Sensitivity and uncertainty analyses for burden of disease and risk factor estimates

Epidemiological studies report confidence or uncertainty intervals around their estimates. Estimates of the burden of diseases and risk factors are subject to a broader range of uncertainty because of the combination of multiple data sources and value choices. Sensitivity analysis can be used to examine the effects of social values that have been incorporated into the design of the disability–adjusted life year (DALY). Age weight, where a year of healthy life lived at one age is valued differently from at another age, is the most controversial value built into the DALY. The discount rate, which addresses the difference in value of current versus future health benefits, also has been criticized. The distribution of the global disease burden and rankings of various conditions are largely insensitive to alternate assumptions about the discount rate and age weighting. The major effects of discounting and age weighting are to enhance the importance of neuropsychiatric conditions and sexually transmitted infections. The Global Burden of Disease study also has been criticized for estimating mortality and disease burden for regions using incomplete and uncertain data. Including uncertain results, with uncertainty quantified to the extent possible, is preferable, however, to leaving blank cells in tables intended to provide policy makers with an overall assessment of burden of disease. No estimate is generally interpreted as no problem. Greater investment in getting the descriptive epidemiology of diseases and injuries correct in poor countries will do vastly more to reduce uncertainty in disease burden assessments than a philosophical debate about the appropriateness of social value

The cystine knot motif in toxins and implications for drug design

The cystine knot structural motif is present in peptides and proteins from a variety of species, including fungi, plants, marine molluscs. insects and spiders. It comprises an embedded ring formed by two disulfide bonds and their connecting backbone segments which is threaded by a third disulfide bond. It is invariably associated with nearby beta-sheet structure and appears to be a highly efficient motif for structure stabilization. Because of this stability it makes an ideal framework for molecular engineering applications. In this review we summarize the main structural features of the cystine knot motif, focussing on toxin molecules containing either the inhibitor cystine knot or the cyclic cystine knot. Peptides containing these motifs are 26-48 residues long and include ion channel blockers, haemolytic agents, as well as molecules having antiviral and antibacterial activities. The stability of peptide toxins containing the cystine knot motif, their range of bioactivities and their unique structural scaffold can be harnessed for molecular engineering applications and in drug design. Applications of cystine knot molecules for the treatment of pain. and their potential use in antiviral and antibacterial applications are described. (C) 2000 Elsevier Science Ltd. All rights reserved.

Smoke derived from burnt vegetation stimulates germination of arable weeds

A commercially available smoke-water solution (Seed Starter (R)) stimulated the germination of caryopses and intact florets of Avena fatua L. The solution was most effective when diluted (5-50%) and presented to intact or dehulled grain that had received a short period of dry after-ripening. It was less effective when applied at full strength or to grains that had been freshly harvested. The same stimulatory effect was observed in par-fly after-ripened caryopses of nine different wild oat biotypes obtained from three different cropping regions of the world. When freshly harvested caryopses were re-tested with the commercial solution (100%) for just 7 days prior to placement on to distilled water, a much higher germination percentage was possible than seen with continuous smoke-water incubation. The stimulatory ability of smoke water was more closely matched to that of gibberellic acid than to potassium nitrate, which had little or no effect on freshly harvested caryopses. The smoke-water solution (5-100%) was tested on the germination of 18 other cool temperate arable weed species. All monocotyledonous species tested (viz. Avena sterilis ssp. ludoviciana L., Alopecurus myosuroides, Sorghum halepense, Phalaris paradoxa) responded positively, while those of the dicotyledonous species were either strongly stimulated (greater than or equal to 40% stimulation Malva neglecta), moderately stimulated (greater than or equal to 20% stimulation Galium aparine, Veronica persica), slightly stimulated (Polygonum persicaria, P pennsylvanicum, Fallopia convolvulus), unaffected (P. aviculare, Sinapis arvensis, Heracleum sphondylium, Angelica sylvestris, Mercurialis annua, Veronica hederifolia) or inhibited (Lamium purpureum). The optimal concentrations required to stimulate germination of the monocotyledonous species were similar to those observed for A. fatua (5-10%). However, for the dicotyledonous species slightly stronger solutions were required (10-20%). When the unaffected species were retested using a 10-day pre-chilling treatment, smoke water showed a small promotive response in three (S. arvensis, P. aviculare and V hederifolia) of the six species. When four different smoke-water solutions (Seed Starter (R), Regen 2000 (R), charred-wood solution and wheat-straw solution) were tested on two representative species (A. fatua and M. neglecta), three formulations were effective in promoting the germination of both species, while the fourth (charred-wood solution) was only active on A. fatua. The active concentrations were different for the four solutions. Three solutions were active in the 2-20% dilution range, while the fourth (Regen 2000 (R)) was only active in the 1-2% dilution range and was inhibitory at higher concentrations. These observations are discussed in the context that smoke may play an important ecological role in the management and control of introduced weeds in native and arable communities.

Stimulation of protein kinase C-dependent and -independent signaling pathways by bistratene A in intestinal epithelial cells

The marine toxin bistratene A (BisA) potently induces cytostasis and differentiation in a variety of systems. Evidence that BisA is a selective activator of protein kinase C (PKC) delta implicates PKC delta signaling in the negative growth-regulatory effects of this agent. The current study further investigates the signaling pathways activated by BisA by comparing its effects with those of the PKC agonist phorbol 12-myristate 13-acetate (PMA) in the IEC-18 intestinal crypt cell line. Both BisA and PMA induced cell cycle arrest in these cells, albeit with different kinetics. While BisA produced sustained cell cycle arrest in G(o)/G(1) and G(2)/M, the effects of PMA were transient and involved mainly a G(o)/G(1), blockade. BisA also produced apoptosis in a proportion of the population, an effect not seen with PMA. Both agents induced membrane translocation/activation of PKC, with BisA translocating only PKC delta and PMA translocating PKC alpha, delta, and epsilon in these cells. Notably, while depletion of PKC alpha, delta, and epsilon abrogated the cell cycle-specific effects of PMA in IEC-18 cells, the absence of these PKC isozymes failed to inhibit BisA-induced G(o)/G(1), and G(2)/M arrest or apoptosis. The cell cycle inhibitory and apoptotic effects of BisA, therefore, appear to be PKC-independent in IEG-18 cells. On the other hand, BisA and PMA both promoted PKC-dependent activation of Erk 1 and 2 in this system. Thus, intestinal epithelial cells respond to BisA through activation of at least two signaling pathways: a PKC delta -dependent pathway, which leads to activation of mitogen-activated protein kinase and possibly cytostasis in the appropriate context, and a PKC-independent pathway, which induces both cell cycle arrest in G(o)/G(1) and G(2)/M and apoptosis through as yet unknown mechanisms. (C) 2001 Elsevier Science Inc. All rights reserved.

The point-of-referral barrier - a factor in the success of telehealth

A feasibility study was carried out to test the hypothesis that, for an effective telehealth service, a full-time coordinator is required to act as a single point of contact for consultation requests. By shifting the responsibility for telepaediatrics from the referrer to the provider, the telehealth process becomes equally (or more) attractive as the conventional alternative. Preliminary results showed that, within six months, telepaediatric activity increased to an average of 8 h per month. Not only did certain health services become more accessible to children and their families in remote areas of Queensland, but significant savings were also made. At least 12 patient transfers were avoided to and from the tertiary facility, with an estimated minimum saving of $18,000 to the health-care provider.

Equity in regional service provision

Most transportation agencies stipulate that an important planning goal is to provide equitable and just public transport services. However, who is to be served and the type of service that should be provided has been ambiguous. This paper develops a methodology for examining equity in the provision of public transportation services. An approach for identifying areas in need of public transport is developed based upon the use of socio-demographic and economic information. Public transport need is then related to levels of access to service. This approach makes it possible to establish the degree to which public transport services may be considered equitable in relation to need and suitable access. A detailed analysis of the southeast Queensland region of Australia illustrates how this approach may be used to inform public transport decision making.

Genetic organization of Pasteurella multocida cap Loci and development of a multiplex capsular PCR typing system

Current serotyping methods classify Pasteurella multocida into five capsular serogroups (serogroups A, B, D, E, and F) and 16 somatic serotypes (serotypes 1 to 16). In the present study, we have developed a multiplex PCR assay as a rapid alternative to the conventional capsular serotyping system. The serogroup-specific primers used in this assay were designed following identification, sequence determination, and analysis of the capsular biosynthetic loci of each capsular serogroup. The entire capsular biosynthetic loci of P. multocida A:1 (X-73) and B:2 (M1404) have been cloned and sequenced previously (J. Y. Chung, Y. M. Zhang, and B. Adler, FEMS Microbiol. Lett. 166:289-296, 1998; J. D. Boyce, J. Y. Chung, and B. Adler, Vet. Microbiol. 72:121-134, 2000). Nucleotide sequence analysis of the biosynthetic region (region 2) from each of the remaining three serogroups, serogroups D, E, and F, identified serogroup-specific regions and gave an indication of the capsular polysaccharide composition. The multiplex capsular PCR assay was highly specific, and its results, with the exception of those for some serogroup F strains, correlated well with conventional serotyping results. Sequence analysis of the strains that gave conflicting results confirmed the validity of the multiplex PCR and indicated that these strains were in fact capsular serogroup A. The multiplex PCR will clarify the distinction between closely related serogroups A and F and constitutes a rapid assay for the definitive classification of P. multocida capsular types