Shared decision making: audiology student perspectives.

Introduction: Shared decision making is a concept in healthcare that actively involves patients in the management of their condition. The process of shared decision making is taught in clinical training programmes, including Audiology, where there are several options for the management of hearing loss. This study sought to explore the perception of Healthcare Science (Audiology) student views on shared decision making. Methods: Twelve students across all years of the BSc Healthcare Science degree took part in three semi-structured focus groups. Four students were work-based learners, and eight students were enrolled on the standard pathway. Data were analysed using Thematic Analysis. Results: Students' definition and understanding of shared decision making was influenced by three key factors that were based on using a range of resources, implementation of a decision aid, and recognising Ida Institute as a pinnacle of shared decision making. Students also identified their roles as the future of healthcare workforce and the importance of disseminating best practice. Conclusion: Shared decision making is valued by students in their roles as healthcare trainees. This study data will enhance teaching practices for healthcare science students in audiology training. Future research involving patient views in clinical training is vital.

Potential Use of Multiplex PCR in Diagnosis of Tuberculous Meningitis.

Accurate and rapid diagnosis of tuberculous meningitis (TBM) is important for early administration of treatment. In this study, we have evaluated the diagnostic value of smear, culture, multiplex PCR and GeneXpert MTB/RIF to detect M. tuberculosis in cerebrospinal fluid (CSF) samples from patients with suspected TBM registered in Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia. Of the 55 CSF samples collected, 12 (21.8%) samples were positive by multiplex PCR, 3 (5.4%) by GeneXpert MTB/RIF and only 1 (1.8%) by smear and culture. Multiplex PCR showed higher sensitivity to detect M. tuberculosis in patients with suspected TBM and has the potential to be used as a diagnostic method.

60 dB high-extinction auto-configured Mach-Zehnder interferometer.

Imperfections in integrated photonics manufacturing have a detrimental effect on the maximal achievable visibility in interferometric architectures. These limits have profound implications for further technological developments in photonics and in particular for quantum photonic technologies. Active optimization approaches, together with reconfigurable photonics, have been proposed as a solution to overcome this. In this Letter, we demonstrate an ultrahigh (>60 dB) extinction ratio in a silicon photonic device consisting of cascaded Mach-Zehnder interferometers, in which additional interferometers function as variable beamsplitters. The imperfections of fabricated beamsplitters are compensated using an automated progressive optimization algorithm with no requirement for pre-calibration. This work shows the possibility of integrating and accurately controlling linear-optical components for large-scale quantum information processing and other applications.

The effect of infection history on the fitness of the gastrointestinal nematode Strongyloides ratti.

SUMMARY: Hosts in nature will often acquire infections by different helminth species over their lifetime. This presents the potential for new infections to be affected (particularly via the host immune response) by a host's history of previous con- or hetero-specific infection. Here we have used an experimental rat model to investigate the consequences of a history of primary infection with either Nippostrongylus brasiliensis, Strongyloides venezuelensis or S. ratti on the fitness of, and immunological response to, secondary infections of S. ratti. We found that a history of con-specific, but not hetero-specific, infection reduced the survivorship of S. ratti; the fecundity of S. ratti was not affected by a history of either con- or hetero-specific infections. We also found that a history of con-specific infection promoted Th2-type responses, as shown by increased concentrations of total IgE, S. ratti-specific IgG1, rat mast cell protease II (RMCPII), IL4 (but decreased concentrations of IFNgamma) produced by mesenteric lymph node cells in response to S. ratti antigen. Additionally, S. ratti-specific IgG1 was positively related to the intensity of both primary and secondary infections of S. ratti. Hetero-specific primary infections were only observed to affect the concentration of total IgE and RMCPII. The overall conclusion of these experiments is that the major immunological effect acting against an infection is induced by the infection itself and that there is little effect of prior infections of the host.

Hypothalamic-pituitary-adrenal axis function and the cellular immune response in former preterm children.

CONTEXT: Animal data suggest that adverse early experiences may affect endocrine and immune functioning in later life. OBJECTIVE: Our objective was to assess the impact of preterm delivery on hypothalamus-pituitary-adrenal axis functioning, heart rate responses, and immune function. PARTICIPANTS: Former preterm children [aged 8-14 yr (n = 18)], sex and age-matched full-term born control children (n = 18), data on birth weight, gestational age, birth weight for gestational age (in sd units), actual body weight, height, and body mass index were assessed. DESIGN AND OUTCOME MEASURES: Subjects were exposed to a standardized laboratory stressor ("Trier Social Stress Test for Children"). Cortisol in saliva was determined in 10-min intervals before and after the stress test; heart rates were obtained continuously during the stress test. Additional assessment of saliva cortisol was performed: 1) on 3 consecutive days after awakening and at +10, +20, and +30 min (morning cortisol); and 2) at 0800, 1400, 1600, and 1900 h (short diurnal profile). Measurement of the delayed type hypersensitivity reaction to seven recall antigens [Multitest cellular mediated immunity (Multitest-Immignost, Biosyn, Fellbach, Germany)]. RESULTS: Exposure to the Trier Social Stress Test for Children yielded significantly increased cortisol levels [F (8, 232) = 19.86; P < 0.001] and heart rates [F (38, 988) = 10.46; P < 0.001], however, no difference between former preterms and full-terms could be observed. No between-group differences were found in the short diurnal cortisol profile. Former preterms showed significantly higher cortisol levels after awakening [F (3, 102) = 3.14; P < 0.05]. In addition, a significantly suppressed delayed type hypersensitivity response [reduced number of positive antigens (t = -2.64, P < 0.05); induration (t = -2.4, P < 0.05)] was found in former preterms. CONCLUSION: The data suggest that preterm delivery may be associated with altered endocrine and immune functions well into late childhood.

The immune response during a Strongyloides ratti infection of rats.

A range of immune parameters was measured during a primary infection of Strongyloides ratti in its natural rat host. The immune parameters measured were interleukin-4 (IL-4) and interferon-gamma from both the spleen and mesenteric lymph node (MLN) cells; parasite-specific immunoglobulin G(1)(IgG(1)), IgG(2a) and IgG(2b) in serum and in intestinal tissue; parasite-specific IgG and total IgE in serum; parasite-specific and total IgA in intestinal tissue and rat mast cell protease II in intestinal tissue. Parasite-specific IgG(1), IgG(2a) and total IgE in serum and parasite-specific IgA and rat mast cell protease II in intestinal tissue all occurred at significantly greater concentrations in infected animals, compared with non-infected animals. Similarly, the production of IL-4 by MLN cells stimulated with parasitic female antigen or concanavalin A occurred at significantly greater concentrations in infected animals, compared with non-infected animals. In all, this suggests that there is a T-helper 2-type immune response during a primary S. ratti infection. These data also show the temporal changes in these components of the host immune response during a primary S. ratti infection.

The reversibility of constraints on size and fecundity in the parasitic nematode Strongyloides ratti.

The size and fecundity of parasitic nematodes are constrained by the host immune response. For the parasitic nematode of rats, Strongyloides ratti, parasitic females infecting immunized rats are smaller and less fecund than those infecting naïve rats. Here, we investigated whether these constraints on size and fecundity are life-long. This was done by comparison of worms from different immunization and immunosuppression regimes. It was found that the per capita fecundity of parasitic females of S. ratti is fully reversed, but that their size is only partially reversed, if previously immunized hosts are subsequently immunosuppressed, suggesting that fecundity is not subject to life-long constraints. The host immune response also resulted in allometric changes in the parasitic females. The significance of these results with respect to the growth and control of nematode fecundity are discussed.

An attempt to artificially select Strongyloides ratti for resistance to the host immune response.

Previous work has selected Heligmosomoides polygyrus for increased survival and reproduction in hosts with prior exposure to H. polygyrus, and therefore 'immune' to this parasite. We investigated whether Strongyloides ratti would respond similarly to selection for survival and reproduction in S. ratti-immune hosts. During 32 generations of selection, there appeared to be an initial, brief response to this selection, but this was not sustained and, eventually, the immune-selected line died out. Specific measures of the response to selection at generations 6, 12 and 25 did not detect any significant response to selection. Therefore, we have failed to select a line of S. ratti for increased resistance to its host immune response.

The effect of the host immune response on the parasitic nematode Strongyloides ratti.

The host immune response has profound effects on parasitic nematode infections. Here we have investigated how a range of infection parameters are affected by host immune responses and by their suppression and enhancement. The infection parameters considered were the number of parasitic females, their size, per capita fecundity and intestinal position. We found that in immunosuppressive treatments worms persist in the gut, sometimes with a greater per capita fecundity, maintain their size and have a more anterior gut position, compared with worms from control animals. In immunization treatments there are fewer worms in the gut, sometimes with a lower per capita fecundity and they are shorter and have a more posterior gut position, compared with worms from control animals. Worms from animals immunosuppressed by corticosteroid treatment reverse their changes in size and gut position. This description of these phenomena pave the way for a molecular biological analysis of how these changes in infection parameters are brought about by the host immune response.

Assessing exposure to disinfection by-products in women of reproductive age living in Corpus Christi, Texas, and Cobb county, Georgia: descriptive results and methods.

We conducted a field study in Corpus Christi, Texas, and Cobb County, Georgia, to evaluate exposure measures for disinfection by-products, with special emphasis on trihalomethanes (THMs). Participants were mothers living in either geographic area who had given birth to healthy infants from June 1998 through May 1999. We assessed exposure by sampling blood and water and obtaining information about water use habits and tap water characteristics. Two 10-mL whole blood samples were collected from each participant before and immediately after her shower. Levels of individual THM species (chloroform, bromodichloromethane, dibromochloromethane, and bromoform) were measured in whole blood [parts per trillion (pptr)] and in water samples (parts per billion). In the Corpus Christi water samples, brominated compounds accounted for 71% of the total THM concentration by weight; in Cobb County, chloroform accounted for 88%. Significant differences in blood THM levels were observed between study locations. For example, the median baseline blood level of bromoform was 0.3 pptr and 3.5 pptr for participants in Cobb County and Corpus Christi, respectively (p = 0.0001). Differences were most striking in blood obtained after showering. For bromoform, the median blood levels were 0.5 pptr and 17 pptr for participants in Cobb County and Corpus Christi, respectively (p = 0.0001). These results suggest that blood levels of THM species vary substantially across populations, depending on both water quality characteristics and water use activities. Such variation has important implications for epidemiologic studies of the potential health effects of disinfection by-products.

Clinical supervision for specialist nurses.

The UKCC has stated that every practitioner should have access to clinical supervision. There is little literature on the supervision needs of specialist nurses. Choosing the appropriate model of supervision and establishing formal ground rules was essential to the success of the project.

Pro-drinking messages and message environments for young adults: the case of alcohol industry advertising in African American, Latino, and Native American communities.

This paper examines targeted alcohol advertising in three ethnic communities: African Americans, Latinos, and Native Americans in the U.S. We focus on the appropriation of cultural systems and the reinvention of them as commodities to consumers. We outline the specific strategies used in each ethnic community. For African Americans, there is an emphasis on selling malt liquor to young adults through the use of "power" and gang-related images. For Latinos, there is an appropriation of historical and cultural symbols such as the national flags and maps of Mexico and Central America. Native Americans have coalesced to keep the image of a chief and warrior, Crazy Horse, from being used to market malt liquor. Each of the ethnic groups is engaged in action to prevent alcohol-related problems in their communities. Generating and implementing solutions is a universal social responsibility.

Cloning and expression of a Xenopus laevis oocyte lectin and characterization of its mRNA levels during early development.

cDNA clones encoding a soluble, calcium-dependent, melibiose-binding lectin from Xenopus laevis oocytes have been isolated, characterized, and expressed in bacteria. This lectin has been shown by others to be localized in oocyte cortical granules where it ultimately is released and participates in the formation of the fertilization envelope. A lectin with similar specificity has been purified by others from blastula and immunolocalized to specific locations in developing embryos, which suggests it may also function after fertilization in regulating cell adhesion and migration. We have used melibiose affinity chromatography to isolate the oocyte lectin (monomer molecular masses of about 45 and 43 kDa) and shown that after exhaustive treatment with N-glycanase, only one major protein band at 35 kDa was observed, suggesting that a single polypeptide with variable N-linked glycosylation is expressed in the oocyte. After obtaining internal peptide sequences, a PCR-based cloning approach allowed the isolation of full length cDNAs from an ovary lambda gt11 library encoding a protein of 313 amino acids with three potential N-linked oligosaccharide sites. Although this lectin, termed XL35, requires calcium ions for oligosaccharide binding, its sequence does not contain the sequence motif defined for "C-type" lectins. A 6-Histagged from of the lectin was expressed in E. coli and purified on a Ni(2+)-NTA column from bacterial extracts. The recombinant lectin was active using an agglutination assay, and this activity was inhibitable by EDTA and melibiose, properties exhibited by the native lectin. Southern blot analysis revealed a single hybridizing band, arguing against the existence of a multigene family. Northern blot analysis demonstrated that the lectin mRNA is expressed in oocytes and remains at relatively high levels through late gastrulae, continuing until tadpole stages. The persistence of the lectin mRNA, coupled with results from earlier studies, strongly suggests that XL35 is zygotically expressed and functions during morphogenesis.

Localization by fluorescence in situ hybridization (FISH) of human mitochondrial polymerase gamma (POLG) to human chromosome band 15q24-->q26, and of mouse mitochondrial polymerase gamma (Polg) to mouse chromosome band 7E, with confirmation by direct sequence analysis of bacterial artificial chromosomes (BACs).

Cloned cDNAs for the human mitochondrial DNA polymerase gamma (POLG) were identified by homology with the yeast mitochondrial DNA polymerase catalytic subunit (MIP). Fluorescence in situ hybridization (FISH) of human and mouse bacterial artificial chromosomes (BACs), hybridized by radioactively labeled POLG cDNAs, mapped to human chromosome band 15q24-->q26, as well as to mouse chromosome band 7E. Direct sequencing of the BAC DNA without subcloning confirmed the presence of both human POLG and mouse mitochondrial DNA polymerase gamma (Polg) in the respective BACs.

Modeling the effects of water usage and co-behavior on inhalation exposures to contaminants volatilized from household water.

The volatilization of volatile organic chemicals during domestic water usage can result in significant indoor air concentrations, and the subsequent inhalation of these contaminants is an important route of exposure. The magnitude of these exposures is highly dependent on the activities undertaken by the exposed individual, as well as the activities of other occupants of the home. The indoor air quality-exposure Model for the Analysis of Volatiles and Residential Indoor Air Quality (MARVIQ) was used to ascertain the impact of water-use activities on the potential contaminant dose to household members. Human time-activity patterns of various population groups were sampled from the California Air Resources Board database, applying distributions of water-use occurrence and water-use duration to each activity based on survey results. Indoor air concentrations in a sample house and the resulting potential inhalation dose to the occupants were computed for different individuals and pairs of individuals to test for exposure and coexposure effects. The simulated daily exposure is well described by a simplified equation that is a function of the amount of time the individual spends in the shower, the bath, and the bathroom; the total water usage in the home; and the fraction of time the individual is at home. These results can be used to identify high-risk populations, individuals, and households. The study also demonstrates the importance of further research on joint time-activity patterns in multiperson households for assessment of exposure and coexposure effects.

Analysis of sampling strategies for estimating annual average indoor NO2 concentrations in residences with gas ranges.

Range gas consumption in households tends to follow an annual cycle resembling a sinusoid, with peak consumption during the winter. When outdoor NO2 concentrations have a constant or small impact, the resulting indoor NO2 concentrations also tend to resemble an annual sinusoid. Optimal monitoring strategies can be designed to take advantage of this knowledge to obtain a better estimate of the true annual average gas consumption or indoor NO2 concentration. Gas consumption data, together with measured outdoor concentrations, house volumes, sampled emission rates, air exchange rates, and NO2 decay rates, are used to model weekly indoor NO2 concentrations throughout the year. Based on the modeling results, various monitoring strategies are evaluated for their accuracy in estimating the annual mean. Analysis of the results indicates that greater accuracy is attained using samples equally spaced throughout the year. In addition, the expected error for various monitoring strategies and various numbers of equally spaced samples is quantified, and their ability to classify homes into correct concentration categories is assessed.

Safety and tolerability of zalcitabine (ddC) in patients with AIDS or advanced AIDS-related complex in the European expanded access programme.

This international expanded access programme was initiated to provide zalcitabine (o 75 mg three times daily) to patients with AIDS or advanced ARC who had failed, were no longer able to tolerate or were ineligible to receive zidovudine (ZDV). Data are available from 517 patients. No unexpected adverse events occurred during the study with 13.2% of patients discontinuing treatment due to drug-related adverse events. Peripheral neuropathy (PN) was the most common adverse event reported. This was considered to be at least possibly related to zalcitabine in 12.2% of patients, with only 2.3% of patients withdrawing from the study due to zalcitabine-associated PN. Patients with a baseline diagnosis of AIDS and a CD4 count

Glycosyltransferase assay system utilizing an acylated glycopeptide acceptor.

A glycosyltransferase assay system was devised utilizing as acceptor a purified glycopeptide which was acylated at its N-terminus using caprylic (C8) anhydride. The glycopeptide contained five amino acids and an N-linked biantennary oligosaccharide, and it was purified from a pronase digest of bovine fibrinogen. Desialylation and beta-galactosidase digestion conditions were developed to produce asialo- and asialo-agalacto glycopeptides. Using fatty acid anhydrides, N-acylation conditions for these glycopeptides were then optimized. The products formed when the appropriate acylated glycopeptide was incubated with either of two N-acetylglucosaminyltransferases and UDP-[3H]N-acetylglucosamine were easily separated from unused sugar nucleotide and breakdown products by exploiting the affinity of the radiolabeled acylated glycopeptide products for pellicular C18 cartridges. The products of the enzymatic reactions bound quantitatively to the cartridges and could be eluted in small amounts of methanol. The Km values for the unacylated and acylated glycopeptide acceptors were similar when measured using either N-acetylglucosaminyltransferase V or the N-acetylglycosaminyltransferase which transfers N-acetylglucosamine in beta(1,3) linkage to N-acetyllactosamine (or lactose). This assay system can be used to measure many glycosyltransferases and other enzymes which transfer to N-linked biantennary oligosaccharides and is applicable to additional glycosyltransferases that transfer to other oligosaccharides which can be prepared as glycopeptides.

Pediatric internal derangements of the temporomandibular joint: effect on facial development.

To evaluate the relationship between internal derangement(s) of the temporomandibular joint(s) (TMJ) and disturbed facial skeleton growth (dysmorphogenesis), 128 consecutive children (103 girls, 25 boys), who were 14 years of age or younger and had undergone combined radiographic and magnetic resonance (MR) imaging studies of both TMJs, were retrospectively analyzed. Imaging studies had been performed to investigate suspected TMJ derangement because of symptoms that included, either individually or in various combinations, pain, mechanical TMJ dysfunction, and facial skeleton abnormalities, such as mandibular deficiency (particularly retrognathia) and lower facial (mandibular) asymmetry, manifested by chin deviation from the midline. Of these patients, 112 were found to have at least one internally deranged TMJ on imaging studies; in 85 patients, both TMJs were abnormal. Of the 60 retrognathic patients 56 were found to have TMJ derangement, generally bilateral and often of advanced stage. In cases of lower facial asymmetry, the chin was uniformly deviated toward the smaller or more degenerated TMJ. Both TMJs were normal in 16 patients, most of whom had normal facial structure. We conclude that TMJ derangements are both common in children and may contribute to the development of retrognathia, with or without asymmetry, in many cases.