Improving access to health information for older migrants by using grounded theory and social network analysis to understand their information behaviour and digital technology use.

Migrant well-being can be strongly influenced by the migration experience and subsequent degree of mainstream language acquisition. There is little research on how older Culturally And Linguistically Diverse (CALD) migrants who have 'aged in place' find health information, and the role which digital technology plays in this. Although the research for this paper was not focused on cancer, we draw out implications for providing cancer-related information to this group. We interviewed 54 participants (14 men and 40 women) aged 63-94 years, who were born in Italy or Greece, and who migrated to Australia mostly as young adults after World War II. Constructivist grounded theory and social network analysis were used for data analysis. Participants identified doctors, adult children, local television, spouse, local newspaper and radio as the most important information sources. They did not generally use computers, the Internet or mobile phones to access information. Literacy in their birth language, and the degree of proficiency in understanding and using English, influenced the range of information sources accessed and the means used. The ways in which older CALD migrants seek and access information has important implications for how professionals and policymakers deliver relevant information to them about cancer prevention, screening, support and treatment, particularly as information and resources are moved online as part of e-health.

Decompensation of a congenital retinal macrovessel with arteriovenous communications induced by repetitive rollercoaster rides.

PURPOSE: To describe a congenital retinal venous macrovessel that communicates with a cilioretinal artery and a retinal artery, and to report how this vascular anomaly decompensated as a result of repetitive rollercoaster rides. METHODS: Case report with serial fundus photography and fluorescein angiography. RESULTS: After a short period of intensive rollercoaster rides, a 19-year-old woman complained of reduced vision in one eye. Funduscopy and fluorescein angiography revealed a venous congenital retinal macrovessel with arteriovenous communications, and retinal exudation was visible at the termination of the anomalous vessel. Exudation resolved, and acuity recovered after a period of avoidance of rollercoaster rides. CONCLUSION: This case represents the first report of a retinal artery and a cilioretinal artery communicating with a congenital retinal macrovessel, and it suggests that such patients are at increased risk of retinal vascular decompensation if involved in activities associated with changes in g-forces, such as bungee jumping or rollercoaster rides.

Vitrectomy for vitreous opacification in Fuchs' heterochromic uveitis.

PURPOSE: To assess the role of pars plana vitrectomy (PPV) for symptomatic vitreous opacification in a series of patients with Fuchs' heterochromic uveitis (FHU). METHODS: A retrospective review was undertaken of 13 patients with FHU who underwent vitrectomy for vitreous opacification between April 1989 and December 1998. RESULTS: An improvement in visual symptoms was recorded in all patients, 9 of 13 (69%) demonstrating at least a 2 line increase in Snellen visual acuity. All but one patient attained 6/9 or better visual acuity post-operatively. Surgery was uneventful and did not appear to exacerbate any existing intraocular inflammation. CONCLUSION: From this series we conclude that PPV has an important role in the management of patients with FHU who present with symptomatic vitreous opacification.

Comparative genome sequence analysis of the Bpa/Str region in mouse and Man.

The progress of human and mouse genome sequencing programs presages the possibility of systematic cross-species comparison of the two genomes as a powerful tool for gene and regulatory element identification. As the opportunities to perform comparative sequence analysis emerge, it is important to develop parameters for such analyses and to examine the outcomes of cross-species comparison. Our analysis used gene prediction and a database search of 430 kb of genomic sequence covering the Bpa/Str region of the mouse X chromosome, and 745 kb of genomic sequence from the homologous human X chromosome region. We identified 11 genes in mouse and 13 genes and two pseudogenes in human. In addition, we compared the mouse and human sequences using pairwise alignment and searches for evolutionary conserved regions (ECRs) exceeding a defined threshold of sequence identity. This approach aided the identification of at least four further putative conserved genes in the region. Comparative sequencing revealed that this region is a mosaic in evolutionary terms, with considerably more rearrangement between the two species than realized previously from comparative mapping studies. Surprisingly, this region showed an extremely high LINE and low SINE content, low G+C content, and yet a relatively high gene density, in contrast to the low gene density usually associated with such regions.

Lateral canthotomy and inferior cantholysis: an effective method of urgent orbital decompression for sight threatening acute retrobulbar haemorrhage.

Retrobulbar haemorrhage (RBH) occurs in a variety of situations. It can complicate facial fractures, orbital surgery and retrobulbar injections and can occur spontaneously. It is relatively uncommon and sight-threatening RBH is even less common. If not detected early enough it can lead to devastating loss of vision. We have collected five cases of acute RBH, following trauma, associated with a profound reduction in vision. In each case a permanent loss of vision was avoided using a lateral canthotomy and inferior cantholysis approach to obtain urgent orbital decompression.

Correction of blepharoconjunctivitis-related upper eyelid entropion using the anterior lamellar reposition technique.

Upper eyelid entropion is a complication of chronic blepharoconjunctivitis which may be easily missed unless careful examination of the lid margin of patients with trichiasis is carried out. Many patients undergo years of unsuccessful treatment for trichiasis because the underlying upper eyelid entropion has not been detected. We would like to recommend the already established procedure of anterior lamellar repositioning as a more permanent solution to this distressing condition and present the results of this procedure on 19 consecutive patients (28 lids). Our surgical technique is described and the results in this group of patients reported. The procedure was successful in 24 of 28 eyelids (85%), with success being defined as complete resolution of symptoms for a follow-up period of at least 10 months. Anterior lamellar repositioning is easy and relatively quick to perform and provides good functional and cosmetic results.

Graves ophthalmopathy: intracranial fat prolapse on CT images as an indicator of optic nerve compression.

PURPOSE: To determine the usefulness of a number of imaging features in the differentiation of patients with Graves ophthalmopathy who had optic neuropathy from those who did not. Intracranial herniation of orbital fat through the superior ophthalmic fissure and its clinical importance was also assessed. MATERIALS AND METHODS: The computed tomographic (CT) appearance of the orbital apex was examined in 50 patients without and in 50 patients with Graves ophthalmopathy. The clinical diagnosis of optic neuropathy was made by an ophthalmologist who was unaware of the imaging appearances and was based on clinical features and abnormalities of visual evoked potentials or changes at automated perimetry. RESULTS: Intracranial fat prolapse (P < .001) and optic nerve crowding (P < .05) were the only imaging features that were independently related to optic neuropathy. The presence of intracranial fat prolapse or optic nerve crowding on CT scans helped identify 16 of 17 patients with optic neuropathy. Sensitivity was 94%, specificity was 91%, positive predictive value was 69%, and negative predictive value was 98%. CONCLUSION: Intracranial fat prolapse correlates closely to the presence of optic neuropathy in Graves ophthalmopathy. This sign, in combination with optic nerve crowding, demonstrates a closer correlation to optic neuropathy than previously described imaging features.

Glycans of the trabecular meshwork in primary open angle glaucoma.

AIMS: Glycan expression was compared in glaucomatous trabecular meshwork (TM) and normal TM in order to determine any differences which may reflect pathological changes underlying primary open angle glaucoma (POAG). METHODS: Resin embedded TM from trabeculectomy specimens from 15 eyes with POAG and from 12 eyes with normal anterior segments were probed with a panel of biotinylated lectins and an avidin-peroxidase revealing system at the light microscope level. Statistical analyses were performed on the comparative staining results. RESULTS: The lectins ConA and ePHA showed strong staining in all areas of both glaucomatous and normal TM; ePHA staining of Schlemm's canal (SC) from POAG TM was significantly less than that from normal TM (ePHA-SC p = 0.04). The lectins PSA, LCA, and SNA bound moderately strongly to SC endothelium and weakly to the endothelium of the corneoscleral meshwork (CSM); glaucomatous SC endothelial binding was significantly less than that of normal SC endothelium for PSA and LCA (PSA-SC p = 0.002, LCA-SC p = 0.002). STA and DSA showed moderately strong binding while WGA, ECA, AHA, and MPA bound weakly throughout the TM; for DSA and MPA this staining was significantly greater in POAG than in normal TM (DSA-SC p = 0.001, DSA-CSM p = 0.002, MPA-SC p = 0.01, MPA-CSM p = 0.02). Jac stained strongly throughout the TM and showed no significant difference in POAG compared with normal TM (Jac-SC p = 0.6, Jac-CSM p = 1). 1PHA, SBA, DBA, CTA, UEA-1 and LTA did not bind to glaucomatous TM or normal TM. There were no age-related changes seen. CONCLUSIONS: The expression of some complex and hybrid, bisected and non-bisected N-linked glycans is significantly diminished in glaucomatous TM compared with normal TM. Some glycans with multiple N-acetylglucosamine residues and O-linked glycans with terminal and subterminal galactosyl groups are significantly increased in POAG TM. Glycan expression does not change significantly with age in POAG or normal TM.

Enlargement of the tensor intermuscularis muscle in Graves' ophthalmopathy. A computed tomographic and magnetic resonance imaging study.

OBJECTIVE: To determine whether the tensor intermuscularis muscle (TIM), which consists of muscle fibers in the superolateral intermuscular orbital septum, is involved in Graves' ophthalmopathy (GO). DESIGN: The computed tomographic (n = 24) and magnetic resonance imaging (n = 10) appearances of the TIM were retrospectively examined in 34 patients with known GO. The severity of GO was assessed by applying a scoring system from 0 to 3 (ie, normal [0], mild [1], moderate [2], and severe [3]) to each of the rectus muscles and superior oblique muscle. The severity of exophthalmos, enlargement of the superior ophthalmic vein, and displacement of the lacrimal gland were also recorded. RESULTS: The TIM appeared as thickening of the septum immediately behind the globe, and it was best seen on coronal magnetic resonance images. There was enlargement of the TIM in 19 of the 34 patients, and it was bilateral in 17. Enlargement was present only in patients with moderate or severe involvement of other muscles (muscle index, > 7/15), and it was significantly correlated with the muscle index (P < .05), exophthalmos (P < .05), enlargement of the superior ophthalmic vein (P < .005), and anterior displacement of the lacrimal gland (P < .01). Severe enlargement of the TIM was seen in only five of the 34 patients, and it showed a close correlation with the muscle index (P < .005), exophthalmos (P < .001), enlargement of the superior ophthalmic vein (P < .001), and anterior displacement of the lacrimal gland (P < .001). CONCLUSIONS: Enlargement of the TIM in GO can be identified on computed tomographic and magnetic resonance imaging scans. It is invariably associated with moderate or severe involvement of other extraocular muscles, and it correlates closely with other well-recognized imaging features of severe GO.

An analysis of in vivo hprt mutant frequency in circulating T-lymphocytes in the normal human population: a comparison of four datasets.

In this paper, we have compared mutant frequency data at the hprt locus in circulating T-lymphocytes from four large datasets obtained in the UK (Sussex), the USA (Vermont), France (Paris) and The Netherlands (Leiden). In total, data from > 500 non-exposed individuals ranging in age from newborns (cord blood samples) to > 80 years old have been included in the analysis. Based on raw data provided by the four laboratories, a model is presented for the analysis of mutant frequency estimations for population monitoring. For three of the laboratories, a considerable body of data was provided on replicate estimates of mutant frequency from single blood samples, as well as estimates from repeat blood samples obtained over a period of time from many of the individual subjects. This enabled us to analyse the sources of variation in the estimation of mutant frequency. Although some variation was apparent in the results from the four laboratories, overall the data were in general agreement. Thus, in all laboratories, cellular cloning efficiency of T-cells was generally high (> 30%), although in each laboratory considerable variation between experiments and subjects was seen. Mutant frequency per clonable T-cell was in general found to be inversely related to cloning efficiency. With the exception of a few outliers (which are to be expected), mutant frequencies at this locus were in the same range in each dataset; no effect of subject gender was found, but an overall clear age effect was apparent. When log mutant frequency was analysed vs log (age + 0.5) a consistent trend from birth to old age was seen. In contrast, the effect of the smoking habit did differ between the laboratories, there being an association of smoking with a significant increase in mutant frequency in the Sussex and Leiden datasets, but not in those from the Vermont or Paris datasets. Possible reasons for this are discussed. One of the objectives of population monitoring is an ability to detect the effect of accidental or environmental exposure to mutagens and carcinogens among exposed persons. The large body of data from non-exposed subjects we have analysed in this paper has enabled us to estimate the size of an effect that could be detected, and the number of individuals required to detect a significant effect, taking known sources of variation into account.(ABSTRACT TRUNCATED AT 400 WORDS)

A paramedic based emergency domiciliary obstetric service: the South Glamorgan experience.

OBJECTIVE: To assess the potential benefits of using extended trained ambulance personnel (paramedics) as primary responders for domiciliary obstetric and gynecological emergencies. DESIGN: An observational study of performance and analysis of operational data in a newly established service. SETTING: A mixed urban and rural population served by South Glamorgan Health Authority. MAIN OUTCOME MEASURES: Work load, response times, management and transfer of patients, efficiency of communications and appropriateness of training. RESULTS: There was an initial increase in requests above that when a hospital-based service operated. Targets for response times were met. The mean response time for providing appropriate skilled help was halved compared with the previous arrangements and a safe and efficient service was provided. Prompt transport and advance notice and preparation for reception in the delivery unit contributed to optimal management. Medical staff depletion in the delivery unit was minimised. CONCLUSION: An Emergency Domiciliary Obstetric Service based on primary response by specially trained ambulance service paramedics can beneficially replace traditional hospital-based Obstetric Flying Squads.

The complex formed between plastocyanin and cytochrome c. Investigation by NMR spectroscopy.

Spinach plastocyanin and horse heart cytochrome c have been shown, by monitoring the behaviour of the hyperfine-shifted heme resonances of Fe(III) cytochrome c on titration with Cu(II) plastocyanin, to form a 1:1 complex with a dissociation constant of 67 mM (D2O, pH* 7.0, 300 K). The interaction sites on the plastocyanin surface have been investigated in one- and two-dimensional NMR experiments involving competition for plastocyanin between cytochrome c and the paramagnetic cation Cr(NH3)(3+)6. The plastocyanin resonances which are paramagnetically broadened in the spectrum of plastocyanin alone are also broadened in the spectrum of the mixture of the two proteins. This shows that, on the NMR time scale, no plastocyanin residues are hidden from Cr(NH3)(3+)6 by complexation with cytochrome c. [It has been shown that Cr(NH3)(3+)6 does not disrupt formation of the complex between the two proteins.] It appears that initial complexation of cytochrome c takes place at the acidic east site of plastocyanin, and that the extensive negative electrostatic surface of plastocyanin accommodates the paramagnetic probe and cytochrome c simultaneously in a dynamic ternary complex. The location of the electron transfer site on plastocyanin is discussed.

Variations in the provision of extended-trained ambulance personnel within the Welsh ambulance services.

This paper describes the distribution of extended-trained ambulance personnel within the nine Welsh Ambulance Services. While over a quarter of all emergency ambulance crews possess some extended skills, there is a wide variation in their distribution and protocols of treatment. Increasing numbers of ambulance personnel will receive such training in the future, leading to improved standards of pre-hospital care. To justify the use of such skills in terms of clinical outcome and expenditure, the ambulance services must provide accurate data to allow subsequent audit of pre-hospital clinical practice. It is therefore essential that the medical profession becomes aware of these developments and participates in advising, assessing and training extended-trained ambulance personnel.

The relative contributions of antithrombin III during heparin treatment, and of clinically recognisable risk factors, to early recurrence of venous thromboembolism.

The influence of antithrombin III (ATIII) level and ATIII activity, measured during intravenous heparin treatment for venous thromboembolism (VTE), on 'heparin requirement' (the heparin dose required to prolong the activated partial thromboplastin time (APTT) into its designated therapeutic range), and on the likelihood of recurrent VTE during the first month of anticoagulant therapy, were examined in a prospective study of 232 patients with VTE treated according to a standard protocol. 15 patients with recurrent VTE (6.5%) had a lower mean APTT during heparin treatment than patients without recurrence; a finding due partly to their heparin requirement. However, there was no measurable relationship between ATIII level or ATIII activity and either heparin requirement or recurrence of VTE. By contrast, both the presence of disseminated malignancy and the development of heparin induced thrombocytopenia were powerful, clinically recognisable, risk factors for recurrence during or soon after heparin therapy.

A social services-public health partnership in child protection: a rural model.

It is widely recognized that the amelioration of individual and family problems which contribute to child abuse and neglect requires a multidisciplinary effort. Unfortunately, however, these efforts are often sporadic or disjointed. This article is a description of a county social service-public health partnership in rural Minnesota which can serve as a model for other agencies interested in developing more interactive relationships with one another to the benefit of dysfunctional families and vulnerable children. A respect for one another's professional knowledge base and skills, a shared philosophy of intervention, and supportive agency administrators are the key components that make this model successful. Social workers and public health nurses working together--and in cooperation with still other professionals in the community--can identify and help to resolve those unmet social, psychological, and health needs which often are found in dysfunctional families. Public health nurses have many talents and a very diverse knowledge base that can be tapped by legally designated social workers who are charged by State statutes with intervening in cases involving physical or sexual abuse or neglect of children. The Brown County, MN, model is an example of a collaborative strategy that can be replicated nationwide.

Oral contraceptives and surgery: reduced antithrombin and antifactor Xa levels without postoperative venous thrombosis in low-risk patients.

The effect of preoperative treatment with an estrogen containing oral contraceptive on the incidence of postoperative thrombosis (detected with 125I-fibrinogen leg scanning) was examined in 221 patients aged 18-49 years who had elective or emergency general intra-abdominal or gynecologic surgery, 99 of whom were taking an oral contraceptive before their operation. Eighty-five percent of the contraceptive treated patients had taken their preparation until 1-7 days before surgery and the rest until within a month of surgery; 81% were taking preparations containing 30 or 50 micrograms estrogen. Postoperative thrombosis developed in 1 of the 122 patients who were not taking a contraceptive and in none of the 99 contraceptive treated patients. As the 95% confidence limits for the 0% thrombosis rate observed in the contraceptive treated patients are 0-3.7%, the added risk of postoperative thrombosis attributable to oral contraceptive treatment before surgery is very small in young women who are otherwise at low risk of thrombosis. Plasma antithrombin level (by immunoassay), antithrombin activity (by chromogenic substrate assay), and antifactor Xa activity (by clotting assay), were measured before surgery in 81 patients, 42 of whom had been taking an oral contraceptive. Contraceptive treatment significantly reduced all 3 assay results. Its most marked effect was on antifactor Xa activity, which was reduced by contraceptive treatment from 103 +/- 24% (range 68 - 172%) to 81 +/- 27% (range 24 - 155%; with less than 80% activity in 54%, and less than 50% activity in 15% of patients). These results suggest that reduced preoperative antifactor Xa activity has a low specificity for thrombosis after moderately extensive surgery in young, otherwise fit, oral contraceptive treated women. This test is therefore unlikely to be a clinically useful predictor for postoperative thrombosis in this group of patients.

PIP: The effect of preoperative treatment with an estrogen containing oral contraceptive (OC) on the incidence of postoperative thrombosis (detected with 125 I-fibrinogen leg scanning) was examined in 221 patients ages 18-49 who had elective or emergency general intraabdominal or gynecologic surgery, 99 of whom were taking an OC before their operation. 85% of the contraceptive treated patients had taken their preparation until 1-7 days before surgery and the rest until within a month of surgery; 81% were taking preparations containing 30 or 50 mcg estrogen. Postoperative thrombosis developed in 1 of the 122 patients who were not taking a contraceptive and in none of the 99 contraceptive treated patients. As the 95% confidence limits for the 0% thrombosis rate observed in the contraceptive treated patients are 0-3.7%, the added risk of postoperative thrombosis attributable to OC treatment before surgery is very small in young women who are otherwise at low risk of thrombosis. Plasma antithrombin level (by immunoassay), antithrombin activity (by chromogenic substrate assay), and antifactor xa activity (by clotting assay), were measured before surgery in 81 patients, 42 of whom had been taking an OC. Contraceptive treatment significantly reduced all 3 assay results. Its most marked effect was on antifactor Xa activity, which was reduced by contraceptive treatment from 103 +or- 24% (range 68-172%) to 81 +or-27% (range 24-155%) with 80% activity in 54%, and 50% activity in 15% of patients. These results suggest that reduced preoperative antifactor Xa activity has low specificity for thrombosis after moderately extensive surgery in young, otherwise fit, OC treated women. This test is therefore unlikely to be a clinically useful predictor for postoperative thrombosis in this group of patients.