Practical considerations for the measurement of free light chains in serum

Background: A new immunoassay for free light chain measurements has been reported to be useful for the diagnosis and monitoring of monoclonal light chain diseases and nonsecretory myeloma. We describe experience with and some potential pitfalls of the assay. Methods: The assay was assessed for precision, sample type and stability, recovery, and harmonization of results between two analyzers on which the reagents are used. Free-light-chain concentrations were measured in healthy individuals (to determine biological variation), patients with monoclonal gammopathy of undetermined significance, myeloma patients after autologous stem cell transplants, and patients with renal disease. Results: Analytical imprecision (CV) was 6-11% for kappa and A free-light-chain measurement and 16% for the calculated kappa/lambda ratio. Biological variation was generally insignificant compared with analytical variation. Despite the same reagent source, values were not completely harmonized between assay systems and may produce discordant free-light-chain ratios. In some patients with clinically stable myeloma, or post transplantation, or with monoclonal gammopathy of undetermined significance, free-light-chain concentration and ratio were within the population reference interval despite the presence of monoclonal intact immunoglobulin in serum. In other patients with monoclonal gammopathy of undetermined significance, values were abnormal although there was no clinical evidence of progression to multiple myeloma. Conclusions: The use of free-light-chain measurements alone cannot differentiate some groups of patients with monoclonal gammopathy from healthy individuals. As with the introduction of any new test, it is essential that more scientific data about use of this assay in different subject groups are available so that results can be interpreted with clinical certainty. (C) 2003 American Association for Clinical Chemistry.

Prosecution and radical discourse during the 1790s: The case of the Scottish sedition trials

This essay looks at the sedition trials in Scotland during the 1790s to examine how prosecution was exploited by radicals as a forum for political expression. As the government instituted a concerted campaign against radical activism, an increasing number of reformers faced trial on sedition and treason in this period. The courtroom emerged as an alternative venue for political discourse and this essay will explore some of the ways by which radicals challenged the dominant discursive and performative elements of trial proceedings. (c) 2005 Elsevier Ltd. All rights reserved.

Formal considerations of rule-based messaging for Business Process Integration

In the last decade, with the expansion of organizational scope and the tendency for outsourcing, there has been an increasing need for Business Process Integration (BPI), understood as the sharing of data and applications among business processes. The research efforts and development paths in BPI pursued by many academic groups and system vendors, targeting heterogeneous system integration, continue to face several conceptual and technological challenges. This article begins with a brief review of major approaches and emerging standards to address BPI. Further, we introduce a rule-driven messaging approach to BPI, which is based on the harmonization of messages in order to compose a new, often cross-organizational process. We will then introduce the design of a temporal first order language (Harmonized Messaging Calculus) that provides the formal foundation for general rules governing the business process execution. Definitions of the language terms, formulae, safety, and expressiveness are introduced and considered in detail.

Environmental poisoning: Presentation and management

Environmental poisoning is most commonly associated with chronic longterm exposure to toxins rather than to acute exposure. Such repeated exposure to sublethal doses of compounds and elements presents problems in risk assessment. This is primarily because the data are unavailable to describe relationships between dose and effect at lower levels of exposure to toxins. Bioavailability of toxins also presents a problem because the data on bioavailability are sparse and seldom as high as the default of 100% bioavailability commonly used in risk assessment. Examples are presented of two toxins: arsenic as an elemental anthropogenic and geologic poison and ciguatoxin, a polyether ladder compound, as a toxin produced naturally by dinoflagellates. Bioavailability drives the toxicity of arsenic from contaminated sites, whereas tissue accumulation drives the toxicity of ciguatoxin. Considerable benefit is derived from the harmonization of regulatory processes where there is linkage of health and environmental factors in the derivation of credible risk assessment.

A framework for progressively improving small area population estimates

The paper presents a framework for small area population estimation that enables users to select a method that is fit for the purpose. The adjustments to input data that are needed before use are outlined, with emphasis on developing consistent time series of inputs. We show how geographical harmonization of small areas, which is crucial to comparisons over time, can be achieved. For two study regions, the East of England and Yorkshire and the Humber, the differences in output and consequences of adopting different methods are illustrated. The paper concludes with a discussion of how data, on stream since 1998, might be included in future small area estimates.