IT Evaluation of Foundation Healthcare Group NHS Vanguard programme: IT simultaneously an enabler and a rate limiting factor

The goal of the Foundation Healthcare Group (FHG) Vanguard model was to develop a sustainable local hospital model between two National Health Service (NHS) Trusts (a London Teaching Hospital Trust and a District General Hospital Trust) that makes best use of scarce resources and can be replicated across the NHS, UK. The aim of this study was to evaluate the provision, use, and implementation of the IT infrastructure based on qualitative interviews focused mainly on the perspectives of the IT staff and the clinicians' perspectives.

METHODS

In total, 24 interview transcripts, along with 'Acute Care Collaboration' questionnaire responses, were analyzed using a thematic framework for IT infrastructure, sharing themes across the vascular, pediatric, and cardiovascular strands of the FHG programme.

RESULTS

Findings indicated that Skype for Business had been an innovative and helpful development widely available to be used between the two Trusts. Clinicians initially reported lack of IT support and infrastructure expected at the outset for a national Vanguard project but later appreciated that remote access to most clinical applications including scans between the two Trusts became operational. The Local Care Record (LCR), an IT project was perceived to have been delivered successfully in South London. Shared technology reduced patient traveling time by providing locally based shared care.

CONCLUSION

Lesson learnt is that ensuring patient benefit and priorities is a strong driver to implementation and one needs to identify IT rate-limiting steps at an early stage and on a regular basis and then focus on rapid implementation of solutions. In fact, future work may also assess how the IT infrastructure developed by FHG vanguard project might have helped/boosted the 'digital health' practice during the COVID-19 times. Spreading and scaling-up innovations from the Vanguard sites was the aspiration and challenge for system leaders. After COVID-19, the use of IT is scaled up and now, the challenges in the use of IT are much less compared to the pre-COVID-19 time when this project was evaluated.

Attention-deficit/hyperactivity disorder: parent/carer perceptions of barriers to healthcare access

BACKGROUND

Children and young people (CYP) with attention-deficit/hyperactivity disorder (ADHD) face delays in diagnosis and barriers to accessing appropriate interventions. Evidence is limited on how these barriers are perceived by their parents and carers.

METHODS

Focus group in South London with parents/carers of CYP with ADHD. Data were thematically analysed using an inductive/deductive hybrid approach.

RESULTS

Participants (n=8) described the challenge of accessing services within a disjointed, multiagency system for their CYP's ADHD and broader health needs. They described feeling judged and overlooked by healthcare professionals, which could negatively impact the health, relationships and educational progress of their children. Pragmatic solutions were proposed, including providing parents with information on navigating services at an early stage of ADHD symptom recognition.

CONCLUSIONS

Parents/carers sought improved continuity of care within and between services. They are a key group for consultation on the development of interventions to improve access for CYP with ADHD.

"Let us define ourselves": forced migrants' use of multiple identities as a tactic for social navigation

Background

The article examines how and why multiple identities are altered, used and discarded by forced migrants.

Methods

The research is located in the constructivist paradigm. We used thematic analysis to analyse data gathered through interviews with nineteen forced migrants.

Results

We found that, though individual migrants can make deliberate choices about which identities to be associated with, they are constrained in the process by external socio-economic factors that lead them to adopt identities that are perceived to be advantageous to navigate the new social system. Moreover, the construction of forced migrants’ identity includes significant contextuality, transactionality and situatedness.

Conclusions

Our research contributes to the literature on migrant identity practice concerning the stigma associated with forced migrant status and the extent to which migrants appraise their reception in exile as undignified. Additionally, examining migrant identities allows the researchers to apprehend the diverse facets of identity as far as migrants are concerned. Future research may draw a larger sample to examine other impactful dimensions of identity fluctuation, e.g. gender, education, social media, the extent of prior trauma, etc.

Lean implementation within healthcare: imaging as fertile ground

PURPOSE

The purpose of this paper is to understand the barriers and enablers to lean implementation as part of an imaging quality improvement programme from a socio-cultural perspective.

DESIGN/METHODOLOGY/APPROACH

An in-depth 33 month ethnographic study, using observation and qualitative interviews, examined the process of lean implementation as part of an improvement programme.

FINDINGS

Implementation of lean was more successful compared with other reports of lean in healthcare settings. Key enablers of lean were high levels of multidisciplinary staff involvement and engagement; the professional credibility of facilitators and clinicians as early adopters, all within a wider culture of relatively strong inter-professional relationships in the imaging department. These enablers combined with the more routinised and standardised nature of imaging pathways compared to some other acute specialties suggest that imaging is fertile ground for lean, linked to the manufacturing origins of lean.

PRACTICAL IMPLICATIONS

When introducing lean within healthcare settings, special attention needs to be paid to the specific healthcare context and the existing cultures of inter-professional relationships. Fostering an improvement culture and engagement with training, together with adequate financial resource, are a key to contributing to the level of acceptability of an improvement tool such as lean.

ORIGINALITY/VALUE

This ethnographic study, bringing together rich multi-source data, has provided a detailed insight into the cultural workings of the process of lean implementation within a complex healthcare system.

IT Evaluation of Foundation Healthcare Group Vanguard Project

The aim of the Foundation Healthcare Group (FHG) Vanguard model was to develop a sustainable local hospital model between two National Health Service (NHS) Trusts (a London Teaching Hospital Trust and a District General Hospital Trust) that makes best use of scarce resources and can be replicated across the NHS, UK. The aim of this study was to evaluate the provision, use and implementation of the IT infrastructure; based on qualitative interviews and focused mainly on the perspectives of the IT staff and the clinicians' perspectives. In total 24 interview transcripts, along with 'Acute Care Collaboration' questionnaire responses, were analysed using a thematic framework for IT infrastructure, sharing themes across the vascular, paediatric and cardiovascular strands of the FHG programme. Findings indicated that Skype for Business had been an innovative and helpful development widely available to be used between the two Trusts. Clinicians initially reported lack of IT support and infrastructure expected at the outset for a national Vanguard project, but later appreciated that remote access to most clinical applications between the two Trusts became operational. The Local Care Record (LCR), an IT project was perceived to have been delivered successfully in South London. Shared technology reduced patient travelling time by providing locally based shared care. Spreading and scaling-up innovations from the Vanguard sites was the aspiration and challenge for system leaders.

Community assets and multimorbidity: A qualitative scoping study

Little is known of how community assets can play a role in multimorbidity care provision. Using a rapid ethnographic approach, the study explored perceptions of the role of community assets in how multimorbidity is managed within Southwark and Lambeth in Southeast London, England. The scoping work comprised of four micro-studies covering (1) Rapid review of the literature (2) Documentary analysis of publicly available local policy documents (3) Thematic analysis of community stories and (4) Semi-structured stakeholder interviews. The data were analysed using framework thematic analysis. Themes are presented for each of the microstudies. The literature review analysis highlights the role of attitudes and understandings in the management of multiple long-term conditions and the need to move beyond silos in their management. Documentary analysis identifies a resource poor climate, whilst recognising the role of community assets and solution-focussed interventions in the management of multimorbidity. Community patient stories underline the lack of joined up care, and psychosocial issues such as the loss of control and reducing isolation. The stakeholder interview analysis reveals again a sense of disjointed care, the need for holism in the understanding and treatment of multimorbidity, whilst recognising the important role of community-based approaches, beyond the biomedical model. Recommendations stemming from the study's findings are proposed. Upholding access to and resourcing community assets have key practical importance.

Exploring the relationship between intimate partner violence and contraception use by Tanzanian women

Intimate partner violence (IPV) can be described as a global epidemic which has long term effects on numerous aspects of life. The effect of IPV on contraception use is also wide-ranging and culturally bound. Among the continents, Africa has the highest IPV prevalence. The relationship between IPV on contraception use by Tanzanian women is explored in this study as an illustrative case. This is a descriptive cross-sectional design study, for which we utilized the Tanzania Demographic and Health Survey Data 2015-2016. Data from the responses of 13,266 ever-partnered women were used in this study. The mean age of the respondents was 28.69 years, median 27. 63% of respondents used contraceptives. Women with more than three pregnancies were more likely to use contraceptives (OR: 1.56, 95% CI, p < .001). Education levels also correlated with contraceptive use. Notably, contraceptive use was also significantly lower among the Tanzanian women who were exposed to IPV, suggesting a need for appropriately tailored social interventions and support. The need for interventions relating to IPV to take into account the multifactorial nature of a woman's uptake of contraceptive methods is underlined.

Individualised or Standardised Outcome Measures: A Co-habitation?

Mental health outcome measurement is conflicted between two different schools of thought which underlie the division between standardised (nomothetic) and individualised or patient-generated (idiographic) measures. The underpinning philosophies of both approaches have very different starting points in terms of how we understand the world. And yet the strengths of both may contribute something useful for patients and mental health services. We suggest a convergence of approaches with new thinking on options for co-habitation.

PSYCHLOPS in Polish primary care: how do clients conceptualise their problems on a patient-generated outcome measure?

BACKGROUND

PSYCHLOPS, a patient-generated mental health outcome questionnaire, invites clients to describe the problem that troubles them most. PSYCHLOPS was utilised in Polish primary care in the context of a brief CBT-based intervention for mild to moderate mental health problems.

AIM

To explore how patients conceptualise their problems and the consequences of these problems with the aid of PSYCHLOPS.

METHOD

243 patients were recruited from a primary care setting; 241 completed PSYCHLOPS. Free-text data were obtained from the Problem and Function domains of PSYCHLOPS, blind translated into English and independently analysed using a pre-existing thematic framework. A total of 780 free-text responses were analysed.

RESULTS

The most commonly reported responses to the pre-therapy Problem domain category were "somatic" (denoting responses relating to physical health); the most common responses to the Function domain category were "competence/performance" (denoting responses relating to the respondents' perceived ability to achieve, cope, function). Compared with pre-therapy Problem 1 domain categories, during-therapy responses revealed a higher proportion of the "interpersonal" category (denoting responses relating to social relationships) and a lower proportion of the "somatic" category.

CONCLUSIONS

Despite the brevity of clients' responses, PSYCHLOPS allowed an insight into patients' most troubling problems and their consequences. Possible reasons underlying the transition from a somatic to an interpersonal problem reporting during the course of talking therapy are discussed.

Ethnic differences in psychosis-Lay epidemiology explanations

BACKGROUND

Much research attention has been given to the high rates of psychosis diagnosed in the Black community. However, little has been heard about possible reasons for this from Black African and Caribbean mental health service users themselves.

AIMS

To determine how Black African and Caribbean service users perceive and explain these apparent differences.

METHODS

We conducted four focus groups between 2014 and 2015 with 35 participants from the Black African and Black Caribbean community in Lambeth and Southwark, South East London, diagnosed with a psychotic illness. Recruitment was through a local voluntary sector organization and other community contacts.

RESULTS

Each group described an elevated risk of psychosis in their community and explanations followed the following themes, with increased rates due to: (a) an accumulation of stressors due to disadvantaged ethnic minority status, (b) further disadvantage due to inequitable experiences of mental health services, (c) an absence of community support and (d) a double stigma: as a result of external discrimination, due to ethnicity, and internal stigma about mental illness from within the Black community itself.

CONCLUSIONS

Black mental health service users attributed an elevated risk of psychosis in their community to an accumulation of stressors directly related to ethnic minority status.

The development and testing of PSYCHLOPS Kids: a new child-centred outcome measure

BACKGROUND

There are currently no client generated measures able to capture a child's perspective of the value of generic therapeutic mental health interventions. We have developed a new measure called 'PSYCHLOPS Kids'. It measures areas of individual importance to the respondent and contains both quantitative and qualitative elements. We aimed to pilot this new outcome measure and determine its psychometric properties.

METHODS

PSYCHLOPS Kids was adapted from the adult PSYCHLOPS questionnaire, a validated and reliable client-generated measure used in primary care mental health. Development of PSYCHLOPS Kids involved an expert group, pilot testing with dramatherapists followed by psychometric testing with children receiving dramatherapy aged 7-13 years.

RESULTS

One hundred and thirty-two children completed pre- and postintervention questionnaires. Mean initial PSYCHLOPS Kids scores (scale of 0-12) were 4.98 (SD: 3.42); mean post-therapy, 3.24 (SD: 3.03); mean effect size of change, 0.51. The Strengths and Difficulties Questionnaire (SDQ) was used as a comparator instrument completed by parent/carers of 32 children; mean effect size, 0.39. The effect size difference between both instruments was not significant (t = 1.05; p = .30); the PSYCHLOPS Kids Problem domain effect size (mean, 0.68) was significantly greater than for the SDQ (t = 2.06; p = .04). Concurrent validity was demonstrated by strong predictive power of change scores for the self-assessment of change item in PSYCHLOPS Kids; therapist-assessment of change was not a significant predictor of change scores. PSYCHLOPS Kids and SDQ change scores were not significantly correlated.

CONCLUSIONS

PSYCHLOPS Kids is the first client generated mental health outcome measure focussing on problems for generic use in children. It has demonstrated moderate responsiveness to change and satisfactory testing for measured aspects of validity and reliability. PSYCHLOPS Kids now requires further validity, reliability and qualitative testing.

Identifying poorly performing general practices in England: a longitudinal study using data from the quality and outcomes framework

OBJECTIVE

to determine the characteristics of general practices which perform poorly in terms of Quality and Outcome (QOF) performance indicators in England's NHS.

METHOD

retrospective, four year longitudinal study, 2005 to 2008. Data were obtained from 8515 practices (99% of practices in England) in year 1, 8264 (98%) in year 2, 8192 (98%) in year 3 and 8256 (99%) in year 4.

OUTCOME MEASURES

QOF performance scores; social deprivation (IMD-2007) and ethnicity from the 2001 national census; general practice characteristics.

RESULTS

we identified a cohort of 212 (2.7%) practices which remained in the lowest decile for total QOF scores in the four years following the introduction of the QOF. A total of 705,386 patients were registered at these practices in year 4. These practices were more likely to be singlehanded (odds ratio [OR], 13.8), non-training practices (OR, 3.9) and located in deprived areas (OR, 2.6; most vs least deprived quintiles). General practitioners (GPs) in these practices were more often aged ≥ 65 years or more (OR, 7.3; mean GP age ≥ 65 years vs <45 years), male (OR 2.0), UK qualified (OR 2.0) with small list sizes (OR 3.2; list size <1000 vs 1500-2000 patients). We identified individual QOF indicators which were poorly achieved. The reported prevalence of most chronic diseases was lower in the poorly performing cohort.

CONCLUSIONS

a small minority of practices have remained poor performers in terms of measurable performance indicators over a four-year period. The strongest predictors of poor QOF performance were singlehanded and small practices, and practices staffed by elderly GPs.

How does an accreditation programme drive improvement on acute inpatient mental health wards? An exploration of members' views

BACKGROUND

Concerns have been raised about inpatient mental health care. An accreditation model can improve compliance with standards associated with improved quality of health care.

AIMS

To explore the effects of a standards-based, peer review, accreditation model on standards of care in acute inpatient wards and explore how staff achieved change.

METHOD

Quality of care was assessed by independent peer review against evidence-based standards in an accreditation process. Staff from the 11 wards receiving subsequent accreditation were interviewed to find out what processes had enabled accreditation.

RESULTS

Sixteen wards enrolled: four achieved immediate and 11 subsequent accreditation. The most common reasons for initial failure of accreditation were lack of psychological therapies or 1:1 time for patients, and presence of ligature points. Ward staff perceived the accreditation process improved communication, gave power to negotiate for resources, clear guidance how to practice, rewarded good practice and led to additional unrelated improvements in care.

CONCLUSIONS

Acute wards need to attend to basic safety and provide talking treatments (both formal psychotherapy and basic time spent with patients). An accreditation, peer-reviewed, standards-based process can enable staff to feel confident about improvements in the quality of care.

Quality and Outcomes Framework: smoke and mirrors?

Since its inception in 2004 the Quality and Outcomes Framework (QOF) has become embedded in the fabric of day-to-day general practice. Yet despite some of its tangible successes, the QOF's vulnerability to gaming poses challenges to its applicability as the dominant quality improvement framework in primary care. This paper questions whether high QOF scores amount to better care or simply the illusory effects of better data recording. Suggestions for developing QOF are made in the light of its limitations as a public health improvement initiative.

Properties of the blood group LW glycoprotein and preliminary comparison with Rh proteins

The major component immunoprecipitated from human red cell membranes by murine monoclonal antibodies (BS46 and BS56) against the LW blood group antigens is a 42,000 mol. wt glycoprotein. Upon digestion by an N-glycanase the LW component migrated as a 25,000 mol. wt component on SDS gels, whereas treatment by an O-glycanase led only to a small size reduction (2000). These data suggest that the LW glycoprotein might carry approximately eight to nine N-linked sugar chains and only a few (one or two) O-linked oligosaccharide chains. A minor component of 31,000 mol. wt was also identified in the LW immunoprecipitate. Preliminary analyses by two-dimensional peptide mapping indicate that the 31,000 mol. wt polypeptide is identical to authentic Rh proteins, therefore raising the possibility that the Rh and LW antigens are associated in the membrane as a functional complex called Rh cluster. Since the N-deglycosylated form of the LW and RhD proteins have different sizes (25,000 vs 31,000-32,000 respectively) and since their externally 125I-labelled domains have different two-dimensional peptide maps, it is concluded that LW is probably not a simple glycosylated form of the Rh proteins.

Structure elucidation of blood group B-like and I-active ceramide eicosa- and pentacosasaccharides from rabbit erythrocyte membranes by combined gas chromatography-mass spectrometry; electron-impact and fast-atom-bombardment mass spectrometry; and two-dimensional correlated, relayed-coherence transfer, and nuclear Overhauser effect 500-MHz 1H-n.m.r. spectroscopy

The structures of two glycosphingolipids, a ceramide eicosasaccharide BIrab-3 and a ceramide pentacosasaccharide BIrab-4 with "B-like" and distinct I blood-group activity, isolated in high yield from rabbit erythrocyte membranes, were investigated. The determination of their general structure, alpha-D-Galp-(1----3)-beta-D-Galp-(1----4)-beta-D-GlcpNAc-(1----3)- [alpha-D-Galp-(1----3)-beta-D-Galp-(1----4)-beta-D-Glcp-NAc-(1----6)]-be ta- D-Galp-(1----n4)-beta-D-GlcpNAc-(1----3)-beta-D-Galp-(1----4)-beta-D-Gl cp- (1----1)-ceramide, with n = 3 for BIrab-3 and n = 4 for BIrab-4, was based on the results of methylation analysis, fast-atom-bombardment and electron-impact mass spectrometry, 1D and 2D COSY, RCT, and n.O.e. 1H-N.m.r. spectra, and specific enzymic and chemical degradation.

Structure elucidation of the blood group B like and blood group I active octaantennary ceramide tetracontasaccharide from rabbit erythrocyte membranes by two-dimensional 1H NMR spectroscopy at 600 MHz

The primary structure of the ceramide tetracontasaccharide (1) from rabbit erythrocyte membranes has been determined with the aid of 600-MHz two-dimensional phase-sensitive correlated, "totally correlated" (TOCSY, homonuclear Hartmann-Hahn), relayed coherence transfer, triple quantum filtered, and nuclear Overhauser enhancement 1H NMR spectra. It was shown that obtaining subspectra of the constituent sugar residues from a totally correlated spectrum and assigning the resonances occurring in these subspectra by analyzing the relevant cross-peaks in phase-sensitive correlated spectra is the most efficient way for establishing complex oligosaccharide structures. This analysis has shown 1 to be the highest homologue of the multiantennary neolactoglycosphingolipids of the following general formula with n = 7: (Formula: see text).

The Dantu erythrocyte phenotype of the NE variety. I. Dodecylsulfate polyacrylamide gel electrophoretic studies

Red cell membranes from patient NE, Mr. Dantu and 16 additional Black individuals, positive for the low-frequency MNSs-system antigen Dantu, were studied by dodecylsulfate polyacrylamide gel electrophoretic techniques. The content of the major, blood group M- or N-active sialoglycoprotein (glycophorin A, GP A) was found to be decreased by about 57%. The blood group S- or s-active sialoglycoprotein (GP B) was decreased by about 51% in membranes from proven Dantu/U heterozygotes and not detectable in those from patient NE and other Dantu+U- individuals. Donor NE was shown to exhibit the genotype Dantu/u. Dantu-positive cells exhibit a proteinase-resistant GP B-GP A hybrid with an apparent molecular mass of 29 KDa whose intramembraneous and cytoplasmic domains were shown to be similar to those of GP A. The molar hybrid: GP A ratio in all cells was found to be about 2.4: 1, indicating that the NE variety of the Dantu phenotype is much more frequent than the Ph or MD types. The significance of an additional minor 'new' component (molecular mass 21 KDa) in Dantu+ membranes and the minor component J (molecular mass 22 KDa) occurring in normal and Dantu+U+ GP preparations, but not in those from Dantu+U- cells, has not been resolved. The apparent molecular mass of the anion channel protein (band 3) in all cells of the NE variety was shown to be decreased by about 3 KDa, due to a shortening of carbohydrate chains. This suggests that the hybrid, just like GP A, might form a complex with band 3.

Characterization of the Ss sialoglycoprotein and its antigens in Rhnull erythrocytes

The Ss sialoglycoprotein (glycophorin B) and its antigens in Rhnull erythrocytes, which lack the Rhesus blood group antigens, due to apparently silent (amorphic type) or independent suppressor (regulator type) genes, were investigated. The quantity of the molecule in amorphic and in regulator type red cell membranes was found to be decreased by about 60%-70%, as judged from sodium-dodecylsulfate polyacrylamide gel electrophoresis. The Ss glycoprotein content in the erythrocytes from heterozygotes (regulator type) was diminished to an extent of about 30%. Confirming and extending previous studies, the S, s, Ux, Uz and 'N' antigens were slightly weakened in Rhnull erythrocytes. The U and Duclos receptors were only slightly or not depressed in amorphic Rhnull cells, but almost absent from or not detectable in those of the regulator type. This demonstrates that an additional alteration, apart from the decreased Ss glycoprotein content of the membranes, accounts for the weakness of these receptors in regulator type cells. We propose the hypothesis that (a) protein(s) encoded by the Rhesus locus form(s) a complex with the Ss glycoprotein. Thus, it (they) might facilitate the incorporation of the Ss glycoprotein into the membrane and also contribute to the complete expression of the U and Duclos antigens in normal cells.

Immunochemistry of the Lewis blood-group system: isolation and structures of Lewis-c active and related glycosphingolipids from the plasma of blood-group O Le(a-b-) nonsecretors

Five different glycosphingolipid fractions (GL-3, 285 micrograms; GL-5, 1090 micrograms; GL-6, 615 micrograms; GL-7, 555 micrograms; and GL-8, 155 micrograms) have been isolated from 25 liters of plasma of O Le(a-b-) nonsecretors by means of ethanol extraction, several steps of Folch distribution, and reversed-phase, silicic acid, and ion-exchange column chromatography of native or peracetylated substances. Final purification, accomplished by preparative silica gel high-performance thin-layer chromatography, led to chromatographic homogeneity of GL-3 and GL-6. In the hemagglutination inhibition as well as quantitative passive hemagglutination techniques two of these substances (GL-3, GL-5) exhibited distinct, and the other three (GL-6-GL-8) very strong, Lec blood-group activities when tested against two different Lec antisera of human or goat origin. The fragments' structures were elucidated by fast atom bombardment and electron impact mass spectrometry of permethylated derivatives in order to determine molecular weight, sugar sequence, position of branching points, and type of oligosaccharide chains, as well as fatty acid and sphingosine patterns of the ceramide residue. Combined gas-liquid chromatography and mass spectrometry of partially methylated alditol acetates identified sugar composition and glycosidic linkages. Thus, the following structures could be established: (formula; see text) In contrast to the structurally homogeneous GL-3, minor amounts of 4-O-substituted GlcNAc pointed to a small contamination of GL-6 by branched type 2 ceramide nonasaccharide analogs. Glycolipids containing hepta- or nonasaccharides as in GL-3 or GL-6 could also be identified in fractions GL-5 (ceramide heptasaccharide) and GL-7 and GL-8 (ceramide nonasaccharide). These latter fractions revealed, however, distinct heterogeneity due to the presence of a small amount of either a type 2 analog of GL-3 (GL-5) or linear, mainly type 2, ceramide hexa- (GL-5, GL-7) or octasaccharides (GL-8). In addition to previous immunochemical communications the presented Lec active structures of GL-3 and GL-6 provide evidence that 3-fucosyl-N-acetyllactosamine in combination with a type 1 based oligosaccharide sequence and a 3,6-galactosyl branching point are essential parts of the Lec antigenic determinant (as marked in the formula of GL-6).

Immunochemistry of I/i-active oligo- and polyglycosylceramides from rabbit erythrocyte membranes. Characterization of linear, di-, and triantennary neolactoglycosphingolipids

A triantennary ceramide pentadecasaccharide (BIrab-2) with blood group I and B-like activity and an unbranched ceramide heptasaccharide (Birab) with i- and B-like activity were isolated in high yield from rabbit erythrocyte membranes. The structures of the native substances and the products obtained after treatment with alpha-galactosidase (BIrab-2 alpha, Birab alpha) and subsequent Smith degradation (BIrab-2 alpha SD) were determined by sugar analysis, methylation analysis, and fast atom bombardment-mass spectrometry of the permethylated derivatives. Together with the results of 1H NMR analysis (Dabrowski, U., Hanfland, P., Egge, H., Kuhn, S., and Dabrowski, J. (1984) J. Biol. Chem. 259, 7649-7651), the following structures were established for the native substances: (formula; see text) and Gal alpha 1----3Gal beta 1----4GlcNAc beta 1----3Gal beta 1----4GlcNAc beta 1----3Gal beta 1----4Glc beta 1----1Cer. Both compounds exhibit strong blood group B-like activity. BIrab-2 alpha is a strong receptor for human anti-I cold agglutinin and Birab for anti-i cold agglutinin.

Purification and structures of branched blood-group-B-active glycosphingolipids from human erythrocyte membranes

Three different variants of complex, branched, highly blood-group-B-active glycosphingolipids (B-III, B-IV, and B-V) have been isolated from human erythrocytes by means of partition of their membranes in n-butanol/phosphate buffer, subsequent removal of nonpolar lipids and proteins by several steps of phase distribution, acetone or sodium acetate precipitation, peracetylation and repeated fractionation of all crude extracts by silicic acid and ion exchange column chromatography. Finally, peracetylated B-glycolipid fractions were purified to homogeneity by preparative silica gel high-performance thin-layer chromatography. Their structures were elucidated by gas chromatographical sugar analysis, by combined gas chromatography/mass spectrometry of partially methylated alditol acetates for the identification of glycosidic linkages, and by fast atom bombardment and electron impact mass spectrometry of the undegraded, permethylated substances in order to establish the molecular mass, sugar sequence, type of oligosaccharide chain, position of hexosyl branching points, number of N-acetyllatosamine units, as well as sphingosine and fatty acid patterns of the ceramide residues. 360-MHz 1H nuclear magnetic resonance spectroscopy in (2H)dimethylsulfoxide of deuterium-exchanged native B-III and B-IV identified all carbohydrate components, their sites of attachment, the anomeric nature of their glycosidic linkages and the sequential arrangement within the oligosaccharide chain. Furthermore, it established the nature of branching points within the carbohydrate sequence, and assigned the different typical saccharide branches to either the position 2 versus 3, or position 3 versus 6 of the 2,3-disubstituted or 3,6-disubstituted galactoses. The nature of the anomeric linkages and branching points of B-V was based upon the series of NMR data obtained from the B-I--B-IV analogues. All results thus establish the following structures: (formula; see text)

Structures of fucose-containing ceramide pentasaccharides from the plasma of blood group O Le(a-b-) nonsecretors

A minor, Lec blood-group inactive ceramide pentasaccharide double band fraction has been isolated from the plasma of blood group O Le(a-b-) nonsecretors. The two purified glycolipids were analysed by NMR spectroscopy, mass spectrometry and combined gas chromatography-mass spectrometry. The following structures could be established: GlcNAc(beta 1----3)Gal(beta 1----4)Glc(beta 1----1)Cer (I); Gal(beta 1----4) [Fuc(alpha 1----3)]GlcNAc(beta 1----3)Gal(beta 1----4)Glc(beta 1----1)Cer (II). It must be concluded that at least part of the secretor gene-independent plasmatic H type 2 blood-group activity can be attributed to glycosphingolipid I, whereas substance II, originally detected in cancerous tissue, also occurs in the plasma of healthy individuals.

Structural analysis of the Ss sialoglycoprotein specific for Henshaw blood group from human erythrocyte membranes

The N-terminal structures of the MN and Ss erythrocyte membrane sialoglycoproteins (glycophorins A, B) from two Henshaw (He) blood-group heterozygotes were determined by manual sequencing of tryptic glycopeptides and various secondary fragments. No structural alteration of the MN glycoprotein could be detected. The He-specific portion of the Ss glycoprotein was found to exhibit the N-terminal sequence Trp-Ser+-Thr+-Ser+-Gly-(+ = glycosylation). Thus it differs at three positions from its normal counterpart which possesses 'N' activity and exhibits the N-terminal structure Leu-Ser+-Thr+-Thr+-Glu-. Analysis of the Ss glycoprotein from 15 He-negative erythrocyte samples did not reveal any of the three He-specific structural alterations. The presence of a glycine residue at the fifth position of the blood-group-M-active MN glycoprotein as well as in the He-specific Ss glycoprotein provides an explanation for the occurrence of antisera (anti-Me) reacting with the M and He antigens.

Structures of Miltenberger class I and II specific major human erythrocyte membrane sialoglycoproteins

The N-terminal structures of the Miltenberger (Mi-) blood group class I and II specific human MN erythrocyte membrane sialoglycoproteins were determined by manual sequencing of tryptic glycopeptides and various secondary fragments. The Mi-I and Mi-II active glycoproteins were found to exhibit a threonine leads to methionine and threonine leads to lysine exchange, respectively, at position 28 which prevents N-glycosylation of asparagine 26. Due to the absence of the N-glycosidic oligosaccharide chain, the monomeric form of the Mi-I and Mi-II specific glycoproteins possesses a slightly increased sodium dodecyl sulfate/polyacrylamide gel electrophoretic mobility, in comparison to its normal counterpart. Serological studies suggest that antibodies, specific for Mi-I or Mi-II red cells, react with the structurally altered region of the MN glycoprotein.

N-terminal amino acid sequence of sialoglycoprotein D (glycophorin C) from human erythrocyte membranes

The amino acid sequence of the N-terminal tryptic glycopeptide from a minor human erythrocyte membrane sialoglycoprotein (component D or glycophorin C) was determined by manual sequencing. The glycosylation sites were identified by a new procedure for the detection of the glycosylated derivatives released by Edman degradation. The fragment, comprising 47 residues, was found to contain an average of about 12 O-glycosidically linked oligosaccharides and one asparagine-linked carbohydrate chain. An identical hexapeptide sequence occurring in two regions of the glycopeptide provides evidence that it has developed by an internal gene duplication during evolution. In addition, a part of its structure shows a striking similarity to the sequence of a certain region of the MN and Ss erythrocyte membrane sialoglycoproteins (glycophorins A and B), suggesting that the molecules might be related.

The amino acid sequence of the Mc-specific major red cell membrane sialoglycoprotein--an intermediate of the blood group M- and N-active molecules

The sequence and glycosylation of the N-terminal 12 amino acids of the blood group Mc-specific major erythrocyte (MN) membrane sialoglycoprotein was determined by analyses of aminoterminal tryptic and secondary V8 protease peptides from McM erythrocytes. As predicted previously, the sequence of the N-terminal seven residues was found to be: Ser-+Ser-+Thr-+Thr-Glu-Val-Ala-(+ = glycosylation). This suggests that the variant Mc represents the evolutionary link between the blood group M- and N-specific glycoproteins, which possess Ser or Leu and Gly or Glu at the positions one and five, respectively. The elucidation of the structure of the Mc-specific glycoprotein explains the specificity of various anti-M and anti-N reagents.

Specific antibodies for desialized M and N blood group antigens

Antisera obtained by immunizing rabbits with desialized M and N blood group glycoproteins (M' and N' glycoproteins) agglutinate desialized erythrocytes and precipitate desialized glycoproteins, but they do not react with sialic acid containing erythrocytes or glycoproteins. By absorption of anti-M' serum with N' glycoprotein, and of anti-N' serum with M' glycoprotein, reagents specifically agglutinating M' or N' erythrocytes were obtained. The absorbed anti-M' and anti-N' sera were specifically inhibited by M' or N' glycoproteins, respectively. The results show that sialic acid residues of red cell glycoproteins are not essential for the differentiation of M an N blood group determinants.