Molecularly imprinted polymers for the determination of a pharmaceutical development compound in plasma using 96-well MISPE technology

The use of molecularly imprinted polymers (MIPs) as sorbents for the solid phase extraction (SPE) of a pharmaceutical compound in development, prior to quantitative analysis was investigated. Three MIPs were synthesised using a structural analogue as the template molecule. Each polymer was prepared with different monomers and porogens. The MIPs were then tested for their performance both in organic and aqueous environments, the final aim being to load plasma directly onto the polymers. At an early development stage, there is a limited amount of compound available. Due to this limitation, reducing the amount of template required for imprinting was investigated. A MIP capable of extracting the analyte directly from plasma was produced. The specificity of the polymer allowed the method to be validated at a lower sensitivity than a more conventional SPE assay. For the first time, MIPs were packed into 96-well blocks enabling high throughput analysis. The analytical method was fully validated for imprecision and inaccuracy down to 4 ng/ml in plasma.

Diagnosis of manic episodes in adolescent inpatients: structured diagnostic procedures compared to clinical chart diagnoses

This study examined the accuracy of clinical chart diagnoses of manic episodes in adolescent psychiatric patients, as well as treatment selection and patient outcome. A consecutive sample of 120 consenting adolescent patients was assessed at admission, discharge, and 30 and 120 days post-discharge. Clinical chart diagnoses were compared to research-quality diagnoses involving structured interview, chart review, and consensus. Agreement statistics were computed, and the symptom and treatment differences were compared between patients for whom there was and was not diagnostic agreement. Clinical diagnoses of manic episodes were more common than research diagnoses, and the rate of agreement between diagnoses was low (kappa = 0.15). Patients diagnosed as experiencing a manic episode by the clinical chart, but not via the research procedure, had reduced severity scores on elation and activity, and higher scores on depression. These patients also had more severe scores on depressive symptoms at follow-up. Manic episodes were diagnosed more frequently by clinicians relative to research-quality procedures. Patients who were diagnosed as experiencing manic episodes by the clinician, but not the research procedure, appeared to have depression and hostility, but not elation. The depression in these patients may not be adequately treated, and there are potential clinical implications of over-diagnosis of manic episodes in adolescents.

Distribution of glucocorticoid and mineralocorticoid receptors and 11beta-hydroxysteroid dehydrogenases in human and rat ocular tissues

PURPOSE

The administration of glucocorticoids as topical or systemic medications may lead to the development of ocular hypertension through the induction of morphologic and biochemical changes in the trabecular meshwork leading to a reduction in the facility of aqueous outflow. Glucocorticoids exert their physiological effects by binding to and activating glucocorticoid and mineralocorticoid receptors. The activity of glucocorticoids is critically regulated at a prereceptor level by the two isozymes of 11beta-hydroxysteroid dehydrogenase. The purpose of this study was to determine the distribution of glucocorticoid target receptors and the isozymes of 11beta-hydroxysteroid dehydrogenase (11 beta-HSD) that regulate the activity of glucocorticoids at a prereceptor level in human and rat ocular tissues.

METHODS

Horizontal sections of normal adult human and rat eyes were cut and hybridized with 35S-labeled cRNA probes specific for the glucocorticoid receptor, mineralocorticoid receptor, and 11beta-HSD types 1 and 2 using in situ hybridization. Immunohistochemical analysis of glucocorticoid and mineralocorticoid receptors using monoclonal antibodies was carried out on rat eye tissue sections. Whole rat eyes were homogenized and the activity of 11beta-HSD types 1 and 2 in the eye assessed as the percentage conversion of tritiated corticosterone to tritiated 11-dehydrocortico-sterone when corticosterone was added to the homogenate.

RESULTS

In the rat ocular tissues mRNAs encoding glucocorticoid receptor, mineralocorticoid receptor, and 11beta-HSD types 1 and 2 were detected in nonpigmented ciliary epithelium, trabecular meshwork, corneal epithelium and endothelium, and anterior lens epithelium. Immunohistochemistry confirmed the presence of glucocorticoid and mineralocorticoid receptors at these sites. Activity of both isozymes of 11beta-HSD was demonstrated in homogenized rat eyes (percentage conversion of tritiated corticosterone to 11-dehydrocorticosterone; mean +/- SD, 11beta-HSD 1 = 15% +/- 5.3%, 11beta-HSD 2 = 7.9% +/- 2.8%). In both human and rat eyes, expression of mRNAs encoding glucocorticoid receptor and 11beta-HSD type 1 was high in the trabecular meshwork and lens epithelium, whereas expression of mRNAs encoding the mineralocorticoid receptor and 11beta-HSD type 2 was high in nonpigmented ciliary epithelium and corneal epithelium and endothelium.

CONCLUSIONS

Glucocorticoid target receptors and the enzymes regulating glucocorticoid activity at these receptors are present in mammalian ocular tissues, which regulate aqueous humor formation and outflow. Alteration in the number or affinity of receptors or in the activity of regulatory enzymes may alter the susceptibility of certain individuals to the effects of glucocorticoids on intraocular pressure.

The manifestation and nursing management of agitation in institutionalised residents with dementia

This participatory action research study is the first formal research study undertaken by nurses in a nursing development unit. The study emerged as the result of nurses brainstorming issues that they perceived to be problematic in their nursing practice and their unit environment. The nurses of the psycho-geriatric nursing development unit, Wallsend Aged Care Facility, New South Wales, Australia identified that the management of agitated behaviour manifested by their severely demented clients was a major challenge in their practice. As a result, a pilot participatory action research study was designed to measure how agitation manifested, to measure the severity of agitation and to identify current nursing practices used to manage it and their outcome. Results of the study demonstrated that nurse actions triggered the majority of most highly rated episodes of agitated behaviour in this group of elderly residents, and that the majority of these nurse actions related to those involved in carrying out activities of daily living for the residents.

Monograph series on aging-related diseases: XII. Parkinson's disease--recent developments and new directions

Parkinson's disease, a chronic progressive disorder of the central nervous system characterized by tremor, rigidity and bradykinesia, usually affects those over the age of 50. Recent developments in research on Parkinson's disease include investigation of the possible role of diet and a growing interest in genetics and inherited factors. The identification of biological markers and other environmental risk factors will play a significant role in future research of the disease as they will be important in the development of prevention strategies.

Monograph series on aging-related diseases: XI. Glaucoma

In Canada, glaucoma is the second leading cause of blindness in people aged 50 and over, with primary open-angle glaucoma (POAG) accounting for 90% of all cases. Prevalence of POAG increases with age, and the condition is found more commonly among blacks than whites. Elevated intraocular pressure is an important risk factor for the disease; however, its positive predictive value for the presence of disease is poor. Prevalence of primary angle-closure glaucoma also increases with age, occurs more frequently among the Inuit and Asians, and has been reported to be more common among women. There are various diagnostic methods used to determine the presence or absence of glaucoma, but none can effectively identify the disease in its early stages unless routine screening is conducted. Current treatment of glaucoma is aimed at lowering intraocular pressure, which usually, but not always, stops disease progression.

Euthanasia and doctor-assisted suicide: responses by oncologists and non-oncologists

PURPOSE

Public interest concerning euthanasia and doctor-assisted suicide is creating ethical dilemmas in the health care profession. We surveyed the views of oncologists and non-oncologists in Florida.

METHODS

Physicians responded to an attitudinal questionnaire. The data collected were compared with standard statistical methods.

RESULTS

Both oncologists and non-oncologists had similar opposition to euthanasia on philosophic or general grounds, with more opposition on general grounds expressed by oncologists. Both groups preferred better pain control and improved quality of life rather than euthanasia, but more oncologists than non-oncologists favored this alternative. Both groups admitted to participation in passive euthanasia, with little support for active euthanasia and doctor-assisted suicide. However, should the acts of euthanasia and doctor-assisted suicide become legalized, more non-oncologists than oncologists would agree to participate.

CONCLUSION

In Florida, more opposition to aspects of the termination of life was expressed by oncologists than by non-oncologists.

Monograph series on aging-related diseases: X. Prostate cancer

Prostate cancer is the most commonly diagnosed cancer among Canadian men, excluding non-melanoma skin cancer. Prostate cancer incidence increases almost exponentially with age; most cases are diagnosed in men aged 65 years or older. With the possible exception of animal fat consumption, no known widespread modifiable risk factors have been identified. Although the prognosis is good if appropriate treatment occurs in the early stages of disease, the ability of existing early detection techniques to decrease mortality has not yet been demonstrated. The considerable economic and societal burden of prostate cancer and its treatment, coupled with the projected large increase in the number of new prostate cancer cases as the population ages, make this disease a very important public health issue.

The challenge of evaluating a child bereavement programme

This paper will discuss the challenge of evaluating the efficacy of child bereavement services. Such services are being developed and it is essential that expansion is based on research and evaluation. A literature review details the limited research which has so far been conducted on such interventions. The paper then addresses four key components regarding child bereavement programme evaluation: preliminary evaluation of the Winston's Wish programme; the feasibility and validity of using an experimental method in the evaluation of child bereavement services; the identification of appropriate measures-what are we really attempting to measure with regard to child bereavement interventions; and the importance of measuring the family dynamics of grief-how can we incorporate the Dual Process Model?

A case-controlled study of the sexual health needs of lesbians

OBJECTIVES

To evaluate and compare the range of genital infections diagnosed in a group of lesbians attending an inner city genitourinary clinic with a control group of heterosexual women attending the same clinic.

SETTING

The Ambrose King Centre, the Royal London Hospital, a genitourinary clinic within which the Audre Lorde Clinic, a specialist sexual health clinic for women identifying as lesbians, is operated.

SUBJECTS

Two hundred and forty one women attending the specialist clinic between October 1993 and September 1994. Heterosexual controls matched for age and ethnicity were selected from the same time period.

METHODS

A retrospective case note analysis was made of 241 lesbians and 241 matched heterosexual controls. Data were collected on age, ethnicity, symptoms, diagnoses and services used.

RESULTS

An infection was diagnosed in 129 (65%) of the lesbians and 126 (62%) of the heterosexual women. Only 23 (10%) of the lesbians exclusively practised same gender sexual contact. Genital herpes (p = 0.05) and genital warts (p = 0.005) were more common in the heterosexual women. Gonorrhoea and chlamydia infection were infrequent diagnoses in both groups, occurring in four (2%) lesbians and 14 (7%) heterosexuals (p = 0.05). Bacterial vaginosis occurred in 65 (33%) of the lesbians and 27 (13%) of the heterosexuals (p < 0.0001). Cervical cytology abnormalities were uncommon but only found in the lesbians.

CONCLUSIONS

Screening for genital infections in lesbians is appropriate. The high prevalence of bacterial vaginosis in this group is unexplained but suggests a possible sexual transmission. Lesbians should be included within the cervical cytology screening programme.

Major causes of death and hospitalization in Canadian seniors

Since Canadian seniors are living longer, their proportion of the general population is getting increasingly larger. This paper focuses on presenting the leading causes of death and hospitalization in seniors (aged 65 and over), examining interprovincial differences and comparing trends from one decade to another. Although both mortality and hospitalization rates for coronary heart disease were found to be stable or falling during the past couple of decades, it remains the leading cause of death and hospitalization for both sexes. Lung cancer; stroke; chronic bronchitis, emphysema and asthma; pneumonia; and accidental falls are some of the other major causes of death and/or hospitalization in seniors.

Use of knee braces in sport. Current recommendations

This article provides a review of the progress that has been made on the biomechanical, functional performance and epidemiological investigations into the effectiveness of prophylactic knee braces (PKBs) since the position statement against their use was issued in 1987 by the American Academy of Orthopaedics and a review of this subject was last published in Sports Medicine in 1989 by Montgomery and Korziris. The evolution of the salient design features of three surrogate knee models are reviewed along with the results of PKB effectiveness and safety factor testing. While still too limited in scope to be totally realistic, major advances have been made in the sophistication of the present biomechanics laboratory testing conditions. The on-the-field functional performance effects of wearing a knee brace are not always manifest in all individuals. The efficacy of PKBs remains in question but recent studies have taught us enough to put their use into perspective. While they may play some role, PKBs probably represent the least important factor in influencing the likelihood that a medial collateral ligament (MCL) sprain will occur. On the other hand, there is no evidence that such braces put added valgus pressure on some knees, or that wearing a brace is associated with an increased frequency or severity of knee or ankle injury. All else being equal, from the biomechanical studies, we know that whilst some braces are better than others, currently available PKBs can provide 20 to 30% greater resistance to a lateral blow, with the possibility that the anterior cruciate ligament (ACL) is given even greater protection than the MCL. This appears to be true when the lateral blow is of sufficient magnitude to cause significant medial joint line opening, but is not as great at the very lowest levels of impact. Regardless of the material they are made of, the most effective PKBs are those sufficiently stiff to prevent an external blow at the joint line from causing brace hinge contact with the knee tissues. Based on the superior results of the custom-fit functional braces, the most important future design feature appears to be the sizing and fitting of the thigh and tibial cuffs. On the negative side, the presence of a brace may slow an athlete's straight-ahead sprint speed and cause early fatigue to its wearer. This effect appears to vary from one brace to another according to its weight, design features, and pressure from the leg and thigh straps. However, it appears that knee braces do have the potential to restrict performance of the athlete for high-speed running but the effect is related to several factors. The weight of the brace resultant friction of the hinges, completeness of fit, and tightness of straps appear to be important. The most measurable effects include: increased muscular relaxation pressures; increased energy expenditure; and a related increase in blood lactate levels, maximal torque output, oxygen consumption and heart rate. On the other hand, experienced brace wearers and larger, stronger individuals displayed fewer, or no effects of donning a brace. Improvements in the protectiveness of the PKB are likely to accompany improvements in the ability to contour the braces to fit each individual's leg in the equipment room without the added expense of the cast-moulding process. Further improvement may be realised by friction-free polycentric joints, as well as an attachment system that minimises thigh and calf soft tissue compression perhaps by incorporating the braces into the trousers of the uniform to provide suspension from the waist.

Predictors of smoking cessation: the Framingham Study

The relation of demographic, behavioral, and health-related variables to smoking cessation was studied in 1,178 women and 1,506 men cigarette smokers enrolled in the Framingham Heart Study. Smoking cessation was defined as abstinence from all tobacco products for at least 1 year. Proportional hazard models were used to identify baseline variables associated with long-term cessation. In order to identify factors predictive of cessation in the following 2 years, logistic regression models on person-examination data were used. Recent hospitalization and development of coronary heart disease were predictive of smoking cessation, while diagnosis of cancer or changes in pulmonary function were not. Overall, women were as likely to quit as men; however, women who smoked heavily were the least likely to quit. Secular trends were noted in men only; men were more likely to quit after the release of the 1964 Surgeon General's report on smoking. The relation of illness development and sex to smoking cessation should be considered in developing smoking cessation programs.

Psychometric vs. attentional correlates of early onset alcohol and substance abuse

Adolescent inpatients with a diagnosis of alcohol abuse (n = 28), nonalcohol substance abuse disorders (n = 15), or psychiatric disorders without substance abuse (n = 46) were examined on measures of attentional, intellectual, and personality functioning. High scores on a personality measure, the Substance Abuse Proclivity Scale (SAP), was the best predictor of substance abuse in general. Alcohol abusers were differentiated from other substance abusers by their increased impairment on the Continuous Performance Test. Adolescents with alcohol abuse did not manifest the types of cognitive impairments associated with chronic alcoholism. These data suggest that certain attentional impairments may be associated with early onset alcohol abuse and that earlier conceptions of the role of attentional impairments in risk prediction for alcohol abuse are supported.

Variability of body weight and health outcomes in the Framingham population

BACKGROUND

Fluctuation in body weight is a common phenomenon, due in part to the high prevalence of dieting. In this study we examined the associations between variability in body weight and health end points in subjects participating in the Framingham Heart Study, which involves follow-up examinations every two years after entry.

METHODS

The degree of variability of body weight was expressed as the coefficient of variation of each subject's measured body-mass-index values at the first eight biennial examinations during the study and on their recalled weight at 25 years of age. Using the 32-year follow-up data, we analyzed total mortality, mortality from coronary heart disease, and morbidity due to coronary heart disease and cancer in relation to intraindividual variation in body weight, including only end points that occurred after the 10th biennial examination. We used age-adjusted proportional-hazards regression for the data analysis.

RESULTS

Subjects with highly variable body weights had increased total mortality (P = 0.005 for men, P = 0.01 for women), mortality from coronary heart disease (P = 0.009 for men, P = 0.009 for women), and morbidity due to coronary heart disease (P = 0.0009 for men, P = 0.006 for women). Using a multivariate analysis that also controlled for obesity, trends in weight over time, and five indicators of cardiovascular risk, we found that the positive associations between fluctuations in body weight and end points related to mortality and coronary heart disease could not be attributed to these potential confounding factors. The relative risks of these end points in subjects whose weight varied substantially, as compared with those whose weight was relatively stable, ranged from 1.27 to 1.93.

CONCLUSIONS

Fluctuations in body weight may have negative health consequences, independent of obesity and the trend of body weight over time.

Dietary lipid predictors of coronary heart disease in men. The Framingham Study

The relationship between dietary lipids and the 16-year incidence of coronary heart disease (CHD) morbidity and mortality was examined in two male cohorts, aged 45 to 55 years (n = 420) and 56 to 65 years (n = 393) from the Framingham Study. Dietary lipids were assessed through a single 24-hour recall at the initiation of follow-up in 1966 to 1969. In the younger cohort, there were significant positive associations between the incidence of CHD and the proportion of dietary energy intake from total fat and monounsaturated fatty acids. The proportion of energy intake from saturated fatty acids had a marginally significant positive association with CHD. The associations remained even after adjustment for cardiovascular disease risk factors, including serum cholesterol level, suggesting that their effects are at least partially independent of other established risk factors. In contrast to the younger cohort, none of the dietary lipids were associated with CHD in the older cohort. Dietary intervention for the prevention of CHD in younger men is supported by these findings.