FTIR microscopic imaging of collagen and proteoglycan in bovine cartilage

Articular cartilage, a connective tissue that provides resistance to compressive forces during joint movements, has not been examined in detail by conventional Fourier transform infrared (FTIR) spectroscopy, microspectroscopy (FTIRM), or imaging (FTIRI). The current study reports FTIRM and FTIRI analyses of normal bovine cartilage and identifies the specific molecular components of cartilage that contribute to its IR spectrum. FTIRM data acquired through the superficial, middle, and deep zones of thin sections of bovine articular cartilage showed a variation in intensities of the absorbance bands that arise from the primary nonaqueous components of cartilage, collagen, and proteoglycan (primarily aggrecan) and thus reflected the differences in quantity of these specific components. The spectra of mixtures of model compounds, which had varying proportions of type II collagen and aggrecan, were analyzed to identify spectral markers that could be used to quantitatively analyze these components in cartilage. Collagen and aggrecan were then imaged by FTIRI based on markers found in the model compounds. Polarization experiments were also performed to determine the spatial distribution of the collagen orientation in the different zones of cartilage. This study provides a framework in which complex pathological changes in this heterogeneous tissue can be assessed by IR microscopic imaging.

Clinical trials in a rural population: professional education aspects

BACKGROUND

While the majority of cancer patients in rural New Hampshire and Vermont are treated in community hospitals, few have entered clinical trials. This report describes a rural hospital consortium as a single Cancer and Leukemia Group B (CALGB) affiliate that used local cancer teams and itinerant oncologists to develop a clinical trials program.

METHOD

Grafted onto an existing oncology outreach program, educational programs were developed to help identify patients and recruit them to cooperative group clinical trials. Outcomes included the number of patients accrued to clinical trials, and a comparison of the quality of audited research records with those of affiliated institutions of the CALGB. The consequences of the program were to measure changes in patterns of care of breast, prostate, colorectal, and lung cancers during the study period. These included diagnostic, staging, and treatment changes that occurred over time.

RESULTS

3.3% of incident cases were accrued to clinical trials during the study period, more often for breast and colorectal than for lung and prostate cancers. Reasons that were identified for low accrual were lack of clinical trials for the majority of cases, including the elderly. More than 65% of the patients in the outreach population were older than 65, compared with 50% at the cancer center. Patterns of care did change for breast and prostate cancers, but were similar to national trends.

Alcohol-related aggression in the general population

OBJECTIVE

This study estimates the relationships between drinking in the event and drinking patterns and different levels of aggression severity.

METHOD

A telephone survey of 1,001 adults (542 women) age 18 and over was conducted (response rate of 67%) using computer assisted telephone interviewing (CATI). Respondents were asked whether they had been personally involved in a serious argument, an incident involving threat, or physical aggression in the past year and whether anyone had been drinking alcohol in the most recent incident. Respondents also reported their typical alcohol consumption patterns.

RESULTS

The proportion of respondents reporting involvement in serious arguments, threats or physical aggression was 19.8%, 11.8% and 12.0%, respectively. Someone in the incident had been drinking in 38.1% of serious arguments, 56.5% of threats and 67.9% of incidents of physical aggression. When gender, age, education, marital status and employment status were controlled for, high quantity drinking (as measured by the largest number of drinks consumed on one drinking occasion in the past year), overall estimated annual volume of alcohol consumed, and frequency of consuming five drinks per occasion were significantly greater for physical aggression, compared with arguments and no aggression. However, drinker status (abstainer/drinker) and frequency of drinking were not significantly associated with involvement in aggression. In a logistic regression analysis controlling for demographic variables, a composite measure of alcohol consumption was highly significant for physical aggression versus no aggression and for physical versus verbal aggression. Physical aggression was also associated with being younger, separated/ divorced and a student.

CONCLUSIONS

The results suggest that alcohol intoxication, rather than mere alcohol consumption, is associated with aggression. Moreover, alcohol intoxication is more strongly associated with physical aggression than with verbal aggression.

Evaluating theories of alcohol-related aggression using observations of young adults in bars

AIMS

The objective of the present study is to evaluate 36 explanations of alcohol-related aggression that have been proposed in the research literature in terms of their relevance to naturally-occurring incidents of aggression involving alcohol.

DESIGN

The study involved content analysis of descriptions of 105 incidents of aggression.

SETTING AND PARTICIPANTS

Bars frequented by young adults.

MEASUREMENTS

Step-by-step descriptions of incidents of aggression reported by researcher-observers based on 93 nights of observation in bars between midnight and 3 a.m.

FINDINGS

Some explanations relating to the effects of alcohol (e.g. focused on the present, reduced anxiety about sanctions or danger, heightened emotionality) and the environment (e.g. generally permissive environment, expectation by patrons that aggression will be tolerated) were found to be relevant to most incidents, while other explanations (e.g. crowding, release of pent-up anger) were directly relevant to only a few or no incidents. Incidents involving male-to-male aggression were more likely than incidents involving both males and females to be attributable to expectations, acceptance of aggression, power concerns, male honor and "macho" values. Principal components analysis identified five groupings of explanations: risk-taking effects of alcohol, cognitive impairment from alcohol, hyperemotional effects of alcohol, "macho" subculture, and permissive environment.

CONCLUSIONS

The findings are consistent with a model of alcohol-related aggression that involves multiple contributing factors including alcohol effects and situational contexts. The greater relevance of certain explanations and the natural groupings of explanations point to directions for future research.

Impurity-induced suppression of core turbulence and transport in the DIII-D tokamak

Turbulence is significantly reduced in a tokamak plasma as a result of neon seeding of an L-mode discharge. Correspondingly, confinement is improved and cross-field ion thermal transport reduced. Fully saturated turbulence in the range 0.1</=k( perpendicular)rho(s)</=0. 6 is measured at rho = 0.7 and exhibits a factor of 5 reduction in total power after neon injection, with almost complete suppression for k( perpendicular)rho(s)>0.35. These observations are consistent with a reduction in the calculated linear growth rate for k( perpendicular)rho(s)>0.5 and an increase in the measured ExB flow shearing rate.

Child death reviews: a gold mine for injury prevention and control

OBJECTIVES

The purpose of this study was to demonstrate how child death review teams can be used to prevent future deaths through retrospective, multiagency case analysis and recommendations for educational programs and policy change.

METHODS

A listing of all deaths to persons ages 21 years and younger in Philadelphia that occurred in 1995 was compiled by the Philadelphia Interdisciplinary Youth Fatality Review Team (PIYFRT), a multiagency, multidisciplinary, community based group created in 1993 with the mission to prevent future deaths through review, analysis, and initiation of corrective actions. Data were collected on demographic variables, as well as the circumstantial variables on injuries such as weapon type, alcohol and drug use, and contact with the criminal justice system, among others. Each case was reviewed thoroughly to determine whether or not the death was preventable. Selected injury related death cases were analyzed further by demographic and circumstantial variables.

RESULTS

In 1995, 607 children ages 21 years and younger died in Philadelphia from natural causes (61.6%), unintentional injuries (16.3%), homicide (18.6%), suicide (2.3%), and undetermined causes (1.2%). More than a third (37.2%) of all deaths were considered preventable. Of the injury deaths (n=224), 95% were judged to be preventable. Preventable fire/burn injury deaths (n=29) were associated with lack of a smoke detector, nonsupervision of children, and faulty home appliances. Violent deaths were associated with substance abuse, gang involvement, chronic truancy, academic failure, and access to weapons.

CONCLUSIONS

Relevant policies for these preventable or intervenable deaths are discussed such as use of non-battery powered smoke detectors.

Morbidity and Irish Catholic descent in Britain: relating health disadvantage to behaviour

OBJECTIVES

This paper critically evaluates the evidence for two health-related stereotypes of the Irish, namely that behaviours such as smoking and heavy drinking explain their excess morbidity in Britain, and secondly that, in illness, this ethnic group behaves more stoically.

DESIGN

Data are reported on over 850 respondents from each of three cohorts (aged 18, 39 and 58 in 1990/91) of the West of Scotland 20-07 Study, in which a small but pervasive excess of morbidity has been observed in those of Catholic background (in this area associated with Irish descent). Logistic regression was used to investigate any differences in drinking, smoking and participation in sport between those of Catholic and non-Catholic heritage, whilst controlling for sex and social class. Where a difference was observed, we looked for an association between health-related behaviour and the Catholic morbidity excess for six measures of physical and mental health. Finally, illness behaviour at age 39 and 58 was investigated for those experiencing one of a number of common symptoms in the month prior to interview, by noting whether a general medical practitioner (GP) was consulted.

RESULTS

The only difference in health-related behaviour was in the eldest cohort, where an excess of smoking was observed for the Catholics. However, except for lung power, smoking was not able to explain very much, if any, of the Catholic morbidity disadvantage. For most of the symptoms studied, GP consultation rates were similar, although there was a tendency towards Catholic over-consulting.

CONCLUSION

This paper finds minimal evidence in favour of either stereotype: behaviours such as smoking and excess drinking were not strongly associated with the poor morbidity status of the Irish in the population we have studied; neither have the Irish been found to be more stoic in illness. Therefore the stereotypes are not an adequate explanation, nor a necessary correlate, of the frequent finding of raised morbidity in communities of Irish Catholic origin.

Family and friends' influences on the uptake of regular smoking from mid-adolescence to early adulthood

AIMS

To examine the effect of family and friends' smoking on uptake of regular smoking among young people from mid-adolescence to early adulthood; whether such effects are time limited, vary by social class and gender, and the extent to which uptake precedes or follows friends' smoking.

SETTING

The West of Scotland.

DESIGN AND PARTICIPANTS

A longitudinal survey of 1009 15-year-olds interviewed at baseline, followed-up at 16, 18, 21 and 23 years of age, using interviews and postal questionnaires.

MEASUREMENTS

Self-reported measures of smoking were used, allowing analysis of the uptake of regular smoking (1 + cigarette per day) between 15 and 23, and in the periods 15-16, 16-18 and 18-21 years. Measures of parental and sibling smoking and social class were obtained at baseline and respondents' reports of friends' smoking at 15 and 18 years.

FINDINGS

Regular smoking more than doubled between 15 (14%) and 23 (36%). Adjusted for other factors, no independent effect of parental smoking on uptake in any period was observed, an effect of sibling smoking being confined to uptake between 15 and 16. Friends' smoking at 15 increased the likelihood of uptake up to 10 times over the next year, but did not extend to later years; that at 18 increased it up to three times between 18 and 21. These effects did not vary by gender or social class. Further analysis revealed a strong effect of friends' smoking at age 18 on earlier as well as later uptake.

CONCLUSIONS

Contrasting with prevalent assumptions, the period from mid-adolescence to early adulthood is important for uptake of regular smoking, and in particular reveals friends' smoking to be of continuing significance, especially around school-leaving when friendship networks often change markedly.

Private finance. Oz trials

Privatization of a public sector general hospital in Adelaide, Australia, five years ago has revealed the strengths of the model and the difficulties of contracting with the private sector. Managers believe the new model has reduced overstaffing and increased local management. There have been continual contracting problems and the hospital has made losses, almost from the start. Private finance initiative contracts may always be difficult to negotiate and sustain.

Saccadic strategies in children with hemianopia

Multiple hypometric (undershooting) saccades are generally reported as a compensatory strategy in adults with homonymous hemianopia. However, hypermetric (overshooting) saccades have been reported to develop spontaneously as a beneficial strategy in response to predictable targets. We examined the saccades of 10 children (aged 5 to 16 years) with homonymous hemianopia to determine the type of compensatory eye-movement strategies employed 6 months to 16 years after hemianopia onset. Homonymous hemianopia was identified using perimetry and/or pattern visual evoked potentials and supported with results of neuroimaging. Eye movements were recorded using bitemporal electrooculography. Saccades were elicited to a red light source in a semipredictable paradigm. We found that hypermetria was not a consistent compensatory strategy in our patients. In spite of the predictability of our paradigm and the long follow-up period, multiple hypometric saccades into the blind field appeared to be the preferred strategy.

Alcohol and the U.S.-Canada border: trade disputes and border traffic problems

The public health interest in trade and in cross-border traffic of alcoholic beverages is considered in general terms. Within this framework, three specific issues in U.S.-Canada trade and borders are discussed: cross-border drinking and driving in both directions, particularly by youth; smuggling from the U.S. to Canada; and the "beer wars" and other U.S.-Canada trade disputes involving alcoholic beverages. While problems can be alleviated on each of these fronts, it is concluded that an important step internationally would be to establish that, because of the problems they entail, alcoholic beverages should be exempt from trade agreements, or else provision should be made for the public health interest to be represented in negotiations and dispute resolution involving alcoholic beverage controls.

Health at age 11: reports from schoolchildren and their parents

OBJECTIVE

To present self reports by children and reports by parents on behalf of their children relating to general health, current conditions, and recent symptoms.

DESIGN

Questionnaires completed by children and parents as part of the longitudinal "West of Scotland 11 to 16 study: teenage health."

SETTING

135 primary schools in Central Clydeside.

SUBJECTS

2586 children aged 11 years, surveyed from October 1994 to March 1995 (response rate 93%). Questionnaires also completed by parents of 86% of the sample.

MAIN OUTCOME MEASURES

Ratings of health over the past 12 months, presence of (limiting) longstanding illness, nine current conditions, and 11 recent symptoms.

RESULTS

Only 47% of children described their health as "good" in the previous year. Around 20% reported a longstanding illness and 8% a limiting illness; 20% reported migraine or headaches, 13% reported asthma. Recent stomach aches or sickness, colds or flu, and headaches were each reported by around 60%. "Malaise" (emotional) symptoms were common. Parents reported similar levels of (limiting) longstanding illness, but rates of conditions and symptoms reported by parents were lower than reported by their children. Parent-child agreement was greatest for the presence of longstanding illness and the conditions of asthma, diabetes, and skin problems. It was lower for recent symptoms, particularly those categorised as reflecting malaise.

CONCLUSIONS

These results challenge assumptions of good health and wellbeing at this age. Illness reporting depends on various factors, including saliency, social desirability, and definitions of normality. Parent-child discrepancies may reflect different definitions of illness or symptoms; they do not mean that one should be dismissed as "wrong."

The development and benefits of nursing protocols for fractured neck of femur patients

In this article the authors discuss the development, use and auditing of nursing care protocols, which have been implemented and form a guide for nurses caring for patients with fractured neck of femur in Southend Health Care NHS Trust. The development of these protocols occurred after an initial medical audit, which was followed by a far larger multidisciplinary audit, and both of these revealed there was need for changes in the clinical management of such patients; subsequently a large multidisciplinary working group worked together to develop care protocols/pathways to enable closure of the audit loop. The reasons for focusing on fractured neck of femur as a high priority condition are also discussed. All professional groups caring for these patients were involved in the multidisciplinary working group, which was formed to close the audit loop and to improve clinical practices by increasing the systemization and coordination of care. The development of the nursing protocols represented an extremely important part of this process, and the care of about 700 patients was examined during this work. The audit and associated subsequent work have resulted in direct improvements to both patient care and health outcomes, and the authors conclude that there is great value in developing multidisciplinary protocols, particularly those involving nurses, because they spend more time with patients whilst they are in hospital than any other professional group. The benefits of these nursing protocols have been multifold, in particular they have facilitated a clearer flow of patients through the hospital, increased awareness of responsibilities and reduced duplication of effort, and ensured patients receive the best possible care over the 24-hour period.

Report on primate supply for biomedical scientific work in the UK. EUPREN UK Working Party

A Working Party of the UK group of European Primate Resources Network (EUPREN) considered primate supply for scientific work in the UK. Through a questionnaire, which achieved a very good response, it obtained details of primate use, sources and breeding in the UK and it put forward options to ensure that animal welfare is the best possible whilst ensuring continued supply. The questionnaire showed that contract research laboratories and pharmaceutical companies use about 80% of the 4233 primates used annually at the moment, with the rest accounted for by academic establishments and public sector laboratories. Fifty-four per cent are cynomolgus macaques (Macaca fascicularis), of which nearly 90% are captive-bred outside the European Union (EU), the remainder being bred in the UK. Nearly 90% of cynomolgus macaques are used by only five institutions. Thirty-seven per cent of primates used are marmosets (Callithrix jacchus jacchus), all of which are bred in the UK. Most of the rest are rhesus macaques (Macaca mulatta), about half of which are captive-bred outside the EU, the other half being bred in the UK. Overall primate use has increased from about 3000 per year in 1990 and users predict that requirements for all species except baboons (Papio sp.) will be maintained or increase. Marmoset breeding in the UK is already closely matched to use, and it could be increased reasonably easily if necessary. Some of the existing breeding centres of macaques in the UK would be prepared to consider expanding to supply others, although investment and imported breeding stock would be needed and it is likely that a large investment would be needed to breed a significant fraction of the macaque use in the UK. A further problem is that the users of only about 10% of the cynomolgus macaques said that they could replace this species by rhesus macaques, which are easier to breed in the UK. The questionnaire showed that much of the use of macaques would be transferred to other countries equally remote from the natural source countries of the animals, if constraints on primate use became more severe in the UK. Users felt that it is unlikely that much of the work could be transferred to the natural source countries themselves. A review of the literature revealed a paucity of information on the effects of transport on primate welfare. The importance of obtaining this information before making decisions about alternative means of supply is stressed. Current schemes for the accreditation of primate breeders were reviewed. A list of options is presented for discussion. Users vary so much in their requirements that it is unlikely that one means of supply will be applicable to all. Animal welfare will benefit and supply will be more certain if cooperation between those concerned (preferably through the UK group of EUPREN) is maintained.

Morbidity and Irish Catholic descent in Britain: an ethnic and religious minority 150 years on

Ethnic and religious minorities often suffer disadvantages both in socio-economic status and in health. Data from the West of Scotland Twenty-07 study suggest some differences in morbidity between those descended from Irish Catholic migrants of the great emigration from 1840 onwards and others. Catholic religion of at least one parent or at birth is used here as a proxy measure to indicate Irish Catholic descent, on the basis of estimates of sensitivity and specificity in the local area. Higher proportions of "Catholics" are in manual social classes. Differences between "Catholics" and "non-Catholics" in one or more age cohorts are observed for the following aspects of health and physical development: general and physical health (self-assessed health, number of symptoms, accidents), psychological distress (depression, anxiety, number of psychosomatic symptoms), impairments and disabilities (sight, hearing, wearing dentures, disability), and physical measures (height, waist-to-hip ratio, lung function). Furthermore, for all aspects except hearing, wearing dentures and number of psychosomatic symptoms, significant differences remain after accounting for sex and social class. For each measure where a difference is observed, it is those respondents with a Catholic parent or who were born Catholic who experience poorer health or physical development. This suggests that those of Irish Catholic descent are at some disadvantage compared with the rest of the population, with respect to health as well as social class, 150 years after the start of the main migration.

Information needs of women during early treatment for breast cancer

This study assessed the information needs of 70 women with breast cancer being treated by surgery, chemotherapy or radiation therapy. Information needs were measured by the breast cancer version of the Toronto Informational Needs Questionnaire (TINQ-BC). All women had high information needs, irrespective of type of treatment received. They mainly wanted information about their disease, treatments and investigative tests. An examination of individual items on the TINQ-BC revealed that all women wanted information about recurrence, specifically they wanted to know if the cancer would come back and how to tell if it had recurred. The results provide nurses with some direction as to what information to give women receiving early treatment for breast cancer.

Instrument development: the Mental Health-Related Self-Care Agency Scale

This article addresses the development and initial testing of an instrument to measure individual's capabilities to perform mental health related self-care. A two-step process of development and judgment (Lynn, 1986) was used to develop and evaluate this instrument's content validity. The development phase included explication of the content domains, item generation, and instrument formation. Evaluation of the content validity was addressed by an expert panel for theoretical and clinical relevance. These processes resulted in a 35 item, self-report questionnaire. A pilot study supported the Mental Health Self-Care Agency Scale as a reliable and valid instrument appropriate for theory-testing research.

Informational needs of women with a recent diagnosis of breast cancer: development and initial testing of a tool

This study developed and tested the Toronto Informational Needs Questionnaire-Breast Cancer (TINQ-BC), a questionnaire designed to identify the information which women with a recent diagnosis of breast cancer need to deal with their illness. The 73-item questionnaire had content validity based on findings in the literature and opinions of expert oncology nurses. It was administered to 114 women with a recent diagnosis of breast cancer during chemotherapy (n = 39), radiation therapy (n = 40) or surgery (n = 35). Item analysis determined that 51 items in five subscales should be retained in the questionnaire. The subscales, labelled Disease, Investigative Tests, Treatments, Physical, and Psychosocial had good internal consistency reliabilities with Cronbach's alphas of 0.81 to 0.93. Informational needs of women were high with mean scores over 200 in a possible range of 51-255. Informational needs were greatest in either the Disease or Treatments subscales. Marital status, level of education, and level of income were not related to level of informational need. Younger women had a greater need for information than older women (r = -0.35, P = 0.003). The results suggest that information is important to help women with breast cancer manage their illness. Nurses should give women an opportunity to ask questions and be prepared to give accurate information.