The reported impact of non-communicable disease investment cases in 13 countries

Non-communicable diseases (NCDs) are a leading health and development challenge worldwide. Since 2015, WHO and the United Nations Development Programme have provided support to governments to develop national NCD investment cases to describe the socioeconomic dimensions of NCDs. To assess the impact of the investment cases, semistructured interviews and a structured process for gathering written feedback were conducted between July and October 2022 with key informants in 13 countries who had developed a national NCD investment case between 2015 and 2020. Investment cases describe: (1) the social and economic costs of NCDs, including their distribution and projections over time; (2) priority areas for scaled up action; (3) the cost and returns from investing in WHO-recommended measures to prevent and manage NCDs; and (4) the political dimensions of NCD responses. While no country had implemented all the recommendations set out in their investment case reports, actions and policy changes attributable to the investment cases were identified, across (1) governance; (2) financing; and (3) health service access and delivery. The pathways of these changes included: (1) stronger collaboration across government ministries and partners; (2) advocacy for NCD prevention and control; (3) grounding efforts in nationally owned data and evidence; (4) developing mutually embraced 'language' across health and finance; and (5) elevating the priority accorded to NCDs, by framing action as an investment rather than a cost. The assessment also identified barriers to progress on the investment case implementation, including the influence of some private sector entities on sectors other than health, the impact of the COVID-19 pandemic, and changes in senior political and technical government officials. The results suggest that national NCD investment cases can significantly contribute to catalysing the prevention and control of NCDs through strengthening governance, financing, and health service access and delivery.

Vertebral deformities and fractures are associated with MRI and pQCT measures obtained at the distal tibia and radius of postmenopausal women

SUMMARY

We investigated the association of postmenopausal vertebral deformities and fractures with bone parameters derived from distal extremities using MRI and pQCT. Distal extremity measures showed variable degrees of association with vertebral deformities and fractures, highlighting the systemic nature of postmenopausal bone loss.

INTRODUCTION

Prevalent vertebral deformities and fractures are known to predict incident further fractures. However, the association of distal extremity measures and vertebral deformities in postmenopausal women has not been fully established.

METHODS

This study involved 98 postmenopausal women (age range 60-88 years, mean 70 years) with DXA BMD T-scores at either the hip or spine in the range of -1.5 to -3.5. Wedge, biconcavity, and crush deformities were computed on the basis of spine MRI. Vertebral fractures were assessed using Eastell's criterion. Distal tibia and radius stiffness was computed using MRI-based finite element analysis. BMD at the distal extremities were obtained using pQCT.

RESULTS

Several distal extremity MRI and pQCT measures showed negative association with vertebral deformity on the basis of single parameter correlation (r up to 0.67) and two-parameter regression (r up to 0.76) models involving MRI stiffness and pQCT BMD. Subjects who had at least one prevalent vertebral fracture showed decreased MRI stiffness (up to 17.9 %) and pQCT density (up to 34.2 %) at the distal extremities compared to the non-fracture group. DXA lumbar spine BMD T-score was not associated with vertebral deformities.

CONCLUSIONS

The association between vertebral deformities and distal extremity measures supports the notion of postmenopausal osteoporosis as a systemic phenomenon.

Achievement Place: modification of the behaviors of pre-delinquent boys within a token economy

The "pre-delinquent" behaviors of six boys at Achievement Place, a community based family style behavior modification center for delinquents, were modified using token (points) reinforcement procedures. In Exp. I, point losses contingent on each minute late were effective in producing promptness at the evening meal. During the reversal phase, threats (which were not backed up with point losses) to reinstate the point consequences initially improved promptness but the last two of five threats were ineffective. In Exp. II, point consequences effectively maintained the boys' room-cleaning behavior and, during a fading condition where the percentage of days when the contingency occurred was decreased, the point consequences remained effective for over six months, even when they were delivered on only 8% of the days. Experiment III showed that the boys saved considerable amounts of money when point consequences were available for deposits but saved little money when no points were available. Also, when points were given only for deposits that occurred on specific days the boys deposited their money almost exclusively on those days. In Exp. IV, point consequences contingent on the number of correct answers on a news quiz produced the greatest increase in the percentage of boys who watched the news and, to a lesser extent, increased the percentage of correct answers for the boys who watched the news. The results indicate that "pre-delinquent" behaviors are amenable to modification procedures and that a token reinforcement system provides a practical means of modifying these behaviors.

Achievement Place: development of the elected manager system

A series of experiments was carried out to compare several administrative systems at Achievement Place, a family style behavior modification program for pre-delinquent boys. One aspect of the motivation system at Achievement Place was the token economy in which the youths could earn or lose points that could be exchanged for privileges. Several arrangements for assigning routine tasks and for providing token consequences for task performance were compared for their effectiveness in accomplishing the tasks and for their preference by the boys. The independent variables studied included: (1) individually assigned tasks versus group assigned tasks; (2) consequences for individual performance versus consequences for group performance; (3) a peer managership that could be earned by the highest bidder versus a peer managership that could be determined democratically by the peers. The results suggested that among those systems studied the system that best met the criteria of effectiveness and preference involved a democratically elected peer manager who had the authority both to give and to take away points for his peers' performances.

Observation of Psi(3770)-->gammachi(c1)-->gammagammaJ/Psi

From e(+)e(-) collision data acquired with the CLEO detector at the Cornell Electron Storage Ring, we observe the non-DD(_) decay Psi(3770))-->gammachi(c1) with a statistical significance of 6.6 standard deviations, using the two-photon cascades to J/Psi and J/Psi-->l(+)l(-). We determine sigma(e(=)e(-)-->Psi(3770))xBeta(Psi(3770)-->gammachi(c1))=(18.0 +/- 3.3 +/- 2.5) pb and branching fraction Beta(Psi(3770)-->gammachi(c1)=(2.8 +/- 0.5+/-0.4) x 10(-3). We set 90% C.L. upper limits for the transition to chi(c2) (chi(c0)): sigma x Beta<5.7 pb (<282 pb) and Beta<0.9 x 10(-3) (<44 x 10(-3)). We also determine Gamma(Psi(3770)gammachi(c1))/Gamma(Psi(3770)-->pi(+)pi(-)J/Psi)=1.5 +/- 0.3 +/- 0.3 (>1.0 at 90% C.L.), which bears upon the interpretation of X(3872).

Charmonium Decays of Y(4260), psi(4160), and psi(4040)

Using data collected with the CLEO detector operating at the CESR e+e- collider at sqrt[s]=3.97-4.26 GeV, we investigate 15 charmonium decay modes of the psi(4040), psi(4160), and Y(4260) resonances. We confirm, at 11 sigma significance, the BABAR Y(4260)-->pi+pi- J/psi discovery, make the first observation of Y(4260)--> pi(0)pi(0) J/psi (5.1 sigma), and find the first evidence for Y(4260)-->K+K- J/psi(3.7 sigma). We measure e+e- cross sections at sqrt[s]=4.26 GeV as sigma(pi+pi- J/psi)=58(+12)(-10)+/-4 pb, sigma(pi(0)pi(0) J/psi)=23(+12)(-8)+/-1 pb, and sigma(K+K- J/psi)=9(+9)(-5)+/-1 pb, in which the uncertainties are statistical and systematic, respectively. Upper limits are placed on other decay rates from all three resonances.

Measurements of the exclusive decays of the upsilon(5S) to meson final states and improved B(s)* mass measurement

Using 420 pb(-1) of data collected on the upsilon(5S) resonance with the CLEO III detector, we reconstruct B mesons in 25 exclusive decay channels to measure or set upper limits on the decay rate of upsilon(5S) into B meson final states. We measure the inclusive B cross section to be sigma(upsilon(5S) --> BB(X)) = (0.177 +/- 0.030 +/- 0.016) nb and make the first measurements of the production rates of sigma(upsilon(5S) --> B*B*) = (0.131 +/- 0.025 +/- 0.014) nb and sigma(upsilon(5S) --> BB*) = (0.043 +/- 0.016 +/- 0.006) nb, respectively. We set 90% confidence level limits of sigma(upsilon(5S) -->BB) < 0.038 nb, sigma(upsilon(5S) --> B(*)B(*)pi) < 0.055 nb and sigma(upsilon(5S) --> BBpipi) < 0.024 nb. We also extract the most precise value of the B(s)* mass to date, M(B(s)*) = (5411.7 +/- 1.6 +/- 0.6) MeV/c2.

Experimental limits on weak annihilation contributions to decays

We present the first experimental limits on high-q2 contributions to charmless semileptonic decays of the form expected from the weak annihilation (WA) decay mechanism. Such contributions could bias determinations of /Vub/ from inclusive measurements of B-->Xulupsilon. Using a wide range of models based on available theoretical input we set a limit of GammaWA/Gammab-->u<7.4% (90% confidence level) on the WA fraction, and assess the impact on previous inclusive determinations of /Vub/.

Dielectron widths of the Gamma(1S,2S,3S) resonances

We determine the dielectron widths of the Gamma(1S), Gamma(2S), and Gamma(3S) resonances with better than 2% precision by integrating the cross section of e+e- -->Gamma over the e+e- center-of-mass energy. Using e+e- energy scans of the Gamma resonances at the Cornell Electron Storage Ring and measuring Gamma production with the CLEO detector, we find dielectron widths of 1.252+/-0.004(sigma(stat))+/-0.019(sigma(syst)) keV, 0.581+/-0.004+/-0.009 keV, and 0.413+/-0.004+/-0.006 keV for the Gamma(1S), Gamma(2S), and Gamma(3S), respectively.

Measurement of sigma(e+e- -->psi(3770)-->hadrons) at Ec.m.=3773 MeV

We measure the cross section for e+e- -->psi(3770) -->hadrons at Ec.m.=3773 MeV to be (6.38+/-0.08(+0.41)(-0.30) nb using the CLEO detector at the CESR e+e- collider. The difference between this and the e+e- -->psi(3770) -->DD cross section at the same energy is found to be (-0.01+/-0.08(+0.41)(-0.30) nb. With the observed total cross section, we extract Gamma(ee)(psi(3770))=(0.204+/-0.003(+0.041)(-0.027) keV. Uncertainties shown are statistical and systematic, respectively.

New measurements of Cabibbo-suppressed decays of mesons with the CLEO-c detector

Using of data collected with the CLEO-c detector, we report on first observations and measurements of Cabibbo-suppressed decays of D mesons in the following six decay modes: pi+ pi- pi0 pi0, pi+ pi+ pi- pi- pi0, pi+ pi0 pi0, pi+ pi+ pi- pi0, eta pi0, and omega pi+ pi-. Improved branching fraction measurements in eight other multipion decay modes are also presented. The measured D --> pi pi rates allow us to extract the ratio of isospin amplitudes A(DeltaI = (3/2) / A(DeltaI = (1/2)) = 0.420 +/- 0.014(stat) +/- 0.016(syst) and the strong phase shift of delta1 = (86.4 +/- 2.8 +/- 3.3) degrees, which is quite large and now more precisely determined.

Observation of psi(3770) --> pi pi J/psi and measurement of Gamma ee[psi(2S)]

We observe signals for the decays psi(3770) --> XJ/psi from data acquired with the CLEO detector operating at the CESR e+ e- collider with square root of s = 3773 MeV. We measure the following branching fractions Beta(psi(3770) --> XJ/psi and significances: (189 +/- 20 +/- 20) x 10(-5) (11.6sigma) for X = pi+ pi-, (80 +/- 25 +/- 16) x 10(-5) (3.4sigma) for X = pi0 pi0, and (87 +/- 33 +/- 22) x 10(-5) (3.5sigma) for X = eta, where the errors are statistical and systematic, respectively. The radiative return process e+ e- --> gamma psi(2S) populates the same event sample and is used to measure Gamma ee[psi(2S)] = (2.54 +/- 0.03 +/- 0.11) keV.

Search for exclusive multibody non- decays at the resonance

Using data collected at the psi(3770) resonance with the CLEO-c detector at the Cornell e+e- storage ring, we present searches for 25 charmless decay modes of the psi(3770), mostly multibody final states. No evidence for charmless decays is found.

Observation of Bs production at the Y(5S) resonance

Using the CLEO detector at the Cornell Electron Storage Ring, we have observed the Bs meson in e+e- annihilation at the Y(5S) resonance. We find 14 candidates consistent with Bs decays into final states with a J/psi or a Ds(*)- . The probability that we have observed a background fluctuation is less than 8 x 10(-10) . We have established that at the energy of the Y(5S) resonance Bs production proceeds predominantly through the creation of Bs*Bs* pairs. We find sigma(e+e- --> Bs*Bs*) = [0.11(-0.03))(+0.04)(stat) +/- 0.02(syst)]nb , and set the following limits: sigma(e+e- --> BsBs)/ sigma(e+ e- --> Bs*Bs*) <0.16 and [sigma(e+e- --> BsBs*) + sigma(e+e- --> Bs*Bs)]/sigma(e+e- -->Bs*Bs*) < 0.16 (90% C.L.). The mass of the Bs* meson is measured to be M(Bs*) = [5.414+/- 0.001(stat) +/- 0.003(syst)] GeV/c2 .

Precision measurements of the timelike electromagnetic form factors of pion, kaon, and proton

Using 20.7 pb(-1) of e(+)e(-) annihilation data taken at sq.rt(r) = 3.671 GeV with the CLEO-c detector, precision measurements of the electromagnetic form factors of the charged pion, charged kaon, and proton have been made for timelike momentum transfer of |Q(2)| = 13.48 GeV(2) by the reaction e(+)e(-) --> h(+)h(-). The measurements are the first ever with identified pions and kaons of |Q(2)| > 4 GeV(2), with the results F(13.48 GeV(2)) = 0.075 +/- 0.008(stat) +/- 0.005(syst) and F(K)(13.48 GeV(2)) = 0.063 +/- 0.004(stat) +/- 0.001(syst). The result for the proton, assuming G(p)(E) = G(p)(M), is G(p)(M)(13.48 GeV(2)) = 0.014 +/- 0.002(stat) +/- 0.001(syst), which is in agreement with earlier results.

Evidence for Bs* Bs* production at the Gamma(5S) resonance

We use data collected by the CLEO III detector at the Cornell Electron Storage Ring to measure the inclusive yields of D(s) mesons as B(Y(5S) --> D(s)X) = (44-7 +/- 4.2 +/- 9.9)% and B(Y(4S) --> D(s)X) = (18.1 +/- 0.5 +/- 2.8)%. From these measurements, we make a model dependent estimate of the ratio of B(s)*B(s)* to the total bb quark pair production of (16.0 +/- 2.6 +/- 5.8)% at the Y(5S) energy.

Improved measurement of B(D+ --> mu+nu) and the pseudoscalar decay constant fD+

We extract a relatively precise value for the decay constant of the meson by measuring B(D+ --> mu+nu) = (4.40 +/-0.66(+0.09)(-0.12) x 10(-4) using 281 pb(-1) of data taken on phi(3770) the resonance with the CLEO-c detector. We find fD+ = (222.6 +/- 16.7(+2.8)(-3.4)) MeV, and compare with current theoretical calculations. We also set a 90% confidence upper limit on B(D+e+nu)< 2.4 x 10(-5) which constrains new physics models.

Search for rare and forbidden decays D+ --> h+/- e+/- e+

Using 0.8 x 10(6) D+ D- pairs collected with the CLEO-c detector at the psi(3770) resonance, we have searched for flavor-changing neutral current and lepton-number-violating decays of D+ mesons to final states with dielectrons. We find no indication of either, obtaining 90% confidence level upper limits of B(D+ --> pi+ e+ e-) < 7.4 x 10(-6), B(D+ --> pi- e+ d+) < 3.6 x 10(-6), B(D+ --> K+ e+ e-) < 6.2 x 10(-6), and B(D+ --> K- e+ e+) < 4.5 x 10(-6).

Absolute branching fraction measurements of exclusive D+ semileptonic decays

Using data collected at the psi(3770) resonance with the CLEO-c detector at the Cornell e+e- storage ring, we present improved measurements of the absolute branching fractions of D+decays to K0e+ve, pi0e+ve, K*0e+ve, and p0e+ve, and the first observation and absolute branching fraction measurement of D+ --> omega e+ve. We also report the most precise tests to date of isospin invariance in semileptonic D0 and D+ decays.

Absolute branching fraction measurements of exclusive D0 semileptonic decays

With the first data sample collected by the CLEO-c detector at the psi(3770) resonance we have studied four exclusive semileptonic decays of the D0 meson. Our results include the first observation and absolute branching fraction measurement for D0 --> p-e+ve and improved measurements of the absolute branching fractions for D0 decays to K-e+ve, pi-e+ve, and K*-e+ve.

Measurement of absolute hadronic branching fractions of D mesons and e+e- -->DD cross sections at Ec.m.=3773 MeV

Using 55.8 pb(-1) of e+e- collisions recorded at the psi(3770) resonance with the CLEO-c detector at CESR, we determine absolute hadronic branching fractions of charged and neutral D mesons using a double tag technique. Among measurements for three D0 and six D+ modes, we obtain reference branching fractions B(D0-->K-pi+)=(3.91+/-0.08+/-0.09)% and B(D+-->K-pi+pi+)=(9.5+/-0.2+/-0.3)%, where the uncertainties are statistical and systematic, respectively. Final state radiation is included in these branching fractions by allowing for additional, unobserved, photons in the final state. Using a determination of the integrated luminosity, we also extract the cross sections sigma(e+e- -->D0D0)=(3.60+/-0.07(+0.07)(-0.05)) nb and sigma(e+e- -->D+D-)=(2.79+/-0.07(+0.10)(-0.04)) nb.

Observation of the hc(1P1) state of charmonium

The h(c)((1)P(1)) state of charmonium has been observed in the reaction psi(2S) --> pi(0)h(c) --> (gammagamma)(gammaeta(c)) using 3.08 x10(6) psi(2S) decays recorded in the CLEO detector. Data have been analyzed both for the inclusive reaction, where the decay products of the eta(c) are not identified, and for exclusive reactions, in which eta(c) decays are reconstructed in seven hadronic decay channels. We find M(h(c)) = 3524.4 +/- 0.6 +/- 0.4 MeV which corresponds to a hyperfine splitting DeltaM(hf)(1P) triple-bond <M((3)P(J)) - M((1)P(1)) = +1.0 +/- 0.6 +/- 0.4 MeV, and B(psi(2S) --> pi(0)h(c)) x B(h(c) --> gammaeta(c)) = (4.0 +/- 0.8 +/- 0.7) x 10(-4).

Observation of thirteen new exclusive multibody hadronic decays of the psi(2S)

Using data accumulated with the CLEO detector corresponding to an integrated luminosity of [symbol: see text] = 5.63 pb(-1) on the peak of the psi(2S) [3.08 x 10(6) psi(2S) decays] and 20.70 pb(-1) at square root of[s] = 3.67 GeV, we report first measurements of the branching fractions for the following 13 decay modes of the psi(2S): eta3pi, &eta'3pi, rhoK+K-, K+K-pi+pi-pi0, 2(K+K-), 2(K+K-)pi0, rhopp, pppi+pi-pi0, etapp, ppK+K-, lambdalambdapi+pi-, lambdapK+, and lambdapK+pi+pi-, and more precise measurements of 8 previously measured modes: 2(pi+pi-), rhopi+pi-, 2(pi+pi-)pi0, omegapi+pi-, K+K-pi+pi-, omegaK+K-, phiK+K-, and pppi+pi-. We also report new branching fraction measurements of phipi+pi- and omegapp and upper limits for etapi+pi-, etaK+K-, and phivpp. Results are compared, where possible, with the corresponding J/psi branching ratios to provide new tests of the 12% rule.

Branching fractions for psi(2S)-to-J/psi transitions

We describe new measurements of the inclusive and exclusive branching fractions for psi(2S) transitions to J/psi using e(+)e(-) collision data collected with the CLEO detector operating at CESR. All branching fractions and ratios of branching fractions reported here represent either the most precise measurements to date or the first direct measurements. Indirectly and in combination with other CLEO measurements, we determine B(chi(cJ) --> gamma(J/psi)) and B[psi(2S) --> light hadrons].

Quinolone-resistant Neisseria gonorrhoeae isolated in Sydney, Australia, 1991 to 1995

BACKGROUND AND OBJECTIVES

Quinolone antibiotics are used widely for the treatment of gonorrhea, but resistant strains appeared in Sydney in 1984, treatment failure with high-dose regimens in 1991, and isolates with very high minimal inhibitory concentrations (MICs) (16 mg/l) in 1994.

GOALS

To examine the frequency, source, and characteristics of Quinolone-resistant Neisseria gonorrhoeae (QRNG) in Sydney from 1991 to 1995 and to compare these data with those obtained from 1984 to 1990.

STUDY DESIGN

The antibiotic sensitivity, auxotype-serovar class, and geographic source of QRNG isolated in Sydney from January 1, 1991 to June 30, 1995 were analyzed.

RESULTS

One hundred seven QRNG were isolated from 97 patients from 1991 to 1995. The number, proportion, and MICs of QRNG increased slowly in the first 4 years of the study and rapidly in the last 6 months. Most QRNG were isolated from travelers entering Sydney from Asia. Twenty-seven different auxotype-serovar classes were detected including 6 auxotype-serovar classes in 14 isolates with high-level quinolone resistance (MIC, 16 mg/l).

CONCLUSIONS

QRNG isolated in Sydney during the past decade originated in Asia as multiple gonococcal subtypes and increased substantially in numbers and levels of resistance in 1995.

The sensitivity of 173 Sydney isolates of Neisseria gonorrhoeae to cefpodoxime and other antibiotics used to treat gonorrhea

One hundred and thirty seven consecutive isolates of Neisseria gonorrhoeae and a further 36 selected gonococci with either chromosomal (CMRNG) or plasmid mediated (PPNG) resistance to penicillin, all cultured in Sydney in 1993, were found to be sensitive to cefpodoxime, an oral third generation cephalosporin antibiotic (MIC range < 0.001-0.25 mg/L). All isolates were also sensitive to ceftriaxone and spectinomycin. Six gonococci showed high level resistance to tetracycline (TRNG, MIC = 32 mg/L) and 12 had decreased susceptibility to quinolone antibiotics (MIC range 0.06-0.5 mg/L). The MIC50 and MIC90 for both cefpodoxime and ceftriaxone were highest amongst CMRNG and ceftriaxone was 2 to 4 times as active as cefpodoxime weight for weight. Cefpodoxime may be a valuable additional oral agent for the treatment of gonorrhea in Australia. The sensitivity of gonococci to cefpodoxime can probably be inferred from values obtained for ceftriaxone.

A survey of sexually transmitted diseases in five STD clinics in Papua New Guinea

The first multicentre survey of sexually transmitted diseases (STDs) performed in Papua New Guinea was conducted in STD clinics in five towns, Port Moresby, Goroka, Rabaul, Lae and Daru, from September 1989 to May 1990. Infections with Neisseria gonorrhoeae and Chlamydia trachomatis (alone or in combination) were common. Penicillinase-producing N. gonorrhoeae (PPNG) represented 44% of all gonococcal isolates but significant intrinsic resistance to penicillin was not found. Of the other antibiotics tested, significant elevation of minimum inhibitory concentration (MIC) was common only for tetracycline, although no high-level tetracycline resistance was detected. C. trachomatis was detected by direct immunofluorescence (DIF) in 26% of 210 males and 27% of 64 females. 10% (21/210) of males and 11% (7/64) of females were both DIF positive for C. trachomatis and culture positive for N. gonorrhoeae. Of 203 males and 78 females tested, 5% and 12%, respectively, had serological evidence of current syphilis infection. Clinically, genital ulcer disease was most commonly due to syphilis, donovanosis or genital herpes, while specific vaginal infections were commonly seen in female patients attending Port Moresby and Lae STD clinics.

Effects of unopposed conjugated equine estrogen on lipoprotein composition and apolipoprotein-E distribution

Administration of conjugated equine estrogen to 31 postmenopausal women for 3 months produced 14.6% and 9.4% decreases in low density lipoprotein cholesterol (LDL-C) and apolipoprotein-B (apoB), and 11.5%, 12.7%, and 9.6% increases in high density lipoprotein cholesterol (HDL-C), apoA-I and apoA-II, respectively. Phospholipids of HDL2 and HDL3 were increased 57.9% and 19.3%, respectively, while relatively small increases in cholesterol of the two subfractions were not significant. Compositions of LDL and HDL and its subfractions were altered substantially with estrogen treatment. The proportion of LDL triglyceride to LDL-C was increased. The phospholipid content in both the HDL2 and HDL3 subfractions (compared to cholesterol) was increased significantly (34.8% and 10.7%, respectively), while the triglyceride content was increased only in the HDL2 subfraction (43.6%). Estrogen use also caused a 9.1% reduction in total apoE levels and a redistribution of apoE to the very low density lipoprotein (VLDL) from the LDL plus HDL fraction, resulting in a significant 19.5% decrease in apoE in the LDL plus HDL fraction. Changes in apoE in the VLDL fraction were associated positively with changes in the cholesterol levels of the VLDL fraction and inversely with changes in LDL-C and apoB levels, while changes in apoE in the LDL plus HDL fraction were associated positively with changes in the levels of HDL-C. Thus, estrogen causes alterations in lipoproteins that could potentially affect their metabolism and/or function.

Strain characteristics and antibiotic susceptibility of isolates of Neisseria gonorrhoeae causing disseminated gonococcal infection in Australia. Members of the Australian Gonococcal Surveillance Programme

The auxotype (A) and serovar (S) distribution and antibiotic and serum sensitivity of 22 strains of Neisseria gonorrhoeae isolated from blood and joints were determined. With one exception, these strains from disseminated gonococcal infections (DGI) belonged to one of 4 serovars of the IA serogroup and were resistant to killing by normal human serum. The auxotype distribution of these Australian strains differed significantly from that reported elsewhere in that 17 of the 22 isolates were proline requires, but none were of the AHU auxotype. This lack of the AHU auxotype in the DGI strains in Australia was explained by the virtual absence of AHU requirers in a sample of 1560 mucosal strains isolated in Sydney and Darwin from 1987 to 1990. The A/S distribution of these mucosal isolates also helped to account for the low (0.12) percentage of DGI strains in isolates examined by the Australian Gonococcal Surveillance Programme (AGSP) from 1981 to 1991, and the differences in the rates of DGI in Sydney (0.08%) and Darwin (0.87%). There was a relative lack of the IA serogroup strains which are mostly responsible for DGI in the mucosal isolates from Sydney (15% of all strains) but a higher proportion of these serovars (40%) in the Darwin sample. There were 46 cases of DGI in data from the AGSP, 29 of these being women. Seven of the cases diagnosed in Australia were infected with penicillinase-producing gonococci suggesting that antibiotics other than the penicillins should now be used for this condition in this region.

Characteristics of Neisseria gonorrhoeae isolated in Australia showing decreased sensitivity to quinolone antibiotics

Forty three strains of Neisseria gonorrhoeae with decreased sensitivity to quinolone antibiotics were detected amongst 2141 Australian isolates of gonococci examined in the years 1984 to 1990. The strains examined belonged to 23 different auxotype/serovar classes, were generally more resistant to other antibiotics and, in the majority of cases, were isolated from travellers entering or returning to Australia from SE Asia. Quinolone-sensitive wild-type gonococci became less sensitive to these agents in vitro at a relatively high frequency when grown in the presence of quinolone concentrations at or around the MIC (Mean Inhibitory Concentration) of the antibiotic. Further increments in the levels of quinolone resistance of the already less-sensitive gonococci were also produced by this means, but high-level resistance to these agents was not observed. This suggests that mechanisms other than alterations in the DNA-gyrase of the organisms were responsible for the changes seen. Although spread of quinolone resistance in gonococci in Australia is unlikely to be rapid, if these antibiotics are used in therapy, treatment regimens with higher rather than lower dosages of quinolone antibiotics should be employed.

Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical correlates. National Institute of Child Health and Human Development Neonatal Research Network

We studied the occurrence of necrotizing enterocolitis in 2681 very low birth weight infants during an 18-month period to characterize the biodemographic and clinical correlates. Proven necrotizing enterocolitis (Bell stage II and beyond) occurred in 10.1% of study infants; necrotizing enterocolitis was suspected in 17.2% of study infants. Positivity of blood cultures was related to necrotizing enterocolitis staging. The mortality rate increased only for stage III necrotizing enterocolitis (54% died). Logistic regression identified medical center of birth, race, gender, birth weight, maternal hemorrhage, duration of ruptured membranes, and cesarean section as significant risk factors. For one center the odds ratio was 3.7, whereas for another center it was only 0.3. For black boys, the odds ratio was 2.3 relative to nonblack boys; for girls, race did not affect prevalence of necrotizing enterocolitis. Age at onset was related to birth weight and gestational age. Intercenter differences in necrotizing enterocolitis prevalence were related to time required to regain birth weight and other indicators of fluid management. Gram-positive organisms predominated in positive blood cultures for stage I and II necrotizing enterocolitis; enteric bacteria were isolated more frequently in infants with stage III disease. We conclude that necrotizing enterocolitis prevalence varies greatly among centers; this may be related to early clinical practices of neonatal care.

The hemolytic and cytolytic activity of group B streptococcal hemolysin and its possible role in early onset group B streptococcal disease

The in vitro and cytolytic properties of the hemolysin of group B streptococcus (GBS) were investigated using sheep erythrocytes and McCoy cells adapted for growth in a serum-deficient medium. The relationship between the hemolysin, various carrier molecules and phospholipids was examined. Starch-based carriers interfered with the inhibitory activity of phospholipids and solvents for the phospholipids reduced the activity of the hemolysin. These technical problems were resolved by use of an albumin-based carrier, a strain producing large amounts of hemolysin and sonication of the phospholipid. The hemolysin was cytolytic for McCoy cells and this activity and its hemolytic action on sheep erythrocytes were inhibited by a number of phospholipid components of surfactant. It is possible that GBS hemolysin has a direct or indirect role in the pathogenesis of the pneumonitis of early onset GBS infection.

Effects of conjugated equine estrogen with and without three different progestogens on lipoproteins, high-density lipoprotein subfractions, and apolipoprotein A-I

The effects of conjugated equine estrogen and subsequent cyclical progestogen supplementation on lipoprotein and apolipoprotein A-I levels were investigated in three groups of postmenopausal women. Unopposed conjugated equine estrogen (0.625 mg) lowered total cholesterol 4-8% and low-density lipoprotein (LDL) cholesterol 12-19% below pre-treatment levels in all three groups. Levels of high-density lipoprotein (HDL) cholesterol and apolipoprotein A-I were increased 9-13 and 9-18%, respectively, with unopposed estrogen. The increase in HDL cholesterol was mainly due to increases in the high-density lipoprotein2 (HDL2) subfraction. Addition of medroxyprogesterone acetate, norethindrone acetate, or d,l-norgestrel at doses shown previously to provide protection against endometrial hyperplasia reversed some of the beneficial estrogen effects, reducing levels of HDL cholesterol 14-17%, HDL2 cholesterol 22-37%, and apolipoprotein A-I 11-15% from those obtained with unopposed estrogen. The LDL cholesterol levels fell 12-19% with unopposed estrogen but remained 7-12% below baseline when progestogens were added. These observations demonstrate that after 3 months of treatment, all three progestogens reversed some of the favorable effects of unopposed estrogen on lipoproteins but permitted a continued modest reduction in LDL cholesterol.

Maltose-negative Neisseria meningitidis isolated from a case of male urethritis

A maltose-negative strain of Neisseria meningitidis isolated from a male patient with urethritis was initially identified as a gonococcus on the basis of carbohydrate utilization tests. Additional investigations initiated because of atypical colony morphology and a negative superoxol reaction showed the isolate to be a meningococcus with defective maltose-phosphorylating capacity.

Predictive value of renal pathology in diffuse proliferative lupus glomerulonephritis. Lupus Nephritis Collaborative Study Group

We tested the value of the activity (AI) and chronicity (CI) indices devised by Austin et al as predictors of outcome in lupus patients with diffuse proliferative glomerulonephritis (DPGN). Four renal pathologists independently scored the AI and CI on 84 renal biopsy specimens from patients with lupus DPGN followed for 109 +/- 74 weeks (mean +/- SD), and the mean score was compared to the development of renal failure and to adverse outcome (combined data for renal failure, death and predefined clinical stop points). Receiver operator characteristic curves were derived from a series of 2 x 2 tables in which one variable was renal failure or adverse outcome and the other variable was AI or CI dichotomized by a cut-off point. Over the entire range (0 to 10) of the CI there was no value that separated patients who developed renal failure from those who did not. The ROC curve analysis indicated that the sensitivity and specificity of the CI were too low to allow it to function as a good test. Once patients entering renal failure were identified, the mean CI approached but did not reach a significant difference when compared to the mean CI of those who did not go into renal failure (4.38 +/- 0.42, mean +/- SE vs. 3.19 +/- 0.23, P = 0.0620). The CI did not predict the adverse clinical outcomes. There was no cut-off value of the CI which separated patients who had an adverse outcome from those who did not, and this result was confirmed by ROC analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Biochemical classification of circulating immune complexes in human malignant melanoma and hematologic neoplasms

Circulating immune complexes (CIC) in human cancer are known to be very heterogeneous in size and composition. In 95 staged malignant melanoma patients and 71 individuals with leukemia and lymphoma, this heterogeneity was analyzed biochemically in sera positive for CIC. CICs were measured by a multiassay system and individual complexes were isolated and analyzed by immunological and biochemical methods. Analyses of sera from 100 normal individuals, from 25 rheumatoid women, and a group of 12 laboratory staff who work with human melanoma were included for comparison. Three basic patterns of complexes were identified circulating in the sera of the cancer patients. Type I are medium-sized (17-23S), complement-fixing complexes usually occurring in combinations. The prototype in melanoma contained IgG antibody and additional glycoprotein components and bound complement by the classical pathway. In hematological malignancies four subtypes could be identified depending on whether the antibody class was IgG or IgM, the nonimmunoglobulin component was glycoprotein or protein, and whether complement fixation occurred by the classical or alternate pathway. Type II complexes were noncomplement-fixing, medium-sized complexes (15-21S), which in melanoma contained IgG antibody and additional protein components. In the hematologic malignancies two subtypes could be identified depending on whether the antibody class was IgG or IgM. Both subtypes contained a glycoprotein nonimmunoglobulin component. Both melanoma and hematologic tumors had type III heavy complexes (36-44S) which were noncomplement-fixing and contained only immunoglobulin components, either IgG-IgG or IgM-IgG. As expected the rheumatoid arthritis patients frequently had both 7S and 21-23S CICs containing IgG as well as IgM rheumatoid factor with complement fixation via the classical pathway. No CICs were detected in normal young men and women (20-30 years); a few individuals in middle age (31-50 years) had small (7-11S) CICs which bound complement by the classical pathway and contained IgG and a protein nonimmunoglobulin component. The frequency of these 7S complexes increased with advancing age, with the appearance of 23S IgG-IgG or IgM-IgG complexes. IgG antibodies from only the melanoma patients reacted with cytoplasmic components of fresh melanoma cells, except the laboratory workers where all of their isolated CIC antibodies also reacted with melanoma cells. Thus the heterogeneity of complexes in melanoma is not random, but can be classified into three basic biochemical patterns. The hematologic group provides a slightly richer variation of subtypes within this basic scheme.

Chromosomally mediated intrinsic resistance to penicillin of penicillinase producing strains of Neisseria gonorrhoeae isolated in Sydney: guide to treatment with Augmentin

Single dose Augmentin treatment fails to cure an appreciable proportion of patients infected with penicillinase producing Neisseria gonorrhoeae (PPNG) strains in parts of the world where high levels of chromosomally mediated intrinsic resistance are also present in gonococci. The levels of intrinsic resistance to penicillin of 31 PPNG strains isolated in Sydney were assessed by obtaining beta lactamase negative variants of these strains and measuring the minimum inhibitory concentration of penicillin by agar plate dilution techniques. The levels of intrinsic resistance found in these imported PPNG strains were higher than those recorded for local isolates of non-PPNG strains, which indicates that caution should be exercised in the use of single dose Augmentin treatment of infections with PPNG strains in Sydney.

Presumptive identification of group B streptococci by rapid detection of CAMP factor and pigment production

Modified rapid versions of CAMP and pigment tests were developed for the identification of group B streptococci using the supernatant and cell deposit of organisms grown for 4 hr in a modified Todd-Hewitt broth. All but one of 203 group B streptococci were reliably differentiated from 148 nongroup B strains.

The influence of nutritional and cultural factors on CAMP factor production by group B streptococci

Twelve group B streptococci were examined for their capacity to produce CAMP factor in liquid culture media in which the carbohydrate type and concentration and/or the buffering capacity of the media were altered. The effects of these variations of media content on CAMP factor production were determined and related to effects on growth yield and pH changes during growth. For 9 of the 12 strains tested higher CAMP factor titres were obtained in maltose broth than in glucose broth, and accompanying changes in pH were greater and more rapid in glucose containing media. It is suggested that the lesser pH changes occurring during growth in maltose broth may be the mechanism whereby higher CAMP titres were obtained with these strains. The influence of carbohydrate type was not observed with the remaining 3 strains tested, but maximum CAMP factor yields were obtained in the presence of maltose and non-inhibitory concentrations of buffer. CAMP factor production for all strains of GBS may be increased by the addition of maltose and buffer to standard media.

Streptococcus pyogenes streptolysin O as a cause of false-positive CAMP reactions

The synergistic hemolysis of sheep erythrocytes in the CAMP reaction by the sequential action of staphylococcal beta-lysin and the CAMP factor of group B streptococci is the only known function of this extracellular product of group B streptococci. The reaction forms the basis of the CAMP test used to identify group B streptococci because the CAMP factor is believed to be restricted to this group of organisms. However, on occasion other streptococci, notably group A streptococci, may produce a similar synergistic lysis of sheep erythrocytes. The nature of the synergistic lytic factor of group A streptococci responsible for this sequential hemolysis was investigated in a tube CAMP reaction system. The properties of this synergistic lytic factor were found to correspond to those of streptolysin O of group A streptococci. The synergistic lytic factor, like streptolysin O, was produced during the logarithmic phase of growth; the activity was increased by reducing agents and greatly decreased or abolished by heat, trypsin, cholesterol, and anti-streptolysin O, and it was immunogenic in rabbits. This would suggest that the synergistic hemolysis seen in the CAMP reaction system with group A streptococci is due to the action of those small amounts of streptolysin O which remain unoxidized and thus have a capacity to lyse the fragile beta-lysin-treated sheep erythrocytes.

Statistical methods for studying homozygous typing cells of unknown specificity

A situation can arise in D typing in which the HLA (A,B,C,D, or DR) specificities of the responders are known and the specificities of the HTC's are unknown. The most powerful and direct method of detecting association between the unknown stimulator (HTC) and any given HLA specificity is by comparing the observed double normalized values (DNV's) of individuals known to be positive for the specificity with the DNV's of negative individuals. This can be done by comparing the two groups with a Kolmogorov-Smirnov test (K-S test), an established statistical procedure for evaluating correlation between continuous variables, such as the DNV, and discrete variables (such as presence of D type). The application of the K-S test will generate as a "cutoff" value of point that maximizes the average of the frequencies of correct assignments in D positives and D negatives. We also propose an alternative method of computing the "r" value. We have analyzed 49 HTC's from the 8th International Workshop and present the association observed with the D and DR specificities.

Rapid tube CAMP test for identification of Streptococcus agalactiae (Lancefield group B)

A rapid CAMP test for the presumptive identification of Streptococcus agalactiae (Lancefield group B) is described. Sheep erythrocytes, sensitized by staphylococcal beta-lysin and suspended in phosphate-buffered saline, were used to determine the lytic capacity of the neutralized supernatant fluids of 4-h broth cultures of streptococci being tested. A total of 96.2% of 130 group B streptococci gave positive CAMP tests, that is, lysis of the sheep erythrocytes after 10 min of exposure of streptococcal supernatants, whereas none of 381 non-group B streptococci tested produced any lysis. The test described provides presumptive identification of group B streptococci within 4 h and eliminates problems of intermediate reactions so that a positive test is indicative only of CAMP factor production.

A cellulose acetate membrane precipitin (CAP) test for amoebiasis

A simple precipitin test (CAP) using cellulose acetate membrane has been devised and evaluated against the gel diffusion precipitin (GDP) test. In 251 sera tested by both methods, the CAP was never negative when the GDP was positive (110 sera). 34 sera were negative by the GDP but positive by the CAP; in all of these the patients either had a past history of amoebiasis or were considered to have active amoebiasis. The CAP is technically very simple, the result is available within four and a half hours, and the membranes can be impregnated with antigen and stored for several months. The CAP is slightly more sensitive than the GDP and remains positive longer after the patient has been cured; it seems to be equally specific.

Off-axis unstable laser resonator: operation

An experimental investigation of a novel unstable laser resonator configuration is reported. The purpose of the novel configuration is to maximize the area that can be illuminated with uniform intense flux by a given laser device. This is accomplished by displacing the optical axis of the resonator to one edge of the optical cavity. The results indicate that the change causes no loss of device output power and has little effect on the beam quality. Additional experimental results are presented indicating the sensitivity of resonator performance to misalignment of the off-axis resonator.

Development and implementation of a pharmacy technician training program

A nine-month on-the-job training program for hospital pharmacy technicians is described. The first three months of the program are devoted to didactic training and the remaining six months to acquiring practical experience. Candidates for the program are provided through state-sponsored public assistance or manpower training programs. A minimum of six individuals are needed to begin a program to ensure that during at least three complete it. Forth technicians have completed the program during the past six years, and eight are currently employed by the hospital. Thirteen others are known to be employed at other institutions or in health-related occupations.