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Despite proven benefits, less than half of infants and young children globally are breastfed in accordance with the recommendations of WHO. In comparison, commercial milk formula (CMF) sales have increased to about US$55 billion annually, with more infants and young children receiving formula products than ever. This Series paper describes the CMF marketing playbook and its influence on families, health professionals, science, and policy processes, drawing on national survey data, company reports, case studies, methodical scoping reviews, and two multicountry research studies. We report how CMF sales are driven by multifaceted, well resourced marketing strategies that portray CMF products, with little or no supporting evidence, as solutions to common infant health and developmental challenges in ways that systematically undermine breastfeeding. Digital platforms substantially extend the reach and influence of marketing while circumventing the International Code of Marketing of Breast-milk Substitutes. Creating an enabling policy environment for breastfeeding that is free from commercial influence requires greater political commitment, financial investment, CMF industry transparency, and sustained advocacy. A framework convention on the commercial marketing of food products for infants and children is needed to end CMF marketing.

Despite increasing evidence about the value and importance of breastfeeding, less than half of the world's infants and young children (aged 0–36 months) are breastfed as recommended. This Series paper examines the social, political, and economic reasons for this problem. First, this paper highlights the power of the commercial milk formula (CMF) industry to commodify the feeding of infants and young children; influence policy at both national and international levels in ways that grow and sustain CMF markets; and externalise the social, environmental, and economic costs of CMF. Second, this paper examines how breastfeeding is undermined by economic policies and systems that ignore the value of care work by women, including breastfeeding, and by the inadequacy of maternity rights protection across the world, especially for poorer women. Third, this paper presents three reasons why health systems often do not provide adequate breastfeeding protection, promotion, and support. These reasons are the gendered and biomedical power systems that deny women-centred and culturally appropriate care; the economic and ideological factors that accept, and even encourage, commercial influence and conflicts of interest; and the fiscal and economic policies that leave governments with insufficient funds to adequately protect, promote, and support breastfeeding. We outline six sets of wide-ranging social, political, and economic reforms required to overcome these deeply embedded commercial and structural barriers to breastfeeding.

In this Series paper, we examine how mother and baby attributes at the individual level interact with breastfeeding determinants at other levels, how these interactions drive breastfeeding outcomes, and what policies and interventions are necessary to achieve optimal breastfeeding. About one in three neonates in low-income and middle-income countries receive prelacteal feeds, and only one in two neonates are put to the breast within the first hour of life. Prelacteal feeds are strongly associated with delayed initiation of breastfeeding. Self-reported insufficient milk continues to be one of the most common reasons for introducing commercial milk formula (CMF) and stopping breastfeeding. Parents and health professionals frequently misinterpret typical, unsettled baby behaviours as signs of milk insufficiency or inadequacy. In our market-driven world and in violation of the WHO International Code for Marketing of Breast-milk Substitutes, the CMF industry exploits concerns of parents about these behaviours with unfounded product claims and advertising messages. A synthesis of reviews between 2016 and 2021 and country-based case studies indicate that breastfeeding practices at a population level can be improved rapidly through multilevel and multicomponent interventions across the socioecological model and settings. Breastfeeding is not the sole responsibility of women and requires collective societal approaches that take gender inequities into consideration.

BackgroundRisk factors for severe COVID-19 include older age, male sex, obesity, black or Asian ethnicity and underlying medical conditions. Whether these factors also influence susceptibility to developing COVID-19 is uncertain.MethodsWe undertook a prospective, population-based cohort study (COVIDENCE UK) from 1 May 2020 to 5 February 2021. Baseline information on potential risk factors was captured by an online questionnaire. Monthly follow-up questionnaires captured incident COVID-19. We used logistic regression models to estimate multivariable-adjusted ORs (aORs) for associations between potential risk factors and odds of COVID-19.ResultsWe recorded 446 incident cases of COVID-19 in 15 227 participants (2.9%). Increased odds of developing COVID-19 were independently associated with Asian/Asian British versus white ethnicity (aOR 2.28, 95% CI 1.33 to 3.91), household overcrowding (aOR per additional 0.5 people/bedroom 1.26, 1.11 to 1.43), any versus no visits to/from other households in previous week (aOR 1.31, 1.06 to 1.62), number of visits to indoor public places (aOR per extra visit per week 1.05, 1.02 to 1.09), frontline occupation excluding health/social care versus no frontline occupation (aOR 1.49, 1.12 to 1.98) and raised body mass index (BMI) (aOR 1.50 (1.19 to 1.89) for BMI 25.0–30.0 kg/m2and 1.39 (1.06 to 1.84) for BMI >30.0 kg/m2versus BMI <25.0 kg/m2). Atopic disease was independently associated with decreased odds (aOR 0.75, 0.59 to 0.97). No independent associations were seen for age, sex, other medical conditions, diet or micronutrient supplement use.ConclusionsAfter rigorous adjustment for factors influencing exposure to SARS-CoV-2, Asian/Asian British ethnicity and raised BMI were associated with increased odds of developing COVID-19, while atopic disease was associated with decreased odds.Trial registration numberClinicalTrials.gov Registry (NCT04330599).

Background While many of the causes of pulsatile tinnitus (PT) are treatable with endovascular approaches, the risks of treatment must be balanced with the risks of the underlying cause and the psychological impact of symptoms on patients. While many physicians have anecdotal experience, the comorbid relationship of depression and anxiety with PT is unknown. The objectives of this study are to quantify the prevalence of depression and anxiety, and, to identify the demographic risk factors for impactful depression and anxiety in patients with PT.Methods Subjects recruited from online PT groups filled out secure online questionnaires that included demographic questions, validated Tinnitus Functional Index (TFI) as well as PHQ-9 and GAD-7 questionnaires to assess the prevalence of concurrent depression and anxiety, respectively.Results Sample included 515 surveys (84% female, 65% unemployed, mean(sd) age = 46.4 years (14.2)). Median symptom duration was 1.9 years. Data showed 46% and 37% of patients with moderate to severe depression and anxiety, respectively. Higher TFI scores were associated with moderate to severe depression (OR 1.07; 95% CI 1.06–1.09, p < 0.001) and anxiety (OR 1.05, 95% CI 1.04–1.06, p < 0.001), with TFI subscores also independently being associated in a univariate analysis.Conclusions The prevalence of moderate to severe depression and anxiety in the PT population, which was previously unknown, is estimated in our study to be 46% and 37%, respectively. Significant association of TFI score with increased depression and anxiety scales adds further evidence of the impact of PT on the psychological health of these patients.

Background: As a measure to slow down the transmission of Coronavirus disease (COVID-19), governments around the world placed their countries under various stringent lockdown measures. Uganda is one of the countries that had a strict lockdown in Africa. This qualitative study explored the social and economic impacts of the COVID-19 lockdown in both an urban (Kampala) and rural (Wakiso) setting in Central Uganda. Methods: The study used focus group discussions (FGDs), household interviews, and key informant interviews (KIIs). 14 FGDs were conducted among several stakeholders including community health workers, health professionals, and members of the community. 40 household interviews were conducted among low, middle, and high-income households, while 31 KIIs were held among policy makers, non-governmental organisations, and the private sector. Data were analysed thematically in NVivo 2020 (QSR International). Results: Findings from the study are presented under six themes: family disruption; abuse of children’s rights; disruption in education; food insecurity; impact on livelihoods; and violation of human rights. The study found that the COVID-19 lockdown led to family breakups, loss of family housing, as well as increased both caring responsibilities and gender-based violence especially towards females. Children’s welfare suffered through increased child labour, sexual exploitation, and early marriages. The extended closure of schools led to delayed educational milestones, poor adaptation to home-based learning, and increased school drop-out rates. Increased food insecurity led to changes in feeding patterns and reduced food varieties. Livelihoods were negatively affected hence people depleted their savings and capital. Unlawful detention and beating by law enforcement officers increased during the lockdown. Conclusion: Future pandemic planning needs to consider the consequences of lockdown on the social and economic wellbeing of communities hence put in place appropriate mitigation measures during and after the outbreak.

Prior research has demonstrated significant increases in student engagement and learning outcomes when faculty and students share course development and implementation practices. This study is an empirical investigation of collaborative course development (CCD) effects on four dependent variables, specifically: student's felt engagement, perceived learning, course satisfaction, and ratings of instructors. It utilized an interdisciplinary course and teaching method comparison conducted over one academic year. The experimental study included six courses that were each taught with one control-group class that employed traditional, instructor-led course designs and one experimental class for a total of twelve control and experimental conditions (in business and non-business courses). Courses were selected for inclusion in the study based on the availability of a course having two sections offered during the academic year for the participating faculty. Each CCD experimental course carefully employed six student-centered CCD techniques, namely: student-faculty collaborative syllabus and assessment building; elective choice assignments; competitive experimentation; flexible lectures; and creative theory building. We hypothesized that an emphasis on faculty–student collaboration facilitated through student empowerment and choice would positively influence the four dependent variables across all subjects. However, the findings revealed an interdisciplinary-contextual effect. The CCD techniques were significantly more effective in business courses compared to non-business courses. These findings enhance our understanding of teacher collaboration with students and student preferences for collaborative education approaches in business (but not in the non-business courses).

Purpose Earlier reperfusion of large-vessel occlusion (LVO) stroke improves functional outcomes. We hypothesize that use of a stroke cart in the angiography suite, containing all commonly used procedural equipment in a mechanical thrombectomy, combined with parallel staff workflows, and use of conscious sedation when possible, improve mechanical thrombectomy time metrics.Methods We identified 47 consecutive LVO patients who underwent mechanical thrombectomy at our center, retrospectively and prospectively from implementation of these three workflow changes (19 pre- and 28 post-). For each patient, last known normal, NIHSS, angiography suite in-room time, type of anesthesia, groin puncture time, on-clot time, recanalization time, LVO location, number of passes, device(s) used, mTICI score, and outcome (mRS) were recorded. Between-group comparisons of time metrics and multivariate regression were performed.Results Stroke cart, parallel workflows, and primary use of conscious sedation decreased in-room time to groin puncture (−21.3 min, p< 0.0001), in-room to on-clot time (−24.1 min, p= 0.001), and in-room to reperfusion time (−29.5 min, p= 0.01). In a multivariate analysis, endotracheal intubation and general anesthesia were found to significantly increase in-room to on-clot time (p= 0.01), in-room to reperfusion time (p= 0.01), and groin puncture to on-clot time (p= 0.05). The number of patients achieving a good outcome (mRS 0−2), however, did not significantly differ between the two groups (9/18 (47%) vs 14/28 (50%), p= 0.60).Conclusions Use of a stroke cart, parallel workflows by neurointerventionalists, technologists, and nursing staff, and use of conscious sedation may be useful to other institutions in efforts to improve procedural times.

ObjectiveTo investigate factors predictive of short hospital admissions and appropriate placement to inpatient versus clinical decision units (CDUs).MethodThis is a retrospective analysis of attendance and discharge data from an inner-city ED in England for December 2013. The primary outcome was admission for less than 48 hours either to an inpatient unit or CDU. Variables included: age, gender, ethnicity, deprivation score, arrival date and time, arrival method, admission outcome and discharge diagnosis. Analysis was performed by cross-tabulation followed by binary logistic regression in three models using the outcome measures above and seeking to identify factors associated with short-stay admission.ResultsThere were 2119 (24%) admissions during the study period and 458 were admitted for less than 24 hours. Those who were admitted in the middle of the week or with ambulatory care sensitive conditions (ACSCs) were significantly more likely to experience short-stays. Older patients and those who arrived by ambulance were significantly more likely to have a longer hospital stay. There was no association of length of inpatient stay with being admitted in the last 10 min of a 4 hours ED stay.ConclusionOnly a few factors were independently predictive of short stays. Patients with ACSCs were more likely to have short stays, regardless of whether they were admitted to CDU or an inpatient ward. This may be a group of patients that could be targeted for dedicated outpatient management pathways or CDU if they need admission.

How to finance progress towards universal health coverage in low-income and middle-income countries is a subject of intense debate. We investigated how alternative tax systems affect the breadth, depth, and height of health system coverage.

GSK812397 is a potent entry inhibitor of X4-tropic strains of HIV-1, as demonstrated in multiple in vitro cellular assays (e.g., in peripheral blood mononuclear cells [PBMCs] and a viral human osteosarcoma [HOS] assay, mean 50% inhibitory concentrations [IC50s] ± standard errors of the means were 4.60 ± 1.23 nM and 1.50 ± 0.21 nM, respectively). The primary in vitro potency of GSK812397 was not significantly altered by the addition of serum proteins (2.55 [±0.12]-fold shift in the presence of human serum albumin and -acid glycoprotein in the PBMC assay). Pharmacological characterization of GSK812397 in cell-based functional assays revealed it to be a noncompetitive antagonist of the CXCR4 receptor, with GSK812397 producing a concentration-dependent decrease in both an SDF-1-mediated chemotaxis and intracellular calcium release (IC50s were 0.34 ± 0.01 nM and 2.41 ± 0.50 nM, respectively). With respect to the antiviral activity of GSK812397, it was effective against a broad range of X4- and X4R5-utilizing clinical isolates. The potency and efficacy of GSK812397 were dependent on the individual isolate, with complete inhibition of infection observed with 24 of 30 isolates. GSK812397 did not show any detectable in vitro cytotoxicity and was highly selective for CXCR4, as determined using a wide range of receptors, enzymes, and transporters. Moreover, GSK812397 demonstrated acceptable pharmacokinetic properties and bioavailability across species. The data demonstrate that GSK812397 has antiviral activity against a broad range of X4-utilizing strains of HIV-1 via a noncompetitive antagonism of the CXCR4 receptor.

Public-sector health workers are vital to the functioning of health systems. We aimed to investigate pay structures for health workers in the public sector in sub-Saharan Africa; the adequacy of incomes for health workers; the management of public-sector pay; and the fiscal and macroeconomic factors that impinge on pay policy for the public sector. Because salary differentials affect staff migration and retention, we also discuss pay in the private sector. We surveyed historical trends in the pay of civil servants in Africa over the past 40 years. We used some empirical data, but found that accurate and complete data were scarce. The available data suggested that pay structures vary across countries, and are often structured in complex ways. Health workers also commonly use other sources of income to supplement their formal pay. The pay and income of health workers varies widely, whether between countries, by comparison with cost of living, or between the public and private sectors. To optimise the distribution and mix of health workers, policy interventions to address their pay and incomes are needed. Fiscal constraints to increased salaries might need to be overcome in many countries, and non-financial incentives improved.

Objective. To improve the clinical management of severely malnourished children in rural hospitals in South Africa.Study design. A pre- and post-intervention descriptive study in three stages: assessment of the clinical management of severely malnourished children, planning and implementing an action plan to improve quality of care, and monitoring and evaluating targeted activities. A participatory approach was used to involve district and hospital nutrition teams in all stages of the research.Setting. Two rural first-referral level hospitals (Mary Theresa and Sipetu) in Mount Frere District, Eastern Cape Province.Main measures. A retrospective record review of all admissions for severe malnutrition to obtain patient characteristics and case fatality rates, a detailed review of randomly selected cases to illustrate general case management, structured observations in the paediatric wards to assess adequacy of resources for care of malnourished children, and in-depth interviews and focus group discussions with nursing and medical staff to identify barriers to improved quality of care.Results. Before the study, case fatality rates were 50% and 28% in Mary Theresa and Sipetu hospitals, respectively. Information from case studies, observations, interviews, and focus group discussions revealed many inadequacies in knowledge, resources, and practices. The hospital nutrition team developed and implemented an action plan to improve the quality of care and developed tools for monitoring its implementation and evaluating its impact. In the 12-month period immediately after implementation, case fatality rates fell by ∼25% in both hospitals.Conclusion. Participatory research led to the formation of a hospital nutrition team, which identified shortcomings in the clinical management of severely malnourished children and took action to improve quality of care. These actions were associated with a reduction in case fatality rates.

Extracellular nucleotides regulate NaCl transport in some epithelia. However, the effects of nucleotide agonists on NaCl transport in the renal inner medullary collecting duct (IMCD) are not known. The objective of this study was to determine whether ATP and related nucleotides regulate NaCl transport across mouse IMCD cell line (mIMCD-K2) epithelial monolayers and, if so, via what purinergic receptor subtypes. ATP and UTP inhibited Na+absorption [measured via Na+short-circuit current(IscNa)] and stimulated Cl−secretion [measured via Cl−short-circuit current (IscCl)]. Using selective P2 agonists, we report that P2X and P2Y purinoceptors regulate IscNaandIscCl. By RT-PCR, two P2X receptor channels (P2X3, P2X4) and two P2Y G protein-coupled receptors (P2Y1, P2Y2) were identified. Functional localization of P2 purinoceptors suggest that IscClis stimulated by apical membrane-resident P2Y purinoceptors and P2X receptor channels, whereasIscNais inhibited by apical membrane-resident P2Y purinoceptors and P2X receptor channels. Together, we conclude that nucleotide agonists inhibitIscNaacross mIMCD-K2 monolayers through interactions with P2X and P2Y purinoceptors expressed on the apical plasma membrane, whereas extracellular nucleotides stimulate IscClthrough interactions with P2X and P2Y purinoceptors expressed on the apical plasma membrane.

The transient and steady-state cardiopulmonary responses to combined rhythmic (R) and isometric (I) exercise were examined in nine subjects. Isometric exercise at 30% maximal voluntary contraction (MVC) was started 1.5 min prior to either a 50% or 75% maximal oxygen uptake ( ) cycle ride and continued for 1.5 min into the 10-min R. Systolic (Pas) and diastolic (Pad) blood pressure, heart rate (fc), inspired ventilation volumes ( ), and oxygen uptake ( ) were recorded every 30 s throughout each experiment. Responses to I effort alone were recorded for comparison with experiments in which the combined exercises were performed during the first 1.5 min when R had not yet begun.Pas responses in the first 1.5 min of I (no R) showed the typical rapid linear increase. Addition of the R effort further increasedPas to levels which remained nearly constant (steady state) throughout R. R alone produced a slowerPas increase to approximately the same steady-state levels as those of the combined R and I exercise. ForPad, the linear increase which occurred during the first 1.5 min of I was attenuated with the superimposition of R. Following cessation of I,Pad fell rapidly during continued R to levels not different from experiments with R alone. Thefc during I alone increased slightly. As I continued, the onset of the R induced a further rapid increase infc to levels not different from R alone. The showed a similar response to ϕc. during I alone did not change significantly. These results suggest that a 30% MVC started 1.5 min prior to and ending 1.5 min into a R effort may enable steady-statePas andfc for a 50% effort to be reached more rapidly than in response to R alone.

A rhythmic (R) and an isometric (I) exercise were performed separately and in combination to assess their additive effects on arterial systolic (Pas) and diastolic (Pad) blood pressures, heart rate (fc), and minute ventilation (VI). The isometric effort consisted of a 40% maximal voluntary handgrip contraction (MVC) performed for a duration of 80% of a previously determined 40% MVC fatiguing effort. The R effort consisted of a 13-min cycle effort at 75% maximum oxygen consumption (VO2maX). For the combined efforts, I was performed starting simultaneously with or ending simultaneously with R. Data on nine subjects yield statistically significant evidence (P<0.05) that the effects of I and R are not additive for the following three cases: (1)Pas when I and R are ended simultaneously (I alone=4.9, SEM 0.5 kPa increase; R alone=no significant change from steady state; I+R=1.2, SEM 0.4 kPa increase), (2)Pad when I and R are started simultaneously (I alone=4.1, SEM 0.4 kPa increase; R alone=0.7, SEM 0.3 kPa decrease; I+R=1.9, SEM 0.4 kPa increase), and (3)Pad when I and R are ended simultaneously (I alone=4.1, SEM 0.4 kPa increase; R alone=0.3, SEM 0.5 kPa decrease; I+R=0.8, SEM 0.3 kPa increase). For all other variables and cases, there is not sufficient evidence to conclude that the effects of I and R are not additive. We conclude that R and I exercises do not invariably produce strictly additive cardiopulmonary responses. When R and I exercises are started simultaneously, however,Pas,fc, andVI are additive. Finally, cardiopulmonary responses to I efforts superimposed on steady-state 75%VO2max R efforts suggest that cardiopulmonary controls already established during R efforts attenuate responses to the I effort.

• This study was undertaken to determine the efficacy and durability of profundaplasty and define preoperative factors predictive of success. The hospital charts, vascular laboratory data, and arteriograms of 20 patients having 21 isolated profundaplasties for ischemic rest pain between 1979 and 1987 were reviewed. Follow-up extended to 72 months (mean, 26 months). Early success was achieved in 12 extremities (57%) and life-table analysis showed continued success to six years in 11 extremities (55%). Of the multiple preoperative factors assessed, only a low-thigh/ankle gradient pressure index (TAGI) of less than 0.55 was predictive of success. Lifetable analysis for limbs with a TAGI of less than 0.55 showed an 89% success rate at six years compared with only a 32% success rate for limbs with a TAGI of more than 0.55. Isolated profundaplasty for the treatment of ischemic rest pain can be an efficacious and durable procedure when patients are selected based on objective hemodynamic measurements.(Arch Surg 1989;124:441-444)

Malignant mixed mullerian tumors of the extra-genital coelomic epithelium (female peritoneum) are rare. Since the first case report in 1955, only nineteen have been described. In our Case 1 a 58 year-old G3P3 (gravidity = 3; parity = 3) white female with mixed mullerian tumor, homologous type, involving the abdominal peritoneum was treated with surgery and chemotherapy (doxorubicin hydrochloride and cis-platinum). She died of the disease 20 months after initial surgery. Case 2 is a 75 year-old G0P0 (gravidity = 0; parity = 0) white female with mixed mullerian tumor containing heterologous elements involving the pelvic peritoneum who was treated with surgery and chemotherapy (ifosfamide with mesna). She relapsed 6 months after surgery and refused any further treatment. She died 2 weeks later. These cases support the fact that malignant mixed mullerian tumor of the female peritoneum is rare and usually affects elderly females. It has poor prognosis and among the 15 reported cases with follow-up indicating time and presence of disease at death, only 5 survived more than 12 months after initial surgery.

HistoryThe End of History and the Last Man By Francis Fukuyama. Hamish Hamilton, London, 1992, 418 pp., £20.00, ISBN 0-24-1301-1Aeskulap oder Mars? [Asdepius or Mars] (subtitle: Doctors against War) Edited by T.M. Ruprecht and C. Jenssen. (In German). Donat Verlag, Bremen, 1991, 604pp., 48.00DM, ISBN 3-924444-51-X.The Gulf WarHidden Casualties, Volume II: The Environmental, Health and Political Consequences of the Persian Gulf War Edited by Saul Bloom, John M. Miller and Philippa Winkler, with Ross Mirkarimi. ARC/Arms Control Research Center, 942 Market St, Suite 202, San Francisco CA 94102, USA, 1993, 350pp.Medicine and WarWounded Healthy Cities: Searching for Health and Human Dignity A report by the Croatian Healthy Cities Network. Compiled by Ivana Eterovic, Selma Sogoric, and Slobodan Lang. Edited by John Middleton. Sandwell Public Health Publications, 1992, PO Box 1953, Lyndon, West Bromwich, West Midlands, B71 4NA, pp. 68, £5.95 incl. p&p, ISBN 0-9517035-4-4.Public HealthHealth through Public Policy, the Greening of Public Health Edited by Peter Draper. Greenprint, London, 1991, x + 258 pp., £9.99, ISBN 1-85425-045-0.EconomicsThe Culture of Contentment By John Kenneth Galbraith. Sinclair Stevenson, London, 1992, 195pp., £14.95, ISBN 1-85619-147-8.Beyond the Limits: Global Collapse or a Sustainable Future By Donella Meadows, Dennis Meadows and Jorgen Randers. Earthscan, London, 1992, xix + 300 pp., £19.95, ISBN 1-85383-130-1 (hbk), £11.95, ISBN 1-85383-131-X (pbk).Human RightsRefugees: Rationing the Right to Life By David Keen. Zed Books, London, 1992, 86pp., £29.9S(hbk), ISBN 1-85649-091-2, £9.95(pbk), ISBN 1-85649-092-0.Deadly Silence: Black Deaths in CustodyInstitute of Race Relations, London, 1991, 75pp., £4 (pbk), ISBN 085001-038-1.Torture and Its Consequences: Current Treatment Approaches Edited by Metin Basoğlu. Cambridge University Press, Cambridge, 1992, xxiii + 527pp., £55.00, ISBN 0-521-39299-3Militarism and the EnvironmentTaking Stock: The Impact of Militarism on the Environment Working Group on Militarism and the Environment. Science for Peace, 1992, 30pp., Can$ 4.00 (available from WGME, University College, University of Toronto, Ontario, Canada M5S 1A1).AIDSThe AIDS Epidemic: Economic, Political and Security Implications By Alan Whiteside and David FitzSimons. Research Institute for the Study of Conflict and Terrorism, London, 1992, 43pp., £9.00, ISSN 0069-8792 (available from 136 Baker Street, London W1M 1FH)

There are three synthetic methods for direct introduction of a heterosulfur bridging atom into a vinylarene, biaryl, or angularly condensed arene to form a polycyclic thiophene. Two methods employ elemental sulfur, with or without a catalyst (aluminum chloride). The third method, which uses hydrogen sulfide and a heterogeneous catalyst (usually a metallic oxide) at 450-630°, is reviewed in detail. Thus, results on 20 different substrates (including a number of compounds bearing pyridine rings) are presented. Experimental observations which concern mechanistic aspects of the reaction are summarized and interpreted. For most substrates it is suggested that an ECEC mechanism prevails, whereby an adsorbed sulfide ion attacks a π-electron-deficient, adsorbed substrate to form a dihydro intermediate, which then undergoes aromatization. The substrate is adsorbed onto the catalyst either via the π-electrons or n-electrons (for some pyridine compounds). Type of adsorption and/or relative reactivities of ring positions may control isomeric ratios of products. For 2- and 4-vinylpyridines as substrates it is proposed that 1,2-addition leads to β-pyridylethanethiols and bis-(β-pyridylethyl) sulfides, which undergo thermal cyclization.The sulfur bridging reaction as a laboratory and, also possibly, a natural route to the formation of polycyclic condensed thiophenes found in the environment is discussed.

Industrial management became vitally interested in safety engineering only after the coincidence of a low accident rate with increased output was recognized. Just so, exposure to intense noise is an industrial problem being by-passed by management because executives have not clearly realized the possibility of increased efficiency and production through the curtailment of noise. It is evident that in certain occupations associated with continual exposure to loud noise a deafness results which with long exposure is progressive and may be permanent. The worker's deafness, because of its innocuous origin in the little used high frequency range, does not stimulate executive interest as does a temporary injury, such as a broken arm, with which the relationship between cause and effect is more evident. Increased production, accentuating the use of tools such as the pneumatically operated hammer, the chipper and the riveting gun in confined areas, underlines the importance of the noise