Why do women go along with this stuff?

Normal childbirth has become jeopardized by inexorably rising interventions around the world. In many countries and settings, cesarean surgery, labor induction, and epidural analgesia continue to increase beyond all precedent, and without convincing evidence that these actions result in improved outcomes (1,2). Use of electronic fetal monitoring is endemic, despite evidence of its ineffectiveness and consequences for most parturients (1,3); ultrasound examinations are too often done unnecessarily, redundantly, or for frivolous rather than indicated reasons (4); episiotomies are still routine in many settings despite clear evidence that this surgery results in more harm than good (5); and medical procedures, unphysiological positions, pubic shaving and enemas, intravenous lines, enforced fasting, drugs, and early mother-infant separation are used unnecessarily (1). Clinicians write and talk about the ideal of evidence-based obstetrics, but do not practice it consistently, if at all. Why do women go along with this stuff? In this Roundtable Discussion, Part 1, we asked some maternity care professionals and advocates to discuss this question.

Cutting Edge: B and T Lymphocyte Attenuator and Programmed Death Receptor-1 Inhibitory Receptors Are Required for Termination of Acute Allergic Airway Inflammation

T cell activation is regulated by coordinate interaction of the T cell Ag receptor and costimulatory signals. Although there is considerable insight into processes that regulate the initiation of inflammation, less is known about the signals that terminate immune responses. We have examined the role of the inhibitory receptors programmed death receptor-1 and B and T lymphocyte attenuator in the regulation of allergic airway inflammation. Our results demonstrate that there is a temporally regulated expression of both the receptors and their ligands during the course of allergic airway inflammation. Following a single inhaled challenge, sensitized wild-type mice exhibit peak inflammation on day 3, which resolves by day 10. In contrast, mice deficient in the expression of programmed death receptor-1 or B and T lymphocyte attenuator have persistent inflammation out to 15 days following challenge. Thus, these receptors are critical determinants of the duration of allergic airway inflammation.

The host response of CD28-deficient mice to Pneumocystis infection

Pneumocystis infection leads to a life threatening pneumonia in susceptible individuals. While depletion or dysfunction of CD4+T cells is a key determinant of susceptibility to Pneumocystis, the host response that leads to resolution of infection or lung injury is less well understood. We had previously shown that mice deficient in the T cell costimulatory molecule CD28 are susceptible to infection with Pneumocystis. A detailed analysis revealed that they clear Pneumocystis with delayed kinetics. This is associated with an influx of naïve CD8+ T cells. Depletion of CD8+ T cells did not alter organism burden, suggesting these cells are not responsible for clearance. Analysis of the cytokine milieu demonstrated a consistent increase in mRNA for IL-10 and IFN-gamma in the CD28-deficient mice. These data suggest that CD28 function in important in the efficiency of the host response to Pneumocystis pneumonia.

RPE-lactate dissociation during extended cycling

This study examined the association of blood lactate concentration [La] and heart rate (HR) with ratings of perceived exertion (RPE) during 60 min of steady workload cycling. Physically active college-aged subjects (n = 14) completed an exhaustive cycling test to determine VO(2) (peak) and lactate threshold (2.5 mmol l(-1)). Subjects then cycled for 60 min at the power output associated with 2.5 mmol l(-1) [LA]. HR, [LA], RPE-overall, RPE-legs and RPE-chest were recorded at 5, 10, 20, 30, 40, 50 and 60 min. The 60-min trials were below maximal lactate steady state, with peak lactate concentration occurring at 20 min after which [LA] declined. The 20-min point was therefore considered pivotal, and data at other points were compared to this time point. Repeated measures ANOVA with simple contrasts (alpha = 0.05) showed (a) [LA] at 40, 50 and 60 min was significantly lower than at 20 min, (b) RPE-O and RPE-L were significantly greater at 30, 40, 50 and 60 min than at 20 min, (c) RPE-C was significantly greater at 40, 50 and 60 min than at 20 min, and (d) HR was significantly greater at 30, 40, 50 and 60 min than at 20 min. Significant (P < 0.05) positive correlations were found between HR and RPE-O (r = 0.43), RPE-L (r = 0.48) and RPE-C (r = 0.41) while correlations for [LA]-HR (r = 0.13) and [LA]-RPE (RPE-O: r = -0.11, RPE-L: r = 0.01, RPE-C: r = -0.06) were weak and non-significant. There is a dissociation of RPE and [LA] owing to RPE drift and lactate kinetics in longer duration sub-maximal exercise. Apparently, [LA] is not a strong RPE mediator during extended cycling.

Psychosocial aspects of genetic screening of pregnant women and newborns: a systematic review

OBJECTIVES

To address five broad questions concerned with knowledge, anxiety, factors associated with participation/non-participation in screening programmes and the long-term sequelae of false-positive, true-positive in newborns and true-negative results.

DATA SOURCES

Five electronic databases, two journals and attempts were made to locate unpublished work.

REVIEW METHODS

This review started from a substantial literature base that provided the basis for (a) scoping the literature, (b) informing search strategy terms and (c) identifying preliminary article inclusion and exclusion criteria. The main eligibility criteria were: any screening programme aimed at pregnant women or newborn babies that included a 'genetic' target condition, this included chromosomal anomalies; any study that reported psychosocial data collected directly from parents. The data extraction form developed for this study elicited data from the selected studies. The data were entered into a database, which provided a summary of the included papers.

RESULTS

A total of 288 candidate publications were identified, 106 of which were eligible: 78 were concerned with antenatal screening and 28 with newborn screening. It was found that levels of knowledge adequate for decision-making were not being achieved despite information leaflets and videos having some effect. Studies that have succeeded in increasing knowledge have not observed a corresponding increase in anxiety, although some anxiety might be an appropriate response and may aid coping and decision-making. Anxiety is clearly raised in women receiving positive screening results, especially young women. However, evidence is lacking of a beneficial (i.e. reassuring) effect of receiving a screen-negative result. Anxiety in screen-positive women falls on receipt of subsequent reassuring results, but some residual anxiety may remain. A minority (perhaps up to 30%) of women receiving a screen-positive result in pregnancy expressed regret about their screening decision. Uptake of neonatal screening has been treated as a 'given' and not as a research topic.

CONCLUSIONS

The results of this review have many implications for the work of the National Screening Committee. The most pressing of these, in order of priority, relate to: the inadequacy of current procedures for achieving informed consent; the cost of providing a satisfactory service; the unmet needs of 'false-positives', and the unmet needs of women's partners, particularly in carrier screening. It is suggested that research is conducted on the above four topics in order to fill gaps in the evidence base that relate to screening technologies which have been available for many years. In addition, future screening programmes will create a new list of research questions, based on the same main agenda but applied to new areas, for example, new conditions such as haemoglobinopathies and fragile X syndrome; new client groups such as young women and minority ethnic groups; and new testing modalities such as ultrasound.

Requirement for CD28 in the effector phase of allergic airway inflammation

Central to the pathogenesis of allergic airway inflammation are the activation and differentiation of T lymphocytes. This process requires the participation of the CD28 costimulatory receptor. Blockade of CD28 has been demonstrated to prevent inflammation and airway hyperreactivity in a murine model of asthma. Whether this is due specifically to defects in initial T cell activation or whether effector responses are also impaired has not been determined. Using adoptive transfer studies of Ag-specific lymphocytes, we demonstrate that CD28 has a critical role in both the induction and effector phase of allergic airway inflammation. Transfer of in vitro activated and Th2-differentiated Ag-specific lymphocytes from wild-type hosts restored inflammation, but not tissue eosinophilia in CD28-deficient recipients. Furthermore, similarly activated and differentiated CD28-deficient lymphocytes were ineffective at mediating inflammation in wild-type recipients. Secondary cytokine and proliferative responses of activated Th2 cells were highly dependent on CD28 in vitro. Moreover, eosinophil recruitment to both the lung and peritoneum is impaired by the lack of CD28, suggesting a generalized defect in the ability of eosinophils to accumulate at sites of inflammation in vivo. These data identify a novel role for CD28 in the effector phase of allergic airway inflammation and suggest that inhibition of this pathway may be a useful therapeutic intervention in previously sensitized individuals.

Sweat lactate response during cycling at 30°C and 18°C WBGT

Sweat lactate reflects eccrine gland metabolism. However, the metabolic tendencies of eccrine glands in a hot versus thermoneutral environment are not well understood. Sixteen male volunteers completed a maximal cycling trial and two 60-min cycling trials [30 degrees C = 30 +/- 1 degrees C and 18 degrees C = 18 +/- 1 degrees C wet bulb globe temperature (WBGT)]. The participants were requested to maintain a cadence of 60 rev min(-1) with the intensity individualized at approximately 90% of the ventilatory threshold. Sweat samples at 10, 20, 30, 40, 50 and 60 min were analysed for lactate concentration. Sweat rate at 30 degrees C (1380 +/- 325 ml x h(-1)) was significantly greater (P < 0.05) than at 18 degrees C (632 +/- 311 ml x h(-1)). Sweat lactate concentration was significantly greater (P < 0.05) at each time point during the 18 degrees C trial, with values between trials tending to converge across time. During the 30 degrees C trial, both heart rate (20, 30, 40, 50 and 60 min) and rectal temperature (30, 40, 50 and 60 min) were significantly higher than in the 18 degrees C trial. Higher sweat lactate concentrations coupled with lower sweat rates may indicate a greater relative contribution of oxygen-independent metabolism within eccrine glands during exercise at 18 degrees C. Decreases in sweat lactate concentration across time suggest either greater dilution due to greater sweat volume or increased reliance on aerobic metabolism within eccrine glands. The convergence of lactate concentrations between trials may indicate that time-dependent modifications in sweat gland metabolism occur at different rates contingent partially on environmental conditions.

Expression of CD30 and Ox40 on T lymphocyte subsets is controlled by distinct regulatory mechanisms

Members of the TNF receptor (TNFR) superfamily are cell-surface proteins that can be found on most cell types including lymphocytes. Although some TNFR-related molecules are constitutively expressed, others, such as CD30 and Ox40, are induced upon activation of lymphocytes. CD30 and Ox40 are predominantly expressed on activated T helper (T(h))2 cells. Both receptors can activate c-Jun N-terminal kinase (JNK) and nuclear factor-kappaB (NF-kappaB) and have been suggested to play costimulatory roles in lymphocyte activation. To gain further insight into events triggered by both TNFR-related molecules, a detailed analysis of their expression patterns has been performed. We found that CD30 and Ox40 were coexpressed on T(h)2 cells. However, in contrast to CD30, Ox40 was also expressed on T(h)1 cells. Although expression of both receptors is augmented by interleukin-4, only CD30 expression is dependent on signal transducer and activator of transcription (STAT)-6-mediated signaling. Differences in the regulatory pathways controlling expression of CD30 and Ox40 suggest distinct, functional effects triggered by the two TNFR-related molecules during lymphocyte activation.

Sweat lactate response between males with high and low aerobic fitness

Sweat lactate indirectly reflects eccrine gland metabolism. However the potential influence of aerobic fitness on sweat lactate is not well-understood. Six males with high aerobic fitness [peak oxygen consumption ( VO(2)peak): 61.6 (2.5) ml.kg(-1).min(-1)] and seven males with low aerobic fitness [ VO(2)peak: 41.8 (6.4) ml.kg(-1).min(-1)] completed a maximal exertion cycling trial followed on a different day by 60 min of cycling (60 rev.min(-1)) in a 30 degrees C wet bulb globe temperature environment. Intensity was individualized at 90% of the ventilatory threshold ( V(E)/ VO(2) increase with no concurrent V(E)/ VCO(2) increase). Sweat samples were collected from the lumbar region every 10 min and analyzed for lactate concentration. Sweat rate (SR) was significantly greater ( p<0.05) for subjects with a high [1445 (254) ml.h(-1)] versus a low [1056 (261) ml.h(-1)] fitness level. Also, estimated total lactate excretion (SRxmean sweat lactate concentration) was marginally greater ( p=0.2) in highly fit males. However, repeated measures ANOVA showed no significant differences ( p>0.05) between groups for sweat lactate concentration at any time point. Current results show highly fit (vs. low fitness level) males have a greater sweat rate which is consistent with previous literature. However aerobic fitness and subsequent variations in SR do not appear to influence sweat lactate concentrations in males.

T cell costimulatory molecule function determines susceptibility to infection with Pneumocystis carinii in mice

Loss of T cell number and function during HIV infection or secondary to pharmacologic immunosuppression renders individuals susceptible to opportunistic infections, including Pneumocystis carinii pneumonia. Because costimulatory receptors are critical for optimal T cell function, we hypothesized that these proteins would regulate susceptibility to opportunistic infections. We found that despite normal T cell numbers, mice deficient in the costimulatory molecules CD2 and CD28 spontaneously developed P. carinii pneumonia. In experiments using intratracheal injection of P. carinii organisms to induce infection, the loss of CD28 alone was sufficient to render mice susceptible to acute infection; however, the organism was eventually cleared. Examination of inflammatory responses to P. carinii revealed that mice deficient in both CD2 and CD28 accumulated CD8(+) T cells in their lungs in response to infection and demonstrated markedly reduced specific Ab titers. Analysis of cytokine profiles suggested that regulation of IL-10 and IL-15 may be important elements of the response to this pathogen. Thus, costimulatory molecule function is critical in determining the initial susceptibility to infection with P. carinii. Analysis of immunologic responses in these mice may provide important insights into the defects that render individuals susceptible to opportunistic infection, and provide opportunities for novel immunologically based therapies.

Mitochondria control of cell death induced by anti-HLA-DR antibodies

We have previously reported that crosslinking HLA-DR directly induces programmed cell death of malignant B cells. The present study further characterizes the biochemical mechanism for HLA-DR-mediated programmed cell death of tumor cells. Phosphatidylserine exposure on the plasma membrane and propidium iodide incorporation occur with very rapid kinetics and are observed as early as 10 min after the induction of cell death with anti-HLA-DR. In striking contrast to anti-CD95, we observe no activation of caspase-3, -8, or -9 upon anti-HLA-DR addition. Furthermore, the irreversible caspase inhibitor Z-VAD.fmk also failed to inhibit anti-HLA-DR-mediated cell death, further supporting the conclusion that HLA-DR induces cell death via a caspase-independent mechanism. We demonstrate that anti-HLA-DR-induced cell death is instead associated with a rapid disruption of the inner mitochondrial transmembrane potential, DeltaPsi(m), a process that is significantly inhibited by Bcl-2 overexpression. Furthermore, we find that DeltaPsi(m) disruption results in the selective release of apoptosis-inducing factor (AIF) from the mitochondria. We propose that AIF is acting to initiate the morphological and biochemical changes observed in HLA-DR-mediated cell death.

Overall and differentiated ratings of perceived exertion at the respiratory compensation threshold: effects of gender and mode

Research on gender differences in ratings of perceived exertion (RPE) has been equivocal with few studies comparing exercise modes and differentiated RPE. The current study examined gender differences in overall and differentiated RPE at the respiratory compensation threshold (RCT) during cycling and treadmill exercise. Each minute during a maximal treadmill and maximal cycling test, men (n=18) and women (n=16) estimated RPE corresponding to overall (RPE-O), legs (RPE-L), and breathing/chest (RPE-C) exertion. A 2 (gender) x 2 (mode) x 3 (RPE-O, RPE-L, RPE-C) repeated measures MANOVA revealed no significant mode x gender or RPE x gender interactions. The exercise mode x RPE interaction approached significance (P=0.055) when cycling [mean (SD) 14.8 (2.9)] and treadmill exercise [12.8 (2.9)] were compared. No main effects for gender [men: 13.7 (2.6), women: 13.4 (2.6)] were detected. Main effects for mode showed RPE to be significantly greater during cycling [14.4 (2.8)] versus treadmill exercise [12.7 (2.9)]. Main effects for differentiated RPE showed RPE-L [13.8 (2.6)] to be significantly greater than RPE-O [13.5 (2.6)] and RPE-C [13.3 (2.6)]. Results suggest that overall and differentiated RPE at the RCT are not significantly different between genders during cycling or treadmill exercise. While RPE-L was statistically greater than RPE-O and RPE-C, the magnitude of the differences makes this result of little practical significance. The marginal interaction suggests greater RPE-L values might be expected at the RCT during cycling versus treadmill exercise. However, results suggest that minimal RPE differences exist between men and women during cycling and treadmill exercise.

Activation of human CD4+ cells with CD3 and CD46 induces a T-regulatory cell 1 phenotype

The immune system must distinguish not only between self and non-self, but also between innocuous and pathological foreign antigens to prevent unnecessary or self-destructive immune responses. Unresponsiveness to harmless antigens is established through central and peripheral processes. Whereas clonal deletion and anergy are mechanisms of peripheral tolerance, active suppression by T-regulatory 1 (Tr1) cells has emerged as an essential factor in the control of autoreactive cells. Tr1 cells are CD4+ T lymphocytes that are defined by their production of interleukin 10 (IL-10) and suppression of T-helper cells; however, the physiological conditions underlying Tr1 differentiation are unknown. Here we show that co-engagement of CD3 and the complement regulator CD46 in the presence of IL-2 induces a Tr1-specific cytokine phenotype in human CD4+ T cells. These CD3/CD46-stimulated IL-10-producing CD4+ cells proliferate strongly, suppress activation of bystander T cells and acquire a memory phenotype. Our findings identify an endogenous receptor-mediated event that drives Tr1 differentiation and suggest that the complement system has a previously unappreciated role in T-cell-mediated immunity and tolerance.

Polar redistribution of the sialoglycoprotein CD43: implications for T cell function

Contact between T cells and APCs results in the orchestrated segregation of molecules at the cell-cell interface and formation of a specialized structure termed the immunological synapse. This model predicts the topological seclusion of large molecules such as CD43 from the site of closest contact between the T cell and APC, allowing for the close apposition of cell membranes and effective TCR engagement. Similarly, during T cell migration segregation of CD43 to the uropod is thought to aid integrin adhesion at the leading edge of the cell by removing steric hindrance. We show in this work that CD43 distribution on T cells is regulated by a membrane proximal ezrin binding site and that failure to displace CD43 from the immunological synapse has no inhibitory effects on primary T cell activation. We also report that CD43 expression at the contact zone between T cells and matrix does not negatively regulate motility but may regulate LFA-1 de-adhesion. These results suggest that the steric barrier model of CD43 is inadequate and that alternative mechanisms account for the negative regulatory properties of CD43.

Physiological responses at 0% and 10% treadmill incline using the RPE estimation-production paradigm

BACKGROUND

This study examined physiological responses during 0% and 10% inclined treadmill exercise at prescribed ratings of perceived exertion (RPE) using the perceptual estimation-production paradigm.

METHODS

RPE's were estimated during a Bruce treadmill test to volitional exhaustion. Subjects then produced individually prescribed RPE's (associated with 50% and 70% VO2max) during level (0% grade) and inclined (10% grade) treadmill exercise. Heart rate response (HR) and oxygen consumption (VO2) were compared between estimation (EST), level production (LPR), and incline production (IPR) trials using one-way repeated measures ANOVA. Results were considered significant at < or = 0.05.

RESULTS

At 50% VO2max, HR and VO2 were not significantly different between EST (134 +/- 13 b x min-1, 27.1 +/- 5.6 ml x kg x min-1) and IPR (139 +/- 18 b x min-1, 30.6 +/- 11.2 ml x kg x min-1). However, HR and VO2 during LPR (123 +/- 20 b x min-1, 24.3 +/- 8.8 ml x kg x min-1) were significantly lower than IPR. For 70% VO2max, HR and VO2 were not significantly different between EST (168 +/- 9 b x min-1, 42.1 +/- 9.4 ml x kg x min-1) and IPR (169 +/- 14 b x min-1, 41.1 +/- 10.2 ml x kg x min-1). However HR and VO2 during LPR (155 +/- 17 b x min-1, 35.1 +/- 8.1 ml x kg x min-1) were significantly lower than during EST and IPR.

CONCLUSIONS

Results suggest physiological responses during RPE estimation-production trials correspond better when estimation and production trials were performed at a similar treadmill incline. For exercise prescription purposes, RPE estimations made during inclined treadmill exercise may require adjustments to achieve appropriate intensities during level treadmill exercise.

Probability of assertive behaviour, interpersonal anxiety and self-efficacy of South African registered dietitians

OBJECTIVES

There is little information on the probability of assertive behaviour, interpersonal anxiety and self-efficacy in the literature regarding dietitians. The objective of this study was to establish baseline information of these attributes and the factors affecting them.

METHOD

Questionnaires collecting biographical information and self-assessment psychometric scales measuring levels of probability of assertiveness, interpersonal anxiety and self-efficacy were mailed to 350 subjects, who comprised a random sample of dietitians registered with the Health Professions Council of South Africa.

RESULTS

Forty-one per cent (n=145) of the sample responded. Self-assessment inventory results were compared to test levels of probability of assertive behaviour, interpersonal anxiety and self-efficacy. The inventory results were compared with the biographical findings to establish statistical relationships between the variables. The hypotheses were formulated before data collection.

CONCLUSION

Dietitians had acceptable levels of probability of assertive behaviour and interpersonal anxiety. The probability of assertive behaviour was significantly lower than the level noted in the literature and was negatively related to interpersonal anxiety and positively related to self-efficacy.

Microsatellite analysis of the inbreeding grass weed Barren Brome (Anisantha sterilis) reveals genetic diversity at the within- and between-farm scales

Nine microsatellites were used to screen 131 samples of Barren Brome (Anisantha sterilis: synonym Bromus sterilis) collected from within the fields of three English farms [from Oxfordshire (Oxon), Leicestershire (Leics) and Wiltshire (Wilts)] and eight seeds taken from samples of each of 10 farms across England, UK. Most individuals (approximately 97%) were homozygous. Polymorphism occurred at all nine loci in all three farms sampled at the field scale, and at most loci for nine of the other 10 farm samples. Between three and 11 alleles were found per locus. Gene diversity (D = 1 - summation operator p(i)2) ranged from 0.088 to 0.760. Polymorphism occurred among individuals within and among fields, and farms. Some alleles were found in only one farm. On the basis of the alleles at all nine loci in the 211 sampled plants, a total of 92 (44%) different genotypes was identified. Clustering analysis using the unweighted pair group method with arithmetic averages (UPGMA) for the combined Oxon, Wilts and Leics samples did not cluster them into their respective farms. Similarly, a phenogram of samples from all 10 farms showed considerable mixing of individuals with respect to farm origins. Identification of genotypes on field plans showed evidence of both spatial localization and mixing. Previous reports have suggested that A. sterilis is strictly inbreeding with little intrapopulation variation at the genetic level. Our data reveal that A. sterilis exists as numerous separate and genetically different lines, which are maintained by inbreeding but which very occasionally outcross. Possible explanations for this pattern of high genetic diversity are discussed.

Descriptive information about Down syndrome: a content analysis of serum screening leaflets

It is recommended practice that prior to prenatal screening, women receive information about the condition(s) being tested for. The present study critically evaluated information about Down syndrome as contained in 80 leaflets provided to pregnant women in the UK prior to serum screening. First, a content analysis by information type was conducted to give an overall picture of the material provided. Second, the image of the condition as conveyed by the content was analysed and compared with a similar study of cystic fibrosis (CF) screening leaflets. The majority of information (89%) was of a medico-clinical nature, with 11% addressing other issues associated with Down syndrome. The median number of sentences describing the condition was one, with 33% of the leaflets containing no descriptive information. Overall, a negative image of Down syndrome was conveyed by the leaflets, which contrasted with a more neutral image of CF in the comparison study. In order to facilitate informed choices, more attention should be paid to providing women with information about Down syndrome prior to serum screening. Such information needs to be more balanced in its construction, with thought given to the needs of the reader, and to the tone and the content of the message conveyed.

The immunological synapse and CD28-CD80 interactions

According to the two-signal model of T cell activation, costimulatory molecules augment T cell receptor (TCR) signaling, whereas adhesion molecules enhance TCR-MHC-peptide recognition. The structure and binding properties of CD28 imply that it may perform both functions, blurring the distinction between adhesion and costimulatory molecules. Our results show that CD28 on naïve T cells does not support adhesion and has little or no capacity for directly enhancing TCR-MHC-peptide interactions. Instead of being dependent on costimulatory signaling, we propose that a key function of the immunological synapse is to generate a cellular microenvironment that favors the interactions of potent secondary signaling molecules, such as CD28.

Prediction of rectal temperature from ear canal temperature

Personal heat strain monitoring provides the best means for maximizing worker safety and productivity in hot jobs. The present study compared methods for reducing the environmental effect on aural canal temperature in an attempt to reduce the predictive error of a personal heat stress monitor (QST) and a simple ear thermistor (EAR). Subjects underwent three exposures in impermeable protective clothing (PC) in an environment of 30.1 degrees C wet bulb globe temperature (WBGT) wearing either ear plugs (PLG), ear moulds (MLD) or ear moulds and earmuffs (MFS). Mean work time across all trials was 63.1 +/- 7.9 min, with a mean rectal temperature at 60 min of 38.5 +/- 0.1 degrees C and a sweat production rate of 29.7 +/- 8.6 g/min. Rectal temperature was used as the criterion measure of core temperature. Although group mean predictions were satisfactory, large SD of mean differences (+/- 0.36) meant that predictive ability of QST for individuals was greatly impaired. A simple well-insulated ear thermistor showed slightly better accuracy (+/- 0.28) as a predictor of rectal temperature across time, particularly at peak temperatures. Incorporating the predictive error of aural temperature still extended the duration of safe work times relative to ACGIH guidelines. Further investigation is still necessary to ensure that predictions based on aural temperature are accurate and safe for the worker population across varying conditions.

Normal ligand binding and signaling by CD47 (integrin-associated protein) requires a long range disulfide bond between the extracellular and membrane-spanning domains

CD47 is a unique member of the Ig superfamily with a single extracellular Ig domain followed by a multiply membrane-spanning (MMS) domain with five transmembrane segments, implicated in both integrin-dependent and -independent signaling cascades. Essentially all functions of CD47 require both the Ig and MMS domains, raising the possibility that interaction between the two domains is required for normal function. Conservation of Cys residues among CD47 homologues suggested the existence of a disulfide bond between the Ig and MMS domains that was confirmed by chemical digestion and mapped to Cys(33) and Cys(263). Subtle changes in CD47 conformation in the absence of the disulfide were suggested by decreased binding of two anti-Ig domain monoclonal antibodies, decreased SIRPalpha1 binding, and reduced CD47/SIRPalpha1-mediated cell adhesion. Mutagenesis to prevent formation of this disulfide completely disrupted CD47 signaling independent of effects on ligand binding, as assessed by T cell interleukin-2 secretion and Ca(2+) responses. Loss of the disulfide did not affect membrane raft localization of CD47 or its association with alpha(v)beta(3) integrin. Thus, a disulfide bond between the Ig and MMS domains of CD47 is required for normal ligand binding and signal transduction.

Prenatal screening for Down's syndrome: some psychosocial implications of a 'screening for all' policy

The National Screening Committee of the Department of Health has made recommendations to the Government advising that prenatal screening for Down's syndrome should be offered to all pregnant women regardless of their age. As most women over 35 are already offered some form of testing, affected pregnancies in younger women will account for the majority of any increased overall detection rate. Therefore, while a 'screening for all' policy will offer wider reproductive choices to more women, it is likely to specifically increase the number of young women experiencing termination of pregnancy for abnormality. A number of inter-dependent factors predispose some women to high levels of psychological distress following termination, and a combination of these factors is most likely to be found in the very young. In addition, very young women often have little knowledge of prenatal testing and may be more likely to accept screening presented as 'routine' without considering the consequences. At the point where decisions about diagnostic testing or termination are made, more specialised support may be indicated for some very young women. If the UK National Screening Committee's recommendations are taken forward therefore, service providers should ensure suitable support is available for some of their more vulnerable clients.

CD28 and CTLA4 Coordinately Regulate Airway Inflammatory Cell Recruitment and T-Helper Cell Differentiation after Inhaled Allergen

Airway inflammation after inhaled allergen exposure requires the recruitment, activation, and differentiation of antigen-specific T cells into T helper (Th) 2 effector cells. These processes are regulated not only by antigen engagement of the T-cell receptor, but also by specific accessory molecules on the surface of the T cell. We examined how the balance of signals derived through the CD28 and cytotoxic T-lymphocyte antigen (CTLA) 4 receptors modulate the outcome of inhaled antigen exposure in a murine model of allergic airway inflammation. Mice deficient in CD28 have defective Th2 cell development and failed to develop inflammation after sensitization and inhaled challenge with ovalbumin. Prevention of B7-CTLA4 interactions in CD28-deficient mice restored lymphocyte but not eosinophil recruitment to the airway. Analysis of cytokine gene expression revealed that T cells from CD28-deficient mice failed to differentiate into Th2 cells in either the presence or absence of B7-dependent signals, and therefore did not recruit eosinophils to the airway. Thus, the processes of T-cell recruitment to the airway and T-cell differentiation have distinct requirements for signals mediated through the CD28 and CTLA4 receptors, demonstrating that these receptors are important regulatory components in the development of allergic airway inflammation.

Cutting edge: distinct motifs within CD28 regulate T cell proliferation and induction of Bcl-XL

CD28 provides an important costimulatory signal in T cell activation that regulates multiple cellular processes including proliferation and survival. Several signal transduction pathways are activated by CD28; however, the precise biochemical mechanism by which CD28 regulates T cell function remains controversial. Retroviral gene transfer into primary T cells from TCR-transgenic, CD28-deficient mice was used to determine the specific sequences within CD28 that determine function. Discrete regions of the cytoplasmic domain of CD28 were identified that differentially regulate T cell proliferation and induction of the anti-apoptotic protein Bcl-X(L). Mutation of C-terminal proline residues abrogated the proliferative and cytokine regulatory features of CD28 costimulation while preserving Bcl-X(L) induction. Conversely, mutation of residues important in phosphatidylinositol 3-kinase activation partially inhibited proliferation but prevented induction of Bcl-X(L.) Thus the ability of CD28 to regulate proliferation and induction of Bcl-X(L) map to distinct motifs, suggesting independent signaling cascades modulate these biologic effects.