Incentives for voluntary HIV testing in NHS staff

BACKGROUND

HIV seroprevalence is rising in the United Kingdom. While acceptability of HIV testing has been explored among many groups there is a paucity of data regarding voluntary HIV counselling and testing (VCT) among NHS staff.

AIMS

To understand the barriers to HIV testing among NHS employees. To observe how these may be overcome. To assess which factors would motivate staff to undergo VCT and which would be a disincentive.

METHODS

Completion of a cross-sectional anonymous postal questionnaire survey of new employees at a London district general hospital. Demographic and attitudinal factors were collected. Respondents were able to give multiple responses to questions regarding reasons for and against VCT. Those unable to communicate in English were excluded.

RESULTS

There was a 63% response rate; of 69 respondents, 76% were female, 72% had English as their first language and 30% self-identified as white British. Thirty-nine percent were nurses, 19% doctors and the remainder a variety of professions. Of these, 41% had had a previous HIV test; none were known positive. Sixty-two percent would consider future testing. The commonest reasons to consider testing were knowledge of status (79%), treatment benefit (40%) and to inform family members (44%). The commonest reasons not to test were already tested negative (30%) and rather not know (26%).

CONCLUSIONS

Since the NHS is recruiting staff from areas of high HIV prevalence, VCT should be encouraged. NHS staff require information on how to access testing as well as the benefits of early detection of blood-borne viruses.

How many types of cholinergic sympathetic neuron are there in the rat stellate ganglion?

Sympathetic cholinergic postganglionic neurons are present in many sympathetic ganglia. Three classes of sympathetic cholinergic neuron have been reported in mammals; sudomotor neurons, vasodilator neurons and neurons innervating the periosteum. We have examined thoracic sympathetic ganglia in rats to determine if any other classes of cholinergic neurons exist. We could identify cholinergic sudomotor neurons and neurons innervating the rib periosteum, but confirmed that cholinergic sympathetic vasodilator neurons are absent in this species. Sudomotor neurons contained vasoactive intestinal peptide (VIP) and calcitonin gene-related peptide (CGRP) and always lacked calbindin. Cholinergic neurons innervating the periosteum contained VIP and sometimes calbindin, but always lacked CGRP. Cholinergic neurons innervating the periosteum were usually surrounded by terminals immunoreactive for CGRP. We conclude that if any undiscovered populations of cholinergic neurons exist in the rat thoracic sympathetic chain, then they are indistinguishable in size, neurochemistry and inputs from sudomotor or cholinergic neurons innervating the periosteum. It may be that the latter two populations account for all cholinergic neurons in the rat thoracic sympathetic chain ganglia.

CT cystography and virtual cystoscopy in the assessment of new and recurrent bladder neoplasms

OBJECTIVE

To determine if CT cystography and virtual cystoscopy have a role in the assessment of neoplasms of the urinary bladder.

MATERIAL AND METHODS

Twenty five adults suspected of having bladder tumours underwent CT cystography. Twenty three had subsequent virtual cystoscopic reconstructions from the axial data. The examinations were reviewed by two radiologists and the findings were correlated with those at conventional cystoscopy.

RESULTS

Seventeen masses larger than 0.5 cm were identified by CT cystography in 16 patients. Two patients had normal CT cystography, but one had small recurrent neoplasms on conventional examination. Seven patients had nodular mucosal irregularities which were subsequently shown to be neoplastic in three. Accuracy for diagnosis of neoplasm in all patients was 88%.

CONCLUSION

CT cystography is very accurate at identifying masses larger than 0.5 cm and can show mucosal abnormalities as small as 2 mm. It is minimally invasive and can be diagnostic when conventional cystoscopy is inconclusive. It can indicate appropriate areas for assessment and biopsy at conventional examination. Virtual cystoscopy gave comparable views to conventional cystoscopy, but did not add diagnostic information. It is not likely to replace conventional cystoscopy, but may be helpful in occasional circumstances where the latter is inconclusive, or can not be performed.

Enemy-free space maintains swallowtail butterfly host shift

Natural enemies can be significant sources of mortality for herbivorous insects and therefore important agents of natural selection. One might expect selection to favor herbivores that escape from their natural enemies into enemy-free space. Although this is an appealing idea, it has received little empirical support, and no studies have documented enemy-free space as part of a nonagricultural, nonartificial host shift. The Alaskan swallowtail butterfly, Papilio machaon aliaska, uses as host plants a species in the family Apiaceae (Cnidium cnidiifolium) along with two Asteraceae species (Artemisia arctica and Petasites frigidus). I analyzed growth and survival of P. m. aliaska larvae in the field on the three host plants in treatments that either exposed or protected them from predators. I found that, in the presence of predators, larval survival is greater on the novel hosts (Asteraceae) than on the ancestral host (Apiaceae), but that in the absence of predators survival and growth are greater on the ancestral host. These results are a demonstration of enemy-free space as a mechanism for maintaining a naturally occurring host shift.

The effect of the transplanted pineal gland on the sympathetic innervation of the rat sublingual gland

We investigated the effect of the pineal on sympathetic neurons that normally innervate the sublingual gland of the rat. When the pineal gland was transplanted into the sublingual gland, it remained as a distinct mass that was innervated by sympathetic axons. Injection of the retrograde tracer, Fast Blue, into the sublingual gland labelled sympathetic neurons in the ipsilateral superior cervical ganglion (SCG). Thirty per cent of all neurons labelled retrogradely by Fast Blue injection into transplanted pineal glands were immunoreactive for both neuropeptide Y (NPY) and calbindin. This combination is characteristic of sympathetic neurons innervating the pineal gland in its normal location, but not the sympathetic vasoconstrictor neurons normally innervating the sublingual gland. This, and our previous study in which the pineal gland was shown to similarly influence the phenotype of salivary secretomotor neurons, suggests that a range of different functional classes of sympathetic neuron are able to change their phenotype in response to signals released by the pineal gland.

Patients' recall of clinical information following laparoscopy for acute abdominal pain

Background

Failures in doctor–patient communication and patients' understanding continue to confound improvements in the delivery of quality healthcare. In the context of acute abdominal pain managed by means of laparoscopy, it was hypothesized that patients are either not adequately informed, or do not reliably retain simple relevant information transmitted at the time of the procedure. This study was designed to evaluate the reliability of information transfer between doctor and patient in this setting, including the diagnosis and whether or not the appendix was removed.

Methods

A retrospective study of 350 consecutive patients who had undergone laparoscopy for acute abdominal pain over 3·5 years was designed. Each patient completed a telephone questionnaire that was used to evaluate the accuracy of patients' information.

Results

In total, 26·9 per cent of patients did not know or were incorrect regarding the surgical procedure performed. Similarly, 20·0 per cent of all patients did not know or were incorrect regarding the status of their appendix after surgery and 30·0 per cent of patients were incorrect regarding the diagnosis. Despite all of these statistics, 91·4 per cent of patients were happy with the information they had received regarding the procedure.

Conclusion

Some 26·9 per cent of patients who underwent laparoscopy for acute abdominal pain were incorrect or did not know about the procedure that had been performed. This could lead to a further unnecessary operation should they re-present with similar symptoms.

Re-establishment of neurochemical coding of preganglionic neurons innervating transplanted targets

We investigated the effect on neurochemical phenotype of changing the targets innervated by sympathetic preganglionic neurons. In neonatal rats, the adrenal gland was transplanted into the neck, to replace the postganglionic neurons of the superior cervical ganglion. Transplanted adrenal glands survived, and contained noradrenergic and adrenergic chromaffin cells, and adrenal ganglion cells. Retrograde tracing from the transplants showed that they were innervated by preganglionic neurons that would normally have supplied postganglionic neurons of the superior cervical ganglion. The neurochemical phenotypes of preganglionic axons innervating transplanted chromaffin cells were compared with those innervating the normal adrenal medulla or superior cervical ganglion neurons. As in the normal adrenal gland, preganglionic nerve fibres apposing transplanted chromaffin cells were cholinergic. The peptide and calcium-binding protein content of preganglionic fibres was similar in normal and transplanted adrenal glands. In both cases, cholinergic fibres immunoreactive for enkephalin targeted adrenergic chromaffin cells, whilst cholinergic fibres with co-localised calretinin-immunoreactivity innervated noradrenergic chromaffin cells and adrenal ganglion cells. In contrast to the innervation of normal adrenal glands, these axons lacked immunoreactivity to nitric oxide synthase. In a set of control experiments, the superior cervical ganglion was subjected to preganglionic denervation in rat pups the same age as those that received adrenal transplants, and the ganglion was allowed to be re-innervated over the same time course as the adrenal transplants were studied. When the superior cervical ganglion was re-innervated by preganglionic nerve fibres, we observed that all aspects of chemical coding were restored, including cholinergic markers, nitric oxide synthase, enkephalin, calcitonin gene-related peptide and calcium binding proteins in predicted combinations, although the density of nerve fibres was always lower in re-innervated ganglia. These data show that the neurochemical phenotypes expressed by preganglionic neurons re-innervating adrenal chromaffin cells are selective and similar to those seen in the normal adrenal gland. Two explanations are advanced: either that contact of preganglionic axons with novel target cells has induced a switch in their neurochemical phenotypes, or that there has been target-selective reinnervation by pre-existing fibres of appropriate phenotype. Regardless of which of these alternatives is correct, the restoration of normal preganglionic codes to the superior cervical ganglion following denervation supports the idea that the target tissue influences the neurochemistry of innervating preganglionic neurons.

Ireland in the World Cup: trauma orthopaedic workloads

To determine if whether there were any changes in numbers of orthopaedic injuries at the emergency/ orthopaedic trauma department requiring treatment that could be related to televised home matches during World Cup 2002. Numbers of patients attending with musculoskeletal injuries directly attributable to world cup celebrations were collected during the four home matches. Attendances from midnight before the match until midday the day after the match were recorded. Control groups were matched from the previous month of May, and matched with the same day of the week for each of the four groups. Significantly more patients were admitted to the trauma service, referred to orthopaedic outpatients, and referred to the minor trauma clinic in the match versus control groups. 280 patients required onward referral during the match period compared with 233 during the control period. Televised Irish matches during the World Cup significantly increased the workload of the trauma orthopaedic service with musculoskeletal injuries. This should be taken into account when planning for such events in the future.

Computed tomography wire localisation-assisted operative retrieval of a migrated symphysis pubis plate from the ischiorectal fossa

We report an unusual case of migration of a metal plate from the symphysis pubis to the left ischiorectal fossa, and a technique of using pre-operative CT guided wire localisation of the plate as a successful method of assisting plate retrieval.

Control of postganglionic neurone phenotype by the rat pineal gland

As neurones develop they are faced with choices as to which genes to express, to match their final phenotype to their role in the nervous system. A number of processes can guide these decisions. Within the autonomic and sensory nervous systems, there are a handful of examples that suggest that one mechanism that may match phenotype to function is the presence of target-derived differentiation factors. We tested whether the rat pineal gland controls the expression of a neuropeptide (neuropeptide Y) and a calcium-binding protein (calbindin) in sympathetic postganglionic neurones that innervate it. We first showed that the chemical phenotype of sympathetic neurones innervating the rat pineal includes the expression of both neuropeptide Y and the calcium-binding protein, calbindin. After transplanting the pineal gland of neonatal rats into the submandibular salivary gland of neonatal hosts, it was innervated by sympathetic axons from the surrounding salivary gland tissue, which do not normally express neuropeptide Y and calbindin. The presence of the pineal gland led to the appearance of neuropeptide Y and calbindin in many of the postganglionic neurones that innervated the graft. From these findings we suggest that, like the rodent sweat gland, the pineal gland generates a signal that can direct the neurochemical phenotype of innervating sympathetic neurones.

GCP5 and GCP6: two new members of the human gamma-tubulin complex

The gamma-tubulin complex is a large multiprotein complex that is required for microtubule nucleation at the centrosome. Here we report the purification and characterization of the human gamma-tubulin complex and the identification of its subunits. The human gamma-tubulin complex is a ring of ~25 nm, has a subunit structure similar to that reported for gamma-tubulin complexes from other species, and is able to nucleate microtubule polymerization in vitro. Mass spectrometry analysis of the human gamma-tubulin complex components confirmed the presence of four previously identified components (gamma-tubulin and gamma-tubulin complex proteins [GCPs] 2, 3, and 4) and led to the identification of two new components, GCP5 and GCP6. Sequence analysis revealed that the GCPs share five regions of sequence similarity and define a novel protein superfamily that is conserved in metazoans. GCP5 and GCP6, like other components of the gamma-tubulin complex, localize to the centrosome and associate with microtubules, suggesting that the entire gamma-tubulin complex takes part in both of these interactions. Stoichiometry experiments revealed that there is a single copy of GCP5 and multiple copies of gamma-tubulin, GCP2, GCP3, and GCP4 within the gamma-tubulin complex. Thus, the gamma-tubulin complex is conserved in structure and function, suggesting that the mechanism of microtubule nucleation is conserved.

Computed tomography-based spectral imaging for fluorescence microscopy

The computed tomography imaging spectrometer (CTIS) is a non-scanning instrument capable of simultaneously acquiring full spectral information (450-750 nm) from every position element within its field of view (75 microm x 75 microm). The current spatial and spectral sampling intervals of the spectrometer are 1.0 microm and 10 nm, respectively. This level of resolution is adequate to resolve signal responses from multiple fluorescence probes located within individual cells or different locations within the same cell. Spectral imaging results are presented from the CTIS combined with a commercial inverted fluorescence microscope. Results demonstrate the capability of the CTIS to monitor the spatiotemporal evolution of pH in rat insulinoma cells loaded with SNARF-1. The ability to analyze full spectral information for two-dimensional (x, y) images allows precise evaluation of heterogeneous physiological responses within cell populations. Due to low signal levels, integration times up to 2 s were required. However, reasonable modifications to the instrument design will provide higher system transmission efficiency with increased temporal and spatial resolution. Specifically, a custom optical design including the use of a larger format detector array is under development for a second-generation system.

Compartmentation and topology of glucosylceramide synthesis

Evidence is presented supporting a model for glucosylceramide formation on the apoplastic side of the plasma membrane in plants. Glucosylceramide synthase and sterol glucosyltransferase were both localized to the plasma membrane. Whereas sterol glucosylation was sensitive to proteolytic enzymes, ceramide glucosylation was not. These results are consistent with our model in which steryl glucoside is synthesized on the cytosolic side of the membrane and then translocated across the membrane where it donates glucose to ceramide.

Sexual assault and sexually transmitted infections: an updated review

The purpose of this review is to provide an overview of sexual assault (in adults). In particular, the aim is to emphasize changes regarding medical, legal and management issues since the subject was reviewed in this journal in 1990. However some aspects will not have changed in the last 10 years.

After axotomy, substance P and vasoactive intestinal peptide expression occurs in pilomotor neurons in the rat superior cervical ganglion

Autonomic sympathetic postganglionic neurons normally express distinct combinations of neuropeptides which are often highly correlated with the projection of the neurons. When sympathetic postganglionic neurons are axotomized, they can express quite different neuropeptides, notably substance P, vasoactive intestinal peptide or galanin. In this study, we have examined rat sympathetic postganglionic neurons in the superior cervical ganglion that project to the skin, the vasculature of the skeletal muscle or to the submandibular salivary gland, and assessed whether the neuropeptides that they express after axotomy depend on which target tissue they previously innervated. In all three populations, around half of the postganglionic neurons expressed galanin after axotomy. In contrast, only skin-projecting neurons showed a significant increase in the number of neurons that expressed substance P (22%) and vasoactive intestinal peptide (17%) following axotomy. Within the skin-projecting neurons, as judged on the basis of cell body size, substance P and vasoactive intestinal peptide were expressed predominantly in pilomotor neurons, but only rarely were the two neuropeptides present in the same nerve cell body. In conclusion, we have demonstrated that three different neuropeptides, which can be induced by axotomy in postganglionic neurons, follow quite different patterns of expression when they are viewed in relation to the function of the postganglionic neurons in the superior cervical ganglion.

Rodent noradrenergic chromaffin cells contain calbindin D28K immmunoreactivity

The calcium binding protein calbindin D28K is heterogeneously distributed in neurons throughout the body. We have investigated the distribution of calbindin in the chromaffin cells of the adult rodent adrenal medulla, which share the same developmental origin as peripheral sensory and autonomic neurons. Calbindin immunoreactivity was present in all noradrenergic chromaffin cells (defined by their lack of the adrenaline synthesizing enzyme, phenylethanolamine N-methyl transferase) in both the rat and mouse. It was also present in a very few adrenergic chromaffin cells in both rat and mouse. Calbindin-immunoreactivity is present in rat noradrenergic chromaffin cells from the day of birth and so is a useful marker for identifying rodent noradrenergic chromaffin cells.

Examination of particulate macroporous hydrogels in an extracorporeal rat haemoperfusion model

A series of macroporous hydrogels has been synthesized, selected from a range of such materials in which the presence of functional groups has been shown to produce sorbent properties with respect to molecules having clinical significance in the field of liver support. The use of freeze thaw polymerization, together with inverse suspension polymerization in hexane, or in brine, enables macroporous beads ranging in size from 150 to 2000 microm, to be prepared from functional monomers exhibiting a range of chemical functionalities and aqueous solubilities. In order to investigate the behaviour of these rigid porous hydrophilic substrates in haemoperfusion, a rat model was used to explore various aspects of whole blood response. The materials were incorporated into an extracorporeal circuit linking the right carotid artery and left jugular vein of male Sprague-Dawley rats. Erythrocyte, leucocyte and platelet levels were monitored over a 240 min haemoperfusion period. The most significant observation is that, apart from the strongly acidic polyacrylic acid substrate. matrix chemistry has relatively little effect on leucocyte or platelet response. The most important factors appear to be surface area, pore size and surface rugosity, which do produce measurable, but not dramatic differences. This is encouraging for future work, since these variables may be manipulated by polymerization conditions.

Current parent education on infant feeding in the neonatal intensive care unit: the role of the occupational therapist

OBJECTIVES

The purpose of this study was to describe current trends in parent education on infant feeding in the neonatal intensive care unit (NICU) and to clarify the role of the occupational therapist in educating parents.

METHOD

Questionnaires were mailed to 190 neonatologists across the United States who were asked to forward it to a NICU occupational therapist. The questionnaire gathered descriptive information about the structure of parent education in the NICU, the role of the occupational therapist in providing parent education, and demographics about respondents and their NICUs. The response rate was 53% (n = 100).

RESULTS

All 100 hospitals responding provided parent education in some form, and most included a variety of topics and teaching methods. Occupational therapists were on the NICU team at 74 of the hospitals and were identified third most frequently as a provider of parent education. The occupational therapists were most frequently identified as responsible for teaching about positioning, infant development, and infant states and cues and were highly involved in educating parents about feeding.

CONCLUSION

Current parent education programs in NICUs are comprehensive in scope. Occupational therapists' role in educating parents about infant care and feeding consists of a focus on certain topics where occupational therapists have specialized skills and education. Occupational therapists are recognized by their NICU colleagues as providers of parent education, but this study suggests that the occupational therapists' role may not be clearly understood by other NICU professionals.

Chemically distinct preganglionic inputs to iris-projecting postganglionic neurons in the rat: A light and electron microscopic study

Individual autonomic postganglionic neurons are surrounded by pericellular baskets of preganglionic terminals that are easily identifiable with the light microscope. It has been assumed that the target cell of a pericellular basket of preganglionic terminals is the neuron at the centre of the basket. This assumption has enabled the connectivity of preganglionic neurons to be determined at the light microscopic level. However, if the preganglionic terminals in a pericellular basket make synapses with the dendrites of nearby, but functionally different, postganglionic neurons, then the conclusions of light microscopic studies are far less certain. We have used a serial section ultrastructural study to determine the target of the preganglionic pericellular basket in a situation where the apparent target cell is surrounded by neurons of dissimilar function. In the rat superior cervical ganglion, postganglionic neurons projecting to the iris were identified, using retrograde tracers, as single neurons (i.e., not in clusters). We have used immunohistochemistry to show that iris-projecting neurons are surrounded by preganglionic nerve terminals containing calcitonin gene-related peptide (CGRP). We have demonstrated that the pericellular basket of CGRP-immunoreactive preganglionic terminals provides inputs only to the soma at the centre of the basket and not to the dendrites of surrounding neurons. This suggests that, in autonomic ganglia, light microscopic identification of the preganglionic terminal baskets is likely to be a reliable method for identifying the targets of subclasses of preganglionic neurons.