Profiling health in the UK and Ireland.

The technique of describing health using a range of measures has been termed 'health profiling'. This article discusses the emergence of health profiling in the UK and Ireland over recent years, led by the public health observatories (PHOs). The steps in developing health profiles are described, including defining the purpose, consulting users, choosing indicators, establishing the methods of presentation, disseminating and evaluating. Health profiles have developed and improved through collaboration between the PHOs in the UK and Ireland. Looking to the future, the PHOs are developing inter-related health profiles ranging from small area to European regions, enhanced and informed by the addition of themed profiles for different population groups, lifestyles and diseases.

Structures of the O21 and O25 antigens of Stenotrophomonas maltophilia.

The O-specific side-chain polymers from Stenotrophomonas maltophilia serogroups O21 and O25 were isolated from the lipopolysaccharides of the reference strains. The O21 polymer contained D-arabinose, 2-amino-2-deoxy-D-glucose and 2-amino-2-deoxy-D-galactose in equal proportions. Methylation analysis and NMR spectroscopy showed that the polysaccharide is based on a branched trisaccharide repeating unit of the structure shown below. The O25 polymer is linear with a disaccharide repeating unit identical to that forming the backbone of the O21 polymer.

Structure of the O-specific polysaccharide for Acinetobacter baumannii serogroup O1.

A polymeric fraction containing D-galactose, N-acetyl-D-galactosamine, and N-acetyl-D-glucosamine was isolated from the lipopolysaccharide produced by the reference strain for Acinetobacter baumannii serogroup O1. By means of NMR spectroscopy, methylation analysis, and chemical degradation, the repeating unit of the polymer was identified as a branched trisaccharide of the following structure. [formula: see text].

Structural characterisation of a rhamnan and a fucorhamnan, both present in the lipopolysaccharide of Burkholderia vietnamiensis strain LMG 10926.

The polymeric fraction isolated after mild acid hydrolysis of the lipopolysaccharide (LPS) from Burkholderia vietnamiensis strain LMG 10926 contained L-rhamnose (Rha) and D-fucose (Fuc). From NMR studies supported by the results of methylation analysis and Smith degradation, it could be inferred that the material was probably a mixture of two glycans. One component was a linear rhamnan with a trisaccharide repeating unit (1); the other was a branched fucorhamnan with a tetrasaccharide repeating unit (2). The presence of two distinct polymeric fractions in LPS is a common feature for Burkholderia species. [structures: see text]

Structural studies of the O-specific side-chain of lipopolysaccharide from Burkholderia gladioli pv. gladioli strain NCPPB 1891.

A polymeric fraction (the O-antigenic side-chain) has been isolated from the lipopolysaccharide of Burkholderia gladioli pv. gladioli strain NCPPB 1891 after mild acid hydrolysis. The components of the polymer and their molar proportions were L-Rha (1), D-Gal (1), D-Man (1), and O-acetyl (1). By means of chemical degradations and NMR studies, the repeating unit of the polymer was shown to be a linear trisaccharide of the structure shown. [formula: see text]

Structure of the O-specific polysaccharide from Burkholderia pickettii strain NCTC 11149.

A polymeric fraction (the putative O antigen) has been isolated from the lipopolysaccharide of the type strain of Burkholderia pickettii. The components of the polymer and their molar proportions were: L-rhamnose (3), 2-acetamido-2-deoxy-D-glucose (1), and O-acetyl (1). By means of NMR studies and chemical degradations, the basic repeating-unit of the polymer was identified as a linear tetrasaccharide of the structure shown. The O-acetyl group is probably located at position 2 of the 3-substituted alpha-L-Rha p. Similar polymers constitute O antigens in the related species Burkholderia solanacearum.

Elevated serum chromium in patients on total parenteral nutrition and the ionic species of contaminant chromium.

Chromium (Cr), an essential micronutrient required for glucose metabolism, was found in high concentrations in up to 94% of the patients on short-term total parenteral nutrition. Approximately 50% had serum levels > 10-fold of normal (upper reference value of 3.8 nmol/L), about 18% were > 20-fold, and about 2% were 40-fold higher. The major Cr contaminant was detected in the amino acid constituents, and was found to have the trivalent ionic form. Although trivalent Cr is reported to be less genotoxic, further study is required to determine the effects on cells exposed to high concentrations of this element during parenteral nutrition over an extended period of time.

Structural and serological studies of lipopolysaccharides from proposed new serotypes (O25 and O26) of Serratia marcescens.

The surface polysaccharides of the two most recently proposed O-serotype strains of Serratia marcescens, O25 and O26, were characterised in terms of their chemical structure and immunological reactions. No polymer was isolated from O25, which was shown to lack both capsular K-antigen and smooth, O-antigenic lipopolysaccharide. A neutral polysaccharide was isolated from O26 and shown to be a polymer of rhamnose and N-acetylgalactosamine of the type previously found in the O9 and O15 reference strains. Serological cross-reactions among all three strains were demonstrated by using both whole-cell enzyme-linked immunosorbent assay and immunoblotting of lipopolysaccharide resolved by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate. No acidic polysaccharide was found in O26 and this was consistent with the absence of an immunogenic capsule. Thus, neither strain qualifies for inclusion as a new serotype in either an O-typing or a K-typing scheme.

Structure of a surface polysaccharide from Acinetobacter baumannii strain 214.

A polysaccharide containing D-galactose, D-glucose, and 2-acetamido-2-deoxy-D-galactose was obtained from an aqueous phenol extract of isolated cell walls from Acinetobacter baumannii strain 214. By means of NMR studies and chemical degradations, the repeating unit of the polymer was identified as a branched trisaccharide of the structure shown. [formula: see text]

Structure of the O19 antigen of Xanthomonas maltophilia.

The O-specific polymer from a strain of Xanthomonas maltophilia O19 contains D-glucose, L-rhamnose, and D-fucose. By means of chemical degradations and NMR studies, the repeating unit of the polymer was determined to be a branched tetrasaccharide of the structure shown. [formula: see text]

An overnight retreat to facilitate coping with stress.

Stress is an ever-present part of nurses' work and personal lives. In an effort to facilitate coping with this stress, a diverse group of staff came together to plan what ended up being a unique and thoroughly beneficial experience.

Treatment for alteration in oral mucosa related to chemotherapy.

Possibly one of the most painful and difficult side effects of chemoradiotherapy is stomatitis. Early intervention to limit its severity and aggressive treatment to prevent related complications such as infection and hemorrhage are essential.

Human immunodeficiency resulting from a maturational arrest of germinal center B cells.

Common variable immunodeficiency (CVI) is an acquired human disorder involving a striking and heterogeneous maturational defect of B lymphocytes. In this study, we used a recently developed VH gene utilization assay to analyze the abundance of developmentally restricted and unrestricted V genes in blood B cells from nine CVI patients. Unrestricted clones (bearing rearranged VH5, VH4, or VH6 genes) were present in normal abundance in this group of CVI patients. However, clones bearing VH3L, a subgroup of the VH3 family normally abundant in blood B cells but absent in B cells at the germinal center stage, were deficient in seven of nine CVI patients. Based on these findings and a reconsideration of previously reported B cell features in CVI, we propose that the disorder represents in most cases a maturational arrest of B cells at the germinal center stage.

Time-related changes in the diagnostic utility of total lactate dehydrogenase, lactate dehydrogenase isoenzyme-1, and two lactate dehydrogenase isoenzyme-1 ratios in serum after myocardial infarction.

Using receiver-operating characteristic (ROC) curve and likelihood ratio analysis, we examined the diagnostic utility of total lactate dehydrogenase (LD; EC 1.1.1.27) activity (I). LD isoenzyme-1 activity (II), and the LD-1 percentage of total LD activity (III), LD-1 LD-2 (IV), and LD-1/LD-4 (V) in 347 persons admitted to the Cardiac Care Unit (of whom 173 were subsequently proven to have had myocardial infarction). Blood was sampled from these subjects at about 6-h intervals for up to 96 h from the onset of chest pain. Defining an "effective" test as one having an area under the ROC curve of greater than or equal to 0.9, we determined the ranked utility (greatest to least) of these tests as V = IV greater than III greater than II greater than I. Tests III, IV, and V had by this criterion, diagnostic effectiveness equivalent to measurements of creatine kinase-2 in serum but in samples obtained at later time intervals. The decision thresholds for both high (constant) test sensitivity and specificity varied with time, to differing extents, over the entire 96-h period, a finding with important diagnostic implications. We document positive and negative likelihood ratio values for each of these tests throughout the entire period of study.

Staphylococcal slime: a cautionary tale.

Slime production by Staphylococcus epidermidis may be important in the adherence to and colonization of biomedical devices, and slime has been proposed to have various effects on the immune system. Attempts were made to isolate, purify, and chemically characterize slime from S. epidermidis cultivated under fluid on tryptic soy broth-agar medium. "Crude slime" from slime-producing strain RP-12 was characterized by a high galactose content. Similar materials in similar yields were isolated from slime-producing strain Kaplan, a non-slime-producing mutant, Kaplan-6A, and sterile medium controls, suggesting that crude slime was derived mainly from the medium. The occurrence of D- and L-galactose and pyruvate and sulfate residues and methylation analysis of these crude slime preparations, monitored by gas-liquid chromatography and mass spectrometry, showed that the agar was the main source of crude slime, suggesting that the preparation was largely an artifact of the growth and isolation procedures. Similar high-galactose-content preparations from both S. epidermidis and Staphylococcus aureus, assumed to be bacterial products and with a variety of biological activities, have been described by other investigators. Growth attached to a solid surface appears to be important for slime production. An accumulation of turned-over cell surface molecules and released macromolecules such as DNA may contribute to slime production. Avoidance of agar and development of a chemically defined medium for slime production are recommended for further studies.

A computer program to determine diagnostic decision thresholds and likelihood ratios illustrated with aspartate aminotransferase activities after a myocardial infarction.

We describe an enhancement of our earlier computer program which allows calculation of decision thresholds, sensitivity and specificity, and likelihood ratios of negative and positive test results for any chosen value of sensitivity or specificity. The program will also plot continuous receiver operating characteristic and decision level curves which permit examination of the contours created by using all the available data. We illustrate the value of these routines by showing that the sensitivity and specificity of serum aspartate aminotransferase changes during the course of a myocardial infarction.

Re-evaluation of the diagnostic utility of serum total creatine kinase and creatine kinase-2 in myocardial infarction.

The diagnostic utility of total creatine kinase activity (I), creatine kinase-2 isoenzyme activity (II), and II as a percentage of I, was examined by receiver-operating characteristic curve and likelihood ratio (LR) analyses in 310 persons admitted to the Coronary Care Unit (151 proven cases of myocardial infarction and 159 non-myocardial infarction controls), from whom blood was sampled at 6-h intervals for 48 h after the onset of chest pain. I was ineffective either as a "rule-in" or as a "rule-out" test within the first 6 h of the onset of chest pain; thereafter, it was an effective test. II was the most effective test during the entire 48-h period. III was more effective than I in the first 24-h period, but was less effective than I during the next 24-h period. The decision threshold for high test sensitivities varies with time over the entire 48-h period, but remains constant for high test specificities. It is essential to tabulate the LR(+) and LR(-) values for both test sensitivity and specificity at constant values to determine the utility of each test at each time interval for respectively ruling out or ruling in a diagnosis of myocardial infarction.

Structure of the O-specific polysaccharide from Enterobacter cloacae strain N.C.T.C. 11579 (serogroup O10).

The O-specific polysaccharide from the reference strain (N.C.T.C. 11579) for Enterobacter cloacae serogroup O10 has been isolated and characterised. By means of n.m.r. spectroscopy and methylation analysis, and by studies of the products obtained by Smith degradation or by N-deacetylation-deamination, the repeating unit of the polysaccharide could be allocated the structure shown. The polysaccharides from two cross-reacting serogroups (O9 and O11) have the same monosaccharide composition. (Formula: see text)