Longitudinal weight gain of immunized infants and toddlers in Moroto District, Uganda (Karamoja subregion)

This study examines longitudinal weight gain of a sample of 123 immunized children from Moroto District, northeast Uganda. The weight data were combined from two sources: (1) anthropometric examinations carried out between 1998 and 2004 by a research team from the University of Kansas, and (2) weights recorded on children's immunization records by local health care practitioners. Our findings conform generally to the pattern described in previous studies in this as well as other pastoralist populations in sub-Sahara. Relative to international standards, the weight-for-age status of Karimojong children was best during the first 3 months of infancy. Noticeable declines in weight velocity occurred in the fourth month and after the sixth month. Weight gain was static after the second year, when upward of 40% of children were clinically underweight. Factors influencing weight gain in this sample include immunization status and maternal height, weight, and parity, but these effects explain relatively little of the variance in weight gain. We conclude that immunization is not sufficient to buffer Karimojong children from multiple stressors during teething and weaning. Of these, the practice of canine follicle extraction (CFE) is of most interest, although its effects in this study are ambiguous. The data also are suggestive of variability in the pattern of weight gain between closely spaced birth cohorts. This finding may be of particular importance for the interpretation of growth patterns described for other pastoralist populations in sub-Saharan Africa.

A comparison of protein extraction methods suitable for gel-based proteomic studies of aphid proteins

Protein extraction methods can vary widely in reproducibility and in representation of the total proteome, yet there are limited data comparing protein isolation methods. The methodical comparison of protein isolation methods is the first critical step for proteomic studies. To address this, we compared three methods for isolation, purification, and solubilization of insect proteins. The aphid Schizaphis graminum, an agricultural pest, was the source of insect tissue. Proteins were extracted using TCA in acetone (TCA-acetone), phenol, or multi-detergents in a chaotrope solution. Extracted proteins were solubilized in a multiple chaotrope solution and examined using 1-D and 2-D electrophoresis and compared directly using 2-D Difference Gel Electrophoresis (2-D DIGE). Mass spectrometry was used to identify proteins from each extraction type. We were unable to ascribe the differences in the proteins extracted to particular physical characteristics, cell location, or biological function. The TCA-acetone extraction yielded the greatest amount of protein from aphid tissues. Each extraction method isolated a unique subset of the aphid proteome. The TCA-acetone method was explored further for its quantitative reliability using 2-D DIGE. Principal component analysis showed that little of the variation in the data was a result of technical issues, thus demonstrating that the TCA-acetone extraction is a reliable method for preparing aphid proteins for a quantitative proteomics experiment. These data suggest that although the TCA-acetone method is a suitable method for quantitative aphid proteomics, a combination of extraction approaches is recommended for increasing proteome coverage when using gel-based separation techniques.

The impact of telemedicine in cancer care

e20508

Background: The Technology Exchange for Cancer Health Network is a collaborative, multi-state effort using Telemedicine and integrated electronic health records to provide rural cancer care management. Methods: The purpose of the study was to compare quality, safety, and cost outcomes for patients receiving rural Telehealth care versus “routine” urban care. Patients with a cancer diagnosis requiring treatment for at least 1 year were eligible for the study. Telehealth patients saw their oncologist in person at rural sites for initial care and via telemedicine for about half of subsequent visits, allowing clinicians in-person clinical assessments while still taking advantage of time savings associated with telemedicine. Results: 217 patients (134 rural, 83 urban) were enrolled from 05/25/05 to 09/30/08. Patient satisfaction was high; 95 % of patients indicated their telemedicine visit was as good as or better than an in-person visit. Telemedicine patients also reported significant time and travel cost savings. Cost analysis comparing cost savings (physician travel time) with telemedicine costs (equipment, high speed lines) indicated that cost-benefit is driven by distance to rural facility and number of physician trips avoided. Telemedicine must save at least 5 hours of physician travel time per month to break even. Telemedicine was also associated with improvements in access to care. Using patient self-reported health care visit data (verified with local providers), we identified a significant decline in disparities between urban and rural patients (see Table ). Conclusions: Telemedicine offers a promising method for increasing access to oncology care that is convenient for and well-accepted by patients at reasonable costs. Our results also suggest that telemedicine facilitates access to more than just oncology care. The regular follow-up care provided through telemedicine visits may identify unmet need that might otherwise go untreated, yielding improvements in patient outcomes.

[Table: see text]

No significant financial relationships to disclose.

Cellular characterisation of magnetic resonance imaging bone oedema in rheumatoid arthritis; implications for pathogenesis of erosive disease

Objectives:

Magnetic resonance imaging (MRI) bone oedema is an important predictor of bone erosion in rheumatoid arthritis (RA). This study aimed to determine the cellular components of MRI bone oedema, and clarify the relationship between bone erosion and MRI bone oedema.

Methods:

Twenty-eight bones from 11 patients with RA undergoing orthopaedic surgery were analysed by quantitative and semi-quantitative immunohistochemistry. Pre-operative contrast-enhanced MRI scans were analysed for bone oedema.

Results:

The density of osteoclasts was higher in those samples with MRI bone oedema than those without MRI bone oedema (p = 0.01). Other cells identified within bone marrow included macrophages and plasma cells, and these were more numerous in samples with MRI bone oedema (p = 0.02 and 0.05 respectively). B cells were present in lower numbers, but B cell aggregates were identified in some samples with MRI bone oedema. There was a trend to increased RANKL expression in samples with MRI bone oedema (p = 0.09). Expression of RANKL correlated with the number of osteoclasts (r = 0.592, p = 0.004).

Conclusions:

The increased number of osteoclasts and RANKL expression in samples with MRI bone oedema supports the hypothesis that bone erosion in RA occurs through activation of local bone resorption mechanisms within subchondral bone as well as through synovial invasion into bone.

Technology exchange for cancer health network

19598

Background: The Technology Exchange for Cancer Health Network (TECH-Net) is a collaborative, multi-state effort to implement a systematic care program to improve cancer management in the rural communities of west Tennessee, north Mississippi and east Arkansas. This Health Information Technology (HIT) project uses a two-pronged approach to total clinical decision support: (1) provide access to oncology, hematology, and other specialists through the dedicated telehealth network of the University of Tennessee's Health Science Center in conjunction with the University of Tennessee Cancer Institute; and (2) rely on a distributed electronic health record (EHR) with integrated decision support systems for online management of cancer protocols, electronic orders, and medication management. Methods: Patients with a cancer diagnosis requiring treatment for at least one year are eligible to participate. The ultimate goal for this project is to enroll 250 patients (125 rural, 125 urban) and compare quality, safety, and cost outcomes for patients receiving rural Telehealth care versus “routine” urban care. Telehealth patients see their oncologist in person at the rural sites for initial care, and see their physician via telemedicine for approximately one-half of their subsequent visits. This approach allows the clinician to make in-person clinical assessments on a regular basis while still taking advantage of the time savings associated with telemedicine. Results: 163 patients have been enrolled in the study (127 rural, 36 urban) over 18 months. Patient satisfaction has been high - 95 % of patients indicated their telemedicine visit was as good as or better than an in-person office visit. Cost analysis comparing cost savings (physician travel time) with telemedicine costs (equipment, high speed lines) indicates that the cost-benefit depends critically on distance to the rural facility and number of physician trips avoided. Initial cost data indicate that telemedicine must save at least 5 hours of physician travel time per month to break even. Conclusions: Telemedicine offers a feasible method for increasing access to oncology care in rural areas that is well-accepted by both patients and clinicians.

No significant financial relationships to disclose.