The concept of compartmentalisation

The rationale for establishing trade 'regions' and 'zones' is based on principles of epidemiological science and risk analysis that assess and manage animal disease risks so that the safety of trade can be ensured. However, the boundaries of geographical regions and zones may readily be breached through numerous epidemiological pathways. The concept of a 'compartment' extends the application of a 'risk boundary' beyond that of a geographical interface and considers all epidemiological factors that can contribute to the creation of an effective boundary. The fundamental requirement for application of either concept (regions/zones or compartments) is that the population considered for trade is maintained within management or geographical boundaries which allow clear epidemiological differentiation to be made between those animals and surrounding populations of higher risk. Seven factors are presented that an exporting country might use to guide the identification and documentation of a compartment. Additionally, the steps that would be undertaken to implement trade based on the compartmentalisation concept are discussed.

Hot techniques for tonsillectomy

(1) Some patients experience pain and bleeding after a standard or extracapsular tonsillectomy. (2) Evidence suggests that none of the hot tonsillectomy techniques offers concurrent reductions in intra- and post-operative bleeding and pain, compared with traditional cold-steel dissection with packs or ties. (3) Little information is available on the cost effectiveness of the hot techniques. (4) Diathermy is likely to remain the most commonly practised hot tonsillectomy technique.

A case of haemangiopericytoma-associated hypoglycaemia: Beneficial effect of treatment with radiotherapy

A 72-year-old lady presented with recurrent hypoglycaemia and a large pelvic mass. Hypoglycaemia was accompanied by undetectable serum insulin and c-peptide and high insulin-like growth factor II (IGFII) to IGFI ratio. She had undergone successful resection of a large bladder haemangiopericytoma 7 years earlier. A core biopsy was performed, and histology confirmed the recurrence of the haemangiopericytoma. Local palliative radiotherapy resulted in the reduction of IGFII level and IGFII to IGFI ratio and increased insulin, c-peptide and growth hormone (GH) level with long-term amelioration of hypoglycaemic episodes. Clinically and biochemically, radiotherapy was more effective than GH therapy.

Accommodative intraocular lenses for age-related cataracts

The standard intraocular lens (IOL) that is used to replace a cataractous lens cannot change focus from distant to near objects, so most patients need glasses for near vision after cataract surgery. Limited evidence suggests that accommodative IOLs provide better near vision than monofocal IOLs, but not better than multifocal IOLs. Long-term follow-up is needed to confirm patient outcomes, and determine whether the benefits justify the additional cost.

Surgical care practitioner – a confusing and misleading title

In March 2005 the Department of Health released the Curriculum Framework for the Surgical Care Practitioner for consultation. The curriculum framework has been developed by a working party drawn from The Royal College of Surgeons of England (RCSE) Council and an NHS Changing Workforce Programme steering group, which represented a number of involved associations. As well as inviting responses on the curriculum itself, the consultation invited comments with respect to the title of 'surgical care practitioner'.

Are patients happy with SCPs operating?

The traditional model of surgical service is in the process of change. Classically, a consultant surgeon would have the services of an SpR, staff and associate specialist (SAS) and SHO in clinic and theatre. The implementation of the New Deal and the European Working Time Directive has led to a significant reduction in the number of hours worked by junior doctors. Consequently, nearly all SHOs are working a full-shift pattern and most SpRs are moving onto full-shift rotas to ensure out-of-hours service is maintained. This reduction in the number of junior doctors available during the normal working day has increased the development of extended roles for non-medical professionals.

Construction of a 2-Mb resolution BAC microarray for CGH analysis of canine tumors

Recognition of the domestic dog as a model for the comparative study of human genetic traits has led to major advances in canine genomics. The pathophysiological similarities shared between many human and dog diseases extend to a range of cancers. Human tumors frequently display recurrent chromosome aberrations, many of which are hallmarks of particular tumor subtypes. Using a range of molecular cytogenetic techniques we have generated evidence indicating that this is also true of canine tumors. Detailed knowledge of these genomic abnormalities has the potential to aid diagnosis, prognosis, and the selection of appropriate therapy in both species. We recently improved the efficiency and resolution of canine cancer cytogenetics studies by developing a small-scale genomic microarray comprising a panel of canine BAC clones representing subgenomic regions of particular interest. We have now extended these studies to generate a comprehensive canine comparative genomic hybridization (CGH) array that comprises 1158 canine BAC clones ordered throughout the genome with an average interval of 2 Mb. Most of the clones (84.3%) have been assigned to a precise cytogenetic location by fluorescence in situ hybridization (FISH), and 98.5% are also directly anchored within the current canine genome assembly, permitting direct translation from cytogenetic aberration to DNA sequence. We are now using this resource routinely for high-throughput array CGH and single-locus probe analysis of a range of canine cancers. Here we provide examples of the varied applications of this resource to tumor cytogenetics, in combination with other molecular cytogenetic techniques.

Unmet need for recommended preventive health services among clients of California syringe exchange programs: implications for quality improvement

BACKGROUND

Comprehensive preventive services are recommended for injection drug users (IDU), including screening tests, vaccinations, risk reduction counseling, and sterile syringes. Syringe exchange programs (SEP) may facilitate receipt of preventive services by IDUs, but whether SEP clients receive recommended preventive care is not known. We examined use of recommended preventive services by clients of 23 SEPs throughout California.

METHODS

Five hundred and sixty SEP clients were recruited from 23 SEPs throughout California between March and September 2003. Receipt of 10 recommended preventive services and source of care (SEP versus non-SEP providers) was ascertained from client interviews.

RESULTS

On average, SEP clients received only 13% of recommended preventive services and 49% of clients received none of the recommended services. Of services that were received, 76% were received from SEPs. In multivariate analysis, use of drug treatment and more frequent SEP visits were associated with receipt of recommended preventive services by clients.

CONCLUSIONS

SEPs are often the only source of preventive care for their IDU clients. Still, SEP clients fail to receive most recommended preventive services. Interventions to increase use of preventive services and improve the quality of preventive care received by IDUs, such as increased access to drug treatment and SEPs, are needed.

Increased injury and intramuscular collagen of the diaphragm in COPD: autopsy observations

Evidence for diaphragm injury in people with chronic obstructive pulmonary disease (COPD) has been reported, although the extent of injury and collagen accumulation post mortem have not previously been examined. In addition, it is not known whether the amount of injury and collagen are different in key regions of the diaphragm. The cross-sectional area of collagen and the percentage of abnormal myofibres in the post mortem diaphragm and psoas major were determined by computer-assisted image analysis of stained cross-sections of the diaphragm for collagen with picrosirius red and with haematoxylin and eosin for morphology. In the midcostal diaphragm of six subjects with COPD and six subjects with no significant respiratory disease, the COPD diaphragm displayed a greater cross-sectional area of collagen and percentage of abnormal myofibres (collagen: 24.2+/-1.0 versus 18.6+/-1.1%; injury: 28.4+/-7.2 versus 12.0+/-1.3%). In 18 patients with various respiratory conditions, the midcostal diaphragm displayed more collagen and abnormal myofibres than the crural diaphragm, while both costal and crural diaphragms displaying more collagen and abnormal myofibres than psoas major. This study reveals extensive injury and collagen accumulation in the chronic obstructive pulmonary diseased diaphragm, and reveals a regional pattern of injury and intramuscular collagen which may correspond to variations in diaphragm loading.

Bacteriophage therapy to reduce Campylobacter jejuni colonization of broiler chickens

Colonization of broiler chickens by the enteric pathogen Campylobacter jejuni is widespread and difficult to prevent. Bacteriophage therapy is one possible means by which this colonization could be controlled, thus limiting the entry of campylobacters into the human food chain. Prior to evaluating the efficacy of phage therapy, experimental models of Campylobacter colonization of broiler chickens were established by using low-passage C. jejuni isolates HPC5 and GIIC8 from United Kingdom broiler flocks. The screening of 53 lytic bacteriophage isolates against a panel of 50 Campylobacter isolates from broiler chickens and 80 strains isolated after human infection identified two phage candidates with broad host lysis. These phages, CP8 and CP34, were orally administered in antacid suspension, at different dosages, to 25-day-old broiler chickens experimentally colonized with the C. jejuni broiler isolates. Phage treatment of C. jejuni-colonized birds resulted in Campylobacter counts falling between 0.5 and 5 log10 CFU/g of cecal contents compared to untreated controls over a 5-day period postadministration. These reductions were dependent on the phage-Campylobacter combination, the dose of phage applied, and the time elapsed after administration. Campylobacters resistant to bacteriophage infection were recovered from phage-treated chickens at a frequency of <4%. These resistant types were compromised in their ability to colonize experimental chickens and rapidly reverted to a phage-sensitive phenotype in vivo. The selection of appropriate phage and their dose optimization are key elements for the success of phage therapy to reduce campylobacters in broiler chickens.

Effects of ion motion in intense beam-driven plasma wakefield accelerators

Recent proposals for using plasma wakefield accelerators (PWFA) as a component of a linear collider have included intense electron beams with densities many times in excess of the plasma density. The beam's electric fields expel the plasma electrons from the beam path to many beam radii in this regime. We analyze here the motion of plasma ions under the beam fields, and find for a proposed PWFA collider scenario that the ions completely collapse inside of the beam. Simulations of ion collapse are presented. Implications of ion motion on the feasibility of the PWFA-based colliders are discussed.

Does a central MHC gene in linkage disequilibrium with HLA-DRB1*0401 affect susceptibility to type 1 diabetes?

Subtypes of HLA-DR4 are associated with susceptibility or protection against type 1 diabetes (T1DM). We addressed whether this reflects linkage disequilibrium with the true susceptibility locus by studying broader MHC haplotypes marked by alleles of HLA-B, IKBL (adjacent to TNFA) and complement C4. The study used a largely Caucasian cohort from Western Australia. HLA-DRB1*0401 and HLA-DRB1*0405 marked susceptibility to T1DM. In Caucasians, DRB1*0401 occurs predominantly in the 44.1 ancestral haplotype (AH; HLA-A2,B44, DRB1*0401,DQB1*0301) and the 62.1AH (HLA-A2,B15(62),DRB1*0401,DQB1*0302). HLA-B15 marked susceptibility and HLA-B44 marked with resistance to T1DM in patients and controls preselected for HLA-DRB1*0401. A gene between TNFA and HLA-B on the 8.1AH (HLA-A1,B8,;DR3,DQ2) modifies the effects of the class II alleles. Here, alleles characteristic of the 62.1AH (C4B3, IKBL+446*T and HLA-A2,B15) were screened in donors preselected for HLA-DRB1*0401. C4B3 was associated with diabetes, consistent with a diabetes gene telomeric of MHC class II. However, increases in carriage of IKBL+446*T and HLA-A2,B15 were marginal, as too few control subjects were available with the diabetogenic alleles. However, with these tools, selection of HLA-DRB1*0401, DQB1*0302 donors who are positive and negative for C4B3 will allow bidirectional mapping of diabetes genes in the central MHC.

High strain mechanical loading rapidly induces tendon apoptosis: an ex vivo rat tibialis anterior model

BACKGROUND

The role of apoptosis, or programmed cell death, has only recently been explored in tendon.

OBJECTIVE

To investigate the development of apoptosis after high strain loading of rat tendon.

METHODS

The right tibialis anterior tendons of three rats were prepared for mechanical loading, and left tendons were prepared identically as non-loaded controls. Tendon was loaded with 20% strain for six hours using a 1 Hz longitudinal sine wave signal. The following were used to assess apoptosis: (a) a monoclonal mouse antibody (F7-26) to label single stranded DNA breaks; (b) a rabbit polyclonal antibody that specifically recognises the cleaved form of caspase-3.

RESULTS

Light microscopy confirmed that the high strain protocol induced a stretch overload injury. Control tendons showed little or no staining with the F7-26 antibody, but the loaded tendons displayed numerous apoptotic cells. The percentage of apoptotic cells (20%) in the loaded tendon was significantly greater than in the control tendon (1%) (p = 0.000). The labelled cells colocalised with abnormal nuclear morphology, including nuclear fragmentation. The staining against cleaved caspase-3 was positive in loaded tendons only, and localised both to nucleus and cytoplasm.

CONCLUSION

This experiment extends knowledge of human tendon apoptosis by showing that apoptosis can occur in response to short term, high strain mechanical loading. This is the first report of mechanical loading of intact tendon causing excessive apoptosis.

Chromosomal assignment of the canine melanophilin gene (MLPH): a candidate gene for coat color dilution in Pinschers

Pinschers affected by coat color dilution show a specific pigmentation phenotype. The dilute pigmentation phenotype leads to a silver-blue appearance of the eumelanin-containing fur and a pale sandy color of pheomelanin-containing fur. In Pinscher breeding, dilute black-and-tan dogs are called "blue," and dilute red or brown animals are termed "fawn" or "Isabella fawn." Coat color dilution in Pinschers is sometimes accompanied by hair loss and a recurrent infection of the hair follicles. In human and mice, several well-characterized genes are responsible for similar pigment variations. To investigate the genetic cause of the coat color dilution in Pinschers, we isolated BAC clones containing the canine ortholog of the known murine color dilution gene Mlph. RH mapping of the canine MLPH gene was performed using an STS marker derived from BAC sequences. Additionally, one MLPH BAC clone was used as probe for FISH mapping, and the canine MLPH gene was assigned to CFA25q24.

What do we mean by the term "inflammation"? A contemporary basic science update for sports medicine

Most practicing sports medicine clinicians refer to the concept of "inflammation" many times a day when diagnosing and treating acute and overuse injuries. What is meant by this term? Is it a "good" or a "bad" process? The major advances in the understanding of inflammation in recent years are summarised, and some clinical implications of the contemporary model of inflammation are highlighted.

Natural history of cardiac involvement in geleophysic dysplasia

Geleophysic dysplasia is an autosomal recessive short-limbed, dysmorphic syndrome. The condition is frequently associated with cardiac valvular disease, which may result in secondary hypertrophy and cardiac failure. We describe two distantly related Pakistani children with classical features of geleophysic dysplasia. Pulmonary stenosis was recognized in both within a few months of birth. The younger child shows no signs of cardiac decompensation at the age of 7 years whilst her older cousin has developed a significant pulmonary gradient requiring surgical intervention in the second decade of life. The natural history of his disorder highlights that the cardiac involvement seen in apparently stable forms of geleophysic dysplasia is frequently progressive.

Automatic external defibrillators — time for a change?

Defibrillation is the definitive treatment for cardiac arrest. Until relatively recently the use of defibrillators was restricted to medical staff and paramedics. The development of automatic external defibrillators (AEDs) now means that this life-saving equipment may be used by anyone with a short period of training. This article will review the patho-physiology of cardiac arrest, the use of AEDs and their significance to the dental team. A medical emergency could happen at any time in the dental practice. Cardiac arrest is the most serious emergency that can occur. Whilst life-threatening incidents are very rare, the dental team requires to be trained in the management of a cardiac arrest.

Inclusive double-pomeron exchange at the fermilab tevatron p p collider

We report results from a study of events with a double-Pomeron exchange topology produced in p p collisions at sqrt[s]=1800 GeV. The events are characterized by a leading antiproton and a large rapidity gap on the outgoing proton side. We find that the differential production cross section agrees in shape with predictions based on Regge theory and factorization, and that the ratio of double-Pomeron exchange to single diffractive production rates is relatively unsuppressed as compared to the O(10) suppression factor previously measured in single diffractive production.

Are routine breast and pelvic examinations necessary for women starting combined oral contraception?

Millions of women worldwide use combined oral contraception (COC). Most of them are in good health and have no contraindications to using any contraceptive method. Although extremely safe for the vast majority of women and even though the absolute risk of complications is very small, COC is associated with an increased relative risk of serious conditions including cardiovascular disease and breast and cervical cancer. In many countries, breast and pelvic examinations are routinely undertaken annually for all women using hormonal contraception. Breast and pelvic examination have low detection rates for abnormality and may yield clinically irrelevant results, causing anxiety and inconvenience to the patient for no obvious gain. There is no good evidence to support routine breast or pelvic examination either for women starting hormonal contraception or for monitoring long-term use.

Longitudinal study of Campylobacter jejuni bacteriophages and their hosts from broiler chickens

A longitudinal study of bacteriophages and their hosts was carried out at a broiler house that had been identified as having a population of Campylobacter-specific bacteriophages. Cloacal and excreta samples were collected from three successive broiler flocks reared in the same barn. Campylobacter jejuni was isolated from each flock, whereas bacteriophages could be isolated from flocks 1 and 2 but were not isolated from flock 3. The bacteriophages isolated from flocks 1 and 2 were closely related to each other in terms of host range, morphology, genome size, and genetic content. All Campylobacter isolates from flock 1 were genotypically indistinguishable by pulsed-field gel electrophoresis (PFGE). PFGE and multilocus sequence typing indicated that this C. jejuni type was maintained from flock 1 to flock 2 but was largely superseded by three genetically distinct C. jejuni types insensitive to the resident bacteriophages. All isolates from the third batch of birds were insensitive to bacteriophages and genotypically distinct. These results are significant because this is the first study of an environmental population of C. jejuni bacteriophages and their influence on the Campylobacter populations of broiler house chickens. The role of developing bacteriophage resistance was investigated as this is a possible obstacle to the use of bacteriophage therapy to reduce the numbers of campylobacters in chickens. In this broiler house succession was largely due to incursion of new genotypes rather than to de novo development of resistance.

An integrated 4249 marker FISH/RH map of the canine genome

BACKGROUND

The 156 breeds of dog recognized by the American Kennel Club offer a unique opportunity to map genes important in genetic variation. Each breed features a defining constellation of morphological and behavioral traits, often generated by deliberate crossing of closely related individuals, leading to a high rate of genetic disease in many breeds. Understanding the genetic basis of both phenotypic variation and disease susceptibility in the dog provides new ways in which to dissect the genetics of human health and biology.

RESULTS

To facilitate both genetic mapping and cloning efforts, we have constructed an integrated canine genome map that is both dense and accurate. The resulting resource encompasses 4249 markers, and was constructed using the RHDF5000-2 whole genome radiation hybrid panel. The radiation hybrid (RH) map features a density of one marker every 900 Kb and contains 1760 bacterial artificial chromosome clones (BACs) localized to 1423 unique positions, 851 of which have also been mapped by fluorescence in situ hybridization (FISH). The two data sets show excellent concordance. Excluding the Y chromosome, the map features an RH/FISH mapped BAC every 3.5 Mb and an RH mapped BAC-end, on average, every 2 Mb. For 2233 markers, the orthologous human genes have been established, allowing the identification of 79 conserved segments (CS) between the dog and human genomes, dramatically extending the length of most previously described CS.

CONCLUSIONS

These results provide a necessary resource for the canine genome mapping community to undertake positional cloning experiments and provide new insights into the comparative canine-human genome maps.

What does GP out of hours care cost? An analysis of different models of out of hours care in Scotland

BACKGROUND

The changes to out of hours care provided by General Practitioners have led to wide variation in the types and costs of out of hours care across the country.

AIM

To examine the costs of different models of service delivery for GP out of hours organisations.

METHODS

This was a prospective cross-sectional survey of eight GP out of hours organisations and samples of their patients. A deputising service, rotas, and various types of GP co-operative across Scotland were surveyed. Information on the quantities of resources used by each organisation was combined with unit costs. Costs incurred by patients and other NHS costs subsequent to the out of hours contact were also calculated.

RESULTS

Annual costs incurred by the GP out of hours organisation per 1,000 population ranged from pounds sterling 2,916 to pounds sterling 12,120. There was no relationship between costs and type and size of organisation. There was a three-fold variation in total costs per out of hours contact (pounds sterling 15 to pounds sterling 51). Costs per phone contact were lowest (pounds sterling 6 to pounds sterling 11), followed by cost per centre contact (pounds sterling 10 to pounds sterling 16) and cost per home contact (pounds sterling 21 to pounds sterling 60). Total costs per episode ranged from pounds sterling 78 to pounds sterling 136 for centre contacts, from pounds sterling 130 to pounds sterling 303 for home contacts, and from pounds sterling 70 to pounds sterling 553 for telephone contacts. Home contacts had the highest average cost per episode (pounds sterling 212), followed by telephone contacts (pounds sterling 117) and centre contacts (pounds sterling 85).

CONCLUSIONS

There are wide variations in the costs of operating GP out of hours services, It is likely that the context in which organisations were set up and local geography infuence variations in costs, as well as the level of GP cover.

Consultants in nhs scotland: a survey of work commitments, remuneration, job satisfaction and retirement plans

BACKGROUND AND AIMS

UK consultants have reported working long hours, increased stress and reduced morale. This study set out to elicit consultants' views on flexible working and to gather data on consultants' workloads, remuneration, job satisfaction and retirement plans. As such it is the first comprehensive study of consultants in NHS Scotland.

METHODS

The Information and Statistics Division of the Scottish Executive Health Dept provided a list of consultants working in NHS Scotland Focus groups and interviews informed the design of a postal self-completion, questionnaire.

RESULTS

The response ratewas 61%. Almost two-thirds (65%) of respondents felt their workloads were unreasonable and unsustainable and 67% were unable to provide their desired standards of patient care. Two-thirds (67%) did not normally take meal breaks, 63% had insufficient time for outside interests, whilst 44% felt their health was being adversely affected Many (84%) believed that some of their work could be delegated to someone less qualified but 79% agreed that there were insufficient staff to make this possible. The average planned retirement age was 60 years, with 23% describing their plans as definite and 70% as quite or very likely. When asked what might induce them to postpone retirement, 50% cited reduced workload/work intensity.

CONCLUSIONS

In 2003, a majority of consultants in the UK voted in favour of the new consultant contract. This will improve consultant pay and introduce a standard 40-hour working week, including worked on-call. This should address tow of the main areas of consultant dissatisfaction in NHS Scotland. However, staff shortages will require to be addressed if the contract is to be successfully implemented.

A comparison of pollutant biomarker responses with transcriptional responses in European flounders (Platicthys flesus) subjected to estuarine pollution

European flounders from two UK estuaries with different contaminant profiles were sampled and analysed for impacts of PAHs, heavy metals and estrogenic compounds by currently adopted measurement procedures used in statutory monitoring programs. These showed that fish from the polluted Tyne estuary had responded to all three classes of pollutants with elevations in hepatic EROD, MT and plasma VTG and that there was considerable interanimal variation in the magnitude of the response. Analysis of PAH metabolites in bile showed recent uptake of low molecular weight PAHs. The pollutant response was also apparent when hepatic levels of cytochrome P450 1A (CYP1A), metallothionein (MT) and vitellogenin (VTG) mRNAs were quantified by real time PCR. Whilst there did not appear to be a direct correlation between levels of gene transcripts and their protein products on an individual basis, these results demonstrate that measurements of mRNA levels of specific genes, or their protein products both demonstrate induction in polluted environments and are thus valid measures in biomonitoring studies. Procedurally, the use of the single generic technology of Q-PCR was much simpler and is worth pursuing in future studies.

The national survey of adverse reactions to dental materials in the UK: a preliminary study by the UK Adverse Reactions Reporting Project

OBJECTIVE

Dental treatment involves the use of a wide range of materials. Many of the dental materials or their components pose a potential risk to the patient and member of the dental team. Pre-market biocompatibility testing cannot guarantee absolute safety, making monitoring of materials likely to cause an adverse reaction essential. The prevalence of adverse reactions to dental materials amongst dental patients and staff has not been systematically monitored in the UK. This project aims to develop a systematic approach to the evaluation and monitoring of the extent and severity of adverse reactions to dental materials in the UK.

METHOD

Through the distribution of reporting forms to dental surgeries and laboratories in the UK, the ARRP has received 1,075 complete reports relating to adverse reactions seen or experienced by dental staff and patients.

RESULTS

The main findings were that different materials cause adverse reactions to different groups of people. The largest proportion of patient related adverse reactions were reported to be due to metals (n = 175). These were mainly amalgam associated oral lichenoid reactions (n = 124). Dental technicians reported acrylic resin as the causal factor of hand dermatitis in 61% (44 out of a total 72) of cases reported. Finally, dental surgery staff reported gloves as causing hand dermatitis in 75% of cases (398 out of a total 531).

CONCLUSIONS

Different dental materials affect different person groups depending on their exposure to the material. Dental staff are most at risk from an adverse reaction to latex gloves, whereas most reported reactions for patients were due to metals. For dental technicians the biggest danger of an adverse reaction was from acrylic resins. There is a need to continue to raise the awareness among dental professionals of the existence of the Adverse Reactions Reporting Project so as to overcome problems of under-reporting.

Search for Kaluza-Klein graviton emission in pp collisions at square root[s] = 1.8 TeV using the missing energy signature

We report on a search for direct Kaluza-Klein graviton production in a data sample of 84 pb(-1) of ppmacr; collisions at sqrt[s]=1.8 TeV, recorded by the Collider Detector at Fermilab. We investigate the final state of large missing transverse energy and one or two high energy jets. We compare the data with the predictions from a (3+1+n)-dimensional Kaluza-Klein scenario in which gravity becomes strong at the TeV scale. At 95% confidence level (C.L.) for n=2, 4, and 6 we exclude an effective Planck scale below 1.0, 0.77, and 0.71 TeV, respectively.

Search for pair production of scalar top quarks in R-parity violating decay modes in pp collisions at square root of s=1.8 TeV

We present the results of a search for pair production of scalar top quarks (t(1)) in an R-parity violating supersymmetry scenario in 106 pb(-1) of pp collisions at square root of s=1.8 TeV collected by the Collider Detector at Fermilab. In this mode each t(1) decays into a tau lepton and a b quark. We search for events with two tau's, one decaying leptonically (e or mu) and one decaying hadronically, and two jets. No candidate events pass our final selection criteria. We set a 95% confidence level lower limit on the t(1) mass at 122 GeV/c(2) for Br(t(1)-->tau b)=1.

Adverse reactions to protective gloves used in the dental profession: experience of the UK Adverse Reaction Reporting Project

The Adverse Reaction Reporting Project (ARRP) was set up to measure the extent and severity of adverse reactions to dental materials in the UK. Further analysis into the use of protective gloves has been carried out to establish the degree to which gloves are having a deleterious effect on the dental profession. In addition the survey aimed to establish the techniques used to manage adverse reactions and their effectiveness. In a 23-month period, 369 reports were received concerning adverse reactions to protective gloves used in dental practices. Reporters were contacted for further information, and a 92% response rate was achieved. The 330 reports analysed showed dentists to be the largest group to report adverse reactions, whilst dental technicians reported the fewest. The referral rate for staff and patients was similar with a third of adverse reactions being referred (n=110) to a specialist for diagnosis. A confirmed diagnosis was received in 65% of referred cases (n=72), but the symptoms reported suggested a larger degree of Type I reactions occurring than diagnosed. The use of non-powdered gloves appeared to be favoured over powdered gloves in 42% of glove changes, and nitrile gloves were used as an alternative to latex in 39% of changes. In conclusion, the results from this survey showed that wearing gloves in dental practices in the UK caused a range of adverse reactions. In 79% (n=330) of cases reported and analysed, these reactions were readily resolved or improved by self-medication, prescribed medication and/or changing to a different type of protective glove.

Chromosomal assignment of 20 candidate genes for canine congenital sensorineural deafness by FISH and RH mapping

The analysis of inherited diseases in the domestic dog (Canis familiaris) provides a resource for the continued use of this species as a model system for human diseases. Many different dog breeds are affected by congenital sensorineural deafness. Since mutations in various genes have already been found causative for sensorineural hearing impairment in humans or mice, 20 of these genes were considered as candidates for deafness in dogs. For each of the candidate genes a canine BAC clone was isolated by screening with heterologous human or murine cDNA probes. The gene-containing BAC clones were physically assigned to the canine genome by FISH and the BAC-derived STS-markers were positioned with the RHDF5000 panel on the canine RH map. The mapping data, which confirm the established conservation of synteny between canine and human chromosomes, provide a resource for further association studies in segregating canine populations and the basis for new insights into this common canine and human disease.

Management of benign rectal strictures: a review of present therapeutic procedures

PURPOSE

A significant benign stricture of the rectum is uncommon but can be a recalcitrant condition to treat. Case reports detailing a particular treatment option abound in the surgical literature. An overall précis of the different techniques available is presented, with a comparison of their relative strengths and weaknesses.

METHODS

A literature search was undertaken from 1963 to the present day, using MEDLINE. Keywords were benign, strictures, and rectum.

RESULTS

Balloon dilation is the most frequent intervention described in the literature. Repeated dilation with time often is required to achieve normal bowel function. Electrocautery resection or incision combined with dilation increases the success rate without increasing the complication rate. Transanal strictureplasty with mechanical staplers is reported as achieving the best success with the smallest complication rate; however, only a minority of strictures are suitable to be managed in this way, and therefore, the numbers treated are small.

CONCLUSIONS

All of the techniques reviewed compared favorably with formal stricture resection in terms of success rate and complications.

Search for lepton flavor violating decays of a heavy neutral particle in p(-)p collisions at sqrt[s]=1.8 TeV

We report on a search for a high mass, narrow width particle that decays directly to emu, etau, or microtau. We use approximately 110 pb(-1) of data collected with the Collider Detector at Fermilab from 1992 to 1995. No evidence of lepton flavor violating decays is found. Limits are set on the production and decay of sneutrinos with R-parity violating interactions.

Preventable in-hospital medical injury under the "no fault" system in New Zealand

OBJECTIVES

To describe the pattern of preventable in-hospital medical injury under the "no fault" system and to assess the level of serious preventable patient harm.

DESIGN

Cross sectional survey using a two stage retrospective assessment of medical records conducted by structured implicit review.

SETTING

General hospitals with over 100 beds providing acute care in New Zealand.

PARTICIPANTS

A sample of 6579 patients admitted in 1998 to 13 hospitals selected by stratified systematic list sample.

MAIN OUTCOME MEASURES

Occurrence, preventability, and impact of adverse events.

RESULTS

Over 5% of admissions were associated with a preventable in-hospital event, of which nearly half had an element of systems failure. The elderly, ethnic minority groups, and particular clinical areas were at higher risk. The chances of a patient experiencing a serious preventable adverse event subsequent to hospital admission were just under 1%, a figure close to published results from comparable studies under tort. On average, these events required an additional 4 weeks in hospital. System related issues of protocol use and development, communication, and organisation, as well as requirements for consultation and education, were pre-eminent.

CONCLUSIONS

The risk of serious preventable in-hospital medical injury for patients in New Zealand, a well established "no fault" jurisdiction, is within the range reported in comparable investigations under tort.

Central pseudorapidity gaps in events with a leading antiproton at the fermilab tevatron pp collider

We report a measurement of the fraction of events with a large pseudorapidity gap deltaeta within the pseudorapidity region available to the proton dissociation products X in p+p-->p+X. For a final state p of fractional momentum loss xi(p) and 4-momentum transfer squared t(p) within 0.06<xi(p)<0.09 and |t(p)|<1.0 [0.2] GeV2 at sqrt[s]=1800 [630] GeV, the fraction of events with deltaeta>3 is found to be 0.246+/-0.001 (stat)+/-0.042 (syst) [0.184+/-0.001 (stat)+/-0.043 (syst)]. Our results are compared with gap fractions measured in minimum bias pp collisions and with theoretical expectations.

Search for the supersymmetric partner of the top quark in dilepton events from pp collisions at square root of s=1.8 TeV

We have searched for pair production of the supersymmetric partner of the top quark (stop) in 107 pb(-1) of pp collisions at square root of s=1.8 TeV collected by the Collider Detector at Fermilab (CDF). Each stop is assumed to decay into a lepton, bottom quark, and supersymmetric neutrino. Such a scenario would give rise to events with two leptons, two hadronic jets, and a substantial imbalance of transverse energy. No evidence of such a stop signal has been found. We exclude stop masses in the region (80</=m(t)</=135 GeV/c(2)) in the mass plane of stop versus sneutrino.

Overexpression of Skp2 in carcinoma of the cervix does not correlate inversely with p27 expression

S-phase kinase associated protein 2 (Skp2) is a member of the F-box family of substrate recognition subunits of SCF-ubiquitin ligase complexes and controls progression from G(1)-S-phase by targeting cell cycle regulators such as p21 and p27. Its locus is at 5p13, a region of frequent amplification in several cancers including carcinoma of the cervix (CaCx). Overexpression of Skp2 has been observed in many cancers of an advanced stage. We examine the expression of Skp2 in 42 invasive CaCx and its correlation with tumour differentiation state and p27 expression. Using immunohistochemistry we found increased nuclear expression of Skp2 in 55% of invasive CaCx cases analysed. It is significant that poorly differentiated tumours invariably exhibit high Skp2 expression (>40% positive nuclei), whereas well-differentiated tumours express Skp2 at a lower level (<20% positive nuclei). Skp2 expression in normal cervical epithelia is <10% (positive nuclei). Increased Skp2 protein levels did not correlate inversely with p27 expression. Our data suggest that Skp2 may contribute to the progression of CaCx, however, unlike non-human papillomavirus (HPV) containing tumours, p27 is unlikely to be the major target protein contributing to malignant progression. The high prevalence of HPV types in CaCx may circumvent the need for Skp2 to eliminate p27.