IBEX: an iterative immunolabeling and chemical bleaching method for high-content imaging of diverse tissues

High-content imaging is needed to catalog the variety of cellular phenotypes and multicellular ecosystems present in metazoan tissues. We recently developed iterative bleaching extends multiplexity (IBEX), an iterative immunolabeling and chemical bleaching method that enables multiplexed imaging (>65 parameters) in diverse tissues, including human organs relevant for international consortia efforts. IBEX is compatible with >250 commercially available antibodies and 16 unique fluorophores, and can be easily adopted to different imaging platforms using slides and nonproprietary imaging chambers. The overall protocol consists of iterative cycles of antibody labeling, imaging and chemical bleaching that can be completed at relatively low cost in 2-5 d by biologists with basic laboratory skills. To support widespread adoption, we provide extensive details on tissue processing, curated lists of validated antibodies and tissue-specific panels for multiplex imaging. Furthermore, instructions are included on how to automate the method using competitively priced instruments and reagents. Finally, we present a software solution for image alignment that can be executed by individuals without programming experience using open-source software and freeware. In summary, IBEX is a noncommercial method that can be readily implemented by academic laboratories and scaled to achieve high-content mapping of diverse tissues in support of a Human Reference Atlas or other such applications.

Brain findings associated with risperidone in rhesus monkeys: magnetic resonance imaging and pathology perspectives

Brain changes associated with risperidone, a dopamine-2/serotonin-2 receptor antagonist, have been documented in rats and humans, but not in nonhuman primates. This study characterized brain changes associated with risperidone in nonhuman primates. Rhesus monkeys were orally administered risperidone in a dose-escalation paradigm up to a maximum tolerated dose of 0.5 mg/kg/day for 3 weeks, or 3 months followed by a 3-month recovery period. Transient and fully reversible neurological signs consistent with risperidone pharmacology were observed. The results of a magnetic resonance imaging evaluation after 3 months of treatment and at the end of the 3-month recovery period showed no meaningful changes in the brain. There were no risperidone-related brain weight changes or gross findings. Histomorphological evaluation of brain sections stained with hematoxylin and eosin, ionized calcium binding adaptor molecule 1 (Iba1), and luxol fast blue/cresyl violet double staining showed no notable differences between control and risperidone groups. However, evaluation of the brain after glial fibrillary acidic protein (GFAP) immunohistochemical staining revealed increased staining in the cell bodies and processes of astrocytes in the putamen without apparent alterations in numbers or distribution. The increase in GFAP staining was present after 3 weeks and 3 months of treatment, but no increase in staining was observed after the 3-month recovery period, demonstrating the reversibility of this finding. The reversible increase in GFAP expression was likely an adaptive, non-adverse response of astrocytes, associated with the pharmacology of risperidone. These observations are valuable considerations in the nonclinical risk assessment of new drug candidates for psychiatric disorders.

Congenital high myopia and central macular atrophy: a report of 3 families

AIMS

To report the clinical phenotype in a series of four children from three families with the rare association of high myopia, central macular atrophy, and normal full-field electroretinography (ERG).

METHODS

Four male patients were ascertained with reduced vision, nystagmus, and atrophy of the macula from early childhood. Patients underwent full ophthalmic examination, electrophysiological testing, and retinal imaging.

RESULTS

Minimum duration of follow-up was 8 years. At last review, visual acuity ranged from 0.22 to 1.20 logMAR (6/9.5-6/95 Snellen) at a mean age of 10.5 years (median 9.5 years, range 9-14 years). Refractive error ranged from a spherical equivalent of -7.40 D to -24.00 D. Three had convergent squint. Fundus examination and imaging demonstrated bilateral macular atrophy in all patients that varied from mild atrophy of the retinal pigment epithelium (RPE) to well-demarcated, punched-out atrophic lesions of retina, RPE, and choroid. Flash ERG was normal under photopic and scotopic conditions in all patients. Pattern ERG, performed in three patients, was consistent with mild to severe macular dysfunction. Progression of the area of atrophy was evident in one patient and of the myopia in two patients but all patients had stable visual acuity.

CONCLUSIONS

Patients with congenital high myopia and macular atrophy present in infancy with reduced visual acuity and nystagmus. The macular atrophic lesions vary in size and severity but electrophysiological testing is consistent with dysfunction confined to the macula. There was no deterioration in visual acuity over 8-10 years of monitoring.

Biochemical comparisons of osteoarthritic human synovial fluid with calf sera used in knee simulator wear testing

Osteoarthritic human synovial fluid was obtained from the knees of 20 patients and was compared with four different calf sera solutions frequently used as lubricants in knee simulator wear testing. Assuming that the fluid after arthroplasty was the same as the fluid in patients with osteoarthritis, the total protein concentration, protein constituent fractions, osmolality, trace element concentrations, and the thermal stability obtained via differential scanning calorimetry were determined. Human synovial fluid, with an average total protein concentration of 34 g/L, was significantly different from all undiluted calf sera. However, alpha-calf serum and iron-supplemented alpha-calf serum were closest in protein constituent fractions (albumin, alpha-1-globulin, alpha-2-globulin, ss-globulin, and gamma-globulin) to human synovial fluid. Diluting calf sera with low-ion distilled water to a total protein concentration of 17 g/L (as recommended by ISO 14243) produced non-clinically relevant total protein concentration and osmolality levels. Performing the same dilution of iron-supplemented alpha-calf serum with phosphate-buffered saline solution and 1.5 g/L hyaluronic acid produced an artificial lubricant with both a clinically relevant level of osmolality and clinically relevant thermal stability as seen in human synovial fluid from patients with osteoarthritis. The present study suggested that alpha-calf serum, phosphate-buffered saline solution and hyaluronic acid were essential constituents of an artificial lubricant to mimic the major biochemical properties of human synovial fluid for simulator wear testing of total knee replacements.

Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial

BACKGROUND

Dienogest is a selective progestin that has been investigated in a clinical trial programme for the treatment of endometriosis. The current non-inferiority trial compared the efficacy and safety of dienogest against leuprolide acetate (LA) for treating the pain associated with endometriosis.

METHODS

Patients with confirmed endometriosis were randomized to treatment with dienogest (2 mg/day, orally) or LA (3.75 mg, depot i.m. injection, every 4 weeks) for 24 weeks. The primary efficacy variable was absolute change in pelvic pain from baseline to end of treatment, assessed by visual analogue scale (VAS). Safety variables included adverse event profile, laboratory parameters, bone mineral density (BMD), bone markers and bleeding patterns.

RESULTS

A total of 252 women were randomized to treatment with dienogest (n = 124) or LA (n = 128); 87.9 and 93.8% of the respective groups completed the trial. Absolute reductions in VAS score from baseline to Week 24 were 47.5 mm with dienogest and 46.0 mm with LA, demonstrating the equivalence of dienogest relative to LA. Hypoestrogenic effects (e.g. hot flushes) were reported less frequently in the dienogest group. As expected, bleeding episodes were suppressed less with dienogest than with LA. Changes in mean lumbar BMD between screening and final visit were +0.25% with dienogest and -4.04% with LA subgroups (P = 0.0003). Markers of bone resorption increased with LA but not dienogest.

CONCLUSIONS

Dienogest 2 mg/day orally demonstrated equivalent efficacy to depot LA at standard dose in relieving the pain associated with endometriosis, although offering advantages in safety and tolerability.

The evolution of physiotherapy in animal rehabilitation in Durban, Kwazulu Natal

Introduction:Animal physiotherapy is a specialized branchof physiotherapy. As this specialization is not introduced at undergraduatelevel, there is a need to ascertain whether qualified physiotherapists had an interest in this field. The need for post-graduate interest in this subjectwould support a post-graduate programme as there is no academic insti -tutional programme in this field in South Africa.Aim of study:To gain information on the awareness of and interest in animalphysiotherapy from veterinary surgeons and qualified physiotherapists.Methodology: Two questionnaires were constructed, one for veterinarysurgeons and one for physiotherapists. Sixty physiotherapists and 30 veteri-nary surgeons in private practice in Durban, KwaZulu Natal participated in the study. A return of 73% of the question-naires for veterinary surgeons and 65% for physiotherapists was obtained. Data  analysis: Data  for  Physiotherapists  and  veterinary  surgeons  were  grouped  together  for  responses  to  the questionnaire and compared. Results: All physiotherapists and veterinary surgeons involved in the study are aware of animal physiotherapy. 81.5% of the veterinary surgeons administer physiotherapy treatment as part of their overall rehabilitation programmeand 7.41% refer their clients to physiotherapists. All the veterinary surgeons stated that physiotherapy is necessary inthe overall animal rehabilitation. 12.5% of physiotherapists treated animals and all felt under-qualified to treat animals.Conclusion: The study reveals a need for post-graduate specialization in animal physiotherapy and this would promote public awareness of its existence and benefit to animals.

Hurricane Isabel-related mortality--virginia, 2003

BACKGROUND

Hurricane Isabel had a massive negative environmental, public health, and economic impact; Virginia bore the highest death toll (32) among nine states affected by this storm. A descriptive mortality analysis was conducted to identify modifiable risk factors and corresponding injury prevention measures that might mitigate future natural disaster-related morbidity and mortality in Virginia.

METHODS

Information for the decedents, including demographic data, health status, and injury circumstances, was collected from the records of the Virginia Office of the Chief Medical Examiner and Office of Vital Records/Health Statistics. Criteria from the National Hurricane Center were used to classify deaths as direct or indirect. Storm assessments and emergency-response reports were also reviewed.

RESULTS

A total of 32 deaths associated with Hurricane Isabel occurred in several densely populated localities in southeastern and central Virginia. The median age of decedents was 48 years (range: 7-85 years). A disproportionately higher mortality (21 [66%] of 32) occurred among persons older than 45 years (Virginia 2000 Census data). Twelve deaths were directly caused by environmental factors related to the storm (eg, seven drowning deaths and five traumatic head injuries from falling trees). Twenty deaths were indirectly associated with the storm and its effects: six fatal motor vehicle crashes, five related to clean-up operations, seven associated with power outages, and two stress-related (ie, myocardial infarction and suicide). The presence of alcohol or drugs was observed in 9 (28%) of 32 deaths.

CONCLUSIONS

Classifying deaths as direct or indirect facilitates better target interventions on the basis of the identification of modifiable risk factors underlying hurricane-associated fatal injuries. Public education messages that reinforce avoidance of use of alcohol and drugs during natural disaster situations might reduce risk for injury.

Efficacy and Safety of a Low-Dose 21-Day Combined Oral Contraceptive Containing Ethinylestradiol 20??g and Drospirenone 3mg

OBJECTIVE

The purpose of this study was to assess the efficacy and safety of a new low-dose oral contraceptive containing ethinylestradiol 20microg and drospirenone 3mg (EE 20microg/drsp 3mg).

METHODS

This was an open-label, non-comparative, multicentre study conducted at 33 centres in Germany and Switzerland. The combined contraceptive was administered over 26 cycles of treatment, with each cycle consisting of once-daily treatment for 21 consecutive days followed by a 7-day hormone-free interval.

RESULTS

A total of 527 women were randomised, of whom 516 (97.9%) started treatment and had at least one study observation. Two pregnancies occurred during 11 165 cycles of treatment, giving a Pearl Index of 0.23 (upper limit of 97.5% CI 0.84). The corresponding 2-year cumulative pregnancy rate was 0.44% (95% CIs 0, 1.05). One of the two pregnancies was attributed to non-compliance with treatment, giving an adjusted Pearl Index of 0.12 (upper limit of 97.5% CI 0.67) over 10 827 compliant cycles. Only three (0.6%) women discontinued treatment because of bleeding problems in this long-term study, suggesting an acceptable bleeding profile. Overall, the study drug was well tolerated and adverse events experienced were typical of hormonal contraceptive use. The majority of women who responded (435 of 501; 86.8%) were satisfied or very satisfied with the study treatment and most (367 of 501; 73.3%) would continue with it if given the choice.

CONCLUSION

The EE 20microg/drsp 3 mg combined oral contraceptive is an effective and well tolerated contraceptive with an acceptable bleeding pattern.

Delivery of the clinical components of the Newcastle University medical course in a multidisciplinary academic unit in Tamworth

The University Department of Rural Health (UDRH), northern New South Wales, Australia, was established in late 2001 by the University of Newcastle in Tamworth, New South Wales (NSW). The UDRH is part of the Commonwealth Department of Health and Ageing's Health Workforce Undergraduate Initiative and was the eighth UDRH to be established in Australia. The UDRH northern NSW delivers medical education as part of a multidisciplinary academic unit. At the end of 2003, six medical students graduated having completed all of their clinical training based in Tamworth. Over 60% of the local medical community were teachers in the program. These students studied with final year dietetic, occupational therapy and radiography students co-located in Tamworth during 2002 and 2003. In 2004, ten new graduates from the program have chosen to commence employment in the New England Area Health Service, including two medical students completing their internship in 2004. This represents the first time that the full clinical curriculum of an Australian medical school has been delivered entirely in a single rural setting. It demonstrates a new way of funding medical education which embraces local clinicians as 'faculty' and provides a way for regional centres to develop their own future medical workforce.

The use of the Bonny Method of Guided Imagery and Music in spiritual growth

Reports on the Bonny Method of Guided Imagery and Music (GIM) used as a modality for reflection and prayer in retreat, group process, and spiritual direction. Explains GIM as a music-centered, depth-oriented therapy that has been found to be an effective catalyst for spiritual experiences and growth. Records two case studies illustrating aspects of the method. Shows how spiritual and emotional insights can be gained and a sense of healing achieved by using the GIM method.

[Treatment of endometriosis with dienogest: preliminary report]

AIM OF THE STUDY

Influence of two hormonal therapies (GnRH agonist--leuprolein acetate and a new progestin--dienogest) on symptoms of endometriosis in patients with different clinical grade of disease.

MATERIAL AND METHODS

34 women with endometriosis confirmed by laparoscopy and histology were included into the study. Patients were randomized and divided into two therapeutic groups. One group was treated with dienogest and the second with leuprolein acetate during 6 month of study. The intensification of pain was assessed with Visual Analog Scale (VAS) and pelvic symptoms scale before, during (3 month) and after therapy. Dyspareunia was assessed with pelvic symptoms scale before, during (3 month) and after therapy. Frequency of adverse effects was assessed in 1, 3 and 6 month of therapy. Emotional state, bone density and basic serum parameters were assessed before and after therapy.

RESULTS AND CONCLUSIONS

Dienogest as well as leuprolein acetate decreased pelvic pain and dyspareunia. There were no differences between these influences. Dienogest did not reveal androgenic activity (did not reveal activity nor intense seborrheic lesions, nor hirsutism, nor voice tone). Dienogest did not reveal hot flashes. Bleeding (caused by dienogest therapy) did not influence hematologic indices nor affected the patients' decision on preterm end of treatment.

Interaction of Xenopus Cdc2 x cyclin A1 with the origin recognition complex

The initiation of DNA replication in eukaryotes is regulated in a minimum of at least two ways. First, several proteins, including origin recognition complex (ORC), Cdc6 protein, and the minichromosome maintenance (MCM) protein complex, need to be assembled on chromatin before initiation. Second, cyclin-dependent kinases regulate DNA replication in both a positive and a negative way by inducing the initiation of DNA replication at G(1)/S transition and preventing further rounds of origin firing within the same cell cycle. Here we characterize a link between the two levels. Immunoprecipitation of Xenopus origin recognition complex with anti-XOrc1 or anti-XOrc2 antibodies specifically co-immunoprecipitates a histone H1 kinase activity. The kinase activity is sensitive to several inhibitors of cyclin-dependent kinases including 6-dimethylaminopurine (6-DMAP), olomoucine, and p21(Cip1). This kinase activity also copurifies with ORC over several fractionation steps and was identified as a complex of the Cdc2 catalytic subunit and cyclin A1. Neither Cdk2 nor cyclin E could be detected in ORC immunoprecipitations. Reciprocal immunoprecipitations with anti-Xenopus Cdc2 or anti-Xenopus cyclin A1 antibodies specifically co-precipitate XOrc1 and XOrc2. Our results indicate that Xenopus ORC and Cdc2 x cyclin A1 physically interact and demonstrate a physical link between an active cyclin-dependent kinase and proteins involved in the initiation of DNA replication.

Improved cervical smear assessment using antibodies against proteins that regulate DNA replication

Carcinoma of the cervix is one of the most common malignancies. Papanicolaou (Pap) smear tests have reduced mortality by up to 70%. Nevertheless their interpretation is notoriously difficult with high false-negative rates and frequently fatal consequences. We have addressed this problem by using affinity-purified antibodies against human proteins that regulate DNA replication, namely Cdc6 and Mcm5. These antibodies were applied to sections and smears of normal and diseased uterine cervix by using immunoperoxidase or immunofluorescence to detect abnormal precursor malignant cells. Antibodies against Cdc6 and Mcm5 stain abnormal cells in cervical smears and sections with remarkably high specificity and sensitivity. Proliferation markers Ki-67 and proliferating cell nuclear antigen are much less effective. The majority of abnormal precursor malignant cells are stained in both low-grade and high-grade squamous intraepithelial lesions. Immunostaining of cervical smears can be combined with the conventional Pap stain so that all the morphological information from the conventional method is conserved. Thus antibodies against proteins that regulate DNA replication can reduce the high false-negative rate of the Pap smear test and may facilitate mass automated screening.

Association of the origin recognition complex with heterochromatin and HP1 in higher eukaryotes

The origin recognition complex (ORC) is required to initiate eukaryotic DNA replication and also engages in transcriptional silencing in S. cerevisiae. We observed a striking preferential but not exclusive association of Drosophila ORC2 with heterochromatin on interphase and mitotic chromosomes. HP1, a heterochromatin-localized protein required for position effect variegation (PEV), colocalized with DmORC2 at these sites. Consistent with this localization, intact DmORC and HP1 were found in physical complex. The association was shown biochemically to require the chromodomain and shadow domains of HP1. The amino terminus of DmORC1 contained a strong HP1-binding site, mirroring an interaction found independently in Xenopus by a yeast two-hybrid screen. Finally, heterozygous DmORC2 recessive lethal mutations resulted in a suppression of PEV. These results indicate that ORC may play a widespread role in packaging chromosomal domains through interactions with heterochromatin-organizing factors.

Efficacy of sodium stibogluconate alone and in combination with allopurinol for treatment of mucocutaneous leishmaniasis

A randomized, open, controlled clinical trial was designed to evaluate the efficacy, tolerance, and safety of sodium stibogluconate plus allopurinol and sodium stibogluconate alone as treatment of patients with mucocutaneous leishmaniasis. In phase 1 of the study, all 22 patients with severe disease had improvement of their lesions, but only two had clinical cure (both of these patients received sodium stibogluconate alone). In phase 2, which included 59 patients with moderate disease, the cure rate among sodium stibogluconate recipients was 75% (21 of 28) compared with 63.6% (14 of 22) among the sodium stibogluconate plus allopurinol recipients. The rates of clinical adverse events were similar among both groups. Thrombocytopenia was more frequent in the sodium stibogluconate plus allopurinol recipients, but the difference was not statistically significant. Eight patients (two sodium stibogluconate recipients and six sodium stibogluconate plus allopurinol recipients) withdrew from the study because of severe thrombocytopenia. In this study, the addition of allopurinol to sodium stibogluconate provided no clinical benefit as treatment of mucocutaneous leishmaniasis.

1-Methoxypyrene and 1,6-dimethoxypyrene: two novel metabolites in fungal metabolism of polycyclic aromatic hydrocarbons

The metabolism of pyrene by Penicillium glabrum strain TW 9424, a strain isolated from a site contaminated with polycyclic aromatic hydrocarbons (PAHs) was investigated in submerged cultures. The metabolites formed were identified as 1-hydroxypyrene, 1,6- and 1, 8-dihydroxypyrene, 1,6- and 1,8-pyrenequinone, and 1-pyrenyl sulfate. In addition, two new metabolites were isolated and identified by UV, 1H nuclear magnetic resonance, and mass spectroscopy as 1-methoxypyrene and 1,6-dimethoxypyrene. Experiments with [methyl-3H]S-adenosyl-l-methionine (SAM) revealed that SAM is the coenzyme that provides the methyl group for the methyltransferase involved. To our knowledge, this is the first time that methoxylated metabolites of PAHs have been isolated from fungal cultures.

Transformation and mineralization of halophenols by Penicillium simplicissimum SK9117

The metabolism of monohalophenols by Penicillium simplicissimum SK9117, isolated from a sewage plant was investigated. In submerged cultures, 3-, 4-chlorophenol, and 4-bromophenol were metabolized in the presence of phenol. 3-Chlorophenol was transformed to chlorohydroquinone, 4-chlorocatechol, 4-chloro-1,2,3-trihydroxybenzene, and 5-chloro-1,2,3-trihydroxybenzene. With 4-chlorophenol only 4-chlorocatechol was observed as transient product. A release of chloride ions was not observed. Whereas monobromo-, and monochlorophenols could not support growth as sole carbon and energy source, growth and release of fluoride ions were observed with monofluorophenols as substrates. In presence of phenol, the degradation of all monofluorophenols was enhanced. Substrate and cosubstrate disappeared simultaneously. 3-Fluorophenol and 4-fluorophenol were completely mineralized as shown by the equimolar release of fluoride ions.

Patient satisfaction: a customer service approach

In health care, as in any service business, monitoring quality is an important component. Patient satisfaction, despite its measurement difficulties, is an excellent gauge of the institution's ability to delivery quality service. As part of quality improvement activities, the Division of Neurosciences at the Toronto Hospital measured patient satisfaction on various validated dimensions, then attempted to identify which components of service provision were key in determining patients' overall levels of perceived satisfaction with care. Results indicated that much of perceived quality and satisfaction was explained by the dimension of care which included prompt response to needs, organization, efficiency of care and communication. The authors recommend focusing improvement efforts on activities with the greatest potential to influence patient satisfaction.

SC-52151, a novel inhibitor of the human immunodeficiency virus protease

SC-52151 is a potent, selective, tight-binding human immunodeficiency virus (HIV) protease inhibitor containing the novel (R)-(hydroxyethyl) urea isostere. The mean 50% effective concentration for lymphotropic, monocytotropic strains and field isolates of HIV type 1 (HIV-1), HIV-2, and simian immunodeficiency virus is 26 ng/ml (43 nM). The combination of SC-52151 and nucleoside reverse transcriptase inhibitors synergistically inhibited HIV-1 replication without additive toxicity. An extended postantiviral effect correlates with inhibition of gag and gag-pol polyprotein processing. SC-52151 is highly protein bound ( >90%) in human plasma, and the level of partitioning into erythrocytes is low. Physiological concentrations of alpha-1-acid glycoprotein, but not albumin, substantially affect the antiviral potency of SC-52151. The oral bioavailability of [14C]SC-52151 is 17% when it is administered as an elixir to the rat, dog, or monkey. Oxidation of the t-butyl moiety is the major route of biotransformation, and elimination is mainly by biliary excretion. No toxicologically significant effects have been observed in animals. Pharmacokinetic and metabolism studies in multiple animal species predict 20 to 30% systemic bioavailability, an elimination half-life of 1 to 2 h, and a volume of distribution of greater than 3 liters/kg in humans.

A supervisory model of professional competence: a joint service/education initiative

This article is concerned with describing how a National Health Service (NHS) Hospital Trust teamed up with a College of Nursing and Midwifery to develop a model of clinical supervision. The article discusses definitions of clinical supervision, which were used as a basis for the development of the model; identifies the roles and responsibilities of clinical supervisors and describes the foundations of an integrated system of educational and professional development. The model aims to set standards for clinical competence which facilitate continuity in professional development throughout the practitioner's career. The collaboration between the two organisations has ensured that the model reflects the inter-relationship between theory and practice, thus enhancing both academic and professional development. The result is a comprehensive model for clinical supervision which encompasses key national initiatives in both professional and educational fields; in particular the United Kingdom Central Council (UKCC) requirements for continuing registration, maintenance of a portfolio of professional development, and continuing education (PREP) and the Ten Key Characteristics of the English National Board (ENB) Higher Award. It also encourages practitioners to demonstrate good practice through the requirement to articulate and enhance professional knowledge using a portfolio, along with a system of peer review and defined clinical competencies.

Willingness to pay for unfunded health services in a family practice clinic

Data collected for this study of willingness to pay for unfunded health services in a family practice setting were collected through a cross-sectional survey of a sample of 250 patients. Willingness to pay was assessed by each patient responding on a five-point scale from "definitely not willing" to "definitely willing" to pay a fee of +10 for the service in question. Data analysis was performed using chi-square contingency tables. Findings indicated a strong willingness to pay for brief doctors' notes, an aversion against paying for telephone advice from a nurse and no consistent opinion for or against paying for prescription renewals received over the telephone.

The impact of HIV on older people: Part 2

This second article of two on HIV infection and its impact on older people concentrates on what type of research needs to be undertaken in this area, and calls for greater awareness of the problems that older people face in dealing with HIV.

The impact of HIV on older people: Part 1

The physical and psychological effects of HIV infection in older people have been under-researched. This two-part article draws together the available literature and concludes that HIV has a major impact on older people, which is often different from that experienced by younger people. Next week, the author looks at what research is needed and how to increase awareness of the issue.

Elderly care: meeting the needs of ethnic patients

This article describes the attempts of a nursing development unit to address the difficulties of providing care for the increasing population of elderly people from ethnic minorities. The specific problems that occur and the measures introduced to combat them are highlighted, and the unit's plans for further improvement are outlined.

An anti-okadaic acid-anti-idiotypic antibody bearing an internal image of okadaic acid inhibits protein phosphatase PP1 and PP2A catalytic activity

Okadaic acid (OA), produced by marine phytoplankton, is the parent compound of a family of marine toxins responsible for diarrheic shellfish poisoning (DSP). A monoclonal antibody to OA (6/50) (Ab1) has been raised and in turn used for immunization of syngeneic animals. Mice inoculated with the 6/50 idiotype produced both anti-idiotypic antibodies (Ab2) and OA binding antibodies (Ab3). The selected anti-idiotypic antibody 1/59 bound to the immunizing 6/50 idiotype but not to F(ab')2 fragments of pooled normal mouse Ig. It inhibited the binding of OA to solid-phase attached F(ab')2 of 6/50 IgG as well as the binding of 6/50 IgG to a solid-phase bound OA. Like OA, 1/59 anti-idiotypic antibody inhibited protein phosphatase 1 and 2A catalytic subunits in a 32P-phosphorylase a phosphatase radioassay. Thus, 1/59 IgG is a novel internal image anti-idiotypic antibody (Ab2 beta) and can serve as a surrogate of OA in biological assays.

Open learning for enrolled nurses

Within the new market economy of the NHS, it is necessary to provide reliable information on the viability of educational initiatives which are planned, implemented and evaluated in an economic manner without compromising quality. The Sheffield and North Trent College of Nursing and Midwifery offers a unique opportunity for enrolled nurses who wish to retake first level nursing examinations. An evaluation of the course was undertaken which revealed that 75 per cent of the students felt the course had enhanced their personal study skills and professional awareness.

The halo vest apparatus: essentials for patient management

Cervical spine trauma or disease, regardless of its cause, warrants prompt diagnosis and treatment. The halo vest apparatus is an external fixation device which is used extensively in the management of these individuals. Since patient management may pose some difficulties, expert knowledge is essential. In this paper we describe our experiences in the management of this challenging group of patients. Our discussion will focus on management techniques and strategies which include hygiene, activity, mobility and emergency procedures.