How valuable is feedback of information on hospital referral patterns?

OBJECTIVES--To determine general practitioners'' responses to and explanations for variation in rates of referral to hospital and how feedback of data on rates of referral could be used to facilitate practices in auditing their own referral behaviour. DESIGN--Visits by audit facilitators to general practices after feedback of details of rates of referral to hospital derived from annual reports in general practice. SETTING--92 general practices in East Anglia. RESULTS--General practitioners judged that access to specialist care, the individual skill of general practitioners, patient demand, and fear of litigation were major determinants of referral behaviour. Because there was widespread scepticism about the accuracy of the data on which the feedback was based and because there is no clear relation between rates of referral and quality of care, it was extremely difficult to encourage doctors to use the feedback as a basis for auditing their own hospital referrals. CONCLUSION--If general practitioners are to contribute meaningfully to monitoring future changes in referral patterns it will be essential to develop reliable information systems in which doctors have confidence. Furthermore, audits need to be based on analysis of clinical cases rather than on rates of referral.     

Restoration management of abandoned chalk grassland in the Netherlands

After abandonment of chalk grassland in the Netherlands, Brachypodium pinnatum had become very dominant and this resulted in a dramatic decrease of plant diversity. Restoration of these abandoned sites is important, because of its former high diversity with many nationally endangered species. To restore the chalk grassland vegetation, the impact of the introduction of different experimental cutting regimes was investigated during three years. The thick litter layer and the dominance of Brachypodium was strongly reduced after introduction of all cutting regimes. In all cutting treatments forb phytomass increased considerably, especially in the twice-a-year cutting vegetation, where the forb phytomass became as high as that of Brachypodium. Phanerogamic species diversity was stimulated in all cutting regimes. Especially the number of short-lived forbs. with a persistent seed bank, increased markedly in the twice-a-year cutting treatment. It is concluded that cutting the vegetation twice is adequate to reduce the negative effects of the thick litter layer and the abundant growth of Brachypodium. It creates an appropriate starting point for more detinite management, whether mowing or grazing. However, the restoration of a more complete species assortment strongly depends on the re-invasion possibilities of these species.     

Real-time monitoring of biomass during Escherichia coli high-cell-density cultivations by in-line photon density wave spectroscopy

An efficient monitoring and control strategy is the basis for a reliable production process. Conventional optical density (OD) measurements involve superpositions of light absorption and scattering, and the results are only given in arbitrary units. In contrast, photon density wave (PDW) spectroscopy is a dilution-free method that allows independent quantification of both effects with defined units. For the first time, PDW spectroscopy was evaluated as a novel optical process analytical technology tool for real-time monitoring of biomass formation in Escherichia coli high-cell-density fed-batch cultivations. Inline PDW measurements were compared to a commercially available inline turbidity probe and with offline measurements of OD and cell dry weight (CDW). An accurate correlation of the reduced PDW scattering coefficient µ_s′ with CDW was observed in the range of 5–69 g L⁻¹ (R² = 0.98). The growth rates calculated based on µ_s′ were comparable to the rates determined with all reference methods. Furthermore, quantification of the reduced PDW scattering coefficient µ_s′ as a function of the absorption coefficient µ_a allowed direct detection of unintended process trends caused by overfeeding and subsequent acetate accumulation. Inline PDW spectroscopy can contribute to more robust bioprocess monitoring and consequently improved process performance.     

Genomic Organization of the Human Skeletal Muscle Sodium Channel Gene

Voltage-dependent sodium channels are essential for normal membrane excitability and contractility in adult skeletal muscle. The gene encoding the principal sodium channel α-subunit isoform in human skeletal muscle (SCN4A) has recently been shown to harbor point mutations in certain hereditary forms of periodic paralysis. We have carried out an analysis of the detailed structure of this gene including delineation of intron-exon boundaries by genomic DNA cloning and sequence analysis. The complete coding region of SCN4A is found in 32.5 kb of genomic DNA and consists of 24 exons (54 to > 2.2 kb) and 23 introns (97 bp-4.85 kb). The exon organization of the gene shows no relationship to the predicted functional domains of the channel protein and splice junctions interrupt many of the transmembrane segments. The genomic organization of sodium channels may have been partially conserved during evolution as evidenced by the observation that 10 of the 24 splice junctions in SCN4A are positioned in homologous locations in a putative sodium channel gene in Drosophila (para). The information presented here should be extremely useful both for further identifying sodium channel mutations and for gaining a better understanding of sodium channel evolution.     

The trace fossils of the Baggy Beds (Upper Devonian) of North Devon,England

The trace fossils of the Baggy Beds are described. They includeTeichichnus cf.rectus Seilacher,Monocraterion cf.tentaculatum Torell,Diplocraterion yoyo sp. nov.,Arenicolites curvatus sp. nov., and other forms insufficiently well preserved for generic assignment. The protrusive and retrusive behaviour pattern ofD. yoyo is interpretated as a response to repeated phases of sedimentation and erosion and as a measure of these.A. curvatus is preserved in two modes: in the position of formation and as eroded tubes in conglomerates. The second reveals that the sediment around the tube was cemented to a thickness equal to the diameter of the tube.     

Colony Member Discrimination by Juvenile Columbian Ground Squirrels (Spermophilus columbianus)

Whether an individual strives to breed or restrains from reproducing directly but increases the fitness of another individual through its help, may be viewed as a result of a trade-off between fitness costs and benefits arising from this decision. A population of the large carpenter bee Xylocopa sulcatipes Maa was studied in southeast Israel over a two year period. Female reproductive success, in terms of genetic representation in the gene pool (genetic gain), was calculated using coefficients of relatedness and the number of offspring produced by solitary, reproductively dominant and helper bees of social nests. In one year helper females, that shared a nest with a related female accrued a higher genetic gain than did solitary females. In the subsequent year solitary females did better than the helper bees. In nests founded by unrelated females a helper bee accrued only little genetic gain. However, evidence is presented to show that subordinate behaviour can have an adaptive value and can ultimately be beneficial through nest inheritance by the subordinate bee.     

CHLOROPLAST DNA VARIATION AND THE PHYLOGENY OF HORDEUM (POACEAE)

Restriction site variation in the chloroplast genome (cpDNA) was surveyed among 37 taxa or cytotypes (40 accessions) of the genus Hordeum. Seventeen restriction enzymes were employed, and a total of 491 restriction sites were assayed. Of these, 120 were variable among the taxa, including 70 synapomorphies. The level of sequence divergence (p) among species of Hordeum varied from 0.0 to 0.017, indicating that Hordeum possesses an about-average level of cpDNA diversity as compared to most other genera of flowering plants for which data are available. Wagner and polymorphism parsimony phytogenies were constructed from the restriction site data. These analyses divided the genus into several distinct groups; 1) American taxa; 2) diploid H. marinum; 3) Asian taxa; 4) H. vulgare-H. bulbosum; and 5) the H. murinum complex. Bootstrap-based confidence limits provided statistical support for the monophylesis of the latter three groups. The cpDNA data showed remarkably good congruence with previously published isoenzymatic, molecular, cytological, and crossing data.     

Intergeneric hybridization between Hordeum and Hordelymus (Poaceae)

Intergeneric hybridization between the monotypic Eurasian genus Hordelymus and species of Hordeum was performed. Hybrids were obtained in nine combinations and the meiotic pairing was analyzed in four combinations (6 families). Hordelymus europaeus is probably an alloploid with two different genomes. The very low pairing in the hybrids with H. jubatum, H. brachyantherum , and H. pusillum indicates that these species do not have any genomes in common with Hordelymus. The hybrids with H. depressum have an intermediate pairing which suggests that there is a certain homoeology in one genome.     

Detection of renal cell carcinoma-associated markers via proteome- and other 'ome'-based analyses.

Proteome analysis has rapidly developed in the post-genome era and is now widely accepted as the complementary technology for genetic profiling. It has been shown to be a powerful tool for studying human diseases and for identifying novel prognostic, diagnostic and therapeutic markers. This review focuses on the identification of new biomarkers and therapeutic targets for renal cell carcinoma using different 'ome'-based technologies.