The acceptability of waiting times for elective general surgery and the appropriateness of prioritising patients

Background  

Problematic waiting lists in public health care threaten the equity and timeliness of care provision in several countries. This study assesses different stakeholders' views on the acceptability of waiting lists in health care, their preferences for priority care of patients, and their judgements on acceptable waiting times for surgical patients.     

Docetaxel and paclitaxel inhibit DNA-adduct formation and intracellular accumulation of cisplatin in human leukocytes

 The purpose of this study was to determine the mechanism of the pharmacodynamic interaction between docetaxel/paclitaxel and cisplatin. Cisplatin-induced DNA-adducts and cisplatin accumulation were quantitated in peripheral blood leukocytes (WBC). The WBC were obtained from patients treated with docetaxel or paclitaxel in phase I/II studies and were incubated in vitro with cisplatin. In addition, blank whole-blood samples were obtained from patients and healthy subjects and incubated in vitro with cisplatin or docetaxel/paclitaxel and cisplatin. The cisplatin-induced DNA-adduct levels measured in WBC after treatment with docetaxel or paclitaxel were significantly lower than those determined in non-pretreated WBC. Docetaxel and paclitaxel reduced the intracellular accumulation of cisplatin in WBC by 46–47%. If the pharmacodynamic interaction between docetaxel/paclitaxel and cisplatin also occurs in other normal tissues such as bone marrow, it may well contribute to the sequence dependent toxicity that has been observed in clinical studies. Received: 15 February 1995/Accepted: 6 June 1995     

Oxygenated metabolites of anandamide and 2-arachidonoylglycerol: conformational analysis and interaction with cannabinoid receptors,membrane transporter,and fatty acid amide hydrolase

This study was aimed at finding structural requirements for the interaction of the acyl chain of endocannabinoids with cannabinoid receptors, membrane transporter protein, and fatty acid amide hydrolase (FAAH). To this end, the flexibility of the acyl chain was restricted by introduction of an 1-hydroxy-2Z,4E-pentadiene system in anandamide (N-arachidonoylethanolamine, AEA) and 2-arachidonoylglycerol (2-AG) at various positions using different lipoxygenases. This brought about selectivity and attenuated the binding potency of AEA and 2-AG. Although the displacement constants were modest, 15(S)-hydroxy-eicosa-5Z,8Z,11Z,13E-tetraenoyl-N-(2-hydroxyethyl)amine was found to bind selectively to the CB(1) receptor, whereas its 1-arachidonoyl-sn-glycerol analogue and 13(S)-hydroxy-octadeca-9Z,11E-dienoyl-N-(2-hydroxyethyl)amine could selectively bind to the CB(2) receptor. 11(S)-Hydroxy-eicosa-5Z,8Z,12E,14Z-tetraenoyl-N-(2-hydroxyethyl)amine did not bind to either receptor, whereas 12(S)-hydroxy-eicosa-5Z,8Z,10E,14Z-tetraenoyl-N-(2-hydroxyethyl)amine did bind to both CB receptors with an affinity similar to that of AEA. All oxygenated anandamide derivatives were good inhibitors of FAAH (low micromolar K(i)) but were ineffective on the AEA transporter. 2-AG rapidly isomerizes into 1(3)-arachidonoyl-sn-glycerol. Both 1- and 3-arachidonoyl-sn-glycerol did not bind to either CB receptor and did not interfere with AEA transport. Thus, after it is isomerized, 2-AG is inactivated, thereby decreasing effective concentrations of 2-AG. Analysis of (1)H NMR spectra revealed that chloroform did not induce notably different conformations in the acyl chain of 15(S)-hydroxy-eicosa-5Z,8Z,11Z,13E-tetraenoic acid as compared with water. Molecular dynamics (MD) simulations of AEA and its analogues in the presence of explicit water molecules revealed that a tightly folded conformation of the acyl chain is not the only requirement for CB(1) binding. Structural details of the C(2)-C(15) loop, such as an sp(2) carbon at position 11, are necessary for receptor binding. The MD simulations may suggest that the average orientations of the pentyl tail of AEA and 12(S)-hydroxy-eicosa-5Z,8Z,10E,14Z-tetraenoyl-N-(2-hydroxyethyl)amine are different from that of the low-affinity, inactive ligands.     

Buoyancy-driven flow in a peat moss layer as a mechanism for solute transport

Transport of nutrients, CO2, methane, and oxygen plays an important ecological role at the surface of wetland ecosystems. A possibly important transport mechanism in a water-saturated peat moss layer (usually Sphagnum cuspidatum) is nocturnal buoyancy flow, the downward flow of relatively cold surface water, and the upward flow of warm water induced by nocturnal cooling. Mathematical stability analysis showed that buoyancy flow occurs in a cooling porous layer if the system's Rayleigh number (Ra) exceeds 25. For a temperature difference of 10 K between day and night, a typical Ra value for a peat moss layer is 80, which leads to quickly developing buoyancy cells. Numerical simulation demonstrated that fluid flow leads to a considerable mixing of water. Temperature measurements in a cylindrical peat sample of 50-cm height and 35-cm diameter were in agreement with the theoretical results. The nocturnal flow and the associated mixing of the water represent a mechanism for solute transport in water-saturated parts of peat land and in other types of terrestrializing vegetation. This mechanism may be particularly important in continental wetlands, where Ra values in summer are often much larger than the threshold for fluid flow.     

Patient characteristics determine differences in the influenza vaccination rate more so than practice features

BACKGROUND: World-wide each year 30-55% of the target population is vaccinated against influenza. Determinants of successful vaccination programs are not clear. This study was aimed at identifying practice- and patient-related factors that determine differences in vaccination rates. METHODS: Data on patients of the target population were extracted from the computerized medical record systems of 48 family practices. Information about organizational factors was collected by a questionnaire for GP's. Multilevel logistic regression analyses were used to assess the determinants. RESULTS: Of all patients at risk (42,426), 76% were vaccinated. The vaccination rate for patients above age 65 was 15% higher when a medical indication was present. Patients with cardiac diseases or diabetes mellitus attained a relatively higher vaccination rate than other groups at risk. Special hours for vaccination led to significantly higher vaccination rates for the elderly and cardiac patients. Patients below 65 years of age were particularly influenced by special information pamphlets. CONCLUSION: Explanations of differences in uptake rates were found at the patient level. All practices in this study were well organized; nevertheless, subgroup analyses showed that special vaccination hours for elderly people and information pamphlets for young people could improve results further.     

An electron microscope study of the formation of the nacreous layer in the shell of certain bivalve molluscs

An electron-microscopic study was made of nacreous shell growth in several species of marine molluscs. Studies of sections of mantle-shell preparations show that the first step in crystal formation is the polymerization of part of the pallial fluid to form lamellae parallel to the surface of the epithelium. These lamellae form compartments enclosing a modified apallial fluid. Initiation of crystals occurs in these compartments in contact with a crystal in an adjacent layer. During crystal growth the organic matrix present in the compartment is displaced by the growing surface of the crystal. When growth is complete the crystal is entirely enveloped by a delicate organic sheath. These studies show that the pallial fluid with its organic constituents is responsible for supplying a matrix or substrate for crystal initiation and growth. It serves as a regulatory device for guiding the orderly growth and arrangement of crystals and, further, it may participate in the induction of new crystals. The formation of compartments during shell growth accounts for the uniform thickness, preferred exhibited orientation and mineralogy of the crystals as well as other features exhibited by the mature nacre.This investigation was aided (in part) by Grant DE-01825, N.I.D.R., U.S.P.H Service.