An electro-active system of immuno-assay (EASI assay) utilising self assembled monolayer modified electrodes

Most immunoassays currently rely on optical methods for signal generation e.g. in ELISA and rapid assay formats. It has become apparent as in the Glucose sensor market that there is a need for simple direct electrical immuno-sensors. We have investigated the novel use of organic conducting monolayers used as a direct electrochemical detection support for an immuno-reaction. It was found that antibodies raised to a carbazole dimer monolayer could increase the charge movement across that monolayer surface. Antibody fragments were taken from a specific anti-carbazole antibody fragment library and combined with an antibody fragment directed to the hormone estrone 3 glucuronide (E3G), the target antigen to form a bispecific antibody fragment. The device utilised these specific antibody fragments and incorporated them on the top plate of a capillary fill format as the immuno-assay components. The immuno-reaction utilised a competition assay. Free E3G analyte in the sample displaced the bispecific antibody fragment from the immuno-surface leaving it free to bind the carbazole monolayer surface. There the binding was detected using amperometric or coulometric methods. By combining all there element it was possible to develop a sensitive immuno-assay that could detect E3G in a reproducible calibrated fashion down to 10 ng/ml.

The historiography of medicine in the U.K

The practice of the history of medicine in Britain is characterized by a health pluralism and diversity. Thirty years ago, history of medicine in Britain was generally considered a space of no particular relevance to history at large; today, public attitudes towards scientific medicine and the medical profession have grown critical, and the history of medicine has itself been problematized, commanding widespread scholarly attention. This article deals with some of the historiographical fields thanks to which the discipline has been energized over the last thirty years: the history of health, analyzing the healthiness of populations, the length of their lives and the causes of death; the history of the body, which has been considered as a biological and as a sociological entity; the history of sexuality and sexual behaviour; the demographic and epidemiological history, both ocnnected with the environmental history; the history of death and corpses; the history of mental disorders; the historical role of the hospital in the reformation of popular health care.

Charles Garrett Phillips: 13 October 1916 - 9 September 1994

Charles Garrett Phillips was born in London on 13 October 1916, the eldest of four children, having one brother and twin sisters. His own comment on his categorically medical ancestry and distinguished family traditions reads: ‘My grandfather, George Arthur Phillips, J.P (1850-1921), was a Surgeon of Walsall, Staffordshire, and my great-grandfather, George Marshall Phillips (1819-1904), was Surgeon of Whitwell, Hertfordshire.’ Charles’s father, George Ramsay Phillips, F.F.A., R.C.S. (1880-1953), was Senior Anaesthetist to St Mary’s Hospital, Paddington, London W2, a position from which he retired in 1948. His mother, Flora Phillips, née Green (1886-1956), had been a nurse at St George’s Hospital, then at Hyde Park Corner. At the age of 29, she married George Ramsay Phillips who had been Resident Anaesthetist at that hospital. Flora was the youngest of six children who were brought up on a farm in Kent. Her mother died when she was 18 and her father soon afterwards. She was helped by family friends in London, trained as a nurse at St George’s and became a ward sister at that hospital. After her marriage she worked at the Victoria Hospital for Children in Chelsea and, in 1939, became a matron at Bradfield College. Charles Phillips was proud of his medical family tree. His great-grandfather and his grandfather had both qualified at St Bartholomew’s Hospital, as had his father’s brother, Alfred Percy Phillips (1881-1961). His grandfather’s brother, Percy Cranston Phillips (1869-1946), had graduated from St Thomas’s Hospital and practised in Putney, London, as a general practitioner, while George Ramsay Phillips, his father, had qualified at Guy’s Hospital and served in the R.A.M.C. in World War I.

WHO principles of perinatal care: the essential antenatal, perinatal, and postpartum care course

World Health Organization (WHO) recommendations and meta-analyses of controlled trials have concluded that inappropriate perinatal care and technology continue to be practiced widely throughout the world, despite the acceptance of evidence-based principles and care. The WHO Regional Office for Europe, in consultation with policy makers and reproductive health experts recently proposed ten "Principles of Perinatal Care," which have been endorsed by the reproductive health units of most member states. A comprehensive training program, based on the principles, is now being offered throughout the European region. This paper describes the development of the WHO principles and the WHO training course "Essential Antenatal, Perinatal and Postpartum Care." Together they provide an innovative model of evidence-based and psychosocially sensitive care for the future guidance of perinatal policy makers and caregivers worldwide.

Randomized clinical trial of a quality improvement intervention in nursing homes

PURPOSE

The purpose of the study was to determine if simply providing nursing facilities with comparative quality performance information and education about quality improvement would improve clinical practices and subsequently improve resident outcomes, or if a stronger intervention, expert clinical consultation with nursing facility staff, is needed.

DESIGN AND METHODS

Nursing facilities (n = 113) were randomly assigned to one of three groups: workshop and feedback reports only, workshop and feedback reports with clinical consultation, and control. Minimum Data Set (MDS) Quality Indicator (QI) feedback reports were prepared and sent quarterly to each facility in intervention groups for a year. Clinical consultation by a gerontological clinical nurse specialist (GCNS) was offered to those in the second group.

RESULTS

With the exception of MDS QI 27 (little or no activity), no significant differences in resident assessment measures were detected between the groups of facilities. However, outcomes of residents in nursing homes that actually took advantage of the clinical consultation of the GCNS demonstrated trends in improvements in QIs measuring falls, behavioral symptoms, little or no activity, and pressure ulcers (overall and for low-risk residents).

IMPLICATIONS

Simply providing comparative performance feedback is not enough to improve resident outcomes. It appears that only those nursing homes that sought the additional intensive support of the GCNS were able to effect enough change in clinical practice to improve resident outcomes significantly.

Assessing effective care in normal labor: the Bologna score

The intention of the "Bologna score" is to quantify, both in an individual labor and in a wider population, the extent to which labors have been managed as if they are normal as opposed to complicated. In this way it may be possible to assess both attitudes and practices within a maternity service toward the effective care of normal labor. A scoring system for normal labor was proposed at the World Health Organization (Regional Office for Europe) Task Force Meeting on Monitoring and Evaluation of Perinatal Care, held in Bologna in January 2000. This paper describes conceptual development of the scale. Recommendations for future evaluation of the Bologna score's validity and potential include field testing globally, comparison with the Apgar score, and evaluation of the relative weight contributed by each of the five measures comprising the Bologna score.

Day 3 morphology is a poor predictor of blastocyst quality in extended culture

OBJECTIVE

To determine how the quality of blastocysts formed on day 5/6 of extended culture compares with their morphology on day 3.

DESIGN

Retrospective observational study of IVF laboratory records.

SETTING

Private assisted reproduction clinic.

PATIENT(S)

101 IVF cycles in which 5 to 25 embryos were produced. The average maternal age was 33.1 years.

INTERVENTION(S)

Embryos were individually cultured in vitro in sequential media for an extended time to enable use of blastocysts for fresh transfer or cryopreservation.

MAIN OUTCOME MEASURE(S)

Comparison of embryo quality for putative ET or cryopreservation on day 3 with quality of embryos used for actual ET and cryopreservation on day 5/6.

RESULT(S)

Of 1,263 cleaving embryos, 559 were judged to have been suitable for use on day 3; 355 would have been used for ET (average per ET, 3.5) and 204 would have been frozen (equivalent to 44% utilization). In actuality, 471 blastocysts were used on day 5/6, of which 234 were transferred (average per ET, 2.3), and 237 were frozen (equivalent to 37% utilization). Only 48% embryos that would have been chosen for ET and/or cryopreservation on day 3 were eventually used in such a manner at the blastocyst stage. Historically, the rate of viable pregnancy from day 3 transfers was 30.5% per transfer; this rate increased to 45% with routine day 5/6 transfers.

CONCLUSION(S)

Extended culture of human embryos seems to increase discrimination of potential embryonic viability. Criteria for embryo selection on day 3 seem to be inadequate. Extended in vitro culture may therefore be an effective means of optimizing IVF clinical success.

Ten misconceptions physicians have about marketing

Negative attitudes about marketing abound in medicine and largely arise from 10 common misconceptions. This article describes each and offers remedies.