What supports and services post COVID-19 do children with disabilities and their parents need and want, now and into the future?

Introduction

Children and youth with disabilities and special healthcare needs, and their families, have been uniquely affected by the COVID-19 pandemic. However, the voices of children themselves are still not well represented in the existing literature.

Methods

This qualitative descriptive study used a combination of visual methods and interviews to learn about the experiences of Canadian children with disabilities (n=18) and their parents (n=14) during the COVID pandemic and into the post-pandemic period. Data collection was carried out between January and July 2023. The aim was to identify the supports and services children and families need at present and moving forward.

Results

Families' pandemic experiences were complex and nuanced. For many, the pandemic complicated and disrupted everyday activities and supports. These disruptions were largely buffered by parents. However, some families also identified unexpected benefits. Key themes pertaining to present and future needs included the need for services that are flexible; consistent; conducive to relationship-building; comprehensive; coordinated across sectors; and designed to support the needs of the whole family.

Discussion

Implications for policy and practice are outlined.

ChatGPT in medical imaging higher education

INTRODUCTION

Academic integrity among radiographers and nuclear medicine technologists/scientists in both higher education and scientific writing has been challenged by advances in artificial intelligence (AI). The recent release of ChatGPT, a chatbot powered by GPT-3.5 capable of producing accurate and human-like responses to questions in real-time, has redefined the boundaries of academic and scientific writing. These boundaries require objective evaluation.

METHOD

ChatGPT was tested against six subjects across the first three years of the medical radiation science undergraduate course for both exams (n = 6) and written assignment tasks (n = 3). ChatGPT submissions were marked against standardised rubrics and results compared to student cohorts. Submissions were also evaluated by Turnitin for similarity and AI scores.

RESULTS

ChatGPT powered by GPT-3.5 performed below the average student performance in all written tasks with an increasing disparity as subjects advanced. ChatGPT performed better than the average student in foundation or general subject examinations where shallow responses meet learning outcomes. For discipline specific subjects, ChatGPT lacked the depth, breadth, and currency of insight to provide pass level answers.

CONCLUSION

ChatGPT simultaneously poses a risk to academic integrity in writing and assessment while affording a tool for enhanced learning environments. These risks and benefits are likely to be restricted to learning outcomes of lower taxonomies. Both risks and benefits are likely to be constrained by higher order taxonomies.

IMPLICATIONS FOR PRACTICE

ChatGPT powered by GPT3.5 has limited capacity to support student cheating, introduces errors and fabricated information, and is readily identified by software as AI generated. Lack of depth of insight and appropriateness for professional communication also limits capacity as a learning enhancement tool.

Practical learning through radiation physics problem solving

INTRODUCTION

The identification of unknown radionuclides is an authentic practical activity for students that provides the foundations for clinical problem solving, especially in the storage and management of radioactive waste. As different radionuclides have different half-lives, some of which are quite long, the storage of waste material has to accommodate the longest of these. Cross contamination requires a method of identifying the radionuclide samples in a mixed sample to safely and appropriately manage disposal. Similarly, identifying a single unknown sample of a radionuclide allows correct handling and disposal.

METHODS

Performing a systematic investigation of the physical properties of unknown radioactive samples is a rich learning opportunity to instil understanding of important physics principles among students in nuclear medicine.

RESULTS

This manuscript outlines an investigation developed that would allow students to identify single unknown radionuclides based on physical properties and identify the constituent radionuclides of a mixed sample using some additional mathematical curve stripping.

CONCLUSION

The processes and solutions are provided with real data and this practical activity can be replicated by students generating their own data.

IMPLICATIONS FOR PRACTICE

This paper provides a template and analysis/interpretation guideline for educators and clinicians to deepen understanding of foundation physics. Enhanced and deeper understanding are a vehicle for improved problem solving in clinical and research practice.

Value of SPECT/CT in the diagnosis of avascular necrosis of the head of femur: A meta-analysis

INTRODUCTION

To evaluate the diagnostic value of single photon emission computed tomography/computed tomography (SPECT/CT) in patients with avascular necrosis (AVN) of the femoral head.

METHODS

A search of the databases PubMed, ScienceDirect, and Google Scholar was undertaken using targeted index word. Studies satisfying inclusions and exclusions criteria were identified and additional related literature sources were considered. Analysis included pooled sensitivity and specificity, odds ratio (OR), and receiver operating characteristic (ROC) analysis.

RESULTS

Seven studies were identified that specifically related to the diagnostic accuracy of SPECT/CT in the detection or characterisation of AVN of the femoral head. These were included in the meta-analysis. The pooled sensitivity and specificity were 94% (95% confidence interval of 87-97%) and 75% (95% confidence interval of 68-81%) respectively, the OR was 44.5 (with a 95% confidence interval of 18.2-108.6), and the area under the SROC was 93.73% (with a 95% confidence interval of 89.2%-98.3%).

CONCLUSION

This meta-analysis provides strong evidence of the high diagnostic efficacy of SPECT/CT in the evaluation of AVN of the femoral head.

IMPLICATIONS FOR PRACTICE

In the absence of or contraindication to MRI, SPECT/CT is able to provide a suitable alternative for diagnosis of AVN of the head of femur.

A muggles guide to deep learning wizardry

OBJECTIVES

Growing interest in the applications of artificial intelligence (AI) and, in particular, deep learning (DL) in nuclear medicine and radiology partitions the professional community. At one end of the spectrum are our expert DL wizards developing potion-like code and waving the DL capabilities like a wand across our professions. On the opposite side of the spectrum are our muggle colleagues who lack the wizardry of DL and may be largely oblivious to the entire magical realm.

KEY FINDINGS

As crafted by Arthur C Clark, any sufficiently advanced technology is indistinguishable from magic. DL is not only an important technology in the future of medical imaging, but its application lives in the capabilities of medical imaging technologists. This may be incidental through application of techniques at the patient interface, through role expansion in data curation and management, or as active members of DL projects and development. Understanding the rudimentary principles of DL is emerging as requisite in medical imaging.

CONCLUSION

AI and DL are valuable tools in advancing capabilities and outcomes in medical imaging. A working knowledge of the technology and techniques is important and achievable for the medical imaging technologist even when capability in application of DL to research and clinical practice is not within one's interests or scope of practice.

IMPLICATIONS FOR PRACTICE

While there is no requisite for all of the professional community to be tutored in the wizardry of DL, there are benefits for the profession and our patients for all to have a rudimentary understanding of the language and landscape. The breadth of DL literature assumes a level of understanding not evident for the bulk of our professions. This manuscript provides a simplified primer on DL with the aim of arming the muggles among us with sufficient insight to navigate the magical realm of DL without transferring any wizardry capability itself.

Effectiveness of Multi-Criteria Optimization-based Trade-Off exploration in combination with RapidPlan for head & neck radiotherapy planning

Background

A new strategy is introduced combining the use of Multi-Criteria Optimization-based Trade-Off Exploration (TO) and RapidPlan™ (RP) for the selection of optimisation parameters that improve the trade-off between sparing of organs at risk (OAR) and target coverage for head and neck radiotherapy planning. Using both approaches simultaneously; three different workflows were proposed for the optimisation process of volumetric-modulated arc therapy (VMAT) plans. The generated plans were compared to the clinical plans and the plans that resulted using RP and TO individually.

Methods

Twenty clinical VMAT plans previously administered were selected. Five additional plans were created for each patient: a clinical plan further optimised with TO (Clin+TO); two plans generated by in-house built RP models, RP_1 with the model built with VMAT clinical plans and RP_TO with the model built with VMAT plans optimised by TO. Finally, these last two plans were additionally optimised with TO for the creation of the plans RP_1 + TO and RP_TO⁺ respectively. The TO management was standardised to maximise the sparing of the parotid glands without compromising a clinically acceptable PTV coverage. Resulting plans were inter-compared based on dose-volume parameters for OAR and PTVs, target homogeneity, conformity, and plans complexity and deliverability.

Results

The plans optimised using TO in combination with RP showed significantly improved OAR sparing while maintaining comparable target dose coverage to the clinical plans. The largest OAR sparing compared to the clinical plans was achieved by the RP_TO⁺ plans, which reported a mean parotid dose average of 15.0 ± 4.6 Gy vs 22.9 ± 5.5 Gy (left) and 17.1 ± 5.0 Gy vs 24.8 ± 5.8 Gy (right). However, at the same time, RP_TO⁺ showed a slight dose reduction for the 99% volume of the nodal PTV and an increase for the 95% (when comparing to the clinical plans 76.0 ± 1.2 vs 77.4 ± 0.6 and 80.9 ± 0.9 vs 79.7 ± 0.4) but remained within clinical acceptance. Plans optimised with RP and TO combined, showed an increase in complexity but were proven to be deliverable.

Conclusion

The use of TO combined with RP during the optimisation of VMAT plans enhanced plan quality the most. For the RP_TO⁺ plans, acceptance of a slight deterioration in nodal PTV allowed the largest reduction in OAR dose to be achieved.

Characteristics of high- and low-risk individuals in the PRIORITY study: urinary proteomics and mineralocorticoid receptor antagonism for prevention of diabetic nephropathy in Type 2 diabetes

AIM

To compare clinical baseline data in individuals with Type 2 diabetes and normoalbuminuria, who are at high or low risk of diabetic kidney disease based on the urinary proteomics classifier CKD273.

METHODS

We conducted a prospective, randomized, double-blind, placebo-controlled international multicentre clinical trial and observational study in participants with Type 2 diabetes and normoalbuminuria, stratified into high- or low-risk groups based on CKD273 score. Clinical baseline data for the whole cohort and stratified by risk groups are reported. The associations between CKD273 and traditional risk factors for diabetic kidney disease were evaluated using univariate and logistic regression analysis.

RESULTS

A total of 1777 participants from 15 centres were included, with 12.3% of these having a high-risk proteomic pattern. Participants in the high-risk group (n=218), were more likely to be men, were older, had longer diabetes duration, a lower estimated GFR and a higher urinary albumin:creatinine ratio than those in the low-risk group (n=1559, P<0.02). Numerical differences were small and univariate regression analyses showed weak associations (R² < 0.04) of CKD273 with each baseline variable. In a logistic regression model including clinical variables known to be associated with diabetic kidney disease, estimated GFR, gender, log urinary albumin:creatinine ratio and use of renin-angiotensin system-blocking agents remained significant determinants of the CKD273 high-risk group: area under the curve 0.72 (95% CI 0.68-0.75; P<0.01).

CONCLUSIONS

In this population of individuals with Type 2 diabetes and normoalbuminuria, traditional diabetic kidney disease risk factors differed slightly between participants at high risk and those at low risk of diabetic kidney disease, based on CKD273. These data suggest that CKD273 may provide additional prognostic information over and above the variables routinely available in the clinic. Testing the added value will be subject to our ongoing study. (European Union Clinical Trials Register: EudraCT 2012-000452-34 and Clinicaltrials.gov: NCT02040441).

Urinary Proteomics for Diagnosis and Monitoring of Diabetic Nephropathy

The last decade has seen a surge in publications describing novel biomarkers for early detection of diabetic nephropathy (DN), but as yet none have outperformed albuminuria in well-designed prospective studies. This is partially attributable to our incomplete understanding of the many complex interrelated mechanisms underlying DN development, a heterogeneous process unlikely to be captured by a single biomarker. Proteomics offers the advantage of simultaneously analysing the entire protein content of a biological sample, and the technique has gained attention as a potential tool for a more accurate diagnosis of disease at an earlier stage as well as a means by which to unravel the pathogenesis of complex diseases such as DN using an untargeted approach. This review will discuss the potential of proteomics as both a clinical and research tool, evaluating exploratory work in animal models as well as diagnostic potential in human subjects.

Validation of an obstetric comorbidity index in an external population

Objectives

An obstetric comorbidity index has been developed recently with superior performance characteristics relative to general comorbidity measures in an obstetric population. This study aimed to externally validate this index and to examine the impact of including hospitalisation/delivery records only when estimating comorbidity prevalence and discriminative performance of the obstetric comorbidity index.

Design

Validation study.

Setting

Alberta, Canada.

Population

Pregnant women who delivered a live or stillborn infant in hospital (n = 5995).

Methods

Administrative databases were linked to create a population‐based cohort. Comorbid conditions were identified from diagnoses for the delivery hospitalisation, all hospitalisations and all healthcare contacts (i.e. hospitalisations, emergency room visits and physician visits) that occurred during pregnancy and 3 months pre‐conception. Logistic regression was used to test the discriminative performance of the comorbidity index.

Main outcome measures

Maternal end‐organ damage and extended length of stay for delivery.

Results

Although prevalence estimates for comorbid conditions were consistently lower in delivery records and hospitalisation data than in data for all healthcare contacts, the discriminative performance of the comorbidity index was constant for maternal end‐organ damage [all healthcare contacts area under the receiver operating characteristic curve (AUC) = 0.70; hospitalisation data AUC = 0.67; delivery data AUC = 0.65] and extended length of stay for delivery (all healthcare contacts AUC = 0.60; hospitalisation data AUC = 0.58; delivery data AUC = 0.58).

Conclusions

The obstetric comorbidity index shows similar performance characteristics in an external population and is a valid measure of comorbidity in an obstetric population. Furthermore, the discriminative performance of the comorbidity index was similar for comorbidities ascertained at the time of delivery, in hospitalisation data or through all healthcare contacts.

Calculation of exit dose for conformal and dynamically-wedged fields, based on water-equivalent path length measured with an amorphous silicon electronic portal imaging device

In this study, we use the quadratic calibration method (QCM), in which an EPID image is converted into a matrix of equivalent path lengths (EPLs) and, therefore, exit doses, so as to model doses in conformal and enhanced dynamic wedge (EDW) fields. The QCM involves acquiring series of EPID images at a reference field size for different thicknesses of homogeneous solid water blocks. From these, a set of coefficients is established that is used to compute the EPL of any other irradiated material. To determine the EPL, the irradiated area must be known in order to establish the appropriate scatter correction. A method was devised for the automatic calculation of areas from the EPID image that facilitated the calculation of EPL for any field and exit dose. For EDW fields, the fitting coefficients were modified by utilizing the linac manufacturer's golden segmented treatment tables (GSTT) methodology and MU fraction model. The nonlinear response of the EPL with lower monitor units (MUs) was investigated and slight modification of the algorithm performed to account for this. The method permits 2D dose distributions at the exit of phantom or patient to be generated by relating the EPL with an appropriate depth dose table. The results indicate that the inclusion of MU correction improved the EPL determination. The irradiated field areas can be accurately determined from EPID images to within ± 1% uncertainty. Cross-plane profiles and 2D dose distributions of EPID predicted doses were compared with those calculated with the Eclipse treatment planning system (TPS) and those measured directly with MapCHECK 2 device. Comparison of the 2D EPID dose maps to those from TPS and MapCHECK shows that more than 90% of all points passed the gamma index acceptance criteria of 3% dose difference and 3 mm distance to agreement (DTA), for both conformal and EDW study cases. We conclude that the EPID QCM is an accurate and convenient method for in vivo dosimetry and may, therefore, complement existing techniques.

Health economic evaluation

A glossary is presented on terms of health economic evaluation. Definitions are suggested for the more common concepts and terms.

Influence of alpha-helices on the emulsifying properties of proteins

A peptide derived from apomyoglobin by cyanogen bromide cleavage was found to be an active emulsifier. This molecule, peptide 1-55, has two potential amphipathic alpha-helices and a hydrophilic C-terminal domain. The importance of each of these domains to the emulsifying properties of this molecule was investigated by testing the products of gene constructs based on the sequence of peptide 1-55, but lacking one of the three domains. The emulsifying activity of the peptides lacking either of the alpha-helices was correlated with the hydrophobic moments of their respective helices. The hydrophobic moment is a measure of the amphipathicity of alpha-helices; a hydrophobic moment analysis of other emulsifying peptides supports the hypothesis that a high hydrophobic moment contributes to good emulsifying properties in a molecule which contains alpha-helices.

The classical arabinogalactan protein gene family of arabidopsis

Arabinogalactan proteins (AGPs) are extracellular proteoglycans implicated in plant growth and development. We searched for classical AGPs in Arabidopsis by identifying expressed sequence tags based on the conserved domain structure of the predicted protein backbone. To confirm that these genes encoded bona fide AGPs, we purified native AGPs and then deglycosylated and deblocked them for N-terminal protein sequencing. In total, we identified 15 genes encoding the protein backbones of classical AGPs, including genes for AG peptides-AGPs with very short backbones (10 to 13 amino acid residues). Seven of the AGPs were verified as AGPs by protein sequencing. A gene encoding a putative cell adhesion molecule with AGP-like domains was also identified. This work provides a firm foundation for beginning functional analysis by using a genetic approach.

Limits to employee empowerment in the UK NHS. Locality managers in a community health trust

The concern of this paper lies with empowerment of middle managers in a community health trust. It considers the impact of traditional structures and cultures upon the level of decision which middle managers are empowered to make. The conclusion reached is one which suggests that the level of discretion available to middle managers was one of making task-oriented decisions rather than decisions about strategic change. However, even this was compromised by financial constraints and by "best practices" imposed by the personnel function.

The glycoinositolphospholipids from Leishmania panamensis contain unusual glycan and lipid moieties

The cell surface of Leishmania parasites is coated by glycosylphosphatidylinositol (GPI)-anchored macromolecules (glycoproteins and a lipophosphoglycan) and a polymorphic family of free GPI glycolipids or glycoinositolphospholipids (GIPLs). Here we show that GIPLs with unusual glycan and lipid moieties are likely to be major cell surface components of L. panamensis (subgenus Viannia) promastigotes. These glycolipids were purified by high performance thin layer chromatography and their structures determined by gas-liquid chromatography-mass spectrometry, fast-atom bombardment mass spectrometry, methylation analysis and chemical and enzymatic sequencing of the glycan headgroups. The major GIPLs contained two glycan core sequences, Manalpha1-3Manalpha1-4GlcN-phosphatidylinositol (type-2 series) or Manalpha1-3[Manalpha1-2Manalpha1-6]Manalpha1- 4GlcN-phosphatidylinosit ol (hybrid series), which were elaborated with Galalpha1-2Galbeta1- or Galalpha1-2/3Galalpha1-2Galbeta1- extensions that were attached to the 3-position of the alpha1-3 linked mannose. The phosphatidylinositol moiety contained exclusively diacylglycerol with palmitoyl, stearoyl and heptadecanoyl chains. Non-galactosylated GIPL species with the same core structures were also found. The galactose extensions and the presence of diacylglycerol in the lipid moieties are novel features for the GIPLs of Leishmania spp. The implications of these structures for the biosynthesis of leishmanial GIPLs and their putative function in the mammalian host are discussed.

Managerialism in the health service: partnership or conflict in a management development programme

This paper describes a management development programme in a hospital-based Trust and the differing responses demonstrated by those taking part. In terms of the impact of the programme, a picture emerges of differentiation and fragmentation rather than culture being managed to produce a social glue. Following this, suggestions are made for successful partnerships in the promotion of managerial effectiveness through management development to clinical services managers in the health service.

Stage-specific proteophosphoglycan from Leishmania mexicana amastigotes. Structural characterization of novel mono-, di-, and triphosphorylated phosphodiester-linked oligosaccharides

Intracellular amastigotes of the protozoan parasite Leishmania mexicana secrete a macromolecular proteophosphoglycan (aPPG) into the phagolysosome of their host cell, the mammalian macrophage. The structures of aPPG glycans were analyzed by a combination of high pH anion exchange high pressure liquid chromatography, gas chromatography-mass spectrometry, enzymatic digestions, electrospray-mass spectrometry as well as 1H and 31P NMR spectroscopy. Some glycans are identical to oligosaccharides known from Leishmania mexicana promastigote lipophosphoglycan and secreted acid phosphatase. However, the majority of the aPPG glycans represent amastigote stage-specific and novel structures. These include neutral glycans ([Glcbeta1-3]1-2Galbeta1-4Man, Galbeta1-3Galbeta1-4Man, Galbeta1-3Glcbeta1-3Galbeta1-4Man), several monophosphorylated glycans containing the conserved phosphodisaccharide backbone (R-3-[PO4-6-Gal]beta1-4Man) but carrying stage-specific modifications (R = Galbeta1-, [Glcbeta1-3]1-2Glcbeta1-), and monophosphorylated aPPG tri- and tetrasaccharides that are uniquely phosphorylated on the terminal hexose (PO4-6-Glcbeta1-3Galbeta1-4Man, PO4-6-Glcbeta1-3Glcbeta1-3Galbeta1-4Man, PO4-6-Galbeta1-3Glcbeta1-3Galbeta1-4Man). In addition aPPG contains highly unusual di- and triphosphorylated glycans whose major species are PO4-6-Glcbeta1-3Glcbeta1-3[PO4-6-Gal]beta1-4Man, PO4-6-Galbeta1-3Glcbeta1-3[PO4-6-Gal]beta1-4Man, PO4-6-Galbeta1-3Glcbeta1-3Glcbeta1-3[PO4-6-Gal]beta1-+ ++4Man, PO4-6-Glcbeta1-3[PO4-6-Glc]beta1-3[PO4-6-Gal]beta1-4Man, PO4-6-Galbeta1-3[PO4-6-Glc]beta1-3Glcbeta1-3[PO4-6-Gal]beta1 -4Man, and PO4-6-Glcbeta1-3[PO4-6-Glc]beta1-3Glcbeta1-3[PO4-6-Gal]beta1 -4Man. These glycans are linked together by the conserved phosphodiester R-Manalpha1-PO4-6-Gal-R or the novel phosphodiester R-Manalpha1-PO4-6-Glc-R and are connected to Ser(P) of the protein backbone most likely via the linkage R-Manalpha1-PO4-Ser. The variety of stage-specific glycan structures in Leishmania mexicana aPPG suggests the presence of developmentally regulated amastigote glycosyltransferases which may be potential anti-parasite drug targets.

Stakeholders' views of management development as a cultural change process in the Health Service

Illustrates the failure of a competence-based management development programme in a hospital trust to achieve organisational objectives. The approach and content of the management development programme is resisted by participants despite the facilitators drawing on management theory to legitimate it. The question posed in this paper, building on an earlier study by Holman and Hall (1996), is whether the generic approach of competence-based management development is appropriate in the UK NHS. The theoretical inspiration for the research is what may be termed a "processual" or "contextualist" approach which is clearly influenced by "negotiated order" literature.

Identification of active-site histidine residues of a self-incompatibility ribonuclease from a wild tomato

The style component of the self-incompatibility (S) locus of the wild tomato Lycopersicon peruvianum (L.) Mill. is an allelic series of glycoproteins with ribonuclease activity (S-RNases). Treatment of the S3-RNase from L. peruvianum with iodoacetate at pH 6.1 led to a loss of RNase activity. In the presence of a competitive inhibitor, guanosine 3'-monophosphate (3'-GMP), the rate of RNase inactivation by iodoacetate was reduced significantly. Analysis of the tryptic digestion products of the iodoacetate-modified S-RNase by reversed-phase high-performance liquid chromatography and electrospray-ionization mass spectrometry showed that histidine-32 was preferentially modified in the absence of 3'-GMP. Histidine-88 was also modified, but this occurred both in the presence and absence of 3'-GMP, suggesting that this residue is accessible when 3'-GMP is in the active site. Cysteine-150 was modified by iodoacetate in the absence of 3'-GMP and, to a lesser extent, in its presence. The results are discussed with respect to the related fungal RNase T2 family and the mechanism of S-RNase action.

Contested terrain: the incomplete closure of managerialism in the health service

Focuses on feelings about culture and change in the health service and the impact of management development programmes on the change process. The issues raised in a series of semistructured interviews are taken forward to a case study, a medium-sized hospital Trust. The researcher "hangs around and listens into" a management development programme aimed at middle managers with a nursing background. The theme of ideological conflict comes into central focus. Analysis of outcomes suggests that the managerial assumptions on which the programme is based result in resistance from participants. They resist the attempts of facilitators to provide "closure" whereby managerial ways of doing things are suggested as the "obvious way ahead". Advocates that management education particularly in the health service should have a pluralistic orientation. As part of such pluralism, more critical approaches should be considered beyond conventional and problematic conceptions of knowledge relating to management. These are reductionist in considering a manager as "having a set of technical competences" rather than exhibiting "a way of being".

Structural characterisation of xyloglucan secreted by suspension-cultured cells of Nicotiana plumbaginifolia

Linkage analysis of a xyloglucan from the extracellular medium of suspension cultures of Nicotiana plumbaginifolia showed mostly 4-Glcp and 4,6-Glcp, terminal Xylp and 2-Xylp, and terminal Araf, along with approximately 10% (w/w) O-acetyl groups, equivalent to approximately 0.28 mol acetyl per mol of glycosyl residue. Methylation with methyl trifluoromethanesulfonate under neutral conditions, followed by re-methylation with CD3I under basic conditions, and conversion into partially methylated alditol acetates showed that O-acetyl groups were primarily attached to C-6 of approximately 44% of the 4-Glcp backbone not substituted with Xylp residues and to C-5 of approximately 15% of the terminal Araf residues. These positions of the O-acetyl groups were confirmed by 1H-NMR. Oligosaccharides generated by digestion of native xyloglucan with endo-(1-->4)-beta-glucanase were separated by a combination of gel-filtration chromatography and anion-exchange HPLC, and analysed by glycosyl linkage analysis and by electrospray ionisation-mass spectrometry (ESI-MS). The major oligosaccharide subunits were Glc4Xyl2 and Glc5Xyl2, of which 50-60% are substituted with one terminal Araf residue attached to O-2 of a Xylp residue, and a further 20-25% are substituted with two terminal Araf residues attached to O-2 of the Xylp residues. ESI-MS showed that many of the oligosaccharide subunits carried one, two, and, occasionally three O-acetyl groups.

Characterization of lipophosphoglycan from a ricin-resistant mutant of Leishmania major

One of the virulence factors of the protozoan parasite Leishmania major is the surface glycoconjugate, lipophosphoglycan (LPG). A Ricin-resistant mutant of L.major was generated and characterised with respect to its virulence in mice and the structure and expression of LPG. The LPG from this mutant (1F6-B5) retained the tripartite structure of wild-type LPG, comprising a glycosylphosphatidylinositol (GPI) anchor linked to a phosphorylated disaccharide backbone terminating in a nonreducing neutral oligosaccharide cap. The structure of the GPI anchor and the major capping oligosaccharide were identical to wild-type LPG. However, there were variations in the number of phosphorylated repeats (PO4-6Gal(beta 1-4)Man(alpha 1-) comprising the backbone of LPG, although the degree of substitution with side branches (approx. 95%) was similar to that of wild-type LPG. Thus, the mutant LPG was shorter in length having, on average, 15 repeat units per molecule compared with 30 in the wild-type LPG. The mutant LPG contained both arabinose (Ara(beta 1-2)[Gal(beta 1-3)-]1,2) and galactose ([Gal(beta 1-3)-]1-8) capped side branches linked to the backbone. In contrast to wild-type LPG, the number of arabinose-capped side chains was significantly reduced, and a new population of galactose-capped (Gal(beta 1-3)]5-8) side branches was present. The level of LPG expression in mutant parasites was approximately one-tenth of the wild-type parasite. The mutant parasites were avirulent in mice. Over a period of 18 months, they did not cause lesions and organisms could not be isolated from the draining lymph nodes.

Analysis of the structural heterogeneity of laminarin by electrospray-ionisation-mass spectrometry

Electrospray-ionisation-mass spectrometry (ESIMS) was used in conjunction with chemical derivatisation and degradation procedures to analyse the size heterogeneity and branching structure of laminarin from the brown alga, Laminaria digitata. Laminarin is a beta-(1-->3)-linked D-glucan with occasional beta-(1-->6)-linked branches. Electrospray-ionisation-mass spectrometry of permethylated laminarin distinguished two homologous series of molecules, a minor G-series containing 22-28 glucosyl residues, and a more abundant M-series containing 20-30 glucosyl residues linked to a mannitol residue. The relative abundance of all these molecular species could be determined simultaneously from a single mass spectrum, with a mean mass error of 0.6 atomic mass units and a mean mass accuracy of 0.011%. Both series had a mean degree of polymerisation of 25 glucosyl residues, and an approximately 3:1 molar ratio of M-series to G-series molecules was maintained across the range of molecular sizes. Treatment of laminarin with periodate, followed by reduction with borohydride, degraded terminal glucosyl residues on both the main chain and the branches, and allowed the detection of isomers differing solely in their degree of branching. M-series molecules were thus shown to contain 0, 1, 2, 3 or 4 branches, with an average of 1.3 branches per molecule; branched G-series molecules were also detected. Subsequent treatment with acid (Smith degradation) showed that 75% of the branches were single glucosyl residues. This study thus shows how the speed, resolution and mass accuracy of electrospray-ionisation-mass spectrometry can be used in the detailed structural analysis of a polydisperse polysaccharide.

The Microphthalmia gene product interacts with the retinoblastoma protein in vitro and is a target for deregulation of melanocyte-specific transcription

Little is known of the molecular mechanisms underlying the differentiation of the melanocyte from the melanoblast or the progression from the melanocyte to a malignant melanoma. Since the adenovirus E1A products have proved a useful tool for understanding control of differentiation in other systems, we explored the possibility of using E1A as a probe for factors controlling melanocyte-specific gene expression and differentiation. The results obtained show that the adenovirus E1A 13S, but not the 12S, product can transform the highly pigmented and TPA-dependent melanocyte cell line melan-a. Transformation is characterised by a morphological change, loss of TPA-dependence, the ability to grow in soft agar and strikingly, loss of pigmentation which correlates with loss of expression of the melanocyte-specific TRP-1 and tyrosinase genes. Cotransfection assays demonstrated that repression of TRP-1 by E1A correlated with E1A binding to p105Rb and p300, with the target in the TRP-1 promoter being the M-box, and 11 bp basic-Helix-loop-Helix (bHLH) factor-binding motif conserved between melanocyte-specific promoters. Consistent with the M-box acting as a target for E1a-mediated transcription repression, we also show that the basic-helix-loop-helix-leucine zipper (bHLH-LZ) protein (Mi) encoded by the microphthalmia gene (mi), which is required for pigment cell differentiation, is a positive acting transcription factor which can interact with the retinoblastoma product in vitro and activate the TRP-1 promoter. Moreover, expression of the mi gene was reduced around 50-fold in the non-pigmented E1a-transformed melan-a cells compared to the nontransformed melan-a cell line, with ectopic expression of Mi able to prevent repression of the tyrosinase and TRP-1 promoters in the presence of E1A. Mi therefore appears to play a crucial role in melanocyte-specific gene expression. The parallels between repression of myogenesis and muscle cell bHLH factors, and Mi and melanocyte differentiation are discussed.

Learning theory and the design of training in a health authority

Gives an explanation of the salient factors which affected the design of a training intervention aimed at clinicians in West Birmingham Health Authority. Discusses the theoretical considerations relevant to learning in an organization, using a case study to illustrate.

A New Macrocyclic γ-Pyrone From a Southern Australian Marine Red Alga

A new macrocyclic γ- pyrone (10) and two known γ- pyrones (2) and (6) have been isolated from a Victorian collection of Phacelocarpus peperocarpos. The Z geometry about ∆17,18 in (2) has been established for the first time. All structure elucidations were supported by detailed spectroscopic analysis.