Observation of NH X(3)Σ(-) as a Primary Product of Methylamine Photodissociation: Evidence of Roaming-Mediated Intersystem Crossing?

3+1 Resonance-enhanced multiphoton ionization and photofragment excitation spectroscopy have been used to identify NH X(3)Σ(-) as a primary product of methylamine photodissociation after state-specific excitation to the S1 state. On the basis of standard thermochemical data, NH X(3)Σ(-) can be formed only in conjunction with closed-shell CH4 coproducts, indicating that dissociation must occur on the T1 surface. It is proposed that the mechanism for the formation of triplet NH and CH4 involves intramolecular abstraction between frustrated radical products and is an example of roaming-mediated intersystem crossing.

The co-construction of couplehood in dementia

Much research has investigated the impact of dementia on spousal relationships. Most often this is from the point of view of the spouse, but occasionally people with dementia are interviewed independently or in parallel. The current study was novel in its aim to understand ‘couplehood’ as it is co-constructed by the couple when one partner has dementia and employed an innovative design that involved interviewing couples together about their relationship. Using grounded theory methodology, the study identified the changing identities within couplehood and the strategies couples employ to maintain their relationship, including normalizing, externalizing, sharing the experience and reframing the experience in light of the past. These findings are discussed in relation to other relevant research and suggest that co-constructed accounts of couplehood are valuable not only when researching the experiences of couples with dementia but also in their clinical assessment and treatment.

Voice hearing within the context of hearers' social worlds: an interpretative phenomenological analysis

OBJECTIVES

Research has found relational qualities of power and intimacy to exist within hearer-voice interactions. The present study aimed to provide a deeper understanding of the interpersonal context of voice hearing by exploring participants' relationships with their voices and other people in their lives.

DESIGN

This research was designed in consultation with service users and employed a qualitative, phenomenological, and idiographic design using semi-structured interviews.

METHOD

Ten participants, recruited via mental health services, and who reported hearing voices in the previous week, completed the interviews. These were transcribed verbatim and analysed using interpretative phenomenological analysis.

RESULTS

Five themes resulted from the analysis. Theme 1: 'person and voice' demonstrated that participants' voices often reflected the identity, but not always the quality of social acquaintances. Theme 2: 'voices changing and confirming relationship with the self' explored the impact of voice hearing in producing an inferior sense-of-self in comparison to others. Theme 3: 'a battle for control' centred on issues of control and a dilemma of independence within voice relationships. Theme 4: 'friendships facilitating the ability to cope' and theme 5: 'voices creating distance in social relationships' explored experiences of social relationships within the context of voice hearing, and highlighted the impact of social isolation for voice hearers.

CONCLUSIONS

The study demonstrated the potential role of qualitative research in developing theories of voice hearing. It extended previous research by highlighting the interface between voices and the social world of the hearer, including reciprocal influences of social relationships on voices and coping. Improving voice hearers' sense-of-self may be a key factor in reducing the distress caused by voices.

An evaluation of the Sebia capillarys Neonat Haemoglobin FAST™ system for routine newborn screening for sickle cell disease

The West Midlands Newborn Screening Laboratory (NBSL) at Birmingham Children's Hospital (BCH), UK, screens approximately 71 000 babies per annum using the Bio-Rad automated VARIANT™ nbs (Vnbs) high-pressure liquid chromatograph (HPLC). Any abnormal haemoglobins detected, including S, C, D-Punjab, E and O-Arab as directed by the NHS Sickle Cell and Thalassaemia Screening Programme (NHS Sickle Cell and Thalassaemia Screening Programme Website, http://sct.screening.nhs.uk), are then confirmed using Resolve® isoelectric electric focusing (IEF) kits supplied by Perkin-Elmer. The Sebia capillarys Neonat Haemoglobin FAST™ system was evaluated as a possible replacement for the first- or second-line methods used. Both the Sebia and Bio-Rad methods were compared using anonymized blood spots with known haemoglobin patterns. These results were then confirmed when necessary by IEF. The Sebia-recommended sample preparation was also modified to enable testing to be more comparable with our current processes. Percentages of haemoglobins calculated from integration of areas under the peaks were compared between the Bio-Rad Vnbs HPLC and Sebia capillarys Neonat Haemoglobin FAST™ system. Of the 347 blood spots tested by both HPLC and capillary electrophoresis, there were no significant differences. The Sebia capillarys Neonat Haemoglobin FAST™ system can be used to successfully screen newborns for sickle cell disease in blood spots collected for newborn screening with full positive sample identification and traceability.

Images of the terminal ileum are more convincing than cecal images for verifying the extent of colonoscopy

BACKGROUND AND STUDY AIMS

Independent verification of colonoscopy completion is important for quality assurance. Cecal photographs aimed at showing key landmarks, including the ileocecal valve (ICV) and appendiceal orifice are the currently recommended standard, but are often perceived as unreliable. Images of the terminal ileum demonstrating villi may provide more robust evidence of completion. We sought to prospectively evaluate the ease of routine intubation of the terminal ileum and to compare the effectiveness of terminal ileum and cecal photographs in convincing independent reviewers that total colonoscopy had been accomplished.

PATIENTS AND METHODS

A prospective, observational study evaluated 216 consecutively completed colonoscopies performed in routine clinical practice. Cecal and terminal ileum photographs were evaluated and scored by independent reviewers. Frequency of terminal ileum intubation, time required, and safety parameters were recorded.

RESULTS

The terminal ileum was intubated and photographed in 188/216 (87%) of cases. Median time taken to intubate, or attempt to intubate the terminal ileum was 1 min 24 s, and was achieved without complications or requirement for additional sedation. Terminal ileum images were significantly more likely to be considered convincing than cecal images ( P<0.0001 for all reviewers). There was excellent interobserver agreement amongst the opinion of reviewers regarding terminal ileum photographs (kappa=0.91).

CONCLUSION

Terminal ileum intubation is achievable rapidly and safely in the majority of patients undergoing colonoscopy. Terminal ileum images provide more convincing evidence of complete examination of the colon than cecal images, even when attempts to capture images specifically of the ICV and appendiceal orifice are made.

Vicarious posttraumatic growth among interpreters

An emerging evidence base indicates that posttraumatic growth might be experienced vicariously by those working alongside trauma survivors. In this study we explored the vicarious experiences of eight interpreters working in a therapeutic setting with asylum seekers and refugees. We adopted a qualitative approach, using semistructured interviews and interpretative phenomenological analysis. Four interrelated themes emerged from the findings: feeling what your client feels, beyond belief, finding your own way to deal with it, and a different person. Although all participants experienced distress, they also perceived themselves to have grown in some way. The implications for a theory of vicarious posttraumatic growth are discussed, along with clinical applications.

An interpretative phenomenological analysis of delusions in people with Parkinson's disease

PURPOSE

The aim of this qualitative study was to explore what delusional experiences mean for people with Parkinson's disease (PD) and to examine how psychosocial factors contribute to the development and maintenance of delusional beliefs.

METHOD

Eight participants were interviewed, and interpretative phenomenological analysis was used to identity themes within their accounts. Participants were either recruited from a hospital-based outpatient movement disorder clinic or from a PD support group in the north-west of England.

RESULTS

Four themes emerged from the analysis: (1) 'I got very frightened': The emotional experience associated with delusions; (2) 'Why the hell's that happening?': Sense of uncertainty and of losing control; (3) 'I feel like I'm disintegrating': Loss of identity and sense of self; (4) 'I've just tried to make the best of things': Acceptance and adjustment to experience of delusions. These interconnected themes in participants' accounts of delusional beliefs were reflected in their descriptions of living with, and adjusting to, PD.

CONCLUSIONS

The results of this study add to the evidence base indicating the urgent examination of psychological alternatives to conventional, medication-based approaches to alleviating the distress caused by delusions in people with PD.

General practice out-of-hours service in Ireland provides a new source of syndromic surveillance data on influenza

The use of routinely available electronic sources of healthcare data on the spread of influenza has the potential to enhance current surveillance activities. This study aimed to develop a method for identifying influenza-related records from general practitioner (GP) out-of-hours (OOH) services in Ireland. Data from one such service were interrogated for keywords relating to influenza-like illness (ILI) and a proxy measure of influenza activity in the community setting was developed. Comparison of this syndromic surveillance measure with national data on ILI consultation rates demonstrated a statistically significant temporal correlation. In five out of six influenza seasons investigated, peaks in the GP OOH influenza-related calls appeared at least one week ahead of peaks in the national ILI consultation rates. The method described in this paper has been extended to nine OOH services in Ireland (covering 70% of the Irish population) to provide weekly figures on self-reported illness for influenza in the community and its data have been incorporated into the national weekly influenza reports produced by the Health Protection Surveillance Centre. These data should provide early warnings of both seasonal and pandemic influenza in Ireland.

General practice out-of-hours service in Ireland provides a new source of syndromic surveillance data on influenza

The use of routinely available electronic sources of healthcare data on the spread of influenza has the potential to enhance current surveillance activities. This study aimed to develop a method for identifying influenza-related records from general practitioner(GP) out-of-hours (OOH) services in Ireland. Data from one such service were interrogated for keywords relating to influenza-like illness (ILI) and a proxy measure of influenza activity in the community setting was developed. Comparison of this syndromic surveillance measure with national data on ILI consultation rates demonstrated a statistically significant temporal correlation.In five out of six influenza seasons investigated,peaks in the GP OOH influenza-related calls appeared at least one week ahead of peaks in the national ILI consultation rates. The method described in this paper has been extended to nine OOH services in Ireland (covering 70% of the Irish population) to provide weekly figures on self-reported illness for influenza in the community and its data have been incorporated into the national weekly influenza reports produced by the Health Protection Surveillance Centre. These data should provide early warnings of both seasonal and pandemic influenza in Ireland.

Comparison of three methods to detect mutations in the PI3K oncogene in FFPE cancer samples

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Background: PI3Kinase is an important target for new oncology therapies, since it is central to several cell signalling pathways associated with proliferation and survival. Many pharmaceutical companies have PI3K inhibitors in their drug development pipelines all of which are in early phase trials. Activating mutations in exons 9 and 20 of the PI3KCA oncogene have been observed in a number of important cancer types including: gastrointestinal, breast, liver, lung and genito-urinary cancers. The presence of such mutations may prove useful as companion diagnostic biomarkers for prediction of response to therapy. Methods: Source BioScience (Nottingham, UK) tested three different methods for the detection of PI3K mutations in archival tumour samples, in their CPA and GLP accredited laboratories. Eighty formalin-fixed paraffin-embedded (‘FFPE') samples from histologically confirmed breast cancer samples were tested by the new DxS P13K Mutation Test Kit using real-time PCR, by pyrosequencing (Qiagen), and by conventional bidirectional capillary sequencing. Tumour content was evaluated by pathology review. Results: The results of the comparison showed that the DxS test using rtPCR technology was easy to perform, convenient and robust. The DxS test had a high degree of sensitivity provided there was more than 20% tumour content in the test sample as determined by histology and pathology review. Conclusions: In conclusion, the DxS test is a valuable tool for detecting PI3K mutations in FFPE samples from breast cancer patients.

No significant financial relationships to disclose.

Weakly bound molecules in the atmosphere: a case study of HOOO

Weakly bound molecules--particularly hydrated complexes of abundant atmospheric species--have long been postulated to play an important role in atmospherically relevant reactions. For example, such complexes could seed cloud formation and alter the global radiation budget. In this Account, we initially describe the current data on weakly bound species produced in association reactions of the hydroxyl radical (OH) with molecular partners, particularly oxygen (O(2)), nitric acid (HONO(2)), and nitrogen dioxide (NO(2)). Researchers have identified weakly bound association products of these reactions as the hydrogen trioxy (HOOO) radical, the doubly hydrogen-bonded OH-HONO(2) complex, and peroxynitrous acid (HOONO), respectively. In each case, previous kinetic studies of the reaction or OH vibrational relaxation processes have indicated unusual, non-Arrhenius behavior. Under the temperature-pressure conditions of the Earth's lower atmosphere, these processes exhibit a negative temperature dependence, indicative of an attractive interaction, or a pressure dependence. Researchers have subsequently carried out extensive theoretical studies of the properties of these weakly bound molecules, but the theoretical studies have lacked experimental validation. Next, we describe experimental studies to determine the vibrational frequencies and stability of HOOO as a prototypical example of these weakly bound molecules. We then use these data to assess its importance in the atmosphere. We discuss the efficient production of the HOOO radical from OH and O(2) under laboratory conditions and its subsequent detection using infrared action spectroscopy, a highly sensitive and selective double resonance technique. Using excitation of OH stretch and combination bands comprising OH stretch with lower frequency modes, we obtain detailed spectroscopic information on the vibrational modes of the two conformers of HOOO. In addition, we infer fundamental information about the dissociation dynamics from the OH product state distribution, which provides insight into the chemical bonding in HOOO. Perhaps most importantly, we utilize a simple conservation of energy relationship based on the highest energetically open OH product state to derive a rigorous upper limit for the stability of HOOO relative to the OH + O(2) asymptote of 5.3 kcal mol(-1). When combined with previous experimental rotational constants that reflect the structure of the HOOO radical, our laboratory characterization of its stability and vibrational frequencies provides critical information to assess its thermochemical properties. Using standard statistical mechanics approaches, we can calculate the likely atmospheric abundance of HOOO. We estimate that up to 25% of the OH radicals in the vicinity of the tropopause may be associated with O(2) as a weakly bound molecule.

The effect of mushroom and pokeweed extract on salmonella, egg production, and weight loss in molting hens

An experiment was conducted to evaluate the effects of mushroom and pokeweed extract alone or in combination with alfalfa meal on Salmonella spp. population, egg production, and weight loss in laying hens during a 10-d molting period. The trial used 54 active laying hens approximately 77 wk of age that were naturally infected with Salmonella spp. The layers were subjected to 1 of 9 treatment groups, replicated 3 times with 2 hens per replicate cage. The treatment conditions were as follows: 1) full-fed + H(2)0 (FFW), 2) full-fed + mushroom (FFM), 3) full-fed + pokeweed (FFP), 4) nonfed + H(2)0 (NFW), 5) nonfed + mushroom (NFM), 6) nonfed + pokeweed (NFP), 7) full-fed alfalfa meal + H(2)0 (FFAW), 8) full-fed alfalfa meal + mushroom (FFAM), and 9) full-fed alfalfa meal + poke-weed (FFAP). The results showed that the base-10 logarithm values of Salmonella from the ceca significantly increased (P <or= 0.05) in treatment NFW (3.48), NFM (3.22), and FFAW (3.33), whereas the greatest reduction was observed in treatment FFAM (2.72). The number of Salmonella bacteria recovered from the crop was significantly greater in the NFW treatment (3.43) and lowest in treatment FFAM (2.62). Treatment FFAM (30.0%) had the lowest BW loss and differed significantly from treatment NFW (42.3%), NFM (39.7%), and NFP (41.5%) but not from FFAW (38.0%) and FFAP (34.0%). Ovary weights for treatments NFW, NFP, FFAM, and FFAP did not differ significantly from each other but did so for NFM and FFAW (38.0%), which had the lowest weight. Return to egg production at 2 mo lagged behind in treatments FFAM, NFP, and FFM more than in any other treatments. At 3 mo, treatments FFAAM and NFW differed from the other treatments. Findings indicate that a greater decrease in the natural Salmonella population in the ceca and crop can be obtained with the combination of full-fed alfalfa plus mushroom extract in molting hens and induce a comparable molt with feed withdrawal.

Idiopathic chondrolysis condition in two young, wild-caught Cynomolgus monkeys (Macaca fascicularis) reared in captivity

Idiopathic chondrolysis is a human clinical entity typically reported in adolescent individuals. In this brief communication, we report 2 cases of presumptive idiopathic chondrolysis of the femoral head in Cynomolgus macaques and discuss the clinical symptomatology and pathology of the disease. In detail, we describe the histomorphologic changes of idiopathic chondrolysis and compare these findings with those typically observed in the primary differential diagnoses of Legg-Calve-Perthes disease and nonspecific osteoarthritis. Consideration of this entity among differential diagnoses in young Cynomolgus macaques with unilateral osteoarthritis could be important both for laboratory animal veterinarians and pathologists.

Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis

BACKGROUND

Early endometrial cancer with low-risk pathological features can be successfully treated by surgery alone. External beam radiotherapy added to surgery has been investigated in several small trials, which have mainly included women at intermediate risk of recurrence. In these trials, postoperative radiotherapy has been shown to reduce the risk of isolated local recurrence but there is no evidence that it improves recurrence-free or overall survival. We report the findings from the ASTEC and EN.5 trials, which investigated adjuvant external beam radiotherapy in women with early-stage disease and pathological features suggestive of intermediate or high risk of recurrence and death from endometrial cancer.

METHODS

Between July, 1996, and March, 2005, 905 (789 ASTEC, 116 EN.5) women with intermediate-risk or high-risk early-stage disease from 112 centres in seven countries (UK, Canada, Poland, Norway, New Zealand, Australia, USA) were randomly assigned after surgery to observation (453) or to external beam radiotherapy (452). A target dose of 40-46 Gy in 20-25 daily fractions to the pelvis, treating five times a week, was specified. Primary outcome measure was overall survival, and all analyses were by intention to treat. These trials were registered ISRCTN 16571884 (ASTEC) and NCT 00002807 (EN.5).

FINDINGS

After a median follow-up of 58 months, 135 women (68 observation, 67 external beam radiotherapy) had died. There was no evidence that overall survival with external beam radiotherapy was better than observation, hazard ratio 1.05 (95% CI 0.75-1.48; p=0.77). 5-year overall survival was 84% in both groups. Combining data from ASTEC and EN.5 in a meta-analysis of trials confirmed that there was no benefit in terms of overall survival (hazard ratio 1.04; 95% CI 0.84-1.29) and can reliably exclude an absolute benefit of external beam radiotherapy at 5 years of more than 3%. With brachytherapy used in 53% of women in ASTEC/EN.5, the local recurrence rate in the observation group at 5 years was 6.1%.

INTERPRETATION

Adjuvant external beam radiotherapy cannot be recommended as part of routine treatment for women with intermediate-risk or high-risk early-stage endometrial cancer with the aim of improving survival. The absolute benefit of external beam radiotherapy in preventing isolated local recurrence is small and is not without toxicity.

Vascular cell responsiveness to Toll-like receptor ligands in carotid atheroma

BACKGROUND

Atherosclerosis is potentiated by stimulation of Toll-like receptors (TLRs), which serve to detect pathogen associated molecular patterns (PAMPs). However little is known of which PAMPs may be present in atheroma, or capable of stimulating inflammatory signalling in vascular cells.

MATERIALS AND METHODS

DNA extracted from human carotid atheroma samples was amplified and sequenced using broad-range 16S gene specific primers to establish historical exposure to bacterial PAMPs. Responsiveness of primary human arterial and venous endothelial and smooth muscle cells to PAMPs specific for each of the TLRs was assessed by measurement of interleukin-8 secretion and E-selectin expression.

RESULTS

Extracts of atheromatous tissue stimulated little or no signalling in TLR-transfected HEK-293 cells. However, sequencing of bacterial DNA amplified from carotid atheroma revealed the presence of DNA from 17 different bacterial genera, suggesting historical exposure to bacterial lipopeptide, lipopolysaccharide and flagellin. All cells examined were responsive to the ligands of TLR3 and TLR4, poly inosine:cytosine and lipopolysaccharide. Arterial cells were responsive to a wider range of PAMPs than venous cells, being additionally responsive to bacterial flagellin and unmethylated cytosine-phosphate-guanosine DNA motifs, the ligands of TLR5 and TLR9, respectively. Cells were generally unresponsive towards the ligands of human TLR7 and TLR8, loxoribine and single stranded RNA. Only coronary artery endothelial cells expressed TLR2 mRNA and responded to the TLR2 ligand Pam(3)CSK(4).

CONCLUSIONS

Vascular cells are responsive to a relatively diverse range of TLR ligands and may be exposed, at least transiently, to ligands of TLR2, TLR4, TLR5 and TLR9 during the development of carotid atheroma.

The impact of legislation in Ireland on handheld mobile phone use by drivers

Under the Road Traffic Act, 2006 handheld mobile phone use whilst driving is an offence liable to a fine and penalty points. The aim of this study was to determine whether there has been a change in driver behaviour following the introduction of this legislation. This study found that 2.3% of drivers were still using a handheld mobile phone.

The efficacy and harm of prostaglandin analogues for IOP reduction in glaucoma patients compared to dorzolamide and brimonidine: a systematic review

AIM

To systematically review the literature on the efficacy and harm of prostaglandin analogues (PGAs) compared to brimonidine and dorzolamide in treating elevated intraocular pressure (IOP).

METHODS

Keywords were searched in major literature databases to identify relevant randomised clinical trials (RCTs) of PGAs for ophthalmic use. The study quality of RCTs was assessed using the Jadad scale. Outcomes assessed included reduction in IOP in individual patients, adverse events (AEs) and withdrawals due to AEs.

RESULTS

Eight unique RCTs evaluating a total of 1,722 individuals were included in this systematic review. Analysis did not show a significant reduction in the mean IOP from patients receiving latanoprost compared with those receiving brimonidine (WMD = -1.04; p = 0.30). On the other hand, the latanoprost group showed a significant reduction in mean IOP compared to the dorzolamide group (WMD = -2.64; p<0.00001). The number of ocular AEs (excluding hyperaemia) was significantly higher in the brimonidine group compared with the latanoprost group (RR = 0.66; p = 0.0005).

CONCLUSION

Latanoprost was found to be significantly superior to dorzolamide but not brimonidine. However, ocular adverse events were significantly fewer in latanoprost users than in brimonide users. Neither travoprost nor bimatoprost was compared to dorzolamide or brimonidine in the present literature.

Examining a community model of epilepsy care for people with learning disabilities

PURPOSE

To assess the use of specialised medical epilepsy services by people with learning disabilities (LD) and epilepsy in a community healthcare setting, to compare medical epilepsy care in this group to current management guidelines, and to contrast important outcomes with those achieved in different healthcare settings.

METHODS

Postal survey with a carer completed questionnaire addressed to all adults with epilepsy registered on an LD register in Sheffield, UK (n=442).

RESULTS

An analysis based on 225 returned questionnaires revealed that 22.7% of individuals with LD and epilepsy had been free of seizures for over 1 year. 95.1% were taking antiepileptic drugs (AEDs), 46.2% had had an EEG, and 41.3% a brain scan. 53.3% of diagnoses had been made by epilepsy experts, 38.7% of individuals with LD and epilepsy were under specialist review. Although patients with more severe epilepsy were more likely to be under specialist care, 60.6% of patients with ongoing seizures, 57.9% with major seizures and 68.7% of individuals taken to hospital with prolonged had no access to specialist advice.

CONCLUSION

The proportion of people with LD who achieved seizure-control in the described population was lower than in all previously reported studies of LD patient groups. The poor outcome in terms of seizure-control, the lack of access to the epilepsy specialist service, and the apparent under-utilisation of investigations indicate that there are grounds for serious concern about this community model of medical epilepsy care for people with LD.

Expressed sequence tags from the midgut of Epiphyas postvittana (Walker) (Lepidoptera: Tortricidae)

The midgut is a key tissue in insect science. Physiological roles include digestion and peritrophic membrane function, as well as being an important target for insecticides. We used an expressed sequence tag (EST) approach to identify candidate genes and gene families involved in these processes in the light brown apple moth, Epiphyas postvittana (Walker) (Lepidoptera: Tortricidae). Two cDNA libraries were constructed from dissected midgut of third to fifth instar larvae. Clustering analysis of 6416 expressed sequence tags produced 1178 tentative unique genes comprising 725 tentative contigs and 453 singletons. The sequences show similar codon usage to sequences from other lepidopterans, a Kozak consensus sequence similar to Drosophila and single nucleotide polymorphisms (SNPs) were detected at a frequency of 1.35/kb. The identity of the most common Interpro families correlates well with major known functions of the midgut. Phylogenetic analysis was conducted on representative sequences from selected multigene families. Gene families include a broad range of digestive proteases, lipases and carbohydrases that appear to have degradative capacity against the major food components found in leaves, the diet of these larvae; and carboxylesterases, glutathione-S-transferases and cytochrome P450 monooxygenases, potentially involved in xenobiotic degradation. Two of the larger multigene families, serine proteases and lipases, expressed a high proportion of genes that are likely to be catalytically inactive.