Defining core health services: the New Zealand experience

The New Zealand health service has been extensively changed over the past four years, with the introduction of four new Regional Health Authorities, required to purchase services on behalf of the Government from a range of providers. In order to ensure fairness across the four regions a Core Services Committee has been set up to define which services must be purchased. However, no clear agreement has emerged about a "core" and no list, either positive (inclusions) or negative (exclusions), has been defined. Instead general criteria have been suggested and steps have been taken to consult the community on their priorities. This paper describes seven workshops run by the author in an effort to discover how the community would reach decisions on the rationing of scarce resources. The outcome of these workshops is that there is virtually no community support for an approach based on the social utility of individuals in need.     

Post-exercise metabolic rate in Atlantic cod and its dependence upon the method of exhaustion

This study tests whether or not post-exercise oxygen consumption rates ( M o₂) in fish are dependent upon how exhaustion is induced. A group of eight Atlantic cod ( Gadus morhua ) were each exercised using (1) a critical swimming speed ( U _crit) protocol, (2) an exercise protocol designed to measure anaerobic capacity of fish ( U _burst), and (3) a protocol in which the fish were chased to exhaustion manually. M o₂ was measured for a 2-h period following exhaustion induced by all three exercise regimes ( U _crit, U _burst and chase). Post-exercise M o₂ following exhaustion from the U _burst and chase protocols were significantly higher than post-exercise M o₂ following the U _crit protocol. Each fish during the U _crit protocol exhibited maximal M o₂ during exercise rather than during recovery, yet 75% of the fish during U _brust recovery and 100% during chase recovery exhibited M o₂ higher than that measured during U _crit exercise. These results, as well as the large interindividual variations in M o₂ among the eight fish, show that post-exhaustion M o₂ is specific to the exercise regime employed, thus, investigators must exercise caution when combining results from different exercise protocols and/or individuals.     

Packing interactions of aib-containing helices: Molecular modeling of parallel dimers of simple hydrophobic helices and of alamethicin

α-Aminoisobutyric acid (Aib) is a helicogenic α,α-dimethyl amino acid found in channel-forming peptaibols such as alamethicin. Possible effects of Aib on helix–helix packing are analyzed. Simulated annealing via restrained molecular dynamics is used to generate ensembles of approximately parallel helix dimers. Analysis of variations in geometrical and energetic parameters within ensembles defines how tightly a pair of helices interact. Simple hydrophobic helix dimers are compared: Ala₂₀, Leu₂₀, Aib₂₀, and P20, the latter a simple channel-forming peptide [G. Menestrina, K. P. Voges, G, Jung, and G. Boheim (1986) Journal of Membrane Biology, Vol. 93, pp. 111–132]. Ala₂₀ and Leu₂₀ dimers exhibit well-defined ridges-in-grooves packing with helix crossing angles (Ω) of the order of +20°. Aib₂₀ α-helix dimers are much more loosely packed, as evidenced by a wide range of Ω values and small helix-helix interaction energies. However, when in a 3₁₀ conformation Aib₂₀ helices pack in three well-defined parallel modes, with Ω ca. ?15°, +5°, and 10°. Comparison of helix–helix interaction energies suggests that dimerization may favor the 3₁₀ conformation. P20, with 8 Aib residues, also shows looser packing of α-helices. The results of these studies of hydrophobic helix dimers are analyzed in the context of the ridges-in-grooves packing model. Simulations are extended to dimers of alamethicin, and of an alamethicin derivative in which all Aib residues are replaced by Leu. This substitution has little effect on helix–helix packing. Rather, such interactions appear to be sensitive to interactions between polar side chains. Overall, the results suggest that Aib may modulate the packing of simple hydrophobic helices, in favor of looser interactions. For more complex amphipathic helices, interactions between polar side chains may be more critical. © 1995 John Wiley & Sons, Inc.     

Seven-helix bundles: molecular modeling via restrained molecular dynamics.

Simulated annealing via restrained molecular dynamics (SA/MD) has been used to model compact bundles of seven approximately (anti)parallel alpha-helices. Seven such helix bundles occur, e.g., in bacteriorhodopsin, in rhodopsin, and in the channel-forming N-terminal domain of Bacillus thuringiensis delta-endotoxin. Two classes of model are considered: (a) those consisting of seven Ala20 peptide chains; and (b) those containing a single polypeptide chain, made up of seven Ala20 helices linked by GlyN interhelix loops (where N = 5 or 10). Three different starting C alpha templates for SA/MD are used, in which the seven helices are arranged (a) on a left-handed circular template, (b) on a bacteriorhodopsin-like template, or (c) on a zig-zag template. The ensembles of models generated by SA/MD are analyzed in terms of their geometry and energetics, and the most stable structures from each ensemble are examined in greater detail. Structures resembling bacteriorhodopsin and structures resembling delta-endotoxin are both represented among the most stable structures. delta-Endotoxin-like structures arise from both circular and bacteriorhodopsin-like C alpha templates. A third helix-packing mode occurs several times among the stable structures, regardless of the C alpha template and of the presence or absence of interhelix loops. It is characterized by a "4 + 1" core, in which four helices form a distorted left-handed supercoil around a central, buried helix. The remaining two helices pack onto the outside of the core. This packing mode is comparable with that proposed for rhodopsin on the basis of two-dimensional electron crystallographic and sequence analysis studies.     

Chromosomal Proteins and Cytokinesis: Patterns of Cleavage Furrow Formation and Inner Centromere Protein Positioning in Mitotic Heterokaryons and Mid-anaphase Cells

After the separation of sister chromatids in anaphase, it is essential that the cell position a cleavage furrow so that it partitions the chromatids into two daughter cells of roughly equal size. The mechanism by which cells position this cleavage furrow remains unknown, although the best current model is that furrows always assemble midway between asters. We used micromanipulation of human cultured cells to produce mitotic heterokaryons with two spindles fused in a V conformation. The majority (15/19) of these cells cleaved along a single plane that transected the two arms of the V at the position where the metaphase plate had been, a result at odds with current views of furrow positioning. However, four cells did form an additional ectopic furrow between the spindle poles at the open end of the V, consistent with the established view. To begin to address the mechanism of furrow assembly, we have begun a detailed study of the properties of the chromosome passenger inner centromere protein (INCENP) in anaphase and telophase cells. We found that INCENP is a very early component of the cleavage furrow, accumulating at the equatorial cortex before any noticeable cortical shape change and before any local accumulation of myosin heavy chain. In mitotic heterokaryons, INCENP was detected in association with spindle midzone microtubules beneath sites of furrowing and was not detected when furrows were absent. A functional role for INCENP in cytokinesis was suggested in experiments where a nearly full-length INCENP was tethered to the centromere. Many cells expressing the chimeric INCENP failed to complete cytokinesis and entered the next cell cycle with daughter cells connected by a large intercellular bridge with a prominent midbody. Together, these results suggest that INCENP has a role in either the assembly or function of the cleavage furrow.     

XM-6: A new gel-forming bacterial polysaccharide

A new extracellular microbial polysaccharide, XM-6, has been isolated from cultures of an Enterobacter species and shows unusual gelation properties of potential technological significance. The polysaccharide contains d-glucose, l-fucose and d-glucuronate in the approximate molar ratio 3:1:1. No significant amounts of acetate or pyruvate were detected. d-Glucuronate and some d-glucose are destroyed on periodate oxidation, but l-fucose and some d-glucose may be recovered intact, indicating the presence of some 1,3 linkages in the primary structure. The major oligosaccharide isolated from autohydrolysates was an aldobiuronic acid containing equal amounts of d-glucose and l-fucose.Thermally-reversible gels are formed on addition of salt to solutions of the polysaccharide. A preliminary investigation of the mechanism of gelation by optical rotation, circular dichroism, high resolution n.m.r. and mechanical spectroscopy suggests interchain association through conformationally ordered ‘junction zones’, with specific incorporation of site-bound cations within the ordered structures. In the sol state the polysaccharide shows the shear-rate and temperature dependence of viscosity typical of a disordered (‘random coil’) polymer solution. Divalent cations are, in general, more effective than monovalent cations in promoting gelation of XM-6, while trivalent cations normally cause precipitation. Within Groups I and II, optimum gelation is achieved with Na⁺ and Ca²⁺ (ionic radius ? 0·1 nm), with larger and smaller ions becoming progressively less effective. Both gel strength and melting temperature increase with increasing salt concentration.XM-6 forms gels of reasonable strength at unusually low concentrations of the polysaccharide. For example, gels comparable to those required for normal industrial or food applications may be obtained using 0·3% w/v XM-6 and 1% w/v NaCl. Gel strength increases with increasing polymer concentration but there is no systematic variation in melting point. The sol-gel transition of XM-6 is unusually sharp and, by suitable adjustment of salt concentration, can be made to occur just below body temperature (e.g. 30–35°C), with obvious implications for biomedical or food applications.     

Reduction of chronic hypoxic pulmonary hypertension in the rat by beta-aminopropionitrile

We administered antifibrotic agent beta-aminopropionitrile (BAPN) to rats exposed to 10% O2-90% N2 for 3 wk to prevent excess vascular collagen accumulation. Groups of Sprague-Dawley rats studied were air breathing, hypoxic, and hypoxic treated with BAPN, 150 mg/kg twice daily intraperitoneally. After the 3-wk period, we measured mean right ventricular pressure (RVP), the ratio of weight of right ventricle to left ventricle plus septum (RV/LV + S), and hydroxyproline content of the main pulmonary artery (PA) trunk. Hypoxia increased RVP from 14 to 29 mmHg; RVP was 21 mmHg in hypoxic BAPN-treated animals. Hypoxia increased the RV/LV + S ratio from 0.28 to 0.41; the ratio was 0.32 in hypoxic BAPN-treated animals. Hypoxia increased PA hydroxyproline from 20 to 239 micrograms/artery; hydroxyproline was 179 micrograms/artery in hypoxic BAPN-treated animals. Thus BAPN prevented pulmonary hypertension, right ventricular hypertrophy, and excess vascular collagen produced by hypoxia. We conclude that vascular collagen contributes to the maintenance of chronic hypoxic pulmonary hypertension.     

Catecholamines in fetal pig plasma and the response to acute hypoxia and chronic fetal decapitation

Summary Dopamine, norepinephrine and epinephrine were measured by radioenzymatic assay in blood plasma samples drawn from the umbilical arteries of 30 anaesthetised Landrace pig fetuses. Just prior to term, the concentrations of dopamine (0.46±0.14 ng·ml^–1) and norepinephrine (1.74±0.60 ng·mg^–1) were lower than earlier in gestation, whereas epinephrine concentrations at term (0.80±0.31 ng·ml^–1) were similar to those at mid-gestation, intervening stages of gestation having higher levels of plasma epinephrine. Fetal hypoxia was induced by clamping the umbilical cord for 2 min and the catecholamines determined in arterial blood samples immediately thereafter, then again 3 min after removal of the clamp. Inconsistent effects of cord clamping on catecholamine levels were seen at 55 days, but thereafter, in all but one instance, the hormone levels were increased. Fetuses near term tended to respond less than fetuses at 75 and 96 days gestation (term=114±1 day). Catecholamines were also present in the circulation of fetuses decapitated at 42 days gestation and studied at 109±1 days. The average concentrations of dopamine (1.12±0.27 ng·ml^–1) and norepinephrine (8.23±3.04 ng·ml^–1) were greater than in intact fetuses, the plasma epinephrine levels being comparable to, or slightly higher than, those in intact fetuses. The results demonstrate that catecholamines are present in the circulation of the intact and decapitated pig fetus and that the actual concentrations and the type of response to umbilical cord clamping are dependent on gestation age.