WAND2-A versatile wide angle neutron powder/single crystal diffractometer

Wide Angle Neutron Diffractometer Squared is a high-flux versatile diffractometer with a 2-Dimensional Position Sensitive Detector at the High Flux Isotope Reactor. The instrument has strengths in both powder and single crystal diffraction. It is a unique instrument in the neutron scattering landscape of North America, and its capabilities are at least equal to similar instruments in the world.

Point-of-care test to monitor adherence to anti-tuberculous treatment

Background: In the fight against the global tuberculosis epidemic, it is essential to ensure that patients adhere to the treatment prescribed. As the treatment is given for a minimum of 6 months it is common for patients not to take their drugs regularly. Strategies are therefore needed to assess adherence to treatment. One established method is to examine the patient's urine for the presence of drug metabolites. A rapid point-of-care test would overcome some of the drawbacks associated with currently available methods.

Method: A rapid, safe point-of-care test for isoniazid metabolites (IsoScreen, Surescreen Diagnostics Limited, Derby, UK) has been developed and used to help assess adherence to treatment in a busy clinic for tuberculosis patients in South London.

Results: Urine samples were examined from 191 patients receiving isoniazid, usually in combination with rifampicin and other anti-tuberculous drugs. Isoscreen was positive in 93.2% of patients, suggesting that 6.8% might be poorly adhering to treatment. By contrast, examining the same urine samples for evidence of rifampicin ingestion gave positive results in only 43.5%, due to the fact that this test is only positive for a few hours after drug ingestion.

Conclusion: IsoScreen has been shown to provide a rapid and safe point-of-care test, which contributes to the detection of non-adherence in patients with tuberculosis.

Influences on decision for mastectomy in patients eligible for breast conserving surgery

Increasing emphasis is being placed on low mastectomy rates. Our objective was to investigate factors influencing rates of mastectomy and breast conserving surgery. A group of 171 patients (27%) who could have had breast conserving surgery (BCS) but chose mastectomy was identified as well as all patients who underwent BCS over a 6 year period. A questionnaire asking patient's attitudes to factors which could influence their choice of operation was compiled and sent to this study group. Results showed surgical advice to be the most important factor, with significantly more influence in BCS patients. No significant difference was found in distance to treatment between the groups. Shorter duration radiotherapy would have made 47% of mastectomy patients more likely to accept BCS. BCS rates are a poor measure of quality of patient care. More emphasis should be put on choices offered to patients rather than overall uptake of a specific choice.

Tuberculosis screening in migrants in selected European countries shows wide disparities

Well-established tuberculosis screening units in Western Europe were selectively sampled. Three screening units in Norway, two in the UK, one in the Netherlands and one in Switzerland were evaluated. The aim of this study was to describe a range of service models used at a number of individual tuberculosis units for the screening of new entrants into Europe. Semi-structured interviews were conducted with clinicians, nurses and administrators from a selected sample of European tuberculosis screening units. An outline of key themes to be addressed was forwarded to units ahead of scheduled interviews. Themes included the history of the unit, structure, processes and outputs involved in screening new entrants for tuberculosis. Considerable variation in screening services exists in the approaches studied. Units are sited in transit camps or as units within hospital facilities. Staff capacity and administration varies from one clinic per week with few dedicated staff to fully dedicated units. Only one site recorded symptoms; tuberculin testing was universal in children, but varied in adults; chest radiograph screening was universal except at one site where a positive tuberculin skin test or symptoms were required in those <35 yrs of age before ordering a radiograph. Few output data are routinely and systematically collected, which hinders comparison and determination of effectiveness and efficiency. Service models for screening new immigrants for tuberculosis appear to vary in Western Europe. The systematic collection of data would make international comparisons between units easier and help draw conclusions that might usefully inform service development.

Evaluation of the role of intercellular adhesion molecule 1 in a rodent model of chronic venous hypertension

PURPOSE

To evaluate the role of intercellular adhesion molecule 1 (ICAM-1) in cutaneous leukocyte trapping in venous disease, we used our rodent model of venous hypertension (VH).

MATERIALS AND METHODS

VH was created in adult rats by ligation of the inferior vena cava, bilateral common iliac veins, and bilateral common femoral veins. In the Phase I experimental (exptl) group, anti-ICAM-1 monoclonal antibody (1A29) was given intravenously prior to venous ligations. Acute venous pressures were measured in the exptl and control (ctrl) (ligation only) groups. Bilateral forelimb and hindlimb skin specimens were harvested for myeloperoxidase (MPO) assay. In Phase II, VH was created in a chronic group; in a sham-operated group, ties were placed around the same vessels without ligations. Two weeks later, venous pressures were measured and radiolabeled ((125)I and (131)I) monoclonal antibody (mAb) to ICAM-1 was injected and allowed to circulate for 5 min before the level of radiolabeled antibody within forelimb and hindlimb specimens was measured.

RESULTS

In the acute study with 1A29, hindlimb pressures were significantly elevated in both the ctrl (n = 4) and exptl (n = 4) hindlimbs (15.4 +/- 0.239 and 13.8 +/- 1.89 mm Hg, respectively) compared with ctrl and exptl forelimbs (1.38 +/- 0.554 and 1.50 +/- 0.612 mm Hg, respectively). However, MPO activity was significantly elevated in the hindlimbs of the ctrl group compared with the hindlimbs of the exptl animals (19.8 +/- 1.54 U vs 6.71 +/- 2.46 U). In the chronic VH rats (n = 5) given radiolabeled anti-ICAM-1 mAb, the hindlimb pressures (10.1 +/- 4.52 mm Hg) were significantly elevated (P < 0.05) compared with forelimb pressures (1 +/- 0.447 mm Hg) and compared with the forelimb and hindlimb pressures in the sham-operated animals (n = 4) (1.63 +/- 0.813 and 4.25 +/- 2.13 mm Hg, respectively). However, there was not a significant difference in the quantity of ICAM-1-hindlimb versus forelimb or chronic VH versus sham.

CONCLUSIONS

Anti-ICAM-1 mAb decreased MPO activity in hypertensive hindlimb skin, supporting the instrumental role of ICAM-1 in cutaneous leukocyte trapping. However, the constituent endothelial ICAM-1 is not elevated by VH.

Seating positions and children's risk of dying in motor vehicle crashes

OBJECTIVES

To determine the effects of seating position, combined with restraint use and airbag status, on children's risk of dying in crashes.

METHODS

Using 1988-95 data from the United States Fatality Analysis Reporting System, risk of death was compared among front and rear seated passengers aged 12 and younger who were involved in fatal crashes for different categories of restraint use and in vehicles with and without passenger airbags.

RESULTS

Restrained children in rear seats had the lowest risk of dying in fatal crashes. Among children seated in the rear, risk of death was reduced 35% in vehicles without any airbags, 31% in vehicles equipped only with driver airbags, and 46% in vehicles with passenger airbags. Both restrained and unrestrained children aged 0-12 were at lower risk of dying in rear seats. Rear seats also afforded additional protection to children aged 5-12 restrained only with lap belts compared with lap/shoulder belted children in front seats. Children were about 10-20% less likely to die in rear center than in rear outboard positions.

CONCLUSIONS

Parents and others who transport children should be strongly encouraged to place infants and children in rear seats whether or not vehicles have airbags. Existing laws requiring restraint use by children should be strengthened and actively enforced.

Prisoners' knowledge and attitude toward prophylactic treatment and therapy

Identifying factors that hinder an inmate's compliance with Pneumocystis carinii pneumonia (PCP) prophylaxis therapy can be critical in preventing or decreasing the occurrence of PCP in this population. Anticipated factors include lack of knowledge about PCP and its proposed treatment, fear of the adverse effects of prophylaxis therapy, and lack of trust in the correctional facility medical team. Structured interviews were administered to HIV-positive male inmates chosen randomly (n = 104) at a medium- to maximum-security medical correctional facility located in the western portion of the United States. A basic "HIV 101 and Early Intervention" program encompassed the presentation of HIV facts and knowledge as well as safer sex practices. The results revealed that 95% of the respondents were knowledgeable about PCP and the side effects of their medications, and 56% of the respondents were afraid of the medications' side effects. Significant differences based on age were recorded for several specific knowledge questions, including the preventable nature of PCP.

The epidemiology of trachoma in rural Kenya. Variation in prevalence with lifestyle and environment. Study Survey Group

PURPOSE

Ocular examination surveys were carried out in Kenya by the International Eye Foundation as a component of the Kenya Rural Blindness Prevention Project to determine the national prevalence of blindness and ocular morbidity and major causes. A goal of the surveys was to determine the overall geographic distribution and severity of trachoma throughout Kenya.

METHODS

Using a random cluster household sampling technique, 13,803 people of all ages and of diverse cultural and ethnic backgrounds were identified in eight regions of Kenya. A detailed examination for active and inactive trachoma was carried out on each person surveyed as part of the general ocular examination.

RESULTS

The prevalence rate of visual loss (< 20/60) due to trachoma in the better eye was 7.2/1000. Active trachoma was present in 19% of all persons examined, and 50% of all those with trachoma were found to have moderate to severe inflammation. Prevalence varied according to survey region from less than 1% in four regions where agriculture is the economic base, to 57% and 63% in two arid pastoral regions. Trachoma prevalence varied from 28% in children younger than 3 years of age to 11% in persons older than 60 years of age. Potentially blinding eyelid deformities secondary to chronic trachoma occurred in 5.0% of the rural population, and 1.2% of the rural population displayed associated corneal scarring. Lid scarring, corneal scarring, and lid deformities were greater in prevalence among females of all age groups when compared with males.

CONCLUSIONS

Trachoma prevalence in Kenya varies widely from region to region. High prevalence is associated with high climatic aridity, and lower prevalence is associated with areas of greater rainfall, sustainable agriculture, and a higher general standard of living. Within high-risk regions, there are wide variations in age-specific prevalence and severity of the disease. Potentially blinding sequelae of trachoma are more prevalent in females than in males.

Blindness and eye disease in Kenya: ocular status survey results from the Kenya Rural Blindness Prevention Project

A series of eight regional eye surveys were conducted in Kenya as part of the Kenya Rural Blindness Prevention Project. Each survey consisted of clinical examinations of about 1800 individuals selected by a random cluster sampling technique in geographically distinct and culturally homogeneous rural areas; 13,803 examinations were completed in all. Together these surveys provide the basis for national estimates of the prevalence and aetiology of visual loss and ocular pathology. The results showed that 0.7% of rural Kenyans are blind in the better eye by WHO standards, and another 2.5% suffer significant visual impairment. Rates of visual loss tend to increase five-fold in each 20-year age cohort. Females have higher prevalence of visual loss than males over age 20, and certain geographical areas have markedly higher rates. The commonest cause of both blindness and visual impairment is cataract, accounting for 38% of all visual loss. Trachoma (a localised problem), glaucoma, macular degeneration, and severe refractive errors follow cataract as leading causes of blindness in the better eye. Trauma, corneal scars of various causes, phthisis, and staphyloma are important causes of monocular blindness. Nutritional eye disease does not appear to be a problem of any magnitude in rural Kenya.

Comparative assessment of enprofylline and theophylline for chronic obstructive airways disease in the elderly

Enprofylline, a recently developed xanthine derivative, is a more potent bronchodilator than theophylline. This study compares the efficacy and safety of enprofylline with theophylline for chronic obstructive airways disease (COAD) in elderly subjects. The study was of a randomized double-blind parallel design and commenced with a 1-week reference period when oral bronchodilators were withdrawn. Patients were then treated with either enprofylline or theophylline 150 mg bd for 2 weeks (period 1) followed by 300 mg bd for a further 3 weeks (period 2). Patients recorded peak expiratory flow rate (PEFR) and adverse experiences, if any, in a diary, daily. Of 111 patients recruited for the study, 85 entered active treatment (theophylline, n = 44; enprofylline, n = 41). Mean age was 72 years and mean bronchodilator reversibility was 22%. Enprofylline increased mean morning PEFR by 11% (period 1) and 19% (period 2) whereas theophylline increased PEFR by 13% and 19%, respectively. From the enprofylline group 29% were withdrawn from the study due mainly to headache and nausea/vomiting and from the theophylline group 7% were withdrawn due mainly to nausea/vomiting. Mean plasma concentrations of enprofylline were 2.0 mg l-1 and 3.4 mg l-1, and with theophylline 5.4 mg l-1 and 10.0 mg l-1 at the end of periods 1 and 2, respectively. Enprofylline and theophylline produced similar improvements in lung functions and symptoms of chronic obstructive airways disease, but enprofylline was less well tolerated than theophylline.

Adolescents and their experience of parental divorce

This paper describes the results of an interview-based study of the reactions of 64 adolescents to the separation and divorce of their parents. The results of the interviews suggest that parental divorce does not necessarily interfere with adolescent development. They also suggest that adolescents would prefer to live in a one-parent home than a two-parent home which is fraught with conflict, and that it is preferable for parents who are unable to resolve such conflict in any other way to separate rather than allow it to persist. Further, the results of the interviews provide some suggestions as to the way divorcing parents should behave if they are to facilitate the adjustment of their adolescent children to the divorce process. In particular, attention is drawn to the extent to which they need to keep their children informed about their intentions, their conduct towards each other following the separation and their conduct in forming and maintaining new relationships.

Cataract and corneal opacity are the main causes of blindness in the Samburu tribe of Kenya

An ocular status survey of the Samburu tribe of Kenya was carried out. There were 844 survey members in an age and sex stratified cluster sample. The prevalence of those who were found to have moderate visual loss or worse (less than 20/60 [6/18] in the better eye) was 3.8%. Those blind by USA criteria represented 1.7% of the total population. The two principal causes of blindness, cataract and corneal opacity, are both surgically amenable. A description of the Samburu people, the survey methods, and a summary of the survey findings are included.

Appropriate ophthalmic surgical technology in developing nations

Ophthalmologists working in developing nations are faced with shortages in surgical equipment and expendable supplies. Invention and improvisation can extend financial resources and reduce the unit cost per operation. Examples of appropriate ophthalmic technological invention are described and illustrated.