Problem behaviours and parenting in preschool children with cystic fibrosis

BACKGROUND

Problems with sleep, eating and adherence to therapy may adversely affect health outcomes in children with cystic fibrosis (CF). Data on the prevalence of such problems, associated parenting styles and caregiver mental health are limited.

AIMS

To determine: (a) the prevalence of sleep, mealtime, therapy adherence and externalising and internalising behavioural problems in preschool children with CF; (b) the prevalence of caregiver mental health problems and poor sleep quality; and (c) associations between child behavioural problems and parenting styles.

METHODS

This was a cross sectional survey of caregivers of children aged 6 months to 5 years attending CF outpatient clinics at Royal Children's Hospital (Melbourne), Monash Medical Centre (Melbourne) and Sydney Children's Hospital. Main outcome measures were child externalising and internalising behaviours, sleep, eating and adherence with therapy; the predictor was parenting styles (harsh, inconsistent, overprotective).

RESULTS

117 of 139 families participated. Problems were common with child sleep (small

PROBLEM

31.6%; moderate/large problem: 21.9%), eating (32.4%) and adherence with physiotherapy (50.4%). Compared to normative data, sleep and mealtime problems were more prevalent. Caregivers reported high rates of symptoms indicating depression (33.3%), anxiety (16.4%) and stress (34.2%). Harsh parenting was associated with internalising behaviours (adjusted OR 3.9, 95% CI 1.16 to 13.17, p = 0.03).

CONCLUSIONS

Problems with sleeping, eating and physiotherapy adherence were common in preschool children with CF. Caregivers reported high rates of symptoms indicative of mental health problems. Harsh parenting was associated with internalising problems. An intervention targeting child problem behaviours and parental mental health would be appropriate for CF families.

Brain Imaging in Clinical Psychiatry: Why?

Aims:

To explore clinical indications for, and results of, brain imaging in a department of general adult psychiatry.

Method:

We reviewed the 100 most recent episodes of brain imaging at the Department of General Adult Psychiatry, Mater Misericordiae University Hospital, Dublin.

Results:

Patients had a mean age of 55.30 years. The most common indications for scans were cognitive impairment (33%) and other neurological concerns (e.g. seizures) (30%). Forty-seven per cent of scans were abnormal. The most common abnormalities were ischaemia (17%) and atrophy (10%). Patients with abnormal scans were older than those with normal scans (61.90 and 48.70 years, respectively; p< 0.001).

Conclusion:

Brain imaging contributes significantly to diagnosis in general adult psychiatry, especially for older patients.

The increased need for liaison psychiatry in surgical patients due to the high prevalence of undiagnosed anxiety and depression

BACKGROUND

Depression is the most common mental disease in patients hospitalized with physical illness. Disorders of anxiety and depression in general hospitals are frequently underdiagnosed and inappropriately treated.

AIM

To assess the prevalence of undiagnosed anxiety and depression in surgical inpatients and assess the referral rate and utilization of liaison psychiatry services.

METHODS

A prospective study of surgical admissions (n = 96) to two surgical services at two separate institutions between 01/01/05 and 31/12/05. The Hospital Anxiety and Depression (HADS) scale was used to evaluate all patients.

RESULTS

About 12.5% of patients had significant depression, 18.75% had significant anxiety, and 8.3% had significant mixed anxiety and depression. About 22.9% of patients warranted referral to liaison psychiatry services for further assessment and management.

CONCLUSIONS

Anxiety and depression are highly prevalent in surgical inpatients. An increased awareness of the possibility of undiagnosed psychiatric disorders is required, along with prompt and appropriate use of liaison psychiatry services.

Depression and anxiety in rheumatoid arthritis: the role of perceived social support

BACKGROUND

Rheumatoid arthritis is a common, disabling, autoimmune disease with significant psychiatric sequelae.

AIMS

We aimed to identify the prevalence of depression and anxiety in patients with rheumatoid arthritis attending hospitals, and to elucidate the role played by illness variables, disability variables and psychosocial variables in predicting levels of depression and anxiety.

METHODS

We assessed depression, anxiety, arthritis-related pain, arthritis-related disability and perceived social support in 68 adults with rheumatoid arthritis.

RESULTS

Sixty-five per cent of patients had evidence of depression (37.5% moderate or severe) and 44.4% had evidence of anxiety (17.8% moderate or severe). Both depression and anxiety were highly correlated with several measures of arthritis-related pain and functional impairment. After controlling for age, gender, marital status and duration of arthritis, perceived social support was a highly significant independent predictor of both depression and anxiety.

CONCLUSIONS

These findings suggest that increasing social support may be particularly important in the management of depression and anxiety in rheumatoid arthritis.

A comparison of paediatric soccer, gaelic football and rugby injuries presenting to an emergency department in Ireland

OBJECTIVES

Children presenting with sport related injuries (SRIs) as a result of soccer, rugby and gaelic football are frequently seen in an emergency medicine (EM) setting in Ireland. A comparison of the demographics of injuries in these three sports has however not previously been performed. The purpose of this study was to provide up-to-date data on the nature of these SRIs.

METHOD

Data was collected retrospectively on all children (<17 years of age), injured in these three sports, presenting to an emergency medicine department over 6 months, and was entered into a database for analysis.

RESULTS

Retrospective analysis was performed on 23,000 charts, and 409 SRIs were identified over a 6-month period. None of the children reported using any form of protective gear, and 27% reported a previous presentation to the emergency department with a SRI. Most injuries were as a result of soccer (56%), with 24% occurring in gaelic football, and 20% occurring in rugby. The predominant mechanism of injury was different in each sport, in soccer-falls (38%), in gaelic football-collisions with objects (balls) (37%), and in rugby-collision with persons (55%). Although the predominant type of injury in soccer and gaelic football was a fracture, accounting for 50% and 42% of injuries, respectively, in rugby however, skin/soft tissue injuries presented more commonly, accounting for 44% of injuries. When the general site of injury was investigated, the upper limb accounted for the majority of SRIs in each sport. In the management of SRIs, oral analgesics were prescribed in 50%, however, it was observed that no use was made of topical, intramuscular or rectal analgesic routes of administration. In addition it was observed that RICE/general injury advice was given in only 27%, physiotherapy was requested in 2%, and no injury prevention advice was given to any child. Overall, 8% required admission.

CONCLUSIONS

The data provided from this study may raise awareness of the nature of SRIs affecting children in each of these three sports, and may be useful in formulating much needed injury prevention strategies.

Outcome data from the LEAP (Live, Eat and Play) trial: a randomized controlled trial of a primary care intervention for childhood overweight/mild obesity

OBJECTIVES

To reduce gain in body mass index (BMI) in overweight/mildly obese children in the primary care setting.

DESIGN

Randomized controlled trial (RCT) nested within a baseline cross-sectional BMI survey.

SETTING

Twenty nine general practices, Melbourne, Australia.

PARTICIPANTS

(1) BMI survey: 2112 children visiting their general practitioner (GP) April-December 2002; (2) RCT: individually randomized overweight/mildly obese (BMI z-score <3.0) children aged 5 years 0 months-9 years 11 months (82 intervention, 81 control).

INTERVENTION

Four standard GP consultations over 12 weeks, targeting change in nutrition, physical activity and sedentary behaviour, supported by purpose-designed family materials.

MAIN OUTCOME MEASURES

Primary: BMI at 9 and 15 months post-randomization. Secondary: Parent-reported child nutrition, physical activity and health status; child-reported health status, body satisfaction and appearance/self-worth.

RESULTS

Attrition was 10%. The adjusted mean difference (intervention-control) in BMI was -0.2 kg/m(2) (95% CI: -0.6 to 0.1; P=0.25) at 9 months and -0.0 kg/m(2) (95% CI: -0.5 to 0.5; P=1.00) at 15 months. There was a relative improvement in nutrition scores in the intervention arm at both 9 and 15 months. There was weak evidence of an increase in daily physical activity in the intervention arm. Health status and body image were similar in the trial arms.

CONCLUSIONS

This intervention did not result in a sustained BMI reduction, despite the improvement in parent-reported nutrition. Brief individualized solution-focused approaches may not be an effective approach to childhood overweight. Alternatively, this intervention may not have been intensive enough or the GP training may have been insufficient; however, increasing either would have significant cost and resource implications at a population level.

Acute coronary syndrome and chronic infection in the Cork coronary care case-control study

OBJECTIVE

To examine the association between chronic infection and cumulative burden of infection and acute coronary syndrome.

DESIGN

The 5C (Cork coronary care case-control) study was a community based case-control study. Patients and controls underwent a standard physical examination and had blood samples taken for serological analysis for Helicobacter pylori (IgG), Chlamydia pneumoniae (IgA, IgM, and IgG), cytomegalovirus (IgG), and herpes simplex virus types 1 and 2 (IgG).

SETTING

Patients were recruited from four hospitals in Cork City and Mallow Town. Controls, individually matched on age and sex, were selected by incident density sampling from the same general practices as the referent case.

MAIN OUTCOME MEASURES

Age and sex adjusted and fully adjusted odds ratios for acute coronary syndrome by seropositivity and by increasing number of infections.

RESULTS

Cases and controls did not differ significantly in seropositivity to C pneumoniae, cytomegalovirus, herpes simplex viruses, and H pylori. In unconditional logistic regression analysis adjusted for age, sex, waist to hip ratio, smoking, physical activity, alcohol consumption, and social class there was no evidence of an increasing risk for acute coronary syndrome with increasing burden of infection.

CONCLUSIONS

The findings do not support an association between specific infectious agents and acute coronary syndrome and do not provide evidence of a burden of infection effect.

Early pregnancy loss: how do men feel?

One in five pregnancies (20%) end in miscarriage. A specialized early pregnancy loss clinic to provide dedicated medical advice and support was established at the Rotunda Hospital in July 2002. A qualitative pilot study was conducted in July 2002 to assess the emotional response of male partners and also to establish if sufficient support services are provided for them. Ten consecutive couples attending the clinic 6-8 weeks following early pregnancy loss were included in the study. The partners were asked to complete a questionnaire with open and closed questions and return in the envelope provided. Nine questionnaires were returned. The average age of men attended was 28.6 years (range 20-39). The feelings described by men were typical of the grief and bereavement process. All wanted more time for discussion with doctors. They felt marginalized and although they felt support services for their partner were adequate, they felt that more support services for male partners should be provided. Based on these research findings, the specialized early pregnancy loss clinic is being developed to partner's needs and expectations. The appointment letter sent to the women now specifically states that the partner is welcome to attend. Partners are now included in the consultation.

An investigation of the psychosocial impact of a Compensation Tribunal on women with latrogenic hepatitis C infection

The aim of this study was to investigate the psychosocial impact of a Compensation Tribunal in women with an iatrogenic hepatitis C virus (HCV) infection. Eighty-three women diagnosed with an iatrogenic HCV infection were recruited, 19 women were Pre-Tribunal and 64 women were post-Tribunal. Both standardised and disease specific psychological measures were used. A series of t-tests revealed no differences in psychological well-being and adjustment to HCV infection in women pre and post Compensation Tribunal. Chi-square tests revealed no association between PCR status and 1) psychological well-being and 2) experience of anger/blame in women post-Compensation Tribunal. A further series of t-tests revealed that women with high levels of anger and blame post-Compensation Tribunal perceived their future as more uncertain, experienced more pain, low self-esteem and psychological distress, viewed their ability to work as impeded and complained of increased stress preparing for their Compensation Tribunal. This study suggests that poor adjustment in women with an iatrogenic HCV infection post-Compensation Tribunal is not associated with attendance at a Compensation Tribunal nor PCR status but rather to experiences of anger and blame.

The role and rewards of asylum attendants in Victorian England

This paper reports on a study of the role and rewards of asylum attendants at a West Yorkshire asylum in the period 1852-1889. The role aspect was analysed with reference to the Regulations and Orders of the institution concerned and the rewards aspects with reference to the staff records. It emerged that attendants were the most poorly paid group of staff within the institution and the drop-out rate was high in the early years of service, though a number did give long service.

Effects of aging on the opioid modulation of feeding in humans

OBJECTIVES

To determine whether aging is associated with a reduction in the opioid modulation of feeding, which may be important in the pathogenesis of the "anorexia of aging."

DESIGN

Three studies on separate days, in randomized order and double-blind fashion.

SETTING

Clinical Human Research Laboratory, Department of Medicine, RAH, Adelaide, Australia.

PARTICIPANTS

Twelve older (5 male/7 female) (age 65-84) and 12 young (5 male/7 female) (age 20-26) healthy subjects.

INTERVENTION

Subjects received in double-blinded random order, intravenous bolus (10 minutes) and then continuous (140 minutes) infusions of saline (control), naloxone low dose (LD) (bolus 27 microg/kg; continuous 50 microg/kg/hr), or naloxone high dose (HD) (bolus 54.5 microg/kg; continuous 100 microg/kg/hr).

MEASUREMENTS

After 120 minutes, subjects were offered a buffet meal, and their energy intake was quantified. Hunger, fullness, nausea, and drowsiness were assessed using visual analogue scales.

RESULTS

The naloxone LD and HD infusions had no significant effect on ratings of hunger, fullness, or nausea, but increased drowsiness (P < .01) compared with the control infusion in both age groups. Older subjects ate less (P < .001) at the buffet meal than young subjects during all three infusions. Naloxone infusions reduced energy intake compared with control (P < .001), LD by 13.2 +/- 5.0% and HD by 10.7 +/- 5.0%, with no difference between the doses (P = .71). Overall, naloxone suppressed energy intake in both young and older subjects (P < .01). This suppression was slightly, but not significantly, greater in young than in older subjects (mean of LD and HD 16.4 +/- 4.9% vs 7.5 +/- 4.9%, P = .42), because of a trend to reduced suppression in older women.

CONCLUSIONS

We conclude that healthy older adults retain their sensitivity to the suppressive effects of naloxone on food intake. Possible gender differences in this sensitivity warrant further investigation. A decline in opioid activity is unlikely to contribute substantially to the physiological anorexia of aging observed in older people.

Demonstration of the extrinsic coagulation pathway in teleostei: identification of zebrafish coagulation factor VII

It is not known whether the mammalian mechanism of coagulation initiation is conserved in fish. Identification of factor VII is critical in providing evidence for such a mechanism. A cDNA was cloned from a zebrafish (teleost) library that predicted a protein with sequence similarity to human factor VII. Factor VII was shown to be present in zebrafish blood and liver by Western blot analysis and immunohistochemistry. Immunodepletion of factor VII from zebrafish plasma selectively inhibited thromboplastin-triggered thrombin generation. Heterologous expression of zebrafish factor VII demonstrated a secreted protein (50 kDa) that reconstituted thromboplastin-triggered thrombin generation in immunodepleted zebrafish plasma. These results suggest conservation of the extrinsic coagulation pathway between zebrafish and humans and add credence to the zebrafish as a model for mammalian hemostasis. The structure of zebrafish factor VIIa predicted by homology modeling was consistent with the overall three-dimensional structure of human factor VIIa. However, amino acid disparities were found in the epidermal growth factor-2/serine protease regions that are present in the human tissue factor-factor VIIa contact surface, suggesting a structural basis for the species specificity of this interaction. In addition, zebrafish factor VII demonstrates that the Gla-EGF-EGF-SP domain structure, which is common to coagulation factors VII, IX, X, and protein C, was present before the radiation of the teleosts from the tetrapods. Identification of zebrafish factor VII significantly narrows the evolutionary window for development of the vertebrate coagulation cascade and provides insight into the structural basis for species specificity in the tissue factor-factor VIIa interaction.

Indigenous property rights and river management

The presence of indigenous property rights and interests arising from the survival of native title in Australia presents unique issues in the management of rivers and riverine lands. Existing common law and statutory tidal and non-tidal rights are a complex overlay of public and private property rights which are themselves undergoing significant change through the commodification of many natural resources by Commonwealth and State governments, such as marine species stock and non-tidal water. The melding of indigenous values and management practices with existing management regimes for rivers and riverine lands offers considerable potential for both sustainability of resource utilisation, and respect and recognition of native title with resultant predicted benefits in the vexed area of compensation.

Motivational interviewing to enhance treatment initiation in substance abusers: an effectiveness study

Sixty individuals referred for a substance abuse evaluation by a child welfare worker were randomly assigned to either a standard evaluation or an evaluation enhanced by Motivational Interviewing techniques, each delivered in a single session. Participants who received the enhanced evaluation were significantly more likely to attend at least one additional treatment session after the initial evaluation (59% versus 29%). This finding suggests that comparatively inexpensive modifications of "standard" initial evaluations with substance-using parents may increase engagement of substance-abusing parents in treatment. Moreover, this study adds to an overwhelmingly positive literature supporting Motivational Interviewing with alcohol-using populations and extends prior findings to non-research community settings.

Congenital absence of a cervical pedicle: report of two cases and review of the literature

OBJECTIVE AND IMPORTANCE

The congenital absence of a cervical pedicle is a rare clinical entity. Patients with this anomaly tend to present with cervical pain or after a traumatic incident. Initial evaluations with conventional radiography frequently lead to misinterpretation and misguided intervention. We report two cases of absent cervical pedicles and describe the presentation, diagnosis, and treatment of these patients. Moreover, we review the literature on this clinical entity.

CLINICAL PRESENTATION

The first patient was a 4-year-old boy who presented with neck pain after falling off a trampoline. His neurological examination did not reveal any focal abnormalities, but radiographs were thought to be consistent with a right, C4-C5, unilateral, jumped facet. The second patient was a 27-year-old woman who presented with severe neck, back, and left upper extremity pain and paresthesias after an alleged incident of spousal abuse. Her neurological examination results were remarkable for left upper extremity weakness and hemibody sensory changes. Conventional radiographs were thought to reveal a left, C3-C4, unilateral, locked facet.

INTERVENTION

For both patients, reduction attempts were made with Gardner-Wells tongs and traction. After failure to achieve adequate reduction, evaluations using two-dimensional computed tomography confirmed congenitally absent cervical pedicles. Both patients were ultimately treated conservatively and experienced resolution of their presenting symptoms.

CONCLUSION

The congenital absence of a cervical pedicle is a rare entity that is frequently misdiagnosed. Diagnoses can be accurately confirmed with two-dimensional computed tomography. Conservative treatment resulted in successful management of this clinical entity.

Undetected hyperglycaemia among hospital in-patients

To assess the prevalence of previously undiagnosed hyperglycaemia consistent with a diagnosis of Diabetes Mellitus in a consecutive series of hospital in-patients. Retrospective case note review. University Teaching Hospital. 800 consecutive hospitalised patients aged over 50 years. The main outcome measures the prevalence of hyperglycaemia [corrected]. We searched the biochemistry laboratory computerised database for results of all biochemistry tests carried out during each patient's admission. The medical records of those with at least one plasma glucose value in the hyperglycaemic range (glucose > or =11.1 mmol/l and/or > or =7.0 mmol/l on casual and/or fasting measurements respectively) were reviewed by two observers using a standardised method and a check list for data collection.

The biochemical characterization of aggrecan from normal and tibial-dyschondroplastic chicken growth-plate cartilage

Tibial dyschondroplasia (TD) is a disorder of endochondral ossification characterized by the presence of an avascular, non-mineralized cartilage lesion extending from the growth plate into the metaphysis. Cells within the TD growth plate fail to differentiate to full hypertrophy, and instead appear to maintain a 'pre-hypertrophic' or 'transitional' status. Studies of the expression and distribution of cartilage matrix macromolecules in the TD growth plate have shown a marked decrease in the levels of aggrecan in the TD matrix. In the present study we compared the biochemical characteristics of the aggrecan molecules extracted from normal epiphyseal and TD cartilage. We have shown three major differences between normal and TD cartilage aggrecan. These are: (1) increase in molecular mass; (2) increase in the number of keratan sulphate chains; and (3) difference in the pattern of sulphation in TD aggrecan. Such changes in biochemical characteristics of the aggrecan monomers in TD cartilage may be associated with the lack of mineralization of the diseased cartilage. The present study provides a basis for further investigations into the importance of proteoglycans in normal and pathological bone development.

Transfusion errors in New York State: an analysis of 10 years' experience

BACKGROUND

While public focus is on the risk of infectious disease from the blood supply, transfusion errors also contribute significantly to adverse outcomes. This study characterizes such errors.

STUDY DESIGN AND METHODS

The New York State Department of Health mandates the reporting of transfusion errors by the approximately 256 transfusion services licensed to operate in the state. Each incident from 1990 through 1998 that resulted in administration of blood to other than the intended patient or the issuance of blood of incorrect ABO or Rh group for transfusion was analyzed.

RESULTS

Erroneous administration was observed for 1 of 19, 000 RBC units administered. Half of these events occurred outside the blood bank (administration to the wrong recipient, 38%; phlebotomy errors, 13%). Isolated blood bank errors, including testing of the wrong specimen, transcription errors, and issuance of the wrong unit, were responsible for 29 percent of events. Many events (15%) involved multiple errors; the most common was failure to detect at the bedside that an incorrect unit had been issued.

CONCLUSION

Transfusion error continues to be a significant risk. Most errors result from human actions and thus may be preventable. The majority of events occur outside the blood bank, which suggests that hospitalwide efforts at prevention may be required.

Secondary prevention following fractured neck of femur: a survey of orthopaedic surgeons practice

Fractured neck of femur is one of the most common reasons for hospital admission in the elderly population. Despite this little attention is given to the area of secondary prevention. To assess the variation in clinical practice among orthopaedic surgeons with regard to the use of secondary preventive measures in relation to fractured neck of femur. A postal survey using a self-completed questionnaire among all orthopaedic surgeons throughout the Republic of Ireland. The study questionnaire addressed unit information prophylaxis for deep venous thrombosis and investigation and secondary prevention of fractured neck of femur. It gave a clinical scenario of a 72-year old female who was admitted with a fractured neck of femur after a minor fall. A reminder was sent to the non-responders. Data were analysed using chi-squared test. The number of completed questionnaires returned was 89 giving a response rate of 66%. Of these 71(82.6%) reported that they would not initiate or recommend investigation of the extent of the underlying osteoporosis in the specific case upon which the questionnaire was based. With regard to the issue of secondary prevention 16(18%) stated that they would prescribe Vitamin D and 26(29%) would prescribe calcium supplements. 15(17%) would use bisphosphonates and 15(17%) would prescribe hormone replacement therapy. Only one respondent would use an external hip protector. There is an underuse of secondary preventive measures with regard to fractured neck of femur. There needs to be clear definition of roles and perhaps the development of agreed local protocols in order that patients with hip fractures do not miss out on potentially beneficial treatment. There is an underuse of secondary preventive measures with regard to fractured neck of femur. There needs to be clear definition of roles and perhaps the development of agreed local protocols in order that patients with hip fractures do not miss out on potentially beneficial treatment.

Disassembly of membrane-associated NSF 20S complexes is slow relative to vesicle fusion and is Ca(2+)-independent

N-ethylmaleimide-sensitive fusion protein (NSF) and its co-factor soluble NSF attachment protein (alpha)-SNAP) are essential components of the synaptic vesicle fusion machinery and form part of a structurally-conserved 20S protein complex. However, their precise function, relative to fusion itself, is not clear. Using a UV-activated cross-linking approach, we have measured the rate at which a single round of NSF-driven ATP hydrolysis leads to 20S complex disassembly within synaptic membranes. Although this rate is substantially faster than previous estimates of NSF-dependent ATP hydrolysis, it remains much lower than published rates for fusion of synaptic vesicles. Furthermore, the stability of 20S complexes is unaffected by Ca(2+) at concentrations that elicit rapid membrane fusion. We conclude that the ATPase activity of NSF does not contribute directly to vesicle fusion, but more likely plays an earlier role in the synaptic vesicle cycle.

Factor and subscale structure of a parental health locus of control instrument (parental health beliefs scales) for use in a mainland United States Puerto Rican community

This study was undertaken to determine whether the subscale structure of an instrument used to measure parental health locus of control is a valid representation of the concept of locus of control in the Puerto Rican community. Ethnocultural differences in values and attitudes may create different conceptualizations of questionnaire items, which may impact on the subscale factor loadings for these items. Four hundred and twenty parents of Puerto Rican ethnicity living in a mainland inner city community in the United States completed the Parental Health Beliefs Scales (PHBS) instrument, which was developed to measure parental locus of control regarding their children's health. Results were subject to exploratory factor analysis. The resultant factor structure was then compared to other published factor structures by confirmatory factor analysis. Exploratory factor analysis results show a new five factor solution. Compared to two previously published factor structures for this instrument, the new five factor structure has a better goodness of fit for this Puerto Rican study sample. Through item analysis, we were able to refine the final structure into a four factor, 15 item instrument. We conclude that the new factor structure for the PHBS creates an instrument with subscales that reflect Puerto Rican cultural beliefs and values, especially as it pertains to locus of control issues (e.g. respect of professionals, collectivism, and the importance of fate). When working with ethnocultural minority groups, the health services researcher needs to be certain that the research instruments used are culturally appropriate and sensitive.

How to defuse compliance time bombs. Part 2: Six hypothetical allegations. Panel discussion

In the second and final part of this series, a panel of legal experts discusses more hypothetical allegations against a fictional laboratory, including billing for additional indices, using expired reagents, and falsifying the results of employee competency tests. Learn how to handle these dilemmas before they explode into full-blown legal violations.

Formation and turnover of NSF- and SNAP-containing "fusion" complexes occur on undocked, clathrin-coated vesicle-derived membranes

Specificity of vesicular transport is determined by pair-wise interaction between receptors (SNAP receptors or SNAREs) associated with a transport vesicle and its target membrane. Two additional factors, N-ethylmaleimide-sensitive fusion protein (NSF) and soluble NSF attachment protein (SNAP) are ubiquitous components of vesicular transport pathways. However, the precise role they play is not known. On the basis that NSF and SNAP can be recruited to preformed SNARE complexes, it has been proposed that NSF- and SNAP-containing complexes are formed after SNARE-dependent docking of transport vesicles. This would enable ATPase-dependent complex disassembly to be coupled directly to membrane fusion. Alternatively, binding and release of NSF/SNAP may occur before vesicle docking, and perhaps be involved in the activation of SNAREs. To gain more information about the point at which so-called 20S complexes form during the transport vesicle cycle, we have examined NSF/SNAP/SNARE complex turnover on clathrin-coated vesicle-derived membranes in situ. This has been achieved under conditions in which the extent of membrane docking can be precisely monitored. We demonstrate by UV-dependent cross-linking experiments, coupled to laser light-scattering analysis of membranes, that complexes containing NSF, SNAP, and SNAREs will form and dissociate on the surface of undocked transport vesicles.

Surreptitious observation of responses to hypnotically suggested hallucinations: a test of the compliance hypothesis

Suggestions for arm levitation and for visual, auditory, tactile, and taste hallucinations were administered twice via audiotape to a group of high suggestible students and low suggestible simulators. During one of the administrations, participants were led to believe they were alone, but their behavior was surreptitiously recorded on videotape and observed on a video monitor. During the other administration, they were observed openly by an experimenter who had not been informed about group assignment. When unaware that they were being observed, simulators were significantly less responsive to suggestion and engaged in substantially more role-inappropriate behavior. In contrast, the responsiveness of nonsimulating students was not affected by the presence of an experimenter, and they exhibited little role-inappropriate behavior even when alone. These data indicate that the responses of suggestible individuals reflect internally generated changes in experience and are not due to simple intentional compliance (i.e., faking).

Structural characterisation of two forms of procyclic acidic repetitive protein expressed by procyclic forms of Trypanosoma brucei

A procyclic acidic repetitive protein (PARP) fraction was purified from long-term cultures of Trypanosoma brucei procyclic forms by a solvent-extraction and reverse phase chromatography procedure. The PARP fraction yielded small quantities of a single N-linked oligosaccharide with the structure Man alpha1-6(Man alpha1-3)Man alpha1-6(Man alpha1-3)Manbeta1-4GlcNAcbeta1-4GlcNAc (Man5GlcNAc2). Fractionation of PARP on Con A-Sepharose revealed that the majority (80 to 90%) of the PARP fraction did not bind to Con A and was composed of the parpA alpha gene product that contains repeats of -Glu-Pro-Pro-Thr- (GPEET-PARP) and that lacks an N-glycosylation site. This form of PARP has not been previously identified at the protein-level. The minor Con-A-binding fraction was shown to be rich in the previously described form of PARP, encoded by the parpAbeta and/or parpB alpha genes, that contains a -Glu-Pro- repeat domain (EP-PARP) and an N-glycosylation site. Analysis of longer and shorter-term cultures suggested that procyclic cells initially express predominantly EP-PARP that is gradually replaced by GPEET-PARP. Both forms of PARP were shown to contain indistinguishable glycosylphosphatidylinositol (GPI) membrane anchors, where the conserved GPI core structure is substituted by heterogeneous sialylated branched polylactosamine-like structures that are predicted to form a dense surface glycocalyx above which the polyanionic -Glu-Pro-Pro-Thr- and -Glu-Pro- repeat domains are displayed. The phosphatidylinositol (PI) component of the GPI anchor was shown to be a mixture of 2-O-acyl-myo-inositol-1-HPO4-(sn-1-stearoyl-2-lyso-glycerol) and 2-O-acyl-myo-inositol-1-HPO4-(sn-1-octadecyl-2-lyso-glycerol), where the acyl chain substituting the inositol ring showed considerable heterogeneity. Mass spectrometric and light scattering experiments both suggested an average mass of approximately 15 kDa for GPEET-PARP, with individual glycoforms ranging from about 12 kDa to 20 kDa, that is consistent with its amino acid and carbohydrate composition. A measured translational diffusion coefficient of 3.9 x 10(7) cm2 s(-1) indicates that this molecule has a highly elongated shape. The possible functions of these unusual glycoproteins are discussed.

Risk of aspirin-associated major upper-gastrointestinal bleeding with enteric-coated or buffered product

BACKGROUND

Aspirin products are known to cause irritation and injury to the gastric mucosa. The belief that enteric-coated and buffered varieties are less likely to occasion major upper-gastrointestinal bleeding (UGIB) than plain aspirin was tested in data from a multicentre case-control study.

METHODS

550 incident cases of UGIB admitted to hospital with melaena or haematemesis and confirmed by endoscopy, and 1202 controls identified from population census lists, were interviewed about use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) during the 7 days before the onset of bleeding (cases) or interview (controls). Relative risks of UGIB for each type of aspirin used regularly (at least every other day) were calculated overall, and according to dose, by multiple logistic regression, with control for age, sex, marital status, date, education, cigarette smoking, alcohol use, and use of NSAIDs.

FINDINGS

The relative risks of UGIB for plain, enteric-coated, and buffered aspirin at average daily doses of 325 mg or less were 2.6, 2.7, and 3.1, respectively. At doses greater than 325 mg, the relative risk was 5.8 for plain and 7.0 for buffered aspirin; there were insufficient data to evaluate enteric-coated aspirin at this dose level. There were no important differences in risk attributable to the three aspirin forms according to bleeding site (gastric vs duodenal), or when users of NSAIDs were excluded.

INTERPRETATION

Use of low doses of enteric-coated or buffered aspirin carries a three-fold increase in the risk of major UGIB. The assumption that these formulations are less harmful than plain aspirin may be mistaken.

Type VI collagen is present in human and bovine vitreous

BACKGROUND

Heterotypic (mixed) collagen fibrils that contain collagen types II, IX and V/XI have previously been identified in vitreous gel. The purpose of this study was to determine whether vitreous gel also contains type VI collagen microfibrils, as they are widely distributed in other tissues where they may play an important structural role.

METHODS

Bovine and human vitreous gel was analysed by rotary shadowing electron microscopy after bacterial collagenase digestion and gel filtration chromatography. Bovine vitreous was extracted in 4 M guanidine hydrochloride, and following isopycnic centrifugation fractions were analysed by western blotting.

RESULTS

Type VI collagen microfibrils were identified by electron microscopy in human and bovine vitreous. Type VI collagen was identified by western blot analysis.

CONCLUSION

Type VI collagen is present in vitreous and may participate in the structural assembly of the vitreous gel.

What cost chronic pain?

Chronic non-malignant pain costs the American economy $40 billion a year. An attempt to quantify the total cost to the Irish economy of 95 patients attending a Multi-Disciplinary Pain Clinic was made. The cost to the Health Services was estimated and added to the amount of Social Welfare payments received and the lost earnings of each patient. The results indicated that the 95 patients cost 1.9 million pounds at the time of referral. A subgroup of 22 patients who were younger and unemployed, accounted for 1.5 million pounds. Allocation of resources to treat these patients is necessary.

The effects of hospital admission on drug prescribing in an elderly population

307 consecutive patients admitted to our unit were studied. The reasons for altering patients' drug regimens were noted. The price difference between the patients' drugs on admission to those on discharge was calculated. While over 40% of drugs regimens on admission were unchanged on discharge some adjustments were made in the remainder. The most common reason for stopping a drug was that the hospital physician could find no indication for its use. A 30.3% reduction in price of discharge drugs compared with drugs on admission was achieved.