The ratio of type II collagen breakdown to synthesis and its relationship with the progression of knee osteoarthritis

OBJECTIVE

To examine whether the baseline ratio of a type II collagen breakdown marker to a synthesis marker, or the level of these markers individually, is associated with the likelihood of knee osteoarthritis (OA) progression between baseline and 18 months.

METHODS

Participants were recruited from community sources and had knee OA. Blood was drawn at baseline. Collagen synthesis was measured by commercial enzyme-linked immunosorbent assay (ELISA) assay that detects c-propeptide of type II procollagen (CPII). Serum markers of collagenase cleavage of cartilage type II collagen [C2C epitope (COL2-3/4Clong mono) and C1,2C epitope (COL2-3/4Cshort)] were also assayed. Knee radiographs (semi-flexed with fluoro confirmation) were obtained at baseline and 18 months. OA progression was examined using worsening of joint space grade and worsening of Kellgren/Lawrence grade. The relationship between baseline serum markers and subsequent progression was analyzed from logistic regression.

RESULTS

Baseline levels of these markers, considered individually, were not associated with a change in the odds of progression. Belonging to the low synthesis tertile was associated with a greater likelihood of progression, approaching significance (adjusted odds ratio [OR] 1.86, 95% confidence interval [CI] 0.96, 3.63). A greater C2C:CPII ratio and C1,2C:CPII ratio were each associated with an increase in the odds of joint space grade progression, which approached significance (e.g., adjusted OR of C2C:CPII ratio was 3.15, 95% CI 0.91, 10.85).

CONCLUSION

While the degradation markers individually, considered as continuous variables, did not predict OA progression, belonging to the lower synthesis marker tertile and greater degradation/synthesis marker ratios were associated with an elevation in the odds of progression albeit not achieving significance.

Ensuring accountability: the contribution of the cohort review method to tuberculosis control in New York City

SETTING

In 1993, the New York City (NYC) Bureau of Tuberculosis Control developed the cohort review process as a quality assurance method to track and improve patient outcomes.

METHODS

The Bureau Director reviews every tuberculosis (TB) case quarterly in a multi-disciplinary staff meeting. In 2004 we also began collecting details on issues identified at cohort review to quantify how this process directly impacts TB control efforts.

RESULTS

From 1992 to 2004, NYC TB cases decreased by 72.7% and treatment success rates significantly increased by 26.7%. Implementing the cohort review was key to improving case management, thus leading to these results. For the 1039 patients in 2004, 596 issues were identified among 424 patients; 55.0% were incorrect, unclear or unknown patient information, 13.8% were treatment issues, 12.4% were case management issues and 10.6% were incomplete contact investigations. Most (76.5%) issues were addressed within 30 days of the cohort reviews.

CONCLUSION

A systematic review of every TB case improves the quality of patient information, enhances patient treatment and ensures accountability at all levels of the TB control program.

Electrostimulation for promoting recovery of movement or functional ability after stroke

BACKGROUND

Electrostimulation might improve motor recovery after stroke by providing neuromuscular re-training.

OBJECTIVES

To find if electrostimulation improved functional motor ability, and the ability to undertake activities of daily living.

SEARCH STRATEGY

We searched the Cochrane Stroke Group Trials Register (last searched August 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to January 2004), EMBASE (1980 to January 2004), CINAHL (1982 to January 2004), AMED - Allied and Complementary Medicine Database (1985 to January 2004), Physiotherapy Evidence Database (PEDro), REHABDATA and the ISI Science Citation Index (1981 to 2003). We placed a request on the PHYSIO e-mail discussion list and contacted authors of relevant studies to elicit any unpublished or ongoing studies, searched the reference lists of included trials and contacted trialists.

SELECTION CRITERIA

Randomised controlled trials of electrostimulation delivered to the peripheral neuromuscular system which was designed to improve voluntary movement control, functional motor ability and activities of daily living.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data.

MAIN RESULTS

Of the 2077 references identified, 24 trials were included in this review. For electrostimulation compared with no treatment this review found that electrostimulation improved some aspects of functional motor ability and some aspects of motor impairment and normality of movement. In addition, there was a significant difference in favour of no treatment compared with electrostimulation for an aspect of functional motor ability. For electrostimulation compared with placebo this review found that electrostimulation improved an aspect of functional motor ability. For electrostimulation compared with conventional physical therapy this review found that electrostimulation improved an aspect of motor impairment. There were no statistically significant differences between electrostimulation and control treatment for all other outcomes. However, these results need to be interpreted with reference to the following: (1) the majority of analyses only contained one trial; (2) variation was found between included trials in time after stroke, level of functional deficit, and dose of electrostimulation; and (3) the possibility of selection and detection bias in the majority of included trials.

AUTHORS' CONCLUSIONS

At present, there are insufficient robust data to inform clinical use of electrostimulation for neuromuscular re-training. Research is needed to address specific questions about the type of electrostimulation that might be most effective, in what dose and at what time after stroke.

Iron deficiency anaemia in Jamaican children, aged 1-5 years, with sickle cell disease

OBJECTIVE

The aim of this study was to determine, using a combination of measures, the prevalence of iron deficiency anaemia (IDA) in children under five years-of-age who have sickle cell disease (SCD) and attend the Sickle Cell Clinic (SCU) of the Tropical Medicine Research Institute.

MATERIALS AND METHODS

Children with homozygous sickle cell anaemia (Hb SS) or doubly heterozygous for Hb S and Hb C (Hb SC) disease who had not received a blood transfusion within three months prior to the iron measurements, were enrolled. The diagnosis of IDA was made if transferrin saturation was less than 16% with serum iron less than 10.7 micromol/l and a low mean corpuscular volume (MCV) for age.

RESULTS

Twelve children (8.5%), seven with Hb SS and five with Hb SC had IDA. Adjusting for genotype, children with IDA had significantly higher red blood cell (RBC) counts (4.3 x10(9)/l vs 3.0 x 10(9)/l, p < 0.001) and total iron binding capacity (TIBC) (65.6 micromol/l vs 55.2 micromol/l, p < 0.004) but significantly lower reticulocyte (retic) counts (7.8 % vs 12.2%, p = 0.001) than children without IDA.

CONCLUSION

Iron deficiency anaemia is a clinical problem which affects children with SCD in Jamaica. The higher RBC counts in the IDA group may be due to decreased haemolysis and increased red cell survival whilst the lower reticulocyte counts may be due to impaired erythropoiesis. These observations need to be extended by clinical studies to establish improved diagnostic measures for IDA in SCD. Additionally, clinical trials are needed to determine whether treatment of IDA in children with SCD reduces morbidity and is associated with clinical benefits such as improvements in neurocognitive function.

The attack of the clones: tracking the movement of insecticide-resistant peach-potato aphids Myzus persicae (Hemiptera: Aphididae)

Myzus persicae (Sulzer) collected in Scotland were characterized for four microsatellite loci, intergenic spacer fingerprints and the resistance mechanisms modified acetylcholinesterase (MACE), overproduced carboxylesterase and knockdown resistance (kdr). Microsatellite polymorphisms were used to define a limited number of clones that were either fully susceptible to insecticides or possessed characteristic combinations of resistance mechanisms. Within these clones, intergenic spacer fingerprints could either be very consistent or variable, with the latter indicating ongoing evolution within lineages, most likely derived from the same zygote. Two clones (termed A and B) possessed all three resistance mechanisms and predominated at sites treated with insecticides. Their appearance on seed potatoes and oilseed rape in Scotland in 2001 coincided with extensive insecticide use and severe control failures. Clones C, I and J, with no or fewer resistance mechanisms, were found in samples from 1995 and were dominant at untreated sites in 2001. A comparison of Scottish collections with those from other UK and non-UK sites provides insight into the likely origins, distribution and dynamics of M. persicae clones in a region where asexual (anholocyclic) reproduction predominates, but is vulnerable to migration by novel genotypes from areas of Europe where sexual (holocyclic) reproduction occurs.

Prevalence of the sickle cell gene in Yemen: a pilot study

To determine the prevalence of the sickle cell gene (betaS) in Yemen and amongst people from different regions of the country living in the capital, Sana'a City, cord blood samples from 1,500 consenting mothers were collected from hospitals in Sana'a City between July and December 2001. The names and original homes of the parents were recorded. Cation exchange high performance liquid chromatography (HPLC) analysis was used for screening, while isoelectric focusing (IEF) and DNA polymerase chain reaction (PCR) were used to confirm Hb S [beta6(A3)Glu-->Val]. Thirty-three samples were found to show Hb FAS, giving an overall likely betaS gene frequency of 0.011. The betaS gene frequency varied with the part of the country from which the parents came. Amongst people from Taiz and Haja in the west, the gene frequency was more than 0.04, but less than 0.004 amongst people from Ibb, adjacent to the governorate (administrative division) of Taiz. Of 66 chromosomes from babies carrying the betaS gene, only 1.5% also carried the -158 (C-->T) Ggamma-globin gene XmnI site compared with 16.1% of 168 chromosomes from babies without the betaS gene from the same regions. The results of this study show a higher betaS gene frequency in the western coastal part of Yemen than in the central mountainous and eastern desert areas. The incidence of affected homozygous births may therefore reach 20/10,000 in certain areas, although it is much lower than this overall. Limited health resources can best be invested in developing a program of education, screening and health care, initially prioritizing those communities residing in the western areas of Yemen with the highest betaS gene frequency.

Evaluation of peer review of infection control arrangements for healthcare-associated infection in four acute care trusts in the East of England

In order to constructively use Department of Health surveillance data to address the issue of healthcare-associated infection, a peer review process investigating infection control arrangements for healthcare-associated infection in acute care trusts was initiated in the East of England. This study set out to evaluate that process and determine if it should be rolled out regionwide. A questionnaire survey of infection control doctors at trusts visited was conducted by telephone. Respondents commented that the peer review process raised the profile of infection control and healthcare-associated infection in participating trusts, and that a review of routine surveillance data was a useful way to initiate discussion about and focus attention on hospital infection control. Respondents felt the forum for discussion of infection control was most beneficial. A peer review process utilising routine surveillance data is of value in addressing issues related to infection control arrangements for healthcare-associated infection in acute care trusts.

The effects of resistance exercise on skeletal muscle abnormalities in patients with advanced heart failure

Resistance exercise increases muscular strength and endurance, which prevents injuries associated with musculoskeletal disorders, favorably alters muscle fiber type distribution, and up-regulates the genetic expression of certain enzymes seen in dysfunctional skeletal muscles. Although the benefits of resistance exercise are well documented in the literature, this form of exercise is not routinely recommended for patients with heart failure for fear of symptom exacerbation, and because of poor understanding of how best to prescribe this type of exercise. Because muscle atrophy and deconditioning states are common findings in patients with heart failure, these patients stand to benefit substantially from resistance training because this type of physical activity results in functional adaptations in the neuromuscular system. This article addresses changes in skeletal muscle pathophysiology that occur in patients with heart failure and the potential role resistance training may play in reversing this sequela, and recommends a weight lifting exercise prescription for these patients.

Prevention and management of pneumococcal disease

Pneumococcal pneumonia is associated with high mortality in immunocompromised and older people. The authors discuss the role nurses have in increasing awareness of vaccination and use of preventive interventions to target at-risk patients.

Minimising the risk of hospital transmission of pulmonary TB

Pulmonary tuberculosis is a threat to other patients and healthcare workers in hospital settings. Laila King discusses the ways to minimise the risk of transmission.

Relationship between acute morphine and the course of PTSD in children with burns

OBJECTIVE

To investigate the relationship between the dose of morphine administered during a child's hospitalization for an acute burn and the course of posttraumatic stress disorder (PTSD) symptoms over the 6-month period following discharge from the hospital.

METHOD

Twenty-four children admitted to the hospital for an acute burn were assessed twice with the Child PTSD Reaction Index: while in the hospital and 6 months after discharge. The Colored Analogue Pain Scale was also administered during the hospitalization. All patients received morphine while in the hospital. The mean dose of morphine (mg/kg/day) was calculated for each subject through chart review.

RESULTS

The Pearson product moment correlation revealed a significant association between the dose of morphine received while in the hospital and a 6-month reduction in PTSD symptoms. Children receiving higher doses of morphine had a greater reduction in PTSD symptoms over 6 months.

CONCLUSIONS

This study suggests the possibility that acute treatment with morphine can secondarily prevent PTSD. This result is discussed in terms of the possible effect of morphine on fear conditioning and the consolidation of traumatic memory.

Impaired wound healing in patients with diabetes

BACKGROUND

This article reviews a cross-section of literature on wound healing and highlights how diabetes mellitus can cause deviations from usual healing patterns.

CONCLUSION

Nursing interventions can either enhance or delay the healing process. Nurses need to understand the defective processes to optimise the available healing potential.

Paranoid ideation among elderly African American persons

PURPOSE

The prevalence and correlates of paranoid ideation were investigated.

DESIGN AND METHODS

On the basis of a sample of 998 independently living elderly African American persons in a cross-sectional study, the study used the Brief Symptom Inventory to measure paranoid ideation and 14 independent variables, including demographic characteristics, cognitive deficit, depression, self-reported memory functioning, emotional and instrumental support, stressful life events, limitation of daily activities, self-rated health status, and self-rated hearing and vision.

RESULTS AND IMPLICATIONS

Paranoid ideation (symptoms of paranoia) was found in 10% of this sample. A multiple regression analysis of the data revealed that of the 14 independent variables used in this study, 6 (income, instrumental support, hearing, stressful life events, self-reported memory deficit, and depression) showed a significant relationship with paranoid ideation.

Why positive psychology is necessary

The authors provide a definition of positive psychology and suggest that psychologists should try to cultivate a more appreciative perspective on human nature. Examples are given of a negative bias that seems to pervade much of theoretical psychology, which may limit psychologists' understanding of typical and successful human functioning. Finally, a preview of the articles in the special section is given.

Sequence and analysis of chromosome 5 of the plant Arabidopsis thaliana

The genome of the model plant Arabidopsis thaliana has been sequenced by an international collaboration, The Arabidopsis Genome Initiative. Here we report the complete sequence of chromosome 5. This chromosome is 26 megabases long; it is the second largest Arabidopsis chromosome and represents 21% of the sequenced regions of the genome. The sequence of chromosomes 2 and 4 have been reported previously and that of chromosomes 1 and 3, together with an analysis of the complete genome sequence, are reported in this issue. Analysis of the sequence of chromosome 5 yields further insights into centromere structure and the sequence determinants of heterochromatin condensation. The 5,874 genes encoded on chromosome 5 reveal several new functions in plants, and the patterns of gene organization provide insights into the mechanisms and extent of genome evolution in plants.

Trends of polycyclic aromatic hydrocarbon levels and mutagenicity in Santiago's inhalable airborne particles in the period 1992-1996

Trends of polycyclic aromatic hydrocarbons (PAHs) for 1992-1996 (cold season) and their mutagenic activity were investigated in organic extracts from the Santiago, Chile, inhalable particles (PM(10)). The highest PAH concentrations were observed in 1992 and declined dramatically in the following years. During this period, total PAHs decreased 85%, carcinogenic PAHs 82%, and benzo[a]pyrene, the most potent carcinogen, 85%. In spite of this significant decrease, PAH levels in respirable particles were higher than those reported in recent studies in Australia, Europe, and the United States. PAH profiles were analyzed by principal component (PC) analysis and Pearson correlation analysis. PC1 represents 71% of the variance, suggesting that most PAHs might originate predominantly from one main generic source. Higher correlations were obtained for the major carcinogenic PAHs. Most of the samples assayed were highly mutagenic to Salmonella typhimurium both in the presence and in the absence of metabolic activation system (S9), especially in the coarse fraction, but direct mutagenicity did not decline significantly. Incubation of calf thymus DNA with organic extracts from particulate matter and xanthine oxidase allowed the detection of five nitro-PAH-DNA adducts. Thus, nitroarenes might play an important role in the mutagenic activity of inhalable particles in Santiago, representing a high risk for human health.

Interferon gamma and interleukin 6 modulate the susceptibility of macrophages to human immunodeficiency virus type 1 infection

The effect of interferon gamma (IFN-gamma) and interleukin 6 (IL-6) on infection of macrophages with human immunodeficiency virus type 1 (HIV-1) was investigated. By using a polymerase chain reaction-based viral entry assay and viral infectivity assay, it was demonstrated that IL-6 and IFN-gamma augmented susceptibility of monocyte-derived macrophages (MDMs) to infection with T-cell tropic CXCR4-utilizing (X4) HIV-1 strains. Consistent with this finding, IFN-gamma and IL-6 augmented fusion of MDMs with T-tropic envelope-expressing cells. The enhanced fusion of cytokine-treated MDMs with T-tropic envelopes was inhibited by the CXCR4 ligand, SDF-1, and by T22 peptide. IFN-gamma and IL-6 did not affect expression of surface CXCR4 or SDF-1-induced Ca(++) flux in MDMs. In contrast to the effect of IFN-gamma on the infection of MDMs with X4 strains, IFN-gamma inhibited viral entry and productive infection of MDMs with macrophage-tropic (M-tropic) HIV-1. Consistent with this finding, IFN-gamma induced a decrease in fusion with M-tropic envelopes that correlated with a modest reduction in surface CCR5 and CD4 on MDMs. It was further demonstrated that macrophage inflammatory protein (MIP)-1alpha and MIP-beta secreted by cytokine-treated MDMs augmented their fusion with T-tropic-expressing cells and inhibited their fusion with M-tropic envelope-expressing cells. These data indicate that proinflammatory cytokines, which are produced during opportunistic infections or sexually transmitted diseases, may predispose macrophages to infection with X4 strains that, in turn, could accelerate disease progression.

Moving out of the laboratory: does nicotine improve everyday attention?

The most robust demonstrations of the nicotine-related performance effects on human cognitive processes are seen in tasks that measure attention. If nicotine does have some potential for enhancing attention, the obvious question to ask is whether the effects demonstrated in the laboratory hold any significance for real-life performance. This paper describes three studies that compare the effects in smokers of a single own brand cigarette on laboratory tests of attention and on everyday analogues of these laboratory tasks. In the laboratory measures of sustained attention and in the everyday analogue, performance advantages were registered in the smoking condition. These benefits were observed in smokers who abstained for a self-determined period of not less than 2 h. The studies were unable to replicate previous research reporting positive effects of smoking on a laboratory task of selective attention, the Stroop task. Small but significant improvements in performance were registered in the everyday analogues, which involved sustaining attention in a dual task situation, a telephone directory search task and a map search task. In addition, smokers showed a significant colour-naming decrement for smoking-related stimuli in the Stroop task. This attentional bias towards smoking-related words occurred independent of whether they had abstained or recently smoked an own brand cigarette. The effect is discussed in terms of the two-component model of processing bias for emotionally valenced stimuli.

CCR8 on human thymocytes functions as a human immunodeficiency virus type 1 coreceptor

To determine whether human immunodeficiency virus type 1 (HIV-1) coreceptors besides CXCR4 and CCR5 are involved in HIV-1 infection of the thymus, we focused on CCR8, a receptor for the chemokine I-309, because of its high expression in the thymus. Similar levels of CCR8 mRNA were detected in immature and mature primary human thymocytes. Consistent with this, [(125)I]I-309 was shown to bind specifically and with similar affinity to the surface of immature and mature human thymocytes. Fusion of human thymocytes with cells expressing HIV-1 X4 or X4R5 envelope glycoprotein was inhibited by I-309 in a dose-dependent manner. In addition, I-309 partially inhibited productive infection of human thymocytes by X4, R5, and X4R5 HIV-1 strains. Our data provide the first evidence that CCR8 functions as an HIV-1 coreceptor on primary human cells and suggest that CCR8 may contribute to HIV-1-induced thymic pathogenesis.

Coreceptor competition for association with CD4 may change the susceptibility of human cells to infection with T-tropic and macrophagetropic isolates of human immunodeficiency virus type 1

The chemokine receptors CCR5 and CXCR4 were found to function in vivo as the principal coreceptors for M-tropic and T-tropic human immunodeficiency virus (HIV) strains, respectively. Since many primary cells express multiple chemokine receptors, it was important to determine if the efficiency of virus-cell fusion is influenced not only by the presence of the appropriate coreceptor (CXCR4 or CCR5) but also by the levels of other coreceptors expressed by the same target cells. We found that in cells with low to medium surface CD4 density, coexpression of CCR5 and CXCR4 resulted in a significant reduction in the fusion with CXCR4 domain (X4) envelope-expressing cells and in their susceptibility to infection with X4 viruses. The inhibition could be reversed either by increasing the density of surface CD4 or by antibodies against the N terminus and second extracellular domains of CCR5. In addition, treatment of macrophages with a combination of anti-CCR5 antibodies or beta-chemokines increased their fusion with X4 envelope-expressing cells. Conversely, overexpression of CXCR4 compared with CCR5 inhibited CCR5-dependent HIV-dependent fusion in 3T3.CD4.401 cells. Thus, coreceptor competition for association with CD4 may occur in vivo and is likely to have important implications for the course of HIV type 1 infection, as well as for the outcome of coreceptor-targeted therapies.

Drawing up and administering intramuscular injections: a review of the literature

Drawing up and administering intramuscular injections: a review of the literature Intramuscular (IM) injections have been an integral part of drug administration in nursing practice for almost half a century. However, there are some conflicting practices which warrant investigation to determine their effectiveness in this aspect of patient care. To this end, this paper presents the results of a literature review which was carried out in order to establish current understanding of present day knowledge, procedures and guidelines for the administration of IM injections. Areas addressed within this review include injection sites used, injuries associated with IM injections, issues surrounding needle selection and volume administered through IM injections, injection techniques and nursing skills associated with IM injections. Synthesis of the research reviewed allows the development of research-based guidelines for this skill. These guidelines offer a framework for nurses who wish to provide practice in line with current research into the process of drawing up and administration of intramuscular injections.

Mutations in a new gene in Ellis-van Creveld syndrome and Weyers acrodental dysostosis

Ellis-van Creveld syndrome (EvC, MIM 225500) is an autosomal recessive skeletal dysplasia characterized by short limbs, short ribs, postaxial polydactyly and dysplastic nails and teeth. Congenital cardiac defects, most commonly a defect of primary atrial septation producing a common atrium, occur in 60% of affected individuals. The disease was mapped to chromosome 4p16 in nine Amish subpedigrees and single pedigrees from Mexico, Ecuador and Brazil. Weyers acrodental dysostosis (MIM 193530), an autosomal dominant disorder with a similar but milder phenotype, has been mapped in a single pedigree to an area including the EvC critical region. We have identified a new gene (EVC), encoding a 992-amino-acid protein, that is mutated in individuals with EvC. We identified a splice-donor change in an Amish pedigree and six truncating mutations and a single amino acid deletion in seven pedigrees. The heterozygous carriers of these mutations did not manifest features of EvC. We found two heterozygous missense mutations associated with a phenotype, one in a man with Weyers acrodental dysostosis and another in a father and his daughter, who both have the heart defect characteristic of EvC and polydactyly, but not short stature. We suggest that EvC and Weyers acrodental dysostosis are allelic conditions.

The enzymatic formation of novel bile acid primary amides

Bifunctional peptidylglycine alpha-amidating monooxygenase (PAM) catalyzes the copper-, ascorbate-, and O(2)-dependent cleavage of C-terminal glycine-extended peptides and N-acylglycines to the corresponding amides and glyoxylate. The alpha-amidated peptides and the long-chain acylamides are hormones in humans and other mammals. Bile acid glycine conjugates are also substrates for PAM leading to the formation of bile acid amides. The (V(MAX)/K(m))(app) values for the bile acid glycine conjugates are comparable to other known PAM substrates. The highest (V(MAX)/K(m))(app) value, 3.1 +/- 0.12 x 10(5) M(-1) s(-1) for 3-sulfolithocholylglycine, is 6.7-fold higher than that for d-Tyr-Val-Gly, a representative peptide substrate. The time course for O(2) consumption and glyoxylate production indicates that bile acid glycine conjugate amidation is a two-step reaction. The bile acid glycine conjugate is first converted to an N-bile acyl-alpha-hydroxyglycine intermediate which is ultimately dealkylated to the bile acid amide and glyoxylate. The enzymatically produced bile acid amides and the carbinolamide intermediates were characterized by mass spectrometry and two-dimensional (1)H-(13)C heteronuclear multiple quantum coherence NMR.

Using brief assessments to evaluate aberrant behavior maintained by attention

We examined the use of brief functional assessments to identify idiosyncratic variables associated with aberrant behavior maintained by positive reinforcement in the form of attention. Two participants with severe developmental disabilities and their parents were involved in the assessment and treatment evaluation process. A modified attention condition was introduced, which involved both parents interacting with a third person. Results of the assessment demonstrated that aberrant behavior occurred only in the modified attention condition for both participants. Treatment consisted of the parents delivering attention on a fixed-time schedule during this specific social context. Results indicated that the treatment reduced problem behavior. Follow-up evaluations with 1 participant indicated maintenance of treatment effects for up to 6 months.

An evaluation of knowledge and skill retention following an in-house advanced life support course

The aim of the study was to explore advanced life support (ALS) skills and knowledge retention, in 10 registered nurses, at 6 and 12 weeks following an in-house core ALS course. Data was collected by structured interview and structured observation at 6 and 12 weeks following the course. A sharp decline in the number of subjects attaining the 84% pass level at the 6 and 12 week interviews was noted. A modest increase in ALS theoretical knowledge and a decrease in practical skill performance between 6 and 12 weeks was identified. Implications for future practice and research are proposed.

Experience in treating recalcitrant scalp psoriasis with automated shampooing and debridement

We report the cumulative clinical experience and financial implications of treating severe scalp psoriasis in an outpatient phototherapy center by means of an automated scalp debridement unit. Benefits of this approach included increased patient and staff satisfaction, enhanced response of recalcitrant scalp psoriasis, and detection of scalp dermatoses mimicking psoriasis.

Specificity of peptide-induced depolymerization of the recombinant carboxy-terminal fragment of BiP/GRP78

In the present study, we have used a non-denaturing gel electrophoresis assay to characterize the specificity of the peptide-induced depolymerization process of the isolated recombinant C-terminal domain (C30) of the molecular chaperone BiP, in the presence of specific synthetic peptides and with the neuropeptide Substance P. In the absence of peptidic ligand, C30 self-associates readily into multiple oligomeric species. Upon peptide addition, C30 oligomers convert into dimers, then into monomers. Our data indicate that the algorithm we previously developed to predict putative BiP binding sites in any protein sequence is also a good indicator as to whether a peptide can efficiently induce depolymerization of the C-terminal peptide binding domain and stimulate the ATPase activity of the full-length protein.

The ion channel switch biosensor

A biosensor technology is described which provides a direct measurement for functional molecular interactions, at the surface of a tethered bilayer membrane, through the electrical transduction of chemically modified ion-channels. High sensitivity of analyte detection is achieved due to the large flux of ions transmitted through the ion channel. The biomimetic sensor surface allows the molecular recognition to be measured in complex biological matrices (such as blood and sera) without compromising sensitivity. We have used the sensor for activity and concentration measurements for a range of analytes, which include bacteria, DNA, proteins and drugs. We have a quantitative model for the biosensor performance which is described by three-dimensional molecular interactions with the membrane surface and two-dimensional molecular interactions within the tethered bilayer.

"First aid for scalds" campaign: reaching Sydney's Chinese, Vietnamese, and Arabic speaking communities

OBJECTIVES

As a serious yet preventable problem, scald injuries in children have been a priority for prevention in Australia and other developed countries. Not only can the occurrence of scalds be prevented, but immediate first aid treatment offers an effective method for secondary prevention, reducing the severity of scalds. Despite the success of scald prevention initiatives, local evidence suggested that first aid knowledge was lacking in some minority ethnic groups. To redress this gap, the "First Aid for Scalds" campaign for those from a non-English speaking background was specifically targeted to three ethnic groups (Vietnamese, Chinese, and Arabic), with the aim of increasing the proportions of parents and caregivers who had correct knowledge of first aid treatment for scalds. The primary strategy was a media campaign, including advertisements on ethnic radio and in ethnic newspapers.

METHODS

The evaluation design included formative research and impact evaluation. The impact evaluation study involved random population based telephone surveys with each of the three language groups, before and after the campaign, to assess the reach and effectiveness of the campaign.

RESULTS

After the campaign, there were significant increases in the proportion of people who knew the correct first aid treatment for scalds. There were substantial variations in campaign recall and knowledge between each of the three language groups. The largest improvement was found in the Vietnamese group.

CONCLUSION

The association between campaign recall and increase in correct knowledge, and the absence of any similar interventions during the campaign period, give credence to the conclusion that the changes observed were a result of the campaign. The results demonstrate the value of community based injury prevention campaigns specifically targeting linguistically diverse communities.

N-acylglycine amidation: implications for the biosynthesis of fatty acid primary amides

Bifunctional peptidylglycine alpha-amidating enzyme (alpha-AE) catalyzes the O2-dependent conversion of C-terminal glycine-extended prohormones to the active, C-terminal alpha-amidated peptide and glyoxylate. We show that alpha-AE will also catalyze the oxidative cleavage of N-acylglycines, from N-formylglycine to N-arachidonoylglycine. N-Formylglycine is the smallest amide substrate yet reported for alpha-AE. The (V/K)app for N-acylglycine amidation varies approximately 1000-fold, with the (V/K)app increasing as the acyl chain length increases. This effect is largely an effect on the KM,app; the KM,app for N-formylglycine is 23 +/- 0.88 mM, while the KM,app for N-lauroylglycine and longer chain N-acylglycines is in the range of 60-90 microM. For the amidation of N-acetylglycine, N-(tert-butoxycarbonyl)glycine, N-hexanoylglycine, and N-oleoylglycine, the rate of O2 consumption is faster than the rate of glyoxylate production. These results indicate that there must be the initial formation of an oxidized intermediate from the N-acylglycine before glyoxylate is produced. The intermediate is shown to be N-acyl-alpha-hydroxyglycine by two-dimensional 1H-13C heteronuclear multiple quantum coherence (HMQC) NMR.

Physician office-based diabetes care: comparison to guidelines for care

Over the past decade, we have seen a significant increase in hospitalizations in South Carolina for the major complications of diabetes: myocardial infarcts (+68 percent), amputations (+61 percent), end stage renal disease (+85 percent), diseases of blood vessels (+100 percent), and eye complications (+52 percent). Many of these late stage complications can be prevented or their progression slowed down by early recognition and institution of intensive, well-defined preventive strategies. Independent surveys reviewed above indicate that such preventive practices are not being fully utilized in South Carolina. As one key example, less than 50 percent of people with diabetes receive self-management education. A number of simple and relatively inexpensive laboratory and physical examinations which would trigger preventive and remedial therapy are also performed at less than adequate frequency. The challenge is for all to use these examinations to guide therapy and to continue to monitor and intervene to prevent complications of diabetes. The DSC Board of South Carolina has developed a Ten Year Strategic Plan with nine major goals to improve diabetes care and outcomes in South Carolina. To improve office-based care of diabetes in South Carolina, all health professionals must assume responsibility for closely monitoring each person with diagnosed diabetes and assure that glycemic control is optimized. Early signs of complications must be recognized and interventions to limit their progression utilized. Screening of high-risk individuals to identify the estimated one-third of persons with diabetes who are undiagnosed, targeted education programs to the primary care professionals who deliver the majority of care to individuals with diabetes, implementation of the proven, cost-effective measures that can prevent (postpone) the complications of diabetes, monitoring of the health care delivery system and addressing the potential barriers to adequate care for all persons with diabetes are essential steps to decrease the burden of diabetes for South Carolinians (Table 1).

Substrate binding induces depolymerization of the C-terminal peptide binding domain of murine GRP78/BiP

To investigate the role of each domain in BiP/GRP78 function, we have used a full-length recombinant BiP engineered to contain two enterokinase sites; one site is located after an N-terminal FLAG epitope, and a second site has been inserted at the junction between the N- and C-terminal domains (FLAG-BiP.ent). FLAG-BiP.ent oligomerizes into multiple species that interconvert with each other in a slow, concentration- and temperature-dependent equilibrium. Binding of ATP or AMP-PNP (adenosine 5'-(beta, gamma-imino)triphosphate), but not ADP, or of a peptidic substrate induces depolymerization of FLAG-BiP.ent and stabilization of monomeric species. Enterokinase cleavage of monomeric, nucleotide-free BiP.ent results in the physical dissociation of the 44-kDa N-terminal ATPase fragment (N44.ent) from the 30-kDa C-terminal substrate binding domain (C30.ent). Upon dissociation, the freed C-terminal substrate binding domain readily undergoes self-association while N44.ent remains monomeric. Enterokinase cleavage performed in the presence of a synthetic peptide prevents oligomerization of the freed C30.ent domain. Addition of ATP during enterokinase cleavage has no effect on C30.ent oligomerization. Our data clearly indicate that binding of a specific peptide onto the C-terminal domain, or ATP onto the N-terminal domain, induces internal conformational change(s) within the C30 domain that result(s) in BiP depolymerization.

Ace2p, a regulator of CTS1 (chitinase) expression, affects pseudohyphal production in Saccharomyces cerevisiae

Some diploid strains of Saccharomyces cerevisiae can grow both as a spherical yeast form and as a filamentous pseudohyphal form. Most yeasts capable of forming pseudohyphae possess a functional FLO8 gene. We show that disrupting the ACE2 transcription factor results in the production of pseudohyphae in a flo8-1 background. Disrupting the CTS1 (chitinase) gene also produces pseudohyphal growth in this background, but at a reduced level. Invasion of solid media by haploid and diploid cells is increased in ACE2 disruptions, but the diploids adhere poorly to the agar. Sigma1278b-derived strains, which generally produce pseudohyphae, have about 30-fold lower chitinase activity than other strains.