The aetiology of depression

This review will start by considering studies of the genetic contribution to the liability to depression, and go on to consider some of the ways in which environmental factors can modify gene expression. This will lead on to the pathways by which the genetic factors also appear to control stressful life events in adolescence and adult life, and then to a consideration of causes that are entirely environmental. We will conclude by considering the causes of the gender differences in the prevalence of depression during adult life.

An injectable, biodegradable hydrogel for trophic factor delivery enhances axonal rewiring and improves performance after spinal cord injury

The failure of long descending pathways to regenerate after spinal cord injury (SCI) is generally attributed to inhibitory proteins associated with the glial scar and myelin, or to the loss of neurons' intrinsic capacity to grow, or both. Here, we describe the use of hydrogels as a novel way to deliver molecules that promote axon growth in the injured CNS of adult rats. This method utilizes an injectable liquid polymer solution that crosslinks into a biodegradable, water-swollen hydrogel when photoactivated under visible light. Neurotrophin-3 (NT-3), a trophic factor known to act on corticospinal tract (CST) projection neurons, was used as a prototypic pro-regenerative molecule. Hydrogel release properties were established in vitro to ensure long-term, sustained NT-3 release over a 2-week period; this avoided the need for multiple injections or minipump implantation. Hydrogel/NT-3-treated animals showed improved recovery in the open-field BBB test and in a horizontal ladder walk test compared to controls implanted with hydrogel alone. At the anatomical level, hydrogel/NT-3-treated animals showed far greater axon growth than controls in two major descending pathways for motor control, the CST and the raphespinal tract. In the case of the CST, much of the NT-3-induced growth represented collateral branching from undamaged ventral CST fibers. These studies demonstrate the effectiveness of hydrogel technology as a clinically feasible delivery system to promote regeneration and enhance functional outcome after spinal cord injury.

Activation of murine CD4+ and CD8+ T lymphocytes leads to dramatic remodeling of N-linked glycans

Differentiation and activation of lymphocytes are documented to result in changes in glycosylation associated with biologically important consequences. In this report, we have systematically examined global changes in N-linked glycosylation following activation of murine CD4 T cells, CD8 T cells, and B cells by MALDI-TOF mass spectrometry profiling, and investigated the molecular basis for those changes by assessing alterations in the expression of glycan transferase genes. Surprisingly, the major change observed in activated CD4 and CD8 T cells was a dramatic reduction of sialylated biantennary N-glycans carrying the terminal NeuGcalpha2-6Gal sequence, and a corresponding increase in glycans carrying the Galalpha1-3Gal sequence. This change was accounted for by a decrease in the expression of the sialyltransferase ST6Gal I, and an increase in the expression of the galactosyltransferase, alpha1-3GalT. Conversely, in B cells no change in terminal sialylation of N-linked glycans was evident, and the expression of the same two glycosyltransferases was increased and decreased, respectively. The results have implications for differential recognition of activated and unactivated T cells by dendritic cells and B cells expressing glycan-binding proteins that recognize terminal sequences of N-linked glycans.

Computer expert systems for African-American smokers in physicians offices: a feasibility study

BACKGROUND

Stage-based computer expert systems (CES), delivered in physician offices, may offer unique opportunities to combine high participation and high efficacy, resulting in a high public health impact. Applying this technology in settings serving low-income African-American smokers, with the addition of practical tools for stress reduction, may help to reduce disparities in morbidity and mortality from smoking-related diseases.

METHODS

Ninety-eight African-American smokers were recruited from a publicly funded, continuity care clinic waiting room to a study of computer interactive feedback and stress reduction audiotapes. The study was designed to assess: participation and retention rates; acceptability of both the computer expert system and the audiotapes; the fit of the transtheoretical model for the target population; and the 6-month shift in stages of change.

RESULTS

Overall, 55.6% of invited smokers participated, 75.5% were seen at all three observation points. The CES and the audiotape were rated as highly interesting, relevant, and new, and most participants tried them. The predictable relationship between stage and decisional balance was reproduced in this low income African-American population. Significant stage progression occurred from baseline to 3 months (P = 0.011), from 3 to 6 months (P = 0.0001), and from baseline to 6 months (P = 0.0001).

CONCLUSIONS

These data support the feasibility, acceptability and potential efficacy of stage-tailored computer interactive feedback plus stress reduction intervention delivered at the point of service to low-income African-Americans.

Data mining for proteins characteristic of clades

A synapomorphy is a phylogenetic character that provides evidence of shared descent. Ideally a synapomorphy is ubiquitous within the clade of related organisms and nonexistent outside the clade, implying that it arose after divergence from other extant species and before the last common ancestor of the clade. With the recent proliferation of genetic sequence data, molecular synapomorphies have assumed great importance, yet there is no convenient means to search for them over entire genomes. We have developed a new program called Conserv, which can rapidly assemble orthologous sequences and rank them by various metrics, such as degree of conservation or divergence from out-group orthologs. We have used Conserv to conduct a largescale search for molecular synapomorphies for bacterial clades. The search discovered sequences unique to clades, such as Actinobacteria, Firmicutes and gamma-Proteobacteria, and shed light on several open questions, such as whether Symbiobacterium thermophilum belongs with Actinobacteria or Firmicutes. We conclude that Conserv can quickly marshall evidence relevant to evolutionary questions that would be much harder to assemble with other tools.

Diversity of needle exchange provision in the UK: findings from a national survey

Needle exchanges are key to reducing transmission of bloodborne viruses (BBVs) in injecting drug users (IDUs) through the provision of sterile

Anonymous pilot study of hepatitis C virus prevalence in liver transplant surgeons

The risk of hepatitis C virus (HCV) transmission to surgeons is related to the HCV prevalence in the surgical patient population. As HCV-related cirrhosis is the commonest indication for liver transplantation in Europe and North America, liver transplant surgeons are at particular risk. The prevalence of HCV infection in liver transplant surgeons is unknown. The aim of this study was to estimate the prevalence of HCV infection in liver transplant surgeons attending the 9th Congress of the International Liver Transplantation Society using unlinked anonymous testing for HCV. Surgeons attending the conference were invited to complete an anonymised questionnaire regarding their surgical and transplant practice and provide an unlinked anonymised blood spot sample by finger prick. Samples were screened for antibodies to HCV (enzyme-linked immunosorbent assay III, Ortho Diagnostics, Raritan, NJ). Polymerase chain reaction testing for HCV RNA was performed on reactive samples.A total of 117 liver transplant surgeons (79 European, 16 North American, 10 Asian, 9 South American, 3 Australasian) provided a blood spot sample. Two (1.7%) surgeons had antibodies to HCV, 1 (0.8%) had detectable HCV RNA (genotype 1a). Assuming that both infections were acquired during surgery, the estimated maximum rate of HCV transmission is 1 per 743 to 1,045 years of surgical (0.96 to 1.35 HCV transmissions per 1,000 years of general surgical practice) and 449 to 683 years of liver transplant practice (1.46 to 2.23 HCV transmissions per 1,000 years of liver transplantation practice). In conclusion, risk of HCV transmission to liver transplant surgeons appears to be low despite the particular risks associated with frequently operating on HCV infected patients.

De novo analysis of peptide tandem mass spectra by spectral graph partitioning

We report on a new de novo peptide sequencing algorithm that uses spectral graph partitioning. In this approach, relationships between m/z peaks are represented by attractive and repulsive springs, and the vibrational modes of the spring system are used to infer information about the peaks (such as "likely b-ion" or "likely y-ion"). We demonstrate the effectiveness of this approach by comparison with other de novo sequencers on test sets of ion-trap and QTOF spectra, including spectra of mixtures of peptides. On all datasets, we outperform the other sequencers. Along with spectral graph theory techniques, the new de novo sequencer EigenMS incorporates another improvement of independent interest: robust statistical methods for recalibration of time-of-flight mass measurements. Robust recalibration greatly outperforms simple least-squares recalibration, achieving about three times the accuracy for one QTOF dataset.

Automatic determination of O-glycan structure from fragmentation spectra

Glycosylation is one of the most important classes of post-translational protein modifications, but the identification of glycans is difficult because of their branched structures and numerous isomers. We describe an algorithm called CartoonistTwo that proposes structures for O-linked glycans by automatically analyzing fragmentation mass spectra. CartoonistTwo improves upon previous glycan identification software primarily in its scoring function, which can more successfully distinguish among a number of similar structures. CartoonistTwo was designed and tested with FTICR mass spectra, and includes automatic recalibration and peak selection especially tuned for such data, yet it can be easily adapted to fragmentation spectra (MS2 or MSn) from other instrument types. On a validated test set of 34 SORI-CID MSn FTICR spectra from Xenopus egg jelly, CartoonistTwo gave the manually determined structural assignment either the first or second highest score over 90% of the time. And for over 50% of these spectra, CartoonistTwo selected a unique highest scoring structure that agreed with the manually determined one.

Glycomic profiling of cells and tissues by mass spectrometry: fingerprinting and sequencing methodologies

Over the past decade, rapid, high-sensitivity mass spectrometric strat-egies have been developed and optimized for screening for the types of N- and O-glycans present in a diverse range of biological material, including secretions, cell lines, tissues, and organs. These glycomic strategies are based on matrix-assisted laser desorption/ionization (MALDI) time-of-flight mass fingerprinting of permethylated derivatives, combined with electrospray (ES) or MALDI tandem mass spectrometry (MS/MS) sequencing and gas chromatography (GC)-MS linkage analysis, complemented by chemical and enzymatic degradations. Protocols for these methods are described in the first part of this chapter. Glycomic experiments yield large volumes of MS data, and interpretation of the resulting spectra remains a time-consuming bottleneck in the process. In the second part of this chapter, we describe the use and operation of a mass spectral viewer program capable of displaying and automatically labeling spectra arising from MALDI fingerprinting of N-glycans.

The "NICE Guideline" on the treatment of depression

The National Institute of Clinical Excellence (NICE) in the UK is responsible for producing evidence based guidelines for the treatment of most common illnesses, both physical and psychological. NICE uses a hierarchy of evidence, ranging from data from meta-analyses of randomised controlled trials (RCT's) at the apex, to the opinions of acknowledged experts at the bottom. The task of preparing guideline for depression involved us in performing clean meta-analyses of around 8,000 published RCTs of the treatment of this disorder. Where drug treatments were concerned we used three indicators of efficacy, as well as considering toxicity, tolerability and cost. We also distinguished between studies carried out in primary care, and studies in patients treated by the mental health services. We found it helpful to arrange our report in terms of a "stepped care" model, addressing the indications for patients being referred on for more specialised, and expensive, treatments. In the full guideline we included our doubts that depression was a homogenous clinical entity, and our awareness of the limitations of relying on randomised controlled trials (RCT's) as the only source of evidence. This Editorial summarises the content of the guideline on the treatment of depression and discusses how it was received and also what it did not say.

UK Government Policy and Unaccompanied Adolescents Seeking Asylum

A series of decisions made by successive UK governments with the aim of reducing the flow of immigration has impacted in countless ways on those seeking asylum. The recently published 5-year strategy for asylum and immigration (Home Office, 2005) has potentially very serious implications for unaccompanied asylum seeking children with the government making plans to commence routine detention and deportation of these children if their asylum claim is not accepted. This paper aims to lay out recent legislation in relation to the treatment of unaccompanied 16- and 17-year old young people seeking asylum and to outline the complex asylum process negotiated by these young people.

Prevalence of, and risk factors for, hepatitis C virus infection among recent initiates to injecting in London and Glasgow: cross sectional analysis

Our aim was to compare the prevalence of antibody to hepatitis C virus (anti-HCV) among recently initiated injecting drug users (IDUs) in London and Glasgow, and to identify risk factors which could explain differences in prevalence between the cities. Complementary studies of community recruited IDUs who had initiated injection drug use since 1996 were conducted during 2001-2002. Data on HCV risk behaviours were gathered using structured questionnaires with identical core questions and respondents were asked to provide an oral fluid specimen which was tested anonymously for anti-HCV but was linked to the questionnaire. Sensitivities of the anti-HCV assays for oral fluid were 92-96%. Prevalence of anti-HCV was 35% (122/354) in London and 57% (207/366) in Glasgow (P < 0.001). Multifactorially, factors significantly associated with raised odds of anti-HCV positivity were increasing length of injecting career, daily injection, polydrug use, having had a needlestick injury, and having served a prison sentence. In addition lower odds of anti-HCV positivity were associated with non-injection use of crack cocaine and recruitment from drug agencies. After adjustment for these factors, the increased odds of anti-HCV associated with being a Glasgow IDU were diminished but remained significant. HCV continues to be transmitted among the IDU population of both cities at high rates despite the availability of syringe exchange and methadone maintenance. Effectiveness of harm reduction interventions may be compromised by inadequate coverage and failure to reduce sufficiently the frequency of sharing different types of injecting equipment, as well as the high background prevalence of HCV, and its high infectivity. Comprehensive action is urgently required to reduce the incidence of HCV among injectors.

Mental distress and quality of life in a deaf population

BACKGROUND

High risks of mental illness within the deaf community are reported. The assessment of the level of mental distress and quality of life in the deaf community is difficult due to communication problems in spoken and written language. The deaf community is characterized by the use of sign language.

METHODS

A new measure of acceptable reliability using sign language is described. The interactive computerised package including special versions of the World Health Organisation's Brief Quality of Life questionnaire (WHOQOL-BREF), the 12-Item General Health Questionnaire (GHQ-12) and five subscales of the Brief Symptom Inventory (BSI) was administered to a large community sample of deaf people (n = 236), and results were compared with normative data for German-speaking hearing people.

RESULTS

The deaf sample has a significantly poorer quality of life than the general population for the physical and psychological domains (p < 0.01) as measured by the WHOQOL-BREF. However, in the domain of social relationships, no significant difference (p = 0.19) was demonstrated. All findings with the GHQ-12 and the BSI show much higher levels (p = 0.01) of emotional distress among the deaf.

CONCLUSION

Although a poorer quality of life and a higher level of mental distress are demonstrated, the similarity to the general population in the domain social relationships shows that this does not affect all domains. These findings show the need for easily accessible health services for the deaf which offer sensitive communication with them.

Increase in reported syphilis infections in Scotland in 2004

A total of 186 cases of infectious syphilis were reported in Scotland during 2004 via an enhanced surveillance system

Pervasive alienation: on seeing the invisible, meeting the inaccessible and engaging 'lost to contact' clients with major mental illness

Increasing integration of services for adults with severe mental health problems has highlighted the challenges to services posed by clients who are difficult to engage. There is a dearth of studies on direct work with individuals who are reclusive and difficult to contact, in contrast with the bulk of literature where the patient and network are present and available. This paper describes the work of a busy CMHT with such clients; barriers to collaborative work are explored and some of the team's strategies to overcome these barriers are delineated. Long, slow and persistent contact is observed to be a core feature of the work. The paper goes on to examine the fit between the realities of ongoing work with such clients and the available therapeutic and service discourses.

Patient notification exercise following a dentist's admission of the periodic use of unsterilized equipment

During 2001, Greater Glasgow National Health Service (NHS) Board undertook a patient notification exercise in a Glasgow dental practice following the admission, by the dentist, of the use of unsterilized dental equipment on patients. Four thousand and eighty-nine exposed patients were identified; of these, 1696 contacted the NHS helpline and 1005 were counselled and screened for hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus. One patient showed evidence of previous HBV infection and 13 had antibodies to HCV. Molecular investigation of the HCV isolates indicated no significant associations. The investigation found no evidence of patient-to-patient transmission of HCV among patients attending the practice of a dentist who admitted periodically using unsterilized equipment.

Automatic selection of representative proteins for bacterial phylogeny

Background

Although there are now about 200 complete bacterial genomes in GenBank, deep bacterial phylogeny remains a difficult problem, due to confounding horizontal gene transfers and other phylogenetic "noise". Previous methods have relied primarily upon biological intuition or manual curation for choosing genomic sequences unlikely to be horizontally transferred, and have given inconsistent phylogenies with poor bootstrap confidence.

Results

We describe an algorithm that automatically picks "representative" protein families from entire genomes for use as phylogenetic characters. A representative protein family is one that, taken alone, gives an organismal distance matrix in good agreement with a distance matrix computed from all sufficiently conserved proteins. We then use maximum-likelihood methods to compute phylogenetic trees from a concatenation of representative sequences. We validate the use of representative proteins on a number of small phylogenetic questions with accepted answers. We then use our methodology to compute a robust and well-resolved phylogenetic tree for a diverse set of sequenced bacteria. The tree agrees closely with a recently published tree computed using manually curated proteins, and supports two proposed high-level clades: one containing Actinobacteria, Deinococcus, and Cyanobacteria ("Terrabacteria"), and another containing Planctomycetes and Chlamydiales.

Conclusion

Representative proteins provide an effective solution to the problem of selecting phylogenetic characters.

Unlinked anonymous testing indicates antenatal HIV testing in England and Scotland is being successfully implemented

If HIV infection is detected before or during pregnancy, interventions such as antiretroviral therapy, caesarean section delivery and avoiding breastfeeding have meant that HIV transmission rates from mother to baby can be reduced from around 25% to 1%

Severe illness and death among injecting drug users in Scotland: a case-control study

Between April and September 2000, 60 injecting drug users in Scotland died or were hospitalized with severe illness. Laboratory investigations suggested that Clostridium novyi and other bacteria were important aetiological agents. To determine associated environmental/behavioural factors a case-control study was undertaken with 19 'definite' and 32 'probable' cases in Glasgow, Scotland. For every deceased case (n=19), up to three proxy individuals were interviewed. Three controls were identified for each case. Multivariate logistic regression analyses compared (i) all cases and controls; (ii) definite cases and matched controls; (iii) probable cases and matched controls. In all three analyses injecting into muscle or skin and injecting most of the time with a filter used by someone else were the variables most strongly associated with illness. Comparing only muscle-injecting cases and controls, cases were significantly more likely to have injected larger amounts of heroin per average injection than were controls. The findings make an important epidemiological contribution to the understanding of the public health and clinical implications of the contamination of illicit drugs by histotoxic clostridia.

An innovative and reliable way of measuring health-related quality of life and mental distress in the deaf community

BACKGROUND

Structured assessment of quality of life and mental distress in deaf people is difficult for various reasons. This paper describes the development and reliability of an interactive computer-based assessment package for measuring quality of life and psychological distress in the deaf population.

METHODS

The Brief version of the WHO Quality of Life (WHOQOL) Questionnaire, the 12-item General Health Questionnaire (GHQ-12) and the Brief Symptom Inventory (BSI) had been translated into sign-language and videotaped. A total of 236 members of the deaf community in Upper Austria participated by responding to a programme consisting of self-administered written and videotaped test-items presented to them on a notebook computer. The reliability of the various assessments was established on this large community sample.

RESULTS

When reliability of the versions for the deaf was compared with that of written versions of the same measures in general population samples, it was found to be somewhat lower, although still in an acceptable range, for the WHO-QOL and the GHQ-12. For the BSI, the reliability was even higher than that of the general population.

CONCLUSIONS

For deaf individuals whose preferred communication is sign language, quality of life and mental distress can be effectively and reliably assessed with the use of carefully translated and adapted common instruments.