A retrospective analysis of mycophenolic acid and cyclosporin concentrations with acute rejection in renal transplant recipients

Objectives: Although monitoring of cyclosporin (CsA) is standard clinical practice postrenal transplantation. mycophenolic acid (MPA) concentrations are not routinely measured. There is evidence that a relationship exists between MPA area under the concentration-time curve (AUC) and rejection. In this study, a retrospective analysis was undertaken of 27 adult renal transplant recipients. Methods: Patients received CsA and MPA therapy and had a four-point MPA AUC investigation. The relationship between MPA AUC performed in the first week after transplantation, as well as median trough cyclosporin concentrations, and clinical outcomes in the first month posttransplant were evaluated. Results: A total of 12 patients experienced biopsy proven rejection (44.4%) and 4 patients had gastrointestinal adverse events (14.8%). A statistically significant relationship was observed between the incidence of biopsy proven rejection and both MPA AUC (p = 0.02) and median trough CsA concentration (p = 0.008). No relationship between trough MPA concentration and rejection was observed (p = 0.21). Only 3 of 11 (27%) patients with an MPA AUC > 30 mg.h/L and a median trough CsA > 175 mug/L experienced acute rejection, compared with a 56% incidence of rejection for the remaining 16 patients. Patients who experienced adverse gastrointestinal events had significantly lower MPA AUC (p = 0.04), but median trough CsA concentrations were not significantly different (p = 0.24). Further, 3 of these 4 patients had rejection episodes. Conclusions: in addition to standard CsA monitoring, we propose further investigation of the use of a 4-point sampling strategy to predict MPA AUC in the first week posttransplant, which may facilitate optimization of mycophenolate mofetil dose at a rime when patients are most vulnerable to acute rejection. (C) 2001 The Canadian Society of Clinical Chemists. All rights reserved.

Microchemistry and microstructures of hydrothermally altered shock-metamorphosed basement gneiss, Woodleigh impact structure, Southern Carnarvon Basin, Western Australia

Hydrothermally altered shock-metamorphosed gneisses consisting of relic igneous biotite-K-feldspor-Na-rich alkali feldspar - plagioclase - quartz assemblages ( accessory garnet, corundum, titanite, monazite, zircon), and showing extensive replacement by montmorillonite, illite, sericite, and to a lesser extent chlorite, calcite, epidote, zoisite and pyrite, occur in the basement core uplift of the Woodleigh impact structure, Western Australia. The rocks display extensive hydrothermal clay alteration, complicating identification of pre-hydrothermal and pre-impact textures and compositions. Analysis of quartz-hosted planar deformation features (PDFs) indicates a majority of indexed sets parallel to omega{10 (1) over bar3}, a lesser abundance of sets parallel to pi{10 (1) over bar2}, and some sets parallel to the basal plane (0001) and r,z {10 (1) over bar1}, consistent with pressures about or over 20 GPa. Feldspar-hosted FDFs form reticulate vein networks displaying checkerboard-like to irregular and serrated patterns attributable to preferential replacement of shock-damaged PDFs and/or perthitic twin lamella by clay minerals. The gneisses are pervaded by clay-dominated intergranular and intragranular veins of cryptocrystalline material that display marked departures from bulk-rock chemistry and from mineral compositions. XRD analysis identifies the cryptocrystalline components as illite - montmorillonite, illite and chlorite, while laser Raman analysis identifies high-fluorescence sub-micrometre clay assemblage, feldspar, quartz and minor mica. SEM/EDS-probe and laser-ICPMS analysis indicate low-K high-Mg clay mineral compositions consistent with montmorillonite. Quartz PDF-hosted cryptocrystalline laminae display distinct enrichments in Al, Mg, Ca and K. Altered intergranular veins and feldspar-hosted cryptocrystalline components show consistent enrichment in the relatively refractory elements (Al, Cc, Mg, Fe) and depletion in relatively volatile elements (Si, K, Na). The clay alteration retards determination whether clay-dominated vein networks represent altered shock-induced pseudotachylite veins, diaplectic zones and/or shock-damaged twin lamella, and/or result from purely mineralogical and chemical differentiation affected by hydrothermal fluids, Overall enrichment of the shocked gneiss and of the cryptocrystalline components in Mg and trace ferromagnesian elements (Ni, Cc, Cr) may be attributed alternatively to introduction of siderophile element-rich fluid from the projectile, or/and contamination of hydrothermal fluids by MgO from dolomites surrounding the basement uplift. High Ni/Co and Ni/Cr and anomalous DGE (platinum group elements) may support the former model.

Dynamic breast MRI: Image registration and its impact on enhancement curve estimation

A novel algorithm for performing registration of dynamic contrast-enhanced (DCE) MRI data of the breast is presented. It is based on an algorithm known as iterated dynamic programming originally devised to solve the stereo matching problem. Using artificially distorted DCE-MRI breast images it is shown that the proposed algorithm is able to correct for movement and distortions over a larger range than is likely to occur during routine clinical examination. In addition, using a clinical DCE-MRI data set with an expertly labeled suspicious region, it is shown that the proposed algorithm significantly reduces the variability of the enhancement curves at the pixel level yielding more pronounced uptake and washout phases.

Bioeconomic analysis of aquaculture's impact on wild stocks and biodiversity

Anderson theorizes that development of the aquaculture of a species of fish (also captured in an open-access fishery) favours the conservation of its wild stocks, if competitive market conditions prevail. However, this theory is shown to be subject to significant limitations. While this is less so within his model, it is particularly so in an extended one outlined here. The extended model allows for the possibility that aquaculture development can impact negatively on wild stocks thereby shifting the supply curve of the capture fishery, or raise the demand for the fish species subject both to aquaculture and capture. Such development can threaten wild stocks and their biodiversity. While aquaculture development could in principle have no impact on the biodiversity of wild stocks or even raise aquatic biodiversity overall, its impact in the long-term probably will be one of reducing aquatic diversity both in the wild and overall.

Regulation and properties of KCNQ1 (K(v)LQT1) and impact of the cystic fibrosis transmembrane conductance regulator

The K+ channel KCNQ1 (K(V)LQT1) is a voltage-gated K+ channel, coexpressed with regulatory subunits such as KCNE1 (IsK, mink) or KCNE3, depending on the tissue examined. Here, we investigate regulation and properties of human and rat KCNQ1 and the impact of regulators such as KCNE1 and KCNE3. Because the cystic fibrosis transmembrane conductance regulator (CFTR) has also been suggested to regulate KCNQ1 channels we studied the effects of CFTR on KCNQ1 in Xenopus oocytes, Expression of both human and rat KCNQ1 induced time dependent K+ currents that were sensitive to Ba2+ and 293B. Coexpression with KCNE1 delayed voltage activation, while coexpression with KCNE3 accelerated current activation. KCNQ1 currents were activated by an increase in intracellular cAMP, independent of coexpression with KCNE1 or KCNE3. cAMP dependent activation was abolished in N-terminal truncated hKCNQ1 but was still detectable after deletion of a single PKA phosphorylation motif. In the presence but not in the absence of KCNE1 or KCNE3, K+ currents were activated by the Ca2+ ionophore ionomycin. Coexpression of CFTR with either human or rat KCNQ1 had no impact on regulation of KCNQ1 K+ currents by cAMP but slightly shifted the concentration response curve for 293B. Thus, KCNQ1 expressed in Xenopus oocytes is regulated by cAMP and Ca2+ but is not affected by CFTR.

Should we debrief and counsel people who have had psychological shock?

Design: Randomised controlled trial of psychological debriefing. Setting: A British teaching hospital (the Radcliffe Hospital, Oxford). Patients: 66 men and 40 women, aged 17–69 years, admitted to hospital after a motor vehicle accident. Most had been the driver of a car. Median admission duration was four days for the 52 control patients and eight days for the 54 who underwent the intervention. Interventions: A debriefing of about one hour on Day 2 of admission, encouraging patients to describe the accident and express their emotions, followed by a cognitive appraisal which included describing common reactions to traumatic experiences and suggesting a range of people who might be able to assist in the future, including the patient's general practitioner. 91 patients were assessed at four months and 61 were assessed at three years. Control patients had no debriefing or counselling. Main outcome measures: Impact of Event Scale (IES, which focuses on intrusive thoughts and avoidance of similar situations to the event); Brief Symptom Inventory (BSI, a measure of 53 symptoms); and other questions related to physical pain and functional activities. Main results: At four months there was still considerable psychological morbidity among the patients who were followed up. There was a significant difference (P < 0.05) in changes of IES between the 42 who received the intervention, in whom it increased from 15 (standard deviation [SD], 15) to 16 (SD, 15), and the 49 controls, in whom it fell from 15 (SD, 12) to 13 (SD, 14). Similarly, two subscales of the BSI score changed significantly between the intervention group, among whom it deteriorated from 0.5 (SD, 0.5) to 0.6 (SD, 0.8), and the control s, in whom it hardly changed from 0.4 (SD, 0.3) to 0.4 (SD, 0.4). Among the 61 patients followed for three years, the 30 randomised to receive the intervention were significantly worse, by self-report, both psychologically and physically. Their mean IES score deteriorated from a baseline of 15 (SD, 14) to 16 (SD, 18). In comparison, scores for the 31 control patients improved from 16 (SD, 12) to 13 (SD, 17). The difference in change was significant (P < 0.05). Among all patients with high initial scores, these decreased among the controls but not among those receiving the intervention. Conclusion: Psychological counselling should only be used in the context of trials rather than routine care.

Shoemaker impact structure, Western Australia

The Shoemaker impact structure, on the southern margin of the Palaeoproterozoic Earaheedy Basin, with an outer diameter of similar to30 km, consists of two well-defined concentric ring structures surrounding a granitoid basement uplift. The concentric structures, including a ring syncline and a ring anticline, formed in sedimentary rocks of the Earaheedy Group. In addition, aeromagnetic and geological field observations suggest that Shoemaker is a deeply eroded structure. The central 12 km-diameter uplift consists of fractured Archaean basement granitoids of syenitic composition (Teague Granite). Shock-metamorphic features include shatter cones in sedimentary rocks and planar deformation features in quartz crystals of the Teague Granite. Universal-stage analysis of 51 sets of planar deformation features in 18 quartz grains indicate dominance of sets parallel to omega (10 (1) over bar3}, but absence of sets parallel to pi (10 (1) over bar2}, implying peak shock pressures in the range of 10-20 GPa for the analysed sample. Geophysical characteristics of the structure include a -100 mus(-2) gravity anomaly coincident with the central uplift and positive circular trends in both magnetic and gravity correlating with the inner ring syncline and outer ring anticline. The Teague Granite is dominated by albite-quartz-K-feldspar with subordinate amounts of alkali pyroxene. The alkali-rich syenitic composition suggests it could either represent a member of the Late Archaean plutonic suite or the product of alkali metasomatism related to impact-generated hydrothermal activity. In places, the Teague Granite exhibits partial to pervasive silicification and contains hydrothermal minerals, including amphibole, garnet, sericite and prehnite. Recent isotopic age studies of the Teague Granite suggest an older age limit of ca 1300 Ma (Ar-Ar on K-feldspar) and a younger age limit of ca 568 Ma (K-Ar on illite-smectite). The significance of the K-Ar age of 568 Ma is not clear, and it might represent either hydrothermal activity triggered by impact-related energy or a possible resetting by tectonothermal events in the region.

The impact of changes to heroin supply on blood-borne virus notifications and injecting related harms in New South Wales, Australia

Background: In early 2001 Australia experienced a sudden and unexpected disruption to heroin availability, know as the 'heroin shortage'. This 'shortage has been linked to a decrease in needle and syringe output and therefore possibly a reduction in injecting drug use. We aimed to examine changes, if any, in blood-borne viral infections and presentations for injecting related problems related to injecting drug use following the reduction heroin availability in Australia, in the context of widespread harm reduction measures. Methods: Time series analysis of State level databases on HIV, hepatitis B, hepatitis C notifications and hospital and emergency department data. Examination of changes in HIV, hepatitis B, hepatitis C notifications and hospital and emergency department admissions for injection-related problems following the onset of the heroin shortage; non-parametric curve-fitting of number of hepatitis C notifications among those aged 15 - 19 years. Results: There were no changes observed in hospital visits for injection-related problems. There was no change related to the onset heroin shortage in the number of hepatitis C notifications among persons aged 15 - 19 years, but HCV notifications have subsequently decreased in this group. No change occurred in HIV and hepatitis B notifications. Conclusion: A marked reduction in heroin supply resulted in no increase in injection-related harm at the community level. However, a delayed decrease in HCV notifications among young people may be related. These changes occurred in a setting with widespread, publicly funded harm reduction initiatives.

Segmented polyurethane nanocomposites: Impact of controlled particle size nanofillers on the morphological response to uniaxial deformation

A series of TPU nanocomposites were prepared by incorporating organically modified layered silicates with controlled particle size. To our knowledge, this is the first study into the effects of layered silicate diameter in polymer nanocomposites utilizing the same mineral for each size fraction. The tensile properties of these materials were found to be highly dependent upon the size of the layered silicates. A decrease in disk diameter was associated with a sharp upturn in the stress-strain curve and a pronounced increase in tensile strength. Results from SAXS/SANS experiments showed that the layered silicates did not affect the bulk TPU microphase structure and the morphological response of the host TPU to deformation or promote/hinder strain-induced soft segment crystallization. The improved tensile properties of the nanocomposites containing the smaller nanofillers resulted from the layered silicates aligning in the direction of strain and interacting with the TPU sequences via secondary bonding. This phenomenon contributes predominantly above 400% strain once the microdomain architecture has largely been disassembled. Large tactoids that are unable to align in the strain direction lead to concentrated tensile stresses between the polymer and filler, instead of desirable shear stresses, resulting in void formation and reduced tensile properties. In severe cases, such as that observed for the composite containing the largest silicate, these voids manifest visually as stress whitening.

Woodleigh, Southern Carnarvon Basin, Western Australia: history of discovery, Late Devonian age, and geophysical and morphometric evidence for a 120 km-diameter impact structure

The discovery of the Woodleigh impact structure, first identified by R. P. lasky, bears a number of parallels with that of the Chlcxulub impact structure of K-T boundary age, underpinning complications inherent in the study of buried impact structures by geophysical techniques and drilling. Questions raised in connection with the diameter of the Woodleigh impact structure reflect uncertainties in criteria used to define original crater sizes in eroded and buried impact structures as well as limits on the geological controls at Woodleigh. The truncation of the regional Ajona - Wandagee gravity ridges by the outer aureole of the Woodleigh structure, a superposed arcuate magnetic anomaly along the eastern part of the structure, seismic-reflection data indicating a central > 37 km-diameter dome, correlation of fault patterns between Woodleigh and less-deeply eroded impact structures (Ries crater, Chesapeake Bay), and morphometric estimates all indicate a final diameter of 120 km. At Woodleigh, pre-hydrothermal shock-induced melting and diaplectic transformations are heavily masked by pervasive alteration of the shocked gneisses to montmorillonite-dominated clays, accounting for the high MgO and low K2O of cryptocrystalline components. The possible contamination of sub-crater levels of the Woodlelgh impact structure by meteoritic components, suggested by high Ni, Co, Cr, Ni/ Co and Ni/Cr ratios, requires further siderophile element analyses of vein materials. Although stratigraphic age constraints on the impact event are broad (post-Middle Devonian to pre-Early Jurassic) high-temperature (200-250 degrees C) pervasive hydrothermal activity dated by K-Ar isotopes of illite - smectite indicates an age of 359 +/- 4 Ma. To date neither Late Devonian crater fill, nor impact ejecta fallout units have been identified, although metallic meteoritic ablation spherules of a similar age have been found in the Conning Basin.

Impact of mycophenolate mofetil loading on drug exposure in the early posttransplant period

Achieving adequate therapeutic levels of immunosuppressive medications is important in rejection prevention. This study examined exposure to mycophenolic acid (MPA) in kidney transplant patients within the first 5 days posttransplantation. Methods. This single-center, nonrandomized study of first solitary kidney allograft recipients receiving cyclosporine (n = 116) or tacrolimus (n = 50) included patients who received either 1 g or 1.5 g of mycophenolate mofetil twice daily starting postoperatively. Exposure to MPA was measured at days 3 and 5 posttransplant using published limited sampling time equations. Results. There were no significant differences in exposure in the cyclosporine-treated patients receiving 3-g (n = 22) compared to 2-g (n = 94) daily doses (AUC([0-12]) 33.8 +/- 10.0 mg*h/L versus 30.1 +/- 9.7 mg*h/L, P =.20, respectively). About half the patients in both groups had AUC([0-12]) < 30 mg*h/L on days 3 and 5 posttransplant. On the other hand, there was significantly greater exposure on day 3 in the tacrolimus-treated patients receiving 3 g (n = 21) compared to 2 g (n = 29) daily (AUC([0-12]) 43.1 +/- 9.0 mg*h/L versus 36.8 +/- 11.1 mg*h/L, P =.016, respectively). On day 3 one (4.8%) patient receiving 3 g had an AUC([0-12]) of < 30 mg*h/L; whereas, eight (27.5%) receiving 2 g were below this level (P =.068). The AUC([0-12]) levels were not different on day 5. Conclusions. Loading with higher doses of mycophenolate mofetil results in greater exposure and a trend toward more patients in the therapeutic window within the first week for tacrolimus- but not for cyclosporine-treated patients.

The relative impact of scar and viable tissue in predicting global left ventricular remodeling in medically treated patients

We sought to determine the relative impact of myocardial scar and viability on post-infarct left ventricular (LV) remodeling in medically-treated patients with LV dysfunction. Forty patients with chronic ischemic heart disease (age 64±9, EF 40±11%) underwent rest-redistribution Tl201 SPECT (scar = 50% transmural extent), A global index of scarring for each patient (CMR scar score) was calculated as the sum of transmural extent scores in all segts. LV end diastolic volumes (LVEDV) and LV end systolic volumes (LVESV) were measured by real-time threedimensional echo at baseline and median of 12 months follow-up. There was a significant positive correlation between change in LVEDV with number of scar segts by all three imaging techniques (LVEDV: SPECT scar, r = 0.62, p < 0.001; DbE scar, r = 0.57, p < 0.001; CMR scar, r = 0.52, p < 0.001) but change in LV volumes did not the correlate with number of viable segments. ROC curve analysis showed that remodeling (LVEDV> 15%) was predicted bySPECTscars(AUC= 0.79),DbEscars(AUC= 0.76),CMR scars (AUC= 0.70), and CMR scar score (AUC 0.72). There were no significant differences between any of the ROC curves (Z score

From Midden to Sieve: The Impact of Differential Recovery and Quantification Techniques on Interpretations of Shellfish Remains in Australian Coastal Archaeology

Experimental mechanical sieving methods are applied to samples of shellfish remains from three sites in southeast Queensland, Seven Mile Creek Mound, Sandstone Point and One-Tree, to test the efficacy of various recovery and quantification procedures commonly applied to shellfish assemblages in Australia. There has been considerable debate regarding the most appropriate sieve sizes and quantification methods that should be applied in the recovery of vertebrate faunal remains. Few studies, however, have addressed the impact of recovery and quantification methods on the interpretation of invertebrates, specifically shellfish remains. In this study, five shellfish taxa representing four bivalves (Anadara trapezia, Trichomya hirsutus, Saccostrea glomerata, Donax deltoides) and one gastropod (Pyrazus ebeninus) common in eastern Australian midden assemblages are sieved through 10mm, 6.3mm and 3.15mm mesh. Results are quantified using MNI, NISP and weight. Analyses indicate that different structural properties and pre- and postdepositional factors affect recovery rates. Fragile taxa (T. hirsutus) or those with foliated structure (S. glomerata) tend to be overrepresented by NISP measures in smaller sieve fractions, while more robust taxa (A. trapezia and P. ebeninus) tend to be overrepresented by weight measures. Results demonstrate that for all quantification methods tested a 3mm sieve should be used on all sites to allow for regional comparability and to effectively collect all available information about the shellfish remains.

Research Quality, Publications and Impact in Hydraulic Engineering into the 21st Century. Publish or Perish, Commercial versus Open Access, Internet versus Libraries

One of the main objectives of the first International Junior Researcher and Engineer Workshop on Hydraulic Structures is to provide an opportunity for young researchers and engineers to present their research. But a research project is only completed when it has been published and shared with the community. Referees and peer experts play an important role to control the research quality. While some new electronic tools provide further means to disseminate some research information, the quality and impact of the works remain linked with some thorough expert-review process and the publications in international scientific journals and books. Importantly unethical publishing standards are not acceptable and cheating is despicable.