CVID Colopathy: An Important Clinical Diagnosis with a Broad Differential

Introduction/Objective

Colonic injury with increased epithelial cell apoptosis can be sometimes seen in colonic biopsies; raising a broad differential diagnosis. The possible etiologies include graft-versus-host disease and, drug- induced injury (including but not limited to mycophenolate mofetil, checkpoint inhibitors, antimetabolites, and tumor necrosis alpha inhibitors), infections (particularly cytomegalovirus and adenovirus), and immune disorders (common variable immune deficiency and autoimmune enterocolopathy). Hence, the umbrella term “apoptotic colopathy” was coined as a broad-spectrum diagnosis for further workup.

Methods/Case Report

Herein, we report a case of a 36-year-old Caucasian male who presented for follow-up of ulcerative pancolitis with additional history of decompensated liver cirrhosis. The patient has a past history of Common variable immunodeficiency (CVID) with CVID enteropathy and CMV gastritis. The patient’s long-term medications included Entyvio, IVIG, and Valcyte. Surveillance colonoscopy was performed and revealed portal colopathy, otherwise was unremarkable. Both right and left colon were biopsied. Microscopic examination showed marked epithelial cell apoptosis with no granulomas, dysplasia, or malignancy. No history of mycophenolate or stem cell transplant was noted. No viral cytopathic effect was seen, supported by CMV stain. Apoptotic colopathy with the possible differential diagnosis was rendered as the final diagnosis; mentioning the given clinical history of the patient for CVID, the histological picture is compatible with CVID colopathy.

Results (if a Case Study enter NA)

NA.

Conclusion

It is pertinent to be aware of all above mentioned possible etiologies in such cases. Correlation with detailed clinical history, medications, laboratory findings, and other histopathological findings (including judicial use of immunohistostains) is warranted to reach a definitive diagnosis that would drive patient management accordingly and help provide optimal patient care.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Evaluation of the MP Rapid 2019-NCOV IgM/IgG combo POCT test vs. an established platform-based method

BACKGROUND

Accurate and rapid testing for SARS-COV-2 antibodies could improve the diagnosis and management of COVID-19. In this study, we aim to evaluate the diagnostic accuracy of a commercially available point-of-care lateral flow kit independently and in comparison to an established platform-based system.

METHOD

Samples from 144 PCR-confirmed COVID-19 cases and 130 pre-pandemic negative controls were tested in parallel by MP Rapid 2019-NCOV IgM/IgG Combo test and Roche Elecsys. Comparison of results based on serum and capillary blood testing was undertaken.

RESULTS

Sensitivity at day 15 onwards was 100% for both methods. Between days 1 and 7 post admission, the IgM/IgG Combo test and Roche Elecsys shown sensitivity of 74% (95%CI: 62%-85%) vs. 67% (95% CI: 55%-79%, P = 0.3947). Combo test specificities were 100% for IgG, 98.5% for IgM vs. Roche Elecsys specificity of 100%. Concordance analysis showed 98.5% agreement to the Roche Elecsys method (Cohen's Kappa 0.96 95% CI [0.92-0.99]). Capillary blood results showed complete agreement with serum samples using the Combo test.

CONCLUSION

In comparison to Roche Elecsys, our data show that the MP Rapid 2019-NCOV IgM/IgG Combo test provides a high-confidence assay system for the detection of previous exposure to SARS-COV-2 infection with advantage of affording near-patient testing.

Feng shui And Emotional Response in the Critical care Environment (FARCE) study

The aim of this study was to investigate the relationship between nursing staff emotions and their surrounding environment, using the ancient system of feng shui. Two orientations of critical care bed spaces (wind and water groups, respectively) were mapped using a western bagua. Energy or 'chi' scores for nine emotions were calculated based on the positive or negative flow of chi in each of the two groups. During a two-week period, nursing staff were allocated to work in a bed space in either the wind or water groups; nursing staff who were not allocated to a study bed space acted as a control group. Participating nursing staff completed a questionnaire, ranking nine emotional states and their overall inner harmony, using a 11-point chi scale. In total, 108 questionnaires were completed. Critical bed space orientation according to feng shui principles was not related to nurse-reported chi scores or inner harmony (p > 0.05 for all measurements). There was also poor correlation between the bagua-predicted and reported chi scores for both the wind and water groups (R²  = 0.338 and 0.093, respectively). The use of feng shui to guide the layout of critical care bed spaces does not improve the emotional well-being of nursing staff.

Non-fatal case of Crimean-Congo haemorrhagic fever imported into the United Kingdom (ex Bulgaria), June 2014

Crimean-Congo haemorrhagic fever (CCHF) was diagnosed in a United Kingdom traveller who returned from Bulgaria in June 2014. The patient developed a moderately severe disease including fever, headaches and petechial rash. CCHF was diagnosed following identification of CCHF virus (CCHFV) RNA in a serum sample taken five days after symptom onset. Sequence analysis of the CCHFV genome showed that the virus clusters within the Europe 1 clade, which includes viruses from eastern Europe.

Improving left hemispatial neglect using virtual reality

BACKGROUND

In hemispatial neglect, space can be dissociated on the basis of "near" peripersonal vs "far" extrapersonal space. The clinical manifestations of neglect can be modified by having patients use a tool to explore "far" extrapersonal space. An explanation for this is that the use of a stick produced an extension of body space resulting in a remapping of "far" space as "near" space.

OBJECTIVE

S: To determine whether the remapping of space can be generalized to the amelioration of the "affected" vs the "nonaffected" space, rather than being confined to the selective amelioration of "far" vs "near" neglect; and to determine whether tool use is a necessary condition for the remapping of space.

METHODS

Using virtual reality, the authors asked six hemispatial neglect patients to reach and grasp a real object while simultaneously observing the grasping of a virtual object located within a virtual environment by a virtual hand. The virtual hand was commanded in real time by their real hand.

RESULTS

After a period of adaptation, hemispatial neglect patients coded the visual stimuli within the neglected space in an identical fashion as those presented within the preserved portions of space.

CONCLUSIONS

It is possible to re-create links between the affected and the nonaffected space. Wielding a tool is not a necessary condition in reopening neglected space.

Adolescent health education programmes: theoretical principles in design and delivery

The patterns of health need in youth have changed over the last three decades with increasing rates of psychosocial problems compromising adolescent development and affecting the patterns of morbidity and mortality in adult years. This has increased the public health interest in health promotion, early detection and preventive health care for adolescents. Yet, young people report significant barriers to accessing the health care system, and health professionals report a self-perceived lack of competency and prior training in adolescent health, especially in these areas of youth health need. There is an imperative to provide quality professional development for existing health professionals and undergraduates in adolescent health care. This paper will discuss a model of professional knowledge in adolescent health and the evidence-based principles in design and delivery of effective education programmes. It will also review the published evaluations of adolescent education programmes and outcomes that still require evaluation in the future.

Effects of different resistance training protocols on upper-body strength and endurance development in children

This study examined the effects of 4 different resistance training protocols on upper-body strength and local muscle endurance development in children. Untrained boys and girls (mean +/- SD age, 8.1 +/- 1.6 years) trained twice per week for 8 weeks using child-sized weight machines and medicine balls weighing 1-2.5 kg. In addition to general conditioning exercises, subjects in each exercise group performed 1 set of the following exercise protocols for upper-body conditioning: 6-8 repetitions with a heavy load on the chest press exercise (HL, n = 15); 13-15 repetitions with a moderate load on the chest press exercise (ML, n = 16); 6-8 repetitions with a heavy load on the chest press exercise immediately followed by 6-8 medicine ball chest passes (CX, n = 12); or 13-15 medicine ball chest passes (MB, n = 11). Twelve children served as nontraining controls (CT). After training, only the ML and CX groups demonstrated significant (p < 0.05) improvements in 1RM chest press strength (16.8% and 16.3%, respectively) as compared with the CT group. Local muscle endurance, as determined by the number of repetitions performed posttraining on the chest press exercise with the pretraining 1RM load, significantly increased in the ML group (5.9 +/- 3.2 repetitions) and CX group (5.2 +/- 3.6 repetitions) as compared with the CT group. In terms of enhancing the upper-body strength and local muscle endurance of untrained children, these findings favor the prescription of higher-repetition training protocols during the initial adaptation period.

Higher than normal plasma interleukin-6 concentrations in cancer patients with depression: preliminary findings

OBJECTIVE

This study investigated whether cancer patients with and without major depression exhibit immune system abnormalities similar to those reported in medically healthy, depressed subjects without cancer.

METHOD

The study subjects consisted of patients diagnosed with pancreatic, esophageal, or breast cancer. Other groups consisted of subjects with major depression (without cancer) and healthy comparison subjects. Subjects' diagnoses were made with the Structured Clinical Interview for DSM-III-R. Severity of depression was measured with the Hamilton Depression Rating Scale. Plasma concentrations of interleukin-6 (IL-6) and postdexamethasone cortisol were measured.

RESULTS

Cancer patients with depression had markedly higher plasma concentrations of IL-6 than healthy comparison subjects and cancer patients without depression. Although significant correlations were found between Hamilton depression scale scores and plasma concentrations of postdexamethasone cortisol, no significant correlations were found between plasma IL-6 and postdexamethasone cortisol concentrations.

CONCLUSIONS

Higher than normal plasma IL-6 concentrations were associated with a diagnosis of major depression in cancer patients. IL-6 may contribute to sickness behavior that has overlapping symptoms with major depression.

Effects of regular and slow speed resistance training on muscle strength

BACKGROUND

The study assessed a way to increase the intensity and effectiveness of resistance training by comparing training with a slower repetition speed to training with a conventional repetition speed. Slower repetition speed may effectively increase intensity throughout the lifting phase while decreasing momentum.

METHODS

Two studies were done with untrained men (N=65) and women (N=82), (mean age=53.6) who trained two to three times per week for eight to 10 weeks on a 13 exercise Nautilus circuit performing one set of each exercise. Participants exclusively trained using regular speed repetitions for 8 to 12 repetitions per set at 7 sec each (2 sec lifting, 1 sec pause, 4 sec lowering) or a Super Slow training protocol where they completed 4 to 6 repetitions per set at 14 sec each (10 sec lifting, 4 sec lowering). All of the participants were tested for either the 10 repetition-maximum (RM) weightload (regular-speed group) or the 5-RM weightload (slow-speed group).

RESULTS

In both studies, Super-Slow training resulted in about a 50% greater increase (p<0.001) in strength for both men and women than regular speed training. In Study 1, the Super-Slow training group showed a mean increase of 12.0 kg and the regular speed group showed an increase of 8.0 kg increase (p<0.001). In Study 2, the Super-Slow training group showed a 10.9 kg increase and the regular speed group showed an increase of 7.1 kg (p<0.001).

CONCLUSIONS

Super-Slow training is an effective method for middle-aged and older adults to increase strength. Although studies still need to be done with at-risk populations, repetition speed should be considered when prescribing resistance training.

The role of vision in the on-line correction of illusion effects on action

In this study, participants reached out and picked up a bar placed on a background grating that induced an illusion in the perceived orientation of the bar. The illusion had a large effect on the orientation of the hand early in the reaches, but this effect decreased continuously as the hand approached the target. This pattern occurred whether or not participants were allowed vision of the hand and target while reaching. These results are consistent with a "planning/control" model of action, in which actions are planned using a context-dependent visual representation but monitored and corrected on-line using a context-independent visual representation. The hypothesized neural bases of these representations are discussed.

Building capacity for system-level change in schools: lessons from the Gatehouse Project

The Gatehouse Project is an innovative, comprehensive approach to mental health promotion in secondary schools. It sets out to promote student engagement and school connectedness as the way to improve emotional well-being and learning outcomes. The key elements of the whole-school intervention are the establishment and support of a school-based adolescent health team; the identification of risk and protective factors in each school's social and leaning environment from student surveys; and, through the use of these data, the identification and implementation of effective strategies to address these issues. The project evaluation used a cluster-randomized controlled trial design involving 26 schools with initial results demonstrating considerable success in reducing smoking rates among Year 8 children. This article describes and accounts for how system-level changes have been made in schools through a process of capacity building. This encourages teachers, parents, and students to view the core business of education differently.

Hospital competition in major U.S. metropolitan areas: empirical evidence

In response to dramatic rises in health care costs, policy-makers have been debating the relative merits of competitive strategies as a means of containing costs. This article represents a study of the 29 largest MSAs for 1991. Controlling for environmental conditions in each market, the impact of competition on hospital costs was examined. Competition was found to have had a significant positive impact on overall hospital costs.

Motor adaptation to an optical illusion

This research investigated the effects of an orientation illusion on action, as well as the ability of the motor system to adapt to the illusion. Subjects reached out and picked up a small bar placed at various orientations. A background grating was used to induce an orientation illusion. When the direction of the illusion was reversed, the following seven trials revealed a large illusion effect in the early portion of the reach. In the subsequent seven trials, no effect of the illusion was present. This pattern of adaptation was similar to the pattern often obtained with displacing prisms, suggesting that the two types of visual distortions present the motor system with similar challenges that it meets in similar ways. These findings are consistent with a planning/control model that argues for separate visual representations underlying the planning and on-line control of reaching.

Neurofibromatosis type 1 and McCune-Albright syndrome occurring in the same patient

A patient with both neurofibromatosis type 1 (NF-1) and McCune-Albright syndrome is described. NF-1 and McCune-Albright are separate entities and this is the first report of a patient with clear evidence of both conditions.

Proposing an algorithm for the pharmacological management of posttraumatic stress disorder

The clinical management of posttraumatic stress disorder (PTSD) is as complex as the condition itself. Pharmacotherapy is an important component of this treatment process, which also includes psychosocial interventions and, in most cases, entails long-term efforts. The authors propose a systematic approach to the pharmacological treatment of PTSD using algorithmic techniques. After a careful history-taking phase and a review of available psychotropic agents, the practitioner usually ends up dealing with either PTSD alone or, more frequently, accompanied by other identifiable syndromes. Various antidepressants have demonstrated efficacy in the former, while the latter requires a management aimed at depressive, anxiety/dissociative, hypomanic/manic, or psychotic symptoms. The proposed algorithm provide guidelines for treatment issues such as medication choice, medication dose, maintenance pharmacotherapy, alternative options, and eventual outcomes. Algorithms summarize current information and suggest pharmacotherapy guidelines as a significant component of a comprehensive PTSD management program.

The Gatehouse Project: a systematic approach to mental health promotion in secondary schools

OBJECTIVE

The objective of this paper is to outline the conceptual background and strategy of intervention for a systematic and sustainable approach to mental health promotion in secondary schools.

METHOD

The conceptual origins of the Gatehouse Project are described in terms of the epidemiology of adolescent mental health problems, attachment theory, education reform research and health promotional theory and practice. The elements of health promotional work are described in terms of structural change and priority setting; implementation at multiple levels within the participating schools is described.

RESULTS

The conceptual framework of the Gatehouse Project emphasises healthy attachments with peers and teachers through the promotion of a sense of security and trust, effective communication and a sense of positive self-regard based on participation in varied aspects of school and community life. A school social climate profile is derived from a questionnaire survey of students. An adolescent health team uses this information to set priorities for change within the school. Interventions may focus on the promotion of a positive social climate of the whole school or in the classroom. Curriculum-based health education is also used and based on materials that are relevant to the normal developmental experiences of teenagers. These are integrated into the mainstream curriculum and incorporate a strong component of teacher professional development. Lastly, the intervention promotes linkage between the school and broader community with a particular emphasis on the needs of young people at high risk of school drop-out.

CONCLUSIONS

Educational environments are complex systems undergoing continuous and simultaneous changes. The Gatehouse Project will provide unique information on the relationship between the social environment and the emotional wellbeing of young people. More importantly it outlines a sustainable process for building the capacity of schools to promote the social and emotional development of young people.

The Gatehouse Project: a systematic approach to mental health promotion in secondary schools

OBJECTIVE

The objective of this paper is to outline the conceptual background and strategy of intervention for a systematic and sustainable approach to mental health promotion in secondary schools.

METHOD

The conceptual origins of the Gatehouse Project are described in terms of the epidemiology of adolescent mental health problems, attachment theory, education reform research and health promotional theory and practice. The elements of health promotional work are described in terms of structural change and priority setting; implementation at multiple levels within the participating schools is described.

RESULTS

The conceptual framework of the Gatehouse Project emphasises healthy attachments with peers and teachers through the promotion of a sense of security and trust, effective communication and a sense of positive self-regard based on participation in varied aspects of school and community life. A school social climate profile is derived from a questionnaire survey of students. An adolescent health team uses this information to set priorities for change within the school. Interventions may focus on the promotion of a positive social climate of the whole school or in the classroom. Curriculum-based health education is also used and based on materials that are relevant to the normal developmental experiences of teenagers. These are integrated into the mainstream curriculum and incorporate a strong component of teacher professional development. Lastly, the intervention promotes linkage between the school and broader community with a particular emphasis on the needs of young people at high risk of school drop-out.

CONCLUSIONS

Educational environments are complex systems undergoing continuous and simultaneous changes. The Gatehouse Project will provide unique information on the relationship between the social environment and the emotional wellbeing of young people. More importantly it outlines a sustainable process for building the capacity of schools to promote the social and emotional development of young people.

A clinical study of 57 children with fetal anticonvulsant syndromes

BACKGROUND

Anticonvulsants taken in pregnancy are associated with an increased risk of malformations and developmental delay in the children. To evaluate the pattern of abnormalities associated with prenatal anticonvulsant exposure further, we undertook a clinical study of 57 children with fetal anticonvulsant syndromes.

METHODS

Fifty two children were ascertained through the Fetal Anticonvulsant Syndrome Association and five were referred to the Aberdeen Medical Genetics Service. Pregnancy and medical history were obtained through a standardised questionnaire and interview and the children were examined.

RESULTS

Thirty four (60%) were exposed in utero to valproate alone, four (7%) to carbamazepine alone, four (7%) to phenytoin alone, and 15 (26%) to more than one anticonvulsant. Forty six (81%) reported behavioural problems, 22 (39%) with hyperactivity or poor concentration of whom four (7%) had a diagnosis of attention deficit and hyperactivity disorder. Thirty four (60%) reported two or more autistic features, of whom four had a diagnosis of autism and two of Asperger's syndrome. Forty four (77%) had learning difficulties, 46 (81%) had speech delay, 34 (60%) had gross motor delay, and 24 (42%) had fine motor delay. Nineteen (33%) had glue ear and 40 (70%) had joint laxity involving all sizes of joints. Of 46 who had formal ophthalmic evaluation, 16 (34%) had myopia.

CONCLUSIONS

Speech delay, joint laxity, glue ear, and myopia are common in the fetal anticonvulsant syndromes and autistic features and hyperactivity form part of the behavioural phenotype.

Randomised controlled trial of an educational strategy to increase school-based adolescent hepatitis B vaccination

OBJECTIVES

This study aimed to evaluate a specifically designed hepatitis B education/promotion curriculum package as part of a successful hepatitis B vaccination delivery system to adolescents.

METHODS

A randomised-controlled trial was used to evaluate the effect of the curriculum package (or intervention) on uptake of vaccine. Schools were randomly selected from the metropolitan region of Melbourne to intervention (66 schools or 7,588 students) or control groups (69 schools or 9,823 students). Class teachers administered the intervention to students over 4 class periods before the vaccination course.

RESULTS

The difference in mean school uptake between intervention and control was small at 1-2% per dose. 95% confidence intervals around the differences were -5% to 2% per dose and not significant. Intervention schools taught an average of 7 items out of 12 from the curriculum package. Immunisation rates increased by 4-10% per dose between low and high implementation schools, but this trend was not significant. Impact evaluation demonstrated significantly greater knowledge of hepatitis B and vaccination among students in the intervention than the control group.

CONCLUSION

Hepatitis B vaccination of pre-adolescents was not increased by the implementation of a curriculum package that successfully increased knowledge and awareness of hepatitis B in a school-based vaccination program. Additional strategies directed at the education of parents, the cooperative role of schools and pro-active providers might also be required to maximise vaccine uptake in this age group.

A profile of women CEOs/administrators in community and migrant health centers

Most of the current research on women executives has focused on models in which few women achieve the highest position (e.g. hospital CEOs). This article looks at the nation's Community and Migrant Health Centers where substantial numbers of women hold the highest executive position. A national profile of women Community and Migrant Health Centers (C/MHCs) Chief Executive Officers/Administrators is provided in terms of their personal and work characteristics, as well as their values and beliefs regarding successful C/MHC attributes and important managerial practices. The study compares C/MHC Chief Executive Officers/Administrators based on gender. The study found that 41 percent of the CEO/Administrators were women and that they shared similar values and beliefs about functions/critical managerial factors and managerial characteristics of C/MHCs with their male colleagues. However, the study did find a comparable salary differential of over $11,000 in favor of male Chief Executive Officers/Administrators. The article reviews the literature of female executives in health care and concludes with recommendations for further study using the C/MHCs CEO/Administrators as a model study population.

Periodontopathic bacteria in English HIV-seropositive persons

Selected periodontopathic bacteria were sought in 20 HIV-infected English patients and eight noninfected control subjects with similar periodontal status, using highly specific DNA probes. Actinobacillus actinomycetemcomitans (A. a), Porphyromonas gingivalis, Campylobacter rectus, Prevotella intermedia, and Fusobacterium nucleatum were more frequently detected and were found at higher levels in HIV-infected individuals than in controls. Significantly increased levels of Treponema denticola but, in contrast, lower levels of Eikenella corrodens were found in nonbleeding sites of HIV-infected patients compared with controls. The results of the present investigation on English patients suggest a periodontopathogenic role for A. a, P. gingivalis and C. rectus, and possibly P. intermedia and are in general accord with most previously reported data from the United States. Longitudinal studies are now required to determine more precisely the association between periodontopathic microflora, immune competence and periodontal health and disease in HIV-infected persons.

Physician practice characteristics and satisfaction: a rural-urban comparison of medical directors at U.S. Community and Migrant Health Centers

For this study, the association between physician practice characteristics and satisfaction of medical directors at rural and urban Community and Migrant Health Centers (C/MHCs) was investigated. Data for this study came from a 1996 cross-sectional survey of C/MHCs' medical directors. A total of 411 centers (68.3 percent) responded to the survey, including 240 rural (67.4 percent) and 171 urban (68.7 percent) C/MHCs. Factor analysis was used to synthesize physician practice characteristics related to overall satisfaction. The resulting factors were entered as new variables in a predictive logistic regression model of overall satisfaction. Growing up in an inner-city community was significantly associated with practicing in an urban center; whereas, growing up in a rural or frontier community was more likely to result in practicing in a rural center. The majority of medical directors (82.3 percent) were either somewhat satisfied or very satisfied with their work. Satisfaction with work was most significantly associated with overall level of satisfaction, followed by satisfaction with administration, peers and patients. Recruitment efforts are more likely to succeed when they target individuals with prior exposure to underserved areas. Improving the working conditions and interactions with administrators would help sustain the high level of satisfaction experienced by medical directors at C/MHCs.

The use of rapid-rate transcranial magnetic stimulation (rTMS) in refractory depressed patients

Rapid-rate transcranial magnetic stimulation (rTMS) allows for the noninvasive examination of the cerebral cortex. Recent studies have begun to investigate whether rTMS may be therapeutic for the treatment of depression. In the present study, the authors report on the safety and efficacy of rTMS in treating 50 patients with refractory depression. Overall, there were 21 responders (42%). Interestingly, 56% of the young patients responded, but only 23% of the elderly patients responded to rTMS. Overall, rTMS was well tolerated in all patients. Specifically, no patient developed a new onset of seizures during rTMS. The authors discuss the extant literature on rTMS for the treatment of depression along with future areas of research.

Administrative update: utilization of services. II. Utilization of mental health services in a tri-ethnic sample of adolescents

In our study of a tri-ethnic sample of 2528 junior and high school students, we examined utilization of outpatient mental health services in relation to a number of variables cited in the literature as leading to potential biases and barriers to care. These include: age, gender, ethnicity, socioeconomic status, family size and composition, and linguistic fluency in Hispanic youth. The impact of service availability was examined through differences between the two regions studied: a well-served region of coastal southeast Texas and the markedly under served lower Rio Grande Valley. The impact of symptomatology was evaluated using the total problem score on the Youth Self Report by Achenbach. Hispanic youth had significantly lower mean service utilization than non-Hispanic whites. Multiple regression analyses demonstrated that socioeconomic status and family composition had a greater relative impact on utilization than all other non-clinical factors, both for the total sample as well as for the Hispanic sample. Ethnicity may play a significant role in child mental health services utilization through its close association to socioeconomic status.

Educational preparation and attributes of community and migrant health center administrators

Based on a 1994 national survey of Community and Migrant Health Center (C/MHC) administrators, this study draws a profile of C/MHC administrators in terms of their personal and work characteristics, as well as their values and beliefs regarding successful C/MHC attributes and important managerial practices. Further, the study compares C/MHC administrators with different educational preparation in terms of their personal and work characteristics, values and beliefs, as well as their perceived deficiencies. The study results indicate that critical factors in C/MHC success, in order of ranked importance, were good organizational leadership, organization's value to community and efficiency. Successful managerial characteristics, in order of ranked importance, were vision for the future of organization, honesty/integrity and open to new possibilities. Administrators with more advanced degrees expressed less deficiencies and those with no college degree showed greatest deficiency on five of eight measures.

The economic impact on families of children's participation in junior sport

The study investigated the socio-economic consequences for families of participation in junior sport. Two hundred and twenty families in Queensland and Victoria were surveyed from the sports of cricket, Australian football, gymnastics, hockey, netball and tennis and twenty seven of these interviewed. The study showed that parents make a substantial contribution in terms of financial support to their children's participation in junior sport. Each of the sports mode different financial demands on families depending on the yearly cycle of training and competition, distance from facilities and coaching, costs associated with coaching, equipment and uniforms, and representative level. It is concluded that family income and structure are the key factors in determining the likelihood of a child's involvement in junior sport, and that for many Australian children, financial factors may be barriers to their participation in junior sport.

Translocation of the 85-kDa phospholipase A2 from cytosol to the nuclear envelope in rat basophilic leukemia cells stimulated with calcium ionophore or IgE/antigen

The rat mast cell line RBL-2H3.1 contains an 85-kDa cytosolic phospholipase A2 (cPLA2) that is very likely involved in liberating arachidonate from membrane phospholipid for the synthesis of eicosanoids following stimulation with either calcium ionophore or IgE/antigen. In this study, the intracellular location of cPLA2 was determined using immunofluorescence microscopy and immuno-gold electron microscopy. In nonstimulated cells, cPLA2 is distributed throughout the cytosol and is excluded from the nucleoplasm. Following cell activation with calcium ionophore, most of the cPLA2 translocates to the nuclear envelope, and the enzyme remains there during the entire period that ionophore is present. With IgE/antigen stimulation for 5 min, approximately 20-30% of the cPLA2 translocates to the nuclear envelope, and after 30 min of stimulation, most of the enzyme returns to the cytosol. Measurement of intracellular calcium using the dye Fura-2/AM shows that the level of calcium rises immediately after antigen is added, remains high for about 30 s, and then declines back to resting levels. Activation with calcium ionophore produces a 10-fold larger release of arachidonate than does stimulation with IgE/antigen. Thus, the results suggest that the extent of membrane binding of cPLA2 correlates with the release of arachidonate and that the site of arachidonate liberation is the nuclear envelope where many of the enzymes that oxygenate this fatty acid are located.

Measurement of the attenuation coefficient for Livermore Thoracic Phantom lungs fabricated using contemporary materials

The University of Cincinnati has reproduced the original formulation for the Livermore Thoracic Phantom lungs using contemporary materials and has adopted the linear attenuation coefficient as the primary quality assurance parameter for evaluating the performance capabilities of these new lung phantoms. The Livermore Thoracic Phantom was originally fabricated in 1978 to intercalibrate detector systems used to measure plutonium and other low-energy, photon emitting radionuclides deposited in the respiratory tract. The linear attenuation coefficient is a critical performance indicator for these phantom lungs since the presence of any material with a high effective atomic number (where Z > or = 20) will make a significant change in the photoelectric cross section, the predominant mode of interaction for plutonium x rays. A set of test lungs was fabricated with KCl to introduce a known quantity of 40K in the phantom and to determine, by measurement and calculations, what change would be made to the attenuation coefficient at photon energies below 100 keV as a result of the modified formulation. The KCl increased the linear attenuation coefficient below 60 keV by more than a factor of two, which would produce a substantial systematic error in any subsequent calibration measurements performed with these modified phantom lungs. These results support use of the attenuation coefficient as an important performance indicator for the Livermore Thoracic Phantom lungs and also suggest that KCl not be added to the lung tissue substitute formulation as a means to incorporate 40K in the phantom for low energy calibrations.

Insights into stereochemical features of sulphated carbohydrates: X-ray crystallographic and modelling investigations

The three-dimensional structures of the 2-, 3-, 4- and 6-monosulphates of methyl alpha-D-galactopyranoside have been determined by X-ray crystallography; the first two as the sodium salt, the third as both the sodium and potassium salts, and the fourth as a potassium salt. These represent the principal sulphated monomers of the carrageenan polysaccharides. The results extend our knowledge of the stereochemical features, such as ring conformation, sulphate geometry, hydrogen bonding and cation co-ordination, which characterize sulphated monosaccharides. The stereochemical data have been used to derive a mean geometry of the O-sulphate group and a set of force constants for use in molecular mechanics calculations on sulphated monosaccharides. These may be used in an extrapolation of the populations of stable conformers of related oligo- and polysaccharides.

Genetic transformation of Norway spruce (Picea abies (L.) Karst) using somatic embryo explants by microprojectile bombardment

Stable transformation of Norway spruce tissue has been obtained following bombardment of mature somatic embryos with pRT99gus, a plasmid that contains neo coding for NPTII, and gusA, coding for beta-glucuronidase, both fused to the CaMV 35S promoter. At least 8 lines have been stably transformed (over 15 months in culture) following bombardment and selection on kanamycin. Polymerase chain reaction analyses showed a high frequency of cotransformation of the gusA and neo genes. The frequency of coexpression of the selected and unselected markers was 100%. DNA/DNA hybridization of one transformed line provided conclusive evidence of stable integration and showed copy numbers of over 10 plasmid sequences per genome. None of the transformed lines has remained embryogenic.