Statistical Considerations for Analyzing Ecological Momentary Assessment Data

PURPOSE

The analysis of Ecological Momentary Assessment (EMA) data can be difficult to conceptualize due to the complexity of how the data are collected. The goal of this tutorial is to provide an overview of statistical considerations for analyzing observational data arising from EMA studies.

METHOD

EMA data are collected in a variety of ways, complicating the statistical analysis. We focus on fundamental statistical characteristics of the data and general purpose statistical approaches to analyzing EMA data. We implement those statistical approaches using a recent study involving EMA.

RESULTS

The linear or generalized linear mixed-model statistical approach can adequately capture the challenges resulting from EMA collected data if properly set up. Additionally, while sample size depends on both the number of participants and the number of survey responses per participant, having more participants is more important than the number of responses per participant.

CONCLUSION

Using modern statistical methods when analyzing EMA data and adequately considering all of the statistical assumptions being used can lead to interesting and important findings when using EMA.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.17155961.

Medication state at the time of the offense: Medication noncompliance, insight and criminal responsibility

This study used a mixed quantitative-qualitative methodology to examine whether mock jurors considered a defendant's meta-responsibility - specifically, the defendant's medication noncompliance and degree of insight into his/her schizophrenia - when determining the person's criminal responsibility. The degree of expert witness explanation regarding these factors was also varied. Participants (n = 173) were grouped into 30 juries, randomized across five conditions, and shown mock testimony and attorney arguments based on a real not guilty by reason of insanity court case. Linear mixed-modeling analysis showed that manipulations of medication compliance, insight, and expert testimony elaboration did not predict differential verdict and meta-responsibility outcomes. Nevertheless, qualitative exploration of focus groups from five juries (n = 29) indicated that participants across groups strongly considered meta-responsibility, but did so in a way that, along with a host of other considerations, suggested mock jurors were unable and/or unwilling to follow their duties as the triers of fact. Implications for legal participants, expert witnesses, and researchers are discussed.

Value of Xenografts in the Investigation of Prostatic Function: Preliminary Communication

Two of 33 prostatic tumour xenografts were established and passaged. Testosterone supplementation did not improve tumour take rates. The histological grade of the parent tumour was the principal factor affecting xenograft survival. Preliminary studies on established tumour xenografts suggest that their value lies in the study of tumour biology, and that they have no direct therapeutic application at present.

Protective effect of hormone therapy among women with hysterectomy/oophorectomy

Study question

Does exposure to menopausal hormone therapy (MHT) in mid-aged women alter their risk of cardiovascular disease (CVD) mortality and all-cause mortality?

Summary answer

MHT soon after menopause is unlikely to increase the risk of CVD mortality or all-cause mortality and may have a protective effect for women with hysterectomy/oophorectomy.

What is known already

The balance of benefits and risks of MHT are currently unclear and may differ according to when treatment starts and whether women have an intact uterus.

Study design size, duration

A total of 13 715 participants from the mid-aged population-based cohort (born 1946-1951) of the Australian Longitudinal Study on Women's Health (ALSWH) were followed from 1998 to 2013.

Participants/materials setting methods

The measures included cardiovascular and all-cause mortality, exposure to MHT and menopausal status (based on 3-yearly self-reports). Electronic prescriptions data on MHT were also available from mid-2002 onwards. At each follow-up survey wave, participants were classified as: an existing user of MHT, an initiator of MHT or a non-initiator of MHT.

Main results and the role of chance

After adjusting for confounding variables, existing users of MHT had a reduced risk (hazard ratio 0.63; 95% CI, 0.43-0.92) of CVD mortality compared with non-initiators. Insufficient evidence of an association was identified for initiators of MHT (0.66; 0.35-1.24). For all-cause mortality, risks were reduced for both initiators (0.69; 0.55-0.87) and existing users (0.80; 0.70-0.91). In a subgroup analysis, women with hysterectomy/oophorectomy had lower risks of CVD mortality for both initiators (0.14; 0.02-0.98) and existing users (0.55; 0.34-0.90), but no evidence of an association was found for women whose MHT commenced during or after menopause. Similarly for all-cause mortality, only the women with hysterectomy/oophorectomy had lower risks for both initiators (0.47; 0.31-0.70) and existing users (0.69; 0.58-0.82).

Limitations, reasons for caution

Limitations include the observational nature of the study, the small number of deaths, MHT use being self-reported and the classification of menopausal status also being based on self-reported information.

Wider implications of the findings

Women considering MHT soon after menopause can be reassured that the treatment is unlikely to increase their risk of CVD mortality or all-cause mortality.

Study funding/competing interest(s)

The Australian Longitudinal Study on Women's Health is funded by the Australian Department of Health. G.D.M. is funded by the Australian Research Council Future Fellowship. L.C. was funded by a China scholarship council (CSC) graduate scholarship. All authors report no conflict of interest.

Trial registration number

N/A.

Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases

Background

The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.

Methods

Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).

Results

Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.

Conclusion

Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.

The genomic architecture of resistance to Campylobacter jejuni intestinal colonisation in chickens

BACKGROUND

Campylobacter is the leading cause of foodborne diarrhoeal illness in humans and is mostly acquired from consumption or handling of contaminated poultry meat. In the absence of effective licensed vaccines and inhibitors, selection for chickens with increased resistance to Campylobacter could potentially reduce its subsequent entry into the food chain. Campylobacter intestinal colonisation levels are influenced by the host genetics of the chicken. In the present study, two chicken populations were used to investigate the genetic architecture of avian resistance to colonisation: (i) a back-cross of two White Leghorn derived inbred lines [(61 x N) x N] known to differ in resistance to Campylobacter colonisation and (ii) a 9(th) generation advanced intercross (61 x N) line.

RESULTS

The level of colonisation with Campylobacter jejuni following experimental infection was found to be a quantitative trait. A back-cross experiment using 1,243 fully informative single nucleotide polymorphism (SNP) markers revealed quantitative trait loci (QTL) on chromosomes 7, 11 and 14. In the advanced intercross line study, the location of the QTL on chromosome 14 was confirmed and refined and two new QTLs were identified located on chromosomes 4 and 16. Pathway and re-sequencing data analysis of the genes located in the QTL candidate regions identified potential pathways, networks and candidate resistance genes. Finally, gene expression analyses were performed for some of the candidate resistance genes to support the results.

CONCLUSION

Campylobacter resistance in chickens is a complex trait, possibly involving the Major Histocompatibility Complex, innate and adaptive immune responses, cadherins and other factors. Two of the QTLs for Campylobacter resistance are co-located with Salmonella resistance loci, indicating that it may be possible to breed simultaneously for enhanced resistance to both zoonoses.

Characterization of twenty-five ovarian tumour cell lines that phenocopy primary tumours

Currently available human tumour cell line panels consist of a small number of lines in each lineage that generally fail to retain the phenotype of the original patient tumour. Here we develop a cell culture medium that enables us to routinely establish cell lines from diverse subtypes of human ovarian cancers with >95% efficiency. Importantly, the 25 new ovarian tumour cell lines described here retain the genomic landscape, histopathology and molecular features of the original tumours. Furthermore, the molecular profile and drug response of these cell lines correlate with distinct groups of primary tumours with different outcomes. Thus, tumour cell lines derived using this methodology represent a significantly improved platform to study human tumour pathophysiology and response to therapy.

Genome-wide SNP analysis identifies major QTL for Salmonella colonization in the chicken

Salmonella-infected poultry products are a major source of human Salmonella infection. The prophylactic use of antimicrobials in poultry production was recently banned in the EU, increasing the need for alternative methods to control Salmonella infections in poultry flocks. Genetic selection of chickens more resistant to Salmonella colonization provides an attractive means of sustainably controlling the pathogen in commercial poultry flocks and its subsequent entry into the food chain. Analysis of different inbred chickens has shown that individual lines are consistently either susceptible or resistant to the many serovars of Salmonella that have been tested. In this study, two inbred chicken lines with differential susceptibility to Salmonella colonization (61 ((R)) and N((S)) ) were used in a backcross experimental design. Unlike previous studies that used a candidate gene approach or low-density genome-wide screens, we have exploited a high-density marker set of 1255 SNPs covering the whole genome to identify quantitative trait loci (QTL). Analysis of log-transformed caecal bacterial levels between the parental lines revealed a significant difference at 1, 2, 3 and 4 days post-infection (P < 0.05). Analysis of the genotypes of the backcross (F1  × N) population (n = 288) revealed four QTL on chromosomes 2, 3, 12 and 25 for the two traits examined in this study: log-transformed bacterial counts in the caeca and presence of a hardened caseous caecal core. These included one genome-wide significant QTL on chromosome 2 at 20 Mb and three additional QTL, on chromosomes 3, 12 and 25 at 96, 15 and 1 Mb, respectively, which were significant at the chromosome-wide level (P < 0.05). The results generated in this study will inform future breeding strategies to control these pathogens in commercial poultry flocks.

Campylobacter jejuni gene cj0511 encodes a serine peptidase essential for colonisation

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A novel peptidase Cj0511 in an important human bacterial pathogen Campylobacter jejuni has been characterized.

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Proteolytic properties of Cj0511 protein were detected in whole cell lysates using zymography.

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Enzymatic studies conducted with a purified protein confirmed the prediction of a serine peptidase.

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The cj0511 mutant was severely attenuated in a chicken colonisation model, suggesting a role in infection.

According to MEROPS peptidase database, Campylobacter species encode 64 predicted peptidases. However, proteolytic properties of only a few of these proteins have been confirmed experimentally. In this study we identified and characterised a Campylobacter jejuni gene cj0511 encoding a novel peptidase. The proteolytic activity associated with this enzyme was demonstrated in cell lysates. Moreover, enzymatic studies conducted with a purified protein confirmed a prediction of it being a serine peptidase. Furthermore, cj0511 mutant was found to be severely attenuated in chicken colonisation model, suggesting a role of the Cj0511 protein in infection.

Gene expression signature of normal cell-of-origin predicts ovarian tumor outcomes

The potential role of the cell-of-origin in determining the tumor phenotype has been raised, but not adequately examined. We hypothesized that distinct cells-of-origin may play a role in determining ovarian tumor phenotype and outcome. Here we describe a new cell culture medium for in vitro culture of paired normal human ovarian (OV) and fallopian tube (FT) epithelial cells from donors without cancer. While these cells have been cultured individually for short periods of time, to our knowledge this is the first long-term culture of both cell types from the same donors. Through analysis of the gene expression profiles of the cultured OV/FT cells we identified a normal cell-of-origin gene signature that classified primary ovarian cancers into OV-like and FT-like subgroups; this classification correlated with significant differences in clinical outcomes. The identification of a prognostically significant gene expression signature derived solely from normal untransformed cells is consistent with the hypothesis that the normal cell-of-origin may be a source of ovarian tumor heterogeneity and the associated differences in tumor outcome.

The functional properties of human slow skeletal troponin T isoforms in cardiac muscle regulation

Human slow skeletal troponin T (HSSTnT) shares a high degree of homology with cardiac TnT (CTnT). Although the presence of HSSTnT has not been confirmed in the heart at the protein level, detectable levels of HSSTnT mRNA have been found. Whether HSSTnT isoforms are expressed transiently remains unknown. Because transient re-expression of HSSTnT may be a potential mechanism of regulating function, we explored the effect of HSSTnT on the regulation of cardiac muscle. At least three HSSTnT isoforms have been found to exist in slow skeletal muscle: HSSTnT1 (+exons 5 and 12), HSSTnT2 (+exon 5, -exon 12), and HSSTnT3 (-exons 5 and 12). Another isoform, HSSTnT hypothetical (Hyp) (-exon 5, +exon 12), has only been found at the mRNA level. Compared with HCTnT3 (adult isoform), Tn complexes containing HSSTnT1, -2, and -3 did not alter the actomyosin ATPase activation and inhibition in the presence and absence of Ca(2+), respectively. HSSTnTHyp was not evaluated as it did not form a Tn complex under a variety of conditions. Porcine papillary skinned fibers displaced with HSSTnT1, -2, or -3 and reconstituted with human cardiac troponin I and troponin C (HCTnI·TnC) complex showed a decrease in the Ca(2+) sensitivity of force development and an increase in maximal recovered force (HSSTnT1 and -3) compared with HCTnT3. In contrast, HSSTnTHyp showed an increase in the Ca(2+) sensitivity of force development. This suggests that re- or overexpression of specific SSTnT isoforms might have therapeutic potential in the failing heart because they increase the maximal force of contraction. In addition, circular dichroism and proteolytic digestion experiments revealed structural differences between HSSTnT isoforms and HCTnT3 and that HSSTnT1 is more susceptible to calpain and trypsin proteolysis than the other HSSTnTs. Overall, HSSTnT isoforms despite being homologues of CTnT may display distinct functional properties in muscle regulation.

Early immune dynamics following infection with Salmonella enterica serovars Enteritidis, Infantis, Pullorum and Gallinarum: cytokine and chemokine gene expression profile and cellular changes of chicken cecal tonsils

Salmonella enterica subspecies enterica infection remains a serious problem in a wide range of animals and in man. Poultry-derived food is the main source of human infection with the non-host-adapted serovars while fowl typhoid and pullorum disease are important diseases of poultry. We have assessed cecal colonization and immune responses of newly hatched and older chickens to Salmonella serotypes Enteritidis, Infantis, Gallinarum and Pullorum. S. Enteritidis and S. Infantis colonized the ceca more efficiently than S. Gallinarum and S. Pullorum. Salmonella infection was also associated with increased staining for B-lymphocytes and macrophages in the cecal tonsils of infected birds. S. Enteritidis infection in newly hatched birds stimulated the expression of CXCLi1 and CXCLi2 chemokines in the cecal tonsils, while S. Gallinarum up-regulated the expression of LITAF. In older chickens, S. Enteritidis infection resulted in a significantly higher expression of CXCLi2, iNOS, LITAF and IL-10 while S. Pullorum appeared to down-regulate CXCLi1 expression in the cecal tonsils. Data from spleens showed either no expression or down-regulation of the tested genes.

Failures of the Dual Articular knee prosthesis due to fracture of the polyethylene post

The Dual Articular (DA) total knee replacement was designed for revision and complex primary knee arthroplasty. A number of these knees failed due to fracture of the polyethylene post. We aimed to identify the proportion of DA prostheses that failed in this manner in our hospital. The hospital database was interrogated to identify all patients undergoing revision total knee replacement under the care of one surgeon from 1995 to 2007. Case notes were then reviewed to collect information about the history surrounding the knee surgery, and determine the patient's weight at the time of surgery. Telephone follow-up was carried out to obtain complete contemporary data. Forty-eight prostheses were implanted into 39 patients (21 male, 18 female). Thirty-two of the prostheses were DA and of these, 7 underwent arthroscopy or arthrotomy to reveal a fracture of the polyethylene post (22%). T-tests showed no statistical difference in age (p=0.73) or weight (p=0.79) between the group of DA patients with fractured posts and those without. Six of the 7 fractures were in male patients (Chi-squared; p=0.01). Patients complained of pain, clicking and instability at a mean of 7 years post-surgery. Sixteen DA2000 prostheses were implanted, but none of these had failed due to a fractured polyethylene post. A high proportion of DA prostheses failed due to post fracture. We recommend that patients with DA prostheses be kept under review to detect failures early. Pain, clicking and instability should be investigated with arthroscopy and the tibial insert exchanged as appropriate.

Does the use of a "track and trigger" warning system reduce mortality in trauma patients?

INTRODUCTION

Despite the lack of robust evidence, numerous different "track and trigger" warning systems have been implemented. These have only been validated in an emergency medical admissions setting. The Modified Early Warning Score (MEWS) is the chosen track and trigger system used in the University Hospitals of Leicester trauma unit, but has not been validated in trauma patients. A considerable proportion of all trauma admissions are elderly patients with proximal femoral fractures and significant co-morbidities. Early recognition of physiological deterioration and prompt action could therefore be lifesaving in this patient group.

AIM

To identify whether the implementation of the MEWS system coupled with a critical care outreach service resulted in a reduction in mortality in a busy trauma unit.

METHOD

A retrospective study. The MEWS system was implemented in all trauma and orthopaedic wards at the Leicester Royal Infirmary in the summer of 2005. The numbers of emergency trauma inpatient admissions and deaths from January 2002 to December 2009 were obtained. The diagnosis, primary procedures and cause of death, if known, were noted. Comparisons were made pre- and post-MEWS. Student's t-test was used for statistical analysis.

RESULTS

32,149 patients were admitted (55% male; 45% female). Overall there were 889 deaths (77% female; 33% male, P<0.0001). The in-hospital mortality rate for orthopaedic trauma patients was 2.8% throughout the 7-year study period. 61% of those who died were admitted with proximal femoral fractures. The modal age group with the highest mortality was 81-90 years. Overall, females had a considerably greater mortality rate than males. The mortality rate was lower post-MEWS in males (1.82-1.418%; P=0.214), females (4.871-3.364%; P=0.108) and all patients (3.215-2.294%; P=0.092), but this was not statistically significant.

CONCLUSION

The use of a track and trigger warning system has not led to a statistically significant reduction in mortality in trauma patients. In view of the apparent lack of clinical effectiveness of the MEWS/outreach partnership, the cost effectiveness of this initiative needs to be questioned. Possible reasons for these findings include: failure of the MEWS to be correctly applied, inadequate action once the threshold is triggered, or unsuitability of this tool for this patient population. A better system for identifying and treating elderly, medically unwell trauma patients with co-morbidities needs to be developed.

Functional characterization of TNNC1 rare variants identified in dilated cardiomyopathy

TNNC1, which encodes cardiac troponin C (cTnC), remains elusive as a dilated cardiomyopathy (DCM) gene. Here, we report the clinical, genetic, and functional characterization of four TNNC1 rare variants (Y5H, M103I, D145E, and I148V), all previously reported by us in association with DCM (Hershberger, R. E., Norton, N., Morales, A., Li, D., Siegfried, J. D., and Gonzalez-Quintana, J. (2010) Circ. Cardiovasc. Genet. 3, 155-161); in the previous study, two variants (Y5H and D145E) were identified in subjects who also carried MYH7 and MYBPC3 rare variants, respectively. Functional studies using the recombinant human mutant cTnC proteins reconstituted into porcine papillary skinned fibers showed decreased Ca(2+) sensitivity of force development (Y5H and M103I). Furthermore, the cTnC mutants diminished (Y5H and I148V) or abolished (M103I) the effects of PKA phosphorylation on Ca(2+) sensitivity. Only M103I decreased the troponin activation properties of the actomyosin ATPase when Ca(2+) was present. CD spectroscopic studies of apo (absence of divalent cations)-, Mg(2+)-, and Ca(2+)/Mg(2+)-bound states indicated that all of the cTnC mutants (except I148V in the Ca(2+)/Mg(2+) condition) decreased the α-helical content. These results suggest that each mutation alters the function/ability of the myofilament to bind Ca(2+) as a result of modifications in cTnC structure. One variant (D145E) that was previously reported in association with hypertrophic cardiomyopathy and that produced results in vivo in this study consistent with prior hypertrophic cardiomyopathy functional studies was found associated with the MYBPC3 P910T rare variant, likely contributing to the observed DCM phenotype. We conclude that these rare variants alter the regulation of contraction in some way, and the combined clinical, molecular, genetic, and functional data reinforce the importance of TNNC1 rare variants in the pathogenesis of DCM.

Fetal cardiac troponin isoforms rescue the increased Ca2+ sensitivity produced by a novel double deletion in cardiac troponin T linked to restrictive cardiomyopathy: a clinical, genetic, and functional approach

A novel double deletion in cardiac troponin T (cTnT) of two highly conserved amino acids (Asn-100 and Glu-101) was found in a restrictive cardiomyopathic (RCM) pediatric patient. Clinical evaluation revealed the presence of left atrial enlargement and marked left ventricle diastolic dysfunction. The explanted heart examined by electron microscopy revealed myofibrillar disarray and mild fibrosis. Pedigree analysis established that this mutation arose de novo. The patient tested negative for six other sarcomeric genes. The single and double recombinant cTnT mutants were generated, and their functional consequences were analyzed in porcine skinned cardiac muscle. In the adult Tn environment (cTnT3 + cardiac troponin I), the single cTnT3-ΔN100 and cTnT3-ΔE101 mutations had opposing effects on the Ca(2+) sensitivity of force development compared with WT, whereas the double deletion cTnT3-ΔN100/ΔE101 increased the Ca(2+) sensitivity + 0.19 pCa units. In addition, cTnT3-ΔN100/ΔE101 decreased the cooperativity of force development, suggesting alterations in intrafilament protein-protein interactions. In the fetal Tn environment, (cTnT1 + slow skeletal troponin I), the single (cTnT1-ΔN110) and double (cTnT1-ΔN110/ΔE111) deletions did not change the Ca(2+) sensitivity compared with control. To recreate the patient's heterozygous genotype, we performed a reconstituted ATPase activity assay. Thin filaments containing 50:50 cTnT3-ΔN100/ΔE101:cTnT3-WT also increased the myofilament Ca(2+) sensitivity compared with WT. Co-sedimentation of thin filament proteins indicated that no significant changes occurred in the binding of Tn containing the RCM cTnT mutation to actin-Tm. This report reveals the protective role of Tn fetal isoforms as they rescue the increased Ca(2+) sensitivity produced by a cTnT-RCM mutation and may account for the lack of lethality during gestation.

Strong cross-bridges potentiate the Ca(2+) affinity changes produced by hypertrophic cardiomyopathy cardiac troponin C mutants in myofilaments: a fast kinetic approach

This spectroscopic study examined the steady-state and kinetic parameters governing the cross-bridge effect on the increased Ca(2+) affinity of hypertrophic cardiomyopathy-cardiac troponin C (HCM-cTnC) mutants. Previously, we found that incorporation of the A8V and D145E HCM-cTnC mutants, but not E134D into thin filaments (TFs), increased the apparent Ca(2+) affinity relative to TFs containing the WT protein. Here, we show that the addition of myosin subfragment 1 (S1) to TFs reconstituted with these mutants in the absence of MgATP(2-), the condition conducive to rigor cross-bridge formation, further increased the apparent Ca(2+) affinity. Stopped-flow fluorescence techniques were used to determine the kinetics of Ca(2+) dissociation (k(off)) from the cTnC mutants in the presence of TFs and S1. At a high level of complexity (i.e. TF + S1), an increase in the Ca(2+) affinity and decrease in k(off) was achieved for the A8V and D145E mutants when compared with WT. Therefore, it appears that the cTnC Ca(2+) off-rate is most likely to be affected rather than the Ca(2+) on rate. At all levels of TF complexity, the results obtained with the E134D mutant reproduced those seen with the WT protein. We conclude that strong cross-bridges potentiate the Ca(2+)-sensitizing effect of HCM-cTnC mutants on the myofilament. Finally, the slower k(off) from the A8V and D145E mutants can be directly correlated with the diastolic dysfunction seen in these patients.

GSTM1 null and NAT2 slow acetylation genotypes, smoking intensity and bladder cancer risk: results from the New England bladder cancer study and NAT2 meta-analysis

Associations between bladder cancer risk and NAT2 and GSTM1 polymorphisms have emerged as some of the most consistent findings in the genetic epidemiology of common metabolic polymorphisms and cancer, but their interaction with tobacco use, intensity and duration remain unclear. In a New England population-based case-control study of urothelial carcinoma, we collected mouthwash samples from 1088 of 1171 cases (92.9%) and 1282 of 1418 controls (91.2%) for genotype analysis of GSTM1, GSTT1 and NAT2 polymorphisms. Odds ratios and 95% confidence intervals of bladder cancer among New England Bladder Cancer Study subjects with one or two inactive GSTM1 alleles (i.e. the 'null' genotype) were 1.26 (0.85-1.88) and 1.54 (1.05-2.25), respectively (P-trend = 0.008), compared with those with two active copies. GSTT1 inactive alleles were not associated with risk. NAT2 slow acetylation status was not associated with risk among never (1.04; 0.71-1.51), former (0.95; 0.75-1.20) or current smokers (1.33; 0.91-1.95); however, a relationship emerged when smoking intensity was evaluated. Among slow acetylators who ever smoked at least 40 cigarettes/day, risk was elevated among ever (1.82; 1.14-2.91, P-interaction = 0.07) and current heavy smokers (3.16; 1.22-8.19, P-interaction = 0.03) compared with rapid acetylators in each category; but was not observed at lower intensities. In contrast, the effect of GSTM1-null genotype was not greater among smokers, regardless of intensity. Meta-analysis of the NAT2 associations with bladder cancer showed a highly significant relationship. Findings from this large USA population-based study provided evidence that the NAT2 slow acetylation genotype interacts with tobacco smoking as a function of exposure intensity.

Improved hospital-level risk adjustment for surveillance of healthcare-associated bloodstream infections: a retrospective cohort study

BACKGROUND

To allow direct comparison of bloodstream infection (BSI) rates between hospitals for performance measurement, observed rates need to be risk adjusted according to the types of patients cared for by the hospital. However, attribute data on all individual patients are often unavailable and hospital-level risk adjustment needs to be done using indirect indicator variables of patient case mix, such as hospital level. We aimed to identify medical services associated with high or low BSI rates, and to evaluate the services provided by the hospital as indicators that can be used for more objective hospital-level risk adjustment.

METHODS

From February 2001-December 2007, 1719 monthly BSI counts were available from 18 hospitals in Queensland, Australia. BSI outcomes were stratified into four groups: overall BSI (OBSI), Staphylococcus aureus BSI (STAPH), intravascular device-related S. aureus BSI (IVD-STAPH) and methicillin-resistant S. aureus BSI (MRSA). Twelve services were considered as candidate risk-adjustment variables. For OBSI, STAPH and IVD-STAPH, we developed generalized estimating equation Poisson regression models that accounted for autocorrelation in longitudinal counts. Due to a lack of autocorrelation, a standard logistic regression model was specified for MRSA.

RESULTS

Four risk services were identified for OBSI: AIDS (IRR 2.14, 95% CI 1.20 to 3.82), infectious diseases (IRR 2.72, 95% CI 1.97 to 3.76), oncology (IRR 1.60, 95% CI 1.29 to 1.98) and bone marrow transplants (IRR 1.52, 95% CI 1.14 to 2.03). Four protective services were also found. A similar but smaller group of risk and protective services were found for the other outcomes. Acceptable agreement between observed and fitted values was found for the OBSI and STAPH models but not for the IVD-STAPH and MRSA models. However, the IVD-STAPH and MRSA models successfully discriminated between hospitals with higher and lower BSI rates.

CONCLUSION

The high model goodness-of-fit and the higher frequency of OBSI and STAPH outcomes indicated that hospital-specific risk adjustment based on medical services provided would be useful for these outcomes in Queensland. The low frequency of IVD-STAPH and MRSA outcomes indicated that development of a hospital-level risk score was a more valid method of risk adjustment for these outcomes.

A functional and structural study of troponin C mutations related to hypertrophic cardiomyopathy

Recently four new hypertrophic cardiomyopathy mutations in cardiac troponin C (cTnC) (A8V, C84Y, E134D, and D145E) were reported, and their effects on the Ca(2+) sensitivity of force development were evaluated (Landstrom, A. P., Parvatiyar, M. S., Pinto, J. R., Marquardt, M. L., Bos, J. M., Tester, D. J., Ommen, S. R., Potter, J. D., and Ackerman, M. J. (2008) J. Mol. Cell. Cardiol. 45, 281-288). We performed actomyosin ATPase and spectroscopic solution studies to investigate the molecular properties of these mutations. Actomyosin ATPase activity was measured as a function of [Ca(2+)] utilizing reconstituted thin filaments (TFs) with 50% mutant and 50% wild type (WT) and 100% mutant cardiac troponin (cTn) complexes: A8V, C84Y, and D145E increased the Ca(2+) sensitivity with only A8V demonstrating lowered Ca(2+) sensitization at the 50% ratio when compared with 100%; E134D was the same as WT at both ratios. Of these four mutants, only D145E showed increased ATPase activation in the presence of Ca(2+). None of the mutants affected ATPase inhibition or the binding of cTn to the TF measured by co-sedimentation. Only D145E increased the Ca(2+) affinity of site II measured by 2-(4'-(2''-iodoacetamido)phenyl)aminonaphthalene-6-sulfonic acid fluorescence in isolated cTnC or the cTn complex. In the presence of the TF, only A8V was further sensitized to Ca(2+). Circular dichroism measurements in different metal-bound states of the isolated cTnCs showed changes in the secondary structure of A8V, C84Y, and D145E, whereas E134D was the same as WT. PyMol modeling of each cTnC mutant within the cTn complex revealed potential for local changes in the tertiary structure of A8V, C84Y, and D145E. Our results indicate that 1) three of the hypertrophic cardiomyopathy cTnC mutants increased the Ca(2+) sensitivity of the myofilament; 2) the effects of the mutations on the Ca(2+) affinity of isolated cTnC, cTn, and TF are not sufficient to explain the large Ca(2+) sensitivity changes seen in reconstituted and fiber assays; and 3) changes in the secondary structure of the cTnC mutants may contribute to modified protein-protein interactions along the sarcomere lattice disrupting the coupling between the cross-bridge and Ca(2+) binding to cTnC.

Acid-base effects of a bicarbonate-balanced priming fluid during cardiopulmonary bypass: comparison with Plasma-Lyte 148. A randomised single-blinded study

Fluid-induced metabolic acidosis can be harmful and can complicate cardiopulmonary bypass. In an attempt to prevent this disturbance, we designed a bicarbonate-based crystalloid circuit prime balanced on physico-chemical principles with a strong ion difference of 24 mEq/l and compared its acid-base effects with those of Plasma-Lyte 148, a multiple electrolyte replacement solution containing acetate plus gluconate totalling 50 mEq/l. Twenty patients with normal acid-base status undergoing elective cardiac surgery were randomised 1:1 to a 2 litre prime of either bicarbonate-balanced fluid or Plasma-Lyte 148. With the trial fluid, metabolic acid-base status was normal following bypass initiation (standard base excess 0.1 (1.3) mEq/l, mean, SD), whereas Plasma-Lyte 148 produced a slight metabolic acidosis (standard base excess -2.2 (2.1) mEq/l). Estimated group difference after baseline adjustment was 3.6 mEq/l (95% confidence interval 2.1 to 5.1 mEq/l, P=0.0001). By late bypass, mean standard base excess in both groups was normal (0.8 (2.2) mEq/l vs. -0.8 (1.3) mEq/l, P=0.5). Strong ion gap values were unaltered with the trial fluid, but with Plasma-Lyte 148 increased significantly on bypass initiation (15.2 (2.5) mEq/l vs. 2.5 (1.5) mEq/l, P < 0.0001), remaining elevated in late bypass (8.4 (3.4) mEq/l vs. 5.8 (2.4) mEq/l, P < 0.05). We conclude that a bicarbonate-based crystalloid with a strong ion difference of 24 mEq/l is balanced for cardiopulmonary bypass in patients with normal acid-base status, whereas Plasma-Lyte 148 triggers a surge of unmeasured anions, persisting throughout bypass. These are likely to be gluconate and/or acetate. Whether surges of exogenous anions during bypass can be harmful requires further study.

A troponin T mutation that causes infantile restrictive cardiomyopathy increases Ca2+ sensitivity of force development and impairs the inhibitory properties of troponin

Restrictive cardiomyopathy (RCM) is a rare disorder characterized by impaired ventricular filling with decreased diastolic volume. We are reporting the functional effects of the first cardiac troponin T (CTnT) mutation linked to infantile RCM resulting from a de novo deletion mutation of glutamic acid 96. The mutation was introduced into adult and fetal isoforms of human cardiac TnT (HCTnT3-DeltaE96 and HCTnT1-DeltaE106, respectively) and studied with either cardiac troponin I (CTnI) or slow skeletal troponin I (SSTnI). Skinned cardiac fiber measurements showed a large leftward shift in the Ca(2+) sensitivity of force development with no differences in the maximal force. HCTnT1-DeltaE106 showed a significant increase in the activation of actomyosin ATPase with either CTnI or SSTnI, whereas HCTnT3-DeltaE96 was only able to increase the ATPase activity with CTnI. Both mutants showed an impaired ability to inhibit the ATPase activity. The capacity of the CTnI.CTnC and SSTnI.CTnC complexes to fully relax the fibers after TnT displacement was also compromised. Experiments performed using fetal troponin isoforms showed a less severe impact compared with the adult isoforms, which is consistent with the cardioprotective role of SSTnI and the rapid onset of RCM after birth following the isoform switch. These data indicate that troponin mutations related to RCM may have specific functional phenotypes, including large leftward shifts in the Ca(2+) sensitivity and impaired abilities to inhibit ATPase and to relax skinned fibers. All of this would account for and contribute to the severe diastolic dysfunction seen in RCM.

Heart rate responses to Taekwondo training in experienced practitioners

The purpose of this study was to evaluate the heart rate (HR) responses of specific Taekwondo training activities, practiced by experienced practitioners in a natural training environment. Eight male experienced Taekwondo practitioners, with 3- 13 years (5.4 +/- 3.2 years) experience took part in a 5-day Taekwondo training camp. Continuous HR measures were recorded at 5-second intervals during 6 training sessions; each session was observed and notated, and a diary of training activities was recorded. The HR responses were assimilated into 8 fundamental training activities for analysis: elastics, technical combinations, step sparring, pad work, forms, basic techniques and forms, sparring drills, and free sparring. Taekwondo training elicited HR into 64.7-81.4% of HR maximum (%HRmax). Moderate relative exercise intensities (64.7-69.4%HRmax) were elicited by elastics, technical combinations, and step sparring. The remaining 5 training activities elicited hard relative exercise intensities (74.7-81.4%HRmax). One-way repeated-measures analysis of variance with post hoc analysis revealed that elastics, technical combinations, and step sparring elicited significantly lower relative intensities than the remaining training activities (p < 0.05). Furthermore, forms, basic techniques and forms, sparring drills, and free sparring elicited significantly higher relative intensities than the remaining training activities (p < 0.05). In conclusion, all Taekwondo training activities in this study seemed suitable for cardiovascular conditioning, although different training activities stressed the cardiovascular system to different degrees. Practically, this suggests coaches need to structure Taekwondo training sessions based not only on the technical and tactical needs of practitioners but also in a manner that enables sufficient cardiovascular conditioning for competition.

Effect of an acute necrotic bacterial gill infection and feed deprivation on the metabolic rate of Atlantic salmon Salmo salar

In this study, experiments were conducted to examine the effect of an acute necrotic bacterial gill infection on the metabolic rate (M(O2)) of Atlantic salmon Salmo salar. Fed and unfed Atlantic salmon smolts were exposed to a high concentration (5 x 10(12) CFU ml(-1)) of the bacteria Tenacibaculum maritimum, their routine and maximum metabolic rates (M(O2rout) and M(O2max), respectively) were measured, and relative metabolic scope determined. A significant decrease in metabolic scope was found for both fed and unfed infected groups. Fed infected fish had a mean +/- standard error of the mean (SEM) decrease of 2.21 +/- 0.97 microM O2 g(-1) h(-1), whilst unfed fish a mean +/- SEM decrease of 3.16 +/- 1.29 microM O2 g(-1) h(-1). The decrease in metabolic scope was a result of significantly increased M(O2rout) of both fed and unfed infected salmon. Fed infected fish had a mean +/- SEM increase in M(O2rout) of 1.86 +/- 0.66 microM O2 g(-1) h(-1), whilst unfed infected fish had a mean +/- SEM increase of 2.16 +/- 0.72 microM O2 g(-1) h(-1). Interestingly, all groups maintained M(O2max) regardless of infection status. Increases in M(O2rout) corresponded to a significant increase in blood plasma osmolality. A decrease in metabolic scope has implications for how individuals allocate energy; fish with smaller metabolic scope will have less energy to allocate to functions such as growth, reproduction and immune response, which may adversely affect the efficiency of fish growth.

Recurrent non-specific low-back pain in adolescents: the role of exercise

This study evaluated the efficacy of an exercise programme as an intervention for recurrent non-specific low-back pain (NLSBP) in adolescents. A randomized controlled trial was conducted with an experimental group (n = 27, age 14.6 years) who participated in an 8-week exercise programme and a matched control group (n = 27, age 14.6 years) who continued normal daily activities. All participants suffered from recurrent NSLBP. Pre and post intervention measures of NSLBP status (pain severity and consequences) and daily inactivity (time spent sitting, PC time, TV time) were reported in one week diaries. Two-way mixed ANOVA (independent variables: pre/post and experimental/control) was conducted for each dependent variable, significance was set at P < 0.05. Significant interaction effects were identified for the severity of pain, number of occasions missing sport due to NSLBP and amount of sport participated in. In each case the experimental group benefited from the exercise programme. In contrast, no significant interaction effects were observed for physical inactivity, both groups spent a similar amount of time sitting, watching TV and using a PC pre- and post- intervention. It was concluded that an exercise programme acted as an effective short-term treatment strategy for NSLBP in adolescents. Further evaluation is required to assess the long-term effectiveness.

Evidence that a novel thioesterase is responsible for polyketide chain release during biosynthesis of the polyether ionophore monensin

Polyether ionophores, such as monensin A, are known to be biosynthesised, like many other antibiotic polyketides, on giant modular polyketide synthases (PKSs), but the intermediates and enzymes involved in the subsequent steps of oxidative cyclisation remain undefined. In particular there has been no agreement on the mechanism and timing of the final polyketide chain release. We now report evidence that MonCII from the monensin biosynthetic gene cluster in Streptomyces cinnamonensis, which was previously thought to be an epoxide hydrolase, is a novel thioesterase that belongs to the alpha/beta-hydrolase structural family and might catalyse this step. Purified recombinant MonCII was found to hydrolyse several thioester substrates, including an N-acetylcysteamine thioester derivative of monensin A. Further, incubation with a hallmark inhibitor of such enzymes, phenylmethanesulfonyl fluoride, led to inhibition of the thioesterase activity and to the accumulation of an acylated form of MonCII. These findings require a reassessment of the role of other enzymes implicated in the late stages of polyether ionophore biosynthesis.

The effect of caffeine ingestion on 8 km run performance in a field setting

The aim of this study was to assess the effect of caffeine ingestion on 8 km run performance using an ecologically valid test protocol. A randomized double-blind crossover study was conducted involving eight male distance runners. The participants ran an 8 km race 1 h after ingesting a placebo capsule, a caffeine capsule (3 mg x kg(-1) body mass) or no supplement. Heart rate was recorded at 5 s intervals throughout the race. Blood lactate concentration and ratings of perceived exertion were recorded after exercise. A repeated-measures analysis of variance (ANOVA) identified a significant treatment effect for 8 km performance time (P < 0.05); caffeine resulted in a mean improvement of 23.8 s (95% confidence interval [CI] = 13.1 to 34.5 s) in 8 km performance time (1.2% improvement, 95% CI = 0.7 to 1.8%). In addition, a two-way (time x condition) repeated-measures ANOVA identified a significantly higher blood lactate concentration 3 min after exercise during the caffeine trial (P < 0.05). We conclude that ingestion of 3 mg . kg(-1) body mass of caffeine can improve absolute 8 km run performance in an ecologically valid race setting.

Removal of catheter at midnight versus early morning: the patients' perspective

BACKGROUND

With an increasing role of the patient as a partner in making a combined decision in care plan goals, it is important to identify the patient's perspective of the experience of removal of catheter (ROC).

METHODS

A non-consecutive prospective randomized study was performed in 84 patients who underwent a transurethral resection of the prostate to determine the impact of midnight versus early-morning ROC on sleep deprivation, over all discomfort to the patient.

RESULTS

There was no difference in the patient experience in both groups. We found a reduced frequency during the first 6 h of ROC at midnight. However, there was an increased incidence of sleep disturbances in this group. This may in part be due to an anxiety of urge incontinence and may be allayed by appropriate counselling. There was no delay in discharge of the patients in both groups.

CONCLUSION

The patients must, therefore, be given the choice of ROC either at midnight or early morning, as the advantages of a reduced frequency must be correlated with an increased incidence of sleep disturbances.

Histological evidence for the role of mechanical stress in modulating thermal denaturation of collagen

The hyperthermia and thermal denaturation literatures reveal a time-temperature equivalency when heating cells or connective tissues: thermal damage increases with increasing temperature (for the same duration) and increases with increasing duration (for the same temperature). Recent findings conversely suggest that increasing the mechanical loading on a tissue during heating decreases the thermal damage (for a given temperature and duration of heating). Surprisingly, however, there are few histological correlates of such damage. In this paper, we show that progressive light microscopic changes - swelling of collagen bands, thickening of collagen-rich layers, hyalinization, and loss of birefringence approximately - correlate very well with both increased heating times and decreased mechanical loading. Increased mechanical stress is thus thermally protective and should be considered in the design of clinical procedures that use heating to treat diseases or injuries.

Campylobacter jejuni gene expression in the chick cecum: evidence for adaptation to a low-oxygen environment

Transcriptional profiling of Campylobacter jejuni during colonization of the chick cecum identified 59 genes that were differentially expressed in vivo compared with the genes in vitro. The data suggest that C. jejuni regulates electron transport and central metabolic pathways to alter its physiological state during establishment in the chick cecum.

Identification of 4-amino-4-deoxychorismate synthase as the molecular target for the antimicrobial action of (6s)-6-fluoroshikimate

(6S)-6-Fluoroshikimate has antimicrobial activity. The molecular basis of this effect had not been identified, but there was speculation that (6S)-6-fluoroshikimate is first converted in vivo into 2-fluorochorismate, which then could inhibit 4-amino-4-deoxychorismate synthase (ADCS). 2-Fluorochorismate was prepared from E-fluorophosphoenolpyruvate and erythose-4-phosphate by the sequential reactions of DAHP synthase, dehydroquinate synthase, dehydroquinase, shikimate dehydrogenase, EPSP synthase, and chorismate synthase. Inhibition studies on ADCS showed that it was inhibited rapidly and irreversibly by 2-fluorochorismate. Electrospray mass spectrometry of the inactivated enzyme showed an additional mass of 198 +/- 10 Da. A novel peptide of 1087.6 Da was identified in the HPLC trace for the tryptic digest of 2-fluorochorismate-inactivated ADCS. Sequencing of this peptide by MS/MS showed that the peptide corresponded to residues 272-279 with a modification of 206.1 Da on Lys-274. This observation is particularly exciting in the context of a recent proposal for the catalytic mechanism of ADCS.

A school-based survey of recurrent non-specific low-back pain prevalence and consequences in children

The aim of this investigation was to provide evidence of the prevalence and consequences of recurrent low-back pain in children from Northwest England. A cross-sectional survey was conducted involving a standardized questionnaire with established reliability and validity. A cross-sectional sample of 500 boys (n = 249) and girls (n = 251) aged between 10 and 16 years participated in the study. Average lifetime prevalence of low-back pain was 40.2% [95% confidence interval (CI) = 38.7-41.6]. Most cases of low-back pain were acute episodes that did not lead to disabling consequences. In contrast, 13.1% (95% CI = 12.5-13.7) experienced recurrent low-back pain that led to disabling consequences; 23.1% visited a medical practitioner, 30.8% experienced loss of physical activity/sports and 26.2% had been absent from school because of low-back pain. Recurrent low-back pain was particularly evident during late adolescence where one in five children were cases. The health education implications of low-back pain in children are discussed. It was concluded that low-back pain is a common complaint during childhood, although most cases are acute episodes that represent little health consequence. In contrast, some children experience recurrent low-back pain that can lead to disabling consequences. Future research should focus on recurrent low-back pain cases since they often led to disabling consequences.

AVM modelling by multi-branching tube flow: large flow rates and dual solutions

Cerebral arteriovenous malformations (AVMs) present a common yet complex clinical challenge, through 'steal' phenomena, haemorrhage risks and epilepsy effects, aspects which are little understood even for individual lesions. The main difficulty lies in understanding the detailed haemodynamics of AVMs and especially the enhanced through-flow associated with steal. Mathematically, as a basic step, the paper investigates a nonlinear inviscid model for the planar incompressible flow of fluid through a branched geometry consisting of a single feeding mother tube which splits into two or more non-aligned daughter tubes. Recurrence relations between the unknown flow profiles in the daughter tubes and the incoming rotational flow profile in the mother tube are derived, analysed, and solved in detail in order to find the total flow rate. The results show greatly enhanced through-flow arising, for a fixed value of the total downstream flow area, either from non-unique solutions to the problem or more particularly from an increase in the number of daughter tubes, or from both, depending on the distribution of pressure differences applied across the branching region and the total downstream flow area. Extensions of the basic flow model are noted, along with comparisons with recent direct numerical simulations and discussion of possible repercussions in the context of treatment and clinical observations of enhanced through-flows in AVMs.

Specific evaluation of the function of force couples relevant for stabilization of the glenohumeral joint

Two clinical evaluation procedures for assessment of dynamic stability of the glenohumeral joint are presented in this paper, together with the biomedical evidence on which they are based. They are the Dynamic Rotary Stability Test (DRST) and the Dynamic Relocation Test (DRT). The purpose of the tests is presented and the technique required to perform the tests are described in detail.

Dynamic evaluation and early management of altered motor control around the shoulder complex

Altered dynamic control appears to be a significant contributing factor to shoulder dysfunction. The shoulder relies primarily on the rotator cuff for dynamic stability through mid-range. Hence, any impairment in the dynamic stabilizing system is likely to have profound effects on the shoulder complex. The rotator cuff appears to function as a deep stabilizer, similar to the transversus abdominus and vastus medialis obliquus, with some evidence of disruption to its stabilizing function in the presence of pain. Similarly, serratus anterior appears to function as a dynamic stabilizer, also demonstrating altered function in painful shoulders. Examination of dynamic control begins with a detailed examination of posture, evaluation of natural movement patterns and functional movements and assessment of the specific force couples relevant to shoulder function. One useful strategy in management of altered motor control related to these force couples is that of training isolated contraction of the rotator cuff prior to introduction of loaded activity, together with facilitation and training of appropriate scapular muscle force couples--serratus anterior and trapezius, in relation to arm elevation.

Analysis of the biosynthetic gene cluster for the polyether antibiotic monensin in Streptomyces cinnamonensis and evidence for the role of monB and monC genes in oxidative cyclization

The analysis of a candidate biosynthetic gene cluster (97 kbp) for the polyether ionophore monensin from Streptomyces cinnamonensis has revealed a modular polyketide synthase composed of eight separate multienzyme subunits housing a total of 12 extension modules, and flanked by numerous other genes for which a plausible function in monensin biosynthesis can be ascribed. Deletion of essentially all these clustered genes specifically abolished monensin production, while overexpression in S. cinnamonensis of the putative pathway-specific regulatory gene monR led to a fivefold increase in monensin production. Experimental support is presented for a recently-proposed mechanism, for oxidative cyclization of a linear polyketide intermediate, involving four enzymes, the products of monBI, monBII, monCI and monCII. In frame deletion of either of the individual genes monCII (encoding a putative cyclase) or monBII (encoding a putative novel isomerase) specifically abolished monensin production. Also, heterologous expression of monCI, encoding a flavin-linked epoxidase, in S. coelicolor was shown to significantly increase the ability of S. coelicolor to epoxidize linalool, a model substrate for the presumed linear polyketide intermediate in monensin biosynthesis.

Contribution of proton-translocating proteins to the virulence of Salmonella enterica serovars Typhimurium, Gallinarum, and Dublin in chickens and mice

We investigated the attenuating effects of a range of respiratory chain mutations in three Salmonella serovars which might be used in the development of live vaccines. We tested mutations in nuoG, cydA, cyoA, atpB, and atpH in three serovars of Salmonella enterica: Typhimurium, Dublin, and Gallinarum. All three serovars were assessed for attenuation in their relevant virulence assays of typhoid-like infections. Serovar Typhimurium was assessed in 1-day-old chickens and the mouse. Serovar Gallinarum 9 was assessed in 3-week-old chickens, and serovar Dublin was assessed in 6-week-old mice. Our data show variation in attenuation for the nuoG, cydA, and cyoA mutations within the different serovar-host combinations. However, mutations in atpB and atpH were highly attenuating for all three serovars in the various virulence assays. Further investigation of the mutations in the atp operon showed that the bacteria were less invasive in vivo, showing reduced in vitro survival within phagocytic cells and reduced acid tolerance. We present data showing that this reduced acid tolerance is due to an inability to adapt to conditions rather than a general sensitivity to reduced pH. The data support the targeting of respiratory components for the production of live vaccines and suggest that mutations in the atp operon provide suitable candidates for broad-spectrum attenuation of a range of Salmonella serovars.

Measurement error associated with spinal mobility measures in children with and without low-back pain

AIM

Evidence of the reliability of measurements in children is scarce, particularly in children with low-back pain. The aim of this investigation was to evaluate the measurement error associated with repeated measures of spinal mobility measures in children with and without low-back pain by establishing 95% limits of agreement.

METHODS

A repeated measures study was performed involving 119 children aged 11-16 y. Of this sample 30 subjects reported recurrent low-back pain and were classified as symptomatic, the remaining 89 subjects were asymptomatic. Standardized measures were taken, including the sit-and-reach test, hip range of motion (Leighton flexometer), lumbar flexibility (modified Schöber test) and lateral flexion of the spine. The same experimenter performed all testing, with 1 wk between the repeated measures.

RESULTS

Correlation coefficients suggested that all measures exhibited good reliability in both the symptomatic (r = 0.80-0.95) and asymptomatic groups (r = 0.88-0.99). In contrast, the limits of agreement showed that all measures exhibited random error. The magnitude of random error was typically greater in the symptomatic subjects, suggesting that low-back pain may influence the reliability of typical measures used in this population.

CONCLUSION

The magnitude of error must be interpreted in relation to analytical goals and the expected magnitude of change. In the authors' opinion the error presented appears acceptable for the serial monitoring of patients, although this will depend on the differences in mobility typically found.

An overview of the biology of the wharf borer beetle (Nacerdes melanura L., Oedemeridae) a pest of wood in marine structures

The UK distribution of N. melanura is reported, based on records from museum collections, government laboratories and a field survey of wooden marine structures and driftwood along the English and Welsh coastlines. The global distribution is also reported, based on a questionnaire survey. The life cycle of the wharf borer under different environmental conditions is described and the environmental conditions over the adult emergence period presented. The cellulase complex, xylanase and a range of dissacharases were present in the larval digestive tract when tunnelling archaeological oak.

Comparison of two assay methods for activities of uroporphyrinogen decarboxylase and coproporphyrinogen oxidase

Uroporphyrinogen decarboxylase (UROD) and coproporphyrinogen oxidase (copro'gen oxidase) are two of the least well understood enzymes in the heme biosynthetic pathway. In the fifth step of the pathway, UROD converts uroporphyrinogen III to coproporphyrinogen III by the decarboxylation of the four acetic acid side chains. Copro'gen oxidase then converts coproporphyrinogen III to protoporphyrinogen IX via two sequential oxidative decarboxylations. Studies of these two enzymes are important to increase our understanding of their mechanisms. Assay comparisons of UROD and copro'gen oxidase from chicken blood hemolysates (CBH), using a newly developed micro-assay, showed that the specific activity of both enzymes is increased in the micro-assay relative to the large-scale assay. The micro-assay has distinct advantages in terms of cost, labor intensity, amount of enzyme required, and sensitivity.

Juvenile hyperthyroidism in a cat

An 8-month-old, male domestic shorthaired cat presented for chronic weight loss, intermittent dyspnea, chronic diarrhea, hyperactivity, and weakness. The cat had a palpable thyroid nodule and increased serum total thyroxine and 3,5,3' triiodothyronine levels. The cat was diagnosed with hyperthyroidism, and a unilateral thyroidectomy was performed followed by radioactive iodine at a later date. The clinical signs resolved following radioactive iodine, and the cat subsequently developed clinical hypothyroidism.

Kinetic studies of novel di- and tri-propionate substrates for the chicken red blood cell enzyme coproporphyrinogen oxidase

Coproporphyrinogen oxidase is an important enzyme in heme biosynthesis and catalyses the sequential oxidative decarboxylation of propionates on the A and B rings of the porphyrinogen ring. The effects of substituents on the C and D rings have not been systematically evaluated for their effects on the kinetic constants, K(m) and V(max). A series of synthetic porphyrinogens have been tested for their ability to affect these kinetic constants for the chicken enzyme. The enzyme exhibited the largest V(max) when incubated with the authentic substrate and was clearly able to distinguish between various substituents on the C and D rings of the macrocycle. When co-incubated with substrate, the authentic product, protoporphyrinogen-IX, appears to inhibit coproporphyrinogen oxidase and this may have an important role in the regulation of this enzyme. Thus the model for the active site of this enzyme should be modified to take these factors into account.

Engineering of complex polyketide biosynthesis--insights from sequencing of the monensin biosynthetic gene cluster

The biosynthesis of complex reduced polyketides is catalysed in actinomycetes by large multifunctional enzymes, the modular Type I polyketide synthases (PKSs). Most of our current knowledge of such systems stems from the study of a restricted number of macrolide-synthesising enzymes. The sequencing of the genes for the biosynthesis of monensin A, a typical polyether ionophore polyketide, provided the first genetic evidence for the mechanism of oxidative cyclisation through which polyethers such as monensin are formed from the uncyclised products of the PKS. Two intriguing genes associated with the monensin PKS cluster code for proteins, which show strong homology with enzymes that trigger double bond migrations in steroid biosynthesis by generation of an extended enolate of an unsaturated ketone residue. A similar mechanism operating at the stage of an enoyl ester intermediate during chain extension on a PKS could allow isomerisation of an E double bond to the Z isomer. This process, together with epoxidations and cyclisations, form the basis of a revised proposal for monensin formation. The monensin PKS has also provided fresh insight into general features of catalysis by modular PKSs, in particular into the mechanism of chain initiation.