Rare and declining bird species benefit most from designating protected areas for conservation in the UK.

There have been recent renewed commitments to increase the extent of protected areas to combat the growing biodiversity crisis but the underpinning evidence for their effectiveness is mixed and causal connections are rarely evaluated. We used data gathered by three large-scale citizen science programmes in the UK to provide the most comprehensive assessment to date of whether national (Sites of Special Scientific Interest) and European (Special Protection Areas/Special Areas of Conservation) designated areas are associated with improved state (occurrence, abundance), change (rates of colonization, persistence and trend in abundance), community structure and, uniquely, demography (productivity) on a national avifauna, while controlling for differences in land cover, elevation and climate. We found positive associations with state that suggest these areas are well targeted and that the greatest benefit accrued to the most conservation-dependent species since positive associations with change were largely restricted to rare and declining species and habitat specialists. We suggest that increased productivity provides a plausible demographic mechanism for positive effects of designation.

Binding and degradation of semisynthetic tritiated insulin by IM-9 cultured human lymphocytes.

Insulin was tritiated by semisynthetic replacement of the amino-terminal phenylalanine of the B chain with tritiated phenylalanine. At 15 degrees C, (3H) insulin bound to high affinity receptors on IM-9 cultured human lymphocytes with an affinity constant of about 3 x 10(9) M-1, The Scatchard plot was curvilinear. At 37 degrees C, maximal binding occurred after about 15 min of incubation. Binding fell thereafter due to degradation of insulin by the extracellular fluid. The major degradation product after 120 min coeluted with insulin from Sephadex G50 and was precipitated by anti-insulin antibody but to a lesser degree than intact insulin. It had little or no biologic activity as assessed by binding to IM-9 lymphocytes. The cell-associated radioactivity was also eluted as a single peak on Sephadex G-50. In contrast to the degradation product, this material retained its ability to bind to insulin receptors. We deduce that this cell-associated material contains the entire A chain, most of the B chain, and is probably native insulin. These data show that insulin bound to IM-9 lymphocytes remains biologically intact.

Human interleukin-5 expressed in Escherichia coli: assignment of the disulfide bridges of the purified unglycosylated protein.

Human interleukin-5 is a homodimer; each subunit contains two cysteine residues that form two inter-subunit disulfide bonds. The topology of the disulfides in recombinant human interleukin-5 produced in Escherichia coli was studied by proteolytic digestion and peptide mapping. Disulfide linked peptides containing cysteine 42 linked to cysteine 84 were isolated. This indicated that cysteines 42 and 84 of one subunit were linked in an antiparallel manner to cysteines 84 and 42 of the other subunit.

Cure of colon cancer metastasis in rats with the new lipid A OM 174. Apoptosis of tumor cells and immunization of rats.

The antitumoral effect of the new lipid A OM 174 was investigated in a model of colon cancer in rats. Peritoneal carcinomatosis were induced in BDIX rats by intraperitoneal injection of syngeneic PROb cancer cells. The treatment started 2 weeks later, when rats had macroscopic peritoneal nodules. An antitumoral effect was first obtained with OM 174 intraperitoneally injected, then an intravenous treatment was developed. When injected 15 times intravenously, at the dose of 1 mg/kg, 2 days apart, OM 174 induced the complete regression of tumors and hemorrhagic ascitis in 90% of the tumor-bearing rats, whereas all the untreated rats died of their tumors. To our knowledge, this treatment is the most effective ever applied to macroscopic tumors. Furthermore, the treatment induced the immunization of rats since the reinjection of PROb tumor cells in OM 174-cured rats did not cause the formation of new tumors while injection of another syngenic colon tumor cells did. Only in treated rats tumors were infiltrated with lymphocytes, macrophages and fibroblasts. The treatment did not increase necrosis but generated apoptotic areas. OM 174 was not directly toxic for tumor cells, and thus the observed effect involved the host-mediated antitumor reaction. Therefore we hypothesize that OM 174 therapy induces tumor cell apoptosis, stimulates the phagocytosis of apoptotic bodies and then activates immune system by antigen presentation.

A test procedure for evaluating surgical hand disinfection.

A technique for assessing the immediate and prolonged efficacy of surgical scrubs and alcoholic hand rubs is described. A mean baseline count is obtained from all volunteers and logarithmic reductions in resident skin flora immediately after one or more applications, and after wearing gloves for 3 h, are measured. Loose-fitting surgical gloves are used for sampling resident flora. Preparations were applied using a standard technique for 2 min, apart from one test with 70% isopropanol (IPA) in which the application time was 30 s. Two studies are described, one of which compared four chlorhexidine scrubs, and the second 70% IPA, 7.5% povidone-iodine scrub, 2% triclosan cleanser and unmedicated bar soap. In spite of their constituent similarity, the four chlorhexidine scrubs varied considerably in efficacy and user acceptability. A 2 min application of 70% IPA was the most effective treatment, and gave log10 reductions of 1.65 for immediate and 1.58 for prolonged effect. This was marginally more effective than a 30 s application, but the difference was not significant. 'Hibiscrub' was the most effective aqueous formulation and gave reductions of 1.01 for immediate effect and 1.16 for prolonged effect. The test described could be used by reference centres and manufacturers to assess the efficacy of new and existing surgical hand disinfection formulations.

Contamination of protective clothing and nurses' uniforms in an isolation ward.

Staphylococcus aureus was frequently isolated, usually in small numbers, from cotton gowns (12.6 per cent), plastic aprons (9.2 per cent) and nurses' uniforms (15 per cent). Gram-negative bacilli were infrequently isolated. Contamination of the protective clothing did not increase when used over periods of up to 11 days. Fewer organisms were recovered from the front of nurses' uniforms when plastic aprons instead of gowns were worn, but gowns provided better shoulder protection. However, no differences were observed in isolations of Staph, aureus or Gram-negative bacilli from these sites.

Hand disinfection: a comparison of various agents in laboratory and ward studies.

The efficacy of 14 handwashing or disinfectant preparations was compared in laboratory tests on staff volunteers. The test organism, Escherichia coli, was applied to the fingertips and log reductions (LR) were measured following treatment with the test agent and control preparations (70% isopropanol and non-medicated bar soap). Alcoholic preparations, particularly n-propanol and isopropanol were the most effective showing LRs of 3.1-3.8. Chlorhexidine (LR 2.9) and povidone-iodine detergent preparations were significantly more effective than non-medicated soap (LR 2.1), but triclosan products were not. In addition the residual effect of several of these formulations was assessed after 10 applications by comparing the survival of E. coli on the fingertips over a 32-min period. This number of handwashes compares favourably with those recorded during an 8 h nursing shift. Chlorhexidine-detergent consistently showed the best residual activity. Alcoholic formulations showed little or no residual effect. The survival studies show that on the whole gram-positive organisms (Staphylococcus aureus and Candida albicans) survive better on the skin than Gram-negative bacilli (GNB). However, it would seem that GNB which are considered to be residents (Acinetobacter calcoaceticus and Enterobacter spp.) survive much better than many other GNB (Pseudomonas aeruginosa, E. coli and Proteus vulgaris). The Klebsiella species varied in survival times. Random sampling of ward staff hands showed that contamination with S. aureus and GNB was greater in dermatological and general wards than in an isolation unit, where handwashing or disinfection was carried out after every patient contact. No cross-infection occurred in the isolation ward during periods of study in which 70% alcohol, chlorhexidine-detergent and non-medicated soap were used.

A test for the assessment of 'hygienic' hand disinfection using rotavirus.

A standardized test procedure is described in which finger tips are inoculated with bovine rotavirus. The level of virus recovered after disinfection of artificially contaminated hands with various disinfectant detergents, alcoholic solutions and alcoholic formulations was determined. The method was found to be easy to perform and reproducible. The most efficient method for removal of virus from fingertips was found to be treatment with alcoholic solutions or products. Soap and water and disinfectant detergents were found to be a much less effective method of removing virus from contaminated hands.

Preliminary study of test methods to assess the virucidal activity of skin disinfectants using poliovirus and bacteriophages.

Two tests for assessing the virucidal activity of antiseptics are proposed. These involve applying either poliovirus (vaccine strain Sabin 1 an) or Escherichia coli bacteriophage (MS2 or K1-5) to the fingertips. Both test viruses are considered safe although poliovirus may be unacceptably tolerant to antiseptics. The use of bacteriophages as test organisms precludes the need for sophisticated recovery systems and can be undertaken readily by any bacteriology laboratory. The virucidal activity of 70%, 80% and 90% ethanol, 7.5% povidone-iodine, and soap and water was assessed using these tests. Thorough cleansing, followed by disinfection with 90% ethanol, was the most effective treatment. Removal of viruses from the gloved hand was also assessed and this was found to be more easily achieved than cleaning and disinfecting the ungloved hand. Wearing gloves protects the hands from viral contamination but changing them after each patient or contact is expensive.

Disinfection of hands and tubing of CAPD patients.

During a 3 month study the effectiveness of two methods of handwashing was assessed in a group of 31 patients undergoing continuous ambulatory peritoneal dialysis. A defined, double rinse with alcohol, prior to bag exchange, was found to be more convenient and significantly more effective than povidone-iodine alone or povidone-iodine followed by alcohol. Spraying the tubing around the bag connector with 70 per cent ethanol reduced the numbers of adherent skin organisms so reducing the likelihood of bacteria being drawn into the dialysate. Although there was no difference in the overall incidence of peritonitis in the two groups of patients studied, there was an unexpected drop in the incidence of peritonitis caused by coagulase-negative skin staphylococci. This was attributed to an overall awareness of the importance of handwashing and aseptic procedures during bag exchange. Monitoring the bacteriology of the catheter exit site may give some prior indication as to the likelihood of subsequent peritonitis especially with Staphylococcus aureus and Gram-negative bacilli.

A comparison of pre-operative bathing with chlorhexidine-detergent and non-medicated soap in the prevention of wound infection.

In a 60-week cross-over study on 5536 patients in 20 wards of three city hospitals (two general and one orthopaedic), pre-operative bathing with chlorhexidine-detergent failed to influence the incidence of postoperative infection, in spite of the relatively high incidence of infection with skin organisms. Of the patients bathing pre-operatively with chlorhexidine-detergent, 5.4 per cent subsequently became infected (4.0 per cent of clean wounds) and of those bathing with unmedicated soap 4.9 per cent (3.5 per cent of clean wounds). A single pre-operative bath with chlorhexidine-detergent would, therefore, appear to be of dubious value in preventing postoperative wound infection.

Hygienic hand disinfection tests in three laboratories.

A comparative study was made in three laboratories of a test for hygienic hand disinfection. Staphylococcus aureus was applied to the fingertips of a total of 74 volunteers (49 female and 25 male) and the effect of washing with three chlorhexidine preparations and one non-medicated soap was assessed after one and five applications. Fingertip inoculation is convenient and is a realistic representation of the in-use situation. Although significant differences were obtained between log10 reductions in test organisms using the same formulation in different centres, and different periods in the same centre, the maximum differences after a single application of a preparation were small, e.g. between centres 0.39 and between periods in the same centre 0.55, and after multiple applications the maximum difference between centres was 0.42 and between periods in the same centre it was 0.51. The differences between preparations were similar in all centres. This test compares well with other similar tests and products can be placed in rank order of effectiveness. It is concluded that this test, if carried out under the controlled conditions described, is sufficiently reproducible between laboratories and repeatable within laboratories to be used as a standard test.

Comparison of film, hard copy computed radiography (CR) and soft copy picture archiving and communication (PACS) systems using a contrast detail test object.

This paper describes two experiments where a widely available test object (FAXIL TO20) was used to compare film, hard copy computed radiography (CR) and soft copy picture archiving and communication systems (PACS) images. Baseline images were produced with a fixed mAs. All images were scored by four experienced medical physicists. Contrast detail curves for the three types of images were almost identical. A second series of images was produced with the mAs varying from 1 mAs to 250 mAs. The contrast detail curves were plotted for each mAs value and the wider exposure latitude of CR compared with film was demonstrated. Use of PACS provided no further increase in exposure latitude. The density of the film images increased with mAs but the density of the CR hard copy images remained constant. It is of concern that the wider latitude of the CR images extends to exposures that are much higher than those used for film with no noticeable change in CR image density but with better images at higher exposures, because the potential exists for patient doses to increase. Hard copy CR images provide information about the exposure index which relates to the input dose to the plate and hence approximately to the dose to the patient. However, since such information is currently not available on default soft copy images, the authors suggest that all manufacturers of PACS should provide an indication of dose as a mandatory default setting.

Effect of ibuprofen on blood pressure control by propranolol and bendrofluazide.

The effect of 1600 mg/day ibuprofen in two groups of patients with hypertension controlled by either propranolol or bendrofluazide was studied in a double-blind, double-placebo, randomized crossover trial. No significant difference in blood pressure was found at the end of the crossover period in either group, suggesting that the routine co-administration of ibuprofen does not attenuate the anti-hypertensive effect of thiazide diuretics or propranolol. Significant weight gain, attributable to fluid retention, had occurred in the bendrofluazide-treatment group by the end of the drug-free washout period. No significant change in mean weight occurred in the crossover stages in either group, although substantial weight gain was noted during ibuprofen treatment in two patients given bendrofluazide and one given propranolol. Biochemical variables were unaffected by ibuprofen throughout the crossover period. This study suggests that ibuprofen may be administered routinely to patients receiving thiazides or propranolol without loss of control of the anti-hypertensive action of these drugs but it is recommended that individuals are monitored for possible weight gain or an increase in diastolic blood pressure.

A joint approach to treating dental phobics between community dental services and specialist psychotherapy services--a single case report.

A 41-year-old male patient presented at the local dental hospital requesting treatment under IV sedation, a treatment that he had had for the past 25 years. The patient was referred to the specialist psychotherapy services for cognitive behavioural therapy (CBT), and received a 1 hour course of therapy. He was then introduced to dental services, and at this visit had a check-up, OPG, and treatment planning discussion. At a subsequent visit he had local anaesthetic, three fillings, and a scale and polish. The patient is now able to return to general dental practice, after only a brief therapeutic intervention, and subsequent dental treatment. The present and future cost saving to the NHS is substantial compared with the treatment method initially sought by the patient.

Women's views on and adherence to low-molecular-weight heparin therapy during pregnancy and the puerperium.

BACKGROUND: Non-adherence to prescribed medication represents a significant factor associated with treatment failure. Pregnant women identified at risk of venous thromboembolism are increasingly being prescribed low-molecular-weight heparin (LMWH) during pregnancy and the puerperium. It is important to understand women's views on and adherence to LMWH during pregnancy and the puerperium, so that women gain maximum benefit from the treatment. OBJECTIVES: To monitor women's adherence to enoxaparin, when prescribed during pregnancy and the puerperium, and explore their beliefs about the enoxaparin therapy prescribed. PATIENTS/METHODS: A prospective cohort study involving 95 nullparous and multiparous women prescribed enoxaparin for recognized antenatal indications. Adherence to enoxaparin was assessed through self-completion of a diary, additionally verified through laboratory tests. An adapted beliefs about medication questionnaire was administered to women during their pregnancy. RESULTS: Women were highly adherent to enoxaparin: antenatally, mean percentage adherence 97.92%; postnatally, mean percentage adherence 93.37% (paired t-test, P = 0.000). In the cohort of women we followed, their perceived necessity for enoxaparin therapy outweighed any concerns they had regarding enoxaparin antenatally, necessity-concerns differential 2.20. In some women, however, this perceived necessity does decrease postnatally. CONCLUSIONS: Our results suggest that most women prescribed enoxaparin are highly adherent to their therapy during the antenatal period and that women's antenatal beliefs about enoxaparin are able to predict a decrease in postnatal adherence. Our results have important clinical implications, particularly when women are initiated on LMWH just during the postnatal period.

A joint approach to treating dental phobia: a re-evaluation of a collaboration between community dental services and specialist psychotherapy services ten years on.

OBJECTIVE: To audit the records of a group of patients who had previously benefited from cognitive behavioural therapy (CBT) for dental phobia. AIM: To ascertain if they had returned to the use of intravenous (IV) sedation to facilitate dental treatment. Ten years ago these patients were routinely requiring IV sedation to facilitate dental treatment due to severe dental phobia. METHOD: Sixty patients entered the original pilot project. Of those, 30 were offered CBT and 21 attended. Twenty of those patients (95.2%) were subsequently able to have dental treatment without IV sedation. In this follow-up study the electronic records of 19 of the 20 patients who had originally been successful with CBT were re-audited. Our purpose was to see if there was any record of subsequent IV sedation administration in the intervening ten years. RESULTS: Of the 19 successful CBT patients available to follow-up, 100% had not received IV sedation since the study ten years ago. This may suggest the initial benefit of CBT has endured over the ten-year period. CONCLUSION: This study indicates that the use of CBT for patients with dental phobia proves beneficial not only in the initial treatment but that the benefits may endure over time. This results in a significant reduction in health risks to the patient from repeated IV sedation. It may also translate into significant financial savings for dental care providers. Our evidence for CBT as treatment for dental phobia suggests dental services should be implementing this approach now rather than pursuing further research.

Potential subtherapeutic linezolid and meropenem antibiotic concentrations in a patient with severe burns and sepsis.

Altered pharmacokinetics in patients with major burns may result in serum antibiotic concentrations below those required to be effective against the common pathogens encountered in burns patients. The major changes in the fluid volumes of key body compartments, which occur with a large burn, may increase the apparent volume of distribution of a drug, thereby lowering its concentration when a standard dose is given. In addition, the observed increase in renal blood flow reported in burns patients, because of the change in cardiac output, may result in a higher drug clearance and a shorter elimination half-life. As a consequence, studies have recommended higher doses or more frequent dosing or both for some antibiotics in patients with major burns, but data are lacking for many of the antibiotics reserved for treatment of life-threatening infections. The authors measured serum concentrations of two antibiotics, linezolid and meropenem, in an immunosuppressed patient who presented with a severe burn to determine whether therapeutic concentrations were achieved, thereby improving the likelihood of infection control.