Is the ratio of inhaled corticosteroid to bronchodilator a good indicator of the quality of asthma prescribing? Cross sectional study linking prescribing data to data on admissions.

OBJECTIVE: To investigate the ratio of inhaled corticosteroid to bronchodilator as a measure of the quality of asthma prescribing by general practitioners. DESIGN: Ecological cross sectional study linking general practitioner asthma prescribing with hospital admission data and a measure of deprivation. SUBJECTS: 11 family health services authorities in the West Midlands region and 99 general practices in North Staffordshire. MAIN OUTCOME MEASURES: Hospital admission rates for asthma; the ratio of inhaled corticosteroid to bronchodilator; and Townsend deprivation scores. RESULTS: No overall significant correlation was found between admission rates for asthma and corticosteroid:bronchodilator ratios for family health services authorities (Spearman''s rs = -0.109, P = 0.750) or general practices (rs = -0.084, P = 0.407). In deprived family health services authority areas and general practices an inverse non-significant correlation existed between admission rates for asthma and corticosteroid:bronchodilator ratios (rs = -0.300, P = 0.624; rs = -0.218, P = 0.136). In contrast, in more affluent areas and general practices a positive non-significant correlation existed between admission rates and corticosteroid:bronchodilator ratios (rs = 0.371, P = 0.468; rs = 0.038, P = 0.792). CONCLUSION: Although the corticosteroid:bronchodilator ratio may be a valid indicator of the quality of prescribing for individual patients with asthma, caution should be applied in interpreting aggregated ratios. Differences in the severity of asthma or the prevalence of chronic obstructive pulmonary disease may explain inconsistent associations between admission rates for asthma and corticosteroid:bronchodilator ratios in family health services authorities and general practices with different deprivation scores.     

Is there and do we need evidence on eHealth interventions?

The proliferation of information and communication technology (ICT) is transforming the healthcare, as an information-intensive sector, in a way that has never been witnessed before. The use of ICT in health or eHealth has the potential to improve the quality of health services, improve access to services and reduce cost. Huge investments in eHealth initiatives have been made by many countries based on this potential. A body of evidence is being developed to show the value of eHealth. Research and evaluation in eHealth should be comprehensive and not only limited to technology. There is a need for more research in this area using a multidisciplinary approach and teams.     

Gravitropic responses of the Avena coleoptile in space and on clinostats. II. Is reciprocity valid?

Experiments were undertaken to determine if the reciprocity rule is valid for gravitropic responses of oat coleoptiles in the acceleration region below 1 g. The rule predicts that the gravitropic response should be proportional to the product of the applied acceleration and the stimulation time.
Seedlings were cultivated on 1 g centrifuges and transferred to test centrifuges to apply a transverse g-stimulation. Since responses occurred in microgravity, the uncertainties about the validity of clinostat simulation of weightlessness was avoided Plants at two stages of coleoptile development were tested. Plant responses were obtained using time-lapse video recordings that were analyzed after the flight. Stimulus intensities and durations were varied and ranged from 0.1 to 1.0 g and from 2 to 130 min, respectively. For threshold g-doses the reciprocity rule was obeyed. The threshold dose was of the order of 55 g s and 120 g s, respectively, for two groups of plants investigated. Reciprocity was studied also at bending responses which are from just above the detectable level to about 10 degrees. The validity of the rule could not be confirmed for higher g-doses, chiefly because the data were more variable.
It was investigated whether the uniformity of the overall response data increased when the gravitropic dose was defined as (g^m× 1), with m-values different from unity. This was not the case and the reciprocity concept is, therefore, valid also in the hypogravity region. The concept of gravitropic dose, the product of the transverse acceleration and the stimulation time, is also well-defined in the acceleration region studied. With the same hardware, tests were done on earth where responses occurred on clinostats. The results did not contradict the reciprocity rule but scatter in the data was large.     

Is the nucleus in need of translation?

In prokaryotic cells, protein synthesis commences on nascent messenger RNAs while they are still being synthesized on the DNA template. The eukaryotic nuclear envelope spatially segregates protein synthesis away from the genome and messenger RNA production – this being thought to be a defining feature of the Eukarya. New results suggest that the eukaryotic ‘standard model’ might be an oversimplification. How good is the evidence for translation in the cell nucleus, and, if sound, where do the new findings take us?     

Is there sufficient experimental evidence to consider the mitochondrial cytochromebc 1 complex a proton pump? Probably no.

The electron flow through the cytochromebc ₁ complex of the mitochondrial respiratory chain is accompanied by vectorial proton translocation, though the mechanism of the latter phenomenon has not yet been clarified. Several proposed hypotheses are briefly presented and discussed here. Recently, a number of papers have appeared claiming the existence of a proton pump in the enzyme mainly on the basis of the interaction of the complex with N,N-dicyclohexylcarbodiimide. These data are reviewed here with the aim of showing their ability to fit multiple interpretations. This together with some other arguments leads to the conclusion that a proton pump in the mitochondrialbc ₁ complex has not yet been demonstrated.This article is dedicated to the memory of my friend and long-time close collaborator Dr. Robert P. Casey who has passed away after a short, tragic illness at the age of 34.     

Is the adaptation model a valid description of the vestibulo-ocular reflex?

The pendulum model of the vestibulo-ocular reflex, including the effects of adaptation, has been evaluated using the responses of 36 normal subjects to impulsive stimuli of 128 and 256°/s. Estimates of the model parameters such as the time constants, the slow velocity threshold, and the minimum stimulus required to produce an after-nystagmus have been obtained using a new analytical technique. Although some of the data support the validity of the adaptation model, evidence is presented to demonstrate that the overall applicability of the model is limited.     

The reflex mechanism underlying the neuromuscular effects of whole-body vibration: Is it the tonic vibration reflex?

Objectives:Whole-body vibration (WBV) is applied to the sole of the foot, whereas local mechanical vibration (LMV) is applied directly to the muscle or tendon. The time required for the mechanical stimulus to reach the muscle belly is longer for WBV. Therefore, the WBV-induced muscular reflex (WBV-IMR) latency may be longer than the tonic vibration reflex (TVR) latency. The aim of this study was to determine whether the difference between WBV-IMR and TVR latencies is due to the distance between the vibration application point and the target muscle.Methods:Eight volunteers participated in this study. The soleus reflex response was recorded during WBV, LMVs, and tendon tap. LMVs were applied to the Achilles tendon and sole of the foot. The latencies were calculated using the cumulative averaging technique.Results:The latency (33.4±2.8 ms) of the soleus reflex induced by the local foot vibration was similar to the soleus TVR latency (30.9±3.2 ms) and T-reflex (32.0±2.4 ms) but significantly shorter than the latency of the soleus WBV-IMR (42.3±3.4 ms) (F_(3,21)=27.46, p=0.0001, partial η²=0.797).Conclusions:The present study points out that the neuronal circuitries of TVR and WBV-IMR are different.