Black box towards glass box: 'Mapaloguing' a typology of public health CPD activities in UK in 2011/12.

Background: The 1996 Faculty of Public Health study of specialists continuing professional development (CPD) diaries indicated forward-looking approaches. There has been little substantive research on public health CPD records since. Methods: Mixed methods research assessed 795 CPD records/reflective notes from 2011/12. The quantitative methods aimed to analyse types of new learning; a qualitative sub-sample analysis of reflective standards will be reported elsewhere. Many current CPD categories were non-specific and situational, including conferences/workshops and learning as part of the job. These were later classified to a new CPD typology of 13 learning-orientated categories with sub-types. Results: Most (572 = 71.9%) activities fell into current FPH CPD categories that did not identify the learning topic. The new categorization identified four most common CPD learning types: about health protection topics, key specialist knowledge/skills, experiences handling new public health systems and educator/trainer requirements. Conclusions: This new typology illustrates wide-ranging CPD activities, including work-based opportunities from shifts in organizations and policies. A CPD 'Mapalogue' is proposed, with 'Mapaloguing' as an analytical research process, combining mapping of influences and direction of CPD alongside cataloguing actual CPD undertaken. This could inform individual professionals' choice menu for CPD and personal development and increase the profession's transparency and understanding of long-term trends.

Patients' Knowledge of Female Pelvic Health and Related Educational Preferences.

Many patients have a rudimentary knowledge of their body's anatomy and functioning. In a clinical setting, deficits in patient understanding can lead to miscommunication affecting patient care and satisfaction. Hence, this study aims to estimate a baseline of patient knowledge regarding pelvic anatomy and to assess their educational preferences in learning about related topics. For this cross-sectional study, we developed a 24-item assessment with questions related to pelvic anatomy, health, and function. The questionnaire was validated using feedback from anonymous community focus groups, and then distributed to English-speaking female patients at the Women's Clinic of LAC + USC Medical Center (Los Angeles). The participant performance as a percentage-correct score on the anatomy assessment constituted our primary outcome. As secondary outcomes, educational preferences were inquired. Statistical analysis was conducted using two-sample t tests. The majority of our total sample of 269 were Hispanic (65.4 %) with a mean age of 35.3 years. We documented deficits in patient knowledge with a mean score of 66.1 % correct on anatomy assessment. Statistically significant lower scores were associated with less education and with Hispanic/Latino origin. Additionally, we found that while physicians have played a role in health education, women prefer to receive more education from their providers in the future. The deficits we identified indicate the pressing need to improve the pelvic health literacy of our patients. Understanding what our patients know and want to know is critical to effective communication and is fundamental to providing better clinical care in the future.

Inferior vena cava thrombosis: a review of current practice.

Inferior vena cava (IVC) thrombosis remains under-recognised as it is often not pursued as a primary diagnosis. The aetiology of IVC thrombosis can be divided into congenital versus acquired, with all aetiological factors found among Virchow's triad of stasis, injury and hypercoagulability. Signs and symptoms are related to aetiology and range from no symptoms to cardiovascular collapse. Painful lower limb swelling combined with lower back pain, pyrexia, dilatation of cutaneous abdominal wall veins and a concurrent rise in inflammatory markers are suggestive of IVC thrombosis. Following initial lower limb venous duplex, magnetic resonance imaging (MRI) is the optimal non-invasive imaging tool. Aetiology directs treatment, which ranges from anticoagulation and lower limb compression to open surgery, with endovascular therapies increasingly favoured. The objective of this review is to assess current literature on the aetiology, presentation, investigation, treatment, prognosis and other factors pertaining to IVC thrombosis.

Laparoscopic adrenalectomy versus open adrenalectomy: results from a retrospective comparative study.

The relatively new operation of laparoscopic adrenalectomy has now become the procedure of choice for the management of most benign adrenal tumours. We have reviewed the data relating to the first 25 patients on whom we performed laparoscopic adrenalectomy and have made comparison with a group of 25 diagnosis-matched individuals on whom we had previously carried out open adrenalectomy. The patients who underwent laparoscopic adrenalectomy had a significantly shorter hospital stay and experienced significantly less postoperative morbidity than those who had an open operation, but the operation time was significantly longer for the laparoscopic group of patients. There is now good potential and sound evidence base for extending the indications for laparoscopic adrenalectomy.

Selective inhibition of the monosynaptic spinal reflex by a series of hydroxylated alkylaminoindans.

5-Hydroxy-2-piperidino-4,5,6,7-tetrahydroindan (5) and a number of related tetrahydro and dihydro compounds were prepared by selective mono- and dihydroxylation of the dihydro products from the Birch reduction of various alkylaminoalkylindans, tetralins, benzenes, and isoindolines. Some of these compounds showed a remarkably selective inhibition of monosynatpic spinal reflex in the segmental cat preparation.

7-Oxabicyclo[2.2.1]heptyl carboxylic acids as thromboxane A2 antagonists: aza omega-chain analogues.

A novel bicyclic prostaglandin analogue, [1S-[1 alpha, 2 alpha (Z), 3 alpha, 4 alpha]]-7-[3-[[[[(1- Oxoheptyl)amino]acetyl]amino]-methyl]-7-oxabicyclo[2.2.1]hept-2- yl]-5-heptenoic acid [-)-7) was found to be a potent and selective thromboxane A2 (TxA2) receptor antagonist. Unlike the related series of omega-chain allylic alcohols, amide 7 and its congeners were uniformly free of direct contractile activity in vitro (bovine coronary) and in vivo (anesthetized guinea pig). Amide 7 was effective in the inhibition of (a) arachidonic acid induced platelet aggregation of human platelet-rich plasma (I50 = 0.18 +/- 0.006 microM), (b) 11,9-epoxymethano-PGH2 induced platelet aggregation of human platelet-rich plasma (I50 = 0.24 microM), (c) 11,9-epoxymethano-PGH2 induced contraction of guinea pig trachea (Kb = 3.0 +/- 0.3 nM) or rat aorta (Kb = 8.8 +/- 1.1 nM), and (d) arachidonic acid induced bronchoconstriction in the anesthetized guinea pig (0.1-1.0 mg/kg iv). Amide 7 inhibited the binding of [5,6-3H2]-[1S- (1 alpha, 2 alpha (Z), 3 alpha, 4 alpha)]-7-[3-[[2-[(Phenyl- amino)carbonyl]hydrazino]methyl]-7-oxabicyclo[2.2.1]hept-2-yl]-5- heptenoic acid to human platelet membranes in a specific and saturable manner with a Kd = 49.6 +/- 1.4 nM.

9,11-epoxy-9-homoprosta-5-enoic acid analogues as thromboxane A2 receptor antagonists.

A novel bicyclic prostaglandin analogue, (1S)-[1 alpha, 2 alpha(Z),3 alpha(1E,3S*,4R*),4 alpha]-7-[3-(3-hydroxy-4-phenyl-1-pentenyl)-7- oxabicyclo[2.2.1]hept-2-yl]-5-heptenoic acid (4), was found to be a potent and selective thromboxane A2 (TxA2) receptor antagonist. Alcohol 4 was the only member in a series of allylic alcohols which did not display direct contractile activity in the rat stomach strip model. Alcohol 4 was effective in the inhibition of (a) arachidonic acid induced platelet aggregation of human platelet-rich plasma (I50 = 0.65 +/- 0.1 microM); (b) 11,9-epoxymethano-PGH2 induced contraction of guinea pig trachea (pA2 = 8.0 +/- 0.2) or rat aorta (pA2 = 8.1 +/- 0.2); and (c) arachidonic acid induced bronchoconstriction in the anesthetized guinea pig (1 mg/kg iv). A radioiodinated analogue of 4 bound in a specific and saturable manner to human platelet membranes with a Kd = 2.3 +/- 0.9 nM. Modification of the alpha-chain, in an attempt to minimize in vivo metabolism, resulted in TxA2 receptor antagonists of reduced in vitro potency.

Angiotensin-converting enzyme inhibitors: importance of the amide carbonyl of mercaptoacyl amino acids for hydrogen bonding to the enzyme.

A series of mercaptoacyl amino acids and related compounds was synthesized and evaluated for inhibition of angiotensin-converting enzyme (ACE) in order to determine the nature and importance of the putative interaction between ACE and the amide moiety of inhibitors such as captopril (3-mercapto-2-methylpropanoyl-L-proline). It was concluded that the interaction involves a hydrogen bond from a donor site on ACE to the oxygen of the amide carbonyl. Compounds in which the amide moiety is replaced by other groups (ester, ketone, sulfonamide) capable of accepting a hydrogen bond are effective inhibitors, but compounds in which only the geometrical features of the amide are retained are ineffective inhibitors. The presence of an NH group is not necessary for effective inhibition. The activity of a series of mercaptoacyl cycloalkyl carboxylic acids parallels the activity of the isosteric series of mercaptoacyl imino acids.

Introduction of an automated service for the laboratory confirmation of meningococcal disease in Scotland.

The Scottish Meningococcus and Pneumococcus Reference Laboratory provides a national service for the laboratory confirmation of meningococcal and pneumococcal disease in Scotland. The main tests used for the laboratory confirmation of meningococcal disease are culture, the polymerase chain reaction (PCR), antibody testing, and more recently DNA sequencing. This paper describes the automation of PCR for the laboratory confirmation of meningococcal disease and the typing of meningococcal isolates using DNA sequencing. Both methods have been automated using a robotic liquid handler and automated DNA sequencer. These methods, along with standard culture phenotyping and antibody testing, provide Scotland with an excellent service for the confirmation of meningococcal disease.

CDC WONDER: a cooperative processing architecture for public health.

CDC WONDER is an information management architecture designed for public health. It provides access to information and communications without the user's needing to know the location of data or communication pathways and mechanisms. CDC WONDER users have access to extractions from some 40 databases; electronic mail (e-mail); and surveillance data processing. System components include the Remote Client, the Communications Server, the Queue Managers, and Data Servers and Process Servers. The Remote Client software resides in the user's machine; other components are at the Centers for Disease Control and Prevention (CDC). The Remote Client, the Communications Server, and the Applications Server provide access to the information and functions in the Data Servers and Process Servers. The system architecture is based on cooperative processing, and components are coupled via pure message passing, using several protocols. This architecture allows flexibility in the choice of hardware and software. One system limitation is that final results from some subsystems are obtained slowly. Although designed for public health, CDC WONDER could be useful for other disciplines that need flexible, integrated information exchange.

Infection of staff during an outbreak of viral gastroenteritis in an elderly persons' home.

An outbreak of viral gastroenteritis in an elderly persons' residence is reported. Seventeen of 37 (47%) residents and 22 of 50 (44%) staff developed illness. Adenovirus was seen by direct electron microscopy in two vomitus and two faeces specimens. It is suggested that the most likely mode of transmission was environmental contamination by vomitus.

Was Anopheles donaldi a vector of malaria in Kuala Lumpur, Malaysia, in the past?

Anopheles donaldi Reid, a member of the A. barbirostris species group, is a vector of human filariasis and probably malaria. The discovery of some old specimens of this species, collected in Kuala Lumpur town where it no longer occurs, together with evidence from the literature about past malaria in the town, suggest that donaldi may have played a part in transmitting that malaria.

Development and testing of artificial low-frequency speech codes.

In a new approach to the frequency-lowering of speech, artificial codes were developed for 24 consonants (C) and 15 vowels (V) for two values of lowpass cutoff frequency F (300 and 500 Hz). Each individual phoneme was coded by a unique, nonvarying acoustic signal confined to frequencies less than or equal to F. Stimuli were created through variations in spectral content, amplitude, and duration of tonal complexes or bandpass noise. For example, plosive and fricative sounds were constructed by specifying the duration and relative amplitude of bandpass noise with various center frequencies and bandwidths, while vowels were generated through variations in the spectral shape and duration of a ten-tone harmonic complex. The ability of normal-hearing listeners to identify coded Cs and Vs in fixed-context syllables was compared to their performance on single-token sets of natural speech utterances lowpass filtered to equivalent values of F. For a set of 24 consonants in C-/a/ context, asymptotic performance on coded sounds averaged 90 percent correct for F = 500 Hz and 65 percent for F = 300 Hz, compared to 75 percent and 40 percent for lowpass filtered speech. For a set of 15 vowels in /b/-V-/t/ context, asymptotic performance on coded sounds averaged 85 percent correct for F = 500 Hz and 65 percent for F = 300 Hz, compared to 85 percent and 50 percent for lowpass filtered speech. Identification of coded signals for F = 500 Hz was also examined in CV syllables where C was selected at random from the set of 24 Cs and V was selected at random from the set of 15 Vs. Asymptotic performance of roughly 67 percent correct and 71 percent correct was obtained for C and V identification, respectively. These scores are somewhat lower than those obtained in the fixed-context experiments. Finally, results were obtained concerning the effect of token variability on the identification of lowpass filtered speech. These results indicate a systematic decrease in percent-correct score as the number of tokens representing each phoneme in the identification tests increased from one to nine.

Postventriculotomy aneurysm and left ventricular dysfunction following closed mitral commissurotomy.

A ventricular aneurysm at the site of a previous transventricular commissurotomy for mitral stenosis was diagnosed in a 39 year old female. Catheterization data showed abnormal left ventricular response to exercise and to increased afterload. Death occurred following mitral valve replacement. At autopsy no cause other than left ventricular aneurysm could be established to explain left ventricular dysfunction.

Determination of neomycin in animal tissues by liquid chromatography.

Tissue samples are digested under hot alkaline conditions after initial conditioning at room temperature with phosphate-buffered saline. The cooled digest is deproteinated with concentrated perchloric acid. After centrifugation and pH adjustment, the clear supernatant is applied to an ion-exchange cartridge, and after the cartridge is washed, the neomycin is eluted with dilute perchloric acid. This eluate is derivatized with 9-fluorenylmethyl chloroformate prior to liquid chromatography using a wide-pore spherical silica C4 column and fluorescence detection. Recovery and repeatability are calculated from tissue extract standard calibration curves produced from the same assay. Recoveries ranged from 80 to 120% for fortifications of 0.25-1.00 mg/kg for muscle tissue and from 80 to 100% for fortifications of 0.50-10.0 mg/kg for kidney tissue. Limits of quantitation were 0.25 and 0.50 mg/kg, respectively, for muscle and kidney tissues. Limits of detection were 0.125 and 0.20 mg/kg, respectively, for muscle and kidney tissues.

Aneurysm of the inferior vena cava.

Aneurysms of the inferior vena cava (IVC) are extremely rare, with a range of reported presentations including deep venous thrombosis. Computerised Tomography (CT) and Magnetic Resonance Imaging (MRI) scans are suggested appropriate diagnostic imaging modalities, but even then it may not be possible to differentiate between an IVC aneurysm and a retroperitoneal tumour. This case illustrates that an IVC aneurysm should be considered in the differential diagnosis of a retroperitoneal tumour.

Technetium and uranium: sorption by and plant uptake from peat and sand.

The objectives of this study were to compare the effects of technetium and uranium on the yield and uptake, and to identify the organ of accumulation, of an edible leafy vegetable growing in sandy and peaty soils. In sand, where the soil's sorption capacity is negligible, technetium uptake is four orders of magnitude higher than from peat, suggesting no plant mediation of uptake and thus a constant concentration factor (greater than 50) in an oxidizing environment where technetium is continuously supplied. The technetium is predominantly translocated to the shoots. When soil fixation occurs, as in peat, this becomes the controlling factor in the plant uptake of technetium. In the case of uranium, plant mediation is more significant. Uranium uptake by Swiss chard is up to 80 times higher from sand than from peat. The uranium is restricted to the root system and may only be precipitated on the outer root membrane and may not accumulate in the roots.

Computer control of an Imed 929 infusion pump.

There is a growing interest in the potential benefits to be obtained from closed-loop control of drug infusion [1-5]. The most widely available infusion pump which is specifically designed for control by computer is the 929 volumetric infusion pump produced by Imed. The increasing availability of microcomputers suggests that they will be used more frequently to control such pumps. However, difficulties can arise when the attempt is made to establish communication between the computer and the pump [6] and a method employed for this purpose is described in this article. The aim was to provide a simple method of conducting the required communication between the computer and the pump using a high-level language. The commands specified in the high-level language are passed to a machine-code subroutine which organizes transmission to and receives data from the pump.

Computer control of a Braun Infusomat pump.

Machine code programs have been produced to allow a simple method of communication between a computer and the Braun Infusomat pump. Commands are set up as character strings using a high-level language and passed to a machine code program which transmits them to the pump. Messages from the pump are received under interrupt control for display by the high-level language. Any error in communication is stored in memory and the appropriate action taken by the main application program.