Biotechnical development of genetic addiction risk score (GARS) and selective evidence for inclusion of polymorphic allelic risk in substance use disorder (SUD)

Research into the neurogenetic basis of addiction identified and characterized by Reward Deficiency Syndrome (RDS) includes all drug and non-drug addictive, obsessive and compulsive behaviors. We are proposing herein that a new model for the prevention and treatment of Substance Use Disorder (SUD) a subset of RDS behaviors, based on objective biologic evidence, should be given serious consideration in the face of a drug epidemic. The development of the Genetic Addiction Risk Score (GARS) followed seminal research in 1990, whereby, Blum’s group identified the first genetic association with severe alcoholism published in JAMA. While it is true that no one to date has provided adequate RDS free controls there have been many studies using case –controls whereby SUD has been eliminated. We argue that this deficiency needs to be addressed in the field and if adopted appropriately many spurious results would be eliminated reducing confusion regarding the role of genetics in addiction. However, an estimation, based on these previous literature results provided herein, while not representative of all association studies known to date, this sampling of case- control studies displays significant associations between alcohol and drug risk. In fact, we present a total of 110,241 cases and 122,525 controls derived from the current literature. We strongly suggest that while we may take argument concerning many of these so-called controls (e.g. blood donors) it is quite remarkable that there are a plethora of case –control studies indicating selective association of these risk alleles ( measured in GARS) for the most part indicating a hypodopaminergia. The paper presents the detailed methodology of the GARS. Data collection procedures, instrumentation, and the analytical approach used to obtain GARS and subsequent research objectives are described. Can we combat SUD through early genetic risk screening in the addiction field enabling early intervention by the induction of dopamine homeostasis? It is envisaged that GARS type of screening will provide a novel opportunity to help identify causal pathways and associated mechanisms of genetic factors, psychological characteristics, and addictions awaiting additional scientific evidence including a future meta- analysis of all available data –a work in progress.

The development of an HIV-specific complexity rating scale

As treatment for HIV improves, an ageing population is experiencing comorbidity which often leads to complex clinical presentations requiring an interdisciplinary care approach. This study sought to quantify clinician assessment of the level of clinical complexity, through the development of a rating scale for people living with HIV (PLHIV), to improve client care through an interdisciplinary care model. An existing alcohol and other drug complexity rating scale was selected and modified for use with PLHIV. HIV-specific items were included through consultation with an interdisciplinary team. A risk-prediction model was developed and validated using clinician ratings of clients attending The Albion Centre, a tertiary HIV clinic in Sydney, Australia, resulting in the development of the Clinical Complexity Rating Scale for HIV (CCRS-HIV). Multivariable logistic regression models identified eight characteristics based on clinician assessment of complexity in PLHIV: financial instability, social isolation, problematic crystal methamphetamine use, mental illness and/or other problematic substance use, cognitive/neurological impairment, polypharmacy, current hepatitis C infection and/or cancer, and other physical health comorbidity. A weighted risk-prediction model was developed and validated. The final model accurately predicted 85% of complex clients, with a sensitivity of 80% and specificity of 91%. This study developed an HIV-specific clinician-rated complexity scale. Further investigations are required to validate the CCRS-HIV with broader HIV populations. This simple complexity screening tool is a promising adjunct to clinical assessment to identify clients with complex physical and psychosocial needs who may benefit from interdisciplinary care interventions and allocation of resources.

HIV in practice: current approaches and challenges in the diagnosis, treatment and management of HIV infection in Australia

As treatment improves, people living with HIV (PLWHIV) can now expect to live longer, which means that the foci of HIV-related care for them and their medical practitioners continue to change. With an increasingly older cohort of patients with HIV infection, practitioners' key considerations are shifting from issues of acute treatment and patient survival to multiple comorbidities, toxicities associated with chronic therapy, and ongoing health maintenance. Within this context, this paper explores the current standard of practice for the management of HIV infection in Australia. We surveyed 56 Australian practitioners currently involved in managing HIV infection: 'HIV section 100' (HIV therapy-prescribing) general practitioners (s100 GPs; n = 26), sexual health physicians (SHPs; n = 24) and hospital-based physicians (HBPs; n = 6). Survey results for practice approaches and challenges were broadly consistent across the three practitioner specialties, apart from a few key areas. s100 GPs reported less prophylaxis use among patients whom they deemed at risk of HIV infection in comparison with SHPs, which may reflect differences in patient populations. Further, a higher proportion of s100 GPs nominated older HIV treatment regimens as their preferred therapy choices compared with the other specialties. In contrast with SHPs, s100 GPs were less likely to switch HIV therapies to simplify the treatment protocol, and to immediately initiate treatment upon patient request in those newly diagnosed with HIV infection. Considerably lower levels of satisfaction with current HIV practice guidelines were also reported by s100 GPs. It appears that greater support for s100 GPs may be needed to address these identified challenges and enhance approaches to HIV practice. Across all specialties, increasing access to mental health services for patients with HIV infection was reported as a key management issue. A renewed focus on providing improved mental health and wellbeing supports is recommended, particularly in the face of an ageing HIV-infected population.

In-flight characterization of the lunar orbiter laser altimeter instrument pointing and far-field pattern

The Lunar Orbiter Laser Altimeter (LOLA) aboard the Lunar Reconnaissance Orbiter (LRO) has collected nearly seven billion measurements of surface height on the Moon with an absolute accuracy of ∼1  m and a precision of ∼10  cm. Converting time-of-flight laser altimeter measurements to topographic elevations requires accurate knowledge of the laser pointing with respect to the spacecraft body-fixed coordinate system. To that end, we have utilized altimetric crossovers from LOLA, as well as bidirectional observations of the LOLA laser and receiver boresight via an Earth-based laser tracking ground station. Based on a sample of ∼780,000 globally distributed crossovers from the circular-orbit phase of LRO's mission (∼27 months), we derive corrections to the LOLA laser boresight. These corrections improve the cross-track and along-track agreement of the crossovers by 24% and 33%, respectively, yielding RMS residuals of ∼10  m. Since early in the LRO mission, the bidirectional laser tracking experiments have confirmed a pointing anomaly when the LOLA instrument is facing toward deep space or the night side of the Moon and have allowed the reconstruction of the laser far-field pattern and receiver telescope pointing. By conducting such experiments shortly after launch and nearly eight years later, we have directly measured changes in the laser characteristics and obtained critical data to understand the laser behavior and refine the instrument pointing model. The methods and results presented here are also relevant to the design, fabrication, and operation of future planetary laser altimeters and their long-term behavior in the space environment.

Gene expression as a target for new drug discovery

Over the last 7 years we have carried out a major research effort focused on gene transcription as a novel approach to drug discovery. The goal is to identify small molecular weight compounds that modulate the expression of a target gene in a specific manner, thereby either increasing or decreasing the concentration of the corresponding protein product. Transcriptional modulation not only provides a potential means to replace recombinant proteins as drugs, but also provides a novel approach to manipulate key gene targets in many therapeutic areas. This article describes some of the features and advantages of transcription-based pharmaceuticals and illustrates how this approach can be applied to drug discovery with a program we are pursuing to identify new treatments for sickle cell disease and beta-thalassemia.

Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study

BACKGROUND

We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America.

METHODS

We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs).

RESULTS

We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions.

CONCLUSIONS

Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.

Docosahexaenoic acid enrichment in NAFLD is associated with improvements in hepatic metabolism and hepatic insulin sensitivity: a pilot study

This corrects the article DOI: 10.1038/ejcn.2017.9.

A Cross-Cultural Perspective on Adolescent Girls' Body Perception

The purpose of the study was to examine the body perception of 122 Jamaican adolescent girls. The study is a part of a larger project investigating the psychosocial adjustment of these adolescents. Included in the survey were items asking for demographic information such as height, weight, and age. In addition, subjects were asked to indicate whether they were pregnant and whether they considered themselves under- or overweight. Using the standard system of desirable weight the subjects' perceptions of whether they were under- or overweight were compared with their actual weights. In general, Jamaican adolescent girls had accurate perceptions of their body size and weight.

Docosahexaenoic acid enrichment in NAFLD is associated with improvements in hepatic metabolism and hepatic insulin sensitivity: a pilot study

Background/Objective:

Treatment of subjects with non-alcoholic fatty liver disease (NAFLD) with omega-3 polyunsaturated fatty acids (FAs) suggests high levels of docosahexaenoic acid (DHA) tissue enrichment decrease liver fat content. We assessed whether changes in erythrocyte DHA enrichment (as a surrogate marker of changes in tissue enrichment) were associated with alterations in hepatic de novo lipogenesis (DNL), postprandial FA partitioning and hepatic and peripheral insulin sensitivity in a sub-study of the WELCOME trial (Wessex Evaluation of fatty Liver and Cardiovascular markers in NAFLD (non-alcoholic fatty liver disease) with OMacor thErapy).

Subjects/Methods:

Sixteen participants were randomised to 4 g/day EPA+DHA (n=8) or placebo (n=8) for 15–18 months and underwent pre- and post-intervention measurements. Fasting and postprandial hepatic FA metabolism was assessed using metabolic substrates labelled with stable-isotope tracers (²H₂O and [U¹³C]palmitate). Insulin sensitivity was measured by a stepped hyperinsulinaemic-euglycaemic clamp using deuterated glucose. Participants were stratified according to change in DHA erythrocyte enrichment (< or ⩾2% post intervention).

Results:

Nine participants were stratified to DHA⩾2% (eight randomised to EPA+DHA and one to placebo) and seven to the DHA<2% group (all placebo). Compared with individuals with erythrocyte <2% change in DHA abundance, those with ⩾2% enrichment had significant improvements in hepatic insulin sensitivity, reduced fasting and postprandial plasma triglyceride concentrations, decreased fasting hepatic DNL, as well as greater appearance of ¹³C from dietary fat into plasma 3-hydroxybutyrate (all P<0.05).

Conclusions:

The findings from our pilot study indicate that individuals who achieved a change in erythrocyte DHA enrichment ⩾2% show favourable changes in hepatic FA metabolism and insulin sensitivity, which may contribute to decreasing hepatic fat content.

Multi-centre field evaluation of the performance of the Trinity Biotech Uni-Gold HIV 1/2 rapid test as a first-line screening assay for gay and bisexual men compared with 4th generation laboratory immunoassays

BACKGROUND

The Trinity Biotech Uni-Gold HIV test (Uni-Gold) is often used as a supplementary rapid test in testing algorithms.

OBJECTIVE

To evaluate the operational performance of the Uni-Gold as a first-line screening test among gay and bisexual men (GBM) in a setting where 4th generation HIV laboratory assays are routinely used.

STUDY DESIGN

We compared the performance of Uni-Gold with conventional HIV serology conducted in parallel among GBM attending 22 testing sites. Sensitivity was calculated separately for acute and established infection, defined using 4th generation screening Ag/Ab immunoassay (EIA) and Western blot results. Previous HIV testing history and results of supplementary 3rd generation HIV Ab EIA, and p24 antigen EIA were used to further characterise cases of acute infection.

RESULTS

Of 10,793 specimens tested with Uni-Gold and conventional serology, 94 (0.90%, 95%CI:0.70-1.07) were confirmed as HIV-positive by conventional serology, and 37 (39.4%) were classified as acute infection. Uni-Gold sensitivity was 81.9% overall (77/94, 95%CI:72.6-89.1); 56.8% for acute infection (21/37, 95%CI:39.5-72.9) and 98.2% for established infection (56/57, 95%CI:90.6-100.0). Of 17 false non-reactive Uni-Gold results, 16 were acute infections, and of these seven were p24 antigen reactive but antibody negative. Uni-Gold specificity was 99.9% (10,692/10,699, 95%CI:99.9-100.0), PPV was 91.7% (95%CI:83.6-96.6) and NPV was 99.8% (95%CI:99.7-99.9), respectively.

CONCLUSIONS

In this population, Uni-Gold had good specificity and sensitivity was high for established infections when compared to 4th generation laboratory assays, however sensitivity was lower in acute infections. Where rapid tests are used in populations with a high proportion of acute infections, additional testing strategies are needed to detect acute infections.

Ice cover extent drives phytoplankton and bacterial community structure in a large north-temperate lake: implications for a warming climate

Mid-winter limnological surveys of Lake Erie captured extremes in ice extent ranging from expansive ice cover in 2010 and 2011 to nearly ice-free waters in 2012. Consistent with a warming climate, ice cover on the Great Lakes is in decline, thus the ice-free condition encountered may foreshadow the lakes future winter state. Here, we show that pronounced changes in annual ice cover are accompanied by equally important shifts in phytoplankton and bacterial community structure. Expansive ice cover supported phytoplankton blooms of filamentous diatoms. By comparison, ice free conditions promoted the growth of smaller sized cells that attained lower total biomass. We propose that isothermal mixing and elevated turbidity in the absence of ice cover resulted in light limitation of the phytoplankton during winter. Additional insights into microbial community dynamics were gleaned from short 16S rRNA tag (Itag) Illumina sequencing. UniFrac analysis of Itag sequences showed clear separation of microbial communities related to presence or absence of ice cover. Whereas the ecological implications of the changing bacterial community are unclear at this time, it is likely that the observed shift from a phytoplankton community dominated by filamentous diatoms to smaller cells will have far reaching ecosystem effects including food web disruptions.

Effect of testing experience and profession on provider acceptability of rapid HIV testing after implementation in public sexual health clinics in Sydney

OBJECTIVES

Rapid HIV testing (RHT) is well established in many countries, but it is new in Australia since a policy change in 2011. We assessed service provider acceptability of RHT before and after its implementation in four Sydney public sexual health clinics.

METHODS

Service providers were surveyed immediately after training in RHT and again 6-12 months later. Differences in mean scores between survey rounds were assessed via t-tests, with stratification by profession and the number of tests performed.

RESULTS

RHT was rated as highly acceptable among staff at baseline and acceptability scores improved between survey rounds. Belief in being sufficiently skilled and experienced to perform RHT (P = 0.004) and confidence in the delivery of nonreactive results increased (P = 0.007), while the belief that RHT was disruptive declined (P = 0.001). Acceptability was higher for staff who had performed a greater number of tests regarding comfort with their role in RHT (P = 0.004) and belief that patients were satisfied with RHT (P = 0.007). Compared with nurses, doctors had a stronger preference for a faster rapid test (P = 0.027) and were more likely to agree that RHT interfered with consultations (P = 0.014).

CONCLUSIONS

Differences in responses between professions may reflect differences in staff roles, the type of patients seen by staff and the model of testing used, all of which may affect the number of tests performed by staff. These findings may inform planning for how best to implement RHT in clinical services.

Science potential from a Europa lander

The prospect of a future soft landing on the surface of Europa is enticing, as it would create science opportunities that could not be achieved through flyby or orbital remote sensing, with direct relevance to Europa's potential habitability. Here, we summarize the science of a Europa lander concept, as developed by our NASA-commissioned Science Definition Team. The science concept concentrates on observations that can best be achieved by in situ examination of Europa from its surface. We discuss the suggested science objectives and investigations for a Europa lander mission, along with a model planning payload of instruments that could address these objectives. The highest priority is active sampling of Europa's non-ice material from at least two different depths (0.5-2 cm and 5-10 cm) to understand its detailed composition and chemistry and the specific nature of salts, any organic materials, and other contaminants. A secondary focus is geophysical prospecting of Europa, through seismology and magnetometry, to probe the satellite's ice shell and ocean. Finally, the surface geology can be characterized in situ at a human scale. A Europa lander could take advantage of the complex radiation environment of the satellite, landing where modeling suggests that radiation is about an order of magnitude less intense than in other regions. However, to choose a landing site that is safe and would yield the maximum science return, thorough reconnaissance of Europa would be required prior to selecting a scientifically optimized landing site.

Associations of Body Mass and Body Fat Distribution with Parity Among African-American and Caucasian Women: The CARDIA Study

Associations of parity with body fat and its distribution are poorly understood; therefore, we examined the relationships between parity and obesity in young adult women. Body mass index (BMI), skin-folds, and waist-hip ratio were compared in 1452 African-American and 1268 Caucasian nonpregnant women aged 18 to 30, adjusting for age (where no age-parity interactions were present), education, physical activity (assessed by questionnaire) and fitness (assessed by graded exercise test), dietary fat intake, alcohol and smoking. Adjusted mean BMI was significantly higher in African-American women aged 25-30 years with three or more children (28.5 kg/m2) than in those with two (27.0 kg/m2), one (26.2 kg/m2), or no children (26.3 kg/m2). Similar trends were found in Caucasians (BMI = 23.3, 23.4, 23.7, 25.0 kg/m2 for parity = 0, 1, 2, > or = 3, respectively), but the mean BMI was significantly higher in African Americans in each parity group. The association between BMI and parity was not present among women 18-24 years of age. Skinfolds were directly associated with parity in African Americans only. Waist-hip ratios were generally lower among nulliparous than parous women in both ethnic groups; race differences were present only among nulliparas. In conclusion, parity was associated with BMI in women aged 25 to 30 years but did not explain ethnicity-related differences in body mass.

Dawn at Vesta: testing the protoplanetary paradigm

The Dawn spacecraft targeted 4 Vesta, believed to be a remnant intact protoplanet from the earliest epoch of solar system formation, based on analyses of howardite-eucrite-diogenite (HED) meteorites that indicate a differentiated parent body. Dawn observations reveal a giant basin at Vesta's south pole, whose excavation was sufficient to produce Vesta-family asteroids (Vestoids) and HED meteorites. The spatially resolved mineralogy of the surface reflects the composition of the HED meteorites, confirming the formation of Vesta's crust by melting of a chondritic parent body. Vesta's mass, volume, and gravitational field are consistent with a core having an average radius of 107 to 113 kilometers, indicating sufficient internal melting to segregate iron. Dawn's results confirm predictions that Vesta differentiated and support its identification as the parent body of the HEDs.

Clinical experience with nevirapine combined with tenofovir plus emtricitabine or lamivudine-containing regimens in HIV-infected subjects

We retrospectively evaluated the durability and reasons for discontinuation of nevirapine (NVP) in combination with a tenofovir (TDF) and emtricitabine (FTC) or lamivudine (3TC)-containing antiretroviral therapy (ART) regimen in an Australian outpatient setting. Between January 2003 and June 2009, 64 patients (29 naïve and 35 treatment-experienced) received NVP/TDF-based regimens. The median exposure was 13.0 months (interquartile range [IQR] 6.0-20.0 months). The two- and three-year probability of continuing a NVP/TDF with FTC or 3TC regimen was 76% and 70%, respectively. Thirteen (20.3%) patients discontinued their regimen during the observation period. Reasons for discontinuation included virological failure in four (6.3%), rash in three (4.7%), lost to follow-up in three (4.7%), liver toxicity in two (3.1%) and HIV-1-related encephalopathy in one (1.6%). Long-term follow-up with a NVP/TDF-based regimen showed a low rate of discontinuation and enabled physicians to extend the use of ART over a long period, often with simplified (once-daily) regimens.

Hydrogen mapping of the lunar south pole using the LRO neutron detector experiment LEND

Hydrogen has been inferred to occur in enhanced concentrations within permanently shadowed regions and, hence, the coldest areas of the lunar poles. The Lunar Crater Observation and Sensing Satellite (LCROSS) mission was designed to detect hydrogen-bearing volatiles directly. Neutron flux measurements of the Moon's south polar region from the Lunar Exploration Neutron Detector (LEND) on the Lunar Reconnaissance Orbiter (LRO) spacecraft were used to select the optimal impact site for LCROSS. LEND data show several regions where the epithermal neutron flux from the surface is suppressed, which is indicative of enhanced hydrogen content. These regions are not spatially coincident with permanently shadowed regions of the Moon. The LCROSS impact site inside the Cabeus crater demonstrates the highest hydrogen concentration in the lunar south polar region, corresponding to an estimated content of 0.5 to 4.0% water ice by weight, depending on the thickness of any overlying dry regolith layer. The distribution of hydrogen across the region is consistent with buried water ice from cometary impacts, hydrogen implantation from the solar wind, and/or other as yet unknown sources.

The clementine mission to the moon: scientific overview

In the course of 71 days in lunar orbit, from 19 February to 3 May 1994, the Clementine spacecraft acquired just under two million digital images of the moon at visible and infrared wavelengths. These data are enabling the global mapping of the rock types of the lunar crust and the first detailed investigation of the geology of the lunar polar regions and the lunar far side. In addition, laser-ranging measurements provided the first view of the global topographic figure of the moon. The topography of many ancient impact basins has been measured, and a global map of the thickness of the lunar crust has been derived from the topography and gravity.

The shape and internal structure of the moon from the clementine mission

Global topographic and gravitational field models derived from data collected by the Clementine spacecraft reveal a new picture of the shape and internal structure of the moon. The moon exhibits a 16-kilometer range of elevation, with the greatest topographic excursions occurring on the far side. Lunar highlands are in a state of near-isostatic compensation, whereas impact basins display a wide range of compensation states that do not correlate simply with basin size or age. A global crustal thickness map reveals crustal thinning under all resolvable lunar basins. The results indicate that the structure and thermal history of the moon are more complex than was previously believed.

PREPARATION AND EFFECTS OF AN ANTI-MAST CELL SERUM

In an attempt to obtain an antiserum that would bring about widespread destruction of mast cells in the rat, rabbits were immunized with mast cells isolated from the peritoneal cavities of rats. Striking evidence of anti-mast cell activity was indicated in vivo by mast cell disruption and in vitro by positive interfacial precipitin tests of the serum from rabbits so treated. The time course of the production of anti-mast cell activity in the rabbit serum was established. Normal rabbit serum was without effect on mast cells in the several tests. The same was true for rabbit anti-rat liver serum except when it was applied directly to tissues containing mast cells. In the latter case mast cell disruption ensued, but it appeared different from that evoked by anti-mast cell serum. Intraperitoneal injection of anti-mast cell serum was followed by destruction of all of the mast cells of the mesentery and of the majority of mast cells in the ear, scrotum, and abdominal skin. The time course of this destruction, of the phagocytosis of the mast cell debris, and of the repopulation of the tissues with new mast cells was established. Attending the disruption of mast cells the levels of tissue histamine dropped sharply but returned toward normal as new mast cells appeared. In the scrotum and abdominal skin 5-hydroxytryptamine did not fall below normal and was markedly above normal at the time when histamine and mast cell content were lowest. Reddening and swelling of the muzzle, ears, feet, and scrotum were present during the first few days after injection of the anti-mast cell serum. Intraperitoneal injection of normal rabbit serum was without any of the above effects. Similarly injected rabbit anti-rat liver serum had no effect on the mast cells or upon the levels of histamine and 5-hydroxytryptamine in the ear, scrotum, or abdominal skin. It caused no reddening and swelling of the muzzle, ears, feet, and scrotum. It was attended, however, by destruction of the mast cells and by a sharp fall in the histamine content of the mesentery. Gross changes in the tissue of the peritoneal cavity following anti-mast cell and anti-liver serum were described. The possible significance of the several findings were discussed.

THE EFFECT OF COMBINATION WITH DIAZO COMPOUNDS ON THE IMMUNOLOGICAL REACTIVITY OF ANTIBODIES

Sufficient coupling with any of five different diazo compounds eventually destroyed the reactivity of all the antisera here studied. The rates of inactivation varied considerably among the several antisera. By stopping the reaction at intervals, it was possible to prepare partially inactivated antibodies of peculiarly modified reactivity. Thus, the flocculating activity of diphtheria antitoxin with toxin was completely destroyed long before there was any demonstrable impairment of its protective titer in vivo. The first change induced in antipneumococcus horse sera was the apparently complete loss of reactivity with the capsular carbohydrate at a time when the agglutinating, animal-protecting and complement-fixing activity of the sera were only slightly affected. On further coupling, the sera no longer caused visible agglutination; but aggregation of the serum-treated bacteria could be induced by centrifugation. Still further coupling destroyed all antibody activity. Rabbit antisera to egg albumen and horse serum no longer precipitated the homologous antigen after treatment with diazo compounds, probably due to their failure to combine with the antigen. The hemolytic, complement-fixing and lipoid-flocculating activity of coupled rabbit antisera to sheep red blood cells fell off in parallel; the hemagglutinin seemed somewhat more resistant. The reagin of syphilitic serum was destroyed almost instantaneously by comparatively small amounts of diazo compounds. Finally, in the case of antityphoid agglutinin, the isoelectric point of the coupled antibody, measured on the surface of specifically sensitized bacteria, was found to shift from an original value of pH 4.7 to one of less than pH 2.7 as progressively more sulfanilic acid radicals added on to the antibody molecule. The groups in protein which participate in its reaction with diazo compounds probably include aliphatic amines, the imidazole ring of histidine, the indole group of tryptophane, the NH of proline and hydroxyproline and the phenyl group of tyrosine. Although it has been possible to modify antibodies chemically so that they combine with the corresponding antigens without causing their aggregation, the experiments here described furnish no indication as to which of these groups in antibody protein are primarily concerned in the antigen-antibody reaction, and which are responsible for the secondary flocculation. Such localization awaits the development of a technic for attacking individual groups in the protein molecule.

LEAD STUDIES : III. THE EFFECTS OF LEAD ON RED BLOOD CELLS. PART 1. CHANGES IN HEMOLYSIS

It appears, from the investigations in other laboratories, that the anemia observed in cases of lead poisoning is due to destruction of blood rather than to diminished production of blood. The method of poisoning cells in vitro with lead was adopted in order to study this phenomenon, and distinct effects were thereby obtained, even when only 0.001 mg. of lead is added to approximately 5 billion washed red corpuscles. In order to obtain optimum results the usual dosage employed was ten times this or 0.01 mg. per 5 billion cells. The following changes were observed in cells so treated. 1. Such a marked increase in the resistance to hypotonic salt solution develops that complete hemolysis does not occur until the cells are exposed to a saline solution of 0.05 per cent. Untreated cells are completely hemolyzed in 0.25 or 0.225 per cent saline. 2. This reaction is quantitative and varies with the concentration of lead used. Under the conditions of our experiments this phenomenon seems to be unique. The effects of arsenic are very slight in comparison. 3. While from this reaction it may be concluded that lead increases cellular resistance, it also appears that it shortens the life of blood cells. This may be demonstrated by the much more rapid appearance of hemolysis than normal when the cells are merely allowed to stand in Ringer solution of any dilution. 4. In rabbits with acute lead poisoning these same phenomena may be noted in vivo. 5. Both phenomena may be changed in vitro by varying the time and temperature of the reaction and the concentration of lead, as Fici has already pointed out. 6. If normal cells stand in Ringer solution for 6 hours something diffuses into the solution which largely reduces the action of lead. After repeated washing these cells react with lead in the usual manner. 7. Small amounts of serum react with lead and eliminate its effects. Red blood cells, treated with a mixture of lead and blood serum, show normal hemolysis in hypotonic salt solution. 8. When lead is added to whole blood the only evidence of this neutralization is a marked decrease in the intensity of the reaction. This is probably explained by the fact that since both serum and cells are present together, the lead reacts with both simultaneously. This in turn explains how the reaction may occur in vivo. 9. The change in hemolysis does not appear in the blood of all species of animals. In the species in which it does occur, anemia and stippling of the red cells also tend to develop readily during lead intoxication. 10. In vitro, cells which have been exposed to lead are far more fragile than normal blood cells. Slight trauma causes them to hemolyze. In vivo this is probably an important causal factor in the increased destruction of blood and in the anemia of acute lead poisoning. 11. The serum of a rabbit which has been immunized to human blood, causes more rapid and complete hemolysis in cells treated with lead than in the control cells. No satisfactory explanation for this has been found.

LEAD STUDIES : III. THE EFFECTS OF LEAD ON RED BLOOD CELLS. PART 2. SURFACE PHENOMENA AND THEIR PHYSIOLOGICAL EXPLANATION

The physiological changes following the reaction of lead upon red blood cells are numerous and show the marked effects of a change in the cell surface. In experiments here reported 0.01 to 0.05 mg. of lead acting upon 5 billion red cells caused such marked variations from normal as: 1. Partial loss of the normal stickiness of red corpuscles, which is demonstrated by their falling from a clean glass surface. 2. Loss of the agglutination reaction which normally follows mixture with serum of a different isoagglutinating group. 3. Decrease in volume even in isotonic solutions. 4. Loss of normal elasticity and, therefore, reduced changes in volume upon exposure to marked variations in osmotic tension. 5. Increase in resistance to large changes in external osmotic pressure because of this inelasticity, and therefore decreased hemolysis in hypotonic salt solution (Part 1). 6. Increase in the speed of disintegration in spite of this increased resistance to external osmotic pressure. "Leaded" cells break up more readily upon standing than do normal cells, and are easily fractured by rotation or shaking (Part 1). All these phenomena seem to be associated largely with surface changes in the corpuscles. Evidence is cited that there is no chemical reaction between lead and hemoglobin. The gas exchange is identical in normal and "leaded" cells. The function of the interior of the red cells, therefore, appears to be unaffected by lead. The effects of lead upon red blood cells are thus manifested by shrinkage, inability to expand, increased brittleness, and loss of the normal consistency which makes their surface sticky. After exposure to lead, red blood corpuscles are more like hard inelastic brittle rubber balls, than like the soft, elastic, resilient cells characteristic of normal blood.

STUDIES ON PATHOGENIC B. COLI FROM BOVINE SOURCES : IV. A BIOCHEMICAL STUDY OF THE CAPSULAR SUBSTANCE

1. The soluble specific substance obtained from a capsulated strain of B. coli is not identical with any specific substance heretofore described. It is a carbohydrate, composed of 80 per cent of hexose, probably partly of dextro- and partly of levorotatory sugar, since the rotation of the hydrolysate is low. Glucuronic acid is probably present in the molecule. 2. Crude "residue" or specific substance obtained from the uncapsulated mutant was about 100 times less active with homologous serum than similar material from the capsulated strain. This supports the view that capsular substance and soluble specific substance are the same. In cases where there is a well marked capsule, the specific substance is probably produced in greater amount and located peripherally. 3. Capsular substance is probably significant for virulence when functioning as a morphological capsule. It is present in filtrates of young culture only in very small amounts.

IL-33: a tissue derived cytokine pathway involved in allergic inflammation and asthma

Besides classic T cell-derived T-helper type 2 (Th2) cytokines such as IL-4, IL-5 and IL-13, tissue-produced cytokines such as thymic stromal lymphopoietin, IL-25 and IL-33 are now recognized as important contributors to allergic inflammation. IL-33 is produced by various tissue dwelling cells and broadly enhances allergic inflammation through its effects on hematopoietic cell types. The environmental or endogenous triggers that provoke IL-33 cellular release may be associated with infection, inflammation or tissue damage. This review summarizes the wide range of documented IL-33 activities on human cellular mediators of inflammation as well as genetic evidence that IL-33 contributes to disease. Finally, there will be a discussion of still unanswered questions regarding the mechanisms by which cytokine activity is generated and IL-33's relationship with other Th2-associated cytokines.

Factors associated with unprotected anal intercourse between HIV-positive men and regular male partners in a Sydney cohort

Blood plasma HIV-RNA load (BPVL) is the strongest predictor of HIV-1 transmission during sex. Unprotected anal intercourse (UAI) is the highest risk activity for transmission among men who have sex with men (MSM). Awareness of BPVL may influence rates of UAI. We assessed whether optimism towards antiretroviral therapy (ART) and/or biomedical factors influenced sexual activities with regular partners. Questionnaires were administered to 109 HIV-positive MSM participating in a cross-sectional study of BPVL and seminal viral load. The survey assessed HIV transmission beliefs and sexual practices with regular male partners in the past three months. Sixty-nine of 109 (63.3%) had been in a regular relationship and 42 reported having had anal sex. Unprotected receptive anal intercourse without ejaculation (URAI − e) was associated with awareness that their most recent BPVL was detectable (>50 RNA copies/mL) and not taking ART. Receptive UAI with ejaculation (URAI + e) was associated with not taking ART, having a sexually transmissible infection and having an HIV-positive partner; the latter was also associated with insertive UAI with ejaculation (UIAI + e). Treatment optimism was not associated with UAI. In this cohort, sexual practices were based more upon knowledge of biomedical factors rather than attitudes regarding transmission risks.

Biochemical stability during parenteral nutrition in children

The aim of this study was to assess the frequency and importance of biochemical abnormality related to parenteral nutrition (PN) in a group of infants, and to devise an appropriate policy for routine biochemical surveillance. A standard monitoring protocol based on widely published guidelines was applied to 30 consecutive patients (age 3 days-3 years) referred to a children's hospital nutritional care team for PN. No serious biochemical abnormalities were observed to arise simply as a consequence of PN. Electrolyte disturbance most commonly occurred before starting PN. Biochemical abnormality was most likely to be found in patients with abnormal fluid and electrolyte losses. Protocols for biochemical surveillance during PN err on the side of caution and often suggest frequent and comprehensive testing. In stable patients such as the surgical newborn, this is both expensive and unnecessary, and simpler monitoring regimes may be used with safety.

Comparison of different methodologies for CD4 estimation in a clinical setting

OBJECTIVE

To compare flow cytometry assays, using traditional dual platform (DP) or newer single platform (SP) for CD4 enumeration.

METHOD

Records of subjects enrolled in four separate clinical trials using the same central laboratory [SP methodology (Trucount)] were reviewed retrospectively. Eighteen subjects had 60 matching contemporaneous samples at multiple timepoints.

RESULTS

DP flow cytometry yielded higher CD4 counts in 50/60 assays (83%). CD4 count and percentage by the two methods showed strong correlation for the counts (r=0.965, P<0.0001) and percentages (r=0.959, P<0.0001). Bland-Altman plot analysis showed that the limits of variation were within agreeable limits of +/-2SD in 56/60 (93.3%) samples tested. Twenty-five (42%) samples had a difference of >50 cells/microL. Of these six (24%) exceeded 100 cells.

CONCLUSION

This study is in agreement with previous reports of strong correlation between DP and SP flow cytometry. This review found differences in CD4 counts in a high proportion of samples tested highlighting the importance for clinicians to be aware of such differences when interpreting results from the two methods.

Development and Preliminary Experience with an Ease of Extractability Rating System for Prescription Opioids

One important factor in the abuse potential of an opioid product is the ease with which active drug can be extracted. There are currently no standards for testing or reporting extractability. This article describes the development of an Extractability Rating System for use by the pharmaceutical industry and regulators. Despite several limitations, this effort serves as a call for standardized testing and reporting so that products can be accurately rated, and should help establish goals for drug developers who wish to develop "abuse-resistant" opioid products.

The public health impact of widespread availability of nonoccupational postexposure prophylaxis against HIV

OBJECTIVE

The aim of the study was to describe the use of nonoccupational postexposure prophylaxis (NPEP) in Australia, and to estimate the number of HIV infections that its use prevented.

METHODS

We conducted a population-based observational cohort study of people who presented to antiretroviral prescribers in Eastern Australia, and reported a high-risk nonoccupational exposure to HIV, in 1998-2004. Prescribers collected data at baseline, 4 weeks and 6 months. Data collected included details of HIV exposure, drug regimens and HIV serostatus.

RESULTS

The great majority of the 1601 participants were male (95%) and presented after male homosexual exposure (87%). Only 32% of exposures were to HIV-positive sources. Two antiretroviral drugs were prescribed after 48% of events, and three or more drugs after 52% of events. The median time to receipt of NPEP was 23 h. Side effects were reported by 66% of participants. No case of NPEP failure in an adherent individual was identified. It was estimated that 0.9-9.2 HIV infections had been prevented. This compared with a total of 1138 newly acquired HIV infections notified in the geographical area covered by the study.

CONCLUSIONS

In Australia, NPEP has been widely prescribed and is mainly targeted at high-risk exposures. Although there were no identified failures of NPEP, it is likely that only a small proportion of new HIV infections in the study area were prevented. NPEP may be a valuable preventive intervention for an individual, but it can only play a minor role in HIV prevention at the population level unless targeting can be further improved.

Detection of transaldolase deficiency by quantification of novel seven-carbon chain carbohydrate biomarkers in urine

Transaldolase deficiency, a recently discovered disorder of carbohydrate metabolism with multisystem involvement, has been diagnosed in 6 patients. Affected patients have abnormal concentrations of polyols in body fluids and in all patients we have previously found increased amounts of a seven-carbon chain carbohydrate which we suspected of being sedoheptulose. We report development of a liquid chromatography-tandem mass spectrometry method for quantitation of the seven-carbon carbohydrates sedoheptulose and mannoheptulose in urine. Additionally, other seven-carbon chain carbohydrates were characterized in urine, including sedoheptitol, perseitol and sedoheptulose 7-phosphate. Transaldolase-deficient patients had significantly increased urinary sedoheptulose and sedoheptulose 7-phosphate, associated with subtle elevations of mannoheptulose, sedoheptitol and perseitol. Our findings reveal novel urinary biomarkers for identification of transaldolase deficiency.

Change and continuity: childbirth and parenting across three generations of women in the United Arab Emirates

BACKGROUND

The United Arab Emirates (UAE) is a country that has undergone remarkable physical, economic and social shifts in its short modern history. And while the economic and structural transformations of the society have been well documented and publicized, information about the changes and transformations of family processes is sparse. This study is one of the first steps towards documenting the changes in family processes, namely those related to childbirth and parenting, as described by three generations of Emirati women.

METHODS

Family triads of Grandmothers, Mothers and married Daughters (n = 216) were interviewed in local Arabic dialect by Emirati female research assistants. Data were analysed using chi square and Analysis of Variance.

RESULTS

Generational differences were found between the Grandmothers, Mothers and Daughters in: number of births, maternal age at first birth, location and type of birth attendant, medication during labour and birth, father presence at birth, social support following birth, feeding and weaning of infant, and preventive infant health care. Changes were not found in the proximity to the mother of the infant during sleep.

CONCLUSIONS

The age of first birth has risen for Emirati women and the birth rate may have dropped. Health care has also significantly improved. These results are discussed in relation to government initiatives and physical and social change within the UAE and the Middle East.