Aerosol containment device design considerations and performance evaluation metrics

BACKGROUND

Spurred by the Coronavirus infectious disease 2019 pandemic, aerosol containment devices (ACDs) were developed to capture infectious respiratory aerosols generated by patients at their source. Prior reviews indicated that such devices had low evidence of effectiveness, but did not address how ACDs should be evaluated, how well they should perform, nor have clearly defined performance standards. Towards developing design criteria for ACDs, two questions were posed: 1) What characteristics have guided the design of ACDs? 2) How have these characteristics been evaluated?

METHODS

A scoping review was performed consistent with PRISMA guidelines. Data were extracted with respect to general study information, intended use of the device, device design characteristics and evaluation.

RESULTS

Fifty-four articles were included. Evaluation was most commonly performed with respect to device aerosol containment (n = 31, 61%), with only 5 (9%), 3 (6%) and 8 (15%) formally assessing providing experience, patient experience and procedure impact, respectively. Nearly all of the studies that explored provider experience and procedure impact studied intubation. Few studies provided a priori performance criteria for any evaluation metric, or referenced any external guidelines by which to bench mark performance.

CONCLUSION

With respect to aerosol containment, ACDs should reduce exposure among HCP with the device compared with the absence of the device, and provide ≥90% reduction in respirable aerosols, equivalent in performance to N95 filtering facepiece respirators, if the goal is to reduce reliance on personal protective equipment. The ACD should not increase awkward or uncomfortable postures, or adversely impact biomechanics of the procedure itself as this could have implications for procedure outcomes. A variety of standardized instruments exist to assess the experience of patients and healthcare personnel. Integration of ACDs into routine clinical practice requires rigorous studies of aerosol containment and the user experience.

Afterslip Moment Scaling and Variability From a Global Compilation of Estimates

Aseismic afterslip is postseismic fault sliding that may significantly redistribute crustal stresses and drive aftershock sequences. Afterslip is typically modeled through geodetic observations of surface deformation on a case-by-case basis, thus questions of how and why the afterslip moment varies between earthquakes remain largely unaddressed. We compile 148 afterslip studies following 53 M _w 6.0-9.1 earthquakes, and formally analyze a subset of 88 well-constrained kinematic models. Afterslip and coseismic moments scale near-linearly, with a median Spearman's rank correlation coefficient (CC) of 0.91 after bootstrapping (95% range: 0.89-0.93). We infer that afterslip area and average slip scale with coseismic moment as M o 2 / 3 and M o 1 / 3 , respectively. The ratio of afterslip to coseismic moment (M _rel ) varies from <1% to >300% (interquartile range: 9%-32%). M _rel weakly correlates with M _o (CC: -0.21, attributed to a publication bias), rupture aspect ratio (CC: -0.31), and fault slip rate (CC: 0.26, treated as a proxy for fault maturity), indicating that these factors affect afterslip. M _rel does not correlate with mainshock dip, rake, or depth. Given the power-law decay of afterslip, we expected studies that started earlier and spanned longer timescales to capture more afterslip, but M _rel does not correlate with observation start time or duration. Because M _rel estimates for a single earthquake can vary by an order of magnitude, we propose that modeling uncertainty currently presents a challenge for systematic afterslip analysis. Standardizing modeling practices may improve model comparability, and eventually allow for predictive afterslip models that account for mainshock and fault zone factors to be incorporated into aftershock hazard models.

Comparison of technical and systems-based approaches to managing pesticide contamination in surface water catchments

Diffuse pollution of surface waters by herbicides remains a problem despite 25 years of research into mitigation approaches. This study adopts the grassweed herbicide propyzamide as a focus to compare the efficacy of technical, field-scale, interventions with systems-based cropping solutions in a 900 ha headwater catchment on heavy clay soils. Catchment monitoring was combined with modelling of land management options using SWAT, and semi-structured discussions with farmers. Vegetated buffers are the main mitigation in the catchment at present, and these are estimated to be halving propyzamide concentrations in the headwater stream. Increasing vegetated buffers to 20 m width around all water courses would be the most effective technical intervention. Collaboration between farmers to ensure differentiated application timings would be ineffective without precise forecasting to avoid application soon before storm events. Downstream pesticide limits could only be met by restricting the area of land treated with propyzamide, requiring a switch away from oilseed rape cultivation. This restriction was not acceptable to farmers who noted the lack of enablers for coordination between landowners and the need for pesticide targets that are specific to headwater catchments.

Small Water Bodies in Great Britain and Ireland: Ecosystem function, human-generated degradation, and options for restorative action

Small, 1st and 2nd-order, headwater streams and ponds play essential roles in providing natural flood control, trapping sediments and contaminants, retaining nutrients, and maintaining biological diversity, which extend into downstream reaches, lakes and estuaries. However, the large geographic extent and high connectivity of these small water bodies with the surrounding terrestrial ecosystem makes them particularly vulnerable to growing land-use pressures and environmental change. The greatest pressure on the physical processes in these waters has been their extension and modification for agricultural and forestry drainage, resulting in highly modified discharge and temperature regimes that have implications for flood and drought control further downstream. The extensive length of the small stream network exposes rivers to a wide range of inputs, including nutrients, pesticides, heavy metals, sediment and emerging contaminants. Small water bodies have also been affected by invasions of non-native species, which along with the physical and chemical pressures, have affected most groups of organisms with consequent implications for the wider biodiversity within the catchment. Reducing the impacts and restoring the natural ecosystem function of these water bodies requires a three-tiered approach based on: restoration of channel hydromorphological dynamics; restoration and management of the riparian zone; and management of activities in the wider catchment that have both point-source and diffuse impacts. Such activities are expensive and so emphasis must be placed on integrated programmes that provide multiple benefits. Practical options need to be promoted through legislative regulation, financial incentives, markets for resource services and voluntary codes and actions.

The functional response and resilience in small waterbodies along land-use and environmental gradients

There is growing recognition of the essential services provided to humanity by functionally intact ecosystems. Freshwater ecosystems are found throughout agricultural and urban landscapes and provide a wide range of ecosystem services, but globally they are also amongst the most vulnerable. In particular, ponds (lentic waters typically less than 2 ha), provide natural flood management, sequester carbon and hold significant cultural value. However, to inform their management it is important to understand (1) how functional diversity varies in response to disturbance and (2) the link between biodiversity conservation and ecosystem function. In this study, a meta-analysis of seven separate pond studies from across England and Wales was carried out to explore the effect of urban and agricultural land-use gradients, shading, emergent vegetation, surface area and pH upon groups of functionally similar members of the macroinvertebrate fauna. Functional effect groups were first identified by carrying out a hierarchical cluster analysis using body size, voltinism and feeding habits (18 categories) that are closely related to biogeochemical processes (e.g. nutrient and carbon recycling). Secondly, the influence of the gradients upon effect group membership (functional redundancy-FR) and the breadth of traits available to aid ecosystem recovery (response diversity) was assessed using species counts and functional dispersion (FDis) using 12 response traits. The effect of land-use gradients was unpredictable, whilst there was a negative response in both FR and FDis to shading and positive responses to increases in emergent vegetation cover and surface area. An inconsistent association between FDis and FR suggested that arguments for taxonomic biodiversity conservation to augment ecosystem functioning are too simplistic. Thus, a deeper understanding of the response of functional diversity to disturbance could have greater impact with decision-makers who may relate better to the loss of ecosystem function in response to environmental degradation than species loss alone.

Orbit period modulation for relative motion using continuous low thrust in the two-body and restricted three-body problems

This paper presents rich new families of relative orbits for spacecraft formation flight generated through the application of continuous thrust with only minimal intervention into the dynamics of the problem. Such simplicity facilitates implementation for small, low-cost spacecraft with only position state feedback, and yet permits interesting and novel relative orbits in both two- and three-body systems with potential future applications in space-based interferometry, hyperspectral sensing, and on-orbit inspection. Position feedback is used to modify the natural frequencies of the linearised relative dynamics through direct manipulation of the system eigenvalues, producing new families of stable relative orbits. Specifically, in the Hill-Clohessy-Wiltshire frame, simple adaptations of the linearised dynamics are used to produce a circular relative orbit, frequency-modulated out-of-plane motion, and a novel doubly periodic cylindrical relative trajectory for the purposes of on-orbit inspection. Within the circular restricted three-body problem, a similar minimal approach with position feedback is used to generate new families of stable, frequency-modulated relative orbits in the vicinity of a Lagrange point, culminating in the derivation of the gain requirements for synchronisation of the in-plane and out-of-plane frequencies to yield a singly periodic tilted elliptical relative orbit with potential use as a Lunar far-side communications relay. The Δ v requirements for the cylindrical relative orbit and singly periodic Lagrange point orbit are analysed, and it is shown that these requirements are modest and feasible for existing low-thrust propulsion technology.

Finding clean water habitats in urban landscapes: professional researcher vs citizen science approaches

This study investigated patterns of nutrient pollution in waterbody types across Greater London. Nitrate and phosphate data were collected by both citizen scientists and professional ecologists and their results were compared. The professional survey comprised 495 randomly selected pond, lake, river, stream and ditch sites. Citizen science survey sites were self-selected and comprised 76 ponds, lakes, rivers and streams. At each site, nutrient concentrations were assessed using field chemistry kits to measure nitrate-N and phosphate-P. The professional and the citizen science datasets both showed that standing waterbodies had significantly lower average nutrient concentrations than running waters. In the professional datasets 46% of ponds and lakes had nutrient levels below the threshold at which biological impairment is likely, whereas only 3% of running waters were unimpaired by nutrients. The citizen science dataset showed the same broad pattern, but there was a trend towards selection of higher quality waterbodies with 77% standing waters and 14% of rivers and streams unimpaired. Waterbody nutrient levels in the professional dataset were broadly correlated with landuse intensity. Rivers and streams had a significantly higher proportion of urban and suburban land cover than other waterbody types. Ponds had higher percentage of semi-natural vegetation within their much smaller catchments. Relationships with land cover and water quality were less apparent in the citizen-collected dataset probably because the areas visited by citizens were less representative of the landscape as whole. The results suggest that standing waterbodies, especially ponds, may represent an important clean water resource within urban areas. Small waterbodies, including ponds, small lakes<50ha and ditches, are rarely part of the statutory water quality monitoring programmes and are frequently overlooked. Citizen scientist data have the potential to partly fill this gap if they are co-ordinated to reduce bias in the type and location of the waterbodies selected.

Urban ponds as an aquatic biodiversity resource in modified landscapes

Urbanization is a global process contributing to the loss and fragmentation of natural habitats. Many studies have focused on the biological response of terrestrial taxa and habitats to urbanization. However, little is known regarding the consequences of urbanization on freshwater habitats, especially small lentic systems. In this study, we examined aquatic macro-invertebrate diversity (family and species level) and variation in community composition between 240 urban and 782 nonurban ponds distributed across the United Kingdom. Contrary to predictions, urban ponds supported similar numbers of invertebrate species and families compared to nonurban ponds. Similar gamma diversity was found between the two groups at both family and species taxonomic levels. The biological communities of urban ponds were markedly different to those of nonurban ponds, and the variability in urban pond community composition was greater than that in nonurban ponds, contrary to previous work showing homogenization of communities in urban areas. Positive spatial autocorrelation was recorded for urban and nonurban ponds at 0-50 km (distance between pond study sites) and negative spatial autocorrelation was observed at 100-150 km and was stronger in urban ponds in both cases. Ponds do not follow the same ecological patterns as terrestrial and lotic habitats (reduced taxonomic richness) in urban environments; in contrast, they support high taxonomic richness and contribute significantly to regional faunal diversity. Individual cities are complex structural mosaics which evolve over long periods of time and are managed in diverse ways. This facilitates the development of a wide range of environmental conditions and habitat niches in urban ponds which can promote greater heterogeneity between pond communities at larger scales. Ponds provide an opportunity for managers and environmental regulators to conserve and enhance freshwater biodiversity in urbanized landscapes whilst also facilitating key ecosystem services including storm water storage and water treatment.

Developing and enhancing biodiversity monitoring programmes: a collaborative assessment of priorities

Biodiversity is changing at unprecedented rates, and it is increasingly important that these changes are quantified through monitoring programmes. Previous recommendations for developing or enhancing these programmes focus either on the end goals, that is the intended use of the data, or on how these goals are achieved, for example through volunteer involvement in citizen science, but not both. These recommendations are rarely prioritized.We used a collaborative approach, involving 52 experts in biodiversity monitoring in the UK, to develop a list of attributes of relevance to any biodiversity monitoring programme and to order these attributes by their priority. We also ranked the attributes according to their importance in monitoring biodiversity in the UK. Experts involved included data users, funders, programme organizers and participants in data collection. They covered expertise in a wide range of taxa.We developed a final list of 25 attributes of biodiversity monitoring schemes, ordered from the most elemental (those essential for monitoring schemes; e.g. articulate the objectives and gain sufficient participants) to the most aspirational (e.g. electronic data capture in the field, reporting change annually). This ordered list is a practical framework which can be used to support the development of monitoring programmes.People's ranking of attributes revealed a difference between those who considered attributes with benefits to end users to be most important (e.g. people from governmental organizations) and those who considered attributes with greatest benefit to participants to be most important (e.g. people involved with volunteer biological recording schemes). This reveals a distinction between focussing on aims and the pragmatism in achieving those aims. Synthesis and applications. The ordered list of attributes developed in this study will assist in prioritizing resources to develop biodiversity monitoring programmes (including citizen science). The potential conflict between end users of data and participants in data collection that we discovered should be addressed by involving the diversity of stakeholders at all stages of programme development. This will maximize the chance of successfully achieving the goals of biodiversity monitoring programmes.

Global link between deformation and volcanic eruption quantified by satellite imagery

A key challenge for volcanological science and hazard management is that few of the world’s volcanoes are effectively monitored. Satellite imagery covers volcanoes globally throughout their eruptive cycles, independent of ground-based monitoring, providing a multidecadal archive suitable for probabilistic analysis linking deformation with eruption. Here we show that, of the 198 volcanoes systematically observed for the past 18 years, 54 deformed, of which 25 also erupted. For assessing eruption potential, this high proportion of deforming volcanoes that also erupted (46%), together with the proportion of non-deforming volcanoes that did not erupt (94%), jointly represent indicators with ‘strong’ evidential worth. Using a larger catalogue of 540 volcanoes observed for 3 years, we demonstrate how this eruption–deformation relationship is influenced by tectonic, petrological and volcanic factors. Satellite technology is rapidly evolving and routine monitoring of the deformation status of all volcanoes from space is anticipated, meaning probabilistic approaches will increasingly inform hazard decisions and strategic development.

Deformation is often used in volcano monitoring, but the associated hazard is hard to interpret. Biggs et al. analyse 20 years of global satellite data and show a strong statistical link between deformation and eruption, although deformation alone is not necessarily a precursor of imminent eruption.

Impacts of differences in epidemiological case definitions on prevalence for upper-extremity musculoskeletal disorders

OBJECTIVE

The aim of this study was to systematically evaluate prevalence based on variations in case definitions used for epidemiological studies of musculoskeletal disorders (MSDs).

BACKGROUND

Prior studies of MSDs have mostly relied on a single case definition based on questionnaires.

METHOD

In a multicenter prospective cohort study, we systematically collected data to evaluate impacts of differences in case definitions of MSDs on prevalence of three common musculoskeletal disorders: (a) shoulder tendinosis, (b) lateral epicondylalgia, and (c) carpal tunnel syndrome. Production workers were from 21 employment settings in three diverse U.S. states and performed widely varying work. All workers completed laptop-administered structured interviews, two standardized physical examinations, and nerve conduction studies (NCS). Case definitions included symptoms only, and symptoms plus physical examinations and/or NCS.

RESULTS

A total of 1,227 subjects had complete health data at baseline. The prevalence for shoulder tendinosis is 23.0% if only glenohumeral pain is used for a case definition, compared with 8.0% if a combination of pain plus a positive supraspinatus test is used. The prevalence for lateral epicondylalgia varied on the basis of lateral elbow pain (12.0%), pain plus tenderness on palpation (9.9%), or pain plus tenderness on palpation plus resisted wrist or middle finger extension (3.5%). Carpal tunnel syndrome prevalence varied on the basis of tingling or numbness in a median nerve-served digit (29.9%) or tingling or numbness plus NCS abnormalities consistent with carpal tunnel syndrome (9.0%).

CONCLUSION

Variations in epidemiological case definitions have major impacts on prevalence of common MSDs. Wide-ranging differences in prevalence may have impacts on purported risk factors that need to be determined.

Low-back pain ratings for lifetime, 1-month period, and point prevalences in a large occupational population

OBJECTIVE

This manuscript systematically quantifies multiple measures of low-back pain (LBP) prevalence by pain rating in a large, multisite cohort of workers.

BACKGROUND

Published LBP prevalence rates vary. Studies rely on one measure of LBP and none report prevalence stratified by pain rating.

METHOD

Cross-sectional analyses of baseline data from a multicenter prospective cohort study were performed to evaluate differences in lifetime prevalence, 1-month period prevalence, and point prevalence of LBP. Workers were from 28 different employment settings in 4 diverse U.S. states. All workers completed computerized questionnaires and structured interviews. LBP prevalence measures were stratified by pain ratings.

RESULTS

A total of 828 subjects had complete health data at baseline. Lifetime prevalence, 1-month period prevalence, and point prevalence for any LBP (> or = 1/10) were 63.4%, 44.0%, and 20.8% respectively. Prevalence of LBP decreased with increasing pain ratings. As an example, using a threshold of LBP > or = 3/10 pain, prevalence measures were 61.0%, 37.6%, and 16.7% respectively. A threshold of LBP > or = 5/10 had prevalence measures of 51.2%, 22.9%, and 9.9% respectively. Age, systolic and diastolic blood pressure, high cholesterol, high blood pressure, and tobacco use were statistically significantly related to lifetime prevalence of LBP.

CONCLUSION

Lifetime LBP prevalence, 1-month period prevalence, and point prevalence stratified by pain ratings demonstrate a wide variation of prevalence measures of LBP and self-reported pain ratings. Higher pain rating thresholds yield lower prevalence measures and may impact assessments of risk factors. Differences in pain ratings may allow for focused surveillance within an occupational cohort.

Electrical stimulation for chronic non-specific low back pain in a working-age population: a 12-week double blinded randomized controlled trial

Background

Non-invasive electrotherapy is commonly used for treatment of chronic low back pain. Evidence for efficacy of most electrotherapy modalities is weak or lacking. This study aims to execute a high-quality, double-blinded randomized controlled clinical trial comparing 1) H-Wave® Device stimulation plus usual care with 2) transcutaneous electrical nerve stimulation (TENS) plus usual care, and 3) Sham electrotherapy plus usual care to determine comparative efficacy for treatment of chronic non-specific low back pain patients.

Methods/Design

Patients- Chronic non-specific low back pain patients between ages of 18–65 years, with pain of at least 3 months duration and minimal current 5/10 VAS pain. Patients will have no significant signs or symptoms of lumbosacral nerve impingement, malignancy, spinal stenosis, or mood disorders.

Study design- Double blind RCT with 3 arms and 38 subjects per arm. Randomization by permuted blocks of random length, stratified by Workers Compensation claim (yes vs. no), and use of opioids. The null hypothesis of this study is that there are no statistically significant differences in functional improvement between treatment types during and at the end of a 12-week week treatment period.

Data collection- Subjective data will be collected using Filemaker Pro™ database management collection tools. Objective data will be obtained through functional assessments. Data will be collected at enrollment and at 1, 4, 8, and 12 weeks for each participant by a blinded assessor.

Interventions- H-Wave® device stimulation (Intervention A) plus usual care, transcutaneous electrical nerve stimulation (TENS) (Intervention B) plus usual care, and sham electrotherapy plus usual care (control). Each treatment arm will have identical numbers of visits (4) and researcher contact time (approximately 15 hours).

Outcomes- Primary outcome measure: Oswestry Disability Index. Secondary measures include: Rowland Morris Instrument, VAS pain score, functional evaluation including strength when pushing and pulling, pain free range of motion in flexion and extension. Outcome measures assessed at baseline, 1, 4, 8, and 12 weeks. Treatment failure will be defined if patient terminates assigned treatment arm for non-efficacy or undergoes invasive procedure or other excluded cointerventions. Data will be analyzed using intention-to-treat analysis and adjusted for covariates related to LBP (e.g. age) as needed.

Discussion

Study strengths include complex randomization, treatment group allocation concealment, double blinding, controlling for co-interventions, rigorous inclusion criteria, assessment of compliance, plans for limiting dropout, identical assessment methods and timing for each treatment arm, and planned intention-to-treat analyses.

The influence of simulated immigration and chemical persistence on recovery of macroinvertebrates from cypermethrin and 3,4-dichloroaniline exposure in aquatic microcosms

BACKGROUND

Chemical dissipation and organism immigration are considered important factors that influence recovery potential from perturbation of aquatic macroinvertebrates. Experiments were conducted to investigate the effect of simulated immigration on recovery of aquatic macroinvertebrates exposed in outdoor microcosms to ecotoxicologically similar concentrations of the rapidly dissipating pyrethroid insecticide cypermethrin (70 ng L(-1)) or the more persistent herbicide intermediate and degradate 3,4-dichloroaniline (10 mg L(-1)). Microcosms were covered with light-permeable mesh to prevent recolonisation. Immigration was simulated by the regular addition of organisms after treatment.

RESULTS

Microcosms exposed to 3,4-dichloroaniline treatment suffered substantial loss of taxon richness and by 10 months after treatment had only recovered where invertebrates had been added. Those treated with cypermethrin underwent an initial decline in certain crustacean and insect populations. These populations showed some signs of recovery over a period of 5 months through internal processes alone. However, rate of recovery was further enhanced where immigration was simulated, and in this case recovery had occurred around 100 days after treatment.

CONCLUSION

Although not the only factors involved, simulated immigration and chemical fate clearly influence the ability of communities to recover from chemical exposure. Consideration of immigration processes and development of models will help to increase the realism of risk assessments.

SPEAR indicates pesticide effects in streams--comparative use of species- and family-level biomonitoring data

To detect effects of pesticides on non-target freshwater organisms the Species at risk (SPEAR(pesticides)) bioindicator based on biological traits was previously developed and successfully validated over different biogeographical regions of Europe using species-level data on stream invertebrates. Since many freshwater biomonitoring programmes have family-level taxonomic resolution we tested the applicability of SPEAR(pesticides) with family-level biomonitoring data to indicate pesticide effects in streams (i.e. insecticide toxicity of pesticides). The study showed that the explanatory power of the family-level SPEAR(fm)(pesticides) is not significantly lower than the species-level index. The results suggest that the family-level SPEAR(fm)(pesticides) is a sensitive, cost-effective, and potentially European-wide bioindicator of pesticide contamination in flowing waters. Class boundaries for SPEAR(pesticides) according to EU Water Framework Directive are defined to contribute to the assessment of ecological status of water bodies.

How realistic are outdoor microcosms? A comparison of the biota of microcosms and natural ponds

This study investigated the extent to which aquatic plant and macroinvertebrate assemblages in small outdoor microcosms (cylinders 1.25-m diameter x 1.25 m deep) resembled assemblages found in natural ponds in Britain. Comparisons were made in terms of community structure, species richness, and numbers of uncommon species. Multivariate analysis indicated that, although the microcosms had no exact natural analogues, their plant and animal assemblages were most like those of deep, circumneutral ponds. Unlike natural ponds, the microcosms supported relatively species-poor invertebrate assemblages, lacking uncommon species. Among individual taxa, microcosms supported similar numbers of species of Gastropoda, Isopoda, Amphipoda, and Odonata as natural ponds but significantly fewer Coleoptera, Hemiptera, and Trichoptera species. This was most likely due to the absence of a shallow littoral area in the microcosms. Because of their vertical sides, the microcosms supported no marginal wetland plants, but submerged and floating-leaved plant assemblages were similar in community type and species richness to natural ponds. Refinements to microcosm and mesocosm designs are identified that would enable experimental systems to more closely replicate the assemblages found in natural ponds. In particular, the incorporation of natural margins would be likely to lead to experimental communities that were closer analogues of natural ponds.

Regional mapping of low-affinity kainate receptors in mouse brain using [(3)H](2S,4R)-4-methylglutamate autoradiography

Recent data indicate that (2S,4R)-4-methylglutamate is a selective agonist for low affinity (GluR5 and GluR6) kainate receptor subunits. In the present study, we have employed [(3)H](2S,4R)-4-methylglutamate to examine low affinity kainate receptor distribution in mouse brain. [(3)H](2S,4R)-4-Methylglutamate labelled a single site in murine cerebrocortical membranes (K(d)=9.9+/-2.7 nM, B(max)=296.3+/-27.1 fmol mg protein(-1)). The binding of 8 nM [(3)H](2S,4R)-4-methylglutamate was displaced by several non-NMDA receptor ligands (K(i)+/-S.E.M.): domoate (1.1+/-0.2 nM)>kainate (7.1+/-1.1 nM) >> L-glutamate (187.6+/-31.9 nM) >> (S)-alpha-amino-3-hydroxy-5-methyl-4-isoazolepropionic acid (AMPA) (>50 microM). [(3)H](2S,4R)-4-Methylglutamate autoradiography revealed a widespread regional distribution of low affinity kainate receptors. Highest binding densities occurred within deep layers of the cerebral cortex, olfactory bulb, basolateral amygdala and hippocampal CA3 subregion. Moderate labelling was also evident in the nucleus accumbens, dentate gyrus, caudate putamen, hypothalamus and cerebellar granule cell layer. These data show that [(3)H](2S,4R)-4-methylglutamate is a useful radioligand for selectively labelling low affinity kainate receptors.

Peripheral blood stem cell transplantation for rheumatoid arthritis--Australian experience

Trials of high dose immunosuppression and peripheral blood stem cell transplantation (PBSCT) in patients with severe rheumatoid arthritis (RA) have now commenced based on encouraging data from case reports of patients with coexistent malignancy and animal transplant models. Early case reports in Australia documented the potential for cure of RA in most patients receiving allogeneic or syngeneic transplants. However, the relatively high morbidity and mortality of these procedures has necessitated the use of autologous PBSCT. in accordance with international guidelines released by the EBMT/EULAR working party. Phase I trials in autologous PBSCT have seen substantial remissions of RA in the majority of patients who had previously failed all available therapies. Recurrence of disease occurs in most patients usually within 2 years; however, the use of disease modifying agents after recurrence results in substantial amelioration of the disease, again suggesting a form of "immunomodulation." This observation raises the possibility of maintenance therapy associated with procedure to prolong responses. Other modifications of the procedure are discussed, including T cell depletion of the graft, currently the subject of a randomized trial.

Electrical resistivity of the upper arm and leg yields good estimates of whole body fat

Single frequency bioelectrical impedance analysis is an inexpensive, quick and painless means of estimating body composition. However, current approaches to estimating body composition from segment resistivity have some drawbacks. The purpose of this study was to overcome these limitations by developing a better model of the relationship between resistivity and body composition. A three-compartment model of body mass and body segment resistivity is presented and calibrated to predict %Fat estimated by underwater weighing. The subject population from which the data were obtained was heterogeneous. Both sexes were represented, as were a range of ages (21-44 years), ethnic backgrounds, body masses (47.0-129.0 kg) and body compositions (%Fat = 8.7-50.7%). Based on resistivity measurements from the upper arm and upper leg, and measurements of subject height and weight, the model predicted %Fat with errors comparable to those reported for other methods based on segmental resistivity. All the terms in the calibrated model represented a physical component of the body and show reasonable agreement with resistivity measured in tissue samples. In short, predicting %Fat from resistivity of the proximal arm and leg segments compares favourably with other methods based on segment resistivity.

The revised two-factor Study Process Questionnaire: R-SPQ-2F

AIM

To produce a revised two-factor version of the Study Process Questionnaire (R-SPQ-2F) suitable for use by teachers in evaluating the learning approaches of their students. The revised instrument assesses deep and surface approaches only, using fewer items.

METHOD

A set of 43 items was drawn up for the initial tests. These were derived from: the original version of the SPQ, modified items from the SPQ, and new items. A process of testing and refinement eventuated in deep and surface motive and strategy scales each with 5 items, 10 items per approach score. The final version was tested using reliability procedures and confirmatory factor analysis.

SAMPLE

The sample for the testing and refinement process consisted of 229 students from the health sciences faculty of a university in Hong Kong. A fresh sample of 495 undergraduate students from a variety of departments of the same university was used for the test of the final version.

RESULTS

The final version of the questionnaire had acceptable Cronbach alpha values for scale reliability. Confirmatory factor analysis indicated a good fit to the intended two-factor structure. Both deep and surface approach scales had well identified motive and strategy subscales.

CONCLUSION

The revision process has resulted in a simple questionnaire which teachers can use to evaluate their own teaching and the learning approaches of their students.

Self-tolerance and the composition of T cell repertoire

T cell recognition of self-major histocompatibility complex-peptide complexes dictates the composition of the T cell receptor repertoire. Research projects in our laboratory deal with the mechanisms that regulate the composition of the repertoire specific for self-antigens and the defects that can result in autoimmunity. Two different types of disease models are under investigation: juvenile (type I) diabetes and cancer. Both of these diseases are impacted by the presence of anti-self CD8 cells, yet in opposite ways. By understanding the mechanisms of peripheral tolerance and the reasons they fail in autoimmunity, we may learn how to prevent undesirable autoimmunity and how to encourage an autoimmune response when it is needed to eliminate tumor cells.

Both service and training demand attention in obstetrics and gynaecology

New proposals for workforce planning, training and ways of working in the NHS are under consideration. Aspects of service, training and workforce in obstetrics and gynaecology that call out for change include training in the senior house officer grade, especially for GPs and non-EC doctors, and the work of consultants. Proposals for change present a golden opportunity for the specialty to lead in new systems of both service and training, which are closely linked.

A three-dimensional kinematic model of the human long finger and the muscles that actuate it

A kinematic model of the human long finger and the six muscles that actuate it is presented. The model transforms finger pose into estimates of muscle excursions and fingertip location. The effects of abduction/adduction about the metacarpo-phalangeal joint are accounted for, as are the effects of flexion of the three finger joints. A set of parameters are provided which approximate kinematics of the segments and muscles of a cadaver finger over the range of finger poses humans normally assume.

Biomechanical model predicts directional tuning of spindles in finger muscles facilitates precision pinch and power grasp

Humans have a sense of static limb position derived primarily from the output of secondary muscle spindle endings. The features of finger pose these proprioceptors signal best were predicted by singular value decomposition of a kinematic model of the human long finger and the six muscles that actuate it. The analysis indicated that muscle spindles signal the location of the fingertip with less error than they signal angles of individual finger joints. The fingertip displacements for which proprioceptors have greatest sensitivity were also predicted. These fingertip displacements seem to correspond to the fine positioning of an object pinched between the fingertip and distal phalanx of the thumb. The analysis also predicted the directions in which subjects can displace the fingertip most rapidly. The directions seem to correspond to rapid closure of precision pinch or power grasp.

A patient decision aid regarding antithrombotic therapy for stroke prevention in atrial fibrillation: a randomized controlled trial

CONTEXT

Decision aids are tools designed to help patients participate in the clinical decision-making process.

OBJECTIVE

To determine whether use of an audiobooklet (AB) decision aid explaining the results of a clinical trial affected the decision-making process of study participants.

DESIGN

Randomized controlled trial conducted from May 1997 to April 1998.

SETTING

Fourteen centers that participated in the Stroke Prevention in Atrial Fibrillation (SPAF) III trial.

PARTICIPANTS

A total of 287 patients from the SPAF III aspirin cohort study, in which patients with atrial fibrillation and a relatively low risk of stroke received 325 mg/d of aspirin and were followed up for a mean of 2 years.

INTERVENTION

At the end of SPAF III, participants were randomized to be informed of the study results with usual care plus use of an AB (AB group) vs usual care alone (control group). The AB included pertinent information to help patients decide whether to continue taking aspirin or switch to warfarin.

MAIN OUTCOME MEASURES

Patients' ability to make choices regarding antithrombotic therapy, and 6-month adherence to these decisions. Their knowledge, expectations, decisional conflict (the amount of uncertainty about the course of action to take), and satisfaction with the decision-making process were also measured.

RESULTS

More patients in the AB group made a choice about antithrombotic therapy than in the control group (99% vs 94%; P = .02). Patients in the AB group were more knowledgeable and had more realistic expectations about the risk of stroke and hemorrhage (in the AB group, 53%-80% correctly estimated different risks; in the control group, 16%-28% gave correct estimates). Decisional conflict and satisfaction were similar for the 2 groups. After 6 months, a similar percentage of patients were still taking their initial choice of antithrombotic therapy (95% vs 93%; P = .44).

CONCLUSIONS

For patients with atrial fibrillation who had participated in a major clinical trial, the use of an AB decision aid improved their understanding of the benefits and risks associated with different treatment options and helped them make definitive choices about which therapy to take. Further studies are necessary to evaluate the acceptability and impact of decision aids in other clinical settings.

Autologous versus allogeneic transfusion: patients' perceptions and experiences

BACKGROUND

Preoperative autologous donation is one way to decrease a patient's exposure to allogeneic blood transfusion. This study was designed to determine patients' perceptions about the autologous blood donation process and their experiences with transfusion.

METHODS

To assess patient perception, a questionnaire was administered a few days before surgery to patients undergoing elective cardiac and orthopedic surgery in a Canadian teaching hospital. All patients attending the preoperative autologous donation clinic during a 10-month period were eligible. A convenience sample of patients undergoing the same types of surgery who had not predonated blood were selected from preadmission clinics. Patient charts were reviewed retrospectively to assess actual transfusion practice in all cases.

RESULTS

A total of 80 patients underwent cardiac surgery (40 autologous donors, 40 nondonors) and 73 underwent orthopedic surgery (38 autologous donors, 35 nondonors). Of the autologous donors, 75 (96%) attended all scheduled donation appointments, 73 (93%) said that they were "very likely" or "likely" to predonate again, and 75 (96%) said that they would recommend autologous donation to others. There was little difference in preoperative symptoms between the autologous donors and the nondonors, although the former were more likely than the latter to report that their overall health had remained the same during the month before surgery (30 [75%] v. 21 [52%] for the cardiac surgery patients and 30 [79%] v. 18 [51%] for the orthopedic surgery patients). When the autologous donors were asked what they felt their chances would have been of receiving at least one allogeneic blood transfusion had they not predonated, the median response was 80%. When they were asked what their chances were after predonating their own blood, the median response was 0%. The autologous donors were significantly less likely to receive allogeneic blood transfusions (6 [15%] for cardiac surgery and 3 [8%] for orthopedic surgery) than were the nondonors (14 [35%] for cardiac surgery and 16 [46%] for orthopaedic surgery). They were, however, more likely to receive any transfusion (autologous or allogeneic) than were the nondonors (25 [63%] v. 14 [35%] for cardiac surgery and 31 [81%] v. 16 [46%] for orthopedic surgery).

INTERPRETATION

Patients who underwent preoperative autologous blood donation were positive about the experience and did not report more symptoms than patients who did not donate blood preoperatively. Autologous donors overestimated their chances of receiving allogeneic blood transfusions had they not predonated and underestimated their chances after they had predonated. They were less likely to receive allogeneic transfusions, but more likely to receive any type of transfusion, than were patients who did not predonate.

Extrinsic muscles of the hand signal fingertip location more precisely than they signal the angles of individual finger joints

Studies have demonstrated that muscle spindle organs provide the majority of the proprioceptive information available to the nervous system about limb position. Other studies suggest that a sense of position may be lacking in the fingers, as subjects were unaware of rather large excursions of finger joints if the excursions were made slowly enough. We sought to investigate the basis for this unexpected finding with a biomechanical model of the human long finger and the forearm muscles which actuate it, in order to study potential contributions of spindle organs in the extrinsic muscles of the hand to a sense of position of the finger. The model, based on cadaver data, allowed us to determine how precisely estimates of the lengths of the extrinsic finger muscles can be transformed into estimates of: (1) the flexion/extension angles of the individual finger joints, and (2) the location of the fingertip in the flexion/extension plane. We found that, for some finger positions, length information from all three extrinsic muscles was not sufficient to precisely estimate the flexion angles of all finger joints. Precision of joint angle estimates could be as poor as +/- 18% of joint range of motion. However, length information from just two of the extrinsic muscles taken together could always provide information sufficient to estimate the location of the fingertip relative to the metacarpophalangeal joint within a reasonably small tolerance (+/- one-half thickness of the fingertip). Furthermore, it was possible to make this estimate without determining any of the finger joint angles. These results suggest that spindles in the extrinsic muscles alone can signal fingertip location, even though they may not provide sufficient information to estimate the individual joint angles that set the position of the fingertip. Thus, an absence of position sense for individual joints (the sense many studies have tried to measure) may say little about a sense of location of the tip of the finger.

Tumonoic acids, novel metabolites from a cyanobacterial assemblage of Lyngbya majuscula and Schizothrix calcicola

Five new metabolites have been isolated from a lyngbyastatin 1- and dolastatin 12-producing assemblage of Lyngbya majuscula and Schizothrix calcicola collected at Tumon Bay, Guam. Structure elucidation employed 2D NMR techniques and chemical derivatization. These compounds have been assigned the trivial names tumonoic acids A (2), B (1), and C (5); methyl tumonoate A (3), and methyl tumonoate B (4). Compounds 1 and 4 were also found in a lyngbyastatin 1-producing strain of L. majuscula from Guam.

Isolation, structure determination, and biological activity of dolastatin 12 and lyngbyastatin 1 from Lyngbya majuscula/Schizothrix calcicola cyanobacterial assemblages

Lyngbyastatin 1 (1a), a new cytotoxic analogue of dolastatins 12 (2a) and 11 (4), was isolated as an inseparable mixture with its C-15 epimer (1b) from extracts of a Lyngbya majuscula/Schizothrix calcicola assemblage and a L. majuscula strain collected near Guam. Dolastatin 12 (2a) was also encountered as an inseparable mixture with its C-15 epimer (2b) in L. majuscula/S. calcicola assemblages. At least one of the compounds in each mixture appeared to exist in solution as a mixture of slowly interconverting conformers resulting in broadened signals in 1H NMR spectra. Structure elucidation therefore relied principally on mass spectroscopy and chemical degradation studies. Both 1ab and 2ab proved toxic with only marginal or no antitumor activity when tested against colon adenocarcinoma #38 or mammary adenocarcinoma #16/C. Both 1ab and 2ab were shown to be potent disrupters of cellular microfilament networks.

The sequence alteration associated with a mutational hotspot in p53 protects cells from lysis by cytotoxic T lymphocytes specific for a flanking peptide epitope

A high proportion of tumors arise due to mutation of the p53 tumor suppressor protein. A p53 hotspot mutation at amino acid position 273 from R to H, flanking a peptide epitope that spans residues 264-272, renders cells resistant to killing by human histocompatibility leukocyte antigen (HLA)-A*0201-restricted cytotoxic T lymphocytes (CTLs) specific for this epitope. Acquisition of the R to H mutation at residue 273 of the human p53 protein promotes tumor growth in vivo by selective escape from recognition by p53.264-272 peptide-specific CTLs. Synthetic 27-mer p53 polypeptides covering the antigenic nonamer region 264-272 of p53 were used as proteasome substrates to investigate whether the R to H mutation at the P1' position of the COOH terminus of the epitope affects proteasome-mediated processing of the protein. Analysis of the generated products by tandem mass spectrometry and the kinetics of polypeptide processing in conjunction with CTL assays demonstrate that the R to H mutation alters proteasomal processing of the p53 protein by inhibiting proteolytic cleavage between residues 272 and 273. This prevents the release of the natural CTL epitope that spans flanking residues 264-272 as well as a putative precursor peptide. These results demonstrate that mutation of p53 not only leads to malignant transformation but may also, in some instances, affect immune surveillance and should be considered in the design of cancer vaccines.

Strategies for tumor elimination by cytotoxic T lymphocytes

Despite differences in their tissue of origin, many tumors share high level expression of certain tumor-associated proteins. Our laboratory has focused on the possibility of utilizing antigenic components of these proteins as a focus for T-cell immunotherapy of cancer. The advantage of targeting such commonly expressed proteins is the fact that such therapy could be of value in eliminating many different types of tumors. A potential barrier in the identification of T-cell epitopes derived from these proteins and presented by tumor cells is the fact that these proteins are also expressed at low levels in some normal tissues, and therefore, self-tolerance may eliminate T cells that are capable of recognizing these epitopes with high avidity. We have utilized two different murine model systems to explore the extent to which self-tolerance may limit the immune response to a tumor-specific antigen. The first compared the ability of mice deficient in expression of murine p53 (p53 knock-out mice) and normal mice, to respond against several epitopes of the p53 protein. The second model compares the ability of conventional mice with transgenic mice that express the influenza hemagglutinin in the periphery to respond to a dominant antigenic peptide of this transgene product. In both models we have investigated the effect self-tolerance has on elimination of tumors expressing the toleragen.

Complex regulation of CDK2 during phorbol ester-induced hematopoietic differentiation

Phorbol myristate acetate (PMA) treatment of U937 human leukemic cells results in late G1 cell cycle arrest and terminal monocyte/macrophage-like differentiation. The PMA-induced G1 arrest involves a marked decrease in cdk2 activity, which correlates with total cdk2 dephosphorylation. Here, we show that the levels of cyclin A mRNA and protein markedly decrease during PMA-induced differentiation of U937 cells. In contrast, the level of cyclin E protein remains unchanged and in a complex with cdk2 during the entire course of PMA treatment. During the PMA-induced differentiation, cyclin E-associated cdk2 activity drops markedly. Furthermore, the amount of p27(Kip1) protein associated with cyclin E/cdk2 greatly increases 24 to 72 hours after PMA treatment. The absence of changes in p27(Kip1) mRNA levels by Northern blot suggest that the levels of this protein are controlled by posttranscriptional or posttranslational mechanism(s). These results show that the mechanisms mediating PMA-induced G1 arrest are complex. The inhibition of cdk2 activity is associated with (1) a decrease in cyclin A protein levels, (2) inactivation of cdk2 complexes, and (3) upregulation of p27(Kip1) protein.

Detection of a soluble form of the leukocyte surface antigen CD48 in plasma and its elevation in patients with lymphoid leukemias and arthritis

Proteins with glycosylphosphatidylinositol (GPI) anchors exhibit a range of activities and some of these proteins exist in both a membrane-associated and a soluble form. CD48 is a 47-kd GPI-linked glycoprotein which is expressed on T and B lymphocytes, monocytes, and many lymphoid malignancies. The biological function of CD48 is unknown. We describe the detection of a soluble form of CD48 in plasma and serum. Its level was quantified by an immunoenzymometric assay (IEMA) specific for soluble CD48. While soluble CD48 was detected in the plasma of healthy individuals (median = 29 ng/ml; range, 15-48 ng/ml), elevated levels were detected in some patients with lymphoproliferative disease (median = 41 ng/ml; range, 9-213 ng/ml, arthritis (median = 42 ng/ml; range, 13-67 ng/ml), and acute EBV infection (174 ng/ml). Soluble CD48 was also detectable in tissue culture supernatants from the Raji lymphoid cell line. The mechanism of CD48 release from cells is unclear. The finding of significant levels of soluble CD48 in plasma and the development of a sensitive IEMA for its measurement will facilitate further studies on its normal function and its role in disease.

Code generation through annotation of macromolecular structure data

The maintenance of software which uses a rapidly evolving data annotation scheme is time consuming and expensive. At the same time without current software the annotation scheme itself becomes limited and is less likely to be widely adopted. A solution to this problem has been developed for the macromolecular Crystallographic Information File (mmCIF) annotation scheme. The approach could be generalized for a variety of annotation schemes used or proposed for molecular biology data. mmCIF provides a highly structured and complete annotation for describing NMR and X-ray crystallographic data and the resulting macromolecular structures. This annotation is maintained in the mmCIF dictionary which currently contains over 3,200 terms. A major challenge is to maintain code for converting between mmCIF and Protein Data Bank (PDB) annotations while both continue to evolve. The solution has been to define a simple domain specific language (DSL) which is added to the extensive annotation already found in the mmCIF dictionary. The DSL calls specific mapping modules for each category of data item in the mmCIF dictionary. Adding or changing the mapping between PDB and mmCIF items of data is straightforward since data categories (and hence mapping modules) correspond to elements of macromolecular structure familiar to the experimentalist. Each time a change is made to the macromolecular annotation the appropriate change is made to the easily located and modifiable mapping modules. A code generator is then called which reads the mapping modules and creates a new executable for performing the data conversion. In this way code is easily kept current by individuals with limited programming skill, but who have an understanding of macromolecular structure and details of the annotation scheme. Most important, the conversion process becomes part of the global dictionary and is not open to a variety of interpretations by different research groups writing code based on dictionary contents. Details of the DSL and code generator are provided.