Raising standards in pathology: the accreditation process in the United Kingdom

The accreditation scheme established by Clinical Pathology Accreditation (UK) Ltd has been in formal operation since 1992. So far, 933 laboratories have been inspected, nearly two-thirds of all laboratories in the UK. Of these, 73% are fully accredited, 24% have outstanding conditions requiring correction, and 3% have been referred. Inspectors have identified some regional and specialty differences, most notably in histopathology and cytology. The second cycle of inspection visits is underway. Most UK departments of pathology have embraced the concept of accreditation with relative enthusiasm and there has been strong support from professional bodies, specialist societies, health service managers, the independent sector and government departments.

Gene therapy for cystic fibrosis: a psychosocial study of trial participants

As yet little is known of psychological aspects of gene therapy. This pilot study aimed to investigate the attitudes, expectations, knowledge and psychological functioning of participants in a phase l safety trial of a single application of gene therapy to cystic fibrosis patients. Sixteen patients were assessed before and after the trial and at a 16 week follow-up using a semi-structured qualitative interview. They completed the Family Assessment Scale, the CF-12 quality of life measure and repeat measures of the Hospital Anxiety and Depression Scale and SF-36. Most patients had an emotionally driven optimism about gene therapy and few complaints about the procedures in a nasal trial. The majority of subjects were in good psychological/health A significant minority had anxiety disorders and this group were more likely to have concerns over the safety and promise of gene therapy. A preference was expressed for the potential of gene therapy over heat-lung transplantation. Results suggest that there are unlikely to be major psychological contraindications to proceeding with gene therapy research in this patient group. Patients with anxiety disorders may need special consideration. Qualitative data collected in this pilot study can now be used to develop survey questions for large scale studies.

Culicoides variipennis (Diptera:Ceratopogonidae) host selection in Colorado

Drop traps containing either steer or ewe bait were used to investigate host selection and crepuscular period host seeking activity of Culicoides spp. at 2 farms in Colorado. Of the 1,103 Culicoides spp. collected, 755 were Culicoides variipennis (Coquillett). Of these, 86% were collected from steers and 14% from ewes. The engorgement rate of C. variipennis was 31% on steers and 6% on ewes. Culicoides crepuscularis Malloch was the 2nd most abundant species. Of the 253 collected, 39% were from the steers, and 61% were from ewes: The engorgement rate of the C. crepuscularis collected was 71% on ewes and 34% on steers. Thus, C. variipennis preferentially selected and fed upon cattle, whereas C. crepuscularis preferentially selected and fed upon sheep.

Gender and ethnic differences in survival in a cohort of HIV positive clients

OBJECTIVES

The purpose of this study was to examine gender and ethnic differences in survival of persons receiving treatment for HIV infection to determine if differences existed, and if they did, to assess the possibility of explaining these differences by examining other factors, such as age, disease severity when beginning treatment, alcohol, illicit drugs, tobacco, educational level, living arrangements, antiretroviral treatment, PCP prophylaxis, sexually transmitted diseases, mode of transmission and opportunistic infections.

DESIGN

A retrospective cohort study of all clients receiving treatment at an HIV only clinic from its opening in early 1988 until the end of May 1993. Statistical methods used to examine the data included incidence density ratios, Kaplan-Meier survival curves, Breslow (generalized Wilcoxon) tests of equality of survival curves and Cox proportional hazards models both with and without time dependent covariates.

RESULTS

In the cohort (37% African American, 7% Hispanic American and 25% female), 220 deaths occurred during 1223 person years of follow-up. Compared to European American males, the following incidence density ratios were observed: European American females: 0.50, Hispanic American females: 0.70, Hispanic American males: 0.96, African American females: 1.28 and African American males: 2.38. The differences were noted above for gender/ethnicity groups were significant at the p < 0.0001 level. After adjusting for disease stage (as measured by laboratory testing of CD4 positive T-lymphocytes), educational level, and age, no differences in survival by gender or ethnicity remained. Disease stage and educational level had the greatest prognostic significance.

CONCLUSIONS

European Americans entered treatment at a much earlier disease stage (as measured by CD4 positive T-lymphocyte counts) and had higher educational levels (a surrogate for socioeconomic status) than African Americans. These factors may explain the longer survival in European Americans as compared to African Americans in this cohort.

The families of anorexia nervosa and cystic fibrosis patients

The objective of the study was to determine whether the families of anorexia nervosa (AN) patients were more dysfunctional than those of cystic fibrosis (CF) patients and well controls. Data were collected from self-report questionnaires, from an interview rated for Expressed Emotion (EE) and from direct observation of a family problem solving task which was rated for evidence of Minuchin's 'psychosomatic family' dimensions. A total of 87 families participated. Most self-report measures of family functioning did not distinguish between groups. There were no differences in levels of EE criticism. AN and CF households showed more EE emotional over-involvement than did the well households. Over-involvement correlated with illness severity. More households in the AN group were enmeshed, over-protective and poor at problem solving than in the CF and well groups. Minuchin's conceptualization of the anorexia nervosa family was partly supported.

Early intervention for low birthweight, premature infants: participation and intellectual development

The Infant Health and Development Program was an eight-site randomized controlled trial of comprehensive early intervention for low birthweight, premature infants during the first 3 years of life in which intellectual development was an outcome of major importance. At 24 and 36 months, but not at 12 months, higher Mental Development Index and IQ were associated with higher levels of participation in the intervention. In a longitudinal analysis of these data, we found that the intellectual development of children in the intervention group was associated with each of the three intervention modalities (the number of home visits received, days attended at child centers, and the number of parent meetings attended) but not with children's background characteristics (i.e., maternal education, birthweight). We suggest that these findings represent a dose-response relation between intervention and outcome.

Psychosocial functioning of young adults with cystic fibrosis and their families

BACKGROUND

The psychosocial functioning of adolescents and young adults with cystic fibrosis still living in the parental home was investigated. With its proven genetic aetiology cystic fibrosis is an ideal model with which to assess the impact of a chronic and life threatening disorder on family and individual psychological and social functioning.

METHODS

Twenty nine patients with cystic fibrosis and their families were compared with those of 27 patients with anorexia nervosa and 31 well controls. Assessments were made using self reporting, interview, and observational methods.

RESULTS

Most patients with cystic fibrosis were in robust psychological health and only differed from their healthy peers in that they were much less likely to be in employment. Mothers of patients with cystic fibrosis or anorexia nervosa were more likely than the mothers of the well group to be emotionally distressed, although this was not so for fathers. Young people in both illness groups were more likely to have parents with high levels of expressed emotion. Most families of patients with cystic fibrosis had good problem solving abilities.

CONCLUSIONS

In spite of the burden of illness in cystic fibrosis psychological functioning in many respects matches that of well young people.

Social discomfort and depression in a sample of adults with leg amputations

We examined the relationship between social discomfort and depression in a sample of 89 adults with leg amputations at two outpatient clinics. It was hypothesized that individuals who reported being uncomfortable with social contacts involving acknowledgement of their amputation or prosthesis were more prone to depression than other patients. A set of questions addressing different aspects of social discomfort demonstrated internal consistency and were used as a scale. Social discomfort was significantly correlated with scores on the Center for Epidemiologic Studies-Depression Scale depression scale (r = .41). Multiple regression analysis showed that social discomfort was a significant independent predictor of depression, after holding constant the effects of age, gender, social support, time since amputation, reason for amputation, and perceived health. These data indicate that health care professionals should view the expression of social discomfort by amputee patients as a possible "marker" for depression. Further studies are planned to develop and validate an expanded social discomfort scale.

Reverse targeting in a media-promoted breast cancer screening project

BACKGROUND

The American Cancer Society has sponsored community-based, low-cost, Breast Cancer Detection Awareness Projects throughout the United States. The authors hypothesized that these projects tend to exclude minorities and women of lower socioeconomic status--groups with a higher incidence of late-stage disease.

METHODS

A cross-sectional survey was performed of participants in the 1990 Breast Screening Project in Tampa, Florida. The demographic profile of participants was compared with that predicted by 1990 census data.

RESULTS

There were 13,920 women who called phone banks for additional information. Of these, 13,215 were deemed eligible and 6640 completed mammographic screening. Forty percent of participants were having mammography for the first time. Comparisons with census data indicated that elderly people, members of minority groups, and women of lower educational levels were underrepresented.

CONCLUSIONS

The results of this study support the concept that "reverse targeting" occurs with these breast cancer screening projects, and recommendations for recruiting underrepresented groups are given.

Concurrent administration of albumin with total parenteral nutrition in sick newborn infants

The effects of concurrent administration of albumin with total parenteral nutrition were studied in 12 premature newborns (birth weight 1.26 +/- 0.1 kg [mean +/- SEM] and gestational age 30 +/- 0.8 weeks [mean +/- SEM]) compared with a control group of 12 premature newborns (birth weight 1.17 +/- 0.2 kg and gestational age 29 +/- 0.1 weeks) who received total parenteral nutrition. All newborns had a plasma albumin level below 3 g/dL and were in cardiorespiratory distress requiring assisted ventilation. Albumin supplementation of total parenteral nutrition resulted in a sustained increase in serum albumin concentration as well as increased mean arterial blood pressures in the study group. Slow albumin infusion had no observed effect on the severity of respiratory distress. Study group infants regained birth weight earlier than control group infants. These data suggest that the concurrent administration of albumin may be clinically beneficial in critically ill newborn infants.

Pregnancy outcomes in women with primary Raynaud's phenomenon

Pregnancy outcomes were assessed in 67 women who had well-defined primary Raynaud's phenomenon and in 30 controls, each of whom had been pregnant at least once. Twenty-seven patients had onset of Raynaud's phenomenon prior to any pregnancy, and 37 patients had onset of Raynaud's phenomenon after their last pregnancy. The frequency of miscarriage, stillbirth, and small full-term infants was similar in all 3 study groups. Among the 4 Raynaud's phenomenon patients who had second-trimester miscarriages, 2 of 3 who were tested had moderately positive levels of IgG or IgM anticardiolipin antibody. Premature births were significantly more common in pregnancies that occurred after the onset of Raynaud's phenomenon (24%) than in pregnancies that occurred prior to the onset of Raynaud's phenomenon or in pregnancies among control subjects (9% and 1%, respectively). In addition, the mean weight of the full-term babies of women in both Raynaud's phenomenon groups was significantly less than that of babies born to controls. There were no neonatal deaths or other serious adverse outcomes. These findings may represent yet another manifestation of systemic vasospasm in patients with primary Raynaud's phenomenon.

Successful resolution of severe perianal ulceration with photochemotherapy (PUVA)

We report a case of recurrent perianal ulceration associated with gastrointestinal symptoms, but without evidence of underlying disease, that responded to a course of photochemotherapy (PUVA).

Detection of dengue virus type 2 in Aedes albopictus by nucleic acid hybridization with strand-specific RNA probes

A molecular hybridization technique with radiolabeled, strand-specific RNA probes was developed to detect dengue virus type 2 RNA in pools of infected Aedes albopictus mosquitoes. One infected mosquito in a pool of 25 could be detected, corresponding to a dengue virus type 2 titer of 2.75 log10 50% tissue culture infectious doses.

Firing and contractile properties of human lower lip motor units during sustained isometric contractions

Human subjects were taught to generate constant forces with their lips by contracting across a pair of hooks which held the corners of the mouth fixed in place. The force was measured with a strain gauge attached to one of the hooks. The activity of single motor units was recorded during production of small to near maximal levels of force. The recruitment and firing patterns of each unit were observed, and in vivo contractile properties of each unit were estimated using spike-triggered averaging of the high-gain force record. Recruitment of units was observed at all levels of force and recruitment level varied from trial to trial for each unit. Interspike interval variability was high at all levels of force. The twitch tensions of the units were all less than 10 g; the contraction times ranged from 16 to 90 ms. It is hypothesized that the differences between lip and limb motor unit properties in this task reflect the mechanical, anatomic, and neurophysiologic differences between these systems.

Somatosensory projections of cerebellar granule cell layer of giant bushbaby, Galago crassicaudatus

Recent neurophysiological studies of the granule cell (GC) layer in opossums and rats revealed extensive somatosensory projections to the cerebellar hemispheres and caudal vermis. These projections are organized as asomatotopic mosaics that are species-specific. To determine whether similar projections exist in a primate with a relatively small and simple cerebellum, we explored the GC layer of exposed folial crowns of anterior and posterior lobe cerebellar cortex of anesthetized giant galagos using juxtathreshold natural stimulation of mechanoreceptors and in-depth microelectrode micromapping techniques. We found (1) that stimulation of somatosensory mechanoreceptors by gentle touch, deep pressure, muscle stretch and joint movement revealed projections to the GC layer throughout the mediolateral extent of crus II, paramedian lobule, pyramis and rostral uvula (crus I was unresponsive); (2) that mosaic patterns of peripheral sources and submodality of projections were different for each lobule, and (3) that there were intraspecies and individual differences in subfoliation and in details of projections. Except for differences in mosaic pattern and relative size of different projections, these findings are similar to those in opossums and rats. These data suggest that somatosensory inputs to the cerebellum are not only functionally significant, but that they exist widely among mammals.

The illusion of catch-up growth in premature infants. Use of the growth index and age correction

Growth data of 61 premature infants who were observed for 29 months were analyzed to determine if there is validity to the concept of catch-up growth. Weight, length, and head circumference were recorded at each visit. For each measurement, a growth index was calculated to facilitate comparison of infants of different ages and sexes. The age of a child at each visit was also corrected for prematurity by subtracting the number of weeks premature from the postnatal chronological age to generate a corrected age. The corrected age was then used to create a corrected growth index for all variables at each visit. Growth data evaluated in the traditional manner (without correction) suggested that catch-up growth occurred. However, growth data for corrected age more closely approximated the growth of full-term children. Graphic impressions were generally substantiated by Hotelling's T2 tests and factorial and one-way repeated-measures analyses of variance with Bonferroni adjustments. The corrected growth data of appropriate-for-gestational-age children approximated normal expected growth, whereas small-for-gestational-age children still demonstrated subnormal growth at 29 months of age, despite correction. In both appropriate-for-gestational-age and small-for-gestational-age children, catch-up growth appears to be a statistical illusion created by charting growth of premature infants using chronological age rather than the more appropriate corrected age. This finding has important implications for the follow-up of premature infants and may affect the diagnostic interpretation of failure to thrive.