Introduction to the DAPPLE Air Pollution Project

The Dispersion of Air Pollution and its Penetration into the Local Environment (DAPPLE) project brings together a multidisciplinary research group that is undertaking field measurements, wind tunnel modelling and computer simulations in order to provide better understanding of the physical processes affecting street and neighbourhood-scale flow of air, traffic and people, and their corresponding interactions with the dispersion of pollutants at street canyon intersections. The street canyon intersection is of interest as it provides the basic case study to demonstrate most of the factors that will apply in a wide range of urban situations. The aims of this paper are to introduce the background of the DAPPLE project, the study design and methodology for data collection, some preliminary results from the first field campaign in central London (28 April-24 May 2003) and the future for this work. Updated information and contact details are available on the web site at http://www.dapple.org.uk.

Loneliness, health and depression in older males

Loneliness and social isolation, particularly in the older adult, have been shown to influence psychosocial well-being. Loneliness has been related to chronic illness and self-rated health in older adults, and researchers suggest there is an important relationship between loneliness and psychological well-being in older adults particularly in the area of depression. This study investigated relationships between loneliness, health, and depression in 217 older men (> 65 years). Participants completed self-report measures of loneliness, social support, depression, and physical health. Regression analysis showed that a diagnosis of illness or disability was unrelated to depression, however self-reported health was associated with depression, with those reporting poorer health experiencing greater depression. Social support variables were unrelated to depression. The most significant relationship to depression was that of loneliness, with lonelier men reporting higher scores on the Geriatric Depression Scale (GDS). Although research suggests that depression is often a response to declining health and functional impairment in the older adult, the present findings suggest that social isolation may also influence the experience of depression. Age-related losses such as loss of professional identity, physical mobility and the inevitable loss of family and friends can affect a person's ability to maintain relationships and independence, which in turn may lead to a higher incidence of depressive symptoms.

Stress, social support and psychological well-being in older men

Along with an increase in the older population comes a concomitant increase in the number of people for whom issues relating to well-being, for example, stress and social relationships become more salient. In this study, relationships between stress, social support and psychological well-being in men over the age of 65 years were investigated. A convenience sample of 217 men over the age of 65 years, living in a small New Zealand city took part in the study. A questionnaire was used to gather information on stress, social support and psychological well-being, as well as biographical data. Data were analysed quantitatively. Results showed that both the men who were satisfied with the social support they received and those who reported low stress levels experienced higher levels of psychological well-being (p<.001). The number of people available to provide social support was not significantly related to psychological well-being. There were no significant interaction effects between stress, social support variables and psychological well-being, with each variable operating independently in relation to psychological well-being. It appeared that the older the men were the fewer social supports available to them, suggesting the importance of the quality of those supports in maintaining psychological well-being.

Health assessment and its relationship to nursing practice in New Zealand

Health assessment has been an integral component of nursing education in Australia for over a decade. New Zealand has only recently embarked down this path and might benefit from the Australian experience. This article will discuss health assessment in the context of three issues currently topical in nursing in New Zealand. The issues are annual registration based on evidence of competence to practice, a review of undergraduate curricula, and the development of nurse practitioner/advanced nurse practitioner roles. The meaning of the concept 'health assessment' is also clarified in order to provide consistency as new initiatives in nursing are currently being developed.

Factors influencing health and well-being in the older adult

Both in New Zealand and internationally there are increasing numbers of people living well into their senior years. Not only are more individuals reaching late adulthood, more are living beyond this stage. Because of corresponding increases in illness and/or disability this phenomenon has implications for the provision of health care to communities. This article offers a literature review of selected factors influencing the health and well-being of older people, with a particular emphasis on the older male. Implications for nursing practice in New Zealand are discussed.

A cluster of meningococcal disease in western Sydney, Australia initially associated with a nightclub

Fourteen cases of meningococcal disease (MD) occurred in August September 1996 in western Sydney, Australia. Seven of the 10 young adults affected had a direct or indirect link with a local nightclub. Ten of 11 systemic meningococcal isolates had the phenotype C:2a:P1.5 and showed close genetic relationship by pulsed-field gel electrophoresis (PFGE). Organisms of this phenotype have not previously caused outbreaks in Australia, but have been associated with outbreaks and hyperendemic serogroup C MD in Europe, Canada, and the United States. This is the largest cluster of serogroup C MD reported in urban Australia, and the first involving a nightclub. The strain differentiation results were available rapidly enough to augment epidemiological investigations on a daily basis. Public health staff could thus establish links between cases quickly, follow the spread of new cases in the community, give accurate information to health officials and the press, and utilize existing knowledge about the characteristics of this phenotype to predict likely developments during the outbreak and afterwards. The strain differentiation data was also very helpful when the role of vaccination was considered, and existing guidelines on the management of outbreaks of MD could be used effectively for the first time in western Sydney.

Peritonitis associated with a CDC group EO-3 organism

A 63-year-old female with chronic renal failure on continuous ambulatory peritoneal dialysis developed chronic peritonitis. A CDC group EO-3 organism was isolated from the peritoneal dialysis fluid on five occasions over a period of 4 months. This is the first reported isolation of this organism in which it is associated with a patient on continuous ambulatory peritoneal dialysis.

An evaluation of the in vitro activity of piperacillin/tazobactam

Tazobactam is a new, irreversible inhibitor of bacterial beta-lactamases of staphylococci, plasmid-mediated beta-lactamases of the TEM and SHV types found in Escherichia coli and Klebsiella species and beta-lactamases of anerobes such as Bacteroides species. Its combination with piperacillin, a broad spectrum ureido-penicillin, would be expected to improve the activity of piperacillin against staphylococci, TEM and SHV beta-lactamase producing Gram negative bacteria and anerobes. Minimal inhibitory concentrations (MIC) of piperacillin/tazobactam were determined for 1952 individual patient isolates of Gram positive and negative bacteria causing significant infections and compared with MIC values for cefotaxime, ceftazidime, ciprofloxacin, imipenem, ticarcillin/clavulanic acid. MICs were determined by agar dilution (NCCLS 1990 and 1992). Piperacillin/tazobactam had excellent activity against methicillin susceptible staphylococci, Streptococcus pneumoniae, Haemophilus influenzae, enterococci and organisms of the Bacteroides fragilis group. It was also active against the majority of Enterobacteriaceae and Pseudomonas aeruginosa isolates tested. It was not active against extended spectrum beta-lactamase (ESBL) producing Klebsiella species and some high level TEM and SHV beta-lactamase producing E. coli and Klebsiella species. Activity against Gram negative organisms capable of producing chromosomally mediated beta-lactamases was good, since in most organisms tested, the enzymes were not induced in sufficient quantities to cause antibiotic resistance. However some Enterobacter species were derepressed hyperproducing mutants; these isolates showed resistance to piperacillin/tazobactam since tazobactam does not inhibit these Class I beta lactamases. Activity was superior to ticarcillin/clavulanic acid for Gram negative rods. Imipenem was the most active agent against ESBL producing Klebsiella species. Piperacillin/tazobactam has a suitable spectrum of activity in vitro to suggest its use in monotherapy of mixed anerobic infections, mixed respiratory infections such as aspiration pneumonia and, in combination with an aminoglycoside, it would provide Gram positive as well as Gram negative cover of febrile episodes in immunosuppressed patients.

Sex is an important variable affecting spontaneous micronucleus frequency in cytokinesis-blocked lymphocytes

The micronucleus frequency in cytokinesis-blocked lymphocytes of 152 females and 113 males aged between 20 and 89 years (minimum of 15 subjects per sex per decade) was compared. Marked differences in the micronucleus frequency of males and females were observed: (a) there was a greater dispersion in the results for females when compared to males in all age groups older than 40 years; (b) there was a significant positive correlation between micronucleus frequency and age in both sexes (p < 0.0001) but the slope of the linear regression line was steeper in females (slope = 0.499 micronuclei/year) compared to males (slope = 0.289 micronuclei/year) (p < 0.0045); (c) the micronucleus frequency in females (Mf) was significantly higher than the micronucleus frequency in males (Mm) in all decades examined (p < 0.05), the Mf,Mm ratio varied between 1.47 and 1.65 (mean +/- 1 SEM = 1.53 +/- 0.03) and showed no trend with age. These results suggest that an added mechanism, possibly the loss of X chromosomes, is contributing to the micronucleus frequency in females and highlights the importance of sex as a variable that has to be taken into consideration when interpreting data from cross-sectional studies utilising the cytokinesis-block micronucleus assay as a biomarker of chromosome damage.

Planning home care services for people living with AIDS

As the number of individuals infected with the human immunodeficiency virus (HIV) increases, so does the demand for healthcare services. The debilitating manifestations seen in the later stages of illness, in association with the diagnosis of acquired immune deficiency syndrome (AIDS), often require the assistance of home care providers. Establishing a database of information, not only on the clinical needs of individuals but also on person-specific details, is essential to identify the nursing care needs of this population. The delivery of home care services to people living with AIDS (PLWA) includes the client, the significant other(s), and the community in which the client resides.

Microbiological aspects of an outbreak of Legionnaires' disease in south western Sydney

In April 1992 an outbreak of Legionnaires' disease occurred in south western Sydney. Twenty four patients were diagnosed as having Legionnaires' disease either on the basis of a positive culture of Legionella pneumophila serogroup I from a respiratory specimen (14 patients) or a four-fold or greater rise in antibody titre or isolated convalescent titre > 1024 with IgM antibodies present (10 patients). This is the largest outbreak in New South Wales since 44 cases of Legionnaires' disease were reported in Wollongong in 1987. Culture and direct immunofluorescent staining (DFA) were performed for early laboratory diagnosis. The DFA test and a set of defined clinical criteria were then used to classify patients as probable cases of Legionnaires' disease for subsequent Public Health investigations. The DFA test had a predictive value for a positive culture of 45.8% and for a negative culture of 97.1%. Its positive predictive value for a definite diagnosis of Legionnaires' disease (either positive culture or seroconversion), however, was 78.3% with a negative predictive valve of 95.1%. During a 27 day period DFA and culture for Legionella species were performed on 198 specimens from 127 patients. Cultures became positive after a mean of 5 days incubation (range 1-11 days). The use of both selective and non-selective media is recommended for optimal recovery of L. pneumophila since some isolates were obtained on only one culture plate. After an initial evaluation of heat decontamination of specimens this process was abandoned, since in 8/63 specimens so treated, L. pneumophila was recovered prior to but not following heat decontamination and was not grown only in heated specimens.(ABSTRACT TRUNCATED AT 250 WORDS)

Mutagenicity testing of 9-N-substituted adenines and their N-oxidation products

Adenine together with certain 9-N-substituted derivatives such as 9-methyl, 9-benzyl, 9-benzhydryl, and 9-trityl were tested against Salmonella typhimurium strains TA97, TA98, and TA100 in the absence and presence of rat hepatic S9 prepared from Aroclor 1254 pretreated rats. All compounds were positive toward TA98 in the presence of the metabolic activating system, whereas they all lacked mutagenic activity in the absence of S9, and toward TA97 and TA100 with or without S9 when tested at 100 ng/plate. A similar pattern was observed for the corresponding 1-N-oxides. 6-Hydroxylaminopurine was not mutagenic toward TA100 at 100 ng/plate, whereas it was toxic toward TA97 and TA98 at this level. When tested at 1 ng/plate, hydroxylaminopurine was still toxic to TA98 but produced twice the spontaneous reversion rate to TA97 without metabolic activation. Surprisingly, 9-methyl-6-hydroxylaminopurine was only active toward TA98 in the presence of S9, whereas 9-benzyl-6-hydroxylaminopurine was highly active toward TA97 and TA100 in the absence of S9 and even more active in the presence of S9. This compound was inactive toward TA98 in the absence of S9. The results generally support the concept that nuclear N-oxidation of aminoazaheterocycles is a detoxication process, whereas N-hydroxylation of the exo amino group is a toxication reaction.

Effect of cooked meat on micronucleus frequency

The possibility that inclusion of cooked meat in the diet could elevate chromosome damage risk was investigated in mice fed either a cereal diet only or a cereal diet supplemented with mutton cooked by microwaving, pan-frying or charcoal-barbecueing. The meat was provided as a supplement to the standard cereal-based diet on an approximately one-to-one basis. Chromosome damage indices included the cytokinesis-block micronucleus assay in spleen lymphocytes, the bone marrow micronucleus assay in erythrocytes and two versions of the colonic micronucleus assay. These indices were assessed after 3 or 6 months of feeding, and under each circumstance no increment in the micronucleus frequency in any of the tissues could be detected in the groups fed cooked meat when compared with each other or with the group fed the cereal diet only. There was also no correlation between the micronucleus index in lymphocytes and body weight. These data suggest that, over the time-frame studied, inclusion of meat in the diet and the extent to which meat is cooked are unlikely to be important variables affecting the micronucleus index.

Micronucleus induction in bone-marrow cells following consumption of cooked beef in mice. Preliminary investigations

The bone-marrow micronucleus assay was used to investigate whether the consumption of cooked meat could induce chromosome damage. There was no difference in the micronucleus frequency of mice on normal diet (cereal-based, non-purified diet) and mice on normal diet supplemented with microwaved meat. However, supplementing the normal diet with well-done pan-fried meat or rare charcoal-barbecued meat or well-done charcoal-barbecued meat produced significant increments in the micronucleus frequency of polychromatic erythrocytes--the increments were of the order of 73% (p = 0.045), 90% (p = 0.047) and 136% (p = 0.001) respectively and they were observed after a 21-day feeding trial. These results suggest that ingestion of well-done pan-fried or barbecued meat may increase genetic damage, however, the accompanying decreased intake of vegetable constituents may have also contributed to the observed changes.

Purification and initial characterisation of koala immunoglobulins

The production of koala immunoglobulins (Ig) was elicited by the immunisation of a koala (Phascolarctos cinereus) with bovine serum albumin. This Ig was then purified using the highly specific techniques of affinity chromatography. The purified protein was compared with a "potential" koala Ig protein which was subsequently purified by Protein G chromatography and both proteins were further characterised by agarose/SDS-PAGE and immunoelectrophoresis. Results indicate that koalas do produce Ig in response to antigen challenge, koala Ig has a higher net negative charge than that seen in most other mammals and possibly two subclasses of IgG and IgM are present in normal koala serum.

Flavimonas oryzihabitans infection of a surgical wound

An unusual case of a post operative wound infection involving Flavimonas oryzihabitans is described. This organism is rarely isolated from human sources. It can cause infections in patients having continuous ambulatory peritoneal dialysis. Our patient developed a wound infection 2 months after femoro-popliteal bypass grafting. The source of the organism was unknown.

The induction of P450 I proteins by aromatic amines may be related to their carcinogenic potential

The hypothesis has been put forward that genotoxic aromatic amines which induce the P450 I family of haemoproteins, the major enzyme involved in their bioactivation, are more likely to be carcinogenic when compared to those chemicals that fail to do so. Induction of the hepatic P450 I family of proteins by carcinogenic aromatic amines and their non-carcinogenic isomers and analogues was investigated in the rat and correlated to their carcinogenic potential. The activity of the P450 I A1 protein was monitored by the O-deethylation of ethoxyresorufin and of the P450 I A2 by the activation of the premutagen Glu-P-1 to mutagenic intermediates in the Ames test. Results were always confirmed immunologically in Western blots employing antibodies to rat P450 I A1 which recognize both proteins of the P450 I family. With all groups of chemicals used in the present study, the members displaying carcinogenicity were always the more potent inducers, while the non-carcinogenic isomers or analogues displayed little or no induction. It appears that a relationship exists between the carcinogenicity of aromatic amines and their ability to induce hepatic P450 I activity.

Use of traction in cervical spine fractures during interhospital transfer by aircraft

Despite significant improvement in the organization and function of the nation's emergency medical services and the increasing sophistication of initial providers of critical care, there has apparently been no reduction in the incidence of neurological deficits suffered by patients with unstable cervical spine injuries during management prior to intervention by the spine surgeon. In analyzing the techniques used to stabilize patients with suspected unstable cervical spine injuries during this phase, we conclude that present standard techniques are either insufficient or potentially destabilizing. We have developed a system that will permit the use of cervical traction, applied with a halter or the standard Gardner-Wells tongs, during the prehospital phase of management of patients with cervical spine injuries. Based on our experience with the system, we recommend that patients with such injuries be stabilized with skeletal traction when transferred between hospitals by air ambulance. Logic permits consideration of the concept even earlier in the prehospital phase of management and in ground ambulances.

Induction of the P-450 I family of proteins by polycyclic aromatic hydrocarbons: possible relationship to their carcinogenicity

The hypothesis has been put forward that mutagenic polycyclic aromatic hydrocarbons which induce the P-450 I family of cytochromes, the major enzyme system responsible for their activation, are likely to be carcinogenic. In order to test this hypothesis, rats have been pretreated with a number of polycyclic aromatic hydrocarbons of different mutagenic and carcinogenic potency and hepatic P-450 I activity was monitored using chemical probes such as the O-deethylation of ethoxyresorufin and metabolic activation of Glu-P-1 to mutagens, and immunologically employing polyclonal antibodies against purified rat P-450 I A1. All compounds studied enhanced P-450 I activity and induced P-450 I apoproteins but the extent of induction was very markedly different. The results are discussed with reference to the mutagenicity of these chemicals in the Ames test and their carcinogenicity in the classical mouse skin model. A relationship appears to exist between carcinogenicity of polycyclic aromatic hydrocarbons and their ability to induce hepatic P-450 I activity.

Complement activation within the coeliac small intestine is localised to Brunner's glands

Complement activation may play an important role in the pathogenesis of coeliac disease. In the present study immunohistochemical localisation of C3 and of a neoantigen exposed only on the terminal C5b-9 complement complex has been performed on small intestinal biopsy sections from newly diagnosed untreated coeliac patients, from coeliac patients on long-term gluten-free diet and from disease controls. Levels of C3 were markedly increased in treated coeliac patients compared with controls. Staining of C3 was concentrated subepithelially and within the centre of the lamina propria. No staining was detected at these sites using antibody to the neoantigen, however, strongly suggesting that the increased levels of C3 seen in the coeliac patients was the result of increased extravasation of serum proteins rather than complement activation. Surprisingly, complement activation was detected within the glands of Brunner. Positive staining using anti-C5b-9 neoantigen was found in all coeliac patients, both treated and untreated. Three of the 13 disease controls also showed reactivity with this antibody. This novel finding suggests that Brunner's glands, hitherto largely neglected structures, may play an important role in the development of coeliac disease.

A rationale for the non-mutagenicity of 2- and 3-aminobiphenyls

Of the three isomeric forms of aminobiphenyl, only 4-aminobiphenyl is an established carcinogen while the 2-isomer is considered as a non-carcinogen and 3-aminobiphenyl is at best described as a weak carcinogen. In the present studies we investigated the mutagenicity of these three compounds, their N-hydroxy derivatives and their nitrosoderivatives in the Ames test using the Salmonella typhimurium strains TA98 and TA100. The studies were performed both in the absence and presence of an activation system derived from the liver of rats pretreated with Aroclor 1254. Of the three isomers only 4-aminobiphenyl exhibited mutagenicity and only in the presence of an activation system. N-Hydroxy-4-aminobiphenyl was a potent direct mutagen in both bacterial strains, N-hydroxy-2-aminobiphenyl was mutagenic in only TA100 while N-hydroxy-3-aminobiphenyl displayed mutagenicity in neither strain. Both 2- and 3-nitrosobiphenyls were direct mutagens in strain TA100. These findings suggest that the weak carcinogenicity of 3-aminobiphenyl may be attributed to the lack of genotoxicity of its N-hydroxyderivative, whereas in the case of 2-aminobiphenyl it may be due to the inability of the hepatic preparations to catalyse its N-hydroxylation, which is in agreement with published in vivo metabolic studies. It is interesting that of the three isomers only 2-aminobiphenyl is non-planar, forming a dihedral angle of 40 degrees, and this may preclude it from acting as a substrate of the P-450I family of haemoproteins, which selectively catalyses the N-hydroxylation of many aromatic amines including 4-aminobiphenyl.

[Inter-individual testing of water-soluble oral contrast media with reference to their diagnostic value, side effects and taste]

Three groups of patients (n = 55, 53 and 54) were examined with the x-ray contrast media Gastrografin, Peritrast-Oral GI, and Telebrix Gastro and Telebrix Gastroo assess the diagnostic ranking, side effects and taste of water-soluble oral contrast media. No significant differences were seen in respect of diagnostic ranking and side effects. Side effects were exclusively abdominal symptoms; there was no difference with regard to laxative action. Telebrix Gastroas accepted significantly better in respect of taste than Gastrografin and Peritrast-Oral GI.

A study of the mutagenicity of melatonin and 6-hydroxymelatonin

The mutagenicity of melatonin and its major metabolite 6-hydroxymelatonin were evaluated using the Ames test and three strains of Salmonella typhimurium--TA 97, TA 98, and TA 100. Neither compound exhibited mutagenicity whether in the presence or absence of an activation system derived from rats induced with Aroclor 1254. Positive controls were employed throughout and gave the expected response. We conclude that melatonin, 6-hydroxymelatonin, and their microsomal metabolites are not mutagenic in the Ames test.

Jacalin: its binding reactivity with immunoglobulin A from various mammalian species

Jacalin, a recently described lectin, has been demonstrated to have unique binding properties for some forms of human immunoglobulin A (IgA). The lectin has now become commercially available, immobilized to a beaded agarose support. This laboratory undertook a short study to determine whether this immobilized jacalin demonstrated any binding capacity for IgA from various mammalian species, with a view to utilizing this new form of affinity chromatography to simplify the purification of IgA from these species. Utilizing the chromatographic conditions recommended by the manufacturer, the bound jacalin demonstrated no IgA reactivity from pig, goat, horse, cow or dog.

Spinal instability and the log-rolling maneuver

Immobilization of the spine is of prime concern during transportation of trauma patients to prevent neurologic compromise. In an attempt to study certain techniques of prehospital thoracolumbar spine immobilization, we radiographically evaluated the motion of the thoracolumbar spine in a volunteer with a stable spine, a cadaver with an unstable thoracolumbar spine, and a patient with a T12-L1 fracture dislocation. Both the backboard and the Scoop stretcher offered adequate stabilization for thoracolumbar spine instability. The logroll maneuver presented the greatest possibility for movement of the spine at the unstable thoracolumbar segment.