bluuebunny/crossref_metadata_2025 huggingface dataset:
Fatty acids and epithelial permeability: effect of conjugated linoleic acid in Caco-2 cells
Authors: Roche H M , Terres A M , Black I B , Gibney M J , Kelleher D
Published: July 2002

Conjugated linoleic acid (CLA) is a collective term referring to the positional and geometric isomers of linoleic acid. This novel fatty acid has been shown to have a number of beneficial actions, including immunomodulatory, anticarcinogenic, and antiatherogenic effects. Tight junctions of epithelial cells determine epithelial membrane integrity and selective paracellular permeability to ions and macromolecules. Occludin and ZO-1 are integral structural components of the tight junction, which are involved in the biogenesis and functional integrity of the epithelial monolayer. This study investigated the effects of two isomers of CLA (cis-9 andtrans-10 isomers) on Caco-2 cell transepithelial resistance (TER) development, paracellular epithelial permeability, and occludin and ZO-1 expression. Caco-2 cells were grown in media supplemented with 0.05 mM linoleic acid,cis-9 CLA, ortrans-10 CLA for 21 days. Thetrans-10 CLA isomer delayed Caco-2 cell TER development, which is an in vitro measure of epithelial cell integrity, and increased paracellular epithelial permeability. Immunofluorescent staining of Caco-2 cell epithelial monolayers grown in media supplemented trans-10 CLA showed that thetrans-10 CLA isomer altered distribution of occludin and ZO-1. The trans-10 CLA isomer delayed the acquisition of transepithelial resistance and altered the cellular distribution of occludin, which have important implications in relation to epithelial permeability.
Erythropoietin acts as a trophic factor in neonatal rat intestine
Authors: Juul S E , Ledbetter D J , Joyce A E , Dame C , Christensen R D , Zhao Y , DeMarco V
Published: July 2002

BACKGROUND

Erythropoietin (Epo) receptors are present on enterocytes of fetal and neonatal small bowel but the role of Epo in the bowel is not known.

AIMS

We tested the following hypotheses: (1) enterally dosed Epo is absorbed from the intestines of neonatal rats, (2) Epo acts as a trophic factor in developing small bowel, and (3) the trophic effects of Epo are dependant on the route of administration.

METHODS

The dose dependant effects of enterally dosed recombinant human erythropoietin (rEpo 0–1000 U/kg/day) were studied in artificially raised rat pups and compared with dam raised controls and dam raised pups given rEpo in rat milk. After one week, reticulocyte counts, haematocrits, and plasma Epo concentrations were measured, and calibrated morphometric measurements of villi were performed. The effects of route of rEpo administration (enteral v parenteral) on erythropoiesis, bowel growth, and disaccharidase activity were studied in nursing pups treated for one and two weeks.

RESULTS

Serum Epo concentrations ranged from undetectable (<0.6 mU/ml) to 8.4 mU/ml in control and enterally dosed pups (median 1.8 mU/ml), and from 4.9 to 82.3 mU/ml (median 20.4 mU/ml) in parenterally dosed animals. No increase in haematocrit or reticulocyte count was noted in enterally treated pups compared with controls after up to two weeks of treatment. Small bowel length was greater in rEpo treated pups, and a dose dependent increase in villus surface area which was independent of the route of dosing and associated with increased BrdU uptake was found.

CONCLUSIONS

rEpo is not enterally absorbed in an intact and functional form from the intestines of neonatal rat pups. Thus enterally dosed rEpo has no erythropoietic effects. However, rEpo acts as a trophic factor in developing rat small bowel whether given enterally or parenterally.
Live attenuated vaccine trials in medically informed volunteers: a special case?
Authors: Pinching Anthony J
Published: July 2002

A group of activist clinicians have offered to volunteer for clinical trials of live attenuated HIV vaccines. This has provided an important conceptual challenge to medical ethics, and to work on the development of HIV vaccines. In exploring these issues, this article highlights how the HIV field has altered the content as well as the tone of ethical discourse. The balance of expertise and authority between research subjects and triallists is profoundly changed, raising questions about the limits of voluntarism and differing perspectives on risk-benefit analysis. Care is needed to ensure that the novelty of the situation does not confuse the central ethical and scientific issues.
Ethics in the laboratory examination of patients: Figure 1
Authors: Nyrhinen Tarja , Leino-Kilpi Helena
Published: July 2002

Various value problems are connected with the clinical examination of patients. The purpose of this literature review is to clarify: 1) in which patient examinations ethical problems are generally found; 2) what kind of ethical problems are found in the different phases of the examination process, and 3) what kind of ethical problems are found in connection with the use of examination results. Genetic testing, autopsy, prenatal and HIV examinations were ethically the most problematic laboratory examinations. The most problematic phase in the laboratory examination process proved to be the pre-analytic phase. At present the results of laboratory examination are used more and more often for the prediction of diseases. The problems appear when the examination results are used for discrimination and stigmatisation. Because of the lack of empirical ethical research, it is important to chart empirical knowledge about present value conflict situations involved in the laboratory examination process.
The case for a new system for oversight of research on human subjects
Authors: Jamrozik Konrad
Published: July 2002

The increasing emphasis on evidence-based clinical practice has thrown into sharp focus multiple deficiencies in current systems of ethical review. This paper argues that a complete overhaul of systems for ethical oversight of studies involving human subjects is now required as developments in medical, epidemiological and genetic research have outstripped existing structures for ethical supervision. It shows that many problems are now evident and concludes that sequential and piecemeal amendments to present arrangements are inadequate to address these. At their core present systems of ethical review still rely on the integrity and judgment of individual investigators. One possible alternative is to train and license research investigators, make explicit their responsibilities and have ethics committees devote much more of their time to monitoring research activity in order to detect those infringing the rules.
An argument for intolerance
Authors: Catherwood John F
Published: July 2002

“Multiculturalism”, “pluralism” and “tolerance” have become buzz words in applied ethics. While serious and well thought out work is going on in these areas, a misunderstanding of the importance of tolerance, and the difficulties raised by multicultural moral conflict seems common. In this paper I argue that intolerance of some cultural traditions is morally required, and suggest that the forging of a moral mono-culture is preferable to pluralism.
That's another story: narrative methods and ethical practice: Figure 1
Authors: Carson Alex M
Published: July 2002

This paper examines the use of case studies in ethics education. While not dismissing their value for specific purposes, the paper shows the limits of their use. While agreeing that case studies are narratives, although rather thin stories, the paper argues that the claim that case studies could represent reality is difficult to sustain. Instead, the paper suggests a way of using stories in ethics teaching that could be more real for students, while also giving them a way of thinking about their own professional practices. The paper shows how the method can be used to develop a more critical and reflective practice for students in the health care professions. Some immediate problems with the method are discussed.
Doctors' and nurses' attitudes towards and experiences of voluntary euthanasia: survey of members of the Japanese Association of Palliative Medicine
Authors: Asai Atsushi , Ohnishi Motoki , Nagata Shizuko K , Tanida Noritoshi , Yamazaki Yasuji
Published: July 2002

Objective—To demonstrate Japanese doctors' and nurses' attitudes towards and practices of voluntary euthanasia (VE) and to compare their attitudes and practices in this regard.

Design—Postal survey, conducted between October and December 1999, using a self-administered questionnaire.

Participants—All doctor members and nurse members of the Japanese Association of Palliative Medicine.

Main outcome measure—Doctors' and nurses' attitude towards and practices of VE.

Results—We received 366 completed questionnaires from 642 doctors surveyed (response rate, 58%) and 145 from 217 nurses surveyed (68%). A total of 54% (95% confidence interval (CI): 49-59) of the responding doctors and 53% (CI: 45-61) of the responding nurses had been asked by patients to hasten death, of whom 5% (CI: 2-8) of the former and none of the latter had taken active steps to bring about death. Although 88% (CI: 83-92) of the doctors and 85% (CI: 77-93) of the nurses answered that a patient's request to hasten death can sometimes be rational, only 33% (CI: 28-38) and 23% (CI: 16-30) respectively regarded VE as ethically right and 22% (CI: 18-36) and 15% (CI: 8-20) respectively would practise VE if it were legal. Logistic regression model analysis showed that the respondents' profession was not a statistically independent factor predicting his or her response to any question regarding attitudes towards VE.

Conclusions—A minority of responding doctors and nurses thought VE was ethically or legally acceptable. There seems no significant difference in attitudes towards VE between the doctors and nurses. However, only doctors had practised VE.
The relationship between the arts and medicine
Authors: Scott P Anne
Published: July 2002

In this paper some of the intriguing links between the arts and medicine are explored. As a starting point I consider the notion of whole person understanding as articulated by Downie in an article entitled “Literature and medicine”, published in the Journal of Medical Ethics in 1991.1I suggest that the arts can contribute to whole person understanding in at least three ways. The arts may stimulate: (a) insight into common patterns of response (shared human experiences); (b) insight into individual difference or uniqueness, and (c) enrichment of the language and thought of the practitioner.

Much literature which explores the relationship between the arts and medicine tends to focus on the value of the arts in increasing our understanding of the particular individual, “whole person understanding” in Downie's sense of the word. This, however, assumes that “whole person understanding” should focus only on the unique in the individual. This view is, I think, mistaken. If we take the notion of “whole person” seriously then we must recognise that which is unique but also that which humans may share. I suggest that this broader view is of the greatest importance in any consideration of the relationship between the arts and medicine.
Changes to bodily appearance: the aesthetics of deliberate intervention
Authors: Holm Søren
Published: July 2002

Aesthetic plastic surgery is a branch of medicine using surgical techniques to alter the appearance of patients. In this paper it is considered whether aesthetic plastic surgery should be viewed as an art form. The question is answered by trying to see how aesthetic plastic surgery fits a number of classical concepts in philosophical aesthetics, concepts such as “artist” and “work of art”. Further to elucidate the status of aesthetic plastic surgery, it is compared with competitive bodybuilding, another technique for changing appearance.
Writing well: health and the power to make images
Authors: Robinson Mark
Published: July 2002

There is increasing interest in connections between writing and wellbeing, but a perceived tension between writing well and writing to improve health. This paper gives a brief outline of some dominant literary thinking in this area, explores views of this orthodoxy among two groups of writers, examines the writing process and evidence of how it affects wellbeing, and goes on to relate how such evidence relates to recent psychological/clinical findings. Eighty-four per cent of those interviewed testified to therapeutic effects, but tensions existed around quality and catharsis. Bucci's multiple code account of the referential cycle is related to the creative writing process, and the paper concludes there are indications that the process of writing well is linked to the benefits for wellbeing. It therefore suggests that the importance of literary quality, and the re-writing process involved, as well as the value of disclosure, needs to be examined further as writing is increasingly used therapeutically.
Science and the imagination in the age of reason
Authors: Downie Robin
Published: July 2002

The eighteenth century is commonly thought of as the “age of reason”, an age in which the imagination was not given a central role in the arts, far less in science. But in Hume's attempts to account for our belief in a continuing external world he is forced into invoking the activity of the imagination. His views on the activity of the imagination greatly influenced Adam Smith, who adapted them to fashion a theory of the psychology of scientific discovery. In this theory the imagination is shown to be active in creating systematic explanations of the phenomena of nature, to the extent that Smith depicts the aim of scientific theory as that of satisfying the imagination. Smith's account of the logic of scientific theory can be defended even in contemporary philosophy of science. In particular, it can be maintained that all scientific theories are works of the imagination and that the concept of truth does not directly apply to them.
From Kafka to Casualty: doctors and medicine in popular culture and the arts— a special studies module
Authors: Glasser Brian
Published: July 2002

This paper describes and reflects on the content and teaching methods of a two-week medical humanities special studies module (SSM) taken by third-year students at the Royal Free & University College Medical School. It aims to add to the common pool of knowledge, and will be of use to people who are considering setting up something similar.
Transplant: a non-fiction narrative
Authors: Rowe M
Published: July 2002

This narrative is taken from a memoir about my son, Jesse, who died at age 19 in 1995 after a liver transplant. It covers two periods—from May 5, his admission date at the hospital to wait for a transplant, until May 9, when a perforation, caused by cutting through intestinal adhesions during transplant surgery, was discovered, and from May 20 to May 22, when his condition became extremely critical. Since Jesse was largely unconscious or semi-conscious during a good part of the period this narrative covers, his personality and conscious struggles shine through less here than they do in other parts of the memoir. Here, the relative emphasis is on parents and physicians and on facing the critical illness, and possible death, of one's child in an intensive care unit, following the very intervention that was to give him a new chance at a healthy life.
The University of Birmingham Medical School and the history of medicine
Authors: Arnott R
Published: July 2002

The publication in 1993 by the General Medical Council ofTomorrow's Doctors—Recommendations on Undergraduate Medical Educationprovided the first real opportunity for many medical schools to advance the introduction of the history of medicine into the undergraduate medical curriculum. While the University of Birmingham Medical School, was not one of the first to introduce the subject, it has been at the forefront of the introduction of the history of medicine into the undergraduate medical curriculum since 1997, and can now boast a number of special study modules in the subject and the second largest intercalated BMedSc (History of Medicine) degree programme in the country. This article tells the story of why and how we introduced history into the curriculum and how important it is that tomorrow's doctors know something of the history of the profession they are about to enter.
Daily deaths are associated with combustion particles rather than SO2in Philadelphia
Authors: Schwartz Joel
Published: July 2002

OBJECTIVES

To assess whether the association between SO2and daily deaths in Philadelphia during the years 1974–88 is due to its correlation with airborne particles, and vice versa.

METHODS

There is a significant variation in the relation between total suspended particulate (TSP) and SO2in Philadelphia by year and season. Firstly, 30 separate regressions were fitted for each pollutant in the warm and cold season of each year. These regressions controlled for weather, long term temporal patterns, and day of the week. Then a meta–regression was performed to find whether the effect of SO2was due to TSP, or vice versa.

RESULTS

Controlling for TSP, there was no significant association between SO2and daily deaths. By contrast, in periods when TSP was less correlated with SO2, its association with daily deaths was higher. However, all of the association between TSP and daily deaths was explained by its correlation with extinction coefficient, a measurement of the scattering of light by fine particles, which has been shown to be highly correlated with fine combustion particles in Philadelphia.

CONCLUSIONS

The association between air pollution and daily deaths in Philadelphia is due to fine combustion particles, and not to SO2.
Mortality surveillance and occupational hazards: the Solutia mortality experience 1980–94
Authors: Collins James J , Riordan Susan G
Published: July 2002

OBJECTIVES

Several investigators argue that company wide mortalities for recent workers allow early identification of potential workplace hazards. Mortalities for recent workers were compared with published studies of workers with specific exposures in the same company to find whether mortality surveillance results could be used to identify previously unknown health effects from workplace hazards.

METHODS

Relative risks for causes of death in published substance specific studies at the plants were compared with the relative risks in the mortality surveillance of workers 20 or more years after first being employed.

RESULTS

As reported by other companies, low mortalities were found among workers in the mortality surveillance. The mortality surveillance reports often found no increased risk of disease at plants in which substance specific studies had found no effects. However, disease specific relative risks were not found by the mortality surveillance predictions of relative risks in the substance specific studies with increased risk.

CONCLUSION

Mortality surveillance is of limited use for identifying health effects from past workplace exposures to specific materials. The healthy worker and survivor effects, the failure to identify subsets of workers exposed to potentially toxic substances, the typically long induction period between exposure and disease, and the inability of recent mortality levels to reflect historical conditions all may make it difficult to use mortality surveillance to identify workplace hazards. Combining mortality surveillance with studies of workers with potentially toxic exposures helps identify occupational hazards.
Prevalence and pattern of occupational exposure to whole body vibration in Great Britain: findings from a national survey
Authors: Palmer Keith T , Griffin Michael J , Bendall Holly , Pannett Brian , Coggon David
Published: July 2002

OBJECTIVES

To estimate the number of workers in Great Britain with significant occupational exposure to whole body vibration (WBV) and to identify the common sources of exposure and the occupations and industries where such exposures arise.

METHODS

A postal questionnaire was posted to a random community sample of 22 194 men and women of working age. Among other things, the questionnaire asked about exposure to WBV in the past week, including occupational and common non-occupational sources. Responses were assessed by occupation and industry, and national prevalence estimates were derived from census information. Estimates were also made of the average estimated daily personal dose of vibration (eVDV).

RESULTS

From the 12 907 responses it was estimated that 7.2 million men and 1.8 million women in Great Britain are exposed to WBV at work in a 1 week period if the occupational use of cars, vans, buses, trains, and motor cycles is included within the definition of exposure. The eVDV of >374 000 men and 9000 women was estimated to exceed a proposed British Standard action level of 15 ms-1.75. Occupations in which the estimated exposures most often exceeded 15 ms-1.75included forklift truck and mechanical truck drivers, farm owners and managers, farm workers, and drivers of road goods vehicles. These occupations also contributed the largest estimated numbers of workers in Great Britain with such levels of exposure. The highest estimated median occupational eVDVs were found in forklift truck drivers, drivers of road goods vehicles, bus and coach drivers, and technical and wholesale sales representatives, among whom a greater contribution to total dose was received from occupational exposures than from non-occupational ones; but in many other occupations the reverse applied. The most common sources of occupational exposure to WBV are cars, vans, forklift trucks, lorries, tractors, buses, and loaders.

CONCLUSIONS

Exposure to whole body vibration is common, but only a small proportion of exposures exceed the action level proposed in British standards, and in many occupations, non-occupational sources are more important than those at work. The commonest occupational sources of WBV and occupations with particularly high exposures have been identified, providing a basis for targeting future control activities.
Sensitisation to enzymes in the animal feed industry
Authors: Vanhanen M , Tuomi T , Tiikkainen U , Tupasela O , Tuomainen A , Luukkonen R , Nordman H
Published: July 2002

OBJECTIVES

To assess the prevalence of enzyme sensitisation in the animal feed industry.

METHODS

A cross sectional study was conducted in four animal feed factories, where several enzymes had been used in powder form for 7–9 years. Before this study, enzymes in liquid form had started to be used. Sensitisation to enzymes was examined by skin prick and radioallergosorbent (RAST) tests. Altogether 218 workers were tested; 140 people in various tasks in manufacturing, where exposure to various organic dusts and to enzymes was possible, and 78 non-exposed office workers. The workers were interviewed for work related respiratory and skin symptoms. Total dust concentrations were measured by a gravimetric method. The concentrations of protease and α-amylase were measured with catalytic methods and that of xylanase with an immunological method.

RESULTS

Ten workers (7%) were sensitised to enzymes in the exposed group of 140, whereas none were sensitised in the non-exposed group. Six of the sensitised people had respiratory symptoms at work: two of them especially in connection with exposure to enzymes. Enzyme concentrations in the air varied greatly: xylanase from less than 0.8 ng/m3up to 16 ng/m3, α-amylase from less than 20 ng/m3up to 200 ng/m3, and protease from less than 0.4 ng/m3up to 2900 ng/m3. On average, highest xylanase and α-amylase concentrations were found in the various manufacturing sites, whereas the highest protease concentrations were found in areas of high total dust.

CONCLUSIONS

Industrial enzymes may cause allergies in the animal feed industry. There is a need to assess exposure to enzymes at various phases of production, and to minimise exposures.
Predictors of DMSA chelatable lead, tibial lead, and blood lead in 802 Korean lead workers
Authors: Todd A C , Lee B-K , Lee G-S , Ahn K-D , Moshier E L , Schwartz B S
Published: July 2002

OBJECTIVES

To examine the interrelations among chelatable lead (by dimercaptosuccinic acid, DMSA), tibial lead, and blood lead concentrations in 802 Korean workers with occupational exposure to lead and 135 employed controls with only environmental exposure to lead.

METHODS

This was a cross sectional study wherein tibial lead, DMSA chelatable lead, and blood lead were measured. Linear regression was used to identify predictors of the three lead biomarkers, evaluating the influence of age, job duration, sex, education level, alcohol and tobacco use, creatinine clearance rate, and body mass index.

RESULTS

DMSA chelatable lead concentrations ranged from 4.8 to 2102.9 μg and were positively associated with age, current smoking, and creatinine clearance rate. On average, women had 64 μg less DMSA chelatable lead than men. When blood lead and its square were added to a model with age, sex, current smoking, body mass index, and creatinine clearance rate, blood lead accounted for the largest proportion of the variance and sex became of borderline significance. Tibial lead concentrations ranged from −7 to 338 μg/g bone mineral and were positively associated with age, job duration, and body mass index. Women had, on average, 9.7 μg/g less tibial lead than men. Blood lead concentrations ranged from 4.3 to 85.7 μg/dl and were positively associated with age and tibial lead, whereas current smokers had higher blood lead concentrations and women had lower blood lead concentrations.

CONCLUSIONS

The data suggest that age and sex are both predictors of DMSA chelatable lead, blood lead, and tibial lead concentrations and that tibial lead stores in older subjects are less bioavailable and may contribute less to blood lead concentrations than tibial lead stores in younger subjects. Although blood lead concentrations accounted for a large proportion of the variance in DMSA chelatable lead concentrations, suggesting that measurement of both in epidemiological studies may not be necessary, the efficacy of each measure in predicting health outcomes in epidemiological studies awaits further investigation.
Public health response to an incident of secondary chemical contamination at a beach in the United Kingdom
Authors: Goodfellow F J L , Murray V S G , Ouki S K , Iversen A , Sparks A , Bartlett T
Published: July 2002

OBJECTIVES

To gather enough data from a large scale investigation involving two health authorities, to assess the possible concentrations and routes of exposure and the consequent health implications.To use the data to decide whether a polluted beach should remain open to the public. In Spring 1997, a chemical incident came to light at a beach on the south coast of England when a local resident reported a sulphurous smell, visible signs of oil, and reduced numbers of fishing bait. The beach was situated adjacent to a former gasworks site and was accessible to the public. The incident was reported to the local authority and was initially investigated by the Environment Agency and the local authority. An Environment Agency report confirmed contamination of the beach with cyanide, ammonia, and polycyclic aromatic hydrocarbons (PAHs) with associated potential health risks. The incident was then referred to the local health authorities for investigation.

METHODS

The investigation was carried out in four stages: comprehensive sampling and analysis to identify the extent of contamination, followed by an assessment of risk to health; establishment of a long term monitoring programme to identify any changes in contaminant concentrations; investigation of the effects of the contamination on shellfish; and review of the routine monitoring data and current sampling strategy.

RESULTS

The initial investigation confirmed that the beach was contaminated, with the most likely source being the adjacent former gasworks site. The level of contamination was not found to be likely to pose a hazard to users of the beach. However, subsequent investigation of shellfish in the area led to warning signs being erected on the beach to prevent human consumption of mussels contaminated with PAHs.

CONCLUSIONS

Several lessons can be learnt from this investigation, which can be applied to incident management more generally: the importance of collaboration and coordination; the need for early involvement of the health authority; and the importance of carrying out appropriate sampling and analysis as soon as possible, to assess the risk to health and the environment.
What is “powder free”? Characterisation of powder aerosol produced during simulated use of powdered and powder free latex gloves: Table 1
Authors: Phillips M L , Meagher C C , Johnson D L
Published: July 2002

OBJECTIVES

To characterise the distribution of particle size and mass of glove powder aerosol released from powdered and powder free non-sterile latex gloves under controlled conditions.

METHODS

Gravimetric sampling and aerodynamic particle size analysis were performed during simulated use of gloves on a prosthetic hand in a chamber designed to minimise background particle concentrations.

RESULTS

Aerosol was detectable for both powdered and powder free gloves under both aggressive and non-aggressive handling conditions. Most of the particles detected had aerodynamic diameter less than 10 μm.

CONCLUSION

Powder free gloves were not entirely free of powder aerosol. Particles from both powdered and powder free gloves are sufficiently fine to penetrate into the thoracic region of the respiratory tract.
The risk to the United Kingdom population of zinc cadmium sulfide dispersion by the Ministry of Defence during the “cold war”
Authors: Elliott P J , Phillips C J C , Clayton B , Lachmann P J
Published: July 2002

Objectives: To estimate exposures to cadmium (Cd) received by the United Kingdom population as a result of the dispersion of zinc Cd sulfide (ZnCdS) by the Ministry of Defence between 1953 and 1964, as a simulator of biological warfare agents.

Methods: A retrospective risk assessment study was carried out on the United Kingdom population during the period 1953–64. This determined land and air dispersion of ZnCdS over most of the United Kingdom, inhalation exposure of the United Kingdom population, soil contamination, and risks to personnel operating equipment that dispersed ZnCdS.

Results: About 4600 kg ZnCdS were dispersed from aircraft and ships, at times when the prevailing winds would allow large areas of the country to be covered. Cadmium released from 44 long range trials for which data are available, and extrapolated to a total of 76 trials to allow for trials with incomplete information, is about 1.2% of the estimated total release of Cd into the atmosphere over the same period. “Worst case” estimates are 10 μg Cd inhaled over 8 years, equivalent to Cd inhaled in an urban environment in 12–100 days, or from smoking 100 cigarettes. A further 250 kg ZnCdS was dispersed from the land based sites, but significant soil contamination occurred only in limited areas, which were and have remained uninhabited. Of the four personnel involved in the dispersion procedures (who were probably exposed to much higher concentrations of Cd than people on the ground), none are suspected of having related illnesses.

Conclusion: Exposure to Cd from dissemination of ZnCdS during the “cold war” should not have resulted in adverse health effects in the United Kingdom population.
Effect of air pollution and environmental tobacco smoke on serum hyaluronate concentrations in school children
Authors: Fuji Y , Shima M , Ando M , Adachi M , Tsunetoshi Y
Published: July 2002

Objectives: To evaluate serum hyaluronate concentrations relative to air pollution, environmental tobacco smoke (ETS), and respiratory health in Japanese school children.

Methods: Respiratory symptoms and serum IgE concentrations were examined in 1037 school children living in four communities in Japan with differing levels of air pollution. Serum hyaluronate concentrations were assayed in 230 children, consisting of all the children who had symptoms of either asthma or wheeze (65 and 50 subjects, respectively) and normal controls adjusted for sex, school grade, and school without these symptoms (115 subjects).

Results: Although serum hyaluronate concentrations did not differ for either asthma or wheeze, the concentrations were significantly higher in children living in communities with higher levels of air pollution. Children with asthma or wheeze and those with serum IgE concentrations of 250 IU/ml or above showed differences in hyaluronate concentrations that related to the degree of air pollution in the communities. In children with higher serum IgE concentrations, the hyaluronate concentrations among subjects exposed to ETS were significantly higher than among those without exposure to ETS.

Conclusions: The present results suggest that serum hyaluronate concentration is related to the degree of air pollution and exposure to ETS. Children with asthma or wheeze and children with higher IgE concentrations are considered to be more susceptible to environmental factors.
Advanced testicular cancer presenting with phlegmasia cerulea dolens
Authors: Mulatero C , Brogan G , Oliver R T D
Published: July 2002

A case of fulminating deep venous thrombosis secondary to invasion of the inferior vena cava is described in a 45 year old man presenting with a germ cell tumour. Despite aggressive supportive care and emergency chemotherapy his late presentation caused his death. The case highlights the necessity for increased public education of the attendant risks in delayed presentation with a testicular lump.
A case of cerebral haemorrhage—can Ginkgo biloba be implicated?
Authors: Benjamin J , Muir T , Briggs K , Pentland B
Published: July 2002

The case of a 56 year old man who suffered a spontaneous intracerebral haemorrhage after regular self medication with the herbal preparation, Ginkgo biloba leaf extract is described, and the possible association is discussed. Key pointsThe herbal preparation Ginkgo biloba leaf extract is promoted as a remedy for a wide range of conditions (for example, dementia, erectile dysfunction, tinnitus)There are grounds to suspect an association with intracranial haemorrhage as described in this caseAwareness of these suspicions should encourage proper documentation of all herbal remedies used when patients present to medical staff
Do computer generated ECG reports improve interpretation by accident and emergency senior house officers?
Authors: Goodacre S , Webster A , Morris F
Published: July 2002

OBJECTIVES

To determine whether access to a computer generated electrocardiogram (ECG) report can reduce errors of interpretation by senior house officers (SHOs) in an accident and emergency department.

METHODS

Ten SHOs were asked to interpret 50 ECGs each: 25 with computer generated reports, 25 without. Their answers, and the computer generated reports, were compared with a “gold standard” produced by two experienced clinicians. The primary outcome measure was the proportion of major errors of interpretation.

RESULTS

The computer reading system made two major errors (4%, 95% confidence interval (CI) 1.1% to 13.5%) compared with the gold standard. Access to the computer report did not significantly reduce major errors among SHOs (46 (18.4%) with report v 56 (22.4%) without, odds ratio 0.64, 95% CI 0.36% to 1.14%, p=0.13) or improve the proportion completely correct (104 (41.6%) with report v 91 (36.4%) without, odds ratio 1.43, 95% CI 0.88 to 2.33, p=0.15).

CONCLUSIONS

SHOs have a high error rate when interpreting ECGs, which is not significantly reduced by access to a computer generated report. Junior doctors should continue to seek expert senior help when they have to interpret a difficult ECG.
Why do some people look older than they should?
Authors: Bulpitt C J , Markowe H L J , Shipley M J
Published: July 2002

BACKGROUND

As a component of studies on biological age, the age of subjects from their appearance (perceived age) was estimated.

OBJECTIVE

To determine the factors associated with looking older.

METHODS

Cross sectional study of London civil servants (318 men, 129 women) in the Department of the Environment study. Perceived age was recorded by an observer and the difference between this age and chronological age was analysed according to 20 different variables.

RESULTS

Men had an average perceived age of 0.37 years older than their actual age and women a perceived age of 0.54 years younger. In men, looking older was related to greying of the hair, grade of arcus senilis, and grade of baldness. Less expected, looking older was positively related to total serum cholesterol (p=0.03) and blood haemoglobin (p<0.01). In women, looking older was related to greying of the hair, positively to blood erythrocyte sedimentation rate (ESR), and negatively to serum bilirubin (p=0.01). Looking older was not related to alcohol consumption, employment grade, serum high density lipoprotein cholesterol, glucose, albumin, and calcium in either sex.

CONCLUSION

The relationships between looking older and total cholesterol and haemoglobin in men and ESR and bilirubin in women, require further investigation.
Changing thyroid status related to pregnancy
Authors: Shankar P , Kilvert A , Fox C
Published: July 2002

A case of post-thyroidectomy hypothyroidism is reported. The patient became euthyroid in three consecutive pregnancies, reverting to hypothyroid within three months of delivery on each occasion. The alteration in thyroid status is attributed to pregnancy related changes in antibody titres, though the laboratory data to confirm this are not available.
Formal education programmes for senior house officers: comparison of experience in three hospital specialties
Authors: Flett A , Baker M , Williams J
Published: July 2002

This study was designed to compare the attendance rate of senior house officers (SHOs) in three specialties at formal educational events, examine experiences of protected time, use of educational objectives, and perceived barriers to attendance and evaluate differences found in the context of variations in training practice within each specialty. A quantitative questionnaire survey was completed by Trent region SHOs in obstetrics and gynaecology, general medicine, and accident and emergency posts. An independent researcher visited a selection of educational programme events over a two month span, recorded attendances, and administered the questionnaire. Attendance rates ranged from 40.8% of those in obstetrics and gynaecology jobs to 55.4% of those in accident and emergency jobs. The questionnaire findings found that service commitments were a major obstacle to attendance for the majority of those in obstetrics and gynaecology and general medicine jobs, while relatively few of the accident and emergency SHOs specified any barriers. SHOs in accident and emergency jobs had significantly more protected time for education and found educational objectives to be more widely used by senior staff. The findings suggest that the planned integration of formal education programmes with appropriate working pattern systems—in this case full shifts within accident and emergency departments—will result in SHOs receiving a better deal in terms of provision and structure of education.
Acute respiratory failure in a middle aged woman
Authors: McGuigan C , McDonnell G , Mirakhur M , Morrow J I
Published: July 2002

A 61 year old woman presented with a one week history of headache, drowsiness, and shortness of breath. Initial examination revealed bilateral ptosis, which the patient stated had been present for three to four years before this admission. She also reported that her father had died suddenly, shortly after developing “drooping eyelids”. There was restriction in the range of eye movements in all directions. The remaining cranial nerves were intact.
Cor pulmonale: variation on a theme
Authors: Jolobe O M P , Schlayer H J , Yates A
Published: July 2002

A woman aged 89 was admitted with a three month history of effort dyspnoea. She had had a previous admission, at the age of 86, for left lower lobe pneumonia, with coincidental atrial fibrillation.
Epidemiology of Work Related Diseases
Authors: Thomas H F
Published: July 2002

This small volume at first glance appears too slight to adequately cover the subject of its title. However, appearances are deceptive and this well bound and printed book contains over 550 pages of interesting and distilled information. Anyone confronted by a medical problem that could have a work related dimension would do well to consult it.
Breathlessness after percutaneous biliary drainage
Authors: Patel H , Hindle K S , Tsavellas G , Huang A
Published: July 2002

A 77 year old woman presented with painless progressive jaundice and weight loss. She also had generalised pruritus and was passing dark urine and pale stools. On examination there was a palpable right upper quadrant abdominal mass. Plasma bilirubin level was 56 μmol/l and alkaline phosphatase was 350 U/l. Serum amylase was within normal limits. Abdominal ultrasound scan showed a dilated biliary tree and a distended gallbladder but there was no evidence of gallstones. Abdominal computed tomography was performed (fig 1). The patient underwent an endoscopic retrograde cholangiopancreaticogram (ERCP) and insertion of a biliary stent, with resolution of the jaundice.
Exposure of hospitality workers to environmental tobacco smoke
Authors: Bates M N , Fawcett J , Dickson S , Berezowski R , Garrett N
Published: July 2002

Objective:To determine quantitatively the extent of exposure of hospitality workers to environmental tobacco smoke (ETS) exposure during the course of a work shift, and to relate these results to the customer smoking policy of the workplace.

Subjects:Three categories of non-smoking workers were recruited: (1) staff from hospitality premises (bars and restaurants) that permitted smoking by customers; (2) staff from smokefree hospitality premises; and (3) government employees in smokefree workplaces. All participants met with a member of the study team before they began work, and again at the end of their shift or work day. At each meeting, participants answered questions from a standardised questionnaire and supplied a saliva sample.

Main outcome measures:Saliva samples were analysed for cotinine. The difference between the first and second saliva sample cotinine concentrations indicated the degree of exposure to ETS over the course of the work shift.

Results:Hospitality workers in premises allowing smoking by customers had significantly greater increases in cotinine than workers in smokefree premises. Workers in hospitality premises with no restrictions on customer smoking were more highly exposed to ETS than workers in premises permitting smoking only in designated areas.

Conclusions:Overall, there was a clear association between within-shift cotinine concentration change and smoking policy. Workers in premises permitting customer smoking reported a higher prevalence of respiratory and irritation symptoms than workers in smokefree workplaces. Concentrations of salivary cotinine found in exposed workers in this study have been associated with substantial involuntary risks for cancer and heart disease.
Map symbology and analysis of box and polyclinal folds, with examples from the Rocky Mountain Foothills of northeastern British Columbia and the Liard Ranges of southeastern Yukon Territory and southwestern Northwest Territories
Authors: Stockmal Glen S , Kubli Thomas E , Currie Lisel D , McDonough Michael R
Published: July 2002

The hinge surface traces of some types of folds cannot be portrayed adequately on maps using traditional symbology. Specifically, there are no widely accepted symbols suitable for hinge surfaces of (1) box folds (a class of polyclinal folds with two hinges), (2) folds whose limbs both dip in the same direction, or (3) overturned folds whose limbs dip in opposite directions. The latter two cases are not uncommon for hinges within polyclinal or composite folds. An unambiguous symbology is proposed, illustrated using hypothetical examples, and applied to the analysis of kilometre-scale folds mapped in the Rocky Mountain Foothills of northeastern British Columbia and the Franklin Mountain Liard Ranges of southeastern Yukon Territory and southwestern Northwest Territories.
Experimental study on the dynamic effects caused by vehicular traffic on a ferry boarding ramp
Authors: Savard Marc , Careau Marc-André , Drouin Alain
Published: July 2002

This article presents some of the results obtained during a load test conducted on a ferry boarding ramp operated by the Société des traversiers du Québec. The measurements highlight the sensitivity of these structures to the dynamic effects caused by two heavy vehicles. Since the dynamic behaviour of highway bridges is affected by parameters different from those that affect ferry boarding ramps, the article presents a reflection on the dynamic load allowance suitable for the evaluation or design of this latter type of structure.Key words: boarding ramp, bridge, dynamic amplification factor, design codes.
Complexation of the La(III) cation by p-sulfonatocalix[4]arene  A 139La NMR study
Authors: Israëli Yaël , Bonal Christine , Detellier Christian , Morel Jean-Pierre , Morel-Desrosiers Nicole
Published: July 2002

The complexation of La(III) by the water-soluble p-sulfonatocalix[4]arene was thermodynamically characterized by 139La NMR. The 139La NMR data are consistent with the formation of a 1:1 complex resulting from electro static interactions between the sulfonato groups and La(III). The complexation is entropy-driven and is characterized by a positive standard enthalpy (ΔrH° = 11.0 ± 0.5 kJ mol1) and a positive standard entropy (ΔrS° = 108 ± 2 J K1 mol1), which are in very good agreement with the ones determined previously by microcalorimetry. The linear relationship between the 139La NMR linewidth of the free and of the complexed cation, obtained at temperatures ranging from 290 to 340 K, excludes the formation of complexes or aggregates other than the 1:1 complex. It shows also that upon complexation, the effective radius of La(III) undergoes an increase of 50%, related to the replacement of water molecules of the hydrated cation by sulfonato groups of the ligand.Key words: complexation, water-soluble calixarene, p-sulfonatocalix[4]arene, 139La NMR, lanthanum.
Ryanoids and related compounds  Isolation and characterization of 11 new minor ryanoids from the plantRyania SpeciosaVahl
Authors: Ruest Luc , Dodier Marco , De Sève Hélène , Lessard Christian , Mongrain Pascal
Published: July 2002

In a search for minor ryanoids from the plant Ryania Speciosa Vahl, we recently characterized 11 new members of that family of natural compounds. Most of them represent ryanodine (1) and dehydroryanodine (2) with a modified stage of oxidation in ring C. A second member of the new 4-deoxy series has been identified.Key words: minor natural ryanoids, ryanodine, dehydroryanodine, deoxyryanoids.
Estimating price taking behavior with mill-level data: the Norwegian sawlog market, 1974-1991
Authors: Størdal Ståle , Baardsen Sjur
Published: July 2002

A five input transcendental logarithmic (translog) cost function and a set of conditional input demand functions, which were extended to include a conjectural elasticity term, were analyzed. The analysis was based on data covering individual Norwegian sawmills over the period 19741991. The presence of mill-level data allowed us to test cross-sectional effects as well as intertemporal effects. Under the assumption of cost minimization, price-taking behavior was rejected for the years 1982 and 19841991. There was no variation of the conjectural elasticity over regions, but the use of market power increased after the price negotiations were brought from the national to regional levels. The necessity of having information on sawlog purchases and market areas to conclude on welfare effects is explained. This analysis also contributes to explain the post-1992 period, where the Norwegian sawlog market has experienced several structural changes.