Diagnostic accuracy and clinical management by realtime teledermatology. Results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial

Diagnostic accuracy and management recommendations of realtime teledermatology consultations using low-cost telemedicine equipment were evaluated. Patients were seen by a dermatologist over a video-link and a diagnosis and treatment plan were recorded. This was followed by a face-to-face consultation on the same day to confirm the earlier diagnosis and management plan. A total of 351 patients with 427 diagnoses participated. Sixty-seven per cent of the diagnoses made over the video-link agreed with the face-to-face diagnosis. Clinical management plans were recorded for 214 patients with 252 diagnoses. For this cohort, 44% of the patients were seen by the same dermatologist at both consultations, while 56% were seen by a different dermatologist. In 64% of cases the same management plan was recommended at both consultations; a sub-optimum treatment plan was recommended in 8% of cases; and in 9% of cases the video-link management plans were judged to be inappropriate. In 20% of cases the dermatologist was unable to recommend a suitable management plan by video-link. There were significant differences in the ability to recommend an optimum management plan by video-link when a different dermatologist made the reference management plan. The results indicate that a high proportion of dermatological conditions can be successfully managed by realtime teledermatology.

Preliminary results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial:is clinical management by realtime teledermatology possible?

Results from phase 1 of the UK Multicentre Teledermatology Trial demonstrated the diagnostic accuracy of realtime teledermatology using low-cost equipment. Phase 2 of the trial aimed to assess its effectiveness as a management tool for dermatological disease. Teledermatology consultations were organized between two health centres and two hospitals in Northern Ireland using low-cost videoconferencing equipment. For 205 patients seen by a dermatologist over the video-link a diagnosis and management plan were recorded. A subsequent face-to-face consultation was arranged on the same day to confirm the diagnosis and treatment regime. A comparison of these management plans revealed that the same plan was recommended in 64% of cases; the teledermatologist was unable to advocate a suitable management plan in 19% of cases; a suboptimal treatment plan was suggested by the teledermatologist in 6% of cases; and in 11% of cases, the teledermatologist suggested an inappropriate treatment plan. These findings indicate that appropriate clinical management was possible in approximately two-thirds of dermatology consultations via the video-link.

Viability interactions between the left and right arms of the second chromosome of Drosophila melanogaster

Inter and intrachromosomal viability interactions have been detected in a few experimental studies. Computer simulations and analytical models have led to postulation of nonadditivity of gene action. This study reports evidence of strong nonadditive interactions between the arms of the metacentric second chromosome of Drosophila melanogaster. Mean viability for 40 homozygous lines of the second chromosomes was 0.720+0.265 • Mean viability for 40 half homozygous second chromosomes was 0.928!O.)10 • Significant heterogeneity among and within lines was found in both groups of chromosomes, as well as a highly significant viability difference between the two groups. Comparison of observed viabilities with the expected values, according to the theories of additive and multi - plicative gene action. was made for both groups. Highly significant departures from the expected values were found for over 90% of the lines in both groups of chromosomes, for both additive and multiplicative models of gene action.

A GEOGRAPHICAL REPRESENTATION IN Coats of arms of LATIN AMERICA

This article seeks to reflect on geographic representation in the coats of arms of countries in Latin America, showing how the physical, aspects of the landscape, the elements of the economy and the republican symbols were used by local elites to compose an imaginary nation in the nineteenth century. This process of "naturalization of territory" was used as an important feature in the national discourse, because this time, in most cases, the Latin American nations were composed of multi-ethnic states, with strong differences of class and a large illiterate population plus a very tenuous territory from the point of view of national integration. Thus, the elements related to geographic image through the use of coats of arms, conveyed strong messages to citizens, showing how these heraldic symbols can become an important source of research to unravel the process of building the imaginary nation.

Localization of a putative transcriptional regulator (ATRX) at pericentromeric heterochromatin and the short arms of acrocentric chromosomes

ATRX is a member of the SNF2 family of helicase/ATPases that is thought to regulate gene expression via an effect on chromatin structure and/or function. Mutations in the hATRX gene cause severe syndromal mental retardation associated with α-thalassemia. Using indirect immunofluorescence and confocal microscopy we have shown that ATRX protein is associated with pericentromeric heterochromatin during interphase and mitosis. By coimmunofluorescence, ATRX localizes with a mouse homologue of the Drosophila heterochromatic protein HP1 in vivo, consistent with a previous two-hybrid screen identifying this interaction. From the analysis of a trap assay for nuclear proteins, we have shown that the localization of ATRX to heterochromatin is encoded by its N-terminal region, which contains a conserved plant homeodomain-like finger and a coiled-coil domain. In addition to its association with heterochromatin, at metaphase ATRX clearly binds to the short arms of human acrocentric chromosomes, where the arrays of ribosomal DNA are located. The unexpected association of a putative transcriptional regulator with highly repetitive DNA provides a potential explanation for the variability in phenotype of patients with identical mutations in the ATRX gene.

Innate and acquired humoral immunities to influenza virus are mediated by distinct arms of the immune system

“Natural” Igs, mainly IgM, comprise part of the innate immune system present in healthy individuals, including antigen-free mice. These Igs are thought to delay pathogenicity of infecting agents until antigen-induced high affinity Igs of all isotypes are produced. Previous studies suggested that the acquired humoral response arises directly from the innate response, i.e., that B cells expressing natural IgM, upon antigen encounter, differentiate to give rise both to cells that secrete high amounts of IgM and to cells that undergo affinity maturation and isotype switching. However, by using a murine model of influenza virus infection, we demonstrate here that the B cells that produce natural antiviral IgM neither increase their IgM production nor undergo isotype switching to IgG2a in response to the infection. These cells are distinct from the B cells that produce the antiviral response after encounter with the pathogen. Our data therefore demonstrate that the innate and the acquired humoral immunities to influenza virus are separate effector arms of the immune system and that antigen exposure per se is not sufficient to increase natural antibody production.

Flags, badges, and arms of the British dominions beyond the seas.

Pt. I Flags and badges.--Pt. II. Arms.

Tapestry of the fifteenth century : representing the martyrdom of St. Paul the Apostle, with the arms of Guillaume de Hellande, Bishop-Count of Beauvais /

Mode of access: Internet.

Impresa of the Medici Family and Arms of the Medici and Tornabuoni Families

Giovanni di ser Giovanni Guidi; D: 2 ft. 5 39/64 in. (painted surface); tempera, silver, and gold on wood

The history of the kingdom of Ireland; being an account of all the battles, sieges and other considerable transactions, during the late wars there, till the entire reduction of the country, by the victorious arms of our most gracious sovereign, King William. To which is prefixed, a brief relation of the ancient inhabitants and first conquest of that nation, by King Henry II, and particularly of the horrid rebellion and massacres in 1641.

First published, 1685.

Report [to the] Government of Dominion of Canada, Department of Labour ... March 4, 1942 to October 31, 1942.

Cover title: Removal of Japanese from protected areas.

O gabinete de heráldica do exército e as armas da Junta de Freguesia de Verderena

O processo de ordenação de armas para a Junta de Freguesia da Verderena, a participação do Gabinete de Heráldica do Exército e a intervenção da Associação dos Arqueólogos Portugueses.

Manitoba's case, a submission presented to the Royal Commission on Dominion-Provincial Relations by the government of the province of Manitoba.

1. Introduction.--2. The constitutional relations of the dominion and the provinces.--3. The effects of federal monetary policy on western Canadian economy.--4. The effects of Federal Tariff policy on western Canadian economy.--5. The effects of declining income.--6. The financial problems of municipalities and school districts.--7. Analysis of Manitoba's treasury problem.--8. Manitoba's case--Summary and recommendations.--9. An examination of certain proposals for the readjustment of dominion - provincial financial relations.

A poly(D,L-lactide) resin for the preparation of tissue engineering scaffolds by stereolithography

Porous polylactide constructs were prepared by stereolithography, for the first time without the use of reactive diluents. Star-shaped poly(D,L-lactide) oligomers with 2, 3 and 6 arms were synthesised, end-functionalised with methacryloyl chloride and photocrosslinked in the presence of ethyl lactate as a non-reactive diluent. The molecular weights of the arms of the macromers were 0.2, 0.6, 1.1 and 5 kg/mol, allowing variation of the crosslink density of the resulting networks. Networks prepared from macromers of which the molecular weight per arm was 0.6 kg/mol or higher had good mechanical properties, similar to linear high molecular weight poly(D,L-lactide). A resin based on a 2-armed poly(D,L-lactide) macromer with a molecular weight of 0.6 kg/mol per arm (75 wt%), ethyl lactate (19 wt%), photo-initiator (6 wt%), inhibitor and dye was prepared. Using this resin, films and computer-designed porous constructs were accurately fabricated by stereolithography. Pre-osteoblasts showed good adherence to these photocrosslinked networks. The proliferation rate on these materials was comparable to that on high molecular weight poly(D,L-lactide) and tissue culture polystyrene.