Oviductal antibody response to a defined recombinant sperm antigen in macques

Macaque oviductal fluids were assayed for specific antibodies to the intra-acrosomal sperm protein SP-10 after immunizations with recombinant macaque SP-10 (re-mqSP-10), a candidate contraceptive vaccinogen. Access ports, consisting of a subcutaneous collecting reservoir and a catheter to cannulate the oviduct, were implanted into monkeys for repeated aspiration of oviductal fluid. Monkeys were inoculated i.m. once a month with an emulsion consisting of 2 mg re-mqSP-10 in a vehicle of squalene and mannin monooleate. Oviductal fluids and serum were collected during the periovulatory period for six menstrual cycles, and IgG and IgA antigen-specific antibodies in preimmune and immune fluids were compared by ELISA. Both relative and absolute concentrations of SP-10-specific immunoglobulins (Ig) were determined. Oviductal fluids from immunized animals showed significant increases in anti-SP-10 IgG at cycle 2 and at all subsequent intervals. Anti-SP-10 IgA significantly increased in oviductal fluid at cycles 4, 5, and 6. Serum anti-SP-10 IgG increased at cycle 2 and remained significantly elevated through cycle 6, while serum anti-SP-10 IgA was higher than in preimmune samples at cycle 4. Serum antibodies generated to the recombinant SP-10 recognized SP-10 extracted from macaque sperm on Western blots. Immunocytochemical staining of macaque and human sperm showed acrosomal immunofluorescence with both immune oviductal fluids and serum using both anti-IgG and anti-IgA secondary antibodies. This study demonstrates for the first time 1) IgG and IgA antibodies to a defined recombinant sperm-specific antigen in primate oviductal fluids after systemic immunization and 2) the recognition by primate oviductal fluid IgG and IgA of the endogenous contraceptive target on both human and macaque sperm.

Is peer tutoring beneficial in the context of school resuscitation training?

First year pupils at a Cardiff comprehensive school were trained in cardiopulmonary resuscitation, 106 by the teacher only and 137 by the teacher assisted by older pupils (peer tutoring). Scores in a multiple choice theory test and in practical skill assessment showed no significant difference between instruction methods, but boys taught by the teacher assisted by older pupils expressed less willingness to resuscitate in an emergency than girls instructed by either method (P < 0.01). Girls had higher scores in the multiple choice paper (P < 0.025) and in the skills assessment (P < 0.01). Those pupils who reported some prior knowledge of resuscitation techniques performed better during skill assessment than novice trainees (P < 0.025).

Waiting times. Bones of contention

A slot system allocating a set number of outpatient orthopaedic appointments to general practices in North West Anglia HA means all patients referred are seen in eight weeks. The system has provoked criticism from GPs on the grounds that the burden of waiting lists has shifted onto them, and it limits access to services. The scheme has improved communication between GPs and orthopaedic consultants.

Teaching schoolchildren cardiopulmonary resuscitation

Forty-one children aged 11-12 years received tuition in cardiopulmonary resuscitation (CPR) and subsequently completed questionnaires to assess their theoretical knowledge and attitudes their likelihood of performing CPR. Although most children scored well on theoretical knowledge, this did not correlate with an assessment of practical ability using training manikins. In particular only one child correctly called for help after the casualty was found to be unresponsive, and none telephoned for an ambulance before starting resuscitation. These omissions have important implications for the teaching of CPR and the resulting effectiveness of community CPR programmes.

Pre-hospital thrombolysis: current status and future prospects

The impact of thrombolytic therapy in acute myocardial infarction has been such that it now constitutes standard therapy for patients who present to hospital with acute myocardial infarction. In an attempt to minimise the duration of ischaemia, and subsequent impairment of contractile function, trials of pre-hospital thrombolysis have been initiated. These reveal time gains of up to 60 minutes but convincing evidence of clinical benefit has not yet been forthcoming. This review examines the rationale for very early thrombolysis, in the context of the underlying pathophysiological mechanisms. It examines the impact of recent small scale studies on coronary patency, left ventricular function and infarct size and examines the potential risks. Large scale studies of pre-hospital thrombolysis are in progress and their findings will need to be interpreted in comparison with optimal 'fast-track' in-hospital treatment. The review highlights the need for co-ordinated policies for acute management of myocardial infarction involving primary care, the emergency medical systems and cardiac units. Enthusiasm for wide scale administration of thrombolytics by general practitioners, without electrocardiographic confirmation of the diagnosis, must be tempered by a clear analysis of the potential risks and benefits. Current evidence does not support such widespread clinical application, outwith the current evaluation studies. An urgent re-evaluation of hospital triage of patients with acute myocardial infarction is merited.

Variations in the provision of extended-trained ambulance personnel within the Welsh ambulance services

This paper describes the distribution of extended-trained ambulance personnel within the nine Welsh Ambulance Services. While over a quarter of all emergency ambulance crews possess some extended skills, there is a wide variation in their distribution and protocols of treatment. Increasing numbers of ambulance personnel will receive such training in the future, leading to improved standards of pre-hospital care. To justify the use of such skills in terms of clinical outcome and expenditure, the ambulance services must provide accurate data to allow subsequent audit of pre-hospital clinical practice. It is therefore essential that the medical profession becomes aware of these developments and participates in advising, assessing and training extended-trained ambulance personnel.

Expanding undergraduate dietetic education through a health promotion internship program

The Lifestyle Assistant Program is a health promotion internship offered by the University of Wisconsin-Stevens Point Health Service. Students majoring in health-related disciplines (e.g., dietetics) gain skills in promoting the six dimensions of wellness: social, occupational, spiritual, physical, intellectual, and emotional. Thirteen competencies provide the basis for training Lifestyle Assistants, who develop, market, present, and evaluate wellness sessions for the university and residential communities. Assistants earn academic credit or a wage. Of particular benefit to assistants majoring in dietetics are studying and operating a self-testing physical assessment unit, which approximates body composition, cardiovascular endurance, muscular strength, and flexibility; using a health hazard appraisal; assisting the University's Nutrition Task Force with its education campaign in the campus cafeterias; and presenting programs on popular nutrition topics (e.g., the athlete's diet). Program evaluation reveals that 84% of participants in programs conducted by assistants gained information of personal benefit. The Lifestyle Assistant competencies support The American Dietetic Association Plan IV minimum competencies in such areas as communication and education. The Lifestyle Assistant experience is in accordance with The American Dietetic Association's Dietetic Manpower Study recommendations: to provide student learning experiences in wellness programs and fitness settings.

Myocardial depression and nephrotic syndrome in Streptococcus sanguis endocarditis

Nephrotic syndrome is a most unusual complication of infective endocarditis. We report a case of Streptococcus sanguis endocarditis of the tricuspid valve in a patient with a small congenital ventricular septal defect who developed this complication. Severe myocardial depression also occurred and the clinical behaviour and subsequent recovery of this closely paralleled that of the nephrotic syndrome. These unusual associations, their possible interactions and pathogeneses are discussed.