Localization of type 1 diabetes susceptibility to the MHC class I genes HLA-B and HLA-A

The major histocompatibility complex (MHC) on chromosome 6 is associated with susceptibility to more common diseases than any other region of the human genome, including almost all disorders classified as autoimmune. In type 1 diabetes the major genetic susceptibility determinants have been mapped to the MHC class II genes HLA-DQB1 and HLA-DRB1 (refs 1–3), but these genes cannot completely explain the association between type 1 diabetes and the MHC region4, 5, 6, 7, 8, 9, 10, 11. Owing to the region's extreme gene density, the multiplicity of disease-associated alleles, strong associations between alleles, limited genotyping capability, and inadequate statistical approaches and sample sizes, which, and how many, loci within the MHC determine susceptibility remains unclear. Here, in several large type 1 diabetes data sets, we analyse a combined total of 1,729 polymorphisms, and apply statistical methods—recursive partitioning and regression...

Methodology for developing competency standards for dietitians in Australia

Competency standards document the knowledge, skills, and attitudes required for competent performance. This study develops competency standards for dietitians in order to substantiate an approach to competency standard development. Focus groups explored the current and emerging purpose, role, and function of the profession, which were used to draft competency standards. Consensus was then sought using two rounds of a Delphi survey. Seven focus groups were conducted with 28 participants (15 employers/practitioners, 5 academics, 8 new graduates). Eighty-two of 110 invited experts participated in round one and 67 experts completed round two. Four major functions of dietitians were identified: being a professional, influencing the health of individuals, groups, communities, and populations through evidence-based nutrition practice, and working collaboratively in teams. Overall there was a high level of consensus on the standards: 93% achieved agreement by participants in round one and all revised standards achieved consensus on round 2. The methodology provides a framework for other professions wishing to embark on competency standard review or development.

A systematic review of capnography for sedation

We included six trials with 2524 participants. Capnography reduced hypoxaemic episodes, relative risk (95% CI) 0.71 (0.56-0.91), but the quality of evidence was poor due to high risks of performance bias and detection bias and substantial statistical heterogeneity. The reduction in hypoxaemic episodes was statistically homogeneous in the subgroup of three trials of 1823 adults sedated for colonoscopy, relative risk (95% CI) 0.59 (0.48-0.73), although the risks of performance and detection biases were high. There was no evidence that capnography affected other outcomes, including assisted ventilation, relative risk (95% CI) 0.58 (0.26-1.27), p = 0.17.

Estimating Resource Requirements to Staff a Response to a Medium to Large Outbreak of Foot and Mouth Disease in Australia

A recent report to the Australian Government identified concerns relating to Australia's capacity to respond to a medium to large outbreak of FMD. To assess the resources required, the AusSpread disease simulation model was used to develop a plausible outbreak scenario that included 62 infected premises in five different states at the time of detection, 28 days after the disease entered the first property in Victoria. Movements of infected animals and/or contaminated product/equipment led to smaller outbreaks in NSW, Queensland, South Australia and Tasmania. With unlimited staff resources, the outbreak was eradicated in 63 days with 54 infected premises and a 98% chance of eradication within 3 months. This unconstrained response was estimated to involve 2724 personnel. Unlimited personnel was considered unrealistic, and therefore, the course of the outbreak was modelled using three levels of staffing and the probability of achieving eradication within 3 or 6 months of introduction determined. Under the baseline staffing level, there was only a 16% probability that the outbreak would be eradicated within 3 months, and a 60% probability of eradication in 6 months. Deployment of an additional 60 personnel in the first 3 weeks of the response increased the likelihood of eradication in 3 months to 68%, and 100% in 6 months. Deployment of further personnel incrementally increased the likelihood of timely eradication and decreased the duration and size of the outbreak. Targeted use of vaccination in high-risk areas coupled with the baseline personnel resources increased the probability of eradication in 3 months to 74% and to 100% in 6 months. This required 25 vaccination teams commencing 12 days into the control program increasing to 50 vaccination teams 3 weeks later. Deploying an equal number of additional personnel to surveillance and infected premises operations was equally effective in reducing the outbreak size and duration.

Temperature monitoring of nonanaesthetised patients in a cardiac catheterisation laboratory

Aim and objectives To identify the prevalence that temperature reduced by more than 1°C from pre to post-procedure in a sample of non-anaesthetised patients undergoing procedures in a cardiac catheterisation laboratory. Background Advances in medical technology are minimising the invasiveness of diagnostic tests and treatments for disease, which is correspondingly increasing the number of medical procedures performed without sedation or anaesthesia. Procedural areas in which medical procedures are performed without anaesthesia are typically kept at a cool temperature for staff comfort. As such, there is a need to inform nursing practices in regard to the thermal management of non-anaesthetised patients undergoing procedures in surgical or procedural environments. Design Single-site observational study Methods Patients were included if they had undergone an elective procedure without sedation or anaesthesia in a cardiac catheterisation laboratory. Ambient room temperature was maintained between 18°C and 20°C. Passive warming with heated cotton blankets was applied. Nurses measured body temperature and thermal comfort before and after 342 procedures. Results Mean change in temperature was -0.08°C (Standard deviation 0.43). The reduction in temperature was more than 1°C after 11 procedures (3.2%). One patient whose temperature had reduced more than 1°C after their procedure reported thermal discomfort. A total of 12 patients were observed to be shivering post-procedure (3.6%). No demographic or clinical characteristics were associated with reduction in temperature of more than 1°C from pre to post-procedure. Conclusions Significant reduction in body temperature was rare in our sample of non-anaesthetised patients. Relevance to clinical practice Similar results would likely be found in other procedural contexts during procedures conducted in settings with comparable room temperatures where passive warming can also be applied with limited skin exposure.

Isoperimetric Problem and Meta-fibonacci Sequences

Let G = (V,E) be a simple, finite, undirected graph. For S ⊆ V, let $\delta(S,G) = \{ (u,v) \in E : u \in S \mbox { and } v \in V-S \}$ and $\phi(S,G) = \{ v \in V -S: \exists u \in S$ , such that (u,v) ∈ E} be the edge and vertex boundary of S, respectively. Given an integer i, 1 ≤ i ≤ ∣ V ∣, the edge and vertex isoperimetric value at i is defined as b e (i,G) =  min S ⊆ V; |S| = i |δ(S,G)| and b v (i,G) =  min S ⊆ V; |S| = i |φ(S,G)|, respectively. The edge (vertex) isoperimetric problem is to determine the value of b e (i, G) (b v (i, G)) for each i, 1 ≤ i ≤ |V|. If we have the further restriction that the set S should induce a connected subgraph of G, then the corresponding variation of the isoperimetric problem is known as the connected isoperimetric problem. The connected edge (vertex) isoperimetric values are defined in a corresponding way. It turns out that the connected edge isoperimetric and the connected vertex isoperimetric values are equal at each i, 1 ≤ i ≤ |V|, if G is a tree. Therefore we use the notation b c (i, T) to denote the connected edge (vertex) isoperimetric value of T at i. Hofstadter had introduced the interesting concept of meta-fibonacci sequences in his famous book “Gödel, Escher, Bach. An Eternal Golden Braid”. The sequence he introduced is known as the Hofstadter sequences and most of the problems he raised regarding this sequence is still open. Since then mathematicians studied many other closely related meta-fibonacci sequences such as Tanny sequences, Conway sequences, Conolly sequences etc. Let T 2 be an infinite complete binary tree. In this paper we related the connected isoperimetric problem on T 2 with the Tanny sequences which is defined by the recurrence relation a(i) = a(i − 1 − a(i − 1)) + a(i − 2 − a(i − 2)), a(0) = a(1) = a(2) = 1. In particular, we show that b c (i, T 2) = i + 2 − 2a(i), for each i ≥ 1. We also propose efficient polynomial time algorithms to find vertex isoperimetric values at i of bounded pathwidth and bounded treewidth graphs.

Electrochemical phase formation. Time-dependent nucleation and growth rates

The theory of phase formation is generalised for any arbitrary time dependence of nucleation and growth rates. Some sources of this time dependence are time-dependent potential inputs, ohmic drop and the ingestion effect. Particular cases, such as potentiostatic and, especially, linear potential sweep, are worked out for the two limiting cases of nucleation, namely instantaneous and progressive. The ohmic drop is discussed and a procedure for this correction is indicated. Recent results of Angerstein-Kozlowska, Conway and Klinger are critically investigated. Several earlier results are deduced as special cases. Evans' overlap formula is generalised for the time-dependent case and the equivalence between Avrami's and Evans' equations established.

UK guidance on the initial evaluation of an infant or an adolescent with a suspected disorder of sex development

It is paramount that any child or adolescent with a suspected disorder of sex development (DSD) is assessed by an experienced clinician with adequate knowledge about the range of conditions associated with DSD. If there is any doubt, the case should be discussed with the regional team. In most cases, particularly in the case of the newborn, the paediatric endocrinologist within the regional DSD team acts as the first point of contact. The underlying pathophysiology of DSD and the strengths and weaknesses of the tests that can be performed should be discussed with the parents and affected young person and tests undertaken in a timely fashion. This clinician should be part of a multidisciplinary team experienced in management of DSD and should ensure that the affected person and parents are as fully informed as possible and have access to specialist psychological support. Finally, in the field of rare conditions, it is imperative that the clinician shares the experience with others through national and international clinical and research collaboration. © 2011 Blackwell Publishing Ltd.

Guide to obtaining textbooks in alternative formats

Digital text benefits a wide range of learners, particularly disabled learners. For those with a visual impairment, it can be magnified or read out loud using synthetic speech. It can be navigated by heading and subheading levels, and text colours and backgrounds can be altered, both useful features for dyslexic learners. Definitions of unfamiliar words can be checked without leaving the text.

Local solutions to local problems: A stormwater education collaborative

Currently completing its fifth year, the Coastal Waccamaw Stormwater Education Consortium (CWSEC) helps northeastern South Carolina communities meet National Pollutant Discharge Elimination System (NPDES) Phase II permit requirements for Minimum Control Measure 1 - Public Education and Outreach - and Minimum Control Measure 2 - Public Involvement. Coordinated by Coastal Carolina University, six regional organizations serve as core education providers to eight coastal localities including six towns and cities and two large counties. CWSEC recently finished a needs assessment to begin the process of strategizing for the second NPDES Phase II 5-year permit cycle in order to continue to develop and implement effective, results-oriented stormwater education and outreach programs to meet federal requirements and satisfy local environmental and economic needs. From its conception in May 2004, CWSEC set out to fulfill new federal Clean Water Act requirements associated with the NPDES Phase II Stormwater Program. Six small municipal separate storm sewer systems (MS4s) located within the Myrtle Beach Urbanized Area endorsed a coordinated approach to regional stormwater education, and participated in a needs assessment resulting in a Regional Stormwater Education Strategy and a Phased Education Work Plan. In 2005, CWSEC was formally established and the CWSEC’s Coordinator was hired. The Coordinator, who is also the Environmental Educator at Coastal Carolina University’s Waccamaw Watershed Academy, organizes six regional agencies who serve as core education providers for eight coastal communities. The six regional agencies working as core education providers to the member MS4s include Clemson Public Service and Carolina Clear Program, Coastal Carolina University’s Waccamaw Watershed Academy, Murrells Inlet 2020, North Inlet-Winyah Bay National Estuarine Research Reserve’s Coastal Training and Public Education Programs, South Carolina Sea Grant Consortium, and Winyah Rivers Foundation’s Waccamaw Riverkeeper®. CWSEC’s organizational structure results in a synergy among the education providers, achieving greater productivity than if each provider worked separately. The member small MS4s include City of Conway, City of North Myrtle Beach, City of Myrtle Beach, Georgetown County, Horry County, Town of Atlantic Beach, Town of Briarcliffe Acres, and Town of Surfside Beach. Each MS4 contributes a modest annual fee toward the salary of the Coordinator and operational costs. (PDF contains 3 pages)

Teaching Change: Information Literacy Collaboration at Texas A&M University at Galveston

While college students use a wide array of technologies to access information, their skills at determining what is relevant, in a university setting and in life, are poor. Many of these skills have to be taught in college courses. Instruction must be performed by a collaborative team using technologies that effectively reach students. This team must be ready to go into the classroom when needed and be able to address the problem whenever the student needs assistance. The results will be better writing and better research skills that will not only benefit the faculty but will lead to lifelong learning.

The Cynthia Woods incident: When the rescuer becomes the rescuee

Survival at sea for Steven Conway and five Texas A&M University at Galveston students after the sinking of the sailboat Cynthia Woods.