Successive Ontario governments forced to grapple with problem of health care fraud.

Albert Shu of Willowdale, Ont., is the 1995 winner of the Amy Chouinard Memorial Essay Contest. Named in memory of long time CMAJ and Canadian Journal of Surgery contributor Amy Chouinard, the competition is intended to stimulate interest in medical and health-related writing among journalism students. The winning essay, written prior to Ontario''s 1995 provincial election, examined health care fraud in the province and the impact of the photo health card that was introduced by the New Democrats party government.     

Frozen in time: life in the face of chronic care cutbacks

Kathy Cook won the $750 first prize in CMAJ''s 7th Annual Amy Chouinard Memorial Essay Contest. The deadline for entries to the contest, which is designed to stimulate interest in medical writing among journalism students, is June 1. Entries should be forwarded to the news and features editor. In her winning essay, Cook explores the frustrations and quality-of-life issues that arise in a chronic care institution that is trying to operate in the midst of serious funding cuts.     

The health risks of new-wave vegetarianism

Many young people call themselves vegetarians because they don''t eat meat, but the eating style they are adopting is fraught with health risks. In this article, which won CMAJ''s 1996 Army Chouinard Memorial Essay Contest for Canadian journalism students, Laura Brydges Szabo looks at the "new vegetarianism" and the recommendations health care professionals are making to young people intent on following this incomplete diet. The contest encourages journalism students to write on health care topics.     

A system worth saving.

The country will mark Canada Health Day on May 12, so CMAJ asked Dr. Michael Gordon to reflect on Canada''s health care system and the changes it has seen and will see. The special day, cosponsored by the Canadian Public Health Association, is designed to highlight "the need for better communication between health professionals and the communities they serve." In this article, Gordon reflects on the dangers facing Canada''s medicare system and the need to protect it from the inroads threatened by privatization.     

Differences in the Volume of Pharmaceutical Advertisements between Print General Medical Journals

Background

Pharmaceutical advertisements have been argued to provide revenue that medical journals require but they are intended to alter prescribing behaviour and they are known to include low quality information. We determined whether a difference exists in the current level of pharmaceutical advertising in print general medical journals, and we estimated the revenue generated from print pharmaceutical advertising.

Methods

Six print general medical journals in Canada, the United States, and the United Kingdom were sampled between 2007 and 2012. The number of advertisements and other journal content in selected issues of the Canadian Medical Association Journal (CMAJ), Canadian Family Physician (CFP), Journal of the American Medical Association (JAMA), New England Journal of Medicine (NEJM), British Medical Journal (BMJ), and Lancet were determined. Revenue gained from pharmaceutical advertising was estimated using each journal''s 2013 advertising price list.

Findings

The two Canadian journals sampled (CMAJ, CFP) contained five times more advertisements than the two American journals (JAMA, NEJM), and two British journals (BMJ, Lancet) (p<0.0001). The estimated annual revenue from pharmaceutical advertisements ranged from £0.025 million (for Lancet) to £3.8 million (for JAMA). The cost savings due to revenue from pharmaceutical advertising to each individual subscriber ranged from £0.02 (for Lancet) to £3.56 (for CFP) per issue.

Conclusion

The volume of pharmaceutical advertisements differs between general medical journals, with the two Canadian journals sampled containing the most advertisements. International and temporal variations suggest that there is an opportunity for all general medical journals to reduce the number of pharmaceutical advertisements, explore other sources of revenue, and increase transparency regarding sources of revenue.     

In your face: A new wave of militant doctors lashes out

Doctors in 4 Canadian provinces have chosen to use job action and other militant approaches as leverage to encourage governments to improve health care and funding. CMAJ asked physicians why this is happening now.     

Consensus finally achieved on resuscitative interventions.

A joint policy statement on the resuscitation of patients is published in this issue of CMAJ. Dr. John Williams, the CMA''s director of ethics and legal affairs, discusses how it differs from the joint statement published last year.     

US editorial writers put Canadian health care under microscope

Editorial writers from the US descended on Ottawa recently for their annual meeting, and CMAJ contributing editor Charlotte Gray was one of the speakers. She said the visitors received widely differing views on the Canadian health care system and may have emerged from the meeting more confused than informed.     

The Amylase gene cluster on the evolving sex chromosomes of Drosophila miranda.

On the basis of chromosomal homology, the Amylase gene cluster in Drosophila miranda must be located on the secondary sex chromosome pair, neo-X (X2) and neo-Y, but is autosomally inherited in all other Drosophila species. Genetic evidence indicates no active amylase on the neo-Y chromosome and the X2-chromosomal locus already shows dosage compensation. Several lines of evidence strongly suggest that the Amy gene cluster has been lost already from the evolving neo-Y chromosome. This finding shows that a relatively new neo-Y chromosome can start to lose genes and hence gradually lose homology with the neo-X. The X2-chromosomal Amy1 is intact and Amy2 contains a complete coding sequence, but has a deletion in the 3''-flanking region. Amy3 is structurally eroded and hampered by missing regulatory motifs. Functional analysis of the X2-chromosomal Amy1 and Amy2 regions from D. miranda in transgenic D. melanogaster flies reveals ectopic AMY1 expression. AMY1 shows the same electrophoretic mobility as the single amylase band in D. miranda, while ectopic AMY2 expression is characterized by a different mobility. Therefore, only the Amy1 gene of the resident Amy cluster remains functional and hence Amy1 is the dosage compensated gene.     

A Marathon session: A town's MDs develop a philosophy to call their own

Last June CMAJ described how Marathon--a remote town in Northern Ontario--had gone from medical rags to riches in just over a year (CMAJ 1997;156:1593-6). Once chronically underserviced in terms of physician services, this community of 5500 people went from a single overworked doctor to a group practice of 7 physicians. The change involved far more than numbers, however. The Marathon solution was built on a philosophy of physician sustainability and long-term retention, not just recruitment. The change was designed to ensure that the town could finally get off the roller-coaster ride that saw more than 75 doctors come--and go--during the previous 10 years. A year after its initial report, CMAJ returned to see if the Marathon experiment was still working.     

DNA Sequence Evolution of the Amylase Multigene Family in Drosophila Pseudoobscura

The alpha-Amylase locus in Drosophila pseudoobscura is a multigene family of one, two or three copies on the third chromosome. The nucleotide sequences of the three Amylase genes from a single chromosome of D. pseudoobscura are presented. The three Amylase genes differ at about 0.5% of their nucleotides. Each gene has a putative intron of 71 (Amy1) or 81 (Amy2 and Amy3) bp. In contrast, Drosophila melanogaster Amylase genes do not have an intron. The functional Amy1 gene of D. pseudoobscura differs from the Amy-p1 gene of D. melanogaster at an estimated 13.3% of the 1482 nucleotides in the coding region. The estimated rate of synonymous substitutions is 0.398 +/- 0.043, and the estimated rate of nonsynonymous substitutions is 0.068 +/- 0.008. From the sequence data we infer that Amy2 and Amy3 are more closely related to each other than either is to Amy1. From the pattern of nucleotide substitutions we reason that there is selection against synonymous substitutions within the Amy1 sequence; that there is selection against nonsynonymous substitutions within the Amy2 sequence, or that Amy2 has recently undergone a gene conversion with Amy1; and that Amy3 is nonfunctional and subject to random genetic drift.     

Dr. Max King: the sad life and early death of Mackenzie King's physician brother

While researching her best-selling biography, Mrs. King: The Life and Times of Isabel Mackenzie King, CMAJ contributing editor Charlotte Gray discovered a wealth of information about Dr. Dougal Macdougall (Max) King. Although he never became as famous as his older brother Mackenzie, Gray presents a convincing argument that Dr. Max King''s life and early death speak volumes about medicine and the medical profession at the turn of the century. She also argues that Mackenzie King''s own life would have been much different had his brother not died at the too young age of 42. Gray''s book was nominated for the Viacom Award, which honours the best nonfiction book published annually in Canada.     

A closer look at reproductive technology and postmenopausal motherhood.

Although reproductive technologies have been aimed at young, infertile women, evidence suggests that postmenopausal women are also taking advantage of them. Dr. Eike-Henner Kluge asserts in an article in CMAJ (1994; 151; 353-355) that there are ethical reasons to deny older women access to these technologies. Kluge''s comparison of postmenopausal women to prepubescent girls is fallacious. His assertion that older parents harm children by denying them a "normal" childhood is not supported by any empiric data. Kluge''s distinction between medical intervention, in offering reproductive technologies to a woman in her reproductive years, and "improving on nature", by offering these technologies to postmenopausal a woman is spurious. Unless technologies that are expensive and minimally successful, such as in-vitro fertilization, are denied to everyone, there are no grounds for denying them to postmenopausal women.     

Evolution of nucleotide substitutions and gene regulation in the amylase multigenes in Drosophila kikkawai and its sibling species

In order to determine evolutionary changes in gene regulation and the nucleotide substitution pattern in a multigene family, the amylase multigenes were characterized in Drosophila kikkawai and its sibling species. The nucleotide substitution pattern was investigated. Drosophila kikkawai has four amylase genes. The Amy1 and Amy2 genes are a head-to-head duplication in the middle of the B arm of the second chromosome, while the Amy3 and Amy4 genes are a tail-to-tail duplication near the centromere of the same chromosome. In the sibling species of D. kikkawai (Drosophila bocki, Drosophila leontia, and Drosophila lini), sequencing of the Amy1, Amy2, Amy3, and Amy4 genes revealed that the Amy1 and Amy2 gene group diverged from Amy3 and Amy4 after duplication. In the Amy1 and Amy2 genes, the divergent evolution occurred in the flanking regions; in contrast, the coding regions have evolved in concerted fashion. The electrophoretic pattern of AMY isozymes was also examined. In D. kikkawai and its siblings, two or three electrophoretically different isozymes are encoded by the Amy1 and Amy2 genes (S isozyme) and by the Amy3 and Amy4 genes (F (M) isozymes). The S and F (M) isozymes show different patterns of band intensity when larvae and flies were fed in different media. Amy1 and Amy2, which encode the S isozyme, are more strikingly regulated than Amy3 and Amy4, which encode the F (M) isozyme. The GC content and codon usage bias were higher for the Amy1 and Amy2 genes than for the Amy3 and Amy4 genes. Although the ratio of synonymous and replacement substitutions within the Amy1 and Amy2 gene group was not significantly different from that within the Amy3 and Amy4 gene group, the synonymous substitution rate in the lineage of Amy1 and Amy2 was lower than that of Amy3 and Amy4. In conclusion, after the first duplication but before speciation of four species, the synonymous substitution rate between the two lineages and the electrophoretic pattern of the isozymes encoded by them changed, although we do not know whether there was any evolutionary relationship between the two.     

Suppression of α‐amylase genes improves quality of rice grain ripened under high temperature

High temperature impairs rice (Oryza sativa) grain filling by inhibiting the deposition of storage materials such as starch, resulting in mature grains with a chalky appearance, currently a major problem for rice farming in Asian countries. Such deterioration of grain quality is accompanied by the altered expression of starch metabolism‐related genes. Here we report the involvement of a starch‐hydrolyzing enzyme, α‐amylase, in high temperature‐triggered grain chalkiness. In developing seeds, high temperature induced the expression of α‐amylase genes, namely Amy1A, Amy1C, Amy3A, Amy3D and Amy3E, as well as α‐amylase activity, while it decreased an α‐amylase‐repressing plant hormone, ABA, suggesting starch to be degraded by α‐amylase in developing grains under elevated temperature. Furthermore, RNAi‐mediated suppression of α‐amylase genes in ripening seeds resulted in fewer chalky grains under high‐temperature conditions. As the extent of the decrease in chalky grains was highly correlated to decreases in the expression of Amy1A, Amy1C, Amy3A and Amy3B, these genes would be involved in the chalkiness through degradation of starch accumulating in the developing grains. The results show that activation of α‐amylase by high temperature is a crucial trigger for grain chalkiness and that its suppression is a potential strategy for ameliorating grain damage from global warming.     

Zoospore-specific antigen as a useful marker for molecular analysis of net formation in Hydrodictyon reticulatum (Chlorococcales, Chlorophyceae)

In the green alga Hydrodictyon reticulatum zoospores are arranged in a regular fashion to form an intricate hexagonal network during the asexual reproductive cycle. A monoclonal antibody which was raised against a homogenate of zoospores recognized a single poly‐peptide in zoospores with a molecular mass of 31 kDa. The antigenic polypeptide, which was designated Amy1, was localized within the cytoplasm of zoospores. The accumulation of Amy1 occurred concomitantly with the transition from multinuclear vegetative cells to mononuclear zoospores, and the degradation of Amy1 occurred concomitantly with the further development of zoospores. Amy1 was constantly expressed during the period of mononuclear zoospores. Thus, we conclude that Amy1 is a zoospore‐specific polypeptide. Using the anti‐Amy1 monoclonal antibody, we could easily distinguish between mononuclear zoospores and multinuclear vegetative net‐cells. This provides an important tool for analysing the molecular mechanisms involved in the hexagonal net formation by zoospores.     

Functional roles of protein domains on rice α-amylase activity

Characteristics of two rice α-amylases Amy1A and Amy3D, and those of two chimeric enzymes Amy1A/3D and Amy3D/1A, engineered from the two isozymes, were compared in the light of the functional roles of protein domains in α-amylase. The enzymes that have an Amy1A-type N-terminal domain, Amy1A and Amy1A/3D, showed high activity against soluble starch, while the enzymes that have an Amy3D-type barrel structure, Amy3D and Amy1A/3D, showed high activity in oligosaccharide hydrolysis. Rigidity of protein folding also significantly affected the enzyme activity in both soluble starch and oligosaccharide hydrolysis. Thus, the present work suggests that the structure of the N-terminal domain is important for stability and soluble starch hydrolysis, while the barrel structure that forms the active site significantly affects enzyme activities in oligosaccharide degradation. Received: 27 September 1996 / Received revision: 21 October 1996 / Accepted: 15 November 1996     

Introduction of Raw Starch-Binding Domains into Bacillus subtilis α-Amylase by Fusion with the Starch-Binding Domain of Bacillus Cyclomaltodextrin Glucanotransferase

We constructed two types of chimeric enzymes, Ch1 Amy and Ch2 Amy. Ch1 Amy consisted of a catalytic domain of Bacillus subtilis X-23 α-amylase (Ba-S) and the raw starch-binding domain (domain E) of Bacillus A2-5a cyclomaltodextrin glucanotransferase (A2-5a CGT). Ch2 Amy consisted of Ba-S and D (function unknown) plus E domains of A2-5a CGT. Ch1 Amy acquired raw starch-binding and -digesting abilities which were not present in the catalytic part (Ba-S). Furthermore, the specific activity of Ch1 Amy was almost identical when enzyme activity was evaluated on a molar basis. Although Ch2 Amy exhibited even higher raw starch-binding and -digesting abilities than Ch1 Amy, the specific activity was lower than that of Ba-S. We did not detect any differences in other enzymatic characteristics (amylolytic pattern, transglycosylation ability, effects of pH, and temperature on stability and activity) among Ba-S, Ch1 Amy, and Ch2 Amy.     

Characterization of rice α-amylase isozymes expressed by Saccharomyces cerevisiae

Two rice -amylase isozymes, AmylA and Amy3D, were produced by secretion from genetically engineered strains of Saccharomyces cerevisiae. They have distinct differences in enzymatic characteristics that can be related to the physiology of the germinating rice seed. The rice isozymes were purified with immunoaffinity chromatography. The pH optima for amy3D (pH optimum 5.5) and Amy1A (pH optimum 4.2) correlate with the pH of the endosperm tissue at the times in rice seedling development when these isozymes are produced. Amy3D showed 10–14 times higher reactivity to oligosaccharides than Amy1A. Amy1A, on the other hand, showed higher reactivity to soluble starch and starch granules than Amy3D. These results suggest that the isozyme Amy3D, which is expressed at an early stage of germination, produces sugars from soluble starch during the early stage of seed germination and that the isozyme Amy1A works to initiate hydrolysis of the starch granules.