Objectives: To determine the accuracy of routine identification of Aboriginal and Torres Strait Islander womenconfining at King George V (KGV) Hospital, located in Sydney, Australia.Design: Interviewer-administered survey.Participants: Consecutive sample of women who delivered live, well infants from May to July 1999.Main Outcome Measure: Comparison of hospital documentation compared with confidential self-disclosureof Aboriginal or Torres Strait Islander status to a female Aboriginal health professional.Results: Of 536 women in our sample, 29 (5%) self-disclosed as being Aboriginal or Torres Strait Islander.Only 10 of these were identified as Aboriginal or Torres Strait Islander in hospital records (p<0.001). While specificity as determined by us was 100%, sensitivity was low (34.5%). Those Aboriginal and Torres Strait Islander women referred by another organisation were significantly more likely than those who self-referred to the hospital to be correctly identified (p=0.011). Only 1% of non-Aboriginal women indicated they would have objected to an explicit question by staff about their Aboriginal or Torres Strait Islander status.Conclusions: Routine identification significantly under-represents Aboriginal or Torres Strait Islander women giving birth at an urban obstetric hospital. We recommend the development and use of a sensitive but also specific series of questions to ensure women always are given the opportunity to disclose their status, especially as few women appear to mind such questions.

Partnership in health care will help overcome cultural barriers

SUMMARYWe have begun to characterize the glycophosphatidylinositol (GPI)-anchored proteins of the Paramecium tetraurelia cell body surface where receptors and binding sites for attractant stimuli are found. We demonstrate here (i) that inositol-specific exogenous phospholipase C (PLC) treatment of the cell body membranes (pellicles) removes proteins with GPI anchors, (ii)that, as in P. primaurelia, there is an endogenous lipase that responds differently to PLC inhibitors compared with its response to an exogenous PLC, (iii) that salt and ethanol treatment of cells removes GPI-anchored proteins from whole, intact cells, (iv) that Triton X-114 phase partitioning shows that many GPI-anchored proteins are cleaved from pellicles by the endogenous lipase and enter the aqueous phase, and (v) that integral membrane proteins are not among those cleaved with PLC or in the salt/ethanol wash.Antisera against the proteins removed by the salt/ethanol washing procedure include antibodies against large surface antigens, which we confirm in this species to be GPI-anchored, and against an array of proteins of smaller molecular mass. These antisera specifically block the chemoresponse to some stimuli, such as folate, which we suggest are signaled through GPI-anchored receptors. Responses to cyclic AMP, which we believe involve an integral membrane protein receptor, and to NH4Cl, which requires no receptor, are not affected by the antisera. Antiserum against a mammalian GPI-anchored folate-binding protein recognizes a single band among the GPI-anchored salt and ethanol wash proteins. The same antiserum specifically blocks the chemoresponse to folate.

Introduction: Polyethylene glycol 3350 and electrolytes (PEG) is a perceived safe and commonly prescribed solution prior to colonoscopy, yet case reports suggest the potential for volume overload. We describe a patient with cardiopulmonary comorbidities who developed pulmonary edema and acute hypoxic respiratory failure (AHRF) due to PEG administration. Case Description/Methods: A 55-year-old man with interstitial lung disease (ILD), mild pulmonary hypertension (pHTN), and coronary artery disease (CAD) with multiple coronary stents was admitted to our tertiary academic hospital with cough and constitutional symptoms. He had a brain natriuretic peptide (BNP) of 50 pg/mL, was found to be in AHRF and intubated due to labored breathing. He received broadspectrum antibiotics and corticosteroids with clinical improvement and within 4 days was extubated. Given his severe ILD, he was evaluated for lung transplant. As part of this evaluation, mandatory colon cancer screening was needed in the form of computed tomography (CT) colonography. He had difficulty consuming Golytely at an appropriate rate. Despite 16 liters (L) of PEG over 3 days, the stools were not clear. He then re-developed hypoxia and tachypnea and BNP rise to 475 pg/mL. Chest X-ray (CXR) showed new bilateral opacities concerning for pulmonary edema. Echocardiography demonstrated an IVC greater than 2.0 cm without respiratory variation consistent with volume overload. His bowel prep was held, and he was given diuretics with improvement in his respiratory status, BNP, and CXR. The patient was re-trialed on 6L PEG by nasogastric tube successfully without cardiopulmonary complications and his CT colonography showed no colonic polyps or malignancy. He eventually underwent successful bilateral orthotopic lung transplant. Discussion: Prior research has shown that consumption of 6-8 L of PEG increases mean plasma volume by 5.88% on average, but up to 29.8% in some patients. In this case, our patient consumed double that amount of PEG, with subsequent increase in plasma volume, resulting in pulmonary edema and AHRF due to limited respiratory reserve from his severe ILD, pHTN, and CAD. Literature review shows less than 10 cases worldwide with similar findings. In high-risk patients such as the one described, providers must consider judicious use of PEG for colonoscopy preparation and be quick to identify PEG-associated pulmonary edema as an etiology for respiratory decompensation.