.45. Within ES treatments, variation in pulse frequency between 1/s and 10/s and in pulse width from 5 to 20 ms had no influence on pH(20 min) values as measured by direct probe. However, differences between mean pH(20 min) values attributable to pulse frequency were detected when measured by the iodoacetate method. 3. A further experiment was carried out to determine how different rates of wing flapping would affect the eating quality of PM muscles from commercially-processed broilers stored at chill temperatures for 24 h post mortem. This was achieved by using pulse frequencies of 1/s, 5/s and 10/s, all other ES variables being standardised. Pulse frequency had no effect on ultimate pH, sarcomere length, cooking loss or tenderness of PM muscle compared to controls. 4. We concluded that the rate of wing flapping post-slaughter has no effect, per se, on the extent of post-mortem glycolysis in broiler PM muscle or on its subsequent meat quality assessed after holding the carcases under chill storage conditions for 24 h.

Xplore mRNA assays for the quantification of IL-1 beta and TNF-alpha mRNA in lipopolysaccharide-induced mouse macrophages

Because the accurate measurement of a number of cytokine mRNA transcripts provides valuable knowledge about cytokine gene regulation, we have developed the Xplore assay for the quantification of cytokine mRNA. This microplate-based assay is rapid (under four hours), quantitative over three orders of magnitude and carries no risk of false-positive values from contamination with amplified target. Here, we describe the use of Xplore assays to measure the steady-state mRNA levels of TNF-alpha and IL-1 beta produced by mouse WEHI and J774 macrophage-like cell lines.

Physical activity beliefs and behaviours among adults attempting weight control

OBJECTIVE

To compare the frequency and duration of varying intensities of physical activity performed by adults trying to lose weight, avoid gaining weight and not actively trying to control their weight, and to compare these groups' beliefs about the physical activity they should perform.

METHOD

Random postal survey of 2500 Victorian adults selected from the Australian electoral roll (response rate=42%).

MEASURES

One-week physical activity recall (frequency and duration of walking, other moderate activity and vigorous activity), BMI (based on self-reported height and weight) and weight-control behaviour.

RESULTS

At the time of the survey, 27% of respondents were actively trying to avoid gaining weight, 23. 9% trying to lose weight and 49.1% undertaking no weight control. Respondents spent a mean time of 4.0 (+/-7.1) h walking, 5.5 (+/-7. 9) h in moderate activity and 3.1(+/-5.9) h in vigorous activity during the week prior to the survey. Women trying to lose weight or avoid gaining weight engaged in vigorous activity more often than women not trying to control their weight. After adjusting for age, education and BMI, women trying to avoid gaining weight were 2.4 times more likely, and women trying to lose weight 2.5 times more likely, to have met current physical activity guidelines than women undertaking no weight control. On average, respondents believed they should spend 5.2 (+/-6.9) h walking, 6.5 (+/-8.2) h in moderate activity and 4.3 (+/-6.5) h in vigorous activity each week. Women trying to lose weight felt they should perform vigorous activity more often than other women. Weight-control behaviour was not associated with physical activity beliefs and behaviours of men.

CONCLUSION

Walking is a common activity among adults attempting weight control. However, many men and women do not fully recognize the value of moderate-intensity physical activity. Future efforts should be directed at promoting the role of moderate-intensity activity in weight control, particularly activity that can be performed outside of planned activity sessions. International Journal of Obesity (2000)24, 81-87

Development and initial validation of a brief mental health outcome measure

Using a combination of classical test theory and Rasch item analysis, we developed a short scale designed to measure the effectiveness of mental health treatment across a wide range of mental health services and populations. Item development for the scale was guided by literature review and interviews with senior clinicians and with patients. Using 3 different samples consisting of inpatients, outpatients, and nonpatients, we reduced our initial item pool from 81 to 10 items. The 10-item scale had an alpha of .96 and showed strong correlations with commonly used measures of psychological well-being and distress. Our results suggest that the scale appears to measure a broad domain of psychological health. The scale appeared to lack ceiling and floor effects, and it discriminated between inpatients, outpatients, and nonpatients, suggesting the scale has excellent potential to be broadly responsive to a variety of treatment effects. In addition, the new scale proved to be sensitive to treatment changes in a sample of 20 psychiatric inpatients. Overall, the initial data suggest that we have developed a brief, sensitive outcome measure designed to have wide application across psychiatric and psychological treatments and populations.

Renal function in chronically catheterized conscious diabetic rats using constant and servo-controlled infusion

1. Infusion experiments were performed on chronically catheterized conscious rats to assess kidney function before and after the induction of diabetes mellitus with streptozotocin. 2. Two infusion regimens were used, a conventional constant-infusion protocol and a novel computer-driven, servo-controlled fluid replacement technique. The latter enables body fluid status to be maintained throughout a study occasion by servo-controlled replacement of spontaneous urinary fluid losses. 3. The chronically catheterized conscious rat infused using a servo-controlled system appears to be the optimum model for a study of diabetic renal function. The conscious preparation circumvents problems associated with anaesthesia and acute surgery. The servo-controlled infusion protocol maintains the altered fluid status of the diabetic condition. Both hyperfiltration and polyuria, characteristics of human diabetes often absent in anaesthetized and/or constantly infused diabetic rats, were seen in all conscious servo-controlled diabetic animals. 4. The new regimen enables a more accurate assessment of renal function in experimental diabetes than with previous protocols. It should prove useful in future studies, particularly those assessing the role of anti-diabetic drugs on the kidney.

Mutant cells that do not respond to interleukin-1 (IL-1) reveal a novel role for IL-1 receptor-associated kinase

Mutagenized human 293 cells containing an interleukin-1 (IL-1)-regulated herpes thymidine kinase gene, selected in IL-1 and gancyclovir, have yielded many independent clones that are unresponsive to IL-1. The four clones analyzed here carry recessive mutations and represent three complementation groups. Mutant A in complementation group I1 lacks IL-1 receptor-associated kinase (IRAK), while the mutants in the other two groups are defective in unknown components that function upstream of IRAK. Expression of exogenous IRAK in I1A cells (I1A-IRAK) restores their responsiveness to IL-1. Neither NFkappaB nor Jun kinase is activated in IL-1-treated I1A cells, but these responses are restored in I1A-IRAK cells, indicating that IRAK is required for both. To address the role of the kinase activity of IRAK in IL-1 signaling, its ATP binding site was mutated (K239A), completely abolishing kinase activity. In transfected I1A cells, IRAK-K239A was still phosphorylated upon IL-1 stimulation and, surprisingly, still complemented all the defects in the mutant cells. Therefore, IRAK must be phosphorylated by a different kinase, and phospho-IRAK must play a role in IL-1-mediated signaling that does not require its kinase activity.

Managing the hair and skin of African American pediatric patients

In Africa, the ancestral home of most African Americans, hair is viewed as the epitome of beauty. However, when Africans were brought to America as slaves, they were unable to care for their hair and skin adequately and were exposed to the predominant white culture, which valued straight hair and light skin. As a result, many African Americans lost self-esteem because of the characteristics of their hair and skin. In this article we examine the anatomic and physiologic features of African American hair and skin and typical African American hair and skin care practices. Common African American hair and skin disorders and their management are discussed. The goal of this article is to help primary care providers understand the special hair and skin care required for African American children (as well as other dark-skinned patients). With good patient education, understanding one's own hair and skin characteristics can also support positive self-esteem.

Postmortem diagnosis of leukodystrophies

Leukodystrophies are progressive disorders involving the development and maintenance of myelin in the central and peripheral nervous systems. Although relatively uncommon, leukodystrophic disorders may be undiagnosed or misdiagnosed during life, and may appear as "sudden death." In such instances, these victims may be referred to a forensic pathologist. In general, leukodystrophies are inherited in an autosomal recessive manner so that proper postmortem diagnosis by the forensic pathologist is extremely important to the decendant's family for future family planning.

Cooperative binding of Stat1-2 heterodimers and ISGF3 to tandem DNA elements

Interferon (IFN)-alpha-activated Stat1 homodimers and Stat1-2 heterodimers bind to GAS elements, whereas the transcription factor ISGF3, which contains Stat1, Stat2 and p48, binds to ISREs. We now find that Stat1-2 dimers can form heterotetramers on tandem GAS sites and that the heterotetramers have a much higher binding affinity for a double GAS site than do heterodimers for a single site, suggesting cooperativity mediated through protein-protein interactions. Stat1-2 heterotetramers can also be detected with a single GAS site, again indicating cooperativity mediated through protein-protein interactions. Deleting 40 amino acid residues from the N-terminus of Stat1 abolished Stat1-Stat2 heterotetramer formation, but did not affect heterodimer formation and an N-terminal peptide containing the first 120 residues of Stat2 inhibited heterotetramer formation but did not affect heterodimer formation. Thus, the N-terminal regions of both Stat1 and Stat2 are important for cooperative DNA binding, and heterodimers probably interact with each other through these regions. Cooperative binding of ISGF3 was also observed using the tandem ISREs from the IFN-alpha responsive promoter of the 6-16 gene. A more abundant and larger complex was formed with a probe containing two ISREs than with a probe containing a single ISRE. The N-terminal regions of both Stat1 and Stat2 are important for the cooperative binding of ISGF3 to tandem ISREs but not to a single site. The cooperative DNA-binding activities of ISGF3 and Stat1-2 dimers are likely to contribute to the transcriptional activation of those IFN-alpha-responsive genes that have tandem DNA elements.

Characteristics of L-carnitine transport by lactating rat mammary tissue

The transport of L-carnitine by lactating rat mammary tissue has been examined. L-carnitine uptake by rat mammary tissue explants isolated from lactating rats, 3-4 days post partum, was via both Na+-dependent and Na+-independent pathways. The Na+-dependent pathway, the predominant route for L-carnitine uptake, was a saturable process: the Km and Vmax were, respectively, 132 microM and 201 pmol/2 h/mg of intracellular water. The Na+-independent pathway, which was non-saturable, had a coefficient of 0.26 microl/mg of intracellular water/2 h. The Na+-dependent component of L-carnitine uptake by mammary tissue explants was cis-inhibited by D-carnitine and acetyl-L-carnitine, but not by choline or taurine. In contrast, the Na+-independent component of L-carnitine uptake was not affected by any of these compounds. The uptake of L-carnitine by mammary tissue isolated from lactating rats, 10-12 days post partum, was qualitatively similar to that by mammary tissue taken from rats during the early stage of lactation. However, L-carnitine uptake was quantitatively lower: this was attributable to a reduction in the Na+-dependent component of L-carnitine uptake. L-Carnitine efflux from rat mammary tissue taken from animals 3-4 days post partum, consisted of at least two components; a fast extracellular component and a slow membrane-limited component. Reversing the trans-membrane Na+-gradient did not stimulate L-carnitine efflux suggesting that the Na+-dependent L-carnitine carrier operates with asymmetrical kinetics. A hyposmotic shock, hence cell-swelling, increased L-carnitine efflux from mammary tissue explants.

Characteristics of L-glutamine transport by lactating mammary tissue

The transport of L-glutamine by the lactating rat mammary gland has been investigated using rat mammary tissue explants and the in situ perfused rat mammary gland. L-glutamine uptake by both explants and the perfused mammary gland was via both Na(+)-dependent and Na(+)-independent pathways. It appeared that these pathways are situated on the blood-facing aspect of the mammary gland. L-glutamine uptake by both mammary preparations was markedly inhibited by 2-aminobicyclo[2,2,1]heptane-2-carboxylic acid in the absence of external Na+. This is consistent with L-glutamine uptake via system L. The Na(+)-dependent component(s) of L-glutamine uptake remains to be precisely identified. However, system A can be ruled out on the basis that L-glutamine was not inhibited by (methylamino)isobutyric acid. Mammary tissue concentrates L-glutamine with respect to both milk and plasma: we suggest that the Na(+)-dependent component(s) of L-glutamine uptake is responsible for generating the intracellular to extracellular concentration gradient.

A critique of the World Resources Institute's report "Pesticides and the immune system: the public health risks"

A recent World Resources Institute (WRI) report concluded that pesticides are a likely cause of immune suppression for millions of people throughout the world. The gravity of this conclusion motivated us to review the scientific evidence cited in the report. The predominant human evidence came from cross-sectional studies conducted in the former Soviet Union. These studies were difficult to evaluate due to incomplete reporting and had obvious limitations in terms of subject selection, exposure assessment,lack of quality control, statistical analysis, adequacy of the comparison group, and confounding. The toxicologic evidence was comprised mainly of acute high-dose studies in which the exposure conditions resulted in systemic toxicity. The relevance of these studies to effects at typical human exposure levels is questionable. We did not find consistent, credible evidence to support the conclusion of widespread pesticide-related immune suppression. Nonetheless, the WRI report is an important document because it focuses attention on a potentially important issue for future research and brings a substantial literature of foreign language studies to the attention of Western scientists.

Applicability of telemedicine for assessing patients with schizophrenia: acceptance and reliability

BACKGROUND

Telemedicine holds promise for providing expert psychiatric consultation to underserved populations, but has not been quantitatively studied in schizophrenia or any other major mental disorder. This study was conducted to assess the reliability and acceptance of video-conferencing equipment in the assessment of patients with schizophrenia.

METHOD

We assessed reliability of the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), and Scale for the Assessment of Negative Symptoms (SANS) under three conditions: (1) in person, (2) by videoconferencing at low (128 kilobits per second [kbs]) bandwidth, (3) by videoconferencing at high (384 kbs) bandwidth. All 45 patients met DSM-IV criteria for schizophrenia. All patients and the two interviewers rated various aspects of the study interviews against previous live psychiatric interviews.

RESULTS

Total scores on both the BPRS and SAPS were assessed equally reliably by the three media. Total score on the SANS was less reliably assessed at the low bandwidth, as were several specific negative symptoms of schizophrenia that depend heavily on nonverbal cues. Video interviews were well accepted by patients in both groups, although patients in the high bandwidth group were more likely to prefer the video interview to a live interview.

CONCLUSION

Global severity of schizophrenia and overall severity of positive symptoms were reliably assessed by videoconferencing technology. Higher bandwidth resulted in more reliable assessment of negative symptoms and was preferred over low bandwidth, although patients' and raters' acceptance of video was good in both conditions. Videoconsultation appears to be a reliable method of assessing schizophrenic patients in remote locations who have limited access to expert consultation.

Mammographic phantom studies with synchrotron radiation

PURPOSE

To explore the potential improvement in image contrast for breast imaging with use of monoenergetic photons.

MATERIALS AND METHODS

The x-ray energy available from the National Synchrotron Light Source is from 5 to over 50 keV. A specific energy is selected with a tunable crystal monochromator. The object is scanned with a narrow beam of 80.0 x 0.5 mm. Mammography phantoms were imaged with plate and film as the imaging detectors. Phantom images were obtained at 16-24 keV and compared with images obtained with a conventional mammographic unit.

RESULTS

Preliminary findings indicate improved image contrast of the monoenergetic images compared with that obtained from the conventional x-ray source, particularly at 18 keV and below.

CONCLUSION

Pilot results are encouraging, and the authors presently continue to explore monoenergetic photon imaging with improved instrumentation, scatter rejection, and use of tissue samples.

Cognitive deficits in Machado-Joseph disease

Cognitive function was examined in 6 patients with genetically confirmed Machado-Joseph disease (MJD) and 15 age- and ethnically matched controls using a series of subtests from the Cambridge Neuropsychological Test Automated Battery (CANTAB), a touch screen-based testing system previously validated in a number of movement and neurodegenerative disorders. The MJD patients had deficits in visual attentional function that were characterized by a slowing of the processing of visual information when task demands were high and an inability to shift attention to previously irrelevant stimulus dimensions to discriminate between complex stimuli. Tests of learning and visual memory were normal. These results demonstrate that specific cognitive deficits occur in patients with MJD, independent of motor dysfunction, and these deficits may reflect disruption to frontosubcortical pathways.

Epidemiology of incident spinal fracture in a complete population

STUDY DESIGN

Cross-section observational study of incident spinal fractures using an administrative data-base.

OBJECTIVES

To identify and define all patients who have spinal fractures within a complete population.

SUMMARY OF BACKGROUND DATA

The true incidence of spinal column and cord injury is not known. Previous studies have been institutional or practice based. Accurate information concerning the magnitude of the spinal injury population and their characteristics may provide more rational basis for public health decision making and resource allocation.

METHODS

The study dates were April 1, 1981 to March 31, 1984. Using the Manitoba Health Services Insurance Plan database, all patients with ICD-9-CM coding of 805.x and 806.x (spinal column fracture with and without spinal cord injury) were identified. Incidence rates, age and gender distribution, and ambulatory and hospital contracts were identified. Hospital discharge abstracts were used to classify mechanisms of injury, associated injuries, and length of stay.

RESULT

The annual incidence rate of spinal fracture was 64 per 100,000. Two thousand sixty-three patients were identified, with 944 being admitted to the hospital. There were two peaks of incidence occurring in young men and elderly women. Of the hospitalized patients, 182 had cervical injury, 286 had thoracic fracture, and 403 had injury in the lumbosacral spine Associated injuries occurred in 38% of hospitalized patients. Length of stay was an average of 38.5 days. Overall mortality was 41%. Neurologic injury occurred in 122 patients.

CONCLUSIONS

Ambulatory care of spine injuries is more common than hospital care. Two peaks of incidence occur-in young men and elderly women. Future decisions for research, public health policy, and resource allocation can be based on these data.

Systemic and portal prostacyclin and thromboxane response to hemorrhage in portal hypertension

Prostacyclin (PGI2) and thromboxane (Tx-A2) levels increase in hemorrhagic shock. Prostanoids have been implicated as mediators of the systemic and splanchnic hyperemia characteristic of portal hypertension (PHT). We hypothesized that prostanoid pharmacokinetics could be altered during shock in PHT and mediate the poor tolerance of PHT animals to hemorrhage. Hemodynamics and PGI2 and Tx-A2 levels were determined in portal, systemic venous, and arterial vascular beds at baseline and following hemorrhage and resuscitation. Portal and systemic PGI2 levels were elevated at baseline in PHT animals, with no change in resting Tx-A2. Following hemorrhage, PGI2 and Tx-A2 levels increased in normal animals, but were unchanged in PHT. Portal hypertension PGI2 production was elevated at rest, while Tx-A2 levels were diminished. There is a diminished prostanoid response to hemorrhage in PHT animals compared to normal. This abnormality in prostanoid pharmacokinetics may contribute to the abnormal response to hemorrhage in PHT.