Health Research, Consent and the GDPR Exemption

This article analyses the balance which the GDPR strikes between two important social values: protecting personal health data and facilitating health research through the lens of the consent requirement and the research exemption. The article shows that the normative weight of the consent requirement differs depending on the context for the health research in question. This more substantive approach to consent is reflected in the research exemption which allows for a more nuanced balancing of interests. However, because the GDPR articulates the exemption at an abstract and principled level, in practice the balance is struck at Member State level. Thus, the GDPR increases difficulties for EU cross-border health projects and impedes the policy goal of creating a harmonised regulatory framework for health research. The article argues that in order to address this problem, the European Data Protection Board should provide specific guidance on the operation of consent in health research.

Quality of lamb meat from the Information Nucleus Flock

The effects of production and processing factors on tenderness, and colour of lamb meat produced from 7 locations as part of the Australian Sheep Industry CRC’s Information Nucleus flock were investigated, using data from 2052 lambs slaughtered in 2007. At 24 h post-slaughter, samples of m. longissimus lumborum (LL) and m. semimembranosus (SM) were collected for measurement of intramuscular fat (IMF), myoglobin, iron and copper and fresh meat colour (L*, a*, b*) and pH at 24 h measured on the LL. pH and temperature measurements made pre-rigor were used to calculate the pH at 18°C. Tenderness was measured by LL shear force at days 1 (SF1) and 5 (SF5) post-slaughter, the shear force difference (SF-diff) and SM compression and collagen concentration were determined. Retail colour stability was assessed using over-wrapped LL under simulated retail display for 3 days, according to the change in the oxymyoglobin/metmyoglobin ratio. All traits were affected by flock and date of slaughter (P < 0.001). After 4 days of ageing, 70–95% of the LL samples from all flocks, except for one, had acceptable tenderness for consumers based on their shear force. Low IMF, high LL pH at 18°C and high pH at 24 h increased SF1 and SF5 and also had an effect on SF-diff (P < 0.001). The retail colour of 44.8% of the samples on day 3 of retail display were lower than acceptable. Retail colour was influenced by IMF, pH18 and the concentration of iron and copper (P < 0.001). In conclusion, breeding and management practices that increase muscle IMF levels and reduce ultimate pH values and processing practices that result in moderate rates of pH fall post-slaughter, improve the tenderness of lamb. Extension of retail colour stability may be antagonistic to traits associated with tenderness and nutritional traits, particularly IMF and mineral levels.

434. Identification of differentially expressed proteins in ovine chorion rupture sites at preterm and term using proteomics

Introduction: A significant number of babies are delivered preterm and many of these deliveries are due to spontaneous rupture of fetal membranes. However, the mechanisms underlying fetal membrane rupture are not well defined. The sheep has proved to be a valuable model for elucidating the physiology of birth, with many of the findings clearly relevant to human parturition. In the current study we have used the sheep model to investigate changes in protein expression in the chorion in relation to the onset of spontaneous full term labour. Methods: Proteomic analysis was used to compare the protein profiles at the chorion rupture site between mid/late gestation (136 days, n = 6) and term delivery (145days, n = 6). Proteins were solubilised and separated into soluble and insoluble fractions which were separated by 2D-electrophoresis. Relative protein expression was quantified using the PROGENESIS software and protein spots were picked and identified using Matrix Assisted Laser Desorption Ionisation-Time of Flight (MALDI-TOF) mass spectrometry. Data-mining used gene ontology (GO terms) for each protein and these were clustered into networks using DAVID bioinformatics resource (http://david.abcc.ncifcrf.gov/home.jsp). Results: A total of 150 protein spots were identified of which 60 proteins were found to differ by more than 2-fold between preterm and term samples. This group was significantly enriched for proteins from the several functional GO categories including; Oxidoreductase activity (7 proteins); negative regulation of apoptosis (4); structural molecule activity (7); protease inhibitor activity (7); Carbohydrate metabolism (10); Glucose metabolism (5); Glycolysis (5); response to stress (8) and heat shock (3). Of the differentially regulated proteins, 10 were found to be significantly upregulated at term (ANOVA P < 0.05) including isocitrate dehydrogenase, glutamate dehydrogenase 1, malate dehydrogenase 2. A further 10 proteins, including serpin peptidase inhibitor SERPINA12, serpin peptidase inhibitor SERPINH1 precursor and heat shock protein 90 kDa β were found to be downregulated.

The York review--a systematic review of public water fluoridation: a commentary

Following the election of the British government in May 1997, a policy document outlining proposals to improve the health of the nation was published. This document placed a major emphasis on reducing inequalities in health and recognised the continuing poor state of oral health in deprived communities. However, whilst acknowledging the benefits of water fluoridation as a caries preventive measure, the Department of Health suggested that most of the research had been carried out some years ago and furthermore, recognised that strong views were held both for and against fluoridation.

Both CD45R(low) and CD45R(high) "revertant" CD4 memory T cells provide help for memory B cells

During a primary response to thymus dependent antigens, B cells undergo a number of qualitative changes to become memory B cells - processes that require co-stimulatory signals and cytokine help from CD4 T cells. The question of whether distinct, antigen-experienced memory CD4 T cells are subsequently needed to program memory B cells into antibody synthesis has not been clearly resolved. Using an adoptive transfer model in which memory but not naive B cells were stimulated, we evaluated CD4 T cell help using lymphocytes obtained from primed or unprimed thymectomized donors and expressing a naive (CD45R(high)) or a memory (CD45R(low)) phenotype. Memory B cells, most of which were committed to the IgG1 (Th2) subclass, could be stimulated to produce antibody using help transferred by the CD45R(high) naive subset of unprimed donors (slow onset of response), the CD45R(low) subset of 7 day primed donors (large, rapid antibody response) or by both the CD45R(low) and the CD45R(high) "revertant" subsets of 6 month primed donors. We found that antigen primed CD45R(low) CD4 T cells reverted (defaulted) with time to a CD45R(high) resting state, a change that was prevented by persisting antigen. The evidence suggests that CD4 memory T cells are partitioned into two different functional states (CD45R(high) and CD45R(low)) and that these determine the characteristics of the memory B cell response in terms of speed, size and longevity.

The clinical pharmacokinetics of a new pharmacokinetically enhanced formulation of amoxicillin/clavulanate

BACKGROUND

A new oral pharmacokinetically enhanced formulation of the broad-spectrum antibiotic amoxicillin/clavulanate has been developed to provide more effective therapy against resistant pathogens than is provided by currently available formulations by maintaining therapeutically useful plasma amoxicillin concentrations for a longer period after dosing.

OBJECTIVE

This study explored the pharmacokinetics of the new oral formulation of amoxicillin/clavulanate in healthy male and female subjects.

METHODS

A single oral dose of pharmacokinetically enhanced amoxicillin/clavulanate (2000/125 mg; 16:1 ratio) was administered to subjects at the start of a meal. After dosing, blood samples were collected at frequent intervals up to 12 hours, and plasma was assayed for amoxicillin and clavulanate concentrations using validated procedures. The new formulation consisted of 1 layer of immediate-release amoxicillin and clavulanate and another of sustained-release amoxicillin in a proportion such that for an amoxicillin minimum inhibitory concentration (MIC) of 4 microg/mL, the time above the MIC (T >MIC) would be approximately > or = 40% over a 12-hour dosing interval.

RESULTS

The study enrolled 24 and 31 healthy male and female subjects, respectively. Their mean age was 35 years (range, 18-58 years) and mean body weight was 69 kg (range, 51-86 kg). After the expected sharp peak in plasma amoxicillin concentration, there appeared to be a slower decline with the pharmacokinetically enhanced formulation than is usually seen with conventional formulations, and there was evidence of a second amoxicillin absorption phase. The mean T >MIC for an amoxicillin MIC of 4 microg/mL was 49.4% of a 12-hour dosing interval, a value that cannot be achieved with existing approved doses and formulations of amoxicillin/clavulanate. By 12 hours, plasma amoxicillin concentrations were very low (approximately 0.05 microg/mL), suggesting no expectation of notable dose-to-dose accumulation on repeat dosing with a BID regimen. The terminal half-lives of amoxicillin (1.27 hours) and clavulanate (1.03 hours) with the new formulation were similar to those of existing formulations of amoxicillin/clavulanate. No deaths or serious adverse events were reported.

CONCLUSIONS

The enhanced pharmacokinetic profile of amoxicillin/clavulanate seen in this study suggests that this formulation is likely to be highly effective for the oral treatment of infections caused by bacteria--including beta-lactamase-producing organisms--and strains with amoxicillin MICs < or = 4 microg/mL.

Drug treatment of hypertension in older people: relieving the pressure

Hypertension is very common, occurring in over 50% of older people, and is a major risk factor for stroke and ischaemic heart disease. Based on systematic reviews there is evidence to show that drug treatment of hypertension in older people saves lives and prevents unnecessary morbidity. There is also strong evidence to support the use of diuretics as first line agents. Quality of life does not appear to be reduced by antihypertensive drug therapy, although more high quality research is needed. Through the use of drug treatment older people with hypertension can continue to contribute to society and live active lives.

Field evaluations of marine oil spill bioremediation

Bioremediation is defined as the act of adding or improving the availability of materials (e.g., nutrients, microorganisms, or oxygen) to contaminated environments to cause an acceleration of natural biodegradative processes. The results of field experiments and trials following actual spill incidents have been reviewed to evaluate the feasibility of this approach as a treatment for oil contamination in the marine environment. The ubiquity of oil-degrading microorganisms in the marine environment is well established, and research has demonstrated the capability of the indigenous microflora to degrade many components of petroleum shortly after exposure. Studies have identified numerous factors which affect the natural biodegradation rates of oil, such as the origin and concentration of oil, the availability of oil-degrading microorganisms, nutrient concentrations, oxygen levels, climatic conditions, and sediment characteristics. Bioremediation strategies based on the application of fertilizers have been shown to stimulate the biodegradation rates of oil in aerobic intertidal sediments such as sand and cobble. The ratio of oil loading to nitrogen concentration within the interstitial water has been identified to be the principal controlling factor influencing the success of this bioremediation strategy. However, the need for the seeding of natural environments with hydrocarbon-degrading bacteria has not been clearly demonstrated under natural environmental conditions. It is suggested that bioremediation should now take its place among the many techniques available for the treatment of oil spills, although there is still a clear need to set operational limits for its use. On the basis of the available evidence, we have proposed preliminary operational guidelines for bioremediation on shoreline environments.

Is antenatal care effective in reducing maternal morbidity and mortality?

Women in developing countries are dying from simple preventable conditions but what impact can the procedures collectively called antenatal care having in reducing maternal mortality and morbidity? More importantly what is antenatal care? This review found that questions have been raised about the impact of antenatal care (specifically on maternal mortality) since its inception in developed countries, and that although the questions continue to be asked there is very little research trying to find answers. Many antenatal procedures are essentially screening tests yet it was found that there were very few results showing sensitivity and specificity, and that they rarely complied with the established criteria for the effectiveness of a screening test. The acknowledged gold standard measurement of effectiveness is the randomized controlled trial, yet the only results available referred to nutritional supplementation. This service of flawed methodology has been exported to developing countries and is being promoted by WHO and other agencies. This paper argues that there is insufficient evidence to reach a firm decision about the effectiveness of antenatal care, yet there is sufficient evidence to cast doubt on the possible effect of antenatal care. Research is urgently required in order to identify those procedures which ought to be included in the antenatal process. In the final analysis the greatest impact will be achieved by developing a domiciliary midwifery service supported by appropriate local efficient obstetric services. That this domiciliary service should provide care for women in pregnancy is not disputed but the specific nature of this care needs considerable clarification.

CD45RC+ CD4 T cell subsets are maintained in an unresponsive state by the persistence of transfusion-derived alloantigen

The ability of preoperative blood transfusion to extend the survival of organ allografts is well known but poorly understood. To study this phenomenon, adult PVG (RT1c) rats were rendered tolerant of DA (RT1a) cardiac allografts by prior donor-specific blood transfusion (DST). We investigated the cellular basis of the transfusion effect by adoptively transferring CD4 T cell subsets, obtained from thoracic duct lymph of tolerant rats, into cardiac allografted athymic PVG nude recipients. Surprisingly, CD4 T cells from DST rats evoked acute rejection on adoptive transfer. Evidence indicated that CD8 T cells played no role in DST-induced tolerance. Analysis of CD4 T cell subsets, defined in the rat by mAb OX22 (anti-CD45RC), revealed an unusual pattern of responsiveness. CD45RC+ CD4 T cells (normally capable of inducing prompt rejection), when obtained from rats given a specific blood transfusion, were depleted of alloreactive cells and deficient at inducing rejection. In contrast, the CD45RC- subset (normally slow at evoking graft destruction) was highly active and ten-fold-enriched in its ability to induce rejection. Destruction of cardiac allografts by this latter subset was, however, completely inhibited by giving nude recipients a specific (but not a third-party) blood transfusion two weeks before heart grafting and cell transfer. Apparently, tolerance was maintained by residual elements of the prior blood transfusion that prevented the specific CD45RC- subset from regaining an alloaggressive capacity.

The survival and turnover of mature and immature CD8 T cells

The present investigation has examined the phenotype, survival and fate of immature and mature CD8 T cells. CD4- CD8+ 'single positive' thymocytes (a model for recent thymic emigrants) were Thy-1+ CD45RC- RT6- before transfer to normal euthymic recipients, but changed phenotype within 7-10 days to become Thy-1- CD45RC+ RT6(+)--the phenotype of mature resting CD8 T cells. Following transfer to athymic nude recipients CD8 T cells from thoracic duct lymph of allotype-marked rats increased 12-17-fold during the first 2 months. Proliferation occurred in the complete absence of CD4 T cells and the donor CD8 T cells persisted [at 15-18% of peripheral blood lymphocytes (PBL)] for the life of the recipients. When combined with equal numbers of CD4 T cells, however, CD8 T cells occupied only 3-4% of PBL; in these animals CD4 T cells plateaued at 15-16% of PBL. The results suggested that CD8 T cells competed poorly with rapidly dividing CD4 T cells for limited space in a recirculating pool in which total T-cell numbers are homeostatically regulated. Although able to proliferate and self-renew in athymic nude recipients, when transferred to normal euthymic animals donor-derived mature CD8 T cells declined in number with time; their half-life was estimated to be 34 days. Similar studies with purified CD4- CD8+ 'single positive' thymocytes gave a comparable half-life of 37 days. The results indicated that lifespan was not due to an ageing process among CD8 T cells, but was rather a reflection of cell turnover dependent on thymic output.

CD4+ T cell-mediated rejection of major histocompatibility complex class I-disparate grafts: a role for alloantibody

Experimental studies of the T cell requirement for rejection of class I major histocompatibility complex (MHC)-disparate grafts have generated controversy over both the autonomy of CD8+ T cells and the mechanism whereby CD4+ T cells are able to independently mediate rejection. In this study of rejection of RT1Aa class I MHC-disparate rat cardiac and skin allografts by high-responder PVG RT1u recipients, we show that elimination of CD8+ T cells [by anti-CD8 monoclonal antibody (mAb) administration in vivo] fails to prolong graft survival, whereas partial depletion of CD4+ T cells (by anti-CD4 mAb treatment) markedly delays rejection of class I-disparate heart grafts, and marginally prolongs survival of skin grafts. Anti-CD4-treated PVG-RT1u athymic nude rats reconstituted with CD8+ T cells failed to reject class I-disparate skin grafts for several weeks and eventual rejection correlated with re-emergence of a small number of donor derived CD4+ T cells. Conversely, anti-CD8-treated nude rats reconstituted with CD4+ T cells alone rapidly rejected class I-disparate skin grafts. Passive transfer of anti-class I immune serum to anti-CD4-treated euthymic recipients promptly restored their ability to specifically reject a class I-disparate heart graft. Similarly, passive transfer of immune serum to PVG-RT1u nude rats bearing skin allografts caused destruction of class I-disparate but not third-party grafts. These results demonstrate that CD4+ T cells are both necessary and sufficient to cause rejection of class I-disparate heart and skin grafts in this model and that CD4+ T cell-dependent alloantibody plays a decisive role in effecting rejection.

A better approach to well baby care

We believe that well baby care is being done more efficiently by nurse practitioners than by some physicians. We have attempted to lend support to this argument by exploring various reasons for this, by outlining our objectives in doing well baby care and by commenting on how we see our role as perhaps different from that of the physician in this particular area of health care provision.