Selenium status in a Northern Irish pregnant cohort with iodine deficiency.

Selenium and iodine are trace elements that are maximally concentrated in the thyroid. Iodine is a substrate for thyroid hormone synthesis, while the selenoproteins protect the thyroid from the oxidative stress incurred. We measured plasma selenium concentration in 241 pregnant women in 1st trimester, previously reported to have iodine deficiency. Mean age was 30.3 years (SD 5.4), BMI 26.2 kg/m2 (SD 4.9) and 53% reported taking supplements. Median urinary iodine concentration was 73 µg/L (IQR 37-122) (WHO recommendation, ≥150 µg/L). Mean plasma selenium concentration was 75 µg/L (SD 7.7) which is below the 80-125 µg/L reported to be optimal. Four-day food diaries revealed a selenium intake of 43 µg/day (SD 15.9), also below the 55-70 µg/day reported to be optimal. This is the first report of selenium status in pregnancy on the island of Ireland. The possible combined effects of iodine and selenium deficiencies in pregnancy merit further investigation.

Clear cell meningioma of the fourth ventricle in a child: a case report and literature review.

Clear cell meningiomas are rare meningioma variants and are recognized as World Health Organization grade II tumours. They may be difficult to manage given their propensity to recur early especially if present in surgically challenging locations. We describe a rare case of a fourth ventricular clear cell meningioma without dural attachment in a 14-year-old boy with an unusual presentation of failure to thrive. The case is presented in detail and a review of the recent literature is discussed.

Care of children with brain and spine tumours - a review of practice.

Aims and method were to assess the current practice in paediatric tumour management by the departments of neurosurgery and oncology, compare these with nationally agreed recommendations and examine for areas of improvement. Patient records were identified from departmental databases - 30 patients treated from October 2004 to May 2006. Factors assessed included treatment timelines (e.g., referral to admission and imaging, admission to surgery, surgery to further treatment), imaging, MDT discussion, and paediatric neurosurgery & neuro-oncology treatments. Of acute referrals, all patients were admitted within 2 days. All surgery was undertaken by a dedicated paediatric neurosurgeon with paediatric anaesthesia. All cases were discussed in a neuro-oncology MDT prior to surgery and 97% after surgery. In the first 6-months 57% received adjuvant treatment within 40 days; in the remaining period this improved to 91%. When measured against recognised benchmark standards, the SCH paediatric neuro-oncology service appears satisfactory. This study has identified the need to improve certain aspects of care to offer further improvements to the specialist service delivered.

Congenital apocrine tumour: a rare scalp tumour.

We report a rare congenital scalp tumour with histological diagnosis of a congenital apocrine adenoma with features of a tubular adenoma. Following cranial CT and MRI, the tumour was serially excised. The macroscopic and microscopic appearances and management are discussed. To our knowledge, such a case has not been previously reported.

An exploratory study of teachers' knowledge about the symptoms of depression in young people with and without intellectual disabilities.

Research has shown that children and young people with intellectual disabilities are at a greater risk of developing a psychiatric disorder than their non-disabled peers. However, no information exists regarding teachers' knowledge of the signs and symptoms of these conditions. Using a postal questionnaire, 36 teachers working within schools for children and young people with severe intellectual disabilities in one part of the UK were asked about their knowledge of depression. Results indicated that the teachers reported few signs and symptoms. Furthermore, the teachers also highlighted a lack of confidence in working with this doubly disadvantaged population. This study shows that teachers have a vital role to play in the early recognition of psychiatric signs and symptoms in young people with intellectual disabilities. Teachers must also receive the appropriate education and training in an attempt to prompt early referral to specialists for a detailed and comprehensive psychiatric assessment rather than continuing to manage such young people's challenging behaviours.

Order and strain in main-chain smectic liquid-crystalline polymers and elastomers.

The layer correlations in main-chain smectic liquid-crystal polymer and elastomer systems have been studied using high-resolution X-ray scattering. In contrast to side-chain smectic polymers, in main-chain systems the polymer chains are oriented parallel to the layer normal. As a result they couple directly to the lamellar structure and any polymer defect is translated into layer distortions. For the homopolymers the resulting X-ray lineshapes are well described by Lorentzians. This is interpreted as an average of algebraically decaying order in domains with dimensions of hundreds of nm and a wide dispersion of sizes. The elastomers show much broader peaks than the correponding polymers. This is attributed to strong non-uniform strain within the finite-size domains due to defects of the layer structure.

The use of chemical restraint in helicopter transport.

INTRODUCTION: Helicopter transport of the combative patient is a major safety hazard facing air medical teams. Although physical restraints alone are helpful, the addition of chemical restraint (CR) often is necessary to control these patients while in flight. METHODS: A survey was conducted to determine the current practices of using nonparalyzing CR in air medical transport programs nationwide. The survey consisted of 24 questions on the use of CR during transport. Each U.S. program belonging to the Association of Air Medical Services was contacted by telephone, and a flight nurse or paramedic provided answers based on personal experience and statistics compiled by his or her individual program. RESULTS: Of the 100 programs responding, benzodiazepines were used most commonly to control agitation with 51% using micazolam. Patients with a head injury required CR more frequently than any other condition (73%). Crews flying larger aircraft reported less need for CR. A physician order was required by only 30% of the programs, but delays infrequently endangered the patient (2%). Only 7% of the responding programs had a patient whose condition deteriorated because of CR. CONCLUSION: CR is necessary in air medical transport. Most programs use short-acting benzodiazepines. Crews in smaller aircraft use CR more frequently, and head injury is the most common condition requiring such restraint.

The impact of computerization on nursing: an interview study of users and facilitators.

When health care settings are computerized, nurses' jobs are affected. Hospitals must understand this important phenomenon in order to develop the best possible implementation strategies that consider the impact nurses may experience. The goals of this study were the following: 1) to explore the personal and job-related effects of computerization on nurses; 2) to determine the factors that helped these nurses cope during the computerization process; and 3) to derive recommendations that could assist hospitals implementing computerization in future. Twenty nurses were identified by their peers as knowledgeable informants for a research interview: 10 staff nurse users and 10 nurse educators or administrators serving as facilitators of the change. The confidential interviews were analyzed using a grounded theory approach with constant comparative analysis of the emerging categories. The investigators developed a visual model showing six themes that have the greatest effect on the nurses: 1) time frame, 2) choice of software, 3) communication, 4) the change process, 5) training, and 6) leadership. These themes were considered within a broad hospital context, in which budget, nurse involvement, policy practice issues, and other concurrent projects also influenced nursing. In addition, personal characteristics of each nurse affected how each nurse experienced the change to computerization. Recommendations from the respondents addressed a wide range of factors that may be useful to other hospitals planning to implement computerization in nursing.

Impact of computerization on nursing: automated order entry, care planning, and implications for recruitment.

Very few empirical studies have been completed which verify the actual benefits of automation for nursing. This article provides an overview of the results and implications of five research studies undertaken at a Canadian Hospital to ascertain the impact of computerization on selected aspects of nursing. These studies found that nurses perceived few positive benefits for direct care givers when order entry, results reporting and care planning were automated. This article will be of particular interest to nurse administrators who are embarking on automation within their hospitals.

Effects of steroid D-ring modification on suicide inactivation and competitive inhibition of aromatase by analogues of androsta-1,4-diene-3,17-dione.

Analogues of androsta-1,4-diene-3,17-dione (3a) in which the D ring is modified were prepared and tested as suicide inactivators and competitive inhibitors of human placental aromatase. As long as the five-membered ring is intact, modifications of the D ring such as reduction or removal of the carbonyl group or conversion to a gamma-butyrolactone cause a less than 6-fold decrease in affinity for and rate of inactivation of aromatase, compared to 3a. Thus, an oxygen atom at C-17 is not required for binding of these inhibitors to aromatase, suggesting that hydrogen bonding to the D-ring oxygen does not play a major role in binding. Opening the D ring converts the cyclopentane ring to an alkyl chain and causes a greater than 300-fold decrease in affinity; this can be partially reversed by shortening the chain length. These results are consistent with a model in which the free chain of the opened D ring adopts conformations that sterically interfere with binding of the inhibitor to the enzyme. These findings may have practical applications in drug design, by allowing the preparation of 17-deoxo analogues that have high affinity for aromatase but that are not subject to reduction of the 17-carbonyl group, which is a major mode of metabolism of 3a.

[19-14C]androstenedione: a new substrate for assaying aromatase and studying its reaction mechanism.

[19-14C]Androstenedione has been prepared and utilized as a substrate for assaying microsomal human placental aromatase. Enzyme activity is determined by measuring the rate at which [14C]formate is produced by aromatization of this 14C-labeled steroid. Isotope ratio experiments using [19-14C]androstenedione and [1 beta-3H]androstenedione demonstrate that an apparent kinetic hydrogen isotope effect exists for the aromatization of the tritiated steroid with kH/kT approximately 1.09. Metabolic switching occurs to a minor extent (approximately 3%) during aromatization of [1 beta-3H]androstenedione, but not during the aromatization of [19-14C]androstenedione.

Inactivation of Streptomyces hydrogenans 20 beta-hydroxysteroid dehydrogenase by an enzyme-generated ethoxyacetylenic ketone in the presence of a thiol.

Replacement of the 21-methyl group of 20 beta-hydroxypregn-4-en-3-one with an ethoxyacetylene group yields a compound that is an excellent substrate (pH 7.4, Km = 2.3 microM, Vmax = 4.6 nmol min-1 micrograms-1) for the Streptomyces hydrogenans NAD(H)-dependent 20 beta-hydroxysteroid dehydrogenase (EC 1.1.1.53). The enzyme-generated ethoxyacetylenic ketone product is a potent inactivator of the enzyme. Gel filtration chromatography of enzyme inactivated with radiolabeled steroid demonstrates that covalent modification of the enzyme has occurred. Both NAD and NADH retard the rate of inactivation, suggesting that only free enzyme is susceptible to covalent modification. Consequently, enzymatically formed ethoxyacetylenic ketone does not react with the enzyme while it is part of the ternary complex. Moreover, the kinetically preferred release of this reactive ketone prior to NADH release assures that enzyme inactivation occurs only when released ketone subsequently encounters free enzyme. Kinetic analysis of inactivations carried out with chemically prepared ethoxyacetylenic ketone and enzyme at pH 7.4 and 9.2 yields bimolecular rate constants for the inactivation process of 1.15 X 10(4) L mol-1 s-1 and 6.94 X 10(4) L mol-1 s-1, respectively. This bimolecular reaction is faster than the bimolecular reaction of the ethoxyacetylenic ketone with either glutathione, mercaptoethanol, or dithiothreitol. Thus, complete inactivation by ketone generated from 5 microM alcohol and 5 microM NAD occurs in 30 min at pH 7.4 in the presence of 1 mM glutathione.

Northern Ireland twin study 1983.

Two hundred and fifty-three twin deliveries in Northern Ireland during 1983 were studied. A high perinatal mortality rate of 57 per 1000 births was found, over four times greater than the overall perinatal mortality rate for Northern Ireland in that year. The main cause of these losses remains premature delivery which is frequently complicated by fetal growth retardation. Serial ultrasound scanning in the third trimester is considered mandatory in order to reduce the incidence of undiagnosed fetal growth retardation in twins.

Studies of the inactivation of human placental aromatase by 17 alpha-ethynyl-substituted 10 beta-hydroperoxy and related 19-nor steroids.

The inactivation of human placental aromatase by 17 alpha-ethynyl-10 beta-hydroperoxy-17 beta-hydroxy-4-estren-3-one (SCH 10015) was investigated. In either the presence or absence of added NADPH, SCH 10015 (Ki = 41 microM) caused a time-dependent loss of aromatase activity (e.g. 50% loss after 20 min with 20 microM SCH 10015). Evidence for the oxidation of an active site sulfhydryl group as the molecular basis for SCH 10015 inactivation is presented. The contraceptive 17 alpha-ethynyl-substituted 19-nor steroids, norethisterone (Ki = 48 microM) and norethynodrel (Ki = 38 microM), were evaluated and found not to inactivate aromatase, suggesting that the potential conversion of either compound to SCH 10015 did not occur to a significant extent in these microsomal incubations. It is speculated that the previously observed potent contraceptive effects of SCH 10015 may have been the result of irreversible inhibition of estrogen biosynthesis.

Pregnancy-induced hypertension in twin pregnancy.

A prospective study of 54 primigravid twin pregnancies in Durban showed that pregnancy-induced hypertension occurred in 37%. This was more than twice the expected rate for singleton pregnancies in this Black African population. The babies born in the group of patients with pregnancy-induced hypertension were significantly lighter and had a higher rate of fetal growth retardation than the babies born in a normotensive control group of patients matched for age and parity. Monozygotic twins, identified by HLA typing, occurred significantly more often in the group with pregnancy-induced hypertension than in the control group. A possible immunological explanation for this finding is presented.