School students as Drosophila experimenters

Inspired by an undergraduate science project in Drosophila genetics published in PLoS Biology, high school students investigate a model of Alzheimer's Disease.

Treating asthma by the guidelines: developing a medication management information system for use in primary care

The aim of this study was to develop, implement, and assess an automated asthma medication management information system (MMIS) that provides patient-specific evaluative guidance based on 1997 NAEPP clinical consensus guidelines. MMIS was developed and implemented in primary care settings within a pediatric asthma disease management program. MMIS infrastructure featured a centralized database with Internet access. MMIS collects detailed patient asthma medication data, evaluates pharmacotherapy relative to practitioner-reported disease severity, symptom control and model of guideline-recommended severity-appropriate medications and produces a patient-specific "curbside consult" feedback report. A system algorithm translates actual detailed medication data into actual severity-specific medication-class combinations. A table-driven computer program compares actual medication-class combinations to a guideline-based medication-class combinations model. Methodology determines whether the patient was prescribed a "severity-appropriate" amount or an amount "more" or "less" medication than indicated for patient's reported severity. Feedback messages comment on comparison. Missing data, unrecognized amounts of controller medication or unrecognized medication combinations create error cases. Post hoc review analyzed error cases to determine prevalence of non-guideline medicating practices among these practitioners. Proportion of valid and error cases across two clinical visits before and after post hoc clinical review were measured, as well as proportion of severity-appropriate, out-of-severity and non-guideline medications. MMIS produced a valid feedback report for 83% of patient visits. Missing data accounted for 60% of error cases. Practitioners used severity-appropriate medications for 60% of cases. When non-severity-appropriate medications were used they tended to be "too much" rather than "too little" (22%, 5%), suggesting appropriate use of guideline-recommended "step down" therapy by these practitioners.

Increase in interleukin-1beta in late-life depression

OBJECTIVE

Depression has been associated with increases in circulating cytokines in younger adults, and there is evidence for prefrontal inflammation in late-life depression. The authors tested the hypothesis that levels of cytokine interleukin-1beta (IL-1beta) would be higher in subjects with late-life major depression.

METHOD

Serum levels of IL-1beta were measured in three groups of subjects who were older than 60: 19 subjects with major depression, 20 subjects with subsyndromal depression, and 21 healthy comparison subjects. The Montgomery-Asberg Depression Rating Scale and the Geriatric Depression Scale were used to assess severity of depression.

RESULTS

Compared with healthy subjects, those with major depression had significantly higher levels of IL-1beta (170%); the higher levels of IL-1beta strongly correlated with current depression severity. There were no significant differences between subjects with subsyndromal depression and the other two groups.

CONCLUSIONS

These findings support the existence of an inflammatory response, which may be state dependent, in late-life depression.

Characterisation of two triple resistant field isolates of Teladorsagia from Scottish lowland sheep farms

The anthelmintic resistance status of two field isolates derived from farms (farm A and B) located near Edinburgh were examined using both controlled efficacy tests (CET) and faecal egg count reduction tests (FECRT). Efficacies against fenbendazole (FBZ), levamisole (LEV) and ivermectin (IVM) and, for one isolate, against combinations of these anthelmintics and moxidectin were determined in naïve lambs, artificially infected with the isolates and treated with the compounds at the manufacturers recommended dose rates. (FBZ, 5mg/kg bodyweight (BW); LEV, 7.5mg/kg BW; IVM, 0.2mg/kg BW; Moxidectin (MOX) 0.2mg/kg BW). In both field isolates, the predominant species found pre-treatment and the only species found post-treatment was Teladorsagia circumcincta. Resistance to FBZ, LEV and IVM was confirmed in CET and FECRT on farm A and to the latter two compounds on farm B, which had a history of benzimidazole resistance and where TBZ resistance was also demonstrated using an egg hatch assay (EHA). For the farm A isolate CET efficacies against FBZ; IVM; LEV; FBZ + IVM; FBZ + LEV; FBZ, LEV + IVM and MOX were 59, 60, 88, 94,93, 92 and 98%, respectively. The CET efficacies for the farm B isolate were 51% and 72% for LEV and IVM, respectively.

5-HT receptors involved in opioid-activated descending inhibition of spinal withdrawal reflexes in the decerebrated rabbit

The role of 5-HT(1B/1D), 5-HT(2) and 5-HT(3) receptors in mediating descending inhibition of spinal reflexes activated by application of fentanyl to the fourth ventricle has been studied in rabbits decerebrated under N(2)O/isoflurane anaesthesia. In the control state, intraventricular fentanyl (3-30 microg kg(-1)) depressed, to an equal extent, short- and long-latency reflexes in the medial gastrocnemius muscle nerve evoked by electrical stimulation of all sural nerve afferents. Inhibition of reflexes resulted from a decreased base line excitability in the reflex pathway accompanied by a reduction in the rate of temporal summation of responses. Fentanyl-induced suppression of short- and long-latency reflexes was significantly reduced after intrathecal administration of the selective 5-HT(2)-receptor antagonist ICI 170,809 (300 microg). The same dose of the selective 5-HT(1B/1D) blocker GR 127,935 reduced inhibition from intraventricular fentanyl only for long-latency reflexes (i.e. those parts of the response for which the afferent drive is provided mainly by Adelta and C-fibre afferents). The 5-HT(3) antagonist tropisetron (also 300 microg intrathecal) did not significantly alter the descending inhibition of reflexes evoked by fentanyl. Both GR 127,935 and tropisetron reduced temporal summation of reflexes per se, effects that were reversed by intraventricular fentanyl. These data suggest that the descending pathway(s) activated by intraventricular fentanyl liberate 5-HT in the spinal cord to inhibit withdrawal reflexes by acting at 5-HT(2) and 5-HT(1B/1D), but not 5-HT(3) receptors. 5-HT(1B/1D), and to a lesser extent 5-HT(3) receptors also appear to have a role in modulating temporal summation of reflexes evoked by repetitive stimuli.

A survey of anthelmintic resistant nematode parasites in Scottish sheep flocks

The state of anthelmintic resistance in Scottish sheep flocks was evaluated during April-August 2000 using in vitro bioassays, egg hatch assays for detecting thiabendazole (TBZ) resistance and larval development assays for levamisole, ivermectin and TBZ resistance. Anaerobic sampling kits and detailed questionnaires outlining farm demographics and current management practices were mailed to 227 Moredun Foundation member farms, replies were received from 98 farms. Kits received from 90 farms contained sufficient material to conduct one or more of the assays. A majority of the farms examined (64%) exhibited TBZ resistance but there were both farm locality and regional variations in the percentage of resistant farms. Teladorsagia was the predominant genera detected from farms. No resistance to levamisole or ivermectin was detected in any of the samples. There was no strong evidence from this survey that any of the management practices examined greatly affected TBZ resistance.

Sex differences in survival after acute myocardial infarction in patients with diabetes mellitus (Worcester Heart Attack Study)

BACKGROUND

Women with diabetes mellitus are at particularly high risk for coronary heart disease-related morbidity and mortality compared with men with diabetes mellitus. However, recent data comparing hospital and long-term outcomes in women with diabetes mellitus and men hospitalized with acute myocardial infarction (AMI) are scarce. The objectives of our multi-hospital observational study were to examine sex differences and temporal trends (1975-99) in hospital and long-term case-fatality rates (CFRs) in patients with diabetes mellitus and AMI from a population-based perspective.

METHODS

A community-wide study of residents of the Worcester, Mass, metropolitan area who were hospitalized with confirmed AMI was conducted. Data were collected in 12 1-year periods between 1975 and 1999. The study sample consisted of 1354 men and 1280 women with diabetes mellitus.

RESULTS

Overall hospital CFRs were significantly greater for women with diabetes mellitus (21.3%) than for men with diabetes mellitus (14.9%). Between 1975 and 1999, hospital CFRs declined from 39.2% to 17.5% for women and from 18.9% to 9.5% in men. In examining long-term survival patterns for as long as 10 years after hospital discharge, there were no significant sex differences in long-term survival rates after adjustment for a limited number of known potentially confounding factors.

CONCLUSIONS

Hospital death rates after AMI in men and women with diabetes mellitus have declined in the last 2 decades. The gap in hospital CFRs between men and women with diabetes mellitus has decreased considerably with time, although women have a higher risk of dying after AMI than men. Patients with diabetes mellitus continue to represent a high-risk group who will benefit from enhanced surveillance efforts and increased use of effective cardiac treatments.

A comparison of larval development and mucosal mast cell responses in worm-naïve goat yearlings, kids and lambs undergoing primary and secondary challenge with Teladorsagia circumcincta

Larval development, mucosal mast cell (MMC) and eosinophil responses in worm-nai;ve lambs, yearling goats and goat kids were compared using two different experimental challenge regimes involving oral administration of infective Teladorsagia circumcincta L(3). Experimental challenge regimes enabled primary and secondary immune responses in the two species to be compared. Goats carried higher worm burdens than lambs and there were significant differences in the stages of development attained by the larval challenge that established in the two species. Possible physiological reasons for these differences are discussed. There were also differences in the establishment and development of larvae in individual yearlings which may indicate the development of a weak age-related immune response. Quantitative analysis of MMC and globule leukocyte (GL) recruitment and functional activity in the form of mast cell-specific proteinase (MCP) production demonstrated differences between the species with goat tissues containing significantly higher numbers of GL and lower concentrations of MCP than the lambs. Quantitative analysis of blood and tissue eosinophil responses failed to demonstrate any significant differences in either species under the two challenge regimes.

Cytomegalovirus infection and thrombosis: a causative association?

Venous thrombosis is a well-organised complication of hospitalisation and has often been reported in the context of HIV infection. Less frequently cytomegalovirus (CMV) has been implicated in the development of thrombosis, although usually in the context of immunosuppression. We report the case of a young, immunocompetent individual who developed pulmonary emboli as a complication of CMV infection and describe the three proposed mechanisms by which this is thought to occur. The probable mechanism in our patient is discussed.

Aging memory self-efficacy: elders share their thoughts and experience

Twenty-six elders responded to an open-ended question as part of a study that examined the relationships among depression, health, memory self-efficacy, and metamemory. Participants rated their overall memory function as fair to average (M = 4.26, standard deviation [SD] = 1.29). The average memory efficacy scores were high (M = 51.35, SD = 23.56). The final question invited participants to share any additional information they thought might be important to this item. This article represents a content analysis of these comments. The mean age of responders was 68.78; all had high perceived health and no depression. No differences on memory self-efficacy arose among age groups. Themes included memory management, rationalization, reflection, information seeking, and correlation establishment. Therefore, it is important for clinicians to ask elders about memory function during routine health care encounters, as individuals are interested in memory assessment and management.

An overview of chronic fatigue syndrome

This article provides an overview of the condition known as chronic fatigue syndrome, or myalgic encephalomyelitis. The author describes common symptoms and their treatment, and discusses a model of patient care, piloted in the community, which includes elements of a range of therapeutic strategies.

How much do doctors know about consent and capacity?

To assess knowledge of capacity issues across different medical specialties we conducted a cross-sectional survey with a structured questionnaire at academic meetings, lectures and conferences. Of 190 individuals who received the questionnaire 129 (68%) responded-35 general practitioners, 31 psychiatrists, 29 old-age physicians [corrected] and 34 final year medical students. Correct answers on capacity to consent to or refuse medical treatment were given by 58% of the psychiatrists, 34% of the geriatricians, 20% of the general practitioners and 15% of the students. 15% of all respondents wrongly believed that a competent adult could lawfully be treated against his or her will, with no obvious differences by specialty. As judged by this survey, issues of capacity and consent deserve more attention in both undergraduate and postgraduate medical education.

The use of surgical facemasks during cataract surgery: is it necessary?

AIM

To assess whether facemask utilisation by the surgeon during cataract surgery has any effect on the bacterial load falling onto the operative site.

METHOD

Prospective randomised masked study. Consent was obtained from 221 patients. Cases were randomised to wearing a new mask or not wearing any mask throughout the procedure. Blood agar settle plates were placed adjacent to the patient's head in the operative field. Duration of procedure was noted. Plates were incubated and read at 48 hours. Colony forming bacteria were counted and identified.

RESULTS

There were significantly fewer organisms cultured when the surgeon used a facemask (p=0.0006). The majority of organisms were Staphylococcus epidermidis, Bacillus spp, and Diphtheroid spp; however Staphylococcus aureus and Pseudomonas aeruginosa were cultured on several occasions. There were no cases of infective complication.

CONCLUSIONS

The main purpose of an operating mask is to prevent bacteria falling on to the operative site from the surgeon's oropharynx or nasopharynx with the concomitant theoretical risk of infective complication. Operating masks were shown to have a significant effect on the volume of bacterial organisms falling to the operative site; however, whether this is clinically significant is unknown.