Consent to treatment by minors attending accident and emergency departments: guidelines

The absolute right to refuse medical treatment, even if the reasons are irrational, is confined to competent adults. Children under 16 years can give legal consent to treatment in the absence of consent from those with parental responsibility. Children under 18 years do not, however, have an absolute right to consent, or refuse to consent, to treatment. The views of children assume increasing importance with age and maturity. Accident and emergency medical and nursing staff may face difficult decisions when children, or those with parental responsibility, refuse to consent to medical treatment. This paper presents guidelines designed to guide the decision making process in immediately or potentially life threatening conditions and in non-life-threatening conditions.     

Speeding up protein folding: mutations that increase the rate at which Rop folds and unfolds by over four orders of magnitude

The proteasome is a multi-subunit protease responsible for the production of peptides presented by major histocompatibility complex class I molecules. Accumulated evidence indicates that, upon stimulation with interferon-gamma (IFN-gamma), three beta-type subunits, designated LMP2, LMP7, and PSMB10, are incorporated into the 20S proteasome by displacing the housekeeping beta-type subunits designated PSMB6, PSMB5, and PSMB7, respectively. These changes in the subunit composition appear to facilitate class I-mediated antigen presentation, presumably by altering the cleavage specificities of the proteasome. In the present study, we determined the organization of the mouse gene Psmb5, coding for the PSMB5 subunit. Psmb5 is made up of three exons, spanning approximately 5 kilobases. Its exon-intron organization differs radically from those of the other IFN-gamma-regulated, beta-type subunit genes including Lmp7 with which Psmb5 is believed to share an immediate common ancestor. The structure of the mouse Psmb5 gene is identical to that of its recently characterized human counterpart. Thus, the unique organization of the gene coding for the PSMB5 subunit appears to have been established before mammalian radiation. As well as the Psmb5 gene, the mouse genome contains a processed pseudogene designated Psmb5-ps. Interspecific backcross mapping showed that Psmb5 maps close to the Gtrgal2 locus on chromosome 14 and that Psmb5-ps is located in the vicinity of the Psme3 locus on chromosome 11. These results were confirmed by fluorescent in situ hybridization analysis that localized Psmb5 to band C2 to proximal D1 of chromosome 14 and Psmb5-ps to band D of chromosome 11.     

List-mode likelihood: EM algorithm and image quality estimationdemonstrated on 2-D PET

Using a theory of list-mode maximum-likelihood (ML) source reconstruction presented recently by Barrett et al. (1997), this paper formulates a corresponding expectation-maximization (EM) algorithm, as well as a method for estimating noise properties at the ML estimate. List-mode ML is of interest in cases where the dimensionality of the measurement space impedes a binning of the measurement data. It can be advantageous in cases where a better forward model can be obtained by including more measurement coordinates provided by a given detector. Different figures of merit for the detector performance can be computed from the Fisher information matrix (FIM). This paper uses the observed FIM, which requires a single data set, thus, avoiding costly ensemble statistics. The proposed techniques are demonstrated for an idealized two-dimensional (2-D) positron emission tomography (PET) [2-D PET] detector. The authors compute from simulation data the improved image quality obtained by including the time of flight of the coincident quanta     

Detection of a small left atrial myxoma: value and limitations of four imaging modalities

Coronary angiography in a 52-year-old woman with angina-type chest pain showed tumor circulation with feeding arteries arising from the circumflex artery. Transthoracic echocardiography and magnetic resonance imaging both failed to show any intracardiac masses. A sessile mass measuring 1.5 cm in diameter attached to the atrial septum was readily detected by transesophageal echocardiography. Histologic analysis confirmed the tumor to be a myxoma. Coronary angiography may provide the first clue to the presence of a small myxoma. Transesophageal echocardiography is the imaging modality of choice for further evaluation.     

Focal segmental glomerulosclerosis in primates infected with a simian immunodeficiency virus

Focal and segmental glomerulosclerosis (FSG) with endothelial tubuloreticular inclusions (TRIs) is the typical lesion of human HIV-associated glomerulopathy. Autopsy studies showed the presence of FSG in 3 of 15 macaques dying 15-120 weeks after experimental infection with a simian immunodeficiency virus (SIVMne). Ultrastructural studies generally revealed numerous endothelial TRIs (also present in normals), mesangial expansion, and evidence of mesangial cell injury. One additional animal had a small-vessel polyarteritis with a proliferative and focally crescentic glomerulonephritis; seven animals had mild, multifocal interstitial nephritis. All animals had documented viremia after infection; 14 of 15 developed antibodies to SIV postinoculation. Additional postmortem findings included severe enterocolitis, encephalitis, and opportunistic infections. In contrast, autopsy studies of macaques infected with a type D simian retrovirus (SAIDS-D/Washington, SRV-2) for similar periods of time (n = 40) showed no evidence of FSG. One SRV-infected animal had a mild proliferative glomerulonephritis. These studies indicate SIV-infected primates may provide a relevant model for study of human HIV-associated nephropathy. They also indicate the variable pathology that can be seen in primate infections of distinct retrovirus types, each of which produces a simian immunodeficiency state that resembles human AIDS.     

Efficient design/simulation algorithms for simultaneous switching noise in leadframe packages

 Two new modeling and simulation approaches for Simultaneous Switching Noise (SSN) are described and compared to “brute force” simulation by SPICE. Both simulation accuracy and simulation run-time are considered. The two new approaches are: 1) the “effective inductance” method, in which an approximate, very efficient method of extracting an SSN L _eff  is utilized; and 2) the “macromodel” method, in which the complex inductance network responsible for SSN is represented by only a few dominant poles in the frequency domain and the time domain response is obtained by an efficient convolution algorithm. Both approaches are shown to be accurate and fast, but only the effective inductance algorithm is robust in numerical convergence. Received: 19 March 1997 / Accepted: 25 March 1997     

Frequency and etiology of calf losses and calf diseases before weaning in cow-calf farms. II. Microbiological and parasitological diagnoses in diarrheic calves]

Diarrhea is the most frequently diagnosed disease in Swiss cow-calf farms. During an longitudinal study conducted in 105 cow-calf farms in Switzerland in 1993-95, blood and fecal samples were collected from diarrheic calves and from calves that died because of diarrhea. Campylobacter spp. were detected in 42%, E. coli (VTEC) in 32%, rotavirus in 33%, coronavirus in 13%, coccidia in 43% and helminths in 8% of the cases. In some samples Yersinia pseudotuberculosis were isolated. The BVD-virus antigen was not detected in any of the calves examined. In most cases concurrent infection with several enteropathogens was diagnosed. Specific causes of diarrhea were therefore difficult to establish. The bacteriological findings of this study have implication for food safety: VTEC, Campylobacter spp. Yersinia spp. and cryptosporidia are considered as potential causes on zoonoses.