Concern mounts as transfusion medicine loses its lustre

Transfusion medicine is in trouble. Several factors, ranging from the tainted-blood scandal to changes in the way the system operates, mean that young physicians are avoiding the specialty. Dr. Antonio Giulivi of the Red Cross says the issue is serious because these specialists act as the system''s overseers, and this fact won''t change when the Red Cross gets out of the blood business in September.     

"I won't do surgery if you don't try to do my job," head of new blood agency tells MDs

Ken Fyke is known as a tough administrator, and he is going to need all of his administrative tricks as first chair of Canadian Blood Services, the new national organization that is taking over responsibility for the nation''s blood supply from the Red Cross come September. Fyke says he hopes to work closely with physicians, but they will have to realize where their responsibilities end and his begin.     

Concept of a Paediatric Emergency Ward for the Cities of a Developing Country

Children''s hospitals in developing countries carry an enormous patient load. Available facilities must be organized to provide essential care for all. At the Red Cross Children''s Hospital in Cape Town this has been achieved by the development of an emergency ward attached to the outpatient department. It is suggested that this concept should be applied in large hospitals of other developing countries.     

With a system in turmoil,will there be enough blood?

In a short time Canadians won''t be able to recognize their blood-collection system. With the Red Cross getting out of the blood business and the government and business moving in, what will the changes mean for Canadians and their physicians?     

Serum screening for Down's syndrome: some women's experiences.

OBJECTIVES--To describe the experiences of a small group of women who had positive results after serum screening for Down''s syndrome. DESIGN--Semistructured telephone interviews and correspondence with women after a positive screening result (four women) negative amniocentesis results (eight), or termination of a pregnancy with a confirmed abnormality (eight). SUBJECTS--20 women who contacted Support After Termination For Abnormality about their experiences of serum screening for Down''s syndrome. MAIN OUTCOME MEASURES--Women''s knowledge and understanding of the test; staff misconceptions; communication of results; how women coped with the diagnostic process; attitudes to the test and to termination of abnormal fetuses. RESULTS--All women were made anxious by their positive screening test, no matter how they were told. The women''s experiences suggested that medical staff were unclear about the implications of screening tests and how to interpret risk. Even after receipt of negative amniocentesis results some women remained anxious. Staff did not always recognise women''s concerns while awaiting amniocentesis results. CONCLUSIONS--The way in which serum screening is being implemented does not always meet the needs of women with positive results. Some of the problems were not specific to screening for Down''s syndrome. When screening tests are introduced policies should be adopted to ensure appropriate support for participants.     

Effect of a Preparative Technique on the Viability of Concentrated Red Cells

In a study of the technique employed by the Canadian Red Cross Blood Transfusion Service in Montreal, the authors found that the packed red blood cells from 10 healthy donors had a mean hematocrit of 83 ± 1.45 with a 24-hour red cell survival after three weeks'' storage of 79.4 ± 2%. The technique used a centrifugal force of 6975 G, the practical maximum of present-day equipment. In addition to finding excellent survival of packed cells subjected to extreme plasma deprivation and extreme forces of centrifugation they also report excellent survival of stored, highly concentrated red cells infused under pressure.     

Social structure of the donor sample of a district blood donation and transfusion institute

The change from paid blood donation to that made within the Red Cross Organization at the Erfurt District Institute for Blood Donation and Transfusion Service is reflected in the altered composition of the donor population. Team A (n = 4903) consists of "traditional" paid blood donors and Red Cross blood donors. It is characterized as follows: - approximately equal percentage of men and women, - high percentage of working class people with skilled worker's certificate. Women are relatively less frequent among blood donors than men, they are more frequently represented, however, as Red Cross blood donors. Team B (n = 759) covers all new blood donors since 1986, exclusively Red Cross blood donors. It is characterized as follows: - women are represented by 69% (predominantly female students), - the highest percentage (42%) of the team is made up of students. The percentage of blood donors from working class people with a skilled worker's certificate correspond to GDR average. Among the donors graduates from technical colleges and universities are overrepresented, whereas trained working class people with a skilled worker's certificate and those without it are underrepresented. Members of the staff of the municipal health service and Medical Academy as well as students of medicine and education made up the highest percentage of blood donors. About 17% of all members of the medical health service are blood donors, far more than in other branches of Erfurt.     

Effect of a Multi-Dimensional Intervention Programme on the Motivation of Physical Education Students

This research study purports to verify the effect produced on the motivation of physical education students of a multi-dimensional programme in dance teaching sessions. This programme incorporates the application of teaching skills directed towards supporting the needs of autonomy, competence and relatedness. A quasi-experimental design was carried out with two natural groups of 4^th year Secondary Education students - control and experimental -, delivering 12 dance teaching sessions. A prior training programme was carried out with the teacher in the experimental group to support these needs. An initial and final measurement was taken in both groups and the results revealed that the students from the experimental group showed an increase of the perception of autonomy and, in general, of the level of self-determination towards the curricular content of corporal expression focused on dance in physical education. To this end, we highlight the programme''s usefulness in increasing the students'' motivation towards this content, which is so complicated for teachers of this area to develop.     

Results of first year (1989) of a national register of Down's syndrome in England and Wales.

OBJECTIVE--To examine the feasibility of a national register of Down''s syndrome and its effectiveness in evaluating prenatal screening for the syndrome. DESIGN--Information for the register was obtained from all eligible cytogenetic laboratories on relevant cytogenetic diagnoses, including date and place of birth or termination, maternal age, indication for karyotyping, and type of diagnostic test used. SETTING--Cytogenetic laboratories in England and Wales. SUBJECTS--All fetuses with trisomy 21 diagnosed prenatally and live births with Down''s syndrome diagnosed at birth. MAIN OUTCOME MEASURES--Number of prenatal and postnatal diagnoses of Down''s syndrome. National and maternal age specific prevalence of Down''s syndrome. RESULTS--For 1989 there were 1060 registrations--323 prenatal diagnoses and 737 postnatal diagnoses--after exclusion of postnatally diagnosed miscarriages and stillbirths. The estimated national rate of affected births for mothers resident in England and Wales was 1.4/1000 live births, assuming no terminations of affected pregnancies and after correction for natural losses which would have occurred in the absence of termination. The corrected maternal age specific rates were close to those found in previous population based studies. The proportion of affected pregnancies diagnosed prenatally in mothers aged 35 to 39 was 44%, and for those aged 40 or more it was 71%. Abnormal findings on ultrasonography played an unexpectedly important part in initiating cytogenetic investigation (13% of the prenatal diagnoses). CONCLUSIONS--The findings establish the feasibility of a national Down''s syndrome register and its use in evaluating prenatal screening services. Together with information held by the Office of Population Censuses and Surveys on congenital malformations, data from the register will permit studies of environmental variables affecting the prevalence of the syndrome.     

Another Look at the Medical “Generation Gap”—Second Triennial Survey of Attitudes of Medical Students and Recent Graduates

A 1969 survey of attitudes held by medical students and recent graduates was repeated in 1972, using the same samples of respondents and adding a new freshman group. Findings from both surveys showed that a “generation gap” existed on many issues.Furthermore, a comparison of the two studies suggested that two kinds of attitude change are occurring simultaneously. On some issues, the next generation of physicians will probably continue to differ from their predecessors. Perhaps the primary thread woven through this cluster of attitudes is that today''s medical students and young physicians perceive themselves as members of a larger structure for providing health care.However, many of the students'' attitudes held early in their medical careers appear to have been modified in the process of becoming physicians. It appears that medical education continues to convey many traditional professional values to students, and it seems likely that tomorrow''s physicians will retain a core of those values.     

Anti-IgA-mediated transfusion reactions in Canada.

During a 6-year period (1977 to 1982) blood samples from 152 Canadian patients were referred to the national reference laboratory of the Canadian Red Cross Society because the referring hospitals had not been able to determine the cause of the patients'' severe nonhemolytic transfusion reactions. Twenty-one patients were found to be IgA deficient, and 12 of them had strong class-specific anti-IgA antibodies, which were presumed to have been responsible for the reactions. The spectrum of symptoms that accompanied these violent reactions was documented for 10 of the patients. As a probable minimum, the incidence of anti-IgA-mediated reactions averaged 1.3 per million units of blood or blood products transfused during this period.     

Association of cardiovascular disease risk factors with socioeconomic position during childhood and during adulthood.

OBJECTIVE: To investigate strength of associations between risk factors for cardiovascular disease and socioeconomic position during childhood and adulthood. DESIGN: Cross sectional analysis of status of cardiovascular risk factors and past and present social circumstances. SUBJECTS: 5645 male participants in the west of Scotland collaborative study, a workplace screening study. MAIN OUTCOME MEASURES: Strength of association between each risk factor for cardiovascular disease (diastolic blood pressure, serum cholesterol concentration, level of recreational physical exercise, cigarette smoking, body mass index, and FEV1 score (forced expiratory volume in one second as percentage of expected value) and social class during childhood (based on father''s main occupation) and adulthood (based on own occupation at time of screening). RESULTS: All the measured risk factors were significantly associated with both father''s and own social class (P < 0.05), apart from exercise and smoking (not significantly associated with father''s social class) and body mass index (not significantly associated with own social class). For all risk factors except body mass index, the regression coefficient of own social class was larger than the regression coefficient of father''s social class. The difference between the coefficients was significant for serum cholesterol concentration, cigarette smoking, body mass index, and FEV1 score (all P < 0.001). CONCLUSIONS: Subjects'' status for behavioural risk factors (exercise and smoking) was associated primarily with current socioeconomic circumstances, while status for physiological risk factors (serum cholesterol, blood pressure, body mass index, and FEV1) was associated to varying extents with both past and present socioeconomic circumstances.     

“趣味教学法”在微生物学课堂中的应用及探讨

微生物学属于生命科学的重要分支,是生物、食品科学、临床医学等大学专业一门重要的基础课。该课程综合性强、知识涉及面广,所以如何有效调动学生的学习兴趣将直接影响课堂效果。为达到良好的教学效果,教师可在微生物学教学过程中综合运用多种方式提高学生学习兴趣与学习质量。因此,我们采用“趣味教学法”进行教学设计,并针对连续3个不同年级的相同专业班级做出教学改革,通过学生期末闭卷成绩、过程考核（签到率、课堂参与度、注意力集中程度等）成绩与学生反馈评语对教学成果进行验证。结果表明,采用“趣味教学法”进行教学改革的班级学生期末闭卷成绩中不及格率低于未改革的班级,“良好”与“优秀”学生比例均高于未改革的班级,过程考核成绩远高于未改革的班级,说明“趣味教学法”教学改革有效调动了学生的学习兴趣。我们认为,在大学微生物学课堂上,教师可在教学设计中适当引入趣味教学内容并适时展开,有助于改善教学气氛,调动学生学习积极性与主动性,提高教学质量。     

Mobile Unit for Screening for Cervical and Breast Cancer

In 12 months'' use of a mobile unit for cervical and breast cancer screening in Gloucestershire 3,211 women attended at an average of five sessions a week. Clinic sessions were organized and the running costs of the service met by a voluntary organization. The keeping of records, provision of laboratory facilities, and the follow-up of patients were carried out in close cooperation with the county health department.     

Fluorescent measurement of lipid content in the model organism Chlamydomonas reinhardtii

The green alga Chlamydomonas reinhardtii is one of the most studied microalgae, which has the potential to be used as a model system to study lipid metabolism. Establishment of a method in this organism for rapid and simple measurement of neutral lipids is desirable. Fluorescent measurement of neural lipids by Nile Red staining has been widely used in various cell types including microalgae. However, a systematic study of Nile Red staining to measure neutral lipids in Chlamydomonas has not been reported. Here, we show that Nile Red staining is suitable for relative and absolute quantification of neutral lipids as well as for possible large-scale screening for mutants defective in lipid accumulation. We have compared and optimized the factors involved Nile Red staining including solvents, cell concentration, staining time, and Nile Red concentration. We determined that 5 % DMSO with 1 μg mL^?1 Nile Red and 5–15-min time window after staining was optimal for measuring lipid content of cells within the range of 1 to 8?×?10⁶ cells mL^?1. The absolute quantification of neutral lipids could be achieved by standard addition method. In addition, we developed a protocol that could be potentially used for large-scale screening for cells with different lipid content. Thus, the work reported here provides timely needed techniques to facilitate Chlamydomonas to be used as a model organism for studying lipid metabolism for biodiesel production.     

Cost-effectiveness analysis for triple markers serum screening for Down's syndrome in Thai setting

BACKGROUND:

Down''s syndrome is an important congenital chromosomal disorder that can be seen around the world. The antenatal screening for this disorder is an important processing in present obstetrics.

OBJECTIVE:

Due to the concept of first do no harm, the use of noninvasive test is recommended. The triple marker screening test has been introduced for a few years and acceptable for its efficacy.

RESULT:

However, an important concern is on its cost-effectiveness. Here, the author analyze and present the cost-effectiveness of the triple markers serum screening for Down''s syndrome in Thai setting.

CONCLUSION:

According to this work, the cost per effectiveness of triple markers serum screening is slightly lower than standard amniocentesis test.     

Coccidioidomycosis in Northern California—An Outbreak among Archeology Students near Red Bluff

An outbreak of coccidioidomycosis occurred among 39 archeology students in the summer of 1972. The students excavated Indian ruins near Red Bluff in Tehama County, California, 20 miles north of the previously recognized northernmost limit of endemicity. At least 17 persons contracted an illness clinically compatible with a diagnosis of coccidioidomycosis. Coccidioidomycosis was documented by skin test conversion as well as by specific serologic reactions. Coccidioides immitis was also isolated from two soil samples taken at the excavation site. In light of its ecological requirements, it is doubtful that C. immitis will be recovered much farther north than Red Bluff. The occupational hazard of coccidioidomycosis to archeologists and others employed in known endemic areas remains a substantial threat to health.     

Cost of allogeneic and autologous blood transfusion in Canada. Canadian Cost of Transfusion Study Group.

OBJECTIVE: To determine the cost, from a societal perspective, of blood transfusion in Canada. STUDY DESIGN: Cost-structure analysis. SETTING: Data were collected from eight hospitals and from six blood centres operated by the Canadian Red Cross Society in four provinces. OUTCOME MEASURES: Costs associated with four stages of transfusion-- collection, production, distribution and delivery--in 1933 were assessed. Costs were divided into the following categories; personnel, purchases, external services, overhead, donors'' time, patients'' time (for autologous transfusion), wastage and infection. RESULTS: The mean overall cost of a transfusion performed on an inpatient basis was $210 per unit of red blood cells for an allogeneic transfusion and $338 per unit of blood for an autologous transfusion. The mean cost of an allogeneic transfusion performed on an outpatient basis was $280 per unit of red blood cells. CONCLUSION: The costs determined in this study can be used in future studies comparing the cost-effectiveness of allogeneic transfusion with that of alternative methods.     

Retrospective audit of different antenatal screening policies for Down's syndrome in eight district general hospitals in one health region

ObjectiveTo compare the effectiveness of different screening policies for the antenatal detection of Down''s syndrome.DesignRetrospective six year survey.SettingMaternity units of eight districts.ParticipantsWomen who completed their pregnancies between 1 January 1994 and 31 December 1999 (155 501 deliveries).Results335 cases of Down''s syndrome were identified, 323 in continuing pregnancies or liveborn children. Of these, 171 were identified antenatally. Seven different screening policies were used, in three principal groups: serum screening offered to all mothers, maternal age with serum screening or nuchal translucency available to limited groups, and maternal age combined with anomaly scans. The districts that used serum screening detected 57%, those using maternal age plus serum or nuchal translucency screening 52%, and those using a maternal age of ⩾35 and anomaly scans detected 54%. The least successful district, which offered amniocentesis only to women aged over 37 years, detected only 31%. If amniocentesis had been offered from 35 years, as in all other districts, the detection rate would have risen to 54%. Across the region 15% (range 12-20%) of pregnant women were 35 years or more at delivery, and 58% (33-69%) of infants with Down''s syndrome were born to women in this age range.ConclusionsCurrent additional serum or nuchal translucency screening techniques for antenatal detection of Down''s syndrome are less advantageous than previously supposed. More pregnant women were aged over 35 than has been presumed in statistical models used in demonstration projects of serum screening and, as a result, the proportion of affected fetuses in this age group is much greater than predicted.

What is already known on this topic

Serum screening for Down''s syndrome has been presumed to be more effective than screening by maternal ageThere have been no controlled studies comparing serum screening with screening by maternal age, and its greater efficacy has been presumed from mathematical modelling, which assumed that only 5% of pregnant women were aged over 35 yearsThe modelling predicted that only 20-30% of cases of Down''s syndrome would arise in women aged over 35 and made no allowance for the effects of routine anomaly scanning

What this study adds

15% of pregnant women were aged over 35 years, more than double the 5-7% presumed in statistical models of screening58% of babies with Down''s syndrome were born to women aged 35 years or moreSerum screening and nuchal scanning did not achieve significantly higher antenatal detection rates of Down''s syndrome than the use of maternal age and routine anomaly scanning     

Attendance and non-attendance for breast screening at the south east London breast screening service.

OBJECTIVES--To ascertain the reasons for a low rate of response for breast screening. DESIGN--All relevant aspects of the organisational process examined, including general practitioners'' notes. Non-responders visited and interviewed. SETTING--An inner city breast screening service working on the model advocated by the Forrest report. SUBJECTS--288 Women aged 50-64 registered with several general practices and invited for screening by post. MAIN OUTCOME--Determination of factors important for success of breast screening programmes. RESULTS--After five women were excluded by their general practitioners the response rate was 129 out of 283 (46%), but 99 (35%) of the women did not receive their invitations because of inaccuracies in the family practitioner committee''s database and general practitioners failing to check women''s addresses completely. CONCLUSIONS--Increased rates of response will depend on enabling general practitioners to check addresses and on an increased awareness of the importance of information.