Factors that affect the food choices made by girls and young women, from minority ethnic groups, living in the UK

BACKGROUND

Lower birth weight, often found in infants from minority ethnic groups, may be partly because of the disproportionate representation of ethnic minority groups in low-income areas. To develop an intervention, to improve the nutritional intake of young women from populations at risk of low-birth-weight babies, which would be culturally sensitive and well received by the intended recipients, a community development approach was used to investigate factors that might influence food choice and the nutritional intake of girls and young women from ethnic minority groups.

METHODS

Focus group discussions were conducted across the UK, to explore factors that might affect the food choices of girls and young women of African and South Asian decent. The data was analysed using deductive content analysis (Qual. Soc. Res., 1, 2000, 1). Discussions were around the broad themes of buying and preparing food, eating food and dietary changes, and ideas for an intervention to improve diet.

RESULTS

The focus group discussions indicated that all the communities took time, price, health and availability into consideration when making food purchases. The groups were also quite similar in their use of 'Western' foods which tended to be of the fast food variety. These foods were used when there was not enough time to prepare a 'traditional' meal.

CONCLUSION

Many issues that affect the food choice of people who move to the UK are common within different ethnic groups. The idea of a practical intervention based on improving cooking skills was popular with all the groups.

A new method of energy prescription to improve weight loss

Clinical outcome audit was carried out on two groups of obese out-patients for a 3-month follow-up period. In the first audit group of 35 patients (A1), energy intake was prescribed by diet history, whereas in the second audit group of 27 patients (A2) energy intake was prescribed from an estimate of individual energy requirements based on age, sex, and activity. There was no significant difference in age or initial BMI between the two groups and the failure-to-attend rate was the same in each group. Patients in Group A2 received a significantly higher energy prescription (P<0.001) than Group A1, but this was still significantly more restricted than the recommended 500 kcal energy deficit from energy expenditure (P<0.05). Weight loss was significant in both groups, but was greater in Group A2 than in Group A1. There was no significant correlation between weight loss and energy deficit. In a selected group of patients from Group A2 who were prescribed energy intake close to the recommended deficit of 500 kcal, weight loss was found to be significantly greater (P<0.05) when compared to the weight loss in Group A1. Results suggest that a diet prescription with an energy deficit below the estimated energy requirements does not lead to greater weight loss and probably reduces compliance. Estimating individual energy requirements rather than using dietary assessment may improve weight loss.

An analysis of erythropoietin (EPO) and venous thromboembolic events (VTE) in multiple myeloma (MM) patients (pts) treated with anthracycline-based chemotherapy and the immunomodulator agent thalidomide

8107

Background: The use of EPO has recently been reported to be associated with higher rates of VTE in MM pts receiving lenalidomide or thalidomide and dexamethasone (Knight et al. NEJM 2006). Uncontrolled erythrocytosis, a recognized risk factor for VTE, may complicate therapy with EPO when the hemoglobin is not carefully monitored. Other risk factors such as renal failure in this pt population might contribute to hypercoagulability. We sought to evaluate the contribution of EPO use to the development of VTEs in pts with MM treated with the immunomodulator agent thalidomide in combination with chemotherapy. Methods: We retrospectively reviewed records of 105 pts enrolled on a clinical trial for newly diagnosed or relapsed MM pts with pegylated liposomal doxorubicin, vincristine, dexamethasone and thalidomide (DVd-T). In this study pts pts were aggressively monitored for VTE as previously described (Hussein et al Mayo Clin.Proc. 81 (7):889–895, 2006). Demographic variables, aspirin therapy (on intent to treat basis), EPO therapy, as well as the occurrence of VTEs were extracted. Results: The median age was 63 years and 62 (59%) received EPO in conjunction with their MM therapy. VTE prophylaxis with aspirin (81mg daily) was administered to all but 21 pts. Of the 62 pts receiving EPO, 15 (24%) had a VTE compared to 11 (26%) who did not receive EPO (OR 0.928, 95% CI 0.38 - 2.3). Among the 21 pts who did not receive aspirin as VTE prophylaxis, 11 (52%) experienced a VTE compared to 18% (15/84) in those who did receive aspirin as VTE prophylaxis (OR 5.1, 95% CI 1.8 - 14). In the subgroup of 62 pts that received EPO, 54% (7/13) of pts who did not receive aspirin developed a VTE compared to 16% (8/49) who received aspirin and developed a VTE (OR 6, 95% CI 1.6 - 22.6), which is comparable to the overall study population. Conclusions: These results do not indicate an association between EPO use and VTE in MM pts receiving anthracycline-based chemotherapy with the immunomodulator thalidomide and on intent to treat basis low dose aspirin is effective in reducing the incidence of VTE with this complex regimen.

[Table: see text]

Prediction of response and progression in multiple myeloma (MM) with serum-free light chains (sFLC): Corroboration of the International Myeloma Working Group (IMWG) criteria

8047

Background: The sFLC assay was proposed as a tool for the assessment of response in patients with non-secretory or oligosecretory MM and patients with primary amyloidosis. Response and progression criteria have been proposed by the IMWG, but have not been thoroughly validated. Methods: Electronic records of patients (pts) with MM enrolled in various clinical trials at the Cleveland Clinic between 4/2004 and 12/2006 were reviewed. Response to treatment and progression were assessed using the European Blood and Bone Marrow Transplantation (EBMT) criteria for all pts. sFLC responses were defined per IMWG criteria: response (R, decrease in the difference between the involved and uninvolved light chain by greater than 50%), progression (P, increase in the difference between the involved and uninvolved light chain by greater than 25%), and stable disease (SD, not meeting the criteria for either R or P). sFLC responses were assessed in pts with involved FLC =10 mg/dL (=100mg/L) per the IMWG criteria. Results: 89 pts were identified. The median age was 61 years (range 41–87) and 58 pts were males. The involved light chain was kappa in 67 pts (75%), and lambda in the remainder. By EBMT criteria, 4 pts had a complete response, 22 a partial response, 34 stable disease, 26 progressive disease and 3 were inevaluable. Only 43/89 pts (48%) had an involved sFLC=10mg/dL; of which 14 had R, 8 had SD, 18 had P, and 3 were inevaluable. Table 1 reviews the test characteristics for sFLC assay for the prediction of response or progression. Conclusions: sFLC reliably predicts response and progression in MM pts. However, half the pts had an involved sFLC that would not be considered evaluable by IMWG, which limits its potential use.

No significant financial relationships to disclose.

[Table: see text]

Evaluating the accuracy of data entry in a regional colorectal cancer database: implications for national audit

OBJECTIVE

To determine the accuracy and completeness of data entry in a regional colorectal cancer database.

METHOD

Records were obtained for 50 patients selected at random from the database. A sample of 18 key data points (preoperative and operative) were selected from the Association of Coloproctology of Great Britain and Ireland colorectal cancer minimum dataset. Data were extracted from the case notes by a clinician and compared with database entries.

RESULTS

Overall 83% of data elements were present in the patient records. There was agreement between patient records and the database for 61% of data points overall, and for 70% of preoperative data and 47% of operative data.

CONCLUSION

The regional colorectal cancer database is inaccurate, particularly regarding operative data. Insufficient information in patient records accounts for a proportion of missing data, and lack of agreement between records and the database may be due to misinterpretation of records by nonclinical staff. The accuracy of regional data may be improved by weekly review of database entries and/or entry of clinical data by a clinician.

Early intervention in psychosis: a rural perspective

Over the past decade, there has been great interest in both the development and delivery of early intervention in psychosis services in the United Kingdom, supported by national policy and a Policy Implementation Guide (PIG). Despite this, the PIG fails to distinguish the delivery of early intervention services to different population groups. The paper aims to augment available literature with the range of complex issues that practitioners may face when working in rural settings and link this to the development of early intervention services in rural communities. This paper will also outline some of the fundamental factors that challenge delivery of early intervention to individuals with a first episode of psychosis and their families in rural communities. Important key areas for consideration will be highlighted for both the planning and delivery of early intervention to rural communities.

The value of specific radiological features in the classification of acetabular fractures

Specific radiological features identified by Brandser and Marsh were selected for the analysis of acetabular fractures according to the classification of Letournel and Judet. The method employs a binary approach that requires the observer to allocate each radiological feature to one of two groups. The inter- and intra-observer variances were assessed. The presence of articular displacement, marginal impaction, incongruity, intra-articular fragments and osteochondral injuries to the femoral head were analysed by a similar method. These factors were termed ‘modifiers’ and are generally considered when planning operative intervention and, critically, they may influence prognosis.

Six observers independently assessed 30 sets of plain radiographs and CT scans on two separate occasions, 12 weeks apart. They were asked to determine the presence or absence of specific radiological features. This simple binary approach to classification yields an inter- and intra-observer agreement which ranges from moderate to near-perfect (κ = 0.49 to 0.88 and κ = 0.57 to 0.88, respectively). A similar approach to the modifiers yields only slight to fair inter-observer agreement (κ = 0.20 to 0.34) and slight to moderate intra-observer agreement (κ = 0 to 0.55).

Efavirenz and chronic neuropsychiatric symptoms: a cross-sectional case control study

OBJECTIVE

The aim of the study was to investigate symptoms of long-term central nervous system (CNS) toxicity in HIV-positive patients treated with efavirenz (EFV).

METHODS

We carried out a single-centre, cross-sectional case-control study comparing patients treated with EFV for at least 6 months with a matched control group. Self-administered, standardized questionnaires including the Depression, Anxiety and Stress Scales (DASS), the Cognitive Failures Questionnaire (CFQ) and a questionnaire on unusual dreams, insomnia, fatigue, dizziness, depersonalization and derealization were administered.

RESULTS

Data for 32 matched pairs were analysed. Significantly higher total stress scores (P=0.008) were found in the EFV group. Of the patients in this group, 19% also reported severe to extremely severe levels of stress (P=0.014), indicating increased difficulty in relaxing, and being more irritable, impatient, agitated and easily upset. Nineteen per cent of patients treated with EFV also reported severe levels of anxiety (P=0.059) as assessed with the DASS scale. This patient group also reported a higher rate of unusual dreams (P=0.049). No significant differences between groups were found for measures of cognitive impairments, fatigue, dizziness, derealization or depersonalization.

CONCLUSION

EFV-treated patients reported higher levels of severe stress and anxiety as well as a higher rate of unusual dreams than patients not treated with EFV. These differences may be an expression of persisting CNS side effects in patients who remain on EFV for a prolonged period.

Predicting outcome of acute non-variceal upper gastrointestinal haemorrhage without endoscopy using the clinical Rockall Score

BACKGROUND

The Rockall risk scoring system uses clinical criteria and endoscopy to identify patients at risk of adverse outcomes after acute upper gastrointestinal haemorrhage. A clinical Rockall score obtained using only the clinical criteria may be able to predict outcome without endoscopy.

AIM

To validate the clinical Rockall Score in predicting outcome after acute non-variceal upper gastrointestinal haemorrhage.

METHODS

A retrospective observational study of consecutive patients who were admitted with non-variceal acute upper gastrointestinal haemorrhage was undertaken. Medical records were abstracted using a standardised form.

RESULTS

102 cases were identified (51 men and 51 women; mean age 59 years). 38 (37%) patients considered to be at low risk of adverse outcomes (clinical Rockall Score 0) had no adverse outcomes and did not require transfusion. Patients with a clinical Rockall Score of 1-3 had no adverse outcomes, although 13 of 45 (29%) patients required blood transfusions. Clinical Rockall Scores >3 (n = 19) were associated with adverse outcomes (rebleeding in 4 (21%), surgery in 1 (5%) and death in 2 (10%)).

CONCLUSIONS

The clinical Rockall Score without endoscopy may be a useful prognostic indicator in this cohort of patients with acute non-variceal upper gastrointestinal haemorrhage. This score may reduce the need for urgent endoscopy in low-risk patients, which can instead be carried out on a more elective outpatient basis.

Is screening for tuberculosis acceptable to immigrants? A qualitative study

BACKGROUND

Screening of immigrants has been a widespread response to the global resurgence of tuberculosis but has been criticized as discriminatory and stigmatising. Acceptability is an essential but neglected ethical prerequisite of screening programmes, particularly those targeting vulnerable groups such as refugees. No data exist concerning acceptability of tuberculosis screening. We therefore examined the responses of immigrants to screening for tuberculosis in a range of settings.

METHODS

We carried out a qualitative interview study of a maximum diversity sample of 53 immigrants offered screening for tuberculosis in east London. We recruited people screened in three settings: a social service centre for asylum seekers, a hospital clinic for new entrants and primary care. We confirmed validity of our findings at a focus group of asylum seekers.

RESULTS

The opportunity to be screened for tuberculosis was valued highly by recipients. Moreover, many saw being screened as a socially responsible activity. Of the minority raising concerns, few mentioned the possibility of discrimination. Acceptability was high irrespective of setting, with respondents expressing preference for their chosen place of screening.

CONCLUSION

Screening for tuberculosis was highly acceptable to recipients in these settings. Screening should be offered in a range of settings.

Phase II study of dexamethasone, ascorbic acid, thalidomide and arsenic trioxide (DATA) in high risk previously untreated (PU) and relapsed/refractory (RR) multiple myeloma (MM)

17535

Background: The combination of Thalidomide (T) and Dexamethasone (D) is often used first line in patients with MM. Arsenic trioxide (ATO) is active and well tolerated in patients with RR MM. ATO, D and T have non-overlapping toxicity. We therefore initiated a phase II study to assess the efficacy and toxicity of this combination in patients with high risk PU MM (serum B2 microglobulin>5.5, chromosome 13 or 14 abnormalities by FISH or the presence of peripheral plasma cells) and RR MM. Methods: On week 1, ATO was given at a dose of 0.25mg/kg IV on days 1–5. On weeks 2–12, ATO was given at the same dose twice weekly. On weeks 13–16, the patients did not receive treatment. Ascorbic acid 1000mg IV was given after each ATO infusion. D was given at a dose of 20mg orally on days 1–4 of a 28 days cycle, and T was started at a dose of 50mg daily and increased as tolerated to a dose of 100mg daily. A similar 16 weeks consolidation course was given. Maintenance included ATO 0.25mg/kg on days 1,8,15 and 22 every 12 weeks in addition to the above schedule for D, T and Ascorbic acid. Results: Sixteen patients were enrolled (3 with PU and 13 RR), 13 are evaluable for response. The median age was 57 years and 62% were males. The median number of prior chemotherapy regimen is 2 (range 0–6), 7 patients had received a prior T containing regimen, and 2 patients had received an ATO-containing regimen. Seven, seven and two patients had SWOG stages 2, 3 and 4 respectively. The mean serum B2 microglobulin was 7.1-mg/dL (s.d. 4.4). After a median follow up of 9.5 months (range 1–12), 9 patients progressed and 5 died. The median progression free survival was 9.4 months. The median progression free survival for responder has not been reached. Four patients had a PR (31%), 8 had stable disease (62%), and 1 had progressive disease. No patient had a QT>500 or a cardiac arrhythmia. Grade 3 leukopenia, anemia, neuropathy and renal failure occurred in 3, 2, 1 and 1 patients respectively. Three patients had a venous thromboembolic event (2 DVT and 1 PE). Conclusions: The addition of T to the combination of ATO, Ascorbic acid and D is safe, well tolerated and results in 30% PR and 61% stable disease in patients with poor risk MM.

[Table: see text]

What is the clinical significance of infusing hematopoietic cell grafts contaminated with bacteria?

Although hematopoietic stem cell (HSC) products are routinely cultured for sterility, bacterial contamination of these products is rarely observed and little is known about the clinical consequences of infusing contaminated grafts. We retrieved the sterility cultures of bone marrow and peripheral HSC grafts from 938 patients transplanted at our center from January 1990 to July 2005. Fever, septicemia and other adverse events were assessed for up to 14 days following infusion of the graft. Out of the 1502 grafts collected during this 15-year period, 15 (1.0%) had a positive sterility culture (11 Gram-positive cocci, 2 Gram-positive bacilli and 2 Gram-negative bacilli). No correlation was observed between the graft contamination rate and the extent of graft manipulation or the patient's underlying condition. Thirteen recipients were transplanted with contaminated grafts. Five patients were treated with specific pre-emptive antibiotics. Only one episode of Staphylococcus epidermidis bacteremia possibly related to a contaminated graft was observed on day +5. As the infusion of contaminated grafts with Gram-positive skin contaminants rarely results in unfavorable clinical outcomes, close patient monitoring without the use of specific pre-emptive antibiotics could be appropriate and could avoid antibiotic-associated adverse events.

Violence at work: the experience of general practice receptionists

Receptionists act as intermediaries between the General Practitioner and the public, and are often involved in conflicts between the GP and a demanding patient. However there is a paucity of research in this area. The aim of this study was to quantify the extent of violence directed towards GP receptionists and to categorise the type, frequency and impact of such aggression in two health board areas. A postal questionnaire was designed, piloted and sent to 400 randomly selected receptionists in the former Northern Area Health Board and the Western Health Board. We found that 62% (n= 168) of receptionists experienced violence in the past. 99% (n=166) had experienced verbal abuse while 31% (n=52) had experienced threats of physical abuse. 6% (n= 10) experienced physical abuse. In most cases the perpetrator was the patient 98% (n= 160). 28% (n=75) of practices had a practice policy for dealing with violence while only 13% (n=34) of receptionists received education on dealing with violence. This study shows that violence is a major problem among GP receptionists in Ireland. Aggression during the day is a regular feature for a GP receptionist. There is a higher reporting of violence in the Northern Area Health Board compared to the Western Health Board. We suggest that further education, research and practice policy development is needed to help target this problem and improve the overall quality of healthcare.

Zinc status and age-related changes in peripheral blood leukocyte subpopulations in healthy men and women aged 55-70 y: the ZENITH study

OBJECTIVE

To determine zinc status and age-related changes in the immune function of healthy late-middle-aged men and women (aged 55-70 y).

DESIGN

Observational study.

SETTING

Population of Northern Ireland.

SUBJECTS

Apparently healthy, free-living individuals (45 men, 48 women) aged 55-70 y.

INTERVENTION

Zinc status markers were analysed by flame atomic absorption spectrometry and commercially available kits. Immune function was assessed by flow cytometry.

RESULTS

Serum and erythrocyte zinc concentrations were 13.0 (s.d. 1.40) micromol/l and 222 (s.d. 48.2) micromol/l, respectively. Serum alkaline phosphatase (ALP) concentrations were 76.8 (s.d. 16.1) U/l; women showed significantly higher concentrations of ALP (P = 0.011). Women demonstrated (1) a significant inverse correlation in naive T lymphocytes, specifically naive T-helper lymphocytes (% expression, r = -0.364, P = 0.007 and absolute count, r = -0.275, P = 0.036) with age and (2) a significant positive correlation between late activation of T lymphocytes (% expression, r = 0.299, P = 0.019 and absolute count, r = 0.260, P = 0.039) with advancing age. Men demonstrated a significant positive correlation in the % expression of (CD3-/CD16+/CD56+) natural killer (NK) cells with age (r = 0.316, P = 0.017).

CONCLUSIONS

Between the ages of 55 and 70 y, healthy individuals experience significant alterations in immune function; however, such changes appear largely sex specific. Given the reported importance of adequate zinc status in maintaining optimal immune function, further studies are required to explore the effect of enhanced zinc status on emerging immune deficiencies in cell-mediated immunity in healthy 55-70 y olds.

Macroglossia and carpal tunnel syndrome associated with multiple myeloma: a case report

BACKGROUND

Macroglossia is an unusual symptom in primary care. It may be an indicator of an underlying plasma cell dyscrasia or multiple myeloma in the elderly.

AIM

To describe such a case of multiple myeloma.

RESULTS

A 69-year-old man,with a recent history of bilateral carpal tunnel repair, presented to his GP with progressive macroglossia. This was eventually diagnosed as being due to amyloidosis, secondary to multiple myeloma.

CONCLUSION

Physicians should be aware of the association between macroglossia, carpal tunnel syndrome and multiple myeloma in this age group.

Health and lifestyle characteristics of older European adults: the ZENITH study

OBJECTIVE

To describe health and lifestyle factors of participants in the ZENITH study.

DESIGN

A prospective multicentre intervention study employing a randomised double-blind design.

PARTICIPANTS

Community dwelling older adults (n = 387), aged 55-87 y were recruited from regions in France, Italy and the UK.

INTERVENTION

A self-report questionnaire comprising socio-demographic variables, dietary habits, physical activity in the home, at work and recreation.

RESULTS

Participants differed with regards dietary habits and physical activity for each region. Recreational activity was higher in France and women generally tend to perform less hours of recreational activity per week than men.

CONCLUSIONS

The differences found for these regions of Europe in relation to lifestyle factors will affect health and well-being within these countries and may mediate the impact of zinc supplementation on various biological and psychological parameters.

133Xenon ventilation scintigraphy applied to bronchoscopic lung volume reduction techniques for emphysema: relevance of interlobar collaterals

BACKGROUND

133Xenon ventilation scintigraphy and (99m)Tc-MAA perfusion scintigraphy can be used to assess dynamic ventilation patterns in patients with severe emphysema.

AIM

To describe the scintigraphic features of attempted bronchoscopic lung volume reduction (BLVR), exploring mechanisms that might explain the unexpected lack of postoperative atelectasis.

METHODS

Five patients with heterogenous severe upper lobe emphysema were evaluated with 133Xenon ventilation and (99m)Tc-MAA perfusion scintigraphy, chest radiography, bronchoscopy and high resolution computed tomography before and up to 1 month after endoscopic placement of bronchial prostheses (BLVR). Ex vivo assessment of the lungs of two further patients with severe upper lobe emphysema was performed.

RESULTS

No significant subsegmental or lobar collapse was evident on post-procedure chest radiography or high resolution computed tomography, despite bronchoscopic confirmation of adequate position and functioning of prostheses. 133Xenon ventilation scintigraphy confirms significantly decreased upper lobe wash-in (P < 0.023), unchanged lower lobe wash-in and significantly increased lower lobe wash-out rates (P < 0.005) after BLVR. Significant redistribution of perfusion to the lower lobes occurred after BLVR (P < 0.025). Ex vivo experiments on explanted emphysematous lungs demonstrated that these findings could best be explained by collateral interlobar ventilation, which was calculated in one specimen to be as high as 15% of total lower lobe ventilation. Peri-valvular leak is a much less likely possibility.

CONCLUSION

133Xenon ventilation scintigraphy indicated the presence of significant interlobar collateral ventilation in patients with severe emphysema that may have major relevance to these novel alternative techniques to lung volume reduction surgery. 133Xenon scintigraphy can be used in the evaluation of severe emphysema before and after novel therapeutic interventions.

Lecozotan (SRA-333): A Selective Serotonin 1A Receptor Antagonist That Enhances the Stimulated Release of Glutamate and Acetylcholine in the Hippocampus and Possesses Cognitive-Enhancing Properties

Recent data has suggested that the 5-hydroxytryptamine (5-HT)(1A) receptor is involved in cognitive processing. A novel 5-HT(1A) receptor antagonist, 4-cyano-N-{2R-[4-(2,3-dihydrobenzo[1,4]-dioxin-5-yl)-piperazin-1-yl]-propyl}-N-pyridin-2-yl-benzamide HCl (lecozotan), which has been characterized in multiple in vitro and in vivo pharmacological assays as a drug to treat cognitive dysfunction, is reported. In vitro binding and intrinsic activity determinations demonstrated that lecozotan is a potent and selective 5-HT(1A) receptor antagonist. Using in vivo microdialysis, lecozotan (0.3 mg/kg s.c.) antagonized the decrease in hippocampal extracellular 5-HT induced by a challenge dose (0.3 mg/kg s.c.) of 8-hydroxy-2-dipropylaminotetralin (8-OH-DPAT) and had no effects alone at doses 10-fold higher. Lecozotan significantly potentiated the potassium chloride-stimulated release of glutamate and acetylcholine in the dentate gyrus of the hippocampus. Chronic administration of lecozotan did not induce 5-HT(1A) receptor tolerance or desensitization in a behavioral model indicative of 5-HT(1A) receptor function. In drug discrimination studies, lecozotan (0.01-1 mg/kg i.m.) did not substitute for 8-OH-DPAT and produced a dose-related blockade of the 5-HT(1A) agonist discriminative stimulus cue. In aged rhesus monkeys, lecozotan produced a significant improvement in task performance efficiency at an optimal dose (1 mg/kg p.o.). Learning deficits induced by the glutamatergic antagonist MK-801 [(-)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine maleate] (assessed by perceptually complex and visual spatial discrimination) and by specific cholinergic lesions of the hippocampus (assessed by visual spatial discrimination) were reversed by lecozotan (2 mg/kg i.m.) in marmosets. The heterosynaptic nature of the effects of lecozotan imbues this compound with a novel mechanism of action directed at the biochemical pathologies underlying cognitive loss in Alzheimer's disease.

Spatial and Temporal Variability of Cytotoxic Metabolites in Populations of the New Zealand Sponge Mycale hentscheli

Intraspecific variation in the composition of three cytotoxic secondary metabolites from the New Zealand marine sponge Mycale hentscheli collected at two sites in central New Zealand was quantified by 1H NMR techniques. A total of 275 sponges were analyzed bimonthly over 15 mo to compare intersite (approximately 100 km) and intrasite (approximately 100 m) spatial and temporal variations in the metabolites. Biological and physical characteristics of sponge size, morphology, depth, and temperature were recorded at each site. Metabolite concentrations were found to vary in space and time. Metabolite composition was site-specific; mycalamide A, pateamine, and peloruside A were present at Pelorus Sound, whereas pateamine was absent from sponges at Kapiti Island. Pateamine and peloruside A concentrations in sponges at Pelorus Sound varied seasonally; no such patterns were observed at Kapiti Island. Relationships of compound concentration with volume and depth were complex. High levels of peloruside A in Pelorus Sound sponges from between 8 and 10 m depth coincided with a density boundary layer and chlorophyll a maximum.

Indirect carotid-cavernous fistula - embolisation using the superior ophthalmic vein approach

No abstract available.

Exploring the concept of recovery in schizophrenia

The concept of recovery in psychosis has gained much momentum in recent years in the UK. Current government policy describes its underpinning philosophy as the way forward for mental health services. Many mental health professionals now claim to embrace this concept yet fail to make the desired impact upon the care and treatment of individuals with schizophrenia. This article reviews some of the literature and explores what the concept of recovery means. The formal evidence will be augmented with personal accounts about recovery written by individuals who have schizophrenia. In doing so the main components that appear to have influenced the recovery process will be highlighted, and the implications for mental health nurses and practitioners will be discussed.

Extrarenal Wilms' tumor of the uterine corpus

BACKGROUND

Extrarenal Wilms' tumors (EWT) are rare. In the female genital tract, only 15 cases (6 adults, 9 children) of EWT have been reported. A case of uterine Wilms' tumor in an adult is presented with a review of the literature.

CASE

A 44-year-old woman presented with a bleeding polypoid cervical mass. Biopsy revealed EWT. She was surgically staged, received chemotherapy, and is without evidence of disease at 1 year follow-up.

CONCLUSIONS

Prognosis and treatment of EWT may differ by location and patient age. Literature review of uterine Wilms' tumor reveals favorable outcome with (1) focal disease confined to the uterus and (2) adequate surgery, including hysterectomy. The National Wilms' Tumor Study Group recommends adjuvant chemotherapy for all EWT. Radiation may be reserved for patients with residual, metastatic and/or recurrent disease.

What is the clinical significance of positive blood cultures with Aspergillus sp in hematopoietic stem cell transplant recipients? A 23 year experience

Hematopoietic stem cell (HSC) transplantation is the most frequent underlying predisposing condition to invasive aspergillosis. However, the significance of positive blood culture with Aspergillus sp in this particular population remains uncertain. We retrospectively reviewed all blood cultures performed in 1453 patients who received HSC transplant at our institution between 1980 and 2002. We identified 19 patients with positive blood cultures with Aspergillus sp. Only one of these patients had clinical, histologic or microbiologic evidence of invasive aspergillosis. Thus, even in a population at highest risk for invasive aspergillosis, positive blood cultures with Aspergillus sp remain unusual, and cannot be readily associated with invasive aspergillosis. A case by case assessment by treating physicians of the clinical and radiologic parameters should be systematically made to establish the significance of aspergillemia. Single bottle positivity, obtained with the lysis-centrifugation blood culture system, is a common indicator of pseudoaspergillemia.

Association of periampullary duodenal diverticula with bile duct stones and with technical success of endoscopic retrograde cholangiopancreatography

BACKGROUND AND STUDY AIMS

Periampullary diverticula are thought to be associated with bile duct stones. However, studies to date have been inconclusive as they have not taken into account the influence of age. Our study analysed the association of diverticula with bile duct stones and with the technical success of endoscopic retrograde cholangiopancreatography (ERCP).

PATIENTS AND METHODS

A total of 415 consecutive patients who were undergoing ERCP were prospectively entered into a database. Of these patients, 83 (20 %; mean age 73 years; 34 men, 49 women) were found to have diverticula. The age-matched control group comprised 261 patients (mean age 72 years; 106 men, 155 women). The chi-squared test was used to analyse the results.

RESULTS

In the diverticula group, 53 (64 %) had bile duct stones, compared with 86 (33 %) of the controls ( P < 0.0001), with an odds ratio of 3.6. Significantly more patients in the diverticula group had primary bile duct stones; also significantly more of them had stones in both the bile duct and gallbladder. There was no difference between the two groups with regard to previous history of pancreatitis (10 % in the diverticula group vs. 11 % in the control group). There were no significant differences found between the diverticula group and the control group in terms of successful duct cannulation (94 % in both groups), sphincterotomies (96 % vs. 98 %) or stone extraction (94 % vs. 88 %). The incidence of complications was similar in the two groups (diverticula group 5 % vs. control group 3.3 %).

CONCLUSIONS

Periampullary diverticula are associated with an increased incidence of bile duct stones but not with pancreatitis. Diverticula did not cause any technical difficulties at ERCP or increase the risk of complications.

Inclusive double-pomeron exchange at the fermilab tevatron p p collider

We report results from a study of events with a double-Pomeron exchange topology produced in p p collisions at sqrt[s]=1800 GeV. The events are characterized by a leading antiproton and a large rapidity gap on the outgoing proton side. We find that the differential production cross section agrees in shape with predictions based on Regge theory and factorization, and that the ratio of double-Pomeron exchange to single diffractive production rates is relatively unsuppressed as compared to the O(10) suppression factor previously measured in single diffractive production.

Natural marine sponge fiber skeleton: a biomimetic scaffold for human osteoprogenitor cell attachment, growth, and differentiation

Identification of suitable scaffolds onto which human stem cells can be seeded to generate functional three-dimensional tissues is a major research goal. A natural marine sponge skeleton was selected as a potential scaffold on the basis of the hydration potential of the fiber, the presence of open interconnected channels created by the fiber network, the collagenous composition of the fiber, and the structural diversity of fiber architecture. The skeleton of an undetermined species of Spongia (Class Demospongiae: Order Dictyoceratida: Family Spongiidae), composed of spongin, supported growth of human osteoprogenitor cells. Cell attachment and invasion into the framework were observed within 16 h, followed by development into membranous sheets between the sponge fibers by concentric infilling. Histochemical staining for alkaline phosphatase and type I collagen indicated formation of bone matrix as confirmed by birefringence. At 9 and 14 days alkaline phosphatase-specific activity in sponge fiber-osteoprogenitor cell cultures was significantly greater than in control cultures on cell culture plastic. Adsorption with recombinant human bone morphogenetic protein 2 confirmed the potential of this sponge skeleton as a delivery scaffold for osteogenic factors. The abundance and structural diversity of natural marine sponge skeletons and their potential as multifunctional, cell conductive and inductive frameworks indicate a promising new source of scaffold for tissue regeneration.

Search for Kaluza-Klein graviton emission in pp collisions at square root[s] = 1.8 TeV using the missing energy signature

We report on a search for direct Kaluza-Klein graviton production in a data sample of 84 pb(-1) of ppmacr; collisions at sqrt[s]=1.8 TeV, recorded by the Collider Detector at Fermilab. We investigate the final state of large missing transverse energy and one or two high energy jets. We compare the data with the predictions from a (3+1+n)-dimensional Kaluza-Klein scenario in which gravity becomes strong at the TeV scale. At 95% confidence level (C.L.) for n=2, 4, and 6 we exclude an effective Planck scale below 1.0, 0.77, and 0.71 TeV, respectively.

Neutrophil apoptosis, proinflammatory mediators and cell counts in bronchiectasis

BACKGROUND

Lower airway secretions from patients with bronchiectasis show inflammatory cell infiltration and increased proinflammatory mediators. The aim of this study was to investigate the effects of antibiotic treatment for exacerbations on neutrophil apoptosis and necrosis.

METHODS

Sputum was induced from 15 subjects with idiopathic bronchiectasis at the beginning of an acute exacerbation and after intravenous antibiotic treatment. Neutrophil apoptosis and necrosis were assessed using flow cytometry and morphology and the supernatant was analysed for concentrations of inflammatory mediators.

RESULTS

Neutrophil numbers (x10(6) cells/g sputum) in sputum were significantly greater on day 0 than on day 14 (median difference (95% confidence interval (CI)) 5.14 (1.27 to 8.46), p = 0.02). Controls had a significantly higher percentage of sputum macrophages than patients with bronchiectasis (day 0, 1.35 (95% CI 0.48 to 2.89), p = 0.004; day 14, 1.09 (95% CI 0.26 to 2.86), p = 0.02). The concentrations of tumour necrosis factor alpha (pg/ml), interleukin 8 (ng/ml), and neutrophil elastase (ng/ml) in sputum supernatant were significantly reduced on day 14 compared with day 0 (median difference -94 (95% CI -158 to -27), p = 0.005; -106 (95% CI -189 to -50), p = 0.0006; and -73 451 (95% CI -135 495 to -12 303), p = 0.02 respectively). Patients with bronchiectasis had a significantly lower percentage of cells which were neither apoptotic nor necrotic than healthy controls (both days, -38.8 (95% CI -49.6 to -8.5), p = 0.002; -45.0 (95% CI -58.0 to -34.1), p = 0.0003, respectively), and on day 14 they had a significantly higher percentage of secondary necrotic cells than healthy controls (40 (95% CI 11.6 to 57.5), p = 0.004).

CONCLUSIONS

This study shows that antibiotic treatment affects concentrations of proinflammatory mediators and cell death and clearance may be altered in bronchiectasis.

Search for pair production of scalar top quarks in R-parity violating decay modes in pp collisions at square root of s=1.8 TeV

We present the results of a search for pair production of scalar top quarks (t(1)) in an R-parity violating supersymmetry scenario in 106 pb(-1) of pp collisions at square root of s=1.8 TeV collected by the Collider Detector at Fermilab. In this mode each t(1) decays into a tau lepton and a b quark. We search for events with two tau's, one decaying leptonically (e or mu) and one decaying hadronically, and two jets. No candidate events pass our final selection criteria. We set a 95% confidence level lower limit on the t(1) mass at 122 GeV/c(2) for Br(t(1)-->tau b)=1.

Family intervention in routine practice: it is possible!

Family Intervention for individuals with schizophrenia has a wealth of evidence to attest its efficacy. However, there is little literature available about actual family work services, what they consist of and how they operate. With the publication of the National Institute for Clinical Excellence guidelines for schizophrenia in 2002, there is increased pressure on mental health services to deliver evidence-based Family Interventions to individuals with schizophrenia and their families. This article will outline how a specialist mental health Trust have been able to successfully establish and implement a designated Family Intervention service into routine practice.

Search for lepton flavor violating decays of a heavy neutral particle in p(-)p collisions at sqrt[s]=1.8 TeV

We report on a search for a high mass, narrow width particle that decays directly to emu, etau, or microtau. We use approximately 110 pb(-1) of data collected with the Collider Detector at Fermilab from 1992 to 1995. No evidence of lepton flavor violating decays is found. Limits are set on the production and decay of sneutrinos with R-parity violating interactions.

Central pseudorapidity gaps in events with a leading antiproton at the fermilab tevatron pp collider

We report a measurement of the fraction of events with a large pseudorapidity gap deltaeta within the pseudorapidity region available to the proton dissociation products X in p+p-->p+X. For a final state p of fractional momentum loss xi(p) and 4-momentum transfer squared t(p) within 0.06<xi(p)<0.09 and |t(p)|<1.0 [0.2] GeV2 at sqrt[s]=1800 [630] GeV, the fraction of events with deltaeta>3 is found to be 0.246+/-0.001 (stat)+/-0.042 (syst) [0.184+/-0.001 (stat)+/-0.043 (syst)]. Our results are compared with gap fractions measured in minimum bias pp collisions and with theoretical expectations.

Search for the supersymmetric partner of the top quark in dilepton events from pp collisions at square root of s=1.8 TeV

We have searched for pair production of the supersymmetric partner of the top quark (stop) in 107 pb(-1) of pp collisions at square root of s=1.8 TeV collected by the Collider Detector at Fermilab (CDF). Each stop is assumed to decay into a lepton, bottom quark, and supersymmetric neutrino. Such a scenario would give rise to events with two leptons, two hadronic jets, and a substantial imbalance of transverse energy. No evidence of such a stop signal has been found. We exclude stop masses in the region (80</=m(t)</=135 GeV/c(2)) in the mass plane of stop versus sneutrino.

Search for associated production of Upsilon and vector boson in pp collisions at sqrt[s]=1.8 TeV

We present a search for associated production of the Upsilon(1S) and a vector boson in 83 pb(-1) of ppmacr; collisions at sqrt[s]=1.8 TeV collected by the CDF experiment in 1994-1995. We find no evidence of the searched signal in the data, and set upper limits to the production cross sections.

Identification of the saphenous nerve at arthroscopy

Injury to the saphenous nerve can be a troublesome complication of arthroscopic procedures to the posterior half of the medial meniscus. In this article, we outline a technique for accurately identifying saphenous nerve position using transillumination of the saphenous vein.

Search for long-lived charged massive particles in pp collisions at square root s = 1.8 TeV

We report a search for the production of long-lived charged massive particles in a data sample of 90 pb(-1) of square root[s]=1.8 TeV pp collisions recorded by the Collider Detector at Fermilab. The search uses the muonlike penetration and anomalously high ionization energy loss signature expected for such a particle to discriminate it from backgrounds. The data are found to agree with background expectations, and cross section limits of O(1) pb are derived using two reference models, a stable quark and a stable scalar lepton.

Storage of blood for in vitro generation of dendritic cells

BACKGROUND

Since the development of techniques to cultivate DC from peripheral blood, there has been a great deal of interest in the use of these cells in immunotherapeutic strategies. In a clinical setting, delays often occur between when blood is drawn and when it is processed. We therefore investigated the effect of overnight storage on the yield, morphology and phenotype of DC cultured from the peripheral blood of healthy volunteers.

METHOD

Blood was processed either immediately, or after storage for 24 h in the fridge (4 degrees C) or at room temperature (RT, 20 degrees C). Samples were compared for starting cell number, DC yield and characteristics (morphology and phenotype).

RESULTS

The number of PBMC that could be obtained was significantly lower from the refrigerated samples compared with both the freshly processed sample and that stored at RT. Samples processed after overnight storage at RT yielded cells morphologically identical to DC cultured from freshly processed samples. Only when samples were both stored and processed cold did the cultured cells not have typical DC morphology. DC cultured from the refrigerated samples showed a significant reduction in MHC II expression compared with samples processed fresh or stored at RT. This expression increased slightly when the sample was first warmed. Total DC yield and the percentage yield of cultured DC was not significantly different for any of the groups.

DISCUSSION

We conclude that, if immediate processing of blood for in vitro generation of DC is not possible, samples should be stored at room temperature (approximately 20 degrees C).

Search for a W' boson decaying to a top and bottom quark pair in 1.8 TeV pp collisions

We report the results of a search for a W' boson produced in pp; collisions at a center-of-mass energy of 1.8 TeV using a 106 pb(-1) data sample recorded by the Collider Detector at Fermilab. We observe no significant excess of events above background for a W' boson decaying to a top and bottom quark pair. In a model where this boson would mediate interactions involving a massive right-handed neutrino (nu(R)) and have standard model strength couplings, we use these data to exclude a W' boson with mass between 225 and 536 GeV/c(2) at 95% confidence level for M(W')>>M(nu(R)) and between 225 and 566 GeV/c(2) at 95% confidence level for M(W')<M(nu(R)).

Early intervention in psychosis: who wins, who loses, who pays the price?

The following article discusses Early Intervention in Psychosis services. It is contextualized with the rapidly changing psychiatric system. There is exploration of the reasons for a focus upon Early Intervention in Psychosis at this current time. The article then proceeds to discuss what may be needed for services to meet government targets. It concludes with some tentative answers and further questions to issues raised within the discussion.