ABSTRACT: BACKGROUND: Quality improvement collaboratives (QICs) bring together groups of healthcare professionals to work in a structured manner to improve the quality of healthcare delivery within particular domains. We explored which characteristics of the composition, participation, functioning and organization of these collaboratives related to changes in the healthcare for patients with anxiety disorders, dual diagnosis, or schizophrenia. METHODS: We studied three QICs involving 29 quality improvement (QI) teams representing a number of mental healthcare organizations in the Netherlands. The aims of the three QICs were the implementation of multidisciplinary practice guidelines in the domains of anxiety disorders, dual diagnosis, and schizophrenia, respectively. We used eight performance indicators to assess the impact of the QI teams on self-reported patient outcomes and a number of process of care outcomes for 1.346 patients. The QI team members completed a questionnaire on the characteristics of the composition, participation in a national program, functioning and organizational context for their teams. It was expected that an association would be found between these team characteristics and the quality of care for patients with anxiety disorders, dual diagnosis, and schizophrenia. RESULTS: No consistent patterns of association emerged. Theory-based factors did not perform better than practice-based factors. However, QI teams that received support from their management and both active and inspirational team leadership showed better results. Rather surprisingly, a lower average level of education among the team members was associated with better results although less consistently than the management and leadership characteristics. Team views with regard to the QI goals of the team and attitudes towards multidisciplinary practice guidelines did not correlate with team success. CONCLUSIONS: No general conclusions about the impact of the characteristics of QI teams on the quality of healthcare can be drawn, but support of the management and active, inspirational team leadership appear to be important. Not only patient outcomes but also the performance indicators of monitoring and screening/assessment showed improvement in many but not all of the QI teams with such characteristics. More studies are needed to identify factors associated with the impact of multidisciplinary practice guidelines in mental healthcare.

Correct and consistent condom usage remains a pivotal strategy in reaching the target set by the South African government to reduce new HIV infections by 50% in the next 5 years. Studies have found that there has been an increase in condom usage by some categories of the population, but usage has not yet reached the desired levels in order to meet the target. This article reports on the findings of a study on condom usage in eight communities in the North West Province, which was part of a wider HIV and AIDS programme evaluation commissioned by the North West Provincial Department of Health. The main aim was to assess accessibility to condoms, and knowledge, attitudes and practices around condom use by four sampled communities in the North West Province. Eight focus group discussions were held and 50 households were interviewed. The study found positive results regarding accessibility and awareness of condoms. However, this often did not lead to the desired behavioural change of using condoms in risky sexual interactions. The majority of respondents still resisted condom usage, used condoms inconsistently, or were not in a position to negotiate protected sexual intercourse. The main reasons reported for this were: reduced pleasure, perceived and real physical side-effects, myths, lack of information, status, financial reasons, distrust in the efficacy of condoms, family planning, cultural reasons, gender-related reasons and trust. Many of the barriers to consistent condom use cannot be overcome by strategies that target the individual. Interventions need to address underlying developmental factors such as the non-biological factors that increase the susceptibility of women to HIV infection. As this falls outside of the scope of the mandate of the Department of Health, various partnerships with other key role players need to be established and/or strengthened, such as with local government, non-governmental organisations and faith-based organisations.

The New Horizons (NH) spacecraft observed Io's aurora in eclipse on four occasions during spring 2007. NH Alice ultraviolet spectroscopy and concurrent Hubble Space Telescope ultraviolet imaging in eclipse investigate the relative contribution of volcanoes to Io's atmosphere and its interaction with Jupiter's magnetosphere. Auroral brightness and morphology variations after eclipse ingress and egress reveal changes in the relative contribution of sublimation and volcanic sources to the atmosphere. Brightnesses viewed at different geometries are best explained by a dramatic difference between the dayside and nightside atmospheric density. Far-ultraviolet aurora morphology reveals the influence of plumes on Io's electrodynamic interaction with Jupiter's magnetosphere. Comparisons to detailed simulations of Io's aurora indicate that volcanoes supply 1 to 3% of the dayside atmosphere.

Observations of Jupiter's nightside airglow (nightglow) and aurora obtained during the flyby of the New Horizons spacecraft show an unexpected lack of ultraviolet nightglow emissions, in contrast to the case during the Voyager flybys in 1979. The flux and average energy of precipitating electrons generally decrease with increasing local time across the nightside, consistent with a possible source region along the dusk flank of Jupiter's magnetosphere. Visible emissions associated with the interaction of Jupiter and its satellite Io extend to a surprisingly high altitude, indicating localized low-energy electron precipitation. These results indicate that the interaction between Jupiter's upper atmosphere and near-space environment is variable and poorly understood; extensive observations of the day side are no guide to what goes on at night.

Mutations in the BSCL2 gene have recently been identified in families with (SPG17-linked) Silver syndrome-type hereditary spastic paraparesis as well as in families with distal hereditary motor neuropathy (HMN). We describe the first two Dutch families with BSCL2 mutations and corroborate the phenotypic variability of this gene mutation, as features compatible with Silver syndrome, variant Silver syndrome (with predominant foot rather than hand muscle involvement), distal HMN type II, or distal HMN type V were all encountered.

Mutation of the spastin gene is the single most common cause of pure hereditary spastic paraparesis. In patients with an unexplained sporadic upper motor neuron (UMN) syndrome, clinical distinction between primary lateral sclerosis and sporadic hereditary spastic paraparesis may be problematic. To investigate whether spastin mutations are present in patients with primary lateral sclerosis and sporadic hereditary spastic paraparesis, we screened the spastin gene in 99 Dutch patients with an unexplained, apparently sporadic, adult-onset UMN syndrome. We found 6 mutations, of which 4 were novel, in the subgroup of 47 patients with UMN symptoms restricted to the legs (13%). Another novel spastin mutation was found in a patient with a rapidly progressive spinal and bulbar UMN syndrome that progressed to amyotrophic lateral sclerosis. In the patients with arm or bulbar UMN symptoms and slow progression, no spastin mutations were found. Our study shows that spastin mutations are a frequent cause of apparently sporadic spastic paraparesis but not of primary lateral sclerosis. Ann Neurol 2005.

BACKGROUND: Subtelomeric rearrangements contribute to idiopathic mental retardation and human malformations, sometimes as distinct mental retardation syndromes. However, for most subtelomeric defects a characteristic clinical phenotype remains to be elucidated. OBJECTIVE: To screen for submicroscopic subtelomeric aberrations using multiplex ligation dependent probe amplification (MLPA). METHODS: 210 individuals with unexplained mental retardation were studied. A new set of subtelomeric probes, the SALSA P036 human telomere test kit, was used. RESULTS: A subtelomeric aberration was identified in 14 patients (6.7%)(10 deletions and four duplications). Five deletions were de novo; four were inherited from phenotypically normal parents, suggesting that these were polymorphisms. For one deletion, DNA samples of the parents were not available. Two de novo submicroscopic duplications were detected (dup 5qter, dup 12pter), while the other duplications (dup 18qter and dup 22qter) were inherited from phenotypically similarly affected parents. All clinically relevant aberrations (de novo or inherited from similarly affected parents) occurred in patients with a clinical score of >or=3 using an established checklist for subtelomeric rearrangements. Testing of patients with a clinical score of >or=3 increased the diagnostic yield twofold to 12.4%. Abnormalities with clinical relevance occurred in 6.3%, 5.1%, and 1.7% of mildly, moderately, and severely retarded patients, respectively, indicating that testing for subtelomeric aberrations among mildly retarded individuals is necessary. CONCLUSIONS: The value of MLPA is confirmed. Subtelomeric screening can be offered to all mentally retarded patients, although clinical preselection increases the percentage of chromosomal aberrations detected. Duplications may be a more common cause of mental retardation than has been appreciated.

The amino acid sequences of the alpha-crystallin A chains of 28 mammalian species, representing 14 different orders, have been analyzed, mainly on the basis of amino acid compositions of the composing peptides. The alpha A sequences of chicken and a frog have been completely determined by Edman degradation. A method is described to transport eye lenses, to be used for protein sequence studies, at ambient temperature in a solution of guanidine . HCl. The number of cysteine residues in different alpha A chains could be determined by alkaline urea gel electrophoresis after aminoethylation . In some cases the alpha A chains have been isolated from total lens extracts in a single ion-exchange chromatographic step. The average rate of substitutions in the evolution of the alpha A chains is moderately slow, approximately 3 amino acid substitutions per 100 residues in 100 million years, but varies considerably in different lineages. Substitutions involving changes in charge are strongly underrepresented; the alpha A chains tend to keep their net charge constant throughout evolution. Analysis of the types of substitutions suggests a directional trend leading to an increase in functional density of alpha A in the course of evolution.

One of the most disputed issues in avian phylogeny is the origin of the ratites, the large flightless birds of the Southern Hemisphere (reviewed in refs 1-3). It is still not generally agreed whether the ostriches, rheas, emus and cassowaries, and probably kiwis, form a natural, monophyletic group, although much recent evidence supports this view. Also, their phylogenetic relationship with the other avian orders remains unresolved, comparative protein sequence studies might shed new light on this problem. Therefore, we determined the amino acid sequence of the eye lens protein alpha-crystallin A in ostrich, rhea and emu, and in representatives of 13 other avian orders. Comparison of these sequences with known alpha A sequences of mammals, reptiles, frog and dogfish provides strong evidence that the ratites, as a monophyletic assemblage, represent the first offshoot of the avain line.

Large quantities of calf gamma-crystallin can be prepared by a single and rapid salting-out procedure. The final product is indistinguishable from the gamma-crystallin fraction obtained after gel filtration of a 15000 g lens protein supernatant over Sephadex G 200. Further fractionation is achieved by the mild procedure of chromatofocusing yielding six to eight subfractions. The latter have been characterized by polyacrylamide gel electrophoresis (PAGE) in 6 M-urea, SDS-gel electrophoresis, partial digestion with Staphylococcus aureus protease and amino acid analysis.