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Crystal structure of Streptococcus pneumoniae acyl carrier protein synthase: an essential enzyme in bacterial fatty acid biosynthesis.

Acyl carrier protein synthase (AcpS) catalyzes the formation of holo-ACP, which mediates the essential transfer of acyl fatty acid intermediates during the biosynthesis of fatty acids and lipids in the cell. Thus, AcpS plays an important role in bacterial fatty acid and lipid biosynthesis, making it an attractive target for therapeutic intervention. We have determined, for the first time, the crystal structure of the Streptococcus pneumoniae AcpS and AcpS complexed with 3'5'-ADP, a product of AcpS, at 2.0 and 1.9 A resolution, respectively. The crystal structure reveals an alpha/beta fold and shows that AcpS assembles as a tightly packed functional trimer, with a non-crystallographic pseudo-symmetric 3-fold axis, which contains three active sites at the interface between protomers. Only two active sites are occupied by the ligand molecules. Although there is virtually no sequence similarity between the S.pneumoniae AcpS and the Bacillus subtilis Sfp transferase, a striking structural similarity between both enzymes was observed. These data provide a starting point for structure-based drug design efforts towards the identification of AcpS inhibitors with potent antibacterial activity.

Acyl Carrier Protein↗

Hypovitaminosis A: international programmatic issues.

The virtual elimination of vitamin A deficiency and all its consequences is high on the political agenda as a solvable public health problem by the end of the decade. Five to six times more children in the developing world are likely to be subclinically than clinically deficient. Subclinical deficiency can be detected by newer methodological approaches. Subclinically deficient children are at increased risk of severe and fatal infections. The problem at a population level is avoidable by the appropriate selection and application of a mix of available interventions. Countries are challenged to assess, analyze and take actions to incorporate nutrition concerns into development planning to attain end-of-decade goals.

Child↗

Augmented arterial wall expression of type-1 plasminogen activator inhibitor induced by thrombosis.

Type-1 plasminogen activator inhibitor (PAI-1), the primary physiological inhibitor of endogenous plasminogen activators, modulates fibrinolysis, cell migration, and tissue repair. To determine whether genetic expression of PAI-1 is augmented in the walls of vessels exposed to thrombi but not to a direct physical insult such as electrical injury, we induced arterial thrombosis in rabbit carotid arteries with intraluminal surgical silk sutures and performed in situ hybridization for PAI-1 messenger RNA (mRNA) and immunohistochemistry for PAI-1 antigen at selected intervals. PAI-1 activity in plasma remained virtually constant. In contrast, PAI-1 mRNA increased in endothelial cells juxtaposed to thrombi, in smooth muscle cells adjacent to the neointima, and in macrophages surrounding the suture material. PAI-1 protein was detected in regions in which PAI-1 mRNA was expressed. The increased expression of PAI-1 mRNA colocalized with PAI-1 protein in the endothelium juxtaposed to thrombi may potentiate thrombosis by shifting the local balance between fibrinolysis and thrombosis toward thrombosis. Furthermore, it may alter vascular remodeling and predispose to stenosis after interventions such as angioplasty, in which local thrombosis cannot be avoided.

Animals↗

Acute abdominal pain in pregnancy.

Some degree of abdominal pain is virtually physiologic in pregnancy, for which reason these women will commonly present to the emergency physician for clinical evaluation. Appendicitis is the commonest nonobstetric surgical malady complicating pregnancy; however, its clinical presentation may resemble several other surgical as well as medical entities reviewed in this article. The clinical evaluation of these patients is generally confounded because the symptoms typical of these illnesses are common to pregnancy itself, and the physical examination of the abdomen is hampered by the pregnant state. Nevertheless, prompt clinical diagnosis and surgical intervention when indicated is necessary to minimize maternal and especially fetal mortality. The general reluctance to use conventional radiographic study of these patients must be dismissed whenever the physician is confronted with severely ill or unstable patients. Whenever diagnosis is uncertain, liberal use of surgical and obstetric consultants is warranted.

Abdomen, Acute↗

Core temperature measurements through a new airway device, perilaryngeal airway (CobraPLA).

STUDY OBJECTIVE: The aim of this study was to test the hypothesis that the intraoperative pharyngeal temperatures obtained on the perilaryngeal airway (PLA), a novel airway device with a larger pharyngeal cuff (when inflated) than the laryngeal mask airway, are similar to tympanic membrane core temperatures. DESIGN: This study is a prospective, simultaneous device comparison. SETTING: This study was set at a university hospital. PATIENTS: The study patients included 14 adults with American Society of Anesthesiologists physical statuses I and II, scheduled for minor gynecological or orthopedic surgery. INTERVENTIONS: A PLA was inserted into the pharynx after induction of general anesthesia. Thermocouples were positioned at 3 sites on the PLA: (1) posterior portion of the head of the airway (tip), (2) midposterior portion of the cuff, and (3) left and right lateral-posterior portions of the cuff. Tympanic membrane thermocouples were inserted. MEASUREMENTS: Temperature readings from the airway and the tympanic membrane thermocouples were recorded every 15 minutes throughout surgery. MAIN RESULTS: Temperatures recorded from the lateral-posterior cuff were found to be virtually identical to tympanic membrane temperatures, with 97% of the values differing by less than 0.5 degrees C. Readings from the other 2 sites on the cuff differed considerably more from tympanic membrane values. CONCLUSIONS: These data suggest that the PLA can be adapted to monitor core temperature reliably.

Adult↗

Development of a scale to measure the psychosocial impact of assistive devices: lessons learned and the road ahead.

PURPOSE: In this paper the history of the development and validation of the PIADS is reviewed. Assistive devices (ADs) are extremely prevalent forms of health care intervention for persons who have a disability. There is a consensus that the AD field needs a reliable and valid measure of how users perceive the impact of ADs on their quality of life (QoL) and sense of well-being. The Psychosocial Impact of Assistive Devices Scale (PIADS) is a 26 item self-rating scale designed to fill this measurement gap. The challenges that we encountered are described in attempting to adequately conceptualize QOL impact, and operationalize it in a measure suitable for use with virtually all forms of AD. Current efforts to extend the validation of the PIADS are summarized. CONCLUSIONS: The study concludes by suggesting directions for future research and development of the scale. They include a richer examination of its conceptual relationships to other health care and rehabilitation outcome measures, and further investigation of its clinical utility. The PIADS is a reliable and valid tool that appears to have very significant power to predict AD abandonment and retention. It can and should be used both deductively and inductively to build, discover and test theory about the psychosocial impact of assistive technology.

Health Status Indicators↗

Extracorporeal membrane oxygenation in neonates.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO), originally developed as an artificial replacement for respiratory assistance, is decreasingly used in neonates with respiratory failure. Nevertheless, there is a constant need for this invasive and expensive neonatal treatment modality. INTERVENTION: Review of our experience (80 recent ECMO performances because of circulatory failure) and the literature. RESULTS: In contrary to reduced ECMO performances out of respiratory insufficiency in neonates, ECMO as circulatory support is increasingly used. Neonatal sepsis, pre- and postoperative cardiac failure, combined circulatory and respiratory failure after resuscitation and with congenital diaphragmatic hernia result in a permanent need for ECMO, whenever there are fewer ECMO treatments per year. Nonocclusive pumps, portable devices, small priming volumes and tapered anticoagulation protocols enable survival through ECMO even in virtually hopeless hemodynamic conditions. Special efforts in investigation and prevention of permanent neurological impairment, especially after severe pre-ECMO hypoxia seem to be mandatory. CONCLUSION: ECMO remains an important tool in neonatal and pediatric intensive care. However, the number of ECMO therapies was reduced due to respiratory therapeutic progress, but indications and ECMO technology have changed.

Anticoagulants↗

Testing the generalizability of intervening mechanism theories: understanding the effects of adolescent drug use prevention interventions.

Outcome research has shown that drug prevention programs based on theories of social influence often prevent the onset of adolescent drug use. However, little is known empirically about the processes through which they have their effects. The purpose of the present study was to evaluate intervening mechanism theories of two program models for preventing the onset of adolescent drug use. Analyses based on a total of 3077 fifth graders participating in the Adolescent Alcohol Prevention Trial revealed that both normative education and resistance training activated the causal processes they targeted. While beliefs about prevalence and acceptability significantly mediated the effects of normative education on subsequent adolescent drug use, resistance skills did not significantly predict subsequent drug use. More impressively, this pattern of results was virtually the same across sex, ethnicity, context (public versus private school students), drugs (alcohol, cigarettes, and marijuana) and levels of risk and was durable across time. These findings strongly suggest that successful social influence-based prevention programs may be driven primarily by their ability to foster social norms that reduce an adolescent's social motivation to begin using alcohol, cigarettes, and marijuana.

Adolescent↗

Leukocyte attraction through the CCR5 receptor controls progress from insulitis to diabetes in non-obese diabetic mice.

Lymphocyte infiltration to pancreatic islets is associated to chemoattraction, as are other inflammatory autoimmune processes. We examined whether development of insulitis and diabetes depends on chemoattraction of lymphocytes via the CCR5 chemokine receptor. In non-obese diabetic (NOD) mice, a substantial fraction of peripheral T cells and virtually all B cells expressed high CCR5 levels. CCR5 expression characterized the effector T cell phenotype, suggesting their potential involvement in disease development. In view of these findings and the CCL5 (RANTES, the CCR5 ligand) expression by pancreatic islets, we treated NOD mice with a neutralizing anti-CCR5 antibody. This did not influence peri-insulitis advancement, but inhibited beta-cell destruction and diabetes. These data demonstrate a role of CCR5-dependent chemoattraction in insulitis progression to islet destruction, suggesting the potential value of therapeutic intervention by CCR5 targeting.

Animals↗

Public opinions on alcohol policy issues: a comparison of American and Canadian surveys.

AIMS: To study international and within country differences with regard to views by the general public on alcohol policy topics, describe associations with socio-demographic characteristics and drinking practices, and contrast opinions with variations in actual policies. DESIGN, SETTING, SUBJECTS: Large-scale cross-sectional household surveys were conducted in Canada (n = 11,550) and the United States (n = 4004) in 1989-90, involving representative samples of adults aged 18 and older. MEASURES: Eleven alcohol policy topics were examined: alcohol taxes; hours of off-premise sale; legal drinking age; alcohol sales in corner stores; government advertising against alcohol; warning labels on alcohol products; alcohol advertising on TV; industry sponsorship or cultural or sports events; efforts to prevent service to drunken customers; prevention and education; and treatment. FINDINGS: Even after controlling for drinking levels and respondent characteristics, policy measures that control physical or economic access to alcohol are not as strongly supported as those that provide information or focus on the heavy drinker. There was greater polarization of opinion within both countries for policy items relating to promotion of alcohol or control of physical, demographic or economic access, and virtually no polarization with regard to items such as curtailing service to drunken customers or providing information or treatment. In the jurisdiction with less restrictive measures on a particular policy, there seems to be greater public support for curtailing access to alcohol and, in some instances, more restrictive policies are associated with lower support for increasing restrictions. CONCLUSION: Public opinion data are an important resource in determining whether actual policies are compatible with the views of those affected by them. Disjunctions between research on the most effective policy interventions and views by the public point to special agenda for information dissemination and prevention initiatives.

Adult↗

Teletherapeutic drug administration by long distance closed-loop control of propofol.

BACKGROUND: The objective of this pilot study was to investigate the feasibility of an EEG-controlled closed-loop administration of propofol over a long distance of about 200 km. METHODS: We performed a teletherapeutic propofol infusion during total intravenous anaesthesia with propofol in 11 patients undergoing general surgery. The teletherapeutic system consisted of a computer at the patient site in Munich and a computer at the control site in Erlangen, which were connected via the internet through a virtual private network. The patient's EEG signal was sent to the control site computer, where the median frequency (MEF) of the EEG power spectrum was calculated. The propofol infusion, determined by a model-based adaptive feedback algorithm to maintain a MEF of 1.5 to 2 Hz, was sent to the patient site computer connected to the infusion pump. The quality of the control was assessed by the performance error defined as the percentage deviation of the measured MEF from the set point and the necessity of interventions by the anaesthetist at the patient site. RESULTS: During closed-loop administration of propofol [83 (52) min] the median performance error of the system was - 4.6 (4.4)% and the median absolute performance error was 18.8 (5.7)%. From a total number of 10 905 transmitted EEG epochs, there were five epochs with transmission errors, without further consequences for drug control. In one patient, teletherapy was stopped because the internet connection was interrupted. CONCLUSIONS: Teletherapeutic drug administration could be realized over a longer distance. Further studies have to investigate the practicability and safety of teletherapeutic drug control in anaesthesia.

Adolescent↗

Virtual reality (VR) and psychotherapy: opportunities and challenges.

Virtual reality technology is now being used to provide exposure and desensitization for a number of phobic conditions. In this paper, we first review these current applications and discuss the work needed to refine and expand these applications to phobias. We then comment briefly on some preliminary applications of VR technology to mental-health problems outside the domain of phobias. Finally, we consider ways in which VR might be used to further enhance psychotherapy and assist in the treatment of a wide variety of disorders. Various possible interventions are discussed, along with the technological developments needed to make them possible.

Adaptation, Psychological↗

Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. EUROASPIRE I and II Group. European Action on Secondary Prevention by Intervention to Reduce Events.

BACKGROUND: Patients with coronary heart disease (CHD) are the top priority for preventive cardiology. The first EUROASPIRE survey among patients with established CHD in nine countries in 1995-96 showed substantial potential for risk reduction. A second survey (EUROASPIRE II) was done in 1999-2000 in the same countries to see whether preventive cardiology had improved since the first. We compared the proportion of patients in both studies who achieved the lifestyle, risk-factor, and therapeutic goals recommended by the Joint European Societies report on coronary prevention. METHODS: The surveys were undertaken in the same selected geographical areas and hospitals in the Czech Republic, Finland, France, Germany, Hungary, Italy, the Netherlands, Slovenia, and Spain. Consecutive patients (men and women < or = 70 years of age) were identified after coronary-artery bypass graft or percutaneous transluminal coronary angioplasty, or a hospital admission with acute myocardial infarction or ischaemia, and were interviewed at least 6 months later. FINDINGS: 3569 and 3379 patients were interviewed in the first and second surveys, respectively. The prevalence of smoking remained almost unchanged at 19.4% vs 20.8%. The prevalence of obesity (body-mass index > or = 30 kg/m2) increased substantially from 25.3% to 32.8%. The proportion with high blood pressure (> or = 140/90 mm Hg) was virtually the same (55.4% vs 53.9%), whereas the prevalence of high total cholesterol concentrations (> or = 5.0 mmol/L) decreased substantially from 86.2% to 58.8%. Aspirin or other antiplatelet therapy was as widely used in the second survey as the first (83.9% overall), and reported use of beta-blockers, angiotensin-converting-enzyme inhibitors, and especially lipid-lowering drugs increased. INTERPRETATION: The adverse lifestyle trends among European CHD patients are a cause for concern, as is the lack of any improvement in blood-pressure management, and the fact that most CHD patients are still not achieving the cholesterol goal of less than 5 mmol/L. There is a collective failure of medical practice in Europe to achieve the substantial potential among patients with CHD to reduce the risk of recurrent disease and death.

Adrenergic beta-Antagonists↗

Polio eradication: mobilizing and managing the human resources.

Between 1988 and 2004, the Global Polio Eradication Initiative grew to become the largest international health effort in history, operating in every country of the world. An estimated 10 million health workers and volunteers have been engaged in implementing the necessary polio supplementary immunization activities (SIAs) on a recurring basis, and at least 35,000 well-trained workers have been conducting polio surveillance. A combination of task simplification, technological innovations and adaptation of strategies to fit local circumstances has allowed the Initiative to use a wide range of workers and volunteers, from both inside and outside the health sector, to deliver the polio vaccine during SIAs and to monitor progress in virtually every area of every country, regardless of the health infrastructure, conflict, geography and/or culture. This approach has required sustained political advocacy and mass community mobilization, together with strong management and supervisory processes. Non-monetary incentives, reimbursement of costs and substantial technical assistance have been essential. Given the unique features of eradication programmes in general, and polio eradication in particular, the implications of this approach for the broader health system must continue to be studied if it is to be replicated for the delivery and monitoring of other interventions.

Community Health Planning↗

An accurate and reliable method of thermal data analysis in thermal imaging of the anterior knee for use in cryotherapy research.

OBJECTIVE: To develop an anatomic marker system (AMS) as an accurate, reliable method of thermal imaging data analysis, for use in cryotherapy research. DESIGN: Investigation of the accuracy of new thermal imaging technique. SETTING: Hospital orthopedic outpatient department in England. PARTICIPANTS: Consecutive sample of 9 patients referred to anterior knee pain clinic. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Thermally inert markers were placed at specific anatomic locations, defining an area over the anterior knee of patients with anterior knee pain. A baseline thermal image was taken. Patients underwent a 3-minute thermal washout of the affected knee. Thermal images were collected at a rate of 1 image per minute for a 20-minute re-warming period. A Matlab (version 7.0) program was written to digitize the marker positions and subsequently calculate the mean of the area over the anterior knee. Virtual markers were then defined as 15% distal from the proximal marker, 30% proximal from the distal markers, 15% lateral from the medial marker, and 15% medial from the lateral marker. The virtual markers formed an ellipse, which defined an area representative of the patella shape. Within the ellipse, the mean value of the full pixels determined the mean temperature of this region. Ten raters were recruited to use the program and interrater reliability was investigated. RESULTS: The intraclass correlation coefficient produced coefficients within acceptable bounds, ranging from .82 to .97, indicating adequate interrater reliability. CONCLUSIONS: The AMS provides an accurate, reliable method for thermal imaging data analysis and is a reliable tool with which to advance cryotherapy research.

Analysis of Variance↗

Headaches in the pediatric population.

Headaches are an extremely common complaint encountered in the pediatric population. The headache history establishes the diagnosis in the vast majority and most importantly identifies features suggesting a secondary cause. The headache history outlined will aid in headache classification and screen for ominous causes. A comprehensive headache examination is aimed at excluding secondary causes. Headaches resulting from serious organic causes are virtually always associated with neurologic signs at the time of presentation. Investigations are not routinely required for pediatric headache, but neuroimaging should be strongly considered in children with an abnormal neurologic examination or history worrisome for intracranial pathology. The management approach for children with primary headaches should focus on reassurance and education. Developing an individualized therapeutic strategy requires knowledge of the child's headache-related disability and impact on quality of life. Treatment should begin with a nonpharmacologic approach, which influences lifelong prevention and management of headaches. Pharmacologic interventions target both acute symptomatic treatment and prophylactic medications. Preventative treatment may be beneficial when headaches result in significant disability and impaired quality of life. The limited available evidence for prophylactic treatment options is reviewed. Research into pediatric headache prevention and management remains a priority given the potential lifelong morbidity associated with headache.

Headache↗

Social network normative influence and sexual risk-taking among women seeking a new partner.

This paper examines the relative influence of social network norms on sexual risk-taking among women seeking a new partner in Quebec (Canada). A survey was conducted among 430 women, 30 to 54 years of age, and living without a partner. Condom use is significantly influenced by the norms of women's different social networks: confidants, social circles through which they meet partners (e.g., family, friends, internet or newspapers virtual communities), with a minority following prescribed condom use habits. Further the results indicate that among the study participants the search for love and well being, social proximity, feelings of trust and intimacy that appear to evolve almost instantly in new encounters, are in conflict with the prescribed condom-use norms. These results suggest that there is a need to build new norms for starting relationships, for improved dialogue among women and between women and men on affective solitude. The findings also underscore the need for public health interventions that seek to influence social networks as well as the behavior of individuals.

Adaptation, Psychological↗

Dental care and the health maintenance organization concept.

The principal dental diseases, caries and periodontal disease, affect almost the entire population and result in considerable pain and discomfort, with eventual tooth loss, if untreated. These disorders can either be prevented or their effects minimized through dental intervention so that intact functioning dentitions can be maintained. Despite the fact that enough practicing dentists probably exist in the United States to achieve these results, the majority of the population lose all of their natural teeth if they live out their normal life spans. The solo-practice fee-for-service system, even with third-party payment, may reduce the difficulties somewhat but cannot solve the problem. Prepaid dental group practice, either independently or as part of a general health care system, has the potential of virtually eliminating edentulism in populations for which it has responsibility. At present, it is possible to project costs and resource needs with sufficient accuracy to start viable entities. The "health maintenance organization" concept, therefore, applies to dental care.

Adolescent↗