Impact of approval of home use of misoprostol in England on access to medical abortion: An interrupted time series analysis

OBJECTIVE

In 2018, the Department of Health and Social Care in England approved the use of misoprostol at home for early medical abortions, following administration of mifepristone at clinic. The objective of the present study was to assess the impact of the approval of home administration of misoprostol in England on access to medical abortion, assessed through proxy measures of the proportion of all abortions that were medical and gestational age.

METHODS

This study uses the clinical data from the British Pregnancy Advisory Service on abortions in England in years 2018-2019, containing demographic and procedure characteristics of patients. We conducted an interrupted time series analysis to establish the differences before and after the approval in access to medical abortion, measured by the proportion of all abortions that were medical, and gestational age. The analysis also examined whether these changes were equitable, with focus on area-level deprivation.

RESULTS

The analysis of the data (145 529 abortions) suggested that there was an increase in the proportion of medical abortions and decrease in gestational age of abortions after the approval. Compared with the situation if former trends had continued, the actual proportion of early medical abortions was 4.2% higher in December 2019, and the mean gestational age 3.4 days lower. We found that the acceleration of existing trends in increase in proportion of medical abortions and decrease in gestational age were larger in the most deprived quintiles and in those reporting a disability, but not equal across ethnic groups, with Black and Black British women experiencing little change in trajectories post-approval.

CONCLUSION

The approval of home use of misoprostol as part of an early medical abortion regimen in England was associated with material and equitable improvements in abortion access. Pre-approval trends toward greater uptake of medical abortion and declining gestational age were accelerated post-approval and were greatest in the most deprived areas of England, but not across all racial/ethnic groups. The present findings strongly support the continuation or introduction of home management of medical abortions.

Establishing the health and wellbeing needs of mining host community in Brazil, Chile and Peru: a mixed-method approach to identify priority areas for action to help communities meet their SDG3 targets

BACKGROUND

The global mining industry is an important partner in advancing the 2030 Agenda for Sustainable Development. In 2018, Anglo American plc published their Sustainable Mining Plan, containing a goal for improving health and wellbeing aligned with the Sustainable Development Goal 3 (SDG3) targets. Having formed an independent multidisciplinary research consortium, we designed and implemented a mixed-methods approach to attain a deeper understanding of SDG3 priorities within the local context of communities hosting Anglo American mining operations located in Latin America.

METHODS

In 2019, within the host communities of three mining operations in Chile, three in Brazil, and one in Peru, we conducted a qualitative study which included stakeholder workshops and key informant interviews. We also quantitatively appraised existing health data. Findings emerging from the qualitative and quantitative assessments were compared to identify health and wellbeing priority areas for action relevant to each community.

RESULTS

Across the three countries, 120 people took part in workshops and 35 in interviews. In these workshops and interviews, non-communicable diseases (SDG3.4), harmful alcohol consumption (SDG3.5), and pollution, particularly air pollution (SDG3.9), were consistently identified as areas for priority action. There were similarities in the reporting of individual, interpersonal, community, societal, and structural factors underlying these priority areas across the different communities. The availability of quantitative data was generally good at the state level, becoming increasing sparse as we focused on smaller geographies. The priorities identified in the quantitative assessments generally aligned with those highlighted in the qualitative data.

CONCLUSIONS

We highlight the importance of engaging with local populations to understand and address health needs. To address the priorities identified, intervention packages tailored to the specific needs of host communities, that tackle associated upstream societal level factors, are required. To facilitate this, appropriate monitoring systems and epidemiological investigations should be implemented to better understand the local context and quantify health issues. In the host communities, it is essential for the mining sector to be a key health partner in promoting integrated programmes that contribute to achieving the priority objectives and targets aligned with the SDG3 agenda.

The social determinants of national tuberculosis incidence rates in 116 countries: a longitudinal ecological study between 2005-2015

BACKGROUND

Accelerating declines in tuberculosis (TB) incidence is paramount for achieving global goals set for 2030 by the Sustainable Development Goals and the End TB Strategy. The aim of this study was to identify key country-level social determinants of national TB incidence trends.

METHODS

This longitudinal ecological study used country-level data extracted from online databases from the period 2005-2015. We used multivariable Poisson regression models allowing for distinct within- and between-country effects to estimate associations between national TB incidence rates and 13 social determinants of health. The analysis was stratified by country income status.

RESULTS

The study sample included 48 low- and lower-middle-income countries (LLMICs) and 68 high- and upper-middle income countries (HUMICs), with a total of 528 and 748 observations between 2005-2015, respectively. National TB incidence rates declined in 108/116 countries between 2005-2015, with an average drop of 12.95% in LLMICs and 14.09% in HUMICs. Between LLMICs, higher Human Development Index (HDI), social protection spending, TB case detection, and TB treatment success were associated with lower TB incidence. Higher prevalence of HIV/AIDS was associated with higher TB incidence. Within LLMICs, increases in HDI over time were associated with lower TB incidence rates. Between HUMICs, higher HDI, health spending, and diabetes prevalence were associated with lower TB incidence, whereas higher prevalence of HIV/AIDS and alcohol-use were associated with higher TB incidence. Within HUMICs, increases in HIV/AIDS and diabetes prevalence over time were associated with higher TB incidence.

CONCLUSIONS

In LLMICs, TB incidence rates remain highest in countries with low human development, social protection spending and TB programme performance, and high rates of HIV/AIDS. Strengthening human development is likely to accelerate declines in TB incidence. In HUMICs, TB incidence rates remain highest in countries with low human development, health spending and diabetes prevalence, and high rates of HIV/AIDS and alcohol use. Here, slowing rising rates of HIV/AIDS and diabetes is likely to accelerate declines in TB incidence.

A mixed-methods, exploratory, quasi-experimental evaluation of a radio drama intervention to prevent age-disparate transactional sex in Tanzania

INTRODUCTION

Age-disparate transactional sex (ADTS) is associated with HIV, unintended pregnancy, school dropout and violence, yet few interventions have successfully prevented it, and none have set ADTS prevention as their primary outcome. This exploratory evaluation aimed to assess indications of change after exposure to the Learning Initiative on Norms, Exploitation and Abuse (LINEA) intervention, a mass-media, gender-transformative social norms intervention aimed at preventing ADTS in Tanzania.

METHODS

In a condensed implementation 331 participants were instructed to listen to the LINEA radio drama over seven weeks, and 60 were randomly allocated to household discussion sessions about content. In-depth interviews (n = 81) from girls aged 12-16 years, and women and men caregivers were collected at baseline (September 2021), midline (November) and endline (December 2021). Surveys were conducted (n = 120) at baseline and endline using the Norms and Attitudes on ADTS Scale (NAATSS) and the Gender Roles and Male Provision Expectations (GRMPE) scale. Interviews were thematically analyzed using a framework approach. Age-stratified linear regression models adjusted for baseline scores were used to measure association between the intervention and endline scale scores.

RESULTS

Longitudinal data were available from 59 qualitative (73%) and 95 quantitative participants (79%). Qualitative evidence revealed the drama facilitated family conversations about adolescent challenges, allowing caregivers to advise daughters. Some girls gained confidence to refuse men's gifts, learning that accepting them could necessitate sexual reciprocation. Some caregivers felt increased responsibility for supporting girls in the community to avoid ADTS. Blame for ADTS shifted for some from girls to men, suggesting increased understanding of inequitable power dynamics and reductions in victim blaming. Marginal quantitative evidence revealed that highly exposed girls had improved gender equitable beliefs on the GRMPE (β = -6.26; 95% CI: -12.94, 0.42). Moderately exposed men had increased gender inequitable norms on the NAATSS subscale (β = 0.42 95% CI: 0.05, 0.79), but there was no effect in highly exposed men.

CONCLUSIONS

Given the small sample results should be interpreted cautiously. Our initial findings indicate high engagement with the LINEA intervention shows promise in shifting knowledge, behaviors, and attitudes, beliefs and social norms driving ADTS in Shinyanga, Tanzania, supporting a robust impact evaluation.

The socioeconomic impact of tuberculosis on children and adolescents: a scoping review and conceptual framework

BACKGROUND

Tuberculosis (TB) has been repeatedly shown to have socioeconomic impacts in both individual-level and ecological studies; however, much less is known about this effect among children and adolescents and the extent to which being affected by TB during childhood and adolescence can have life-course implications. This paper describes the results of the development of a conceptual framework and scoping review to review the evidence on the short- and long-term socioeconomic impact of tuberculosis on children and adolescents.

OBJECTIVES

To increase knowledge of the socioeconomic impact of TB on children and adolescents.

METHODS

We developed a conceptual framework of the socioeconomic impact of TB on children and adolescents, and used scoping review methods to search for evidence supporting or disproving it. We searched four academic databases from 1 January 1990 to 6 April 2021 and conducted targeted searches of grey literature. We extracted data using a standard form and analysed data thematically.

RESULTS

Thirty-six studies (29 qualitative, five quantitative and two mixed methods studies) were included in the review. Overall, the evidence supported the conceptual framework, suggesting a severe socioeconomic impact of TB on children and adolescents through all the postulated pathways. Effects ranged from impoverishment, stigma, and family separation, to effects on nutrition and missed education opportunities. TB did not seem to exert a different socioeconomic impact when directly or indirectly affecting children/adolescents, suggesting that TB can affect this group even when they are not affected by the disease. No study provided sufficient follow-up to observe the long-term socioeconomic effect of TB in this age group.

CONCLUSION

The evidence gathered in this review reinforces our understanding of the impact of TB on children and adolescents and highlights the importance of considering effects during the entire life course. Both ad-hoc and sustainable social protection measures and strategies are essential to mitigate the socioeconomic consequences of TB among children and adolescents.

Health and wellbeing needs and priorities in mining host communities in South Africa: a mixed-methods approach for identifying key SDG3 targets

Background

The global mining industry has an opportunity to mobilize resources to advance progress against the Sustainable Development Goals (SDGs). In 2018, the Anglo-American Group outlined aspirations for mining host communities to meet the SDG3 health targets. To progress from aspiration to action we designed and implemented a mixed-methods approach to attain a deeper understanding of the health and wellbeing priorities within the local context of host communities of fifteen mines in South Africa.

Methods

To identify local needs and priorities relating to SDG3 targets in host communities, stakeholder workshops and key informant interviews were conducted between June and August 2019. A baseline assessment of health data, related to each of the SDG3 targets and indicators and to each host community location, was also conducted. Findings emerging from the qualitative and quantitative baseline assessments were compared to identify the extent to which health issues aligned and health and wellbeing priority areas for action.

Results

A total of 407 people participated in the workshops, and 85 key informants were interviewed. Quantitative data were available at sub-national level for seven of the nine SDG3 targets and eleven of the 21 indicators. Key priority areas for action identified through alignment of the qualitative and quantitative data were maternal mortality (SDG3.1), HIV (SDG3.3.1), tuberculosis (SDG3.3.2), substance abuse (SDG3.5), and road traffic accidents (SDG3.6) We found consistency in the individual, interpersonal, community, societal, and structural factors underlying these priority areas. At a structural level, poor access to quality healthcare was raised at every workshop as a key factor underlying the achievement of all SDG3 targets. Of the five priority areas identified, HIV, TB and substance abuse were found to overlap in the study communities in terms of risk, burden, and underlying factors.

Conclusions

We demonstrate a mixed method approach for identifying local health needs and prioritised SDG3 targets in mining host communities. Consistency in reporting suggests the need for effective, efficient and feasible interventions to address five priority areas. Given the prominent economic role of the mining sector in South Africa, it can play a critical role in implementing programmatic activities that further progress towards achieving the SDG3 targets.

Early impact of the DREAMS partnership on young women's knowledge of their HIV status: causal analysis of population-based surveys in Kenya and South Africa

Background

Knowledge of one’s HIV status is the gateway to treatment and prevention, but remains low among young people. We investigated the early impact (2016–2017) of Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS), a multisectoral HIV prevention package, on knowledge of HIV status among adolescent girls and young women (AGYW).

Methods

In 2017, randomly selected AGYW were enrolled into surveys, N=1081 aged 15–22 years in Nairobi slum settlements, and N=2174 aged 13–22 years in rural KwaZulu-Natal. We estimated the causal effect of being a DREAMS beneficiary on knowledge of HIV status (those who self-reported as HIV-positive or tested HIV-negative in the past year), accounting for an AGYW’s propensity to be a DREAMS beneficiary.

Results

In Nairobi, knowledge of HIV status was higher among DREAMS beneficiaries compared with non-beneficiaries (92% vs 69%, adjusted OR=8.7; 95% CI 5.8 to 12.9), with DREAMS predicted to increase the outcome by 28%, from 65% if none were a DREAMS beneficiary to 93% if all were beneficiaries. The increase attributable to DREAMS was larger among younger participants: 32% and 23% among those aged 15–17 and 18–22 years, respectively. In KwaZulu-Natal, knowledge of status was higher among DREAMS beneficiaries aged 13–17 years (37% vs 26% among non-beneficiaries), with a 9% difference due to DREAMS (95% CI 4.8% to 14.4%), and no evidence of effect among 18–22 years (−2.8%; 95% CI −11.1% to 5.7%).

Conclusion

DREAMS substantially increased knowledge of HIV status among AGYW in Nairobi, and among younger but not older AGYW in KwaZulu-Natal. Adolescent girls can be reached early (before age 18) with community-based HIV testing programmes in diverse high-prevalence settings, with a large impact on the proportion who know their HIV status.

Does Ghana's National Health Insurance Scheme provide financial protection to tuberculosis patients and their households?

Financial barriers are a key limitation to accessing health services, such as tuberculosis (TB) care in resource-poor settings. In Ghana, the National Health Insurance Scheme (NHIS), established in 2003, officially offers free TB care to those enrolled. Using data from the first Ghana's national TB patient cost survey, we address two key questions 1) what are the key determinants of costs and affordability for TB-affected households, and 2) what would be the impact on costs for TB-affected households of expanding NHIS to all TB patients? We reported the level of direct and indirect costs, the proportion of TB-affected households experiencing catastrophic costs (defined as total TB-related costs, i.e., direct and indirect, exceeding 20% of their estimated pre-diagnosis annual household income), and potential determinants of costs, stratified by insurance status. Regression models were used to determine drivers of costs and affordability. The effect of enrolment into NHIS on costs was investigated through Inverse Probability of Treatment Weighting Analysis. Higher levels of education and income, a bigger household size and an multi-drug resistant TB diagnosis were associated with higher direct costs. Being in a low wealth quintile, living in an urban setting, losing one's job and having MDR-TB increased the odds of experiencing catastrophic costs. There was no evidence to suggest that enrolment in NHIS defrayed medical, non-medical, or total costs, nor mitigated income loss. Even if we expanded NHIS to all TB patients, the analyses suggest no evidence for any impact of insurance on medical cost, income loss, or total cost. An expansion of the NHIS programme will not relieve the financial burden for TB-affected households. Social protection schemes require enhancement if they are to protect TB patients from financial catastrophe.

The effect of child marriage on the utilization of maternal health care in Nepal: A cross-sectional analysis of Demographic and Health Survey 2016

A range of demographic and socioeconomic factors are known to account for enormous disparities in the uptake of maternal health care in low- and middle-income countries. In contrast, contextual factors such as child marriage are far less explored as a deterrent to the uptake of maternal health care. The present study aimed to assess the total effect of child marriage on the utilization of maternal health services in Nepal. This study drew on data from the Nepal Demographic and Health Survey 2016. The study restricted its analysis to a subsample of 3,970 currently married women of reproductive age who had at least one live birth in the five years preceding the survey. After descriptive analysis, logistic regression models were constructed to estimate adjusted odds ratios. The results of logistic regression controlling for confounders suggested child marriage decreased the likelihood of antenatal care visits (AOR 0.74; 95% CI 0.63–0.86), skilled attendance at delivery (AOR 0.66; 95% CI 0.56–0.78), facility-based delivery (AOR 0.65; 95% CI 0.56–0.77), and postnatal care use (AOR 0.80; 95% CI 0.67–0.96). The findings of this study reinforced the existing evidence for the adverse effect of child marriage on maternal health-seeking behaviors. Women’s restricted access to household resources, limited autonomy in decision-making, social isolation, and the dominant power of husbands and mothers-in-law may play a role in the findings. Addressing women’s social vulnerability as a barrier to accessing health care may help to increase the uptake of maternal health services.

The impact of a cash transfer programme on tuberculosis treatment success rate: a quasi-experimental study in Brazil

Background

Evidence suggests that social protection policies such as Brazil’s Bolsa Família Programme (BFP), a governmental conditional cash transfer, may play a role in tuberculosis (TB) elimination. However, study limitations hamper conclusions. This paper uses a quasi-experimental approach to more rigorously evaluate the effect of BFP on TB treatment success rate.

Methods

Propensity scores were estimated from a complete-case logistic regression using covariates from a linked data set, including the Brazil’s TB notification system (SINAN), linked to the national registry of those in poverty (CadUnico) and the BFP payroll.

Results

The average effect of treatment on the treated was estimated as the difference in TB treatment success rate between matched groups (ie, the control and exposed patients, n=2167). Patients with TB receiving BFP showed a treatment success rate of 10.58 percentage points higher (95% CI 4.39 to 16.77) than patients with TB not receiving BFP. This association was robust to sensitivity analyses.

Conclusions

This study further confirms a positive relationship between the provision of conditional cash transfers and TB treatment success rate. Further research is needed to understand how to enhance access to social protection so to optimise public health impact.

Cash transfers to enhance TB control: lessons from the HIV response

BACKGROUND

The World Health Organization prioritises a more holistic global response to end the tuberculosis (TB) epidemic by 2030. Based on experiences in the HIV response, social protection, and in particular cash transfers, show promise for contributing to this. Currently, individual-level evidence for the potential of cash transfers to prevent TB by addressing the structural social determinants of disease is lacking. To identify priority actions for the TB research agenda, we appraised efforts by the HIV response to establish the role of cash transfers in preventing HIV infection.

MAIN BODY

The HIV response has evaluated the effects of cash transfers on risky sexual behaviours and HIV incidence. Work has also evaluated the added effects of supplementing cash transfers with psychosocial support. The HIV response has focused research on populations with disproportionate HIV risk, and used a mix of explanatory evaluations, which use ideal conditions, and pragmatic evaluations, which use operational conditions, to generate evidence that is both causally valid and applicable to the real world. It has always collaborated with multiple stakeholders in funding and evaluating projects. Learning from the HIV response, priority actions for the TB response should be to investigate the effect of cash transfers on intermediary social determinants of active TB disease, and TB incidence, as well as the added effects of supplementing cash transfers with psychosocial support. Work should be focused on key groups in high burden settings, and look to build a combination of explanatory and pragmatic evidence to inform policy decisions in this field. To achieve this, there is an urgent need to facilitate collaborations between groups interested in evaluating the impact of cash transfers on TB risk.

CONCLUSIONS

The HIV response highlights several priority actions necessary for the TB response to establish the potential of cash transfers to prevent TB by addresing the structural social determinants of disease.

The Unresponsive Partner: Roles of Social Status, Auditory Feedback, and Animacy in Coordination of Joint Music Performance

We examined temporal synchronization in joint music performance to determine how social status, auditory feedback, and animacy influence interpersonal coordination. A partner’s coordination can be bidirectional (partners adapt to the actions of one another) or unidirectional (one partner adapts). According to the dynamical systems framework, bidirectional coordination should be the optimal (preferred) state during live performance. To test this, 24 skilled pianists each performed with a confederate while their coordination was measured by the asynchrony in their tone onsets. To promote social balance, half of the participants were told the confederate was a fellow participant – an equal social status. To promote social imbalance, the other half was told the confederate was an experimenter – an unequal social status. In all conditions, the confederate’s arm and finger movements were occluded from the participant’s view to allow manipulation of animacy of the confederate’s performances (live or recorded). Unbeknownst to the participants, half of the confederate’s performances were replaced with pre-recordings, forcing the participant into unidirectional coordination during performance. The other half of the confederate’s performances were live, which permitted bidirectional coordination between performers. In a final manipulation, both performers heard the auditory feedback from one or both of the performers’ parts removed at unpredictable times to disrupt their performance. Consistently larger asynchronies were observed in performances of unidirectional (recorded) than bidirectional (live) performances across all conditions. Participants who were told the confederate was an experimenter reported their synchrony as more successful than when the partner was introduced as a fellow participant. Finally, asynchronies increased as auditory feedback was removed; removal of the confederate’s part hurt coordination more than removal of the participant’s part in live performances. Consistent with the assumption that bidirectional coupling yields optimal coordination, an unresponsive partner requires the other member to do all the adapting for the pair to stay together.

Sensing sulfur-containing gases using titanium and tin decorated zigzag graphene nanoribbons from first-principles

Atom implantation in graphene or graphene nanoribbons offers a rich opportunity to tune the material structure and functional properties. In this study, zigzag graphene nanoribbons with Ti or Sn adatoms stabilised on a double carbon vacancy site are theoretically studied to investigate their sensitivity to sulfur-containing gases (H2S and SO2). Due to the abundance of oxygen in the atmosphere, we also consider the sensitivity of the structures in the presence of oxygen. Density functional theory calculations are performed to determine the adsorption geometry and energetics, and nonequilibrium Green's function method is employed to compute the current-voltage characteristics of the considered systems. Our results demonstrate the sensitivity of both Ti- and Sn-doped systems to H2S, and the mild sensitivity of Ti-doped sensor systems to SO2. The Ti-doped sensor structure exhibits sensitivity to H2S with or without oxidation, while oxidation of the Sn-doped sensor structure reduces its ability to adsorb H2S and SO2 molecules. Interestingly, oxygen dissociates on the Ti-doped sensor structure, but it does not affect the sensor's response to the H2S gas species. Oxidation prevents the dissociation of the H-S bond when H2S adsorbs on the Ti-doped structure, thus enhancing its reusability for this gas species. Our study suggests the potential of Ti- and Sn-doped graphene in selective gas sensing, irrespective of the sensing performance of the bulk oxides.

Chemical evolution via beta decay: a case study in strontium-90

Using (90)Sr as a representative isotope, we present a framework for understanding beta decay within the solid state. We quantify three key physical and chemical principles, namely momentum-induced recoil during the decay event, defect creation due to physical displacement, and chemical evolution over time. A fourth effect, that of electronic excitation, is also discussed, but this is difficult to quantify and is strongly material dependent. The analysis is presented for the specific cases of SrTiO(3) and SrH(2). By comparing the recoil energy with available threshold displacement data we show that in many beta-decay situations defects such as Frenkel pairs will not be created during decay as the energy transfer is too low. This observation leads to the concept of chemical evolution over time, which we quantify using density functional theory. Using a combination of Bader analysis, phonon calculations and cohesive energy calculations, we show that beta decay leads to counter-intuitive behavior that has implications for nuclear waste storage and novel materials design.

Severe, generalized nummular eczema secondary to interferon alfa-2b plus ribavirin combination therapy in a patient with chronic hepatitis C virus infection

BACKGROUND

With increasing rates of hepatitis C virus infection and diagnosis, more patients are being treated with interferon alfa-2b plus ribavirin therapy. Cutaneous side effects to combination therapy are common and may limit treatment. There are few previous case reports of generalized eczematous dermatoses occurring after combination therapy for hepatitis C virus, none in a North American patient, and none of this severity or recalcitrance.

OBSERVATIONS

A man with chronic hepatitis C virus infection and no history of atopy developed severe, recalcitrant nummular eczema secondary to interferon alfa-2b plus ribavirin combination therapy. The cutaneous side effect was more severe than in previously reported cases and did not remit on discontinuation of therapy.

CONCLUSIONS

Greater awareness of the range of dermatologic responses to interferon alfa-2b plus ribavirin therapy may lead to improved surveillance for and treatment of these side effects. Investigating the underlying pathologic mechanisms may ultimately allow for a greater understanding of the immunomodulatory effects of this therapy in the setting of chronic hepatitis C virus infection.

Endogenously expressed estrogen receptor and coactivator AIB1 interact in MCF-7 human breast cancer cells

Coactivators are believed to mediate estrogen-induced gene responses via interaction with estrogen receptors (ER). Currently, a major challenge is to determine the importance of each coactivator in a specific cell type and promoter context in response to a particular ligand. The potential of ER to interact with a growing list of coactivators has been shown in a variety of in vitro and gene transfer assays, yet very few data have demonstrated the interaction of endogenous coactivators with ER in intact cells. We report here a ligand-specific interaction of endogenous human ER (hER) and the AIB1 coactivator in MCF-7 human breast cancer cells by using immunoprecipitation analyses. Complexes between endogenously expressed hER and AIB1 were detected in estradiol-treated cells and to a much lesser extent in cells treated with the partial agonist, monohydroxytamoxifen. We were unable to detect an hER-SRC-1 complex in our immunoprecipitations from MCF-7 cells. The in vitro-binding affinity for mouse ER interaction with AIB1 was estimated to be 40-120 nM. We conclude that AIB1 is a major coactivator for hER in MCF-7 human breast cancer cells.

Biological-to-electronic interface with pores of ATP synthase subunit C in silicon nitride barrier

An oscillator pore is identified that generates intermittent, large amplitude, ionic current in the plasma membrane. The pore is thought to be composed of 10-12 units of subunit c of ATP synthase. Pore opening and closing is a co-operative process, dependent on the release, or binding, of as many as six calcium ions. This mechanism suggests a more general method of co-operative threshold detection of chemical agents via protein modification, the output being directly amplified in a circuit. Here the authors describe steps in the development of a sensor of chemical agents. The subunit c pore in a lipid bilayer spans a nanometer-scale hole in a silicon nitride barrier. Either side of the barrier are electrolyte solutions and current through the pore is amplified by circuitry. The techniques of laser ablation, electron beam lithography and ion beam milling are used to make successively smaller holes to carry the lipid patch. Holes of diameter as small as 20 nm are engineered in a silicon nitride barrier and protein activity in lipid membranes spanning holes as small as 30 nm in diameter is measured. The signal-to-noise ratio of the ionic current is improved by various measures that reduce the effective capacitance of the barrier. Some limits to scale reduction are discussed.

Factor V Leiden and pulmonary embolism in a young woman taking an oral contraceptive

A 34-year-old woman with a history of asthma and oral contraceptive use died suddenly. Autopsy examination showed chronic pulmonary emboli with an acute pulmonary saddle embolus. An underlying congenital thrombophilic disorder was considered. Molecular studies on DNA isolated from blood using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis revealed coagulation factor V Leiden mutation. The incidence of venous thromboembolism in patients with factor V Leiden mutation and associated activated protein C (APC) resistance is discussed.

Changes in the amount and nutritive characteristics of annual pastures from late spring to autumn on the south coast of Western Australia

We examined declines in annual pasture dry matter on offer (DMO) from around peak accumulation in spring through summer-autumn in 14 supplementary feeding experiments across the south coast of Western Australia. Changes in dry matter digestibility (DMD) and concentrations of nitrogen, phosphorus, potassium (K), calcium, magnesium and sulfur were also measured. Plants which germinated in summer-autumn were manually separated, as far as possible, by removing green components from the dry material, and it was assumed all dry pasture had grown during the previous growing season. Measurements were made under grazing (stocking rates varying from 8 to 16.7 young wethers/ha) and in exclosures, and the experiments were carried out at 5 locations over 3 years. Within any experiment, there were no significant effects of supplementary feeding treatments on declines in DMO, DMD or digestible dry matter on offer (DDMO). Highest measured DMo and DMD varied from 2600 to 8600 kg DM/ha and from 63 to 8 I%, minimum measured values ranged from 100 to 1600 kg DM/ha and 45 to 54%, with amounts of DM0 lost varying from 2000 to 8500 kg DM/ha. The declines in DMO, DMD and DDMO under grazing through summer-autumn were described by exponential decay curves. Losses in DM0 and DDMO, as calculated from curve parameters, were positively correlated (P<0.001) with maximum DM0 or DDMO, respectively. Loss and average rate of loss in DMo were also correlated (P<0.01) with total rainfall through the period of measurement. The number of rainy days, stocking rate and botanical composition of pastures in spring were not significantly correlated with these losses under the conditions of these experiments. The percentage rate of decline in DM0 was not strongly correlated with any of these variables and its variation across experiments was small. Change and rate of change in DMD were positively correlated (P<0.001) with maximum measured DMD and negatively correlated (P<0.05) with the percentage of grass in the pasture. It was estimated that most of the lost material was not consumed by sheep. The concentrations of some essential minerals in grazed dry pasture approached, or fell below, their critical concentrations in most experiments. Of the minerals measured, only changes in K concentrations in dry pasture were well described by exponential regressions.

Effects of 2 mg and 4 mg atropine sulfate on the performance of U.S. Army helicopter pilots

Atropine autoinjectors are issued to aviators for use in the event of organophosphate poisoning on the battlefield. This investigation assessed the effects of unchallenged 2 mg and 4 mg doses on flight performance, vision, tracking, cognitive performance, and electroencephalograms of 12 Army aviators. Effects were seen most often with the 4 mg dose in terms of aircraft control problems, vision disturbances, impaired tracking, reduced cortical activation, and decreased cognitive skill. These problems indicate helicopter tactical flight is dangerous after an unchallenged 4 mg dose. Other types of flight should also be avoided for at least 12 h after atropine.

Atypical apocrine metaplasia in sclerosing lesions of the breast: a study of 51 patients

Sclerosing breast lesions with cytologically atypical apocrine metaplasia present a difficult diagnostic problem. The clinical significance of these lesions has not been established although, historically, apocrine metaplasia and sclerosing adenosis have been regarded as totally benign. To further assess these lesions, we studied 51 patients with atypical apocrine metaplasia in sclerosing lesions of the breast, obtaining an average follow-up of 35 mo (12 to 76 mo). For convenience, these have been grouped together as atypical apocrine sclerosing lesions (AASL). The average age at diagnosis was 58 yr. The lesions tended to be small (67% less than 1.0 cm) and usually were detected by mammography (78%). Four patients had an ipsilateral mastectomy following a biopsy of AASL that was interpreted as carcinoma or "precancerous" by the referring pathologist. Two patients had nonapocrine intraductal and infiltrating duct carcinoma in previous contralateral mastectomy specimens. None of the 47 women with an intact breast developed breast carcinoma during the follow-up period. Immediate treatment with surgery and/or radiation is not indicated. The long-term clinical implication of these lesions is yet to be determined; therefore, continued clinical observation of AASL patients is advisable.

Correlation of computed tomography and postmortem findings of a diffuse astrocytoma: a case report

Diffusely infiltrating astrocytomas often present diagnostic difficulties. We herein correlate the radiologic and postmortem findings of a diffuse astrocytoma and conclude that recognition of abnormal bilateral and fairly symmetric enlargement and increased density of normal structures in CT scans may lead to an antemortem diagnosis of the tumor.

A modified extrathoracic approach to the treatment of dysphagia lusoria

The management of patients with esophageal compression by an anomalous right subclavian artery (dysphagia lusoria) has been controversial. A classic approach involves left thoracotomy, with resection of the aberrant subclavian artery from its origin to the right border of the esophagus. To prevent possible ischemic complications, most surgeons favor revascularization of the distal subclavian artery. Thoracotomy has been the traditional approach for division or reimplantation of the aberrant right subclavian artery. We describe a modification (right supraclavicular incision) of an extrathoracic approach, which was first described by Orvald in 1972, to simplify simultaneous correction of dysphagia lusoria and revascularization of the right upper extremity.

Experimental assessment of wind erosion after soil stabilization treatments at Eneabba, Western Australia

Wind tunnel experiments on rehabilitation surfaces at Eneabba, Western Australia evaluated the techniques used by Associated Minerals Consolidated Ltd. (AMC) and Allied Eneabba Ltd. (AEL) to stabilize regions being revegetated following heavy mineral sand mining.Newly landscaped areas proved to be the most erodible, beginning to erode at 9 m sec(-1) and producing a soil flux of 10 kg m(-1) min(-1) at 18 m sec(-1) wind speeds. Sandier, more organically-rich, surfaces in the rehabilitation areas were somewhat less erodible with losses of only 2 kg m(-1) min(-1) at wind speeds of 18 m sec(-1).The mining companies use various nurse crops and top dressing mulch for surface stabilization. Rows of oats, sparse plantings of the grass cultivar "SUDAX" (Dekalb ST6) supplied by Westfarmers Ltd. and applications of Terolas, a cold, bituminous surface binding material supplied by Shell Co. of Australia Ltd., all proved successful in reducing wind erosion in this semi-arid region where more than 25% of summer days experience winds greater than 8 m sec(-1).

System for long-term review of patients at risk of becoming hypothyroid. Further experience

8 years' experience of a computer-assisted system for long-term follow-up of patients at risk of hypothyroidism shows that the system is reliable, efficient, and economical. Less than 0.1% of registered patients are now lost to follow-up and less than 2% of patients need to be seen by the medical staff each year. Changes have been made in registration procedures and in the methods of finding patient who fail to attend. Improvements in the laboratory screening of thyroid function have also been introduced. The need to follow-up patients already under treatment with thyroxine has been recognised and the importance of a reliable system is reaffirmed.

The effect of treatment of hyper- and hypothyroidism on urinary excretion of cyclic adenosine 3',5'-monophosphate

The urinary excretion of cyclic adenosine 3',5'-monophosphate (cyclic AMP) was examined in patients with hyperthyroidism and primary hypothyroidism, before treatment and at least six months later on return to euthyroid status. Urinary cyclic AMP excretion was significantly greater in the hyperthyroid group than in the hypothyroid group both in the basal state (P less than 0.01) and the ambulant state (P less than 0.001). In ambulant hyperthyroid patients absolute urinary cyclic AMP excretion (mumol/24 h) was significantly greater (P less than 0.05) prior to treatment than on return to euthyroid status. In the hypothyroid group no significant change occurred after treatment with 1-thyroxine (P greater than 0.05). The mechanism of changes in urinary cyclic AMP excretion in thyroid disease are discussed.

Arterial surgery in pseudoxanthoma elasticum

A 25-year-old female with pseudoxanthoma elasticum was referred with disabling ischaemia in one lower limb. She had suffered from peripheral vascular disease from the age of 15. Reconstructive arterial surgery was successful.

The great illusion controversy: a glimpse

Beginning with Mueller-Lyer's original article in 1889 and continuing with subsequent studies, an attempt to translate and/or analyze theoretical explanations of the Mueller-Lyer illusion is well under way. Much new food for thought comes from these old studies.

Subjective median plane as a function of age and source of stimulation

Data consistent with the sensory-tonic position were obtained from children (6 to 14 yr.) who performed a visual and a muscular task.

Further test of deprivation trace hypothesis

32 rats were used to test the deprivation-trace hypothesis of O'Kelly and Heyer (1951). In a 2 × 2 × 2 factorial design the following variables were manipulated: delay between saline injection and bar-press testing, 30 min. vs 240 min., presence or absence of food during the delay period, and schedule of reinforcement, VI-¼ min. vs VI-1 min. The only significant differences were the main effects of schedule and delay. The prediction was supported, but alternative interpretations not requiring the hypothesis were offered.