Applying genomics-related technologies for Africa's health needs.

While the past century has seen significant improvement in life expectancies in the developed world, it has also witnessed diseases like HIV/AIDS, malaria and tuberculosis ravage populations in the developing world. In some Sub-Saharan African countries, life expectancies have plummeted to less than 40 years--nearly half of those in developed countries. Unequal access to the benefits of science and technology, including medical advances, exacerbate this disparity. In order to address the challenge of global health inequities and strengthen the role of science and technology innovation in contributing to real solutions, the Canadian Program on Genomics and Global health (CPGGH), based at the University of Toronto, has identified three guiding questions: Which genomics-related technologies are most likely to improve the health of people in developing countries?; How can developing countries harness these technologies for health development?; and What can industrialized countries do to assist developing countries?

Genetic interaction with vps8-200 allows partial suppression of the vestigial vacuole phenotype caused by a pep5 mutation in Saccharomyces cerevisiae.

pep5 mutants of Saccharomyces cerevisiae accumulate inactive precursors to the vacuolar hydrolases. In addition, they show a vestigial vacuole morphology and a sensitivity to growth on media containing excess divalent cations. This pleiotropic phenotype observed for pep5::TRP1 mutants is partially suppressed by the vps8-200 allele. pep5::TRP1 vps8-200 mutants show near wild-type levels of mature-sized soluble vacuolar hydrolases, growth on zinc-containing medium, and a more "wild-type" vacuolar morphology; however, aminopeptidase I and alkaline phosphatase accumulate as precursors. These data suggest that Pep5p is a bifunctional protein and that the TRP1 insertion does not eliminate function, but results in a shorter peptide that can interact with Vps8-200p, allowing for partial function. vps8 deletion/disruption mutants contain a single enlarged vacuole. This genetic interaction was unexpected, since Pep5p was thought to interact more directly with the vacuole, and Vps8p is thought to play a role in transport between the Golgi complex and the prevacuolar compartment. The data are consistent with Pep5p functioning both at the site of Vps8p function and more closely proximal to the vacuole. They also provide evidence that the three transport pathways to the vacuole either converge or share gene products at late step(s) in the pathway(s).

Emergency medical services legal issues for the emergency physician.

This article discusses the elements of the legal system that impact emergency physicians and their legal responsibilities. It addresses the specific responsibilities of the emergency physician providing on-line direction to EMS units in the field, and the legal principles that control. Special emphasis is placed on compliance with new federal legislation and addressing medical-legal issues presented by field personnel during patient care situations.

COBRA: implications for emergency medicine.

The potential impact of COBRA is staggering and must be confronted. The ultimate scope and effects will take shape quickly. Federal regulations will provide some of the rules, but the most important definitions under the law will develop in court. Because of a lack of understanding hospitals may not have been in compliance with COBRA's strict terms since August 1986 and may only become educated on COBRA through the legal process. Currently, one COBRA lawsuit has been filed in the Chicago court system, and at least one physician group in California has paid a $25,000 fine for COBRA violations. Litigation in the initial phase of COBRA is likely as most hospitals continue to be unaware of the implications of COBRA legislation. EDs, emergency medical services programs, and interhospital transport programs must begin an immediate effort to examine and develop policies to comply with COBRA. Without an effective educational, compliance, and risk management effort, any emergency medical services program or hospital may become a defendant under COBRA legislation. Delays in understanding and implementing the requirements of COBRA may adversely affect the health care system rather than improve it.

COBRA 9121: Federal liability for patient screening and transfer.

Health care is no longer a simple cottage industry of individual providers. Increases in competition and government regulation have transformed the old structure of health care into a fend-for-yourself marketplace dominated by multi-institutional corporations. In order to accomplish this change, health care providers have had to alter their locus of attention from the patient to the bottom line. As a result, it is not surprising to find corporate business practices interspersed among the traditional health care practices. On March 1, 1987, the federal government began an assault on a casualty of this new market oriental philosophy, patient transfers or "dumping". COBRA 9121 is an "anti-dumping" law designed to prevent hospitals from continuing this practice. The vehicle for ensuring that the statute's broad provisions are followed is a set of "sudden death" probations. For example, under COBRA, hospitals found guilty of knowing or negligent violations may be suspended or terminated from receiving all Medicare reimbursement. One way to avoid these "sudden death" probations is to understand the implications of this law.