Biomedical subjects
Publications and source records attributed to J Keen.
Case study evaluations, using one or more qualitative methods, have been used to investigate important practical and policy questions in health care. This paper describes the features of a well designed case study and gives examples showing how qualitative methods are used in evaluations of health services and health policy.
Recombinant (r) transmembrane protein (TM), major capsid protein P25, and matrix protein P16 of ovine lentivirus (OLV) were used as solid phase antigens in enzyme-linked immunosorbent assays (ELISAs) for the detection of specific antibodies against OLV in sheep sera. Sensitivity, specificity, and agreement of these three recombinant assays were compared with each other and with two currently available conventional OLV serological assays, the agar gel immunodiffusion (AGID) test and a whole-virus (WV) ELISA. Field sera from a total of 412 Midwestern United States sheep were tested and compared by the five OLV detection methods, including visibly healthy sheep selected for public sale (Group A, n = 171), samples from a breeding flock of Finnsheep and Finn-cross ewes (Group B, n = 184) and moribund sheep with clinical signs associated with OLV (Group C, n = 57). The rTM ELISA was the most sensitive OLV detection assay, both overall and within each group. Sera from 48.1% (198/412) of field samples were rTM ELISA positive. By contrast, positive rates for the rP25, rP16, and WV ELISAs and AGID test were 34.2%, 32.3%, 36.9%, and 26.9%, respectively. The rTM ELISA reactivity was 36.8% for Group A sera, 50.0% for Group B sera, and 75.4% for Group C sera. Among the 21 Group C sheep possessing OLV lung lesions at necropsy, 20 (95.2%) were rTM ELISA positive. The greatest test agreement occurred between the rP25 and the rP16 ELISAs. The data suggest that the recombinant TM immunoassay is the most accurate and sensitive of the five methods evaluated for the detection of serum anti-OLV antibodies in sheep, both at the subclinical infection and overt clinical disease stages.
Ovine pulmonary carcinoma (OPC) is a contagious pulmonary neoplasia with a suspected retroviral etiology. The major core protein (P27) of the putative OPC virus cross-reacts with antibodies to P27 of the Mason-Pfizer monkey virus (MPMV), a type-D retrovirus. This serological reactivity serves as the only accepted biological marker for OPC. In order to make a useful reagent for the detection of the OPC marker for serodiagnosis and epidemiological studies, the MPMV-P27 coding region was cloned and expressed in Escherichia coli. Gel purified recombinant MPMV-P27 protein was used to develop an immunoassay. This recombinant enzyme-linked immunosorbent assay (ELISA) was then used to screen 223 sera from US sheep and 176 sera from Italian sheep. In this study, we found: (1) a high prevalence of infection with the putative OPC retrovirus in sheep with chronic pneumonia; (2) a subclinical infection with OPC virus may be more common in US sheep than indicated by the rare recorded occurrence of pulmonary carcinoma; (3) an apparent association between ovine lentivirus (OLV) and OPC infection.
This paper describes an investigation into the reasons for variation in the time taken by senior radiologists to complete radiological reports. An observational study of the reporting process at one UK hospital was undertaken for a 25 day period. An independent health service researcher observed the radiology reporting process and collected data on a variety of factors including the time taken to produce the report, the number and nature of all images viewed, the experience of the radiologist, and the number of disturbances that occurred. The nature of the variation in reporting time was explored using both simple comparative statistics and more sophisticated multiple regression techniques. Data were collected on 2345 report observations and the median report time was 117 s. This research provides the first empirical evidence for systematic variation in reporting time. The results confirm the importance of certain factors that were expected to explain report time variation. For example, the results indicate that report time tended to be significantly shorter in reporting sessions that were busy, and significantly longer when the radiologist was disturbed during the reporting process or was training juniors during a reporting session. More surprising were the results indicating that there was no significant difference in report time for reports categorized as urgent or "hot" and those categorized as less urgent or "cold", and that report time appeared to vary systematically depending on the day of the week and on the time of day.
Sera from two sheep experimentally infected with ovine lentivirus (OLV) and from 186 sheep selected from flocks with known high or low prevalence of infection or on the basis of virological or histopathological examination were simultaneously tested by whole virus (WV) ELISA, recombinant transmembrane (r-TM) ELISA and AGID assay. Antigens for both the WV ELISA and AGID were prepared from an Italian field isolate; recombinant antigen was derived from the N'-terminal region of the transmembrane envelope protein of strain K1514. The WV ELISA detected the highest number of seropositives, followed by the r-TM ELISA and AGID test. The sensitivity and specificity of the r-TM ELISA relative to the WV ELISA were 0.66 and 0.95, respectively. Immunoblot analysis of 14 WV ELISA-positive and r-TM ELISA-negative sera showed that the major core protein was immunodominant on WV antigen. It is concluded that the r-TM ELISA was more sensitive than the AGID test but less sensitive that the WV ELISA, particularly for detecting antibodies in the early stages of infection.
The 16 kDa proteolipid (subunit c) of the eukaryotic vacuolar H(+)-ATPase (V-ATPase) is closely related to the ductin polypeptide that forms the connexon channel of gap junctions in the crustacean Nephrops norvegicus. Here we show that the major protein component of Manduca sexta gap junction preparations is a 16 kDa polypeptide whose N-terminal sequence is homologous to ductin and is identical to the deduced sequence of a previously cloned cDNA from Manduca (Dow et al., Gene, 122, 355-360, 1992). We also show that a Drosophila melanogaster cDNA, highly homologous to the Manduca cDNA, can rescue Saccharomyces cerevisiae, defective in V-ATPase function, in which the corresponding yeast gene, VMA3, has been inactivated. Evidence is presented for a single genetic locus (Vha16) in Drosophila, which in adults at least contains a single transcriptional unit. Taken together, the data suggest that in Drosophila and Manduca, the same polypeptide is both the proteolipid subunit c component of the V-ATPase and the ductin component of gap junctions. The intron/exon structure of the Drosophila Vha16 is identical to that of a human Vha16 gene, and is consistent with an ancient duplication of an 8 kDa domain. A pilot study for gene inactivation shows that transposable P-elements can be easily inserted into the Drosophila ductin Vha16 gene. Although without phenotypic consequences, these can serve as a starting point for generation of null alleles.
Mutations in the RDS gene, which encodes the photoreceptor glycoprotein peripherin, have been sought in families with autosomal dominant retinal dystrophies. A cysteine deletion at codon 118/119 is associated with retinitis pigmentosa in one. Three families with similar macular dystrophy have mutations at codon 172, arginine being substituted by tryptophan in two and by glutamine in one. A stop sequence at codon 258 exists in a family with adult vitelliform macular dystrophy. These findings demonstrate that both retinitis pigmentosa and macular dystrophies are caused by mutations in RDS and that the functional significance of certain amino-acids in peripherin-RDS may be different in cones and rods.
An enzyme-linked immunosorbent assay (ELISA) was developed using a recombinant protein corresponding to the N'-terminal hydrophilic region of transmembrane glycoprotein (TM) of ovine lentivirus. This assay reproducibly detected antibodies in sera from 207 of 212 ovine progressive pneumonia (OPP) virus-infected sheep, and the recombinant TM ELISA accurately identified 26% (35 vs. 9) more seropositive samples than did the agar gel immunodiffusion test when applied to 100 sera from an infected flock. This assay also yielded no false-positive results in 14 true negative sera. Results of these experiments were further confirmed by the recombinant TM and recombinant p25 Western blot assay. A single recombinant TM antigen, as the coating antigen in ELISA, can be used successfully for the detection of OPP virus-infected animals and can improve the sensitivity and specificity for OPP diagnosis.
Rat alpha- and alpha-CGRP are substrates for endopeptidase 24.11 in vitro. Cleavage of both peptides occurs at several points, including an unusual substrate recognition site to the amino side of ala36. In alpha-CGRP this resulted in the early formation of val32-gly-ser-glu35, a sequence previously reported to be a component of the eosinophil chemotactic factor of anaphylaxis (ECF-A). The biological activity of this peptide fragment was confirmed by bioassay. Chemotactic activity in other hydrolysis fragments of both alpha- and beta-CGRP was observed. Both alpha- and beta-CGRP could thus serve as precursors to different eosinophil chemotactic peptide fragments. A novel function of endopeptidase 24.11 may be to modify rather than to terminate the biological activity of CGRP peptides.
The sequence of rat alpha-calcitonin gene-related peptide (CGRP-alpha) contains the tetrapeptide eosinophil granulocyte chemotactic factor Val32-Gly-Ser-Glu35. Peptide fragments formed following hydrolysis of rat CGRP-alpha in vitro by endopeptidase-24.11 were identified. The tetrapeptide fragment was generated following cleavage at a substrate recognition site unusual for this enzyme (-Glu-Ala-). Chemotactic activity of rat CGRP-alpha was increased following hydrolysis. Furthermore, rat CGRP-beta, which lacks the tetrapeptide sequence and is completely devoid of chemotactic activity, displayed low but measurable activity after hydrolysis. Val-Gly-Ser-Glu was identified as the principle fragment with chemotactic activity in rat CGRP-alpha. The results show that the chemotactic activity of the neuropeptide rat CGRP-alpha towards eosinophil polymorphonuclear leukocytes is increased following its hydrolysis in vitro by endopeptidase 24.11 through the formation of a previously identified eosinophil chemotactic tetrapeptide.
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Over the last decade the National Health Service (NHS) in the United Kingdom has experienced major organizational change. Successive government initiatives designed to improve local management of hospitals have tended to marginalize nurses. Resource Management, a major initiative, which is the model adopted in the NHS Review for hospital management for the 1990s, appeared initially to offer nurses an opportunity to influence decision-making directly. In practice, nurses' experiences of Resource Management were mixed. This study of the six hospitals which piloted the introduction of Resource Management showed that nurses did not always grasp the opportunity to enhance their power and practice. There was evidence from the study that the introduction of information technology curbed innovations in practice, and removed nurses from patient care delivery.
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The cardiovascular effects of endothelin-1 (ET-1) in trout were examined in unanesthetized fish, perfused tissues, and isolated vascular rings. In vivo, a bolus of 500 ng/kg body wt ET-1 transiently lowered arterial (postgill) blood pressure (BP) by nearly 30%; 1,500 ng/kg body wt produced a triphasic, pressor-depressor-pressor, response. Continuous infusion of 0.1, 1, 10, and 30 ng.kg-1.min-1 progressively lowered BP but did not affect heart rate (HR), urine flow, or electrolyte excretion. In the in situ perfused heart ET-1 (10(-11) to 10(-8) M) had no effect on HR or power output. ET-1 produced dose-dependent increases in vascular resistance in the perfused gill, renal-skeletal muscle, and splanchnic circulations, and increased tension, independent of endothelium, in vascular rings from celiacomesenteric (CA) and coronary arteries and anterior cardinal veins (CV). Ventral aortas were refractory to ET-1. In vitro, ET-1 effects were slow in onset and long lasting. External calcium was required for maximal ET-1 responses in gill and CA. ET-1 effects on CA but not CV were partially inhibited by calcium channel blockers, diltiazem, and D 600, and by the guanylate cyclase activators, atrial natriuretic factor, and sodium nitroprusside. [3H]water flux across the perfused gill was stimulated by ET-1 through what appeared to be a vascular-independent mechanism. These experiments show that the trout vasculature is exquisitely sensitive to ET-1, and they suggest that the physiological expression of this peptide has been highly conserved during the course of vertebrate evolution.
The nucleotide sequence of the gene (engXCA) encoding the major extracellular endoglucanase (ENGXCA) of the phytopathogenic bacterium Xanthomonas campestris pv. campestris (X. c. campestris) was determined and compared with the N-terminal amino acid (aa) sequence of the purified enzyme. An open reading frame of 1479 bp encoding 493 aa was identified, of which the N-terminal 25 aa represent a potential signal peptide. Determination of the exact position of a Tn5 insertion within engXCA, which did not reduce the encoded enzyme activity, indicated that the C-terminal region of the protein is not crucial for ENGXCA activity. Comparison of the complete deduced aa sequence with those deduced from other endoglucanase- and exoglucanase-encoding genes revealed a region with a high degree of homology, located towards the C terminus of the protein. These data indicate that the X. c. campestris ENGXCA may have a domain structure similar to that of many other bacterial and fungal cellulolytic enzymes. Hydrophobic cluster analysis was performed on the deduced aa sequence. Comparison of this analysis with those of 30 other cellulase sequences belonging to six different families indicated that the X. c. campestris enzyme can be classified in family A. The two aa residues which had previously been identified as 'potentially catalytic' within this family of cellulases, are conserved in the X. c. campestris ENGXCA.