Recognizing the power of diversity

"The trouble with the future is that it usually arrives before we are ready for it." While Arnold H. Glasgow did not have diversity in mind when he made this statement, his thought is relevant to that topic nevertheless. In fact, almost everything in the health care environment of the 1990s is fluid, making the future a question mark. Among these changes is the demographic composition of students entering medical school and of patients. Consider the following. While 14 percent of today's physicians are people of color, that number increases to 25 percent for current medical students. In the past 10 years, the number of female physicians has seen the largest percentage growth, followed by American Indians, Blacks, and Hispanics. Physician executives who have vision and energy can capitalize on this demographic revolution and convert diversity into a competitive advantage once its boundaries are understood.

Plasmodium falciparum varies in its ability to induce tumor necrosis factor

Tumor necrosis factor (TNF) has a variety of protective and pathological actions in human malaria. We report that different laboratory lines of Plasmodium falciparum which were derived from a single wild isolate (IT 4/25/5) varied widely in their ability to stimulate TNF production by human mononuclear cells. In the cloned line R29 we observed that subcultures selected for high rosetting frequency gave significantly higher levels of TNF stimulation than subcultures with low rosetting frequency, indicating that TNF induction can vary within populations that have originated from a single genotype. These results raise the possibility that the clinical severity of malaria is partly determined by the TNF-inducing activity of the infecting strain of parasite.

Group work. Cope street revisited

45 Cope Street is a preventive health project working with pregnant women and young mothers aged between 16 and 25 years and their children in the inner city of Nottingham. A beacon of innovative health visiting practice, it has recently passed the fifth anniversary of its opening. Team leader Ann Rowe describes their philosophy and practice.

Black offenders from the prison system in Georgia

This secondary analysis based on a previous study by the author of 14,834 men and women in the state prison system in Georgia shows that cultural differences for youth exhibited in frequency of rule conformity by white and nonwhite inmates did not appear among the middle-aged inmates.

Ets-1 and Ets-2 protooncogene expression in theca cells of the adult mouse ovary

We have investigated the mRNA expression of the Ets-1 and Ets-2 genes in murine gonads and found expression in adult ovaries. In situ hybridization experiments show that the Ets genes are predominantly expressed in theca cells and cells of ovarian interstitium. By gel retardation experiments we detected DNA binding proteins in ovaries that specifically bind to the ETS motif, suggesting the expression of Ets or Ets-related proteins. Our results raise the possibility of Ets-2 involvement in ovarian pathology seen in patients with Down's syndrome.

Position-dependence of retinoic acid receptor-beta gene expression in the chick limb bud

Retinoic acid and 3,4-didehydroretinoic acid are metabolites of vitamin A that can induce duplications and other malformations when locally applied to the anterior margin of the chick limb bud. There is evidence that they may be natural signaling substances in the limb bud. Both compounds are thought to act by binding to ligand-dependent transcription factors that belong to the steroid/thyroid hormone nuclear receptor superfamily. In situ hybridization analyses show that in the mesenchyme of the chick wing bud between embryonic stages 20 and 27, retinoic acid receptor-beta (RAR-beta) transcripts are restricted to the proximal region of the bud and are present at highest levels in the region of the limb bud mesenchyme that contributes to the shoulder. We have performed grafting experiments in order to examine whether RAR-beta gene expression in limb bud mesenchyme cells is cell-autonomous or whether it is dependent upon the cell's position within the limb bud. When tissue from the proximal region of the stage 22 wing bud, which contains high levels of RAR-beta transcripts, was grafted to the distal tip of the bud, RAR-beta transcripts were undetectable in the graft 6 hr later. When tissue from the distal tip of the bud was grafted to a proximal site, most of the grafts exhibited a slight increase in the level of RAR-beta transcripts, which was detectable 6 hr after grafting. However, the levels of RAR-beta transcripts in these grafts never approached those found in the proximal core of the bud. These data indicate that RAR-beta gene expression in the chick wing bud is position-dependent in that it is repressed at the distal tip of the bud and partially activated by grafting distal tissue to a proximal site. However, accumulation of RAR-beta transcripts to high levels appears to be a characteristic of mesenchyme that was initially specified to form proximal structures.

In vivo and in vitro characterization of overproduced colicin E9 immunity protein

We report the overproduction of the immunity protein for the DNase colicin E9 and its characterization both in vivo and in vitro. The genes for colicin immunity proteins are normally co-expressed from Col plasmids with their corresponding colicins. In the context of the enzymatic colicins, the two proteins form a complex, thereby protecting the host bacterium from the antibiotic activity of the colicin. This complex is then released into the medium, whereupon the colicin alone translocates (through the appropriate receptor) into sensitive bacterial strains, resulting in bacterial cell death. The immunity protein for colicin E9 (Im9) has been overproduced in a bacterial host in the absence of its colicin, to enable sufficient material to be isolated for structural studies. As a prelude to such studies, the in-vivo and in-vitro properties of overproduced Im9 were analysed. Electrospray mass spectrometry verified the molecular mass of the purified protein and analytical ultracentrifugation indicated that the native protein approximates a symmetric monomer. Fluorescence-enhancement and gel-filtration experiments show that purified Im9 binds to colicin E9 in a 1:1 molar ratio and that this binding neutralizes the DNase activity of the colicin. These results lay the foundations for a full biophysical and structural characterization of the colicin E9 DNase inhibitor protein, Im9.

Development of the spatial pattern of retinoic acid receptor-beta transcripts in embryonic chick facial primordia

Retinoic acid causes a range of embryonic defects, including craniofacial abnormalities, in both birds and mammals and is believed to have a number of roles in normal development. We have previously shown that the distribution of retinoic acid receptor-beta (RAR-beta) transcripts is spatially restricted within the neural-crest-derived upper beak primordia of the chick embryo. We have now used in situ hybridisation to trace the distribution of RAR-beta transcripts during the migration of cranial neural crest cells and during formation of these primordia. RAR-beta transcripts were present in a subset of migrating neural-crest-derived cells in the head of the stage 10 embryo. These cells were situated in pathways followed by cells that migrate from the neural crest overlying the posterior prosencephalic/anterior mesencephalic region of the developing brain. Cells containing RAR-beta transcripts accumulated around the developing eyes and in the regions of the ventral head from which the upper beak primordia later develop. We mapped the distribution of RAR-beta transcripts as the facial primordia were forming, with particular reference to the development of the maxillary primordia. We found that these form in a region of the ventral head that includes the boundary between regions of high and low levels of RAR-beta transcripts. The boundary between these two groups of cells persisted as the maxillary primordia developed.(ABSTRACT TRUNCATED AT 250 WORDS)

A member of the chicken RXR family of nuclear receptors activates transcription in response to retinoic acid

The chicken cRXR nuclear receptor is a member of the steroid/thyroid hormone receptor superfamily. In this paper we show that cRXR can transactivate gene expression in response to retinoic acid, but that its sensitivity to retinoic acid is lower than that of the hRAR-beta receptor. We have also compared the ability of cRXR and hRAR-beta to respond to a panel of other retinoids. Unlike hRAR-beta, cRXR failed to respond to the naturally occurring retinoid 3,4-didehydro-retinoic acid or to the synthetic retinoid TTNPB, both of which share the ability of retinoic acid to induce digit duplications when locally applied to chick limb buds.

Note on education and self-worth among AngloAmerican, black American, and Mexican-American men in San Antonio

Data from a secondary analysis of a larger study of machismo and alcohol drinking of 481 male regular drinkers in San Antonio support the hypothesis that higher education leads to high perception of self-worth among AngloAmericans, black Americans, and Mexican-Americans.

Is 'evaluation' a dirty word?

How do we measure the important aspects of preventive health care? - what the users of the service value and what we know from experience is working. Pippa Mackeith and Ann Rowe's work at 45 Cope Street, a centre for young mothers, suggests that evaluation can be both acceptable and useful to clients, workers, managers and taxpayers.

Retinoic acid treatment alters the distribution of retinoic acid receptor-beta transcripts in the embryonic chick face

Retinoic acid is a metabolite of vitamin A that can act as a signalling molecule in a number of developmental systems. Retinoic acid is also known to be teratogenic in mammals, causing a range of defects including abnormalities in craniofacial development. Exposure of the developing chick face to retinoic acid released slowly from a bead implanted in the wing bud results in a specific facial defect, in which outgrowth of the frontonasal mass is inhibited. This results in clefting of the primary palate and absence of the upper beak. To investigate the role of nuclear retinoic acid receptors in normal and abnormal chick face morphogenesis, we isolated chick retinoic acid receptor-beta (RAR-beta) cDNA clones and probed northern blots of RNA isolated from chick embryos at stages 22, 24 and 25 and from adults. RAR-beta transcripts of 2.8 and 3.5 kb were present in several regions of the embryo, including the facial primordia, and were also present at much lower levels in adult tissues. In situ hybridisation showed that RAR-beta transcripts were present in all of the facial primordia at embryonic stages 20, 24 and 28, but that their distribution was not uniform. Transcripts were abundant in the lateral nasal processes, at the edges and corners of the frontonasal mass and in the anterior part of the maxillary primordia. Lower levels were present elsewhere. Treatment of stage 20 embryos with retinoic acid altered the distribution of RAR-beta transcripts in the maxillary primordia, such that high levels of transcripts were present throughout, rather than being confined to the anterior part. This change was detectable at stage 24, before any alterations in the morphology of the facial primordia were apparent. By stage 28, when the morphology of the facial primordia was clearly abnormal, there were more widespread changes in the distribution of RAR-beta transcripts. These results show that RAR-beta transcripts are particularly concentrated in regions of the primordia that give rise to the upper beak, the development of which is specifically affected by retinoic acid. In addition, they demonstrate that retinoic acid can induce changes in the pattern of expression of RAR-beta transcripts in vivo.

A member of the RXR nuclear receptor family is expressed in neural-crest-derived cells of the developing chick peripheral nervous system

Retinoic acid (RA) affects differentiation and morphogenesis in various developmental systems and is believed to act through nuclear RA receptors that belong to the steroid/thyroid hormone family of ligand-binding transcription factors. Three closely related receptors, RAR-alpha, -beta and -gamma, with distinct expression patterns, have been identified and a fourth receptor, hRXR-alpha, which responds to RA but which has low homology to RAR-alpha, -beta and -gamma, was recently discovered. Here we report the isolation of a cDNA clone encoding a chicken homologue of hRXR-alpha (cRXR) and show that a cRXR transcript of 2.5 kb is expressed in a range of embryonic chick tissues. By in situ hybridization to sections from stage 24 and stage 27 chick embryos, we show that cRXR transcripts are expressed at high levels in the liver and in elements of the developing peripheral nervous system derived from the neural crest, including dorsal root ganglia, cranial ganglia, enteric ganglia and peripheral nerve tracts. At stage 16, in the posterior trunk region, cRXR transcripts are expressed by cells in the neural crest and in neural crest cells migrating into the sclerotome, indicating that neural crest cells express cRXR transcripts before overt differentiation into peripheral nervous tissue. This distribution suggests a novel role for RA in the developing peripheral nervous system, mediated by cRXR. In addition, it identifies cRXR as a marker for a specific population of neural-crest-derived cells.

Ectodermal inhibition of cartilage differentiation in micromass culture of chick limb bud mesenchyme in relation to gene expression and cell shape

Ectoderm inhibits the formation of cartilage by chick wing bud mesenchyme in micromass culture. This suggests that the pattern of cartilage formation in the limb bud may result from a restriction of cartilage cell differentiation to the limb bud core as cells leave the progress zone. We have used in situ hybridization to investigate whether ectodermal inhibition in micromass culture occurs at the level of gene transcription. We found that ectoderm completely inhibited the accumulation of cartilage-specific type II collagen transcripts in the mesenchyme cells, whilst the level of type I collagen transcripts was unaffected. Morphometric analysis of electron micrographs revealed that inhibition of chondrogenesis in micromass culture was not preceded by cell flattening. In fact, a rounded cell shape was found not to be a prerequisite for cartilage cell differentiation in micromass.

The structure and expression of a hybrid homeotic gene

We describe the structure and expression of an exceptional bithorax complex mutation, C1. This deletion mutation removes major portions of both the Ultrabithorax (Ubx) and abdominal-A (abd-A) protein coding regions, yet retains many of the functions normally executed by these genes. We show that the ends of the C1 deletion map to analogous positions within the Ubx and abd-A transcription units, and that the deletion chromosome gives rise to a set of novel fusion transcripts that may encode hybrid abd-A/Ubx proteins. These fusion products are transcribed from the abd-A promoter, but exhibit a novel spatial pattern of expression that combines aspects of the normal Ubx and abd-A distributions. This pattern provides evidence for the existence of regulatory elements located in the 3' region of the Ubx transcription unit that can act on the abd-A promoter at a distance of at least 20 kb.

Retirement of emeritus medical professors of the University of Chicago and the University of Wisconsin

Limited data from 14 medical professors of two universities suggest that they are like industrial scientists and dentists in retirement. All three types require a preparation for a life of leisure as a component of preparation for retirement.

Transverse myelitis and myelography

A case report of transverse myelitis and optic neuritis is presented in which the latter occurred following a myelogram with iopamidol. The literature relating to neurotoxicity of contrast agents is reviewed, and it is suggested that the optic neuritis may have been a neurotoxic effect of iopamidol.

The impact of converting to an all frozen blood system in a large regional blood center

We studied the impact of converting to an all frozen blood system in a large regional blood center. Several basic assumptions were made including the availability of a sterile docking device which would increase the shelf life of deglycerolized blood to 72 hours. Our study indicated that the most economical manner in which to implement such a program would be to supply deglycerolized blood to all hospitals transfusing more than 500 units per year and to provide frozen units to hospitals transfusing less then this amount (those hospitals would deglycerolize the blood they use). The estimated total cost of the proposed conversion was 3.9 million dollars or a 76 per cent increase over the present operation. Relative to our present fee structure, the average cost of a unit of blood would increase 80 per cent if only frozen or deglycerolized red blood cells were distributed.

Participation and the voluntary sector: the independent contribution

This article is an attempt to create a general theoretical model or ‘scale’ for categorizing voluntary organizations chiefly concerned with social service provision. Consumer participation, which the author believes has positive and particular advantages in voluntary organizations, is taken as one element in the categorization. He discusses what participation may or should mean, and the reasons why it is so rarely found. Where it exists it tends to involve the participation of staff rather than ‘clients’, which may result in more discussion than action. The article also discusses how an organization's position on the ‘scale’ can change. Voluntary organizations which start out as small, highly-participating, self-help organizations tend to become more elitist and altruistic with success and growth. The author suggests that organizations with a higher degree of consumer participation may be more responsive to social change and its consequences, more flexible and even more cost-effective than more traditionally organized institutions and may also be better able to take advantage of the independence afforded only to voluntary organizations in an increasingly state-dominated society.

Composition, quaternary structure, and catalytic properties of D-ribulose-1, 5-bisphosphate carboxylase from Euglena gracilis

D-Ribulose-1,5-bisphosphate carboxylase has been purified in one step by sedimenting extracts of autotrophically-grown Euglena gracilis into a linear 0.2-0.8 M sucrose density gradient. The resultant product was pure by the criteria of disc electrophoresis in gels polymerized from 5 or 7.5% acrylamide and sedimentation. The molecular weight of the enzyme estimated by density gradient centrifugation and electrophoresis in gels polymerized from various concentrations of acrylamide was 5.25 X 10(5). The S20,W was 16.4 S. Dissociation and polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulphate established that the enzyme was composed of two types of subunits (mr 50,000 and 15,000). The oligomeric structure was visualized through negative staining and transmission electron microscopy leading to a model for the quaternary structure. Although the enzyme was moderately unstable, the estimated maximal specific activity was 1.6 mumol CO2 fixed min-1 mg protien-1 at 30 degrees C and pH 8.0 Km values were 2.2 m M, 15. 1 MUM and 0.63 mM for Mg2+, ribulose 1,5-bisphosphate, and CO2, respectively, when measured under air. 6-Phospho-D-gluconate was a noncompetitive inhibitor with respect to ribulose 1,5-bisphosphate (Ki = 0.04 mM). Oxygen was a competitive inhibitor with respect to CO2 suggesting that the enzyme was also an oxygenase. The latter was confirmed by experiments showing a molar equivalence between ribulose-1,5-bisphosphate-dependent oxygen consumption and phosphoglycerate production.