Phase I/II trial of a dendritic cell vaccine transfected with DNA encoding melan A and gp100 for patients with metastatic melanoma

This trial tested a dendritic cell (DC) therapeutic cancer vaccine in which antigen is loaded using a novel non-viral transfection method enabling the uptake of plasmid DNA condensed with a cationic peptide. Proof of principle required the demonstration of diverse T lymphocyte responses following vaccination, including multiple reactivities restricted through both major histocompatibility complex (MHC) class I and II. Patients with advanced melanoma were offered four cycles of vaccination with autologous DC expressing melan A and gp100. Disease response was measured using Response Evaluation Criteria in Solid Tumours. Circulating MHC class I- and II-restricted responses were measured against peptide and whole antigen targets using interferon-γ ELIspot and enzyme-linked immunosorbent assay assays, respectively. Responses were analyzed across the trial population and presented descriptively for some individuals. Twenty-five patients received at least one cycle. Vaccination was well tolerated. Three patients had reduction in disease volume. Across the trial population, vaccination resulted in an expansion of effector responses to both antigens, to the human leukocyte antigen A2-restricted modified epitope, melan A ELAGIGILTV, and to a panel of MHC class I- and II-restricted epitopes. Vaccination with mature DC non-virally transfected with DNA encoding antigen had biological effect causing tumour regression and inducing diverse T lymphocyte responses.

Screening for cognitive impairment, Alzheimer's disease and other dementias: opinions of European caregivers, payors, physicians and the general public

The IMPACT survey queried physicians, caregivers, payors and members of the general public from 5 European countries (France, Germany, Italy, Spain and the United Kingdom) regarding their opinions towards screening for Alzheimer's disease (AD) as part of a 30-minute Web-based questionnaire conducted between April and May 2009. A larger proportion of caregivers (84%) and members of the general public (80%) than of physicians (56%) or payors (40%) viewed routine screening for AD as extremely or very important (P < 0.001 for caregivers or general public vs physicians or payors). When asked if everyone should be routinely screened for AD at age 65, a smaller proportion of physicians (42%) and payors (44%) than members of the general public (81%) or caregivers (80%) agreed (P < 0.001 for caregivers or general public vs physicians or payors). These opinions were generally consistent across the 5 countries for each respondent group. A notable exception was physician respondents from Italy, where most generalists and specialists actually favoured screening. Overall, generalists had a more positive attitude towards screening than specialists. The most frequently cited reason given by those who did not favour routine screening at age 65 was screening inaccuracy. This article discusses these results in relation to what screening is, when to screen and the barriers to screening. Despite the majority of IMPACT respondents being in favour of screening for AD, the evidence to support the introduction of population screening for cognitive impairment is not available; however, the importance of optimal identification of AD and other dementias in primary care should be a priority for community health professionals and payors. In order to do this effectively, further work is required to identify good assessment guidelines for use during opportunistic screening for cognitive impairment in primary care.

Facilitation of inhibition in the compound lateral eye of limulus

In the compound eye of Limulus the inhibitory effect of a burst of impulses from one group of ommatidia on the response of a neighboring ommatidium is greater when that burst is preceded by another burst of impulses. This facilitation of inhibition decays slowly, with a time constant of several seconds. Facilitation of inhibition accumulates as the number of impulses in the first burst increases, but there is a maximum that it cannot exceed. The facilitation is localized; one group of ommatidia does not facilitate the inhibition exerted by another group. The mechanism of this facilitation may be similar to that which has been postulated for facilitation of excitatory influences at the neuromuscular junction.

World psychiatric association section of old age psychiatry consensus statement on ethics and capacity in older people with mental disorders

The World Psychiatric Association (WPA) Section of Old Age Psychiatry, since 1997, has developed Consensus Statements relevant to the practice of Old Age Psychiatry. Since 2006 the Section has worked to develop a Consensus Statement on Ethics and Capacity in older people with mental disorders, which was completed in Prague, September 2008, prior to the World Congress in Psychiatry. This Consensus meets one of the goals of the WPA Action Plan 2008-2011, "to promote the highest ethical standards in psychiatric practice and advocate the rights of persons with mental disorders in all regions of the world". This Consensus Statement offers to mental health clinicians caring for older people with mental disorders, caregivers, other health professionals and the general public the setting out of and discourse in ethical principles which can often be complex and challenging, supported by practical guidance in meeting such ethical needs and standards, and to encouraged good clinical practice.

A comparison of the role of two blue-green algae in THM and HAA formation

The contribution of two blue-green algae species, Anabaena flos-aquae and Microcystis aeruginosa, to the formation of trihalomethanes (THMs) and haloacetic acids (HAAs) was investigated. The experiments examined the formation potential of these disinfection by-products (DBPs) from both algae cells and extracellular organic matter (EOM) during four algal growth phases. Algal cells and EOM of Anabaena and Microcystis exhibited a high potential for DBP formation. Yields of total THMs (TTHM) and total HAAs (THAA) were closely related to the growth phase. Reactivity of EOM from Anabaena was slightly higher than corresponding cells, while the opposite result was found for Microcystis. Specific DBP yields (yield/unit C) of Anabaena were in the range of 2-11micromol/mmol C for TTHM and 2-17micromol/mmol C for THAA, while those of Microcystis were slightly higher. With regard to the distributions of individual THM and HAA compounds, differences were observed between the algae species and also between cells and EOM. The presence of bromide shifted the dominant compounds from HAAs to THMs.

A review of internal medicine re-admissions in a peri-urban South African hospital

OBJECTIVE

To measure the re-admission rate and the number of preventable re-admissions in a secondary-level South African hospital, and to identify factors predictive of re-admission.

METHOD

The admission register for the medical wards at Cecilia Makiwane Hospital (CMH) was used to identify re-admitted patients, whose folders were then reviewed. A comparison group of patients who were not re-admitted was randomly generated from the same register.

RESULTS

The re-admission rate for the 7 months ending October 2006 was 8.5% (262/3 083). Patients who were more likely to be re-admitted had chronic respiratory disease (odds ratio (OR) 4.2, 95% confidence interval (CI) 1.2 - 14.6), HIV infection (OR 5.0, CI 2.1 - 12.0), were older than 50 years (OR 5.2, CI 2.5 - 10.9), had a first admission of more than 8 days (OR 3.2, CI 1.5 - 6.6) or a booked medical outpatients followup (OR 5.1, CI 2.6 - 10.3). Age distribution of re-admissions was bimodal, with HIV-positive individuals (27.4% overall) accounting for 50% of all admissions younger than 50 years, but only 9.1% of those 50 years or older. In individuals older than 50 years, 42.1% of admissions were due to chronic cardiorespiratory illnesses. Half of re-admissions were judged to be potentially preventable, mainly through improved patient education.

CONCLUSION

One in 12 general medical patients was readmitted. Chronic diseases and inadequate patient education and discharge planning accounted for the largest group of re-admissions in older patients. Re-admission of HIV/AIDS patients has generated a second peak in younger individuals, and the impact of the antiretroviral roll-out on admission rates warrants further scrutiny.

The aqueous degradation of bisphenol A and steroid estrogens by ferrate

The aqueous reactivity of five prominent endocrine disrupting chemicals (EDCs) with potassium ferrate has been studied. The degradation kinetics and reaction pathways for bisphenol A (BPA) have been considered in detail, and the reaction rate constants for 17alpha-ethynylestradiol (EE2), estrone (E1), beta-estradiol (E2), and estriol (E3) have been determined, from tests carried out in the pH range of 8-12 and at different reactant molar ratios. The rate constants were determined by a kinetic model incorporating the various species equilibria for the EDC compounds and ferrate, using observations of the temporal reduction in EDC and ferrate concentrations. In agreement with other studies, the oxidation of the EDCs was found to be greater for mono-protonated ferrate, HFeO(4)(-), than for non-protonated ferrate, FeO(4)(2-). Among the five EDCs, all of which have phenol moieties, the ferrate oxidation of the four steroid estrogens (each incorporating the cyclopentanoperhydrophenanthrene ring) had higher reaction rates than BPA. The by-products of BPA degradation by ferrate were analyzed by liquid chromatography/mass spectrometry-mass spectrometry (LC/MS-MS) and gas chromatography/mass spectrometry-mass spectrometry (GC/MS-MS) and nine specific compounds were identified, including p-isopropylphenol, 4-isopropanolphenol, p-isopropenylphenol, and some dicarboxylic acids, etc. It is concluded that ferrate oxidation could be an effective treatment method for the purification of waters containing these particular EDCs.

Casimir forces between arbitrary compact objects

We develop an exact method for computing the Casimir energy between arbitrary compact objects, either dielectrics or perfect conductors. The energy is obtained as an interaction between multipoles, generated by quantum current fluctuations. The objects' shape and composition enter only through their scattering matrices. The result is exact when all multipoles are included, and converges rapidly. A low frequency expansion yields the energy as a series in the ratio of the objects' size to their separation. As an example, we obtain this series for two dielectric spheres and the full interaction at all separations for perfectly conducting spheres.

Non-linearities in texture segregation

The existence of complex (non-Fourier, second-order) channels is suggested by some characteristics of segregation perceived between regions distinguished by visual texture. These complex channels consist of two linear-filtering stages separated by a rectification-type non-linearity. We have investigated (i) the spatial frequency selectivity and orientation selectivity of their first-stage filters; (ii) the relationship between the preferred values of orientation and spatial frequency at the first and second filters; (iii) spatial pooling and its implications for the non-linearity at the middle of the complex channel; and (iv) the dynamics of complex and simple linear channels. An intensive non-linearity is also necessary to explain perceived region segregation. This intensive non-linearity might arise from an early local non-linearity preceding the channels (perhaps retinal light adaptation) or from normalization among the channels themselves (perhaps due to intracortical inhibition). Deciding between these two candidates has been more difficult than we had hoped. It appears that: (i) this intensive non-linearity operates for both simple and complex channels; (ii) the effects on it of changing mean luminance or spatial scale may be accounted for by a sensitivity parameter; (iii) it can be dramatically compressive even at contrasts less than 25% for high mean luminances and large scales; and (iv) at even lower contrasts there is an accelerating non-linearity that acts before the second filter of the complex channels.

An electroweak oscillon

A numerical simulation of the full bosonic sector of the SU(2)xU(1) electroweak standard model in 3+1 dimensions demonstrates the existence of an oscillon--an extremely long-lived, localized, oscillatory solution to the equations of motion--when the Higgs mass is equal to twice the W+/- boson mass. The oscillon contains total energy 6 TeV [corrected] localized in a region of radius 0.05 fm.

Reaction pathways and kinetics of butylated hydroxyanisole with UV, ozonation, and UV/O(3) processes

The chemical degradation of the endocrine disrupting chemical, butylated hydroxyanisole (BHA), was investigated by different treatment processes including ultraviolet (UV) irradiation, ozonation (O(3)), and UV/O(3). O demethylation, dimerization, and oxidation have been found to be the main degradation mechanisms. A systematic decay pathway was proposed based on ten identified intermediates in the studied processes, including a unique pathway leading to the formation of precipitates in the ozonation process. An unconventional minimum-type variation of BHA decay rate constants from acidic to caustic range has been found for both ozonation and UV/O(3) processes. The precipitates formed during ozonation can be removed during the process to optimize the treatment, while the UV/O(3) process can offer a relatively fast and clean process to degrade BHA and its associated intermediates.

Definitions for haemophilia prophylaxis and its outcomes: The Canadian Consensus Study

The creation of acceptable standard definitions for terms used in the care and assessment of haemophilia patients has become increasingly important, as a growing number of international clinical studies have been initiated. The Delphi approach has been used in health research to reach consensus in large groups and can be used to develop definitions by using several iterations of surveys eliciting opinions from specialists in the field. Three consecutive surveys were designed based on the Delphi approach and distributed to specialist physicians, nurses and physiotherapists in order to develop definitions for seven haemophilia terms: 'primary prophylaxis', 'secondary prophylaxis', 'target joint', 'joint bleed', 'significant soft-tissue bleed', 'superficial soft-tissue bleed' and 'mucosal bleed'. Suggestions were solicited, compiled into a subsequent survey and fed back to the group to rank-order the importance of each suggested component of the definition. Final definitions were created using the top-ranked suggestions and sent back to the experts for approval. Five of the seven terms were highly endorsed with greater than 90% agreement. Some differences in agreement were found when analysed by profession. Haemophilia terms were successfully defined using the Delphi approach. Further refinement from members of the international haemophilia community will ensure that comprehensive standard definitions can be used in multicentre studies in the future.

Degradation of the endocrine disruptor carbofuran by UV, O3 and O3/UV

The photodegradation of a carbamate insecticide, Carbofuran (CBF), which has been recognised as a potential endocrine disrupting chemical, was studied via different wastewater treatment processes. This study has shown the efficiency of advanced oxidation process, AOP (UV/O3) than those of the direct UV photolysis and ozonation process, by completely removing 0.2 mM CBF and achieving 24% mineralisation within 30min. The initial decay of CBF by UV/O3 accelerated from 0.05 to 0.16 min(-1) as the initial pH increasing from 3.0 to 11.3. The pH-dependency of CBF has also been shown in both ozonation and UV/O3 process. A linear relationship could be found for the latter process in all pH, while for the former process, two stages of reactions (steady and accelerating) were found in the acidic and alkaline pH condition, respectively.

Automated PCR setup for forensic casework samples using the Normalization Wizard and PCR Setup robotic methods

Human genome, pharmaceutical and research laboratories have long enjoyed the application of robotics to performing repetitive laboratory tasks. However, the utilization of robotics in forensic laboratories for processing casework samples is relatively new and poses particular challenges. Since the quantity and quality (a mixture versus a single source sample, the level of degradation, the presence of PCR inhibitors) of the DNA contained within a casework sample is unknown, particular attention must be paid to procedural susceptibility to contamination, as well as DNA yield, especially as it pertains to samples with little biological material. The Virginia Department of Forensic Science (VDFS) has successfully automated forensic casework DNA extraction utilizing the DNA IQ(trade mark) System in conjunction with the Biomek 2000 Automation Workstation. Human DNA quantitation is also performed in a near complete automated fashion utilizing the AluQuant Human DNA Quantitation System and the Biomek 2000 Automation Workstation. Recently, the PCR setup for casework samples has been automated, employing the Biomek 2000 Automation Workstation and Normalization Wizard, Genetic Identity version, which utilizes the quantitation data, imported into the software, to create a customized automated method for DNA dilution, unique to that plate of DNA samples. The PCR Setup software method, used in conjunction with the Normalization Wizard method and written for the Biomek 2000, functions to mix the diluted DNA samples, transfer the PCR master mix, and transfer the diluted DNA samples to PCR amplification tubes. Once the process is complete, the DNA extracts, still on the deck of the robot in PCR amplification strip tubes, are transferred to pre-labeled 1.5 mL tubes for long-term storage using an automated method. The automation of these steps in the process of forensic DNA casework analysis has been accomplished by performing extensive optimization, validation and testing of the software methods.

Acupuncture for neck disorders

BACKGROUND

Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are the perceptions of benefits. Acupuncture has been used as an alternative to more traditional treatments for musculoskeletal pain. This review summarizes the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain.

OBJECTIVES

To determine the effects of acupuncture for individuals with neck pain.

SEARCH STRATEGY

We searched CENTRAL (2006, issue 1) and MEDLINE, EMBASE, MANTIS, CINAHL from their beginning to February 2006. We searched reference lists and the acupuncture database TCMLARS in China.

SELECTION CRITERIA

Any published trial using randomized (RCT) or quasi-randomized (quasi-RCT) assignment to the intervention groups, either in full text or abstract form, were included.

DATA COLLECTION AND ANALYSIS

Two reviewers made independent decisions for each step of the review: article inclusion, data abstraction and assessment of trial methodological quality. Study quality was assessed using the Jadad criteria. Consensus was used to resolve disagreements. When clinical heterogeneity was absent, we combined studies using random-effects meta-analysis models.

MAIN RESULTS

We did not find any trials that examined the effects of acupuncture for acute or subacute pain, but we found 10 trials that examined acupuncture treatments for chronic neck pain. Overall, methodological quality had a mean of 2.3/5 on the Jadad Scale. For chronic mechanical neck disorders, there was moderate evidence that acupuncture was more effective for pain relief than some types of sham controls, measured immediately post-treatment. There was moderate evidence that acupuncture was more effective than inactive, sham treatments measured immediately post-treatment and at short-term follow-up (pooled standardized mean difference (SMD) -0.37, 95% confidence interval (CI) -0.61 to -0.12). There was limited evidence that acupuncture was more effective than massage at short-term follow-up. For chronic neck disorders with radicular symptoms, there was moderate evidence that acupuncture was more effective than a wait-list control at short-term follow-up.

AUTHORS' CONCLUSIONS

There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment. There is moderate evidence that those who received acupuncture reported less pain at short term follow-up than those on a waiting list. There is also moderate evidence that acupuncture is more effective than inactive treatments for relieving pain post-treatment and this is maintained at short-term follow-up.