Multilaboratory Assessment of Threshold versus Fold-Change Algorithms for Minimizing Analytical Variability in Multiplexed Pneumococcal IgG Measurements

Pneumococcal vaccination is frequently used to assess a patient''s humoral immune function. The comparison of pre- and postvaccination levels of antipneumococcal antibodies is widely held to be the gold standard for documenting a response. However, many of the published criteria for defining an adequate response are based on assays that are no longer widely available. We compared the clinical classification of patient response by multiplex pneumococcal assays currently performed at three large reference laboratories using a variety of published criteria for defining responses in adults. The classification of responders agreed for 79% of the patients when using a threshold-based algorithm compared to 57 to 96% of the patients when using various fold-change-based algorithms. The highest rate of discordance was seen when the most stringent criteria for response were used (4-fold increase postvaccination in 70% of serotypes). The discordant samples tended to show similar patterns of response across all three assays, with small variations in the final number of serotypes converting postvaccination. We conclude that the use of published cut points for documenting response to pneumococcal vaccination can be affected by interlaboratory differences in pneumococcal assays, particularly for algorithms that require large fold changes for a response to be documented. However, the overall patterns of response were similar in virtually all samples, regardless of the assay used.     

Psychosocial impact of testing (by linkage) for the BRCA1 breast cancer gene: An investigation of two families in the research setting

Data are reported on an investigation of the impact of genetic testing in two families with a >95% probability of linkage to the BRCA1 Breast/Ovarian cancer predispostion gene. Levels of psychological morbidity and cancer specific concerns in this highly selected group were not unusually high. At least half of the sample had no specific prior expectation regarding their gene carrier status. However, there was an indication that an unanticipated unfavourable genetic test result can cause subsequent psychological distress. Uptake of testing in this research sample was 41% overall and was higher (59%) in females. This is likely to have important resource implications if this level of uptake is found when genetic testing is extended outside such research cohorts.     

Angina bullosa haemorrhagica: Lesional immunostaining and haematological findings

The aetiology of angina bullosa haemorrhagica remains obscure. Fourteen patients with clinical features suggestive of angina bullosa haemorrhagica were investigated. Haemostatic function tests were carried out on an initial 5 patients and immunostain studies on a total of 12 patients. The results indicate that the aetiology of angina bullosa haemorrhagica is associated with neither a haemostatic defect, nor an immunopathogenic basis, and the cause is, as yet, unclear.     

Radiotherapy alone in carcinoma of the intact uterine cervix according to G. H. Fletcher guidelines: a French cooperative study of 1383 cases

A French Cooperative study of 1383 cases with invasive carcinoma of the intact uterine cervix treated with radiation therapy alone, using the guidelines provided by G. H. Fletcher led to the following conclusions: The techniques of treatment were easily reproducible in 9 French centers, working in a prospective cooperative study; Results similar to those of the original study were achieved in Stages I and IIA (MDAH substaging) with a locoregional failure rate of 7%; In Stage IIB, the locoregional failure rate of 16% is also comparable in both studies; Locoregional failures in Stage III are slightly lower than those reported in Houston, probably reflecting differences in patient's prognostic factors in France and Texas; The 5-year survival rate obtained in advanced Stages (UICC FIGO staging) are among the highest in the literature (76% in Stage IIb, 62% in Stage IIIa and 50% in Stage IIIb); The rate of severe complications remains acceptable and decreased throughout the study thanks to a better use of computer dosimetry.     

Knowledge and practice of behavioral management principles among dentists treating adults with learning disabilities

This study investigated U.K. dentists’ knowledge and practice of behavioral management principles (BMPs) as applied to adults with learning disabilities (AWLD). A postal questionnaire enquired into the dentists’ experience in managing AWLD, utilization of behavioral management techniques, and knowledge of BMPs. The response rate was 41% (N = 53). Two groups were investigated: specialists (dentists registered on the Special Care Dentistry specialists’ list, n = 37) and nonspecialists (dentists not on the list, n = 16). Although specialists treated more AWLD than nonspecialists, both groups of dentists reported they felt highly confident in managing AWLD. However, all dentists’ knowledge of the principles of nonpharmacological BMPs was low. Specialists had a tendency to use a greater range of nonpharmacological behavioral management techniques compared to non‐specialists. These results suggest that dental team members need more training in the theory and practice of BMPs, which might lead to less reliance on costly pharmacological interventions and a clinical experience that is more respectful of the dignity and independence of AWLD.