MEAD (part II)-Predictions of radioactivity concentrations in the Irish Sea

The predictions from MEAD, a model that simulates the transport of radionuclides in the marine environment, are presented for the Irish Sea. MEAD predictions for (137)Cs and Pu(alpha) are presented following discharges from BNFL Sellafield and the predictions compared to measured data from near the discharge location and further a field in the Irish Sea. The model performs well in most circumstances given the uncertainties involved in both modelling and data collection although some inconsistencies in the predictions are found. MEAD is also compared to other models of radionuclide transport in the Irish Sea.

MEAD (part I)--a mathematical model of the long-term dispersion of radioactivity in shelf sea environments

A mathematical model (MEAD) that simulates the transport of radioactivity in shelf-sea environments is presented. In the model it is assumed that the radioactivity can be present in three phases and transport both within and between the phases is captured. The set-up of the model for the Irish Sea is described and results from a simple discharge scenario are presented for (137)Cs and (239)Pu. From these results it appears that MEAD provides a good representation of the transport of radionuclides in the Irish Sea.

Methicillin-resistant Staphylococcus aureus: laboratory detection methods in use in the Republic of Ireland and Northern Ireland

There is no universally agreed laboratory protocol for the detection of methicillin-resistant Staphylococcus aureus (MRSA) and hence a variety of approaches are used. As part of an all-island survey of MRSA in the Republic of Ireland (the South) and Northern Ireland (the North), a questionnaire was circulated to 14 participating laboratories in the North and 49 in the South, to determine the methods used to isolate MRSA from clinical specimens, identify S. aureus and test for susceptibility to methicillin. Almost two-thirds (64%) of laboratories in the North but only 16% of laboratories in the South use enrichment culture. There is heavy reliance on commercial kits to confirm the identification of S. aureus in the South but all laboratories in the North use the staphylocoagulase test. More than 90% of all laboratories use a disc method for susceptibility testing and 71% of laboratories in the North supplement this with the E-test; however, a range of methicillin disk concentrations are in use. There is a need to review current laboratory methods used to detect MRSA, with follow-up audit on their implementation. Additional resources may be needed in some laboratories to comply with revised guidelines, and reference facilities are required to assess new commercially available techniques and to confirm the identification of unusual or difficult strains.

Interleukin-15 inhibits spontaneous apoptosis in human eosinophils via autocrine production of granulocyte macrophage-colony stimulating factor and nuclear factor-kappaB activation

Prolonged eosinophil survival, i.e., reduced apoptosis, is implicated in the pathogenesis of chronic allergic inflammation. Here we demonstrate that interleukin (IL)-15, in the presence or absence of tumor necrosis factor (TNF)-alpha, reduces spontaneous apoptosis in freshly isolated human eosinophils. The prosurvival effect of IL-15 was abrogated by neutralizing antibody to granulocyte macrophage-colony stimulating factor (GM-CSF), although GM-CSF was not detected in conditioned media by ELISA. Additionally, the effect of IL-15 on spontaneous eosinophil apoptosis appeared to require nuclear factor-kappaB (NF-kappaB) activation based on evidence for NF-kappaB nuclear translocation and abrogation of the effect by the NF-kappaB inhibitor, Bay 11- 7082. Finally, the data demonstrate that IL-15 expression is higher in the submucosa of endobronchial tissues from subjects with moderate to severe asthma when compared with control subjects. Thus, our results suggest that IL-15, either alone or in combination with TNF-alpha, may perpetuate allergic inflammation by reduction of spontaneous eosinophil apoptosis through autocrine production of GM-CSF and NF-kappaB activation.

The changing attitudes of health professionals and consumers towards a coordinated care trial--SA HealthPlus

The national coordinated care trials have been a vehicle for health reform in Australia, driven by escalating health care costs and projections of an ageing population. The first round of trials conducted between 1997 and 1999 set the trials a challenge to reduce financial and system barriers to enable health professionals in all sectors and consumers to develop service delivery models which would give better outcomes for patients within existing resources. As part of a change management strategy, the developers of the SA HealthPlus trial assessed the attitudes of health professionals and consumers involved in designing the projects which made up the larger trial, prior to trial development and twelve months later. This paper reports on the results of the survey and how initial enthusiasm gave way to appropriate anxiety as the complexities of creating a new system of care from reactive to prospective patient centred care planning, became a reality. The survey enabled trial developers to show evidence of acceptability for the new model of care and identify areas of concern and appropriate strategies for the project teams. This type of survey and the issues identified may be of benefit to the second round coordinated care trials and health regions aiming to initiate coordinated care programs.

Views of Irish general practitioners on screening for cervical cancer

BACKGROUND

A national cervical screening programme is being established in Ireland and there is little information on the level of resources required.

AIMS

To obtain information on attitudes of Irish general practitioners (GPs) and on the resources needed by them in relation to participation in the programme.

METHODS

An anonymous postal questionnaire was sent to a random sample of 600 GPs, approximately 25% of the total population of GPs in Ireland.

RESULTS

A response rate of 87.5% was obtained. The majority (88%) would participate in a national programme. Those who would not were more likely to be in single-handed practice, aged over 44 years, have no ancillary staff, no computer and be in rural practice. GPs were in favour of a special fee for smear taking, a training programme and management guidelines on the test report. They did not want bonus payments for achieving targets or the report to be sent to the client as well as the doctor.

CONCLUSION

GPs will support a national cervical screening programme but a number of organisational issues must be discussed with them to ensure a successful programme.

The effect of age, gender, risk level and glycosylated hemoglobin in predicting foot amputation in HMO patients with diabetes

PURPOSE

To determine if age, gender, risk level and glucosylated hemoglobin could predict foot amputations in HMO patients with diabetes.

DATA SOURCES

A retrospective chart review of a non-random sample of 27 patients with amputation and 110 randomly selected patients without amputation during the same time period. Chi-square, t-tests and logistic regression were used to analyze the data.

CONCLUSIONS

There was no significant difference between the group with amputation and those without amputation in age or gender. However, there was a significant difference between the two groups in the risk stratification (p = .005) and glycosylated hemoglobin levels (p = .058).

IMPLICATIONS FOR PRACTICE

Nurse practitioners can effectively screen for amputation risk factors and closely monitor glycosylated hemoglobin levels of diabetic patients to reduce the incidence of vascular complications and related lower extremity amputation.

The availability of plutonium and americium in Irish Sea sediments for re-dissolution

The availability of plutonium and americium, for re-dissolution from offshore sediments into Irish Sea water, has been examined. Sediments collected from the mud-patch near the Cumbrian coast were characterized in terms of spatial location, particle size, partitioning of radionuclides with respect to physico-chemical bonds and availability of actinides for release into seawater. Sequential extraction investigations revealed that plutonium was predominantly associated with strongly bound sesquioxide and organic complex fractions. Americium was associated mainly with the organic complex fraction, but a significant fraction was in carbonate form. Sediment/water re-dissolution experiments with and without stirring were compared to simulate the effect of disturbing bed sediment. After 1 week, neither set of re-dissolution data provided significant trends between dissolved activity and time. Stirred systems appeared to release 2.5 times more plutonium and americium into seawater than unstirred systems. Measured 239,240Pu and 241Am distribution coefficients (Kd values) were both typically approximately 10(5) l kg(-1). 241Am Kd values are an order of magnitude lower than previously reported for the north-eastern Irish Sea, but similar to western Irish Sea values. Overall, the fractions of plutonium and americium available for re-dissolution from bed sediment are very low at < 0.1%, with proportionally more plutonium being released than americium. These findings lend further support for the extrapolation of laboratory-derived information to environmental conditions.

Alpha-emitting 'hot particles' in the vicinity of BNFL Sellafield, Cumbria

In a survey of environmental samples in the vicinity of BNFL Sellafield, two alpha-emitting radioactive particles were found in samples of grass. One particle appears to be of mineral origin, the other was not definitively identified, but may be a fragment of fuel cladding. Conservative estimates of the activities of these particles are very low. The abundance of radioactive particles in the terrestrial food chain appears to be low, with no evidence for any alpha-emitting hot particles in foodstuffs for consumption by humans. Results suggest that there is no significant dose to man through inhalation or ingestion pathways.

Reconstructing historical radionuclide concentrations along the east coast of Ireland using a compartmental model

A mathematical model is presented that simulates the annually averaged transport of radionuclides, originating from the BNFL reprocessing plant at Sellafield, throughout the Irish Sea. The model, CUMBRIA77, represents the processes of radionuclide transport and dispersion in the marine environment and allows predictions of radionuclide concentration in various environmental media, including biota, to be made throughout the whole of the Irish Sea. In this paper we describe the use of the model to reconstruct the historical activity concentrations of 137Cs and 239+240Pu in a variety of environmental media in the western Irish Sea and along the Irish east coast back to 1950. This reconstruction exercise is of interest because only limited measurements of 137Cs and 239+240Pu activity are available prior to the 1980s. The predictions were compared to the available measured data to validate their accuracy. The results of the reconstruction indicate that activity concentrations of 137Cs in the western Irish Sea follow a similar, though slightly delayed and smoothed, profile to the discharges from the Sellafield site, with concentrations at the time of peak discharge (the mid-1970s) being around an order of magnitude higher than those measured in the 1980s and 1990s. By contrast, the concentrations of 239+240Pu at the time of peak discharges were similar to those presently measured. These differences reflect the distinct marine chemistries of the two nuclides, in particular the higher propensity of plutonium to bind to sediments leading to extended transport times. Despite these differences in behaviour the doses to Irish seafood consumers from 137Cs remain significantly higher than those from 239+240Pu.

Profound inhibition of myogenic tone in rat cardiac allografts is due to eNOS- and iNOS-based nitric oxide and an intrinsic defect in vascular smooth muscle contraction

BACKGROUND

The physiological consequences of inducible NO synthase (iNOS) expression were studied in allograft coronary arteries by pressure myography.

METHODS AND RESULTS

Septal coronary arteries (diameter, 200.6+/-3.3 microm) were harvested from allograft and isograft hearts, and their myogenic properties were measured before and after iNOS and nonselective NOS inhibition with aminoguanidine (AG, 100 micromol/L) and N(G)-nitro-L-arginine methyl ester (L-NAME) (200 micromol/L). Fura 2 fluorescence microscopy was used to measure [Ca(2+)](i) in isolated endothelial cells. Monoclonal anti-iNOS immunostains demonstrated iNOS protein in day 2, 7, 14, and 28 allograft vessels, but only in day 2 isograft vessels. Myogenic tone was profoundly inhibited in allograft vessels from day 4 onward. In day 4 allograft vessels, these differences were abolished by L-NAME but not AG, suggesting greater basal release of eNOS-based NO from allograft endothelium. Fluorescence measurements confirmed elevation of [Ca(2+)](i) in day 4 allograft endothelium, providing a mechanism for enhanced eNOS activity. For days 7 to 28, AG potentiated myogenic tone in allograft but not isograft vessels, indicating that vasoactive iNOS-based NO was present. In mature vessels, constriction via agonist- and depolarization-mediated mechanisms showed parallel inhibition, suggesting an intrinsic defect in vascular smooth muscle cell contraction.

CONCLUSIONS

Our data indicate that the profound inhibition of myogenic tone in allograft arteries involves direct vasodilation by eNOS- and iNOS-based NO, as well as an intrinsic defect in vascular smooth muscle contraction. The hemodynamic profile resulting from these changes in allograft resistance vessel function would favor movement of extracellular fluid from the intravascular space into the myocardial interstitium, resulting in edema, increased ventricular stiffness, and poor ventricular performance.

The pharmacokinetics of morphine and morphine glucuronide metabolites after subcutaneous bolus injection and subcutaneous infusion of morphine

AIMS

To investigate the pharmacokinetics of morphine, morphine-6-glucuronide (M6G) and morphine-3-glucuronide (M3G) in healthy volunteers after the administration of morphine by subcutaneous bolus injection (s.c.b.) and subcutaneous infusion (s.c. i.) over 4 h, and to compare the results with the intravenous bolus (i.v.) administration of morphine.

METHODS

Six healthy volunteers each received 5 mg morphine sulphate by i.v., s.c.b. and short s.c.i. over 4 h, on three separate occasions, in random order, each separated by at least 1 week. Plasma samples were assayed for morphine, M6G and M3G.

RESULTS

After i.v. morphine, the concentrations of morphine, M6G and M3G and their pharmacokinetic parameters were similar to those we have observed previously, in other healthy volunteers (when standardized to nmol l- 1, for a 10 mg dose to a 70 kg subject). After s.c.b. morphine, similar results were obtained except that the median tmax values for morphine and M3G were significantly longer than after i.v. morphine (P< 0.001 and P< 0.05, respectively), with a trend to a longer tmax for M6G (P = 0. 09). The appearance half-lives after s.c.b. morphine for M6G and M3G were also significantly longer than after i.v. morphine (P = 0.03 and P< 0.05, respectively). Comparison of log-transformed AUC values indicated that i.v. and s.c.b. administration of morphine were bioequivalent with respect to morphine, M6G and M3G. In comparison with i.v. morphine, morphine by s.c.i. was associated with significantly longer median tmax values for morphine (P< 0.001), M6G (P< 0.001) and M3G (P< 0.05), and the mean standardized Cmax values significantly lower than after both i.v. and s.c.b. morphine (morphine P< 0.001, M6G P< 0.001 and M3G P< 0.01 for each comparison). Comparison of log-transformed AUC values after i.v. and s.c.i. morphine indicated that the two routes were not bioequivalent for morphine (log-transformed AUC ratio 0.78, 90% CI 0.66-0.93), M6G (0.72, 90% CI 0.63-0.82), or M3G (0.65, 90% CI 0.54-0.78). A small stability study indicated no evidence of adsorptive losses from morphine infused over 4 h using the infusion devices from the study.

CONCLUSIONS

Although bioequivalence was demonstrated between the s. c.b. and i.v. routes of morphine administration, the bioavailabilities of morphine, M6G and M3G after s.c.i. were significantly lower than after i.v. administration. However, despite this, the study demonstrates that the subcutaneous route is an effective method for the parenteral administration of morphine.

Modelling the contribution of individual radionuclides to the total gamma air kerma rate for the sediments of the Ribble Estuary, NW England

The aim of this study was to test the performance of a published dose-rate model, investigate the contribution of individual radionuclides to the total gamma air kerma rate (GAKR) and derive external doses to man in the Ribble Estuary, NW England. GAKRs were measured and sediment cores were collected in order to determine radionuclide specific activities with depth. The latter values were used as input data for the external dose-rate model. The model has a slight tendency to over-predict the GAKR, but, on average, the model predictions fall within +/-26% of the measured value. Improvements, in the present case, might be made by accounting for core shortening and variations in soil density in the input data. The model predicted that, for exposed intertidal mud sites, a range of GAKRs between 0.011 and 0.022 microGy h(-1) was attributable to Springfields discharges alone. The contribution due to 234mPa and 234Th ranged between 20 and 60%. An excess GAKR (GAKR arising from anthropogenic emissions alone) of 0.139-0.150 microGy h(-1), used in conjunction with relevant habit-survey data (for a potential critical group) and conversion factors, yielded a dose to man of 0.029-0.031 mSv year(-1).