Human papillomavirus testing with a liquid-based system: feasibility and comparison with reference diagnoses

OBJECTIVE: To validate the utilization of cervical specimens collected in the fixative liquid used in the CYTO-screen System (SEROA, Monaco) for oncogenic human papillomavirus (HPV) DNA detection by the Hybrid Capture II technique (HCII) (Digene, Gaithersburg, Maryland, U.S.A) by reference to cytologic and/or histologic results. STUDY DESIGN: A technical feasibility study was conducted on 3 modalities of sample preparation before HCII technique, 1 with a proteinase digestion, I with PBS washing and I using the Digene sample conversion kit recommended for ThinPrep medium preparation (Cytyc Corp., Boxborough, Massachusetts, U.S.A.). The stability of cells after storage at days 28, 60 and 90 was tested on 26 positive samples (13 with high initial indices and 13 with low initial indices). Results of HPV testing were compared to cytologic and histologic results on a sample of 98 smears already identified as high grade squamous intraepithelial lesion (HSIL) (48) or low grade squamous intraepithelial lesion (LSIL) (50). A retrospective analysis was then performed on 995 HPV tests perfornmed routinely in 2003 in terms of comparison with the corresponding cytologic and/or histologic results. RESULTS: The HCII technique after direct treatment by proteinase K appeared to be as effective as the Digene sample conversion kit. By using the first technique, all 26 positive cases remained positive at 60 days, but 4 of 13 (30%) with low indices became negative at 90 days. The sensitivity of HPV testing for detecting biopsy- proven cervical intraepithelial neoplasia (CIN) 2 or worse was 100% in the 50 LSIL and 98% in the 48 HSIL samples. In the retrospective study (n = 995), the cytologic diagnoses of atypical squamous cells of undetermined significance (ASC-US) (n=278), LSIL (n = 137) and HSIL (n = 28) were associated with a positive HPVtest in 44%, 75% and 96% of cases, respectively. On a subsample of 156 patients among 278 with a diagnosis of ASC- US, the sensitivity of HPV testingfor detecting CIN 2 or worse was 88%, specificity 57%, positive predictive value 10% and negative predictive value 99%. Performing HPV testing by the HCII technique for cervical specimens collected in the fixative liquid used in the CYTO-screen System is feasible in the context of an ASC-US cytologic diagnosis.     

A Monte Carlo study to investigate the feasibility to use the Moroccan panoramic irradiator in sterile insect technique programs

Radiation and Environmental Biophysics - Mediterranean fly pest (Ceratitis) is one of the most destructive pests of fruit species in Morocco. The sterile insect technique (SIT) is an...     

A conceptual model for the identification, organization, and measure of influence of fertility policies and programs.

The fertility program of any government is the procedural action intended to effect the government fertility policy. There may also be unintended results of any fertility program. A conceptual model was designed to measure the effect of governmental action on fertility and to identify sociocultural factors that have the greatest influence on fertility. The model uses sociocultural variables as intervening variables between fertility programs and changes in actual fertility. The structural variables considered by the model are characteristics of the pattern of social order; the cultural variables consist of shared values and norms. Fertility trend analysis is effected by polynomial regression formulae. Puerto Rican data from 1946 to 1970 were used to test the proposed model. Analysis of the data indicated that emigration between 1940-1962 had little effect on national fertility. Governmental family planning programs, beginning in 1946, contributed to a sharp decline in fertility. It is recommended that the model be used with data from other countries to assess the effects of their family planning programs.     

Fidelity of implementation: development and testing of a measure

Background

There is a considerable evidence base for 'collaborative care' as a method to improve quality of care for depression, but an acknowledged gap between efficacy and implementation. This study utilises the Normalisation Process Model (NPM) to inform the process of implementation of collaborative care in both a future full-scale trial, and the wider health economy.

Methods

Application of the NPM to qualitative data collected in both focus groups and one-to-one interviews before and after an exploratory randomised controlled trial of a collaborative model of care for depression.

Results

Findings are presented as they relate to the four factors of the NPM (interactional workability, relational integration, skill-set workability, and contextual integration) and a number of necessary tasks are identified. Using the model, it was possible to observe that predictions about necessary work to implement collaborative care that could be made from analysis of the pre-trial data relating to the four different factors of the NPM were indeed borne out in the post-trial data. However, additional insights were gained from the post-trial interview participants who, unlike those interviewed before the trial, had direct experience of a novel intervention. The professional freedom enjoyed by more senior mental health workers may work both for and against normalisation of collaborative care as those who wish to adopt new ways of working have the freedom to change their practice but are not obliged to do so.

Conclusions

The NPM provides a useful structure for both guiding and analysing the process by which an intervention is optimized for testing in a larger scale trial or for subsequent full-scale implementation.     

DNA-based genetic testing is rising steeply in a national health care system with open access to services: a survey of genetic test use in Germany, 1996-2002

The extent to which the fast-growing body of genetic knowledge is transferred into everyday clinical practice has nowhere been assessed in a systematic way. Available quantitative analyses of DNA-based genetic test provision and uptake rates are all concerned with specific test programs. The German health-care system is ideally suited for a more general approach, because it is highly flexible regarding access to services, thus permitting quick adjustments to sudden changes in particular subfields of medicine such as genetic testing. We have measured the amount of genetic service provision in Germany between 1996 and 2002 by making use of the central database of the German national health-care system and by inquiring with private health insurance. We can document a three-fold increase of DNA-based testing in the time period 1996-2002, whereas cytogenetic analyses and genetic counseling have remained constant. The growing body of genetic knowledge does indeed seem to be transferred into medical practice at an increasing rate, and the uptake rates are largely in proportion to test offers. DNA-based testing appears to be focussed on disease-associated germ-line alterations.     

The use of fluorescent dyes to measure membrane potentials: a response

The use of fluorescent cyanine dyes to estimate membrane potential in cell suspensions has been considered. Several problems related tot he application of the dyes have been reviewed. These problems include: 1) alteration of the membrane potential (Em) and factors involved in establishing Em by the dyes themselves, 2) the effects of altered energy metabolism on the fluorescent response of the dyes and on Em, and 3) calibration of dye fluorescence. Recent reports that advocate the use of the fluorescent dyes are misleading.     

Design and testing of a novel measuring system for use in dental biomechanics--principles and examples of measurements with the hexapod measuring system]

A novel measuring set-up based on a hexapod system for use in dental biomechanics is described. It was specially developed to measure force/deflection characteristics of different dental materials and devices. The functionability and suitability of the system for use in experimental biomechanics were investigated in two different studies. In a first study the micro mobility of prosthetic telescopic crowns prior to and after simulated wear was determined to investigate the influence of wear processes on the stability of the anchorage elements and thus of prostheses. This study investigated the ability of the setup to load a specimen with high forces or torques of up to 100 Newton. The second study looked at the force/deflection characteristics of orthodontic anchorage pins used in orthodontics to additionally stabilize the anchorage unit, for example during molar movement. In this study specimens were loaded with small forces of less than 10 Newton, as are typically used in orthodontics. Using the setup, the deflection behaviour of these devices under high and low loading was measured at a resolution of approximately one micrometer or one angular second.     

On the use of spleen mass as a measure of avian immune system strength

The avian spleen has been frequently used in studies of avian ecology, parasitology, and evolution to infer immune system strength in birds. Traditionally, it has been assumed that a large spleen is representative of a strong immune system and conclusions based on this assumption have led to interesting interpretations of the role of disease and parasitism, for example in predator-prey interactions. This assumption of a positive relationship between spleen size and immune system strength has been made despite an incomplete understanding of the physiology of the avian spleen and little evidence of the validity of such an assumption. In this response, we demonstrate that the assumption of a predictable, positive relationship between spleen size and immunocompetence may be unjustified based on what is known of avian splenology. We also review recent research that may indicate that the inverse of the above assumption is true and we discuss general limitations of the use of the spleen as an indicator of immune system strength in birds. Finally, we make recommendations for future research topics in this field of study.     

The validity and reliability of 5-Hz global positioning system units to measure team sport movement demands

The purpose of this research was to investigate the validity and the reliability of 5-Hz MinimaxX global positioning system (GPS) units measuring athlete movement demands. A team sport simulation circuit (files collected from each unit = 12) and flying 50-m sprints (files collected from each unit = 34) were undertaken, during which the total distance covered; peak speed; player load; the distance covered; time spent and number of efforts performed walking, jogging, running, high-speed running, and sprinting were examined. Movement demands were also separately categorized into low-intensity activity, high-intensity running, and very high-intensity running. The results revealed that GPS was a valid and reliable measure of total distance covered (p > 0.05, percentage typical error of measurement [%TEM] < 5%) and peak speed (p > 0.05, %TEM 5-10%). Further, GPS was found to be a reliable measure of player load (%TEM 4.9%) and the distance covered, time spent, and number of efforts performed at certain velocity zones (%TEM <5% to >10%). The level of GPS error was found to increase along with the velocity of exercise. The findings demonstrated that GPS is capable of measuring movement demands performed at velocities <20 km·h(-1), whereas more caution is to be exercised when analyzing movement demands collected by using GPS velocities >20 km·h(-1).     

Development and psychometric testing of a theory-based tool to measure self-care in diabetes patients: the Self-Care of Diabetes Inventory

Background

Self-care is essential for patients with diabetes mellitus. Both clinicians and researchers must be able to assess the quality of that self-care. Available tools have various limitations and none are theoretically based. The aims of this study were to develop and to test the psychometric properties of a new instrument based on the middle range-theory of self-care of chronic illness: the Self-Care of Diabetes Inventory (SCODI).

Methods

Forty SCODI items (5 point Likert type scale) were developed based on clinical recommendations and grouped into 4 dimensions: self-care maintenance, self-care monitoring, self-care management and self-care confidence based on the theory. Content validity was assessed by a multidisciplinary panel of experts. A multi-centre cross-sectional study was conducted in a consecutive sample of 200 type 1 and type 2 diabetes patients. Dimensionality was evaluated by exploratory factor analyses. Multidimensional model based reliability was estimated for each scale. Multiple regression models estimating associations between SCODI scores and glycated haemoglobin (HbA1c), body mass index, and diabetes complications, were used for construct validity.

Results

Content validity ratio was 100%. A multidimensional structure emerged for the 4 scales. Multidimensional model-based reliabilities were between 0.81 (maintenance) and 0.89 (confidence). Significant associations were found between self-care maintenance and HbA1c (p?=?0.02) and between self-care monitoring and diabetes complications (p?=?0.04). Self-care management was associated with BMI (p?=?0.004) and diabetes complications (p?=?0.03). Self-care confidence was a significant predictor of self-care maintenance, monitoring and management (all p?<?0.0001).

Conclusion

The SCODI is a valid and reliable theoretically-grounded tool to measure self-care in type 1 and type 2 DM patients.

     

The health of Indians in Canadian cities: a challenge to the health care system

It is well known that Canadian native people living on reserves have high morbidity and mortality rates, but less is known about the health of those who migrated to urban centres. Several studies have shown that these people have high rates of mental health problems, specific diseases, injuries, infant death and hospital admission. In addition, there is evidence that cultural differences create barriers to their use of health care facilities. The low socioeconomic status, cultural differences and discrimination that they find in cities are identified as the primary blocks to good health and adequate health care. More epidemiologic studies need to be done to identify health problems, needs and barriers to health care. Federal, provincial and civic governments along with the appropriate departments of faculties of medicine should begin working with native organizations to improve the health of native people living in Canada''s cities.     

The use of a monoclonal antibody to measure plasma atriopeptins in rat

A monoclonal antibody with specificity for atrial natriuretic peptides (ANP) was produced, that can be used for the radioimmunological determination of ANP-immunoreactivity (ANP-IR) in rat plasma. The antibody recognizes atriopeptin I, II, III, as well as alpha-hANP and alpha-hANP fragment (7-28) and does not crossreact with ANP-fragments (13-28) and (18-28). Plasma levels of ANP-IR in conscious Wistar rats were determined before and after volume-loading. Basal plasma levels of ANP-IR were 108 +/- 12 pg/ml, and after volume-loading increased to 800 +/- 59 pg/ml.