The influence of waiting times and sociopolitical variables on public trust in healthcare: A cross-sectional study of the NHS in England.

Objectives: This study aims to assess factors influencing public trust in the National Health Service (NHS) in England, focusing on the impact of waiting times in Accident & Emergency (A&E) departments and for GP-to-specialist cancer referrals. Study design: A cross-sectional survey-based research design was employed, covering the period from July 2022 to July 2023. Methods: Data were collected through YouGov surveys, yielding 7415 responses. Our analysis is based on 6952 of these responses which we were able to aggregate to 42 NHS Integrated Care Boards (ICBs) for A&E waiting times and 106 ICB sub-units for cancer referral times. Multiple regression analysis was conducted, with the dependent variable being trust in the NHS. Results: Waiting times for A&E and cancer referrals did not significantly affect trust in the NHS. However, other sociopolitical factors displayed significant influence. Specifically, being a member of an ethnic minority group, or having voted Conservative in the 2019 general election were associated with lower trust scores. Other variables such as age and local unemployment rate were also significant predictors. Conclusions: Our findings suggest that waiting times for healthcare services have no effect on public trust in the NHS. Instead, trust appears to be largely shaped by sociopolitical factors. Policymakers should therefore look beyond operational efficiency when seeking to bolster trust in the healthcare system.

Localized Delivery of Amifostine Enhances Salivary Gland Radioprotection.

Radiotherapy for head and neck cancers commonly causes damage to salivary gland tissue, resulting in xerostomia (dry mouth) and numerous adverse medical and quality-of-life issues. Amifostine is the only Food and Drug Administration-approved radioprotective drug used clinically to prevent xerostomia. However, systemic administration of amifostine is limited by severe side effects, including rapid decrease in blood pressure (hypotension), nausea, and a narrow therapeutic window. In this study, we demonstrate that retroductal delivery of amifostine and its active metabolite, WR-1065, to murine submandibular glands prior to a single radiation dose of 15 Gy maintained gland function and significantly increased acinar cell survival. Furthermore, in vivo stimulated saliva secretion was maintained in retrograde-treated groups at levels significantly higher than irradiated-only and systemically treated groups. In contrast to intravenous injections, retroductal delivery of WR-1065 or amifostine significantly attenuated hypotension. We conclude that localized delivery to salivary glands markedly improves radioprotection at the cellular level, as well as mitigates the adverse side effects associated with systemic administration. These results support the further development of a localized delivery system that would be compatible with the fractionated dose regimen used clinically.

Inhibition of enteropathogens adhesion to human enterocyte-like HT-29 cells by a dairy strain of Propionibacterium acidipropionici.

Adhesion to the host intestinal mucosa is considered relevant for orally delivered probiotics as it prolongs their persistence in the gut and their health promoting effects. Classical propionibacteria are microorganisms of interest due to their role as dairy starters as well as for their functions as probiotics. Propionibacterium acidipropionici Q4, is a dairy strain isolated from a Swiss-type cheese made in Argentina that displays probiotic potential. In the present work we assessed the ability of this strain to adhere to the human enterocyte-like HT-29 cell line and to counteract the adhesion of two common human enteropathogens, such as Escherichia coli C3 and Salmonella Enteritidis 90/390. The results were compared with those obtained with the well-known probiotic Lactobacillus rhamnosus GG. P. acidipropionici Q4 showed a high adhesion capacity, even higher than the reference strain L. rhamnosus GG (42.3±4.4% and 36.2±2.3%, respectively), whereas adhesion of enteropathogens was significantly lower (25.2±2.2% for E. coli and 21.0±3.4% for S. Enteritidis). Propionibacteria as well as lactobacilli were able to inhibit by exclusion and competition the adherence of E. coli C3 and S. Enteritidis 90/390 whereas only L. rhamnosus GG displaced S. Enteritidis from HT-29 intestinal cells. Inhibition of pathogens by propionibacteria was not exerted by antimicrobials or coaggregation but was mainly due to exclusion by cell surface components, such as proteins and carbohydrates. The relevance of cell surface proteins (CSP) for preventing pathogens infection was confirmed by their concentration dependent effect observed for both pathogens: 100 µg/ml of CSP inhibited E. coli attachment almost as untreated propionibacteria, whereas it partially inhibited the attachment of S. Enteritidis. Results suggest that P. acidipropionici Q4 could be considered for the development of propionibacteria containing functional foods helpful in counteracting enteropathogen infection.

The effect of processing conditions on the stability of fructooligosaccharides in acidic food products.

The effect of processing conditions (temperature and degree of polymerisation, DP) on the stability of short-chain fructooligosaccharides (sc-FOS) was investigated in three reaction media (sodium citrate buffer and orange and tomato juices) in a kinetic study at pH 3.5. In addition, kinetic equations as a function of temperature and pH were developed, using published data. Pentasaccharides were more stable to heat treatment than were trisaccharides under all of the conditions tested. In addition, the sc-FOS were more stable in orange juice, followed by tomato juice and citrate buffer. The results showed that, in addition to temperature and pH, the DP and food matrix, including the type of pasteurisation, must be considered when processing foods enriched with sc-FOS. Furthermore, the continuous thermal processing simulation for each of the equivalent processes at 90 °C revealed that the percent retention of sc-FOS is greater than 95% at temperatures above 95 °C.

Assessment of antiproliferative activity of pectic substances obtained by different extraction methods from rapeseed cake on cancer cell lines.

In this work the antiproliferative activity of pectic substances obtained by different extraction methods from defatted rapeseed cake was assessed on cancer cell lines. The process consisted of sequential treatment with alkalized water (pH∼8), EDTA (0.01 M), alkaline protease (Alkalase 2.4L) and a commercial pectinase preparation (Viscozyme L or Pectinex Ultra SP-L). Pectic extracts identification was performed using spectroscopy and chromatography techniques. FT-IR and HPLC-IR results suggest that the neutral pectic extracts produced would be arabinogalactans and ß-galactans. All the pectic substances extracted (acid and neutral) from RSC exhibited antiproliferative activity, being more effective on MCF-7 cells than Caco-2. The most effective pectic extract was obtained by Alkalase 2.4 L which killed over 80% of MCF-7 cells and 60% of Caco-2 cells. At less than 10 mg/mL pectic extracts enriched in neutral sugars also exhibited antiproliferative activity (50 and 40%, respectively), which was superior to the modified citric pectins activity at the same concentration for the breast cancer cell line (61.6% for MCF-7 and 49.9% for Caco-2 cells). These results show that the antiproliferative activity depends on both the type of pectin (acid or neutral) and the extraction procedure.

Insulin increases ceramide synthesis in skeletal muscle.

AIMS: The purpose of this study was to determine the effect of insulin on ceramide metabolism in skeletal muscle. METHODS: Skeletal muscle cells were treated with insulin with or without palmitate for various time periods. Lipids (ceramides and TAG) were isolated and gene expression of multiple biosynthetic enzymes were quantified. Additionally, adult male mice received daily insulin injections for 14 days, followed by muscle ceramide analysis. RESULTS: In muscle cells, insulin elicited an increase in ceramides comparable to palmitate alone. This is likely partly due to an insulin-induced increase in expression of multiple enzymes, particularly SPT2, which, when knocked down, prevented the increase in ceramides. In mice, 14 days of insulin injection resulted in increased soleus ceramides, but not TAG. However, insulin injections did significantly increase hepatic TAG compared with vehicle-injected animals. CONCLUSIONS: This study suggests that insulin elicits an anabolic effect on sphingolipid metabolism in skeletal muscle, resulting in increased ceramide accumulation. These findings reveal a potential mechanism of the deleterious consequences of the hyperinsulinemia that accompanies insulin resistance and suggest a possible novel therapeutic target to mitigate its effects.

In vitro and mouse in vivo characterization of the potent free fatty acid 1 receptor agonist TUG-469.

Activation of the G protein-coupled free fatty acid receptor 1 (FFA1; formerly known as GPR40) leads to an enhancement of glucose-stimulated insulin secretion from pancreatic ß-cells. TUG-469 has previously been reported as a potent FFA1 agonist. This study was performed to confirm the higher in vitro potency of TUG-469 compared to the reference FFA1 agonist GW9508 and to prove in vivo activity in a pre-diabetic mouse model. The in vitro pharmacology of TUG-469 was studied using Ca(2+)-, cAMP-, and impedance-based assays at recombinant FFA1 and free fatty acid receptor 4, formerly known as GPR120 (FFA4) expressing 1321N1 cells and the rat insulinoma cell line INS-1. Furthermore, we investigated the systemic effect of TUG-469 on glucose tolerance in pre-diabetic New Zealand obese (NZO) mice performing a glucose tolerance test after intraperitoneal administration of 5 mg/kg TUG-469. In comparison to GW9508, TUG-469 showed a 1.7- to 3.0-times higher potency in vitro at 1321N1 cells recombinantly expressing FFA1. Both compounds increased insulin secretion from rat insulinoma INS-1 cells. TUG-469 is > 200-fold selective for FFA1 over FFA4. Finally, a single dose of 5 mg/kg TUG-469 significantly improved glucose tolerance in pre-diabetic NZO mice. TUG-469 turned out as a promising candidate for further drug development of FFA1 agonists for treatment of type 2 diabetes mellitus.

Enzymatic synthesis of fructooligosaccharides with high 1-kestose concentrations using response surface methodology.

Response surface methodology was used as an optimization tool for the production of short chain fructooligosaccharides (sc-FOS) using the commercial cellulolytic enzyme preparation, Rohapect CM. Three independent variables, temperature, concentrations of sucrose and enzyme were tested in the reaction medium. The responses of the design were, yield (gsc-FOS/100 g initial sucrose), 1-kestose (g/100 g sc-FOS) and volumetric productivity (gsc-FOS/Lh). Significant effects on the three responses included a quadratic effect (temperature), a linear effect (sucrose and enzyme concentrations) and an interaction between temperature and sucrose concentration. The cost-effective conditions to support the process in a high competitive market were 50 °C, 6.6 TU/mL enzyme, 2.103 M sucrose in 50 mM acetate buffer at pH 5.5, and the synthesis for a 5 h reaction time. Under these conditions, a high YP/S (63.8%), QP (91.9 g/Lh) and sGF2 (68.2%) was achieved.

Effects of heptachlor epoxide on components of various signal transduction pathways important in tumor promotion in mouse hepatoma cells. Determination of the most sensitive tumor promoter related effect induced by heptachlor epoxide.

The effects of the organochlorine (OC) liver tumor promoter heptachlor epoxide (HE; 0, 0.1, 1, 10, and 50 microM) on several cellular tumor promoter-sensitive parameters were studied in mouse 1c1c7 hepatoma cells in an effort to identify the most sensitive biomarker for OC promoter exposure and the critical pathway and target of OC promoters. The levels of Ca2+ in the endoplasmic reticulum (ER) store, connexin43 (Cx43), PLCgamma(1), nPKCvarepsilon, and AP-1 DNA binding in nucleus were studied to screen for effects induced by submicromolar HE levels. While all the parameters tested elicited effects, particulate PLCgamma(1) and AP-1 DNA binding were found to be the most sensitive parameters affected by HE on both dose and temporal bases. Their levels were increased with 10- to 100-fold lower HE concentrations than were required to affect nPKCvarepsilon or Cx43. Further, with the lower HE dosages, particulate PLCgamma(1) and nuclear AP-1 were positively modulated by HE after 1 h versus 3 or 72 h for nPKCvarepsilon and Cx43. Ca2+ store depletion was probably the third most sensitive parameter, after AP-1 and PLCgamma(1). These results suggest the tyrosine kinase growth factor receptor pathway is the probable critical pathway for HE-induce tumor promotion with the critical target most likely being upstream of PLCgamma(1) and AP-1. This work also demonstates that upon exposure to a tumor promoter such as HE, many hepatocellular effects or changes result, suggesting that a cellular-program shift occurs similar to that described by the resistant hepatocyte model after exposure to a carcinogen or enzyme inducer.

Down-regulation of particulate protein kinase Cepsilon and up-regulation of nuclear activator protein-1 DNA binding in liver following in vivo exposure of B6C3F1 male mice to heptachlor epoxide.

The effects of in vivo administration of the cyclodiene tumor promoter heptachlor epoxide on mouse liver protein kinase C were studied in male B6C3F1 mice by protein kinase C activity assays and Western blotting under conditions known to increase the incidence of hepatocellular carcinoma because protein kinase C is thought to be critical in phorbol ester-induced tumor promotion. Under these test conditions, 20 ppm dietary heptachlor epoxide for 1-20 days increased cytosolic and decreased particulate total protein kinase C activities, while 10 ppm had no effect. Further, total cytosolic and particulate protein kinase C activities were decreased within 1 hour by 10 mg/kg intraperitoneal (i.p.) heptachlor epoxide. Western blotting showed that conventional protein kinase Calpha and beta isoforms were unaffected by heptachlor epoxide. Particulate novel protein kinase Cepsilon, however, was selectively down-regulated by 1, 10, and 20 ppm dietary heptachlor epoxide, whereas the cytosolic isoform was decreased by 1 and 10 ppm heptachlor epoxide for 10 days. The high-dose treatment for 24 hours also decreased particulate novel protein kinase Cepsilon but increased the cytosolic titer. These results demonstrate that this isoform is unique in its sensitivity to heptachlor epoxide. Activator protein-1 DNA binding, a critical factor in tumor promotion, was substantially increased at 3 and 6 hours with 3.7 mg/kg (i.p.) heptachlor epoxide and at 3 and 10 days with 20 ppm dietary heptachlor epoxide. The effects of heptachlor epoxide on protein kinase C and activator protein-1 are similar to those caused by phorbol ester treatments and correlate well to heptachlor levels found to induce tumors in mice. However, heptachlor epoxide did not initially activate protein kinase C with in vivo treatments or with in vitro treatments of a plasma membrane fraction aimed at demonstrating direct activation, as has been shown for phorbol esters. The ability of heptachlor epoxide to down-regulate particulate novel protein kinase Cepsilon correlates to dosages used in in vivo tumor promotion studies. However, this may represent a negative feedback response rather than a causative effect.

Prednisolone treatment of respiratory syncytial virus infection: a randomized controlled trial of 147 infants.

OBJECTIVE: To evaluate the effect of systemic prednisolone as an adjunct to conventional treatment with beta2-agonist, respiratory support, and fluid replacement in hospitalized infants <24 months of age with respiratory syncytial virus (RSV) infection. METHODS: The study was randomized, double-blind, and placebo-controlled. During the winter of 1995-1996, 147 infants <2 years of age, hospitalized with RSV infection, were allocated to treatment with either systemic prednisolone mixture 2 mg/kg daily or placebo for 5 days. MAIN OUTCOME MEASURES: The acute effect variables were duration of stay in hospital, use of medicine, and supportive measures while in hospital. At follow-up 1 month after discharge, the acute effect variables were duration of illness, start in day care center, morbidity, and use of medicine. At follow-up 1 year after discharge, the acute effect variables were morbidity, use of medicine, and skin prick tests with allergens. RESULTS: Prednisolone treatment had no effect on any of the outcome measures. CONCLUSIONS: Our randomized prospective study in infants hospitalized with acute RSV infection showed no effect of systemic prednisolone treatment either in the acute state of RSV infection, nor in the follow-up 1 month and 1 year after admission to hospital. We find our results in agreement with the largest studies reported earlier; therefore, corticosteroid, whether by the systemic route or by inhalation, should not be prescribed to infants with RSV infection.

Oxime reactivation of RBC acetylcholinesterases for biomonitoring.

A low-variability method to reactivate blood cholinesterases (ChEs) after prior exposure of mammals, including humans, to ChE-inhibiting organophosphate esters (OPs) is presented. A concentration of 10 mM pyridine 2-aldoxime methochloride (2-PAM Cl) was incubated with intact red blood cells (RBCs) and assayed virtually free of interfering oxime and hemoglobin (Hb). Variability was decreased by reducing the number of washing steps and sedimenting RBC ghosts through a 7% sucrose cushion. Statistically significant detections of reactivations as low as 5% with average "false positives" of 3.8% were achieved. Relative rates and extent of reactivation after OP treatment of rabbit RBC AChE in vitro were of the order dimethyl- (DDVP) > diethyl- (ethyl paraoxon) >, diisopropyl-substituted (diisopropyl fluorophosphate; DFP) OPs. Rabbit RBC AChE was reactivatable for up to 60 h following dermal exposure to ethyl parathion and reactivatable for only 12 to 24 h following exposure to methyl parathion. Reactivation of plasma ChEs with 0.1 mM 2-PAM Cl in the same animals was achievable for only 12 to 24 h after ethyl parathion and for only 1 to 4 h after methyl parathion.

Bloodborne pathogens and procedure safety in interventional radiology.

Concern about possible transmission of bloodborne pathogens during medical procedures is growing among patients and healthcare workers alike. This fear has primarily been focused on nosocomial transmission of human immunodeficiency virus (HIV), but other bloodborne infectious agents may also be transmitted during procedures. Chief among these are the hepatitis viruses, particularly hepatitis B virus (HBV) and hepatitis C virus (HCV), both of which are significantly more widespread than HIV. Although radiology is not traditionally thought of as a field with significant risk for exposure to or transmission of pathogens, the expanding role of interventional procedures in recent years belies that perception. The potential for exposure to blood or other possibly infectious material exists in virtually any invasive radiological procedure, from arteriography to image-guided biopsy. Fortunately, the risk of such exposure is low, and the risk of actual transmission of a bloodborne pathogen, whether from patient to healthcare worker or vice versa, is even lower. Nevertheless, it is important for all radiologists who perform invasive procedures to be aware of these risks and to observe pertinent safety and infection control recommendations. This article will review these topics.

Chronic intestinal ischemia caused by intravenous cocaine use: report of two cases and review of the literature.

Chronic mesenteric ischemia caused by thrombosis of large visceral arteries due to cocaine abuse are reported in two young women. Both cases were managed successfully with visceral revascularization.

HIV transmission during invasive radiologic procedures: estimate based on computer modeling.

OBJECTIVE: The primary purpose of this study was to estimate the risk of HIV transmission from physicians to patients during invasive radiologic procedures and to compare this estimate with those previously derived for surgical procedures so that policy on possible practice restrictions can be decided. The risk of HIV transmission from patient to physician, including cumulative career risk for interventional radiologists, was also estimated. MATERIALS AND METHODS: The risk of HIV transmission from physician to patient and vice versa was estimated with computer modeling techniques, using available data on prevalence of HIV infection, rates of injury during invasive radiologic procedures, and risk of viral transmission after an exposure. Cumulative career risk of occupational infection was estimated with a computer simulation model. RESULTS: If the physician's HIV status is unknown, the risk of transmission of HIV to a patient during a procedure is estimated to be 0.03 per million procedures (95% confidence interval, 0-3.8 per million procedures). If the physician is known to be HIV-positive, the risk of transmission to a patient is estimated to be 7.5 per million procedures (95% confidence interval, 0-15.3 per million procedures). The estimated risk of transmission from patient to physician ranges from 0.03 to 7.5 per million for a single procedure, and the cumulative risk of occupational HIV infection over 30 years is estimated to be 0.009-16%. CONCLUSION: The estimated risk of HIV transmission from physician to patient during invasive radiologic procedures is so low that global practice restrictions on HIV-infected interventional radiologists are not warranted. As recommended by the American Medical Association and the Centers for Disease Control, decisions on possible practice restrictions should be made on a case-by-case basis rather than a priori. The risk of HIV transmission from patient to physician is also low, but real. The cumulative career risk of occupational infection with HIV may vary widely based on individual circumstances and the patient population served.

Age-related differences in the distribution of peripheral atherosclerosis: when is atherosclerosis truly premature?

BACKGROUND: The natural history of peripheral atherosclerosis in young adults appears to be unfavorable compared with that in older patients. No universally accepted definition of "premature" atherosclerosis exists, however, making comparison of clinical studies difficult. This study examined age-related differences in distribution of atherosclerotic lesions and determined an age threshold at which such differences became apparent. Such a threshold may provide a definition of premature atherosclerosis. METHODS: Arteriograms of all patients 49 years of age and younger undergoing evaluation of lower extremity ischemia during the past 5 years were reviewed and the findings were tabulated. Medical records were reviewed to obtain demographic data, assess risk factors, and confirm disease etiology. Exclusion criteria included normal arteriograms (three patients), history of acute or remote trauma (six patients), unclear cause of ischemic symptoms (three patients), arteritis (four patients), aneurysmal disease (one patient), and acute ischemia without prior chronic symptoms (12 patients). For comparison we also reviewed arteriograms performed during the same period in 140 patients older than 50 years of age who had chronic lower extremity ischemia caused by atherosclerosis. RESULTS: The mean age of the 59 study patients was 43.4 +/- 5.8 years (median age, 46 years; range, 25 to 49 years). Arteriograms were available in all cases; medical records were available in 54 (92%). Atherosclerosis involved only the aortoiliac segment in 25 patients (42%), the femoropopliteal-tibial arteries alone in 21 (36%), and both levels in 13 (22%). Patients with distal atherosclerosis had a higher prevalence of diabetes than those with proximal atherosclerosis (p = 0.004). Ninety-two (66%) of the 140 patients older than 50 years of age had atherosclerosis confined to a single arterial segment, which was not significantly different from the prevalence of single-level disease in the study group. However, 25 (54%) of the 46 study patients with single-level atherosclerosis had aortoiliac disease compared with only 15 (16%) of 92 patients older than 50 years of age with single-level disease (p < 0.001). CONCLUSIONS: In contrast to the pattern of disease in older adults, atherosclerosis in young, nondiabetic patients most commonly involves the aortoiliac segment. Differences in lesion distribution become increasingly apparent with age but are most striking between those 49 years of age and younger and those 50 years of age and older. Accordingly, we propose that premature peripheral atherosclerosis be defined as beginning at or before the age of 49 years.

The influence of sex and aortic size on late patency after aortofemoral revascularization in young adults.

PURPOSE: The purpose of this study was to determine whether aortic size influences late patency of aortofemoral reconstructions in men and women with premature atherosclerosis. METHODS: We studied 37 consecutive young women (mean age +/- SEM, 44 +/- .7 years) and 36 young men (mean age 44 +/- .8 years) who underwent elective operations for aortoiliac occlusive disease during the past 15 years. Clinical data from patients with occluded versus patent grafts were studied, and angiographic findings in patients with occluded versus patent grafts and in young adult patients in a control group (n = 50) who had nonatherosclerotic conditions were compared. RESULTS: Twenty (54%) women and 17 (47%) men had limb occlusions within a mean of 31 +/- 6 months. These occlusions resulted in major amputations in 17 (23%) patients. When patients with occluded versus patent grafts were compared no differences were found in age, sex, symptoms, type or number of atherosclerotic risk factors, or operative details. As a whole, patients in the study group had smaller infrarenal aortas than did patients in the control group (p = 0.009). Women with limb occlusions had smaller infrarenal aortas than did women with patent grafts (p = 0.03) or healthy female patients in the control group (p = 0.002). Men with limb occlusions had smaller infrarenal aortas than did men with patent grafts (p = 0.017) or male patients in the control group (p < 0.001). Angiographic outflow scores were not different in men or women with occluded versus patent grafts. Among all variables studied proportional hazards regression analysis indicated that only mean infrarenal aortic diameter was predictive of graft patency. CONCLUSIONS: These data suggest that late graft failure after aortofemoral reconstruction is common in young adults. Patients with premature atherosclerosis have smaller infrarenal aortas compared with young adults in a control group, making them more vulnerable to symptoms from atherosclerotic lesions. Size of the infrarenal aortic segment is a critical determinant of late graft patency regardless of sex.

Reference citations in radiology: accuracy and appropriateness of use in two major journals.

OBJECTIVE: Errors in reference citation and use are common in the medical and scientific literature. The prevalence of such errors in the radiology literature has not been reported. We did a study to assess the accuracy and appropriateness of use of references cited in two general radiology journals. MATERIALS AND METHODS: All references cited in the June 1993 issues of the American Journal of Roentgenology and Radiology were numbered consecutively. Fifty references were chosen at random from each journal, and copies of the original publications were obtained from the medical library at our institution or through interlibrary loan. Each reference was studied for accuracy and appropriateness of its citation in the June 1993 journal article (the "index article"). Errors were classified as major or minor in each category. Data were analyzed with the SAS statistical package. RESULTS: Forty-seven (94%) of 50 references were obtained from AJR, and 48 (96%) of 50 from Radiology. Of the 47 from the AJR, one (2%) had a major error and 21 (45%) had a minor error in accuracy. Of the 48 from Radiology, two (4%) had a major error and 11 (23%) had a minor error in accuracy. These values were significantly different for minor errors (p = .0188), but not for major ones (p = 1.000). When we adjusted for index article type, error rates for the two journals were not significantly different (p = .0612). We found four major errors (9%) and two minor errors (4%) in appropriateness of citation in the AJR references we studied. Three references (6%) from Radiology contained major errors in appropriateness of use; we found no minor errors of that type. These values were not significantly different (p = .232 for minor errors; p = .709 for major errors). One error in accuracy prevented location of the original reference. Errors were not related to the number of references cited in an index article (p = .528 for accuracy; p = .092 for appropriateness). CONCLUSION: The rate of minor errors in accuracy of references is fairly high in the two journals studied and is comparable to rates previously reported for other types of journals. The rate of major errors in accuracy of references is slightly lower than rates for other types of journals. The percentage of cited references that could not be located was also smaller than in previous reports. Errors in citation appropriateness were less common as well. Given the small number of errors that prevented references from being located, significant expenditure of time and money by journal staff members in checking references is probably not justified. However, authors should be encouraged to exercise greater care in checking all of their references for both accuracy and appropriateness of use. Differences in error rates between AJR and Radiology may have resulted in part from the random sampling method, which produced different mixtures of index articles for the two journals.