Public health practitioners can learn from the weather forecasters.
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The pattern of sheep nematode infective larvae on pasture shows a marked midsummer peak arising largely from the ewe peri-parturient egg output. Records of larval pattern over a nine-year period were examined in relation to meteorological data, and a correlation was demonstrated between the time of the summer peak and cumulative rainfall. A "wet score" was allocated to 12-hourly rainfall figures, and a "critical index" of 440 units of wetness was shown to be necessary before the larval peak was reached. A "warning index" of 350 to 380 wetness units is suggested which would allow a prediction to be made of the onset of major infection in lambs.
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In order to run a small business effectively you must be in financial control and this means that you have to be aware how the business is performing. If you wait until your accountant has got out the annual accounts valuable time has been wasted in making necessary decisions and corrections to poor trends in your business so monthly/quarterly records are required. Decisions as to whether you can afford to take another assistant, set up a branch surgery, the level of your fee increases, whether to buy or lease your cars; are all dependent on having available up to date financial knowledge of your business. If you have a microcomputer in the practice you can use spreadsheets which will allow the accurate prediction of cash flow or profitability. You can also ask the question 'what happens if...?' and get the answer in seconds. But even without a computer, financial control can be easily maintained if you are prepared to spend a couple of hours each month with your practice figures.
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PURPOSE: To determine whether magnetic resonance (MR) imaging quantification of cervical spinal cord damage improves the prediction of motor recovery after spinal cord injury. MATERIALS AND METHODS: The extent of cervical spinal cord injury was measured on MR images obtained in 104 patients (aged 17-70 years) within 72 hours of spinal cord injury. The effects of hemorrhage and edema length on motor outcome were examined for at least 12 months. RESULTS: Patients with spinal cord hemorrhage had significantly lower upper and lower extremity motor scores at the time of injury and at 12 months than did patients without hemorrhage (P < .001). There was little recovery of lower extremity function even in patients without hemorrhage. Upper extremity motor function improved significantly in all patients (P < .001); patients without hemorrhage showed the largest improvements. The motor recovery rates for patients without hemorrhage were 0.74 (upper extremities; range, 0-1) and 0.55 (lower extremities; range, 0-1); those for patients with hemorrhage were 0.31 (range, 0-1) and 0.091 (range, 0-1). Stepwise multiple regression analyses indicated that MR information on hemorrhage and the length of edema increases the ability to predict clinical outcome by 16%-33% over that with initial clinical scores alone. CONCLUSION: An initial MR imaging evaluation of the spinal cord after spinal cord injury provides supplemental prognostic information on the recovery of motor function in the upper and lower extremities.
In a longitudinal survey of 122 healthy criminal offenders aged 18 to 37 years, the relationship between intelligence measured by the Wechsler Adult Intelligence Scale (WAIS), neuropsychological scales and delinquency was investigated. The Benton Test correlates well with the WAIS and moderately with offence data, but not with recidivism in delinquency. The 122 men had normal intelligence test scores (average IQ = 102), but bad school and working records. The 34 per cent and 60 per cent respectively of offenders, who relapsed within the time span of 1.5 and 3 years respectively, showed significantly worse results in the Verbal Scale and in the Block Design of the Wechsler Intelligence Scale. Poor performance in the Information and the Block Design sub-tests of the WAIS, a low level of formal education and the belief in external control by circumstances and powerful others are predictors of a high risk of recidivism.
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Extensive clinical experience has shown that systemic interleukin (IL)-2 administration can induce complete or partial regression of renal cell cancer (RCC) metastases in 15 to 20 % of patients. Since IL-2 has no direct anti-cancer effects, it is believed that cancer regression is mediated either by a direct modulation of immune cell effector functions or through the mediation of soluble factors released as a result of IL-2 administration.We previously observed that transcriptional and protein changes induced by systemic IL-2 administration affect predominantly mononuclear phagocytes with little effect, particularly within the tumor microenvironment, on T cell activation, localization and proliferation. It further appeared that mononuclear phagocyte activation could be best explained by the indirect mediation of a secondary release of cytokines by IL-2 responsive cells either in the circulation or in peripheral tissues.To better characterize the cytokine outburst that follows systemic IL-2 administration we followed the serum levels of 68 soluble factors in ten patients with RCC undergoing high dose (720,000 IU/kg intravenously every 8 hours) IL-2 therapy. Serum was collected before therapy, 3 hours after the 1st and 4th dose and assayed on a multiplexed protein array platform. This study demonstrated that 1) the serum concentration of more than half the soluble factors studied changed significantly during therapy; 2) changes became more dramatic with increasing doses; 3) subclasses of soluble factors displayed different kinetics and 4) cytokine patterns varied quantitatively among patients.This study shows that the cytokine storm that follows systemic IL-2 administration is complex and far-reaching inclusive of soluble factors with disparate, partly redundant and partly contrasting effects on immune function. Therefore comparing in parallel large number of soluble factors, it sets a comprehensive foundation for further elucidation of "cytokine storm" in larger patient pools. Based on this analysis, we propose a prospective collection of serum samples in a larger cohort of patients undergoing IL-2 administration with the purpose of discerning patterns predictive of clinical outcome and toxicity.
Little effort has been directed toward studying the relationship between morbidity and mortality at exceptional ages, perhaps for no better reason than it has been difficult to do given available data resources. Two study innovations/adjustments are required to adequately represent count data with reports of health from aged sample persons. These design features are oversampling of the exceptional group and linkage to detailed administrative reports. The National Long-Term Care Survey (NLTCS) has made it possible to study health and functioning in the context of exceptional longevity.
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The steroid hormone ecdysone initiates metamorphosis in Drosophila melanogaster by activating a cascade of gene activity that includes primary response transcriptional regulators and secondary response structural genes. The Broad-Complex (BR-C) primary response gene is composed of several distinct genetic functions and encodes a family of related transcription factor isoforms. Our objective was to determine whether BR-C isoforms were components of the primary ecdysone response in all tissues and whether tissue-specific isoform expression is associated with tissue-specific metamorphic outcomes. We used specific antibody reagents that recognize and distinguish among the Z1, Z2 and Z3 BR-C protein isoforms to study protein expression patterns during the initial stages of metamorphosis. Western blot analyses demonstrated that BR-C isoforms are induced at the onset of metamorphosis, each with unique kinetics of induction and repression. Whole-mount immunostaining showed that the BR-C proteins accumulate in the nuclei of all larval and imaginal tissues indicating that the BR-C is induced as a primary response in many tissues. Several tissues express different levels and combinations of the BR-C isoforms suggesting that the BR-C is important in determining the tissue-specific outcome of many parallel ecdysone response cascades. For example, prepupal salivary glands (destined for histolysis during metamorphosis) express Z1 isoforms while imaginal discs (destined for cell differentiation and morphogenesis) shift from the synthesis of Z2 isoforms to the synthesis of Z1 isoforms. The prepupal central nervous system (destined for tissue remodeling) expresses all isoforms, with Z3 predominating. Salivary gland chromosome immunostaining indicated that BR-C proteins interact directly with numerous loci in the polytene genome. Finally, western blot analyses showed that distinct BR-C genetic functions can be correlated with single and specific BR-C protein isoforms.
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