[What determines a breast cancer patient's choice of hospital? The role of travel time, care history of the patient and the general practitioner's referral history]

OBJECTIVE

To examine to what extent patients' hospital choices are influenced by travel time, their care history, and their general practitioners' (GP) referral history.

DESIGN

Quantitative study.

METHOD

We used care claims data from 2015 of patients with breast cancer. We selected the initial care products of the breast cancer patients who had been referred to a hospital by a GP or GP practice. We used conditional logit choice models with 82 hospitals in the choice set to assess whether travel time to the hospital, care history of the patient in the preceding two years, and referral history of the GP were related to the choice of hospital. How often patients opted for a default choice hospital was also determined.

RESULTS

We identified 74,227 breast cancer care products representing the hospital choices of 70,608 unique patients (96% female; mean age 52.7 years) who originated from 4840 different GP practices. Travel time, the patient's care history, and GP referral history were all statistically significantly related to hospital choice. Patients more often visited a hospital where they had been before, with a shorter travel time, or where relatively more patients from the same GP practice went to for breast cancer care. The latter improved the model most, followed by patient's care history and travel time. Twelve percent of patients without previous care, and 7% of patients with a care history, did not opt for a default hospital; relatively often a university hospital or specialized hospital was chosen in these cases.

CONCLUSION

Next to travel time, the patient's care history and the GP's referral history clearly contribute to the hospital choice of breast cancer patients. A considerable cohort opts to receive care in a hospital that, based on travel time, the patient's care history and GP referral history, would not be the default destination.

Abstract P4-06-18: Withdrawn

This abstract was withdrawn by the authors.

Citation Format: Dunbier AK, Hazlett J, Niemi G, Kemp R. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-06-18.

Campylobacter lari: genotype and antibiotic resistance of isolates from cattle, wildlife and water in an area of mixed dairy farmland in the United Kingdom

Campylobacter lari is a rare human pathogen most commonly associated with birds and shellfish. Little information has been published regarding its prevalence in other environments, or on its potential role as a reservoir of antibiotic resistance. In this study, we characterized 109 C. lari isolated from a range of hosts using pulsed-field gel electrophoresis of macro-restricted chromosomal DNA, and by determining their susceptibility to a panel of four antibiotics. Pulsed-field gel electrophoresis analysis showed C. lari to be genetically diverse, particularly in isolates from wild birds and environmental water. The most common composite macro-restriction profile (cMRP) was found in multiple hosts (cattle, badgers, wild birds and rabbits), and seven other cMRPs were recovered from more than one host. All isolates were resistant to nalidixic acid and ciprofloxacin. Resistance to erythromycin and ampicillin was uncommon, but was observed in isolates from wild birds, cattle, wild mammals and water samples. The presence of the same cMRP in multiple hosts provides further evidence of transmission between livestock, wildlife and the environment, or for a common source of infection.

Prevalence and genetic diversity of Campylobacter spp. in environmental water samples from a 100-square-kilometer predominantly dairy farming area

Water samples were taken systematically from a 100-km2 area of mainly dairy farmland in northwestern England and examined for Campylobacter spp. Pulsed-field gel electrophoresis-restriction fragment length polymorphism (PFGE-RFLP) and flaA strain typing of Campylobacter jejuni and Campylobacter coli isolates were done. Data on the water source and the adjacent environment were recorded and examined as explanatory variables. Campylobacter spp. were isolated from 40.5% (n = 119) of the water samples tested. C. jejuni was isolated from 14.3%, C. coli was isolated from 18.5%, and Campylobacter lari was isolated from 4.2% of the samples. Campylobacter hyointestinalis was not isolated from any water source. The difference in prevalence between water types (trough, running, and standing) was significant (P = 0.001). C. jejuni was the species most commonly isolated from trough-water and running-water sources, while C. coli was the most frequently isolated from standing water (P < 0.001). No association was found between the presence of Escherichia coli and that of Campylobacter spp. The final multivariable logistic regression model for Campylobacter spp. included the following variables: water source, soil type, aspect, and amount of cattle fecal material in the environment (fecal pat count). Strain typing demonstrated a diverse population of C. jejuni and the presence of a common C. coli flaA type that was widely distributed throughout the area. Most of the isolates within the common flaA type were discriminated by PFGE-RFLP. These findings suggest a possible role for environmental water in the epidemiology of Campylobacter spp. in a farming environment.

Entrepreneurial innovation in chains and networks in Dutch greenhouse horticulture

This paper focuses on the critical success factors in entrepreneurial innovation, and the role of cooperation with chain partners, knowledge institutions and colleague firms in the Dutch glasshouse industry. This industry, typified by a large number of family-owned entrepreneurial firms, is generally acknowledged as one of the world leaders in horticultural production and trade. Not only are the auctions of Aalsmeer and Naaldwijk among the most important horticultural auctions in the world, but the knowledge of cultivation techniques is also highly developed in the Netherlands. In order to maintain its leading position and to compete successfully with low-cost countries, Dutch horticulture is constantly reinventing itself. If we take a closer look, however, we see that only a limited number (3%) of the Dutch glasshouse companies actually take the lead in innovation. Using expert advice, we selected the 74 most successful innovative companies to be included in this study, of which 44 companies were willing to participate. In 2004, all the participating companies were visited. In total 139 innovations were analysed, using a combination of half-structured in-depth interviews with the glasshouse entrepreneurs and a structured questionnaire based on 10-point Likert scales. The entrepreneurs were asked to fill out the questionnaire for their most and least successful innovations. As expected, more successful (87) than failed innovations (52) were reported. Our results show that the characteristics demonstrated by the innovative entrepreneurs are essential for success in innovation. The innovative entrepreneur has a strategic vision of how to serve the market and create value. Also, team communication was extremely important. Successful entrepreneurs maintain an open atmosphere and show real commitment to the innovation process. They are in contact with a diverse network of business relations to develop innovations. Intensifying the network relations, e.g. by clustering glasshouse companies, leads to more successful innovation. The more firms in the horticultural production chain were actively involved in the innovation process, the bigger the chances of success. This was especially true for firms downstream toward the market.

A Java application for tissue section image analysis

The medical industry has taken advantage of Java and Java technologies over the past few years, in large part due to the language's platform-independence and object-oriented structure. As such, Java provides powerful and effective tools for developing tissue section analysis software. The background and execution of this development are discussed in this publication. Object-oriented structure allows for the creation of "Slide", "Unit", and "Cell" objects to simulate the corresponding real-world objects. Different functions may then be created to perform various tasks on these objects, thus facilitating the development of the software package as a whole. At the current time, substantial parts of the initially planned functionality have been implemented. Getafics 1.0 is fully operational and currently supports a variety of research projects; however, there are certain features of the software that currently introduce unnecessary complexity and inefficiency. In the future, we hope to include features that obviate these problems.

Frequency and spatial distribution of environmental Campylobacter spp

Humans are exposed to Campylobacter spp. in a range of sources via both food and environmental pathways. For this study, we explored the frequency and distribution of thermophilic Campylobacter spp. in a 10- by 10-km square rural area of Cheshire, United Kingdom. The area contains approximately 70, mainly dairy, farms and is used extensively for outdoor recreational activities. Campylobacter spp. were isolated from a range of environmental samples by use of a systematic sampling grid. Livestock (mainly cattle) and wildlife feces and environmental water and soil samples were cultured, and isolates were presumptively identified by standard techniques. These isolates were further characterized by PCR. Campylobacter jejuni was the most prevalent species in all animal samples, ranging from 11% in samples from nonavian wildlife to 36% in cattle feces, and was isolated from 15% of water samples. Campylobacter coli was commonly found in water (17%) and sheep (21%) samples, but rarely in other samples. Campylobacter lari was recovered from all sample types, with the exception of sheep feces, and was found in moderate numbers in birds (7%) and water (5%). Campylobacter hyointestinalis was only recovered from cattle (7%) and birds (1%). The spatial distribution and determinants of C. jejuni in cattle feces were examined by the use of model-based spatial statistics. The distribution was consistent with very localized within-farm or within-field transmission and showed little evidence of any larger-scale spatial dependence. We concluded that there is a potentially high risk of human exposure to Campylobacter spp., particularly C. jejuni, in the environment of our study area. The prevalence and likely risk posed by C. jejuni-positive cattle feces in the environment diminished as the fecal material aged. After we took into account the age of the fecal material, the absence or presence of rain, and the presence of bird feces, there was evidence of significant variation in the prevalence of C. jejuni-positive cattle feces between grazing fields but no evidence of spatial clustering beyond this resolution. The spatial pattern of C. jejuni is therefore consistent with that for an organism that is ubiquitous in areas contaminated with cattle feces, with a short-scale variation in infection intensity that cannot be explained solely by variations in the age of the fecal material. The observed pattern is not consistent with large-scale transmission attributable to watercourses, wildlife territories, or other geographical features that transcend field and farm boundaries.

Genotypic and antibiotic susceptibility characteristics of a Campylobacter coli population isolated from dairy farmland in the United Kingdom

Campylobacter infections are the most common cause of bacterial enteritis in humans, and nearly 8% of such infections are caused by Campylobacter coli. Most studies have concentrated on Campylobacter jejuni, frequently isolated from intensively farmed poultry and livestock production units, and few studies have examined the spread and relatedness of Campylobacter across a range of geographical and host boundaries. Systematic sampling of a 100-km2 area of mixed farmland in northwest England yielded 88 isolates of C. coli from a range of sample types and locations, and water was heavily represented. Screening for antibiotic resistance revealed a very low prevalence of resistance, while genotyping performed by using three methods (flaA PCR restriction fragment length polymorphism [RFLP], pulsed-field gel electrophoresis [PFGE], and fluorescent amplified fragment length polymorphism [fAFLP]) provided insights into the genomic relatedness of isolates from different locations and hosts. Isolates were classified into 23 flaA groups, 34 PFGE groups, and five major fAFLP clusters. PFGE banding analysis revealed a high level of variability and no clustering by sample type. fAFLP and flaA analyses successfully grouped the isolates by sample type. We report preliminary findings suggesting that there is a strain of C. coli which may have become adapted to survival or persistence in water and that there is a group of mainly water-derived isolates from which unusual flaA PCR fragments were recovered.

Interdependency in joint ventures: the relationship between dependence asymmetry and performance

This paper reports the results of a survey on joint venture collaborations. It focuses on the relations between the level and intensity of conflict, trust and norms of exchange, and ultimately the performance of a joint venture, in case of dependency asymmetry between the partners. In management literature, the relative dependency position of the partners is often indicated as an important antecedent of conflict. In a survey of 78 Dutch companies in joint ventures, we investigated these relationships in depth. Contrary to expectations, we did not find a relationship between the relative dependency of the partners, conflict and performance. The potential threat of conflict seems to be mediated by the norms of exchange shared by the partners. We therefore tentatively conclude that the best way to manage the dependency position in a JV might be to invest time and effort in discussing the norms of exchange up-front, which will help the partners develop a trusting relationship..

Regulation of preglomerular microvascular 20-hydroxyeicosatetraenoic acid levels by salt depletion

BACKGROUND

20-hydroxyeicosatetraenoic acid (20-HETE) is the preeminent renal eicosanoid. The protean properties of 20-HETE - vasoactivity, mitogenicity and modulation of transport in key nephron segments - serve as the basis for the essential roles of 20-HETE in the regulation of the renal circulation and electrolyte excretion and as a second messenger for endothelin-1 (ET-1) and a mediator of selective renal effects of angiotensin II (AII). Renal autoregulation and tubular glomerular feedback are mediated by 20-HETE through constriction of preglomerular microvessels, particularly afferent arterioles.

METHODS AND RESULTS

We had reported that rat preglomerular microvessels (PGMV; afferent-interlobular-arcuate/interlobular) in response to angiotensin II (AII) generate primarily 20-HETE and lesser quantities of 19-HETE. We have now addressed a possible link between the renin-angiotensin-system (RAS) and induction of cyclooxygenase (COX-2). As Na+ deprivation induces COX-2 expression/activity in the renal cortex and AII stimulates release of 20-HETE from PGMV, we used a stimulus, low dietary salt, to activate the RAS and COX-2 and thereby explore potential interactions involving 20-HETE and COX-2.

CONCLUSIONS

The capacity of COX to metabolize 20-HETE to prostaglandin analogs e.g., 20-OH PGF2a and 20-OH PGE2, may be critical to modifying the renal vascular and tubular actions of the eicosanoids.

Hepatitis services at an injecting drug user outreach clinic

AIMS

To provide a culturally appropriate, accessible and affordable hepatitis outreach clinic for injecting drug users, a traditionally hard-to-reach population.

METHODS

The community-based clinic, a collaborative project between the Wellington Drugs and Health Development Project and Capital Coast Health, was established in Wellington in 1997. Characteristics of the first 100 injecting drug users with hepatitis C assessed through the clinic are presented.

RESULTS

Of 51 patients found to be hepatitis C positive, five have received hepatitis C treatment, four at the outreach and one at a base hospital. 25 have been vaccinated for hepatitis B. The clinic has established trust and rapport with the injecting-drug-user community.

CONCLUSIONS

The hepatitis outreach clinic is an innovative project, crossing the primary/secondary interface of health services provision and providing personal health services within a public health initiative. The success of this model indicates potential value in offering outreach hepatitis clinics for injecting drug users in the major cities to close a gap in health service provision.

Pharmacological antagonism of the slow-activating delayed rectifying potassium channel (I(Ks)) has no effect on cochlear structure and function in vivo

The experimental class III antiarrhythmic drug, L-768673, prolongs the refractory period of cardiac myocytes by selectively blocking the slow-activating delayed rectifying potassium (I(Ks)) channel. The I(Ks) channel has also been identified in vestibular dark cells and in the marginal cells of the stria vascularis. In the stria vascularis, the I(Ks) channel plays an important role in cochlear homeostasis. Genetic null deletion of the I(Ks) channel in mice and man results in profound hearing loss and cochlear pathology. Therefore, the purpose of the present study was to investigate the effect of L-768673 on the auditory function and cochlear morphology in rats using auditory brainstem-evoked response and light microscopy. Auditory testing was performed one week prior to dosing, following 14 days of administration and 28 days after the completion of dosing. L-768673 (50 or 250 mg/kg/day for 14 days), had no significant effects on auditory function or cochlear morphology. The results of this study suggest that high doses of L-768673 are not toxic to the inner ear of adult rats treated for 14 consecutive days, and that the ototoxic potential of orally administered L-768673 and similar I(Ks)-selective compounds is unlikely at doses within the therapeutic range.

Cumulative incidence of hepatitis C seroconversion in a cohort of seronegative injecting drug users

AIM

To measure the cumulative incidence of hepatitis C virus seroconversion over a two year period in a group of seronegative injecting drug users.

METHODS

The study involved follow-up, in 1996, of a cohort (n=85) of injecting drug users identified as hepatitis C virus seronegative in 1994. Participants were interviewed about risk factors for hepatitis C. A blood sample was also taken for anti-hepatitis C virus antibody and hepatitis C virus RNA testing.

RESULTS

Forty-four participants were interviewed and 39 gave blood for testing. Most (80%) were aged 29 years or under and two thirds (n=26) were male. Around half reported borrowing (49%) or lending (57%) needles and syringes since 1994 and both of these behaviours were associated with seroconversion. The majority (88%) also reported sharing other injecting equipment. Nine were anti-hepatitis C virus positive giving a seroconversion rate over two years of 23% (13 per 100 person years). Four out of the nine seropositive specimens tested were also hepatitis C virus RNA positive.

CONCLUSIONS

This study demonstrates a high rate of recent hepatitis C virus seroconversion amongst a group of New Zealand injecting drug users. Transmission of hepatitis C virus appears to be unabated by current control measures. These findings confirm the need to develop more effective policy and practices to prevent further spread, not just of hepatitis C, but of other blood-borne viruses in injecting drug user populations.

Effects of spaceflight conditions on fertilization and embryogenesis in the sea urchin Lytechinus pictus

Calcium loss and muscle atrophy are two of the main metabolic changes experienced by astronauts and crew members during exposure to microgravity in space. Calcium and cytoskeletal events were investigated within sea urchin embryos which were cultured in space under both microgravity and 1 g conditions. Embryos were fixed at time-points ranging from 3 h to 8 days after fertilization. Investigative emphasis was placed upon: (1) sperm-induced calcium-dependent exocytosis and cortical granule secretion, (2) membrane fusion of cortical granule and plasma membranes; (3) microfilament polymerization and microvilli elongation; and (5) embryonic development into morula, blastula, gastrula, and pluteus stages. For embryos cultured under microgravity conditions, the processes of cortical granule discharge, fusion of cortical granule membranes with the plasma membrane, elongation of microvilli and elevation of the fertilization coat were reduced in comparison with embryos cultured at 1 g in space and under normal conditions on Earth. Also, 4% of all cells undergoing division in microgravity showed abnormalities in the centrosome-centriole complex. These abnormalities were not observed within the 1 g flight and ground control specimens, indicating that significant alterations in sea urchin development processes occur under microgravity conditions.

Human phase I vaccine trials of 3 recombinant asexual stage malaria antigens with Montanide ISA720 adjuvant

Two phase I vaccine trials were conducted to test the immunogenicity and safety of a vaccine containing three recombinant malaria antigens from the asexual stage of Plasmodium falciparum. The three antigens are a fragment of MSP1 (190LCS.T3); MSP2 and a portion of RESA and were formulated in Montanide ISA720 adjuvant. These trials investigated the dose response of each antigen for eliciting both antibody and T-cell responses and the immunogenicity of a mixture of the antigens compared with the antigens injected separately. All three antigens elicited both antibody and T-cell responses. Strong T-cell responses were observed with 190LCS.T3 and RESA with stimulation indices exceeding 100 for peripheral blood leucocytes in some individuals. The antibody responses were generally weak. The human antibody responses observed with MSP2 in Montanide ISA720 were not significantly different from those obtained in an earlier trial which used MSP2 with alum as the adjuvant. No antigenic competition was observed: volunteers receiving a mixture of antigens had similar responses to those receiving the three antigens at separate sites. Tenderness and pain at the injection site were common over the first few days following immunization. In some volunteers, especially those receiving the highest doses tested, there was a delayed reaction at the injection site with pain and swelling occurring approximately 10 days after injection.

Cost-effectiveness evaluation of compliance therapy for people with psychosis

BACKGROUND

Non-compliance rates with antipsychotic medication can be high, and the personal and societal costs are considerable. A new psychological intervention, compliance therapy seeks to improve compliance and patient outcomes and reduce treatment costs.

METHOD

A randomised controlled study examined the cost-effectiveness of compliance therapy compared to non-specific counselling over 18 months for 74 people with psychosis admitted as inpatients at the Maudsley Hospital. Bivariate and multivariate analyses were conducted to test for differences and to explore inter-patient cost variations.

RESULTS

Compliance therapy is more effective and is no more expensive. Consequently, compliance therapy is more cost-effective than non-specific counselling at six, 12 and 18 months.

CONCLUSIONS

There are compliance, outcome and cost-effectiveness arguments in favour of compliance therapy in preference to non-specific counselling.

Randomised controlled trial of compliance therapy. 18-month follow-up

BACKGROUND

A randomised controlled trial was conducted in an acute treatment setting to examine the effectiveness of compliance therapy, a brief pragmatic intervention targeting treatment adherence in psychotic disorders, based on motivational interviewing and recent cognitive approaches to psychosis.

METHOD

Seventy-four patients with psychotic disorders according to DSM-III-R criteria recruited from consecutive admissions to an acute in-patient unit, received 4-6 sessions of either compliance therapy or non-specific counselling, and were followed-up over 18 months. The principal outcome measures were observer-rated compliance, attitudes to treatment, insight and social functioning.

RESULTS

Significant advantages were found for the compliance therapy group post-treatment on measures of insight, attitudes to treatment and observer-rated compliance which were retained over the follow-up period. Global social functioning improved relatively more over time in the compliance therapy group compared with the control group. Survival in the community prior to readmission was significantly longer in the compliance therapy group.

CONCLUSIONS

The results support the effectiveness of compliance therapy in improving functioning and community tenure after an acute psychotic episode.

A comparative study of insight scales and their relationship to psychopathological and clinical variables

BACKGROUND

Research on the subject of insight has been hampered by difficulties in definition and reliable measurement.

METHODS

We compared several rating scales to measure insight on a group of 33 psychotic patients as well as assessing patients' psychopathology, clinical characteristics and cognitive functioning.

RESULTS

Most currently used scales showed a high degree of inter-correlation. Measures of insight related strongly to the presence of delusions; grandiosity (inversely), and depression (positively). Higher insight scores correlated with indices of treatment compliance and inversely with substance abuse. Measures of pre-morbid IQ and impaired executive functioning, including the Wisconsin Card Sorting Test were not associated with poor insight.

CONCLUSIONS

The study highlights aspects of psychopathology and clinical variables particularly related to insight and supports the continued use of standardized scales in further research in this area.

Injecting behaviours and prevalence of hepatitis B, C and D markers in New Zealand injecting drug user populations

AIM

To determine the seroprevalence of hepatitis C virus (HCV), hepatitis B virus (HBV) & hepatitis D virus (HDV) markers of infection among injecting drug user populations in New Zealand and to examine the relationship between demographic features, risk behaviours and infection.

METHODS

A total of 323 current injecting drug users completed a questionnaire that explored their needle and syringe using behaviours. Information was collected on injection pattern, sharing behaviours and methods of cleaning needles and syringes. Two hundred and forty-one respondents gave blood samples which were tested for hepatitis B, C and D markers.

RESULTS

Over half the respondents (59%) were male and 41% were female. Most (89%) identified as European. Sixty-four percent were anti-HCV positive. The likelihood of infection increased with age and duration of injecting. Forty-one percent (33/81) of those aged 25 or under, sixty-four percent (45/70) of those aged 26-30 and eighty-seven percent (78/90) over 30 were anti-HCV positive. Those who tested anti-HCV positive had been injecting for an average of 12.0 years compared to 6.0 years for those were anti-HCV negative. The results for hepatitis B are to be reported fully at a later date. Sharing behaviour was also a factor although this was less important as an independent factor. Comparisons with earlier surveys suggested that there has not been a significant decline in the rate of sharing needles and syringes since the initial period following introduction of the needle exchange programme.

CONCLUSION

The prevalence of hepatitis C infection is common among injecting drug users of all ages. Without a significant reduction in sharing behaviour, particularly among younger injecting drug users, it is unlikely that the prevalence of hepatitis C among injecting drug users will decline in the future. Evidence suggests that the carriage of hepatitis C is higher than that of hepatitis B which would help explain the differing rates of prevalence. However, the risk of future transmission of other parenterally transmitted diseases remains high without a further significant decline in sharing behaviour.

Religious faith after psychotic illness

Religion can play an important role in the lives of psychiatric patients. We assessed how often a psychotic illness can lead to a change in the strength of religious faith and how commonly religion is used for coping with such illnesses in a sample of consecutively admitted patients. 52 patients with psychosis were interviewed regarding their religious beliefs after their index admission. 69.4% of the patients were religious, and 11 (22.4%) stated that religion was the most important part of their lives. 30.4% of the sample described that there had been an increase in their religiousness after the onset of illness. 61.2% of patients were using their religion for coping with the illness. Such patients had a better insight into their illness and were more compliant with antipsychotic medication. We conclude that the experience of a psychotic illness is likely to lead to an increase in religious beliefs. Such beliefs are commonly used for coping with the illness and some patients attach a great importance to them.

Reasoning and delusions

BACKGROUND

Delusions are assumed to reflect disordered reasoning. but with little empirical support. We attempted to study this in 16 relatively intelligent deluded patients and 16 normal volunteers.

METHOD

Standard tests were used which required subjects to choose between logically fallacious and valid responses, both of which were plausible. The tests were: (a) conditional statements (if...then), (b) syllogisms (e.g. no A are C, some B are C, some C are not A), and (c) judgements of probability. All three tasks incorporated neutral and emotive content.

RESULTS

Both normal and deluded subjects frequently made logical errors. With conditionals, deluded subjects tended to endorse fallacies more often than normal controls and this was accentuated when the content was emotive. Similarity, with syllogisms, the effect of emotional content on the endorsement of unbelievable responses was increased slightly in the deluded group. Finally, the deluded patients showed a trend to be less prone to the conjunction fallacy than normals, suggesting less reliance on existing schema. conclusions: Differences in reasoning between deluded patients and controls are surprisingly small. Patients are somewhat more prone to endorse invalid or fallacious responses, especially when emotive themes are involved.

Cloning of cold-inducible dehydrin-like genes from the blackcurrant (Ribes nigrum L.) using RT-PCR

A method is described for the identification of conserved genes in one plant species by using sequence information on internal motifs from well-characterized clones from another species. This sequence information is used to design primers for reverse transcriptase polymerase chain reaction (RT-PCR) and to design oligonucleotide probes to identify genuine positive amplification products. The approach was successfully used to clone cDNAs encoding cold-inducible dehydrin-like genes from the woody perennial blackcurrant, Ribes nigrum L. The strategy described can accelerate the cloning of heterologous cDNAs and is a convenient alternative to direct screening of cDNA libraries.

Shifting cerebral dominance in a woman with schizoaffective psychosis: a case study

We describe a case of an intelligent, artistic 50-year-old woman with schizoaffective disorder with a long history of delusional preoccupation with laterality and episodes of reported shifts in handedness. Investigations including dichotic listening and lateralised visual imagery tasks indicated unusual patterns of asymmetry. Executive functions were found to be intact, and EEG and CT scan were normal. Interview schedules revealed high scores for schizotypy, and no evidence of a dissociative disorder, whereas psychotic symptoms with mood lability were evident on mental status examination. The subject's preoccupations are illustrated with a selection of her artistic productions. The case is discussed in the context of reports of a relationship between schizophrenia and ambiguous handedness. A cognitive neuropsychiatric formulation briefly explores the possibility of alternative cerebral hemispheres affecting cognitive-perceptual operations.

Phase I trial in humans of an oil-based adjuvant SEPPIC MONTANIDE ISA 720

Seppic MONTANIDE ISA 720 is a metabolizable oil adjuvant that has given good results in animals with recombinant malarial antigens. Twelve human volunteers were given increasing intramuscular doses of MONTANIDE ISA 720, ranging from 0.6 to 1.8 ml. The adjuvant was well tolerated with only minor local effects, including tenderness, local swelling and discomfort on use. MONTANIDE ISA 720 may prove to be an acceptable and effective adjuvant for use in people.

Psychological predictors of insight and compliance in psychotic patients

BACKGROUND

A possible neuropsychological basis for poor insight in psychosis has been proposed. Consistent supporting evidence for this is lacking.

METHOD

Seventy-four consecutive acutely psychotic in-patients who were recruited for a randomised controlled trial of compliance therapy were given a battery of neuropsychological tests, along with a comprehensive clinical assessment, before and after the intervention.

RESULTS

Performance on neuropsychological tests improved during the patients' admission and treatment in hospital, as did symptoms and levels of insight. Cognitive function showed no relationship to insight and compliance initially, and very little after the intervention. Factors related to insight and compliance prior to discharge included: diagnosis, attitudes to medication, side-effects, being a detained patient, and whether or not compliance therapy was given.

CONCLUSIONS

Clinical variables and attitudes to treatment appear to be more relevant to compliance and the development of insight in acute psychosis than neuropsychological impairment.