Gazetteer of General Practices in the Aylesbury Area

One reason for defects in communication between hospitals and general practitioners may be that hospital staff lack information about local practices. We compiled a handbook giving information about 55 (86%) of the practices which use the district general hospital group in Aylesbury. This included biographical details about each doctor in each practice, when he was available on the telephone, what ancillary staff worked in the practice, and so on. The handbook was given to 500 staff in all grades and departments in the group. It seems to have been effective in improving communications, relationships, and morale within the area.     

Whole genome amplification of buccal cytobrush DNA collected for molecular epidemiology studies.

When cytobrush buccal cell samples have been collected as a genomic DNA (gDNA) source for an epidemiological study, whole genome amplification (WGA) can be critical to maintain sufficient DNA for genotyping. We evaluated REPLI-g WGA using gDNA from two paired cytobrushes (cytobush 'A' kept in a cell lysis buffer, and 'B' dried and kept at room temperature for 3 days, and frozen until DNA extraction) in a pilot study (n=21), and from 144 samples collected by mail in a breast cancer study. WGA success was assessed as the per cent completion/concordance of STR/SNP genotypes. Locus amplification bias was assessed using quantitative PCR of 23 human loci. The pilot study showed > 98% completion but low genotype concordance between cytobrush wgaDNA and paired blood gDNA (82% and 84% for cytobrushes A and B, respectively). Substantial amplification bias was observed with significantly lower human gDNA amplification from cytobrush B than A. Using cytobrush gDNA samples from the breast cancer study (n =20), an independent laboratory demonstrated that increasing template gDNA to the REPLI-g reaction improved genotype performance for 49 SNPs; however, average completion and concordance remained below 90%. To reduce genotype misclassification when cytobrush wgaDNA is used, inclusion of paired gDNA/wgaDNA and/or duplicate wgaDNA samples is critical to monitor data quality.     

Electronic communication between providers of primary and secondary care.

OBJECTIVE--To study the effects of the introduction of electronic data interchange between primary and secondary care providers on speed of communication, efficiency of data handling, and satisfaction of general practitioners with communication. DESIGN--Comparison of traditional paper based communication for laboratory reports and admission-discharge reports between hospital and general practitioners and electronic data interchange. SETTING--Twenty-seven general practitioners whose offices were equipped with a practice information system and two general hospitals. OUTCOME MEASURES--Paper based communication was evaluated by questionnaire responses from and interviews with care providers; electronic communication was evaluated by measuring time intervals between generation and delivery of messages and by assessing doctors'' satisfaction with electronic data interchange by questionnaire. RESULTS--Via paper mail admission-discharge reports took a median of 2-4 days, and laboratory reports 2 days, to reach general practitioners. With electronic data interchange almost all admission-discharge reports were available to general practitioners within one hour of generation. When samples were analysed on the day of collection (as was the case for 174/542 samples in one hospital and 443/854 in the other) the laboratory reports were also available to the general practitioner the same day via electronic data interchange. Fifteen general practitioners (of the 24 who returned the questionnaire) reported that the use of electronic admission-discharge reports provided more accurate and complete information about the care delivered to their patients. Ten general practitioners reported that electronic laboratory reports lessened the work of processing the data. CONCLUSION--Electronic communication between primary and secondary care providers is a feasible option for improving communication.     

Schistosoma mansoni: influence of the female parasite on glutathione biosynthesis in the male

The glutathione (GSH) content of male Schistosoma mansoni increases in the absence of the female. This phenomenon, originally observed in vitro, also occurs within the host. At the time of recovery from mice, the GSH content of males from single-sex infections was 1.7-fold higher than that of paired males from mixed sex infections (P less than 0.01). The effect of mating status on male GSH biosynthetic and turnover rates was examined to determine the basis for increased GSH content in unpaired males. GSH turnover rates, measured when GSH biosynthesis was inhibited by greater than 95% with 5.0 mM DL-buthionine-SR-sulfoximine, were indistinguishable between unpaired and paired males with a first-order rate constant of 0.018 hr-1. In contrast, incorporation of L-[35S]cysteine into GSH revealed that GSH biosynthesis was 5-fold higher in unpaired than in paired males. Transport of L-cystine into male schistosomes, the presumed rate-limiting step in GSH biosynthesis, was unaffected by mating status. The GSH content increased when males were incubated in medium that had previously contained females or when separated from females by a microporous membrane. Males paired to 50% ethanol-fixed females had unchanged GSH content in vitro. It appears that male GSH biosynthesis may be regulated by a response stimulated by the female's physical presence in the gynechophoral canal and not by a soluble factor released from the female.     

Whole genome amplification of buccal cytobrush DNA collected for molecular epidemiology studies

Abstract

When cytobrush buccal cell samples have been collected as a genomic DNA (gDNA) source for an epidemiological study, whole genome amplification (WGA) can be critical to maintain sufficient DNA for genotyping. We evaluated REPLI-g? WGA using gDNA from two paired cytobrushes (cytobush ‘A’ kept in a cell lysis buffer, and ‘B’ dried and kept at room temperature for 3 days, and frozen until DNA extraction) in a pilot study (n=21), and from 144 samples collected by mail in a breast cancer study. WGA success was assessed as the per cent completion/concordance of STR/SNP genotypes. Locus amplification bias was assessed using quantitative PCR of 23 human loci. The pilot study showed > 98% completion but low genotype concordance between cytobrush wgaDNA and paired blood gDNA (82% and 84% for cytobrushes A and B, respectively). Substantial amplification bias was observed with significantly lower human gDNA amplification from cytobrush B than A. Using cytobrush gDNA samples from the breast cancer study (n =20), an independent laboratory demonstrated that increasing template gDNA to the REPLI-g reaction improved genotype performance for 49 SNPs; however, average completion and concordance remained below 90%. To reduce genotype misclassification when cytobrush wgaDNA is used, inclusion of paired gDNA/wgaDNA and/or duplicate wgaDNA samples is critical to monitor data quality.     

Predator-elicited visual signal: why the turquoise-browed motmot wag-displays its racketed tail

Both sexes of the turquoise-browed motmot (Eumomota superciliosa)perform a wag-display in the presence of predators, wherebytheir long racketed tail is repeatedly rocked side-to-side ina pendulous fashion. I tested 3 hypotheses for the functionof the predator-elicited wag-display: 1) pursuit-deterrent signal,2) warning alarm signal, and 3) self-preservation alarm signal.These hypotheses were evaluated by testing whether the presenceof potential receivers (kin, conspecifics, mate) modified theway in which the wag-display was performed. Data on wag-displaywere collected when I experimentally presented predators tomotmots and when naturally occurring predators were observedat nesting colonies. The wag-display was performed by male andfemale motmots who were 1) alone and not within signaling distanceof conspecifics, 2) unpaired and therefore not signaling toa mate, and 3) paired but away from their mate. Motmots in thesecontexts performed the wag-display with similar probabilityand in a similar manner as individuals that were within signalingdistance of conspecifics, paired birds, and paired birds whowere near their mate. These results support the hypothesis thatthe predator-elicited wag-display is directed to the predatorand functions as a pursuit-deterrent signal.     

Multivariate paired data analysis: multilevel PLSDA versus OPLSDA

Metabolomics data obtained from (human) nutritional intervention studies can have a rather complex structure that depends on the underlying experimental design. In this paper we discuss the complex structure in data caused by a cross-over designed experiment. In such a design, each subject in the study population acts as his or her own control and makes the data paired. For a single univariate response a paired t-test or repeated measures ANOVA can be used to test the differences between the paired observations. The same principle holds for multivariate data. In the current paper we compare a method that exploits the paired data structure in cross-over multivariate data (multilevel PLSDA) with a method that is often used by default but that ignores the paired structure (OPLSDA). The results from both methods have been evaluated in a small simulated example as well as in a genuine data set from a cross-over designed nutritional metabolomics study. It is shown that exploiting the paired data structure underlying the cross-over design considerably improves the power and the interpretability of the multivariate solution. Furthermore, the multilevel approach provides complementary information about (I) the diversity and abundance of the treatment effects within the different (subsets of) subjects across the study population, and (II) the intrinsic differences between these study subjects.     

THE STRUCTURE AND FORMATION OF PROTEIN GRANULES IN THE FAT BODY OF AN INSECT

In the larva of the butterfly Calpodes ethlius, the fat body begins to store protein in the form of granules at about 30 to 35 hours before pupation, at a time when the endocuticle is being resorbed. At least two sorts of granule can be distinguished. The first granules to arise are those within vesicles of the Golgi complex. These may increase in size by incorporating material from microvesicles at their surface and by coalescence with one another. Later, at about 10 hours before pupation, another sort of granule arises by the isolation of regions of the endoplasmic reticulum (ER) within paired membranes derived from Golgi vesicles. Several of these ER isolation bodies coalesce, with fusion of their outer isolating membranes. The ribosomes and membranes may then disappear and the granules become indistinguishable from the protein granules formed from Golgi vesicles, or the ribosomes may remain and be embedded in dense crystalline protein, forming a storage body for both protein and RNA. Mitochondria are isolated within paired membranes in the same way as regions of the ER. The isolated mitochondria also coalesce in a similar manner. When the inner membranes are lost, the structure of a group of isolation bodies is indistinguishable from that of a cytolysome. Isolation within paired membranes, as described here, may be of general importance in segregating regions of massive lysis or massive sequestration.     

Effect of spray dryer processing parameters on the insecticidal activity of two encapsulated formulations of baculovirus

The effect of spray dryer processing parameters on the product yield and insecticidal activity of baculovirus was evaluated. Spray-dried samples of a granulovirus (GV) from Pieris rapae (L.) and a multiple nucleopolyhedrovirus (MNPV) from Anagrapha falcifera (Kirby) were prepared using two dryer-atomiser configurations (rotary atomiser and two-fluid spray atomiser), four drying temperatures (50–100°C outlet temperatures) and two encapsulating formulations (lignin and methacrylic acid polymer). The samples were evaluated based on yield and insecticidal activity under laboratory conditions. The two atomising configurations produced similar outlet temperatures for dryer stock feed rates of 4.12 and 20 ml/min when processed using increasing inlet temperatures. The atomiser selection significantly affected the physical properties like the product yield; the microparticles produced with a two-fluid spray atomiser had lower product yields (57.8 ± 18.80% – 74.6 ± 4.26%) when compared with paired samples produced with a rotary-disc atomiser (58.1 ± 7.13% – 82.6 ± 3.12%). Spray drying reduced insecticidal activity of the GV but did not significantly reduce insecticidal activity of the MNPV when compared with samples that were not dried. Among dried samples, the spray dryer processing parameters (atomiser, drying temperatures and formulation) had minimal effect on the insecticidal activity of either baculovirus. The versatility of spray drying for processing baculoviruses was demonstrated by identifying parameters that improve process yield while having minimal impact on insecticidal activity.     

Study on legibility of characters for the elderly--effects of character display modes on legibility

It is more crucial than ever to consider the elderly when designing products. One of the important things to remember is the legibility of characters, since this influences the accessibility and usability of products. We studied the effects of character attributes on legibility using 70 subjects (60 aged 46-79 with no apparent ocular problems except presbyopia, and 10 aged 68-80 with cataracts). Thirty 10-key television remote control models were made. The characters on each were different, and were based on combinations of three attributes-height (5 levels), thickness (3 levels), and display mode (2 levels; positive: black characters on a white background, negative: white characters on a black background). Participants subjectively evaluated the legibility of the characters for each 10-key sample under two ambient illuminance conditions: 500 lx and 50 lx. They also performed paired comparisons on samples with the same height and thickness but different display modes. Subjective data were analyzed using a three-way factorial ANOVA for character height, thickness, and display mode. Legibility was significantly affected by all factors for those without cataracts under both illuminance conditions, and the interaction between thickness and display mode was significant. A two-way factorial ANOVA was performed for height and display mode for each thickness. Legibility was, in general, better for thinner characters in negative mode and was better in negative mode under dark illuminance for those with and without cataracts. This tendency was more pronounced in the elderly (over 65 years old). Paired comparisons showed that legibility was better in negative mode under both illuminance conditions, especially with medium and thin characters, for those with and without cataracts. Although there are few accounts of the effects of positive and negative modes in various existing guidelines, this finding would suggest that legibility can be enhanced by using the negative mode.     

Power in pairs: assessing the statistical value of paired samples in tests for differential expression

Background

When genomics researchers design a high-throughput study to test for differential expression, some biological systems and research questions provide opportunities to use paired samples from subjects, and researchers can plan for a certain proportion of subjects to have paired samples. We consider the effect of this paired samples proportion on the statistical power of the study, using characteristics of both count (RNA-Seq) and continuous (microarray) expression data from a colorectal cancer study.

Results

We demonstrate that a higher proportion of subjects with paired samples yields higher statistical power, for various total numbers of samples, and for various strengths of subject-level confounding factors. In the design scenarios considered, the statistical power in a fully-paired design is substantially (and in many cases several times) greater than in an unpaired design.

Conclusions

For the many biological systems and research questions where paired samples are feasible and relevant, substantial statistical power gains can be achieved at the study design stage when genomics researchers plan on using paired samples from the largest possible proportion of subjects. Any cost savings in a study design with unpaired samples are likely accompanied by underpowered and possibly biased results.

     

Variation in general esterase activity within a population of Haematobia irritans (Diptera: Muscidae).

Control of the horn fly, Hematobia irritans (L.), is generally dependent on chemical insecticides. However, the biology and behavior of the horn fly favors rapid development of insecticide resistance. To prolong the effectiveness of the insecticide option, information is required regarding the mechanisms of insecticide resistance. Metabolic hydrolysis of insecticides by esterases is a detoxification mechanism in many insect species. Measurement of general esterase activity within populations of horn flies may provide a diagnostic tool for resistance management. In this study we evaluated the amount of variation in general esterase activity within female and male horn fly samples from a population that had not been exposed to insecticides for 8 yr. We found considerable variation in general esterase activity within samples of each sex, with females demonstrating the greater variation. The observed variation is thought to be the result of age-structure dynamics within the population. The amount of inherent variation makes it difficult to detect small mean differences between populations, thus limiting the utility of general esterase assays. Thus, effective diagnosis of esterase-mediated resistance mechanisms can only be achieved by the identification of specific detoxification esterases and the design of assays, either biochemical or molecular, for their detection and measurement.     

Low levels of ill health among elderly non-consulters in general practice.

The characteristics of random samples of elderly patients (over 65 years of age), designated as consulters (n = 200) and non-consulters (n = 196), in a group general practice were compared using a postal questionnaire that was validated by comparison with findings by general practitioners in a random sample of 58 responders. A response rate of 90% was obtained, and all non-responders were visited by their general practitioner. The questionnaire had a sensitivity of 79% and a specificity of 82% when compared with general practitioner findings. The use of hospital and social services by non-consulters was low in this practice. Measures of disability and state of health showed that non-consulters were a fit group of the aged. Case finding for problems among elderly people should initially be confined to consulters, who have a high prevalence of problems. Non-consulters are a low risk group that can be assessed only with special effort and extra resources. Once an effective case finding system has been developed it might then be reasonable to consider ways of finding the few patients who have problems but do not consult their doctor.     

Functional Hypermethylation of ALDH1L1 , PLCL2 , and PPP2R3A in Colon Cancer

DNA hypermethylation and mutations are key mechanisms for the downregulation of tumor suppressor genes. NotI-microarrays allowed us to detect hypermethylation and/or deletions in 180 NotI sites associated with 188 genes of human chromosome 3, in 24 paired (tumor/normal) colon samples. The most frequent aberrations (in more than 20% of tumor samples) were detected in the promoter regions of 20 genes. Expression and promoter methylation of these genes were analyzed using the data for paired colon samples from The Cancer Genome Atlas project. Three genes—ALDH1L1, PLCL2, and PPP2R3A—revealed a more than two-fold average decrease in expression and a negative correlation between mRNA level and promoter hypermethylation. The expression of these three genes was then evaluated in 30 paired colon samples by quantitative PCR. Frequent (in more than 60% of cases) and significant (5–9-fold on average) mRNA level decrease was found for each of the genes in the tumor samples. The results indicate a suppressor role of the ALDH1L1, PLCL2, and PPP2R3A genes in colon cancer, as well as functional significance of hypermethylation in the downregulation of these genes.     

Detection of antibodies in serum and cerebrospinal fluid to Toxoplasma gondii by indirect latex agglutination test and enzyme-linked immunosorbent assay.

Sensitivity of anti-Toxoplasma antibody (IgG) test by enzyme-linked immunosorbent assay (ELISA) was evaluated in comparison with indirect latex agglutination (ILA) using 2,016 paired human samples of serum and cerebrospinal fluid (CSF). The samples were collected from neurologic patients in Korea with mass lesions in central nervous system (CNS) as revealed by imaging diagnosis (CT/MRI). When the sera were screened for anti-Toxoplasma antibody by ILA, 76 cases(3.8%) were positive (1:32 or higher titers). In the paired samples of CSF, no positive reactions were observed. When ELISA was performed using PBS extract of Percoll purified tachyzoites as antigen, cut-off absorbance was determined as 0.40 for serum and 0.27 for CSF tests. The antibody positive rates by ELISA were 7.0% in serum and 5.6% in CSF. Of them, 40 cases (2.0%) showed positive reactions in both serum and CSF. The antibody positive rates were higher in groups older than 40 years. The rates were higher in male (4.7% by ILA, 8.3% by ELISA) than in female (2.2% by ILA, 5.0% by ELISA). The rates in CSF showed no such sex difference. ELISA showed twice higher positive rates when serum was tested, and was sensitive enough to detect specific antibodies in CSF. Etiologic relations between positive antibody tests and CNS lesions remained unknown.     

Mutation pattern of paired immunoglobulin heavy and light variable domains in chronic lymphocytic leukemia B cells

B-cell chronic lymphocytic leukemia (CLL) patients display leukemic clones bearing either germline or somatically mutated immunoglobulin heavy variable (IGHV ) genes. Most information on CLL immunoglobulins (Igs), such as the definition of stereotyped B-cell receptors (BCRs), was derived from germline unmutated Igs. In particular, detailed studies on the distribution and nature of mutations in paired heavy- and light-chain domains of CLL clones bearing mutated Igs are lacking. To address the somatic hyper-mutation dynamics of CLL Igs, we analyzed the mutation pattern of paired IGHV-diversity-joining (IGHV-D-J ) and immunoglobulin kappa/lambda variable-joining (IGK/LV-J ) rearrangements of 193 leukemic clones that displayed ≥ 2% mutations in at least one of the two immunoglobulin variable (IGV ) genes (IGHV and/or IGK/LV ). The relationship between the mutation frequency in IGHV and IGK/LV complementarity determining regions (CDRs) and framework regions (FRs) was evaluated by correlation analysis. Replacement (R) mutation frequency within IGK/LV chain CDRs correlated significantly with mutation frequency of paired IGHV CDRs in λ but not κ isotype CLL clones. CDRs of IGKV-J rearrangements displayed a lower percentage of R mutations than IGHVs. The frequency/pattern of mutations in kappa CLL Igs differed also from that in κ-expressing normal B cells described in the literature. Instead, the mutation frequency within the FRs of IGHV and either IGKV or IGLV was correlated. Notably, the amount of diversity introduced by replaced amino acids was comparable between IGHVs and IGKVs. The data indicate a different mutation pattern between κ and λ isotype CLL clones and suggest an antigenic selection that, in κ samples, operates against CDR variation.     

Diagnostic value of dengue virus-specific IgA and IgM serum antibody detection

The diagnostic value of dengue virus (DV)-specific immunoglobulin A (IgA) serum antibody detection, by an indirect immunofluorescence assay (IFA) was evaluated. For this study, the kinetics of DV-specific IgA serum antibodies was analysed in two experimentally immunised macaques, paired samples from 35 patients suspected of a primary or secondary DV infection, paired sera from patients with high levels of IgA specific antibodies against influenza virus (n = 15), sera from patients with other viral infections (n = 40) and healthy blood donors (n = 10), which served as controls. The presence of DV-specific IgA serum antibodies in humans and in monkeys was compared with that of DV-specific IgM demonstrated in a capture enzyme-linked immunosorbent assay (ELISA). The development of DV-specific IgA and IgM antibodies in macaques proved to be similar to that observed in humans with a DV infection. In sera obtained from suspected primary DV patients during the acute phase and convalescent phase, DV-specific IgA was detected in 1/6 (17%) and 6/6 (100%), whereas IgM was detected in 4/6 (67%) and 5/6 (83%), respectively. In sera from suspected secondary DV patients during the acute phase and convalescent phase, DV-specific IgA was detected in 18/29 (62%) and 28/29 (97%), whereas IgM was detected in 20/29 (69%) and 28/29 (97%), respectively. The control group consisted of five paired serum samples from yellow fever vaccinated individuals and a patient with acute tick-borne encephalitis, 15 paired serum samples from patients with high levels of IgA antibodies specific for influenza virus and 40 serum samples from patients with specific IgM antibodies against other viruses. Ten serum samples from healthy blood donors were included. Among the control serum samples, in one patient, both DV-specific IgA and IgM antibodies were present, and in three sera DV-specific IgM antibodies could be demonstrated. These data suggest that detection of DV-specific IgA serum antibodies by IFA may have additional value for the diagnosis of DV infection.     

SOURCES OF ERROR AND THE NO-PREFERENCE OPTION IN DAIRY PRODUCT TESTING

When products are physically identical, consumers will choose a no‐preference option in a paired preference test only about 30% of the time, giving a nonintuitive result. We evaluated the no‐preference false alarm rate in dairy products and the potential sources of error in panelist behavior, including discrimination problems and poor repeatability of judgments. Paired preference tests were conducted with milk (2% versus nonfat or skim), with cottage cheese (4% versus nonfat) and with identical samples. Triangle, dual standard and same/different discrimination tests were also conducted. The no‐preference option was chosen by about 30% of the consumers when samples were identical, and less frequently when samples were different. Discrimination performance, although statistically significant, was poorer than expected with about 30% discriminators (d′ of 1.7) in most tests. Even in the dual standard tests on milk (visually obvious and with references present), performance was only 88% correct (76% discriminators). Repeatability in preference tests was also poorer than expected, with only 56% choosing the same preference option for different samples on repeat trials although the group preferences were stable. Same/different tests indicated that over 50% of the consumers called identical samples different, although this fell short of explaining the 70% average false alarm rate in preferences. Even with apparently discriminable consumer products, accurate discrimination of the samples and repeatability of preferences should not be assumed. Random responding may contribute to error variance and produce nonsensical results such as the expression of choice between identical samples.     

Evaluation of capillary supercritical fluid chromatography with mass spectrometric detection for the analysis of a drug (mebeverine) in a dog plasma matrix

Supercritical fluid chromatography with mass spectrometric detection was evaluated as a technique for the analysis of drugs in biological fluids. Dog plasma was spiked with a model drug, mebeverine, and with a deuterium-labeled analog of mebeverine. The spiked plasma was prepared for analysis by solid-phase extraction on octadecylsilane cartridges. Mebeverine levels in the spiked dog plasma samples were determined by interpolation from a standard curve. Accuracy and precision of the analysis were determined within and between days. In general, accuracy was found to be 100 ± 15% for plasma samples spiked with 6 to 60 ng mebeverine/ml. The relative standard deviation for replicate sample analysis over this concentration range was between 5 and 12.5%.