Self-harm in UK armed forces personnel: descriptive and case-control study of general hospital presentations

BACKGROUND

Little is known about self-harm in the armed forces.

AIMS

To investigate the characteristics of armed forces personnel presenting to a general hospital following self-harm and compare these with matched controls who had self-harmed.

METHOD

Investigation of armed forces personnel presenting to hospital between 1989 and 2003 following self-harm and case-control comparison with people in the general population who had self-harmed.

RESULTS

One hundred and sixty-six armed forces personnel presented with self-harm during the study period, of whom 72.3% (120) were male. Nearly two-thirds (62.7%) were aged under 25 years. Relationship problems (62.0%), employment problems (43.9%) and alcohol misuse (40.5%) were common. Fewer armed forces personnel than controls had evidence of current or past psychiatric disorders or treatment or a prior history of self-harm, and their suicidal intent was lower (males only). Of 64 people in the armed forces who presented during the first 9 years of the study period, 1 had died (from natural causes) by the end of 2000, compared with 9 (5.1%) of the controls, 6 by probable suicide.

CONCLUSIONS

Self-harm by armed forces personnel may often be a response to interpersonal and employment problems complicated by alcohol misuse, with relatively low suicide intent.

Parental perspective of the benefits of genetic testing in children with congenital deafness

AIM

The aim of the study was to assess the perceived value of genetic testing for congenital deafness in families attending a clinical genetic outpatients department at a children's hospital. The major testing objective was to provide information regarding deafness etiology, although families were advised that changes in treatment as a result of the test were unlikely. Using a 'willingness-to-pay' approach in the form of a questionnaire developed by Ryan et al. [J Med Genet 2003;40:1-5], parents were surveyed for their attitudes and willingness to pay for genetic testing.

RESULTS

Forty-nine families provided data for analysis, representing 56% of clinic attendances throughout the period. Most of the parents were themselves unaffected by hearing loss (93%) and none were deaf, although almost a quarter (22%) reported a family member born deaf. Parents considered the major benefit gained from testing was to better achieve clarity of understanding arising from discussion and the possible ascertainment of etiology. The average sum parents were willing to pay for genetic testing was 200 Australian dollars (AUD, 2007) or approximately 123 euros (EUR), ranging from 150 to 295 AUD according to ability to pay (as measured by gross income). However, the amount that even the highest income level were willing to pay underestimated the full economic cost of genetic testing.

CONCLUSION

Genetic testing for deafness is highly valued by affected families despite the current limited overall expectation of definitive genetic diagnosis or changes in treatment. Parents considered the major benefits to be a better understanding of congenital deafness and the potential for assignment of causality.

The operational emergency department attendance register (OPEDAR): a new epidemiological tool

AIM

To determine the number, status and nature of emergency department attendances to deployed field hospitals.

POPULATION

All attendances to the emergency department (ED) of deployed field hospitals in support of Operation TELIC (Iraq) from initial entry war fighting to enduring operations.

METHODS

Analysis of hand written and electronic registers ED attendance registers and validation with four other data sources.

RESULTS

Validation of data held on OpEDAR against 4 other data sources shows that OpEDAR is accurate, but that accuracy can be further improved. 26,746 ED attendances recorded on OP TELIC from 19 March 2003 to 11 November 2006. 21,112 (78.9%) were UK military. Overall, 43.5% were admitted from ED. Attendances peaked during TELIC phases 2 (422.9 per 1,000 troops deployed), but have settled to around 200 per 1,000 troops deployed in the more recent phases. Ophthalmology rates peaked in TELIC 2 to 20.72 per 1,000 and have since reduced to a consistent 10 to 15 per 1,000. This suggests that preventative measures introduced for eye injury are incompletely effective or incompletely utilised.

CONCLUSIONS

OpEDAR is a clinical tool to inform manning, equipment and training requirements for enduring and new operations, focused on the requirements of the emergency department. Multivariate quality control models applied in industry could be applied to OpEDAR to produce a dynamic epidemiological tool that identifies emerging case clusters and facilitates deployed commanders to take preventative action.

The effect of sports injury on insulin-like growth factor-I and type 3 procollagen: implications for detection of growth hormone abuse in athletes

CONTEXT

A method to detect exogenously administered growth hormone (GH) based on the measurement of two GH-dependent markers, IGF-I and type 3 procollagen (P-III-P) has been proposed. Skeletal or soft tissue injury may alter these markers. Elevations in either of these proteins after injury might lead to a false accusation of doping with GH.

OBJECTIVE

The objective of the study was to assess the effect of musculoskeletal or soft tissue injury on IGF-I and P-III-P concentrations in amateur and elite athletes and assess the effect of injury on the proposed GH detection method.

DESIGN

This was a longitudinal observational study after sporting injury.

SETTING

The study was conducted at Southampton General Hospital and British Olympic Medical Centre.

SUBJECTS

Subjects included elite and amateur athletes after an injury.

INTERVENTION

Interventions included measurement of IGF-I and P-III-P and application of the GH-2000 discriminant function score up to 84 d after an injury as well as classification of injury by type and severity.

OUTCOME MEASURES

IGF-I and P-III-P concentration and ability to detect GH abuse in athletes without the risk of false accusation because of an injury were measured.

RESULTS

There was no change in IGF-I concentration after an injury. By contrast, P-III-P concentrations rose by 41.1 +/- 16.6%, reaching a peak around 14 d after an injury. The rise in P-III-P varied according to injury type and severity. This rise had a trivial effect on the GH-2000 discriminant function score, and no subject reached the threshold needed for a doping offense.

CONCLUSIONS

Although there was a rise in P-III-P after injury, this was insufficient to invalidate the GH-2000 detection method based on IGF-I and P-III-P concentrations.

Tomato BRI1 and systemin wound signalling

Brassinosteroids (BRs) are perceived by Brassinosteroid Insensitive 1 (BRI1), that encodes a leucine-rich repeat receptor kinase. Tomato BRI1 has previously been implicated in both systemin and BR signalling. The role of tomato BRI1 in BR signalling was confirmed, however it was found not to be essential for systemin/wound signalling. Tomato roots were shown to respond to systemin but this response varied according to the species and growth conditions. Overall the data indicates that mutants defective in tomato BRI1 are not defective in systemin-induced wound signalling and that systemin perception can occur via a non-BRI1 mechanism.

Helping to Improve the Group Stereotype: On the Strategic Dimension of Prosocial Behavior

Three studies consider a basis for intergroup helping. Specifically, they show that group members may help others to disconfirm a stereotype of their own group as mean. Study 1 shows that Scots believe they are seen as mean by the English, resent this stereotype, are motivated to refute it, and believe out-group helping is a particularly effective way of doing so. Study 2 shows that increasing the salience of the English stereotype of the Scottish as mean leads Scots to accentuate the extent to which Scots are depicted as generous. Study 3 shows that increasing the salience of the stereotype of the Scots as mean results in an increase in the help volunteered to out-group members. These results highlight how strategic concerns may result in out-group helping. In turn, they underscore the point that helping others may be a means to advance a group's interest.

Tomato BRASSINOSTEROID INSENSITIVE1 is required for systemin-induced root elongation in Solanum pimpinellifolium but is not essential for wound signaling

The tomato Leu-rich repeat receptor kinase BRASSINOSTEROID INSENSITIVE1 (BRI1) has been implicated in both peptide (systemin) and steroid (brassinosteroid [BR]) hormone perception. In an attempt to dissect these signaling pathways, we show that transgenic expression of BRI1 can restore the dwarf phenotype of the tomato curl3 (cu3) mutation. Confirmation that BRI1 is involved in BR signaling is highlighted by the lack of BR binding to microsomal fractions made from cu3 mutants and the restoration of BR responsiveness following transformation with BRI1. In addition, wound and systemin responses in the cu3 mutants are functional, as assayed by proteinase inhibitor gene induction and rapid alkalinization of culture medium. However, we observed BRI1-dependent root elongation in response to systemin in Solanum pimpinellifolium. In addition, ethylene perception is required for normal systemin responses in roots. These data taken together suggest that cu3 is not defective in systemin-induced wound signaling and that systemin perception can occur via a non-BRI1 mechanism.

Is crime scene examination science, and does it matter anyway?

This short piece aims to assess the kind of data collected by Crime Scene Examiners (CSEs), and to discuss whether this collection constitutes a scientific process. It also seeks to examine the balance of roles performed by the CSE, between data gatherer and investigator. The piece also aims to conclude on whether a clearer understanding of the structure of data collected by CSEs might be of some practical use in developing a greater understanding of the architecture of knowledge that forensic science as a whole relies upon. As a piece of work it is unapologetically theoretical in its perspective, and seeks to prompt further discussion regarding the structure of scientific knowledge, and any relevance this might have to its application in a forensic context. Ultimately, it seeks the inclusion of the processes of data gathering performed largely by CSEs within the wider processes of forensic science.

Dwarfism and cytochrome P450-mediated C-6 oxidation of plant steroid hormones

BRs (brassinosteroids) are plant steroid hormones that are essential for normal plant development. The dramatic dwarfism exhibited by mutants in the CYP (cytochrome P450) enzymes involved in BR biosynthesis indicates a role for these hormones in plant growth and development. Since the mid-1990s, collaborative research has been geared towards developing a better understanding of the CYP85 class of CYPs involved in BR biosynthesis in both Arabidopsis and tomato. Some of the most recent observations include the fact that certain CYP85 CYPs catalyse the synthesis of the most bioactive BR, BL (brassinolide). Current evidence suggests that evolution of this function may have occurred independently in different dicotyledonous species. Interestingly, BL accumulates in tomato fruits, highlighting a key role for this hormone in fruit development. At the same time as developing a better understanding of the enzymatic function of these CYPs, we have also carried out experiments towards characterizing where and when these genes are expressed and mechanisms of their regulation. As expected for a hormone involved in growth and development, biosynthetic gene promoter activity is associated with young rapidly growing cells and with fruit development.

Potential cervical spine injury and difficult airway management for emergency intubation of trauma adults in the emergency department--a systematic review

BACKGROUND

Emergency airway management for trauma adults is practised by physicians from a range of training backgrounds and with differing levels of experience. The indications for intubation and technique employed are factors that vary within EDs and between hospitals.

OBJECTIVES

To provide practical evidence based guidance for airway management in trauma resuscitation: first for the trauma adult with potential cervical spine injury and second the management when a difficult airway is encountered at intubation.

SEARCH STRATEGY AND METHODOLOGY

Full literature search for relevant articles in Medline (1966-2003), EMBASE (1980-2003), and the Cochrane Central Register of Controlled Trials. Relevant articles relating to adults and written in English language were appraised. English language abstracts of foreign articles were included. Studies were critically appraised on a standardised data collection sheet to assess validity and quality of evidence. The level of evidence was allocated using the methods of the Australian National Health and Medical Research Council.

Patterns of Dwarf expression and brassinosteroid accumulation in tomato reveal the importance of brassinosteroid synthesis during fruit development

Brassinosteroids (BRs) are essential for many physiological functions in plants, however little is known concerning where and when they are synthesized. This is especially true during flower and fruit production. To address this we have used a promoter-GUS reporter fusion and RT-PCR to determine the relative expression levels of the tomato Dwarf (D) gene that encodes a BR C-6 oxidase. In young seedlings GUS reporter activity was observed mainly in apical and root tissues undergoing expansion. In flowers GUS activity was observed in the pedicel joints and ovaries, whereas in fruits it was strongest during early seed development and was associated with the locular jelly and seeds. RT-PCR analysis showed that tissue-specific expression of Dwarf mRNA was consistent with that of the Dwarf:GUS fusion. In good correlation with the high local Dwarf activity, quantitative measurements of endogenous BRs indicated intense biosynthesis in developing tomato fruits, which were also found to contain high amounts of brassinolide. Grafting experiments showed the lack of BR transport indicating that BR action occurs at the site of synthesis.

312. Testosterone secretion in the Australian sea lion

The objectives in this study were to characterize the pattern of testosterone secretion over 24 h in the captive Australian sea lion and to establish whether exogenous hormone stimulation could be used to obtain an index of testosterone secretion in this species. Blood samples were collected from three males at 3-h intervals for 24 h on three occasions at 2-week intervals. Exogenous GnRH, hCG and LH were administered at the end of each 24-h sampling period and changes in circulating testosterone monitored over 5 h. Circulating concentrations of testosterone during 24-h sampling periods were greater (P < 0.01) during darkness than during daylight. Exogenous hCG administered induced a significant rise in circulating concentrations of testosterone. In the 5 h following GnRH, hCG and LH administration, circulating testosterone concentrations reached similar levels to the highest concentrations observed during the respective 24-h sampling periods. These findings have provided evidence of a 24-h pattern of testosterone secretion in the Australian sea lion. This study has also shown that the testis response to exogenous GnRH, hCG and LH in the Australian sea lion can provide an index of the prevailing testosterone biosynthetic capacity of the testes.

Regulators of G protein signaling: potential drug targets for controlling cardiovascular and immune function

Heterotrimeric G-protein-coupled receptors (GPCRs) mediate a wide variety of organismal functions ranging from vision, olfaction, and gustation to the development and physiology of the cardiovascular, neuronal, and immune system. Naturally they are targets of a large number of therapeutic drugs. The regulators of G protein signaling (RGS) are a family of diverse proteins that regulate the GPCR-mediated signaling pathways principally by acting as GTPase activating proteins (GAPs) for the alpha subunit of the heterotrimeric G-proteins. Certain members of the RGS family contain multiple domains and motifs that mediate interactions with other signaling molecules, thus linking GPCR-dependent and GPCR-independent signaling pathways. Because of their ability to fine-tune vital GPCR-mediated processes and recent findings linking them to brain disorders, retinitis pigmentosa, and cancer RGS proteins have become excellent candidates for new drug discovery. The focus of this review is to discuss the roles of the RGS proteins in the development and normal physiology of cardiovascular and immune system, and to explore their potential as drug targets useful for the treatment of pathological conditions of the cardiovascular and immune systems.

RANKL expression is related to the differentiation state of human osteoblasts

Human osteoblast phenotypes that support osteoclast differentiation and bone formation are not well characterized. Osteoblast differentiation markers were examined in relation to RANKL expression. RANKL expression was induced preferentially in immature cells. These results support an important link between diverse osteoblast functions. Cells of the osteoblast lineage support two apparently distinct functions: bone formation and promotion of osteoclast formation. The aim of this study was to examine the relationship between these phenotypes in human osteoblasts (NHBC), in terms of the pre-osteoblast marker, STRO-1, and the mature osteoblast marker, alkaline phosphatase (AP), and the expression of genes involved in osteoclast formation, RANKL and OPG. The osteotropic stimuli, 1alpha,25(OH)2vitamin D3 (vitD3) and dexamethasone, were found to have profound proliferative and phenotypic effects on NHBCs. VitD3 inhibited NHBC proliferation and increased the percentage of cells expressing STRO-1 over an extended culture period, implying that vitD3 promotes and maintains an immature osteogenic phenotype. Concomitantly, RANKL mRNA expression was upregulated and maintained in NHBC in response to vitD3. Dexamethasone progressively promoted the proliferation of AP-expressing cells, resulting in the overall maturation of the cultures. Dexamethasone had little effect on RANKL mRNA expression and downregulated OPG mRNA expression in a donor-dependent manner. Regression analysis showed that RANKL mRNA expression was associated negatively with the percentage of cells expressing AP (p < 0.01) in vitD3- and dexamethasone-treated NHBCs. In contrast, RANKL mRNA expression was associated positively with the percentage of STRO-1+ cells (p < 0.01). In NHBCs sorted by FACS based on STRO-1 expression (STRO-1bright and STRO-1dim populations), it was found that vitD3 upregulated the expression of RANKL mRNA preferentially in STRO-1bright cells. The results suggest that immature osteoblasts respond to osteotropic factors in a potentially pro-osteoclastogenic manner. Additionally, the dual roles of osteoblasts, in supporting osteoclastogenesis or forming bone, may be performed by the same lineage of cells at different stages of their maturation.

Molecular cloning of the cell surface antigen identified by the osteoprogenitor-specific monoclonal antibody, HOP-26

Bone is a highly organized structure comprising a calcified connective tissue matrix formed by mature osteoblasts, which develop from the proliferation and differentiation of osteoprogenitor cells. The osteogenic cell lineage is thought to arise from a population of uncommitted multipotential stromal precursor cells (SPC) which reside close to all bone surfaces, in the bone marrow spaces and the surrounding connective tissue. These SPC also give rise to related cell lineages which form cartilage, smooth muscle, fat, and fibrous tissue. Due to the lack of well defined cell surface markers, little is known of the precise developmentally regulated changes in phenotype which occur during the differentiation and maturation of human osteoprogenitor cells into functional osteoblasts and ultimately, terminally differentiated osteocytes. In order to identify antibody reagents with greater specificity for osteoprogenitors we generated a series of antibodies following immunization with freshly isolated human bone marrow stromal fibroblasts. One such antibody, HOP-26, reacts with a cell surface antigen expressed by SPC and developing bone cells. We now demonstrate that this mAb identifies a member of the tetraspan family of cell surface glycoproteins, namely CD63. Western blot analysis of human bone marrow stromal cells (HBMSC) has revealed that like a well defined CD63 mAb 12F12, HOP-26 interacts with a heavily glycosylated cell surface protein with an apparent molecular weight of 50-60 kD.

Current practice for induction of labour in the United Kingdom: time for a review?

This paper presents the results of postal survey of protocols for induction of labour. The drug regimes used for the induction of labour in NHS hospitals in England and Wales have been compared to both RCOG guidelines and to the drug manufacturer's recommendations. A wide variation in practice was found, with many units using dosages that are different from those recommended. The implications of such departures from the norm are discussed in terms of the importance of evidence-based practice and the role of national guidelines in ensuring optimum care.

Features of occupational rehabilitation systems in Australia: a map through the maze

This review contributes to the limited literature on systems of occupational rehabilitation in Australia. Occupational rehabilitation is defined and features of occupational rehabilitation systems within the workers' compensation framework are described. Common features include: (a) the trend to workplace management, (b) preferred rehabilitation program settings and (c) widespread acceptance of some identified principles of occupational rehabilitation. Other features such as roles of stakeholders and participants, relationship of rehabilitation providers and employers, and the services provided have a number of variations in the Australian systems. Similarities and differences between features of Australian and North American systems are noted. Implications for occupational rehabilitation providers are discussed, and recommendations for practice and future research are made.