Enhancing the implementation of provider-to-provider telehealth in rural and remote areas: A mixed methods study protocol

Background

Virtual healthcare solutions are proposed as a way to combat the inequity of access to healthcare in rural and remote areas, and to better support the front-line providers who work in these areas. Rural provider-to-provider telehealth (RPPT) connects rural and remote clinicians to a 'hub' of healthcare specialists who can increase access to emergency and specialised healthcare via an integrated model. Reported benefits for the place-based provider include enhanced knowledge, expanded professional development opportunities, improved scope of practice, and increased confidence in treating more complex cases. These reported benefits could have implications for supporting and futureproofing our health workforce in terms of productivity, burnout, recruitment, and retention.

Methods

The research uses an explanatory sequential mixed methods approach across multiple phases to evaluate the current implementation of Western Australia Country Health Service's (WACHS) Command Centre (CC) services and explore factors associated with their differential use. The primary population of interest and participants in this study are the place-based providers in country Western Australia (WA). Patient data constitutes the secondary population, informing the access and reach of CC services into country WA. Data collection will include service data, an online survey, and semi-structured interviews with the primary population. The data will be interpreted to inform evidence-based strategies and recommendations to improve the implementation and sustainment of RPPT.

Discussion

Innovative and sustained workforce models and solutions are needed globally. Virtual healthcare, including provider-to-provider models, demonstrate potential, especially in rural and remote areas, designed to increase access to specialised expertise for patients and to support the local workforce. This research will generate new data around behaviour, perceptions, and value from the WACHS rural and remote workforce about provider-to-provider telehealth, to explore the implementation and investigate strategies for the long-term sustainment of RPPT services.

Aerobic and anaerobic movement energetics of hybrid and pure parental abalone

The underlying mechanisms controlling growth heterosis in marine invertebrates remain poorly understood. We used pure blacklip (Haliotis rubra) and greenlip (Haliotis laevigata) abalone, as well as their hybrid, to test whether differences in movement and/or aerobic versus anaerobic energy use are linked to a purported increased growth rate in hybrids. Abalone were acclimated to control (16 °C) and typical summer temperatures (23 °C), each with oxygen treatments of 100% air saturation (O₂sat) or 70% O₂sat. The experiment then consisted of two phases. During the first phase (chronic exposure), movement and oxygen consumption rates (ṀO₂) of abalone were measured during a 2 day observation period at stable acclimation conditions. Additionaly, lactate dehydrogenase (LDH) and tauropine dehydrogenase (TDH) activities were measured. During phase two (acute exposure), O₂sat was raised to 100% for abalone acclimated to 70% O₂sat followed by an acute decrease in oxygen to anoxia for all acclimation groups during which movement and ṀO₂ were determined again. During the chronic exposure, hybrids and H. laevigata moved shorter distances than H. rubra. Resting ṀO₂, LDH and TDH activities, however, were similar between abalone types but were increased at 23 °C compared to 16 °C. During the acute exposure, the initial increase to 100% O₂sat for individuals acclimated to 70% O₂sat resulted in increased movement compared to individuals acclimated to 100% O₂sat for hybrids and H. rubra when compared within type of abalone. Similarly, ṀO₂ during spontaneous activity of all three types of abalone previously subjected to 70% O₂sat increased above those at 100% O₂sat. When oxygen levels had dropped below the critical oxygen level (P_crit), movement in hybrids and H. laevigata increased up to 6.5-fold compared to movement above P_crit. Differences in movement and energy use between hybrids and pure species were not marked enough to support the hypothesis that the purportedly higher growth in hybrids is due to an energetic advantage over pure species.

Changes in prevalence of depression and anxiety following smoking cessation: results from an international cohort study (ATTEMPT)

BACKGROUND

Smoking cessation improves physical health but it has been suggested that in vulnerable individuals it may worsen mental health. This study aimed to identify the short- and longer-term effects of stopping smoking on depression and anxiety in the general population and in those with a history of these disorders.

METHOD

Sociodemographic and smoking characteristics, and mental and physical health were assessed using established measures in the ATTEMPT cohort, an international longitudinal study of smokers (n = 3645). Smokers who had stopped for at least 3 months or less than 3 months at the 12-month follow-up were compared with current smokers (n = 1640).

RESULTS

At follow-up, 9.7% [95% confidence interval (CI) 8.3-11.2] of smokers had stopped for less than 3 months and 7.5% (95% CI 6.3-8.9) for at least 3 months. Compared with current smokers, prevalence of depression prescriptions obtained in the last 2 weeks was lower for those who had stopped for less than 3 months [odds ratio (OR) 0.37, 95% CI 0.14-0.96] or at least 3 months (OR 0.25, 95% CI 0.06-0.94) after adjusting for baseline prescription levels and confounding variables. Adjusted prevalence of recent depression symptoms was also lower for ex-smokers who had stopped for less than 3 months (OR 0.34, 95% CI 0.15-0.78) or at least 3 months (OR 0.24, 95% CI 0.09-0.67) than among continuing smokers. There was no change in anxiety measures in the general population or any increase in anxiety or depression symptoms in ex-smokers with a past history of these conditions.

CONCLUSIONS

Smoking cessation does not appear to be associated with an increase in anxiety or depression and may lead to a reduced incidence of depression.

A pilot study of motivational interviewing training in a virtual world

BACKGROUND

Motivational interviewing (MI) is an evidence-based, patient-centered counseling strategy proven to support patients seeking health behavior change. Yet the time and travel commitment for MI training is often a barrier to the adoption of MI by health care professionals. Virtual worlds such as Second Life (SL) are rapidly becoming part of the educational technology landscape and offer not only the potential to improve access to MI training but also to deepen the MI training experience through the use of immersive online environments. Despite SL's potential for medical education applications, little work is published studying its use for this purpose and still less is known of educational outcomes for physician training in MI using a virtual-world platform.

OBJECTIVE

Our aims were to (1) explore the feasibility, acceptability, and effectiveness of a virtual-world platform for delivering MI training designed for physicians and (2) pilot test instructional designs using SL for MI training.

METHODS

We designed and pilot tested an MI training program in the SL virtual world. We trained and enrolled 13 primary care physicians in a two-session, interactive program in SL on the use of MI for counseling patients about colorectal cancer screening. We measured self-reported changes in confidence and clinical practice patterns for counseling on colorectal cancer screening, and acceptability of the virtual-world learning environment and the MI instructional design. Effectiveness of the MI training was assessed by coding and scoring tape-recorded interviews with a blinded mock patient conducted pre- and post-training.

RESULTS

A total of 13 physicians completed the training. Acceptability ratings for the MI training ranged from 4.1 to 4.7 on a 5-point scale. The SL learning environment was also highly rated, with 77% (n = 10) of the doctors reporting SL to be an effective educational medium. Learners' confidence and clinical practice patterns for colorectal cancer screening improved after training. Pre- to post-training mean confidence scores for the ability to elicit and address barriers to colorectal cancer screening (4.5 to 6.2, P = .004) and knowledge of decision-making psychology (4.5 to 5.7, P = .02) and behavior change psychology (4.9 to 6.2, P = .02) increased significantly. Global MI skills scores increased significantly and component scores for the MI skills also increased, with statistically significant improvements in 4 of the 5 component skills: empathy (3.12 to 3.85, P = .001), autonomy (3.07 to 3.85, P < .001), collaboration (2.88 to 3.46, P = .02), and evocative response (2.80 to 3.61, P = .008).

CONCLUSIONS

The results of this pilot study suggest that virtual worlds offer the potential for a new medical education pedagogy that will enhance learning outcomes for patient-centered communication skills training.

Characteristics of patients referred by police to a psychiatric hospital

To identify any differences between patients referred by police compared with patients referred from other sources, to a psychiatric hospital in Australia, a retrospective audit of 200 patient files was undertaken. The two most common reasons for the involuntary referral of patients by police were bizarre ideas (33%) and threats of suicide (28%). When 101 patients referred by police were compared with 99 patients from other sources, police referrals were three times more likely to be diagnosed with a mental and behavioural disorder because of psychoactive substance use, less likely to be diagnosed with a mood disorder, and less likely to be diagnosed as psychotic. Police referrals were more likely to have worse functional scores; exhibit aggressive behaviour; spend fewer days in hospital; more likely to be admitted to the psychiatric intensive care unit, and to be secluded. The most important predictor for a police referral was drug or alcohol problems. The study indicates that patients referred by the police were more likely to demonstrate particular characteristics compared with patients referred by other sources.

Isolated vulval splitting--is this normal or pathological?

Vulval splitting may be seen in association with clinically apparent dermatological disease but occasionally occurs in patients presenting with dyspareunia only. These patients usually have normal-looking vulvas on examination, apart from splitting. They are usually diagnosed as vulval vestibulitis. We have biopsied several patients with isolated vulval splitting with surprising results. Between the months of October 2000 and April 2002, 310 new patients were seen in the vulval clinic at Hope Hospital, which is a tertiary referral centre. Among these were nine cases of isolated vulval splitting, eight of which had histological features of dermatological disease on vulval biopsies. There were three cases of lichen planus, three with chronic dermatitis and two with candidiasis.

Indication of a Lombard vocal response in the St. Lawrence River Beluga

Noise pollution is recognized as a potential danger to marine mammals in general, and to the St. Lawrence beluga in particular. One method of determining the impacts of noise on an animal's communication is to observe a natural and repeatable response of the vocal system to variations in noise level. This is accomplished by observing intensity changes in animal vocalizations in response to environmental noise. One such response observed in humans, songbirds, and some primates is the Lombard vocal response. This response represents a vocal system reaction manifested by changes in vocalization level in direct response to changes in the noise field. In this research, a population of belugas in the St. Lawrence River Estuary was tested to determine whether a Lombard response existed by using hidden Markhov-classified vocalizations as targets for acoustical analyses. Correlation and regression analyses of signals and noise indicated that the phenomenon does exist. Further, results of human subjects experiments [Egan, J. J. (1966), Ph.D. dissertation; Scheifele, P. M. (2003), Ph.D. dissertation], along with previously reported data from other animal species, are similar to those exhibited by the belugas. Overall, findings suggest that typical noise levels in the St. Lawrence River Estuary have a detectable effect on the communication of the beluga.

Papuloerythroderma of Ofuji associated with acute myeloid leukaemia

Papuloerythroderma of Ofuji (PEO) is an uncommon skin condition most commonly described in Japan. The aetiology of PEO is unknown and treatment may be difficult. There are several reports of an association between PEO and malignancy, most particularly with T-and B-cell lymphomas. We describe PEO complicated by acute myeloid leukaemia occurring in a 62-year-old man. This association has not been reported previously.

Effects of maternal tobacco smoking, sleeping position, and sleep state on arousal in healthy term infants

OBJECTIVES

To investigate whether a history of maternal tobacco smoking affected the maturation of arousal responses and whether sleeping position and infant age alters these relations.

DESIGN

Healthy term infants (13 born to mothers who did not smoke and 11 to mothers who smoked during pregnancy) were studied using daytime polysomnography on three occasions: (a) two to three weeks after birth, (b) two to three months after birth, and (c) five to six months after birth. Multiple measurements of arousal threshold in response to air jet stimulation were made in both active sleep (AS) and quiet sleep (QS) when infants slept both prone and supine.

RESULTS

Maternal smoking significantly elevated arousal threshold in QS when infants slept supine at 2-3 months of age (p<0.05). Infants of smoking mothers also had fewer spontaneous arousals from QS at 2-3 months in both prone (p<0.05) and supine (p<0.001) sleeping positions. In infants of non-smoking mothers, arousal thresholds were elevated in the prone position in AS at 2-3 months (p<0.01) and QS at 2-3 weeks (p<0.05) and 2-3 months (p<0.001).

CONCLUSIONS

Maternal tobacco smoking significantly impairs both stimulus induced and spontaneous arousal from QS when infants sleep in the supine position, at the age when the incidence of sudden infant death syndrome is highest.

De novo deletion of chromosome 18q in a baby with harlequin ichthyosis

Harlequin ichthyosis, (MIM 242500), is a rare, autosomal recessive skin disorder due to an inborn error of epidermal keratinization. The gene for this condition has not been localized. We present a case of HI in which there was a de novo deletion of chromosome 18q: the karyotype was 46, XY, del(18)(q21.3). We postulate that the gene for HI may lie at, or distal to 18q21.3 and that the deletion observed in this case may have unmasked this autosomal recessive disorder.

The prone sleeping position impairs arousability in term infants

OBJECTIVE

To investigate whether the prone sleeping position impaired arousal from sleep in healthy infants and whether this impairment was related to cardiorespiratory variables, temperature, or age.

STUDY DESIGN

Healthy term infants (n = 24) were studied with daytime polysomnography on 3 occasions: 2 to 3 weeks after birth, 2 to 3 months after birth, and 5 to 6 months after birth. Multiple measurements of arousal threshold (cm H(2)O) in response to air-jet stimulation applied alternately to the nares were made in both active sleep and quiet sleep when infants slept both prone and supine.

RESULTS

Arousal thresholds were significantly higher in both active sleep and quiet sleep when infants slept prone at 2 to 3 weeks and 2 to 3 months, but not at 5 to 6 months. These increases were independent of any sleep position-related change in either rectal or abdominal skin temperature, respiratory rate, oxygen saturation, or heart rate.

CONCLUSIONS

The prone position significantly impairs arousal from both active sleep and quiet sleep in healthy term infants. This impairment in arousability occurred with no clinically significant changes in cardiorespiratory variables or body temperature. Decreased arousability from sleep in the prone position provides an important insight into its role as a risk factor for sudden infant death syndrome.

Exogenous topical lactoferrin inhibits allergen-induced Langerhans cell migration and cutaneous inflammation in humans

BACKGROUND

Lactoferrin (LF), an iron-binding protein found in exocrine secretions, is known to possess antibacterial properties. It has recently been proposed that LF may also influence inflammatory reactions.

OBJECTIVES

To characterize in humans the ability of recombinant homologous LF to inhibit the induced migration of epidermal Langerhans cells (LCs) from the skin, a process known to be dependent upon the proinflammatory cytokines tumour necrosis factor (TNF)-alpha and interleukin 1beta and to influence cutaneous inflammatory reactions.

METHODS

We investigated the anti-inflammatory properties of LF in human volunteers.

RESULTS

Topical exposure to LF 2 h prior to sensitization caused a significant reduction in contact allergen (diphenylcyclopropenone, DPC)-induced LC migration from the epidermis as judged by the altered frequency of cells expressing either HLA-DR or CD1a determinants. That this reduction was secondary to an inhibition of TNF-alpha production was indicated by the fact that LF failed to influence LC migration induced by intradermal injection of this cytokine. In approximately 50% of those volunteers who displayed local inflammation in response to DPC, LF was found to cause a discernible reduction in the clinical severity of the reaction, associated with reduced infiltration of inflammatory cells.

CONCLUSIONS

These data demonstrate that LF is able to influence cutaneous immune and inflammatory responses, possibly because of an impaired production of local proinflammatory cytokines.

Use of pulsed-field gel electrophoresis and flagellin gene typing in identifying clonal groups of Campylobacter jejuni and Campylobacter coli in farm and clinical environments

Although campylobacters have been isolated from a wide range of animal hosts, the association between campylobacters isolated from humans and animals in the farm environment is unclear. We used flagellin gene typing and pulsed-field gel electrophoresis (PFGE) to investigate the genetic diversity among isolates from animals (cattle, sheep, and turkey) in farm environments and sporadic cases of campylobacteriosis in the same geographical area. Forty-eight combined fla types were seen among the 315 Campylobacter isolates studied. Six were found in isolates from all four hosts and represented 50% of the total number of isolates. Seventy-one different SmaI PFGE macrorestriction profiles (mrps) were observed, with 86% of isolates assigned to one of 29 different mrps. Fifty-seven isolates from diverse hosts, times, and sources had an identical SmaI mrp and combined fla type. Conversely, a number of genotypes were unique to a particular host. We provide molecular evidence which suggests a link between campylobacters in the farm environment with those causing disease in the community.

Apnoea of prematurity and arousal from sleep

The incidence of sudden infant death syndrome (SIDS) has been found to be consistently higher in preterm and low birth weight infants than in infants born at term and this increase is inversely related to gestational age. The incidence and severity of apnoea of prematurity, are also inversely related to gestational age. The aim of this study was to investigate whether a neonatal history of apnoea/bradycardia affected the maturation of arousal responses. Twenty-five premature infants were studied. A perinatal risk score was determined for each infant and infants were divided into those with a neonatal history of apnoea/bradycardia (n=16) and those without (n=9). All infants were studied using daytime polysomnography on three occasions: (a) a preterm study around 36 weeks gestation, (b) within 3 weeks of term, and (c) 2-3 months post-term. Multiple measurements of arousal threshold (cm H2O) in response to air-jet stimulation applied alternately to the nares were made in both active sleep (AS) and quiet sleep (QS). Arousal thresholds were elevated in apnoeic infants compared to control infants in both AS (P<0.05) and QS (P<0.001) at the term study and in QS at 2-3 months post-term (P<0.01). In addition, arousal thresholds were positively correlated with perinatal risk score in both sleep states, in all studies, with the exception of AS at 2-3 months when all infants were readily arouseable. We conclude that a history of prematurity with neonatal apnoea has a persisting effect on decreasing arousabilty from sleep and these infants may be at increased risk for SIDS.

Murine monoclonal antibodies reactive with a human monoclonal anti-RhD antibody (BRAD-5)

BRAD-3 and BRAD-5 are human monoclonal antibodies that recognize the RhD antigen on red blood cells. Both antibodies are currently in clinical trials for use as a replacement for polyclonal anti-RhD in the prophylactic treatment of haemolytic disease of the newborn. We have produced three murine IgG1 antibodies that cause agglutination of cells sensitized with BRAD-5 and also block binding of BRAD-5 to its target antigen. Using a haemagglutination assay, these antibodies, 1D7, 2E6 and 3B1, have shown specificity for BRAD-5 as they did not bind to other monoclonal anti-RhD antibodies of differing specificity or derived from other donors. This assay has also been used to show a lack of reactivity with anti-RhD antibodies present in 198 human serum samples from 44 anti-RhD immune individuals. The three anti-BRAD-5 antibodies have been shown to recognize different epitopes on the BRAD-5 molecule using a blocking ELISA. These antibodies appear to recognize private idiotopes on BRAD-5 that were not detectable in RhD immune sera, and therefore they will be of use for monitoring BRAD-5 in clinical trials.

Self-efficacy as a predictor of academic performance in science

Nursing students have traditionally experienced difficulties with the science subjects in nursing curricula, and irrespective of the institution conducting a nursing programme, this trend appears to be continuing. A satisfactory means of predicting academic performance in these subjects will facilitate the development of educational strategies designed to assist students overcome their difficulties. In this study, an instrument called the Self-Efficacy for Science (SEFS) was developed and tested. The SEFS was designed to predict academic performance in the science areas of a first-year undergraduate nursing course. A cohort of first-year students enrolled in a bachelor of nursing course were surveyed by questionnaire. Students' academic scores for two first-year science subjects were obtained and used as the criterion measure for the study. Principal component factor analysis revealed the SEFS contained six instead of the hypothesized four factors. These six factors could explain 70% of students' self-efficacy for science. Cronbach alpha of the SEFS was 0.9. The SEFS could predict 24% of the cohort's academic performance in a physical science subject and 18.5% for a bioscience subject. Studying science in the final year at high school was not statistically significantly related to the SEFS. Implications for students and future research are discussed.

Trusts. Larger than strife

Effective working in a large trust depends on devolving responsibility. The model adopted at United Leeds Teaching Hospitals trust has saved 650,000 pounds on management costs. Management innovation is far more critical in organisational effectiveness than the question of size.

A rapid screening method for the detection of mutations in the RET proto-oncogene in multiple endocrine neoplasia type 2A and familial medullary thyroid carcinoma families

Multiple endocrine neoplasia type 2A (MEN2A) and familial medullary thyroid carcinoma (FMTC) are autosomal dominant inherited cancer syndromes with incomplete penetrance. Following the identification of mutations in the RET proto-oncogene that segregate with the disease phenotype in MEN2A, MEN2B, and FMTC, genetic screening of individuals with mutations in RET may be performed. We have employed restriction endonuclease digestion of polymerase chain reaction products as an alternative to sequence analysis for rapid identification of mutant gene carriers in families in which MEN2A and FMTC are segregating. Twenty-one Australasian MEN2A and FMTC families have been screened for mutations in a cysteine-rich region of the RET proto-oncogene. Seven independent mutations were identified in key individuals in 16 of these families. We have identified a mutation in codon 620, 2053 T-->C (Cys620Arg), and two mutations in codon 634 of exon 11 of RET, 2095 T-->C (Cys634Arg) and 2096 G-->A (Cys634Tyr), all three of which were present in both MEN2A and FMTC families.

Geographical distribution of haplotypes in Swedish families with Huntington's disease

This study was planned to determine the number of origins of the mutation underlying Huntington's disease (HD) in Sweden. Haplotypes were constructed for 23 different HD families, using six different polymorphisms [(CCG)n, GT70, 674, BS1, E2 and 4.2], including two within the gene. In addition, extensive genealogical investigations were performed, and the geographical origin of the haplotypes was studied. Ten different haplotypes were observed suggesting multiple origins for the HD mutation in Sweden. Analysis of the two polymorphic markers within the HD gene (the CCG repeat and GT70) indicates that there are at least three origins for the HD mutation in Sweden. One of these haplotypes (7/A) accounts for 89% of the families, suggesting that the majority of the Swedish HD families are related through a single HD mutation of ancient origin. Furthermore, three of the families that were previously considered to be unrelated could be traced to a common ancestor in the 15th century, a finding that is consistent with this hypothesis.

DNA analysis of distinct populations suggests multiple origins for the mutation causing Huntington disease

Results of association studies can be significantly biased if the ancestry of the control population is not similar to that of the affected population. One approach to overcome such a bias is to use distinct populations where controls and affected individuals are likely to be of similar descent. We have examined homogeneous populations of French, Danish and Swedish ancestry for nonrandom allelic association between Huntington disease (HD) and several markers previously shown to be in association with HD. No evidence for nonrandom allelic association between HD and these markers was shown in these populations. The demonstration of association in a United Kingdom (UK) sample of similar size, and lack of significant differences in allele frequencies between the French, Danish, Swedish and UK populations suggested that the absence of association was not predominantly a consequence of allele frequencies or sample size. To investigate further the number of potential HD chromosomes, DNA haplotypes were constructed for the Danish, French, Swedish and UK populations. The minimum of two HD haplotypes observed in each of the French, Danish and Swedish populations, compared to the one haplotype in the UK population of a similar size, is an important factor accounting for the absence of association between HD and the DNA markers in these populations. Furthermore, these data are in favour of multiple independent origins for the mutation causing HD.

Delineation of a 50 kilobase DNA segment containing the recombination site in a sporadic case of Huntington's disease

No detectable rearrangements involving chromosome 4p16.3 have been observed in patients with Huntington's disease (HD). New mutations for HD could involve structural alterations which might aid the localization of the defective gene. We have reinvestigated a well documented sporadic case of HD. DNA haplotyping with markers between D4S10 and the telomeric locus D4S141 reveals a recombination event in one chromosome of the sporadic HD patient. The site of recombination maps within a 50 kilobase (kb) region, about 700 kb from the 4p telomere. Based on the extremely low HD mutation rate and significantly decreased recombination in the distal region of 4p, we hypothesize a direct link between the site of the recombination and HD in this patient.

Early Detection of WATER Intoxication

1. It has been estimated that between 3% and 6% of patients in psychiatric treatment settings are affected by water intoxication. Water intoxication with consequent hyponatremia can result in disturbing clinical conditions. 2. Early detection is an important factor because of the insidious nature and rapid development of this syndrome. 3. A risk analysis for the early detection of this serious condition has been developed. It is easily administered and effective in categorizing a patient's level of risk.

Nonrandom association between huntington disease and two loci separated by about 3 Mb on 4p16.3

The gene for Huntington disease (HD) has been localized close to the telomere on the short arm of chromosome 4. However, refined mapping using recombinant HD chromosomes has resulted in conflicting findings and mutually exclusive candidate regions. Previously reported significant nonrandom allelic association between D4S95 and HD provided support for a more proximal location for the defective gene. In this paper, we have analyzed 17 markers, spanning approximately 6 Mb of DNA distal to locus D4S62, for nonrandom association to HD. We confirm the previous findings of nonrandom allelic association between D4S95 and HD. In addition, we provide new data showing significant nonrandom association between HD and 3 markers at D4S133 and D4S228, which are approximately 3 Mb telomeric to D4S95.

Isolation and characterization of new highly polymorphic DNA markers from the Huntington disease region

The defect causing Huntington disease (HD) has been mapped to 4p16.3, distal to the DNA marker D4S10. Subsequently, additional polymorphic markers closer to the HD gene have been isolated, which has led to the establishment of predictive testing programs for individuals at risk for HD. Approximately 17% of persons presenting to the Canadian collaborative study for predictive testing for HD have not received any modification of risk, in part because of limited informativeness of currently available DNA markers. Therefore, more highly polymorphic DNA markers are needed, which will further increase the accuracy and availability of predictive testing, specifically for families with complex or incomplete pedigree structures. In addition, new markers are urgently needed in order to refine the breakpoints in the few known recombinant HD chromosomes, which could allow a more accurate localization of the HD gene within 4p16.3 and, therefore, accelerate the cloning of the disease gene. In this study we present the identification and characterization of nine new polymorphic DNA markers, including three markers which detect highly informative multiallelic VNTR-like polymorphisms with PIC values of up to .84. These markers have been isolated from a cloned region of DNA which has been previously mapped approximately 1,000 kb from the 4p telomere.

Genomic organization and complete sequence of the human gene encoding the beta-subunit of the cGMP phosphodiesterase and its localisation to 4p 16.3

As part of the search for the Huntington disease (HD) gene we have cloned and sequenced 34 kb of genomic DNA containing the full-length gene for the beta-subunit of the human cGMP phosphodiesterase (beta-cGMP PDE). This gene is localized to 4p16.3 about 700 kb proximal to the 4p telomere and represents the most telomeric gene characterized on 4p to date. We show that this gene is comprised of 22 exons spanning approximately 43 kb of genomic DNA. We also provide 400 bp immediately 5' to the putative initiator methionine and 700 bp of 3' flanking sequences. Northern blot analysis of several human tissues revealed a highly abundant 3.5 kb transcript and a minor signal of 4.5 kb in retinal tissue. Alignment of the deduced amino acid sequence to the previously identified beta-subunits of the cGMP PDEs of mouse and cow demonstrates highly significant similarities and, therefore, confirms the identity of the cloned gene. A defect in the beta-subunit of the cGMP PDE gene has been shown recently to be the cause for the retinal degeneration in the rd mouse. The cloning of the human homolog and the knowledge of its genomic organization with exon/intron boundaries will allow rapid assessment of the role of this gene in the causation of human retinopathies.

Mononuclear and multinuclear macrophages in filarial infections

Filarial infections commonly involve chronic tissue responses to these complex and resiliant organisms. These responses, which occur with a number of the parasitic stages of filariae, involve macrophages, and these cells appear to be important in immunologically induced destruction and removal of these important parasites of man and animals. Details of their presence and experimental induction as well as their distinction into a number of morphological types, including multinuclear (giant cell) forms, is described in this communication. The ability of these various forms to function in phagocytic and immunologically mediated adherence assays is also described.

ABO blood group and susceptibility to urinary tract infection: no evidence for involvement of isohaemagglutinins

Investigations of the possible mechanisms underlying the increased susceptibility of women who are blood group B and non-secretors of water-soluble blood group antigen to recurrent urinary tract infection (UTI) revealed that isohaemagglutinins are not involved in bactericidal killing or agglutination of 8 serotypes (1,2) of Escherichia coli frequently associated with UTI. The implications of these results and possible areas for future studies are discussed.