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Introduction Previous studies have shown an association between number of stroke admissions and outcomes. Small hospitals often support more remote areas and we studied national data to determine if an association exists between hospital remoteness and stroke care. Methods Data from the Irish National Audit of Stroke (INAS) on average stroke admissions, adjusted mortality for ischaemic stroke, thrombolysis rate and proportion with door to needle (DTN) ≤45 min were analysed. Hospital remoteness was quantified by distance to the next hospital, nearest neurointerventional centre and location within 10 km of the national motorway network. Results Data for 23 of 24 stroke services were evaluated. Median number of strokes admitted per year was 186 (range 84–497). Nine hospitals (39%) admitted ≥200 stroke patients per year (mean 332). Average adjusted mortality (7.0 vs. 7.3, P  = 0.67 t -test), mean thrombolysis rate (12.1% vs. 9.2%, P  = 0.09) and mean proportion of patients treated ≤45 min (40.4% vs. 31.3%, P  = 0.2) did not differ significantly between higher and lower volume hospitals. Hospitals close to the motorway network (n  = 15) had a higher mean thrombolysis rate (11.9% vs. 7.5%, P  = 0.01 t -test) and proportion DTN ≤45 min (43.7–18.4%, P  < 0.001). Number of stroke admissions did not correlate with mortality (r  = 0.06, P  = 0.78), DTN (r  = 0.12, P  = 0.95) or thrombolysis rate (r  = 0.35, P  = 0.20). Distance to next hospital correlated strongly negatively with DTN (r  = −0.47, P  = 0.02) and thrombolysis rate (−0.43, P  = 0.04). Conclusion Remoteness of hospitals is associated with worse measures of stroke outcome and management. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Children with Alagille syndrome often have complex forms of congenital heart defects with the majority having peripheral pulmonary artery stenosis (PPAS) and pulmonary valve atresia (PA) or pulmonary valve stenosis. Children with Alagille syndrome also have variable amounts of liver dysfunction. The purpose of this study was to evaluate the impact of liver dysfunction on outcomes in children with Alagille syndrome undergoing congenital heart surgery. METHODS This was a retrospective review of 69 patients with Alagille syndrome who underwent congenital heart surgery at our institution. The underlying diagnoses included PPAS (n  = 29), tetralogy of Fallot with PPAS (n  = 14), tetralogy with PA (n  = 3), PA with ventricular septal defect and major aortopulmonary collateral arteries (n  = 21) and one each with D-transposition and supravalvar aortic stenosis. RESULTS The median age at surgery was 16 months (range 0–228 months). Procedures performed included PPAS repair (n  = 43), tetralogy with PA repair (n  = 3), unifocalization procedures (n  = 21) and other (n  = 2). Forty-two (61%) patients had mild or no liver dysfunction, while 26 (38%) had moderate or severe liver dysfunction. The median cardiopulmonary bypass time was 345 min (341 with liver dysfunction, 345 without liver dysfunction). There were a total of 8 operative (12%) deaths and 3 late (4%) deaths. Six operative and 2 late deaths occurred in patients with liver dysfunction (combined 30.7%) versus 2 operative and 1 late death (combined 7.1%) for patients without liver dysfunction (P  < 0.05). CONCLUSIONS These results suggest that liver dysfunction has a profound impact on survival in children with Alagille syndrome undergoing congenital heart surgery. [ABSTRACT FROM AUTHOR]

This document is a response to a letter regarding the impact of prehospital care and door-to-computed tomography scan time on stroke outcomes. The authors address the issues raised by the letter and provide information about the prehospital assessment and care of stroke patients in Ireland. They explain that Ireland has a standardized training protocol for paramedics, and all hospitals can receive pre-notification of suspected strokes from ambulances. They also mention that technical solutions like mobile stroke units have not been extensively assessed in remote areas due to cost and low frequency of use. The authors conclude that optimizing prehospital and emergency care for stroke patients is important, but there is no evidence that patients attending remote hospitals in Ireland receive poorer care in these respects. [Extracted from the article]

The North Dublin Population Stroke Study in 2012[5] showed a 9.5% non-presentation rate of stroke patients. All had active thrombolysis protocols, all had nationally developed imaging protocols and all had access to thrombectomy services with imaging review by Interventional Neuroradiologists through a central imaging system.[3] All units undergo continuous audit. All the stroke patients in the study were admitted to hospitals with organized stroke services, with accredited stroke units and with senior medical and specialized nursing staff trained in stroke care. [Extracted from the article]

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Background: Greater numbers of older patients are accessing hospital services. Specialist geriatric input at presentation may improve outcomes for at-risk patients. The Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) frailty measure, developed for use in the community, has also been used in the emergency department (ED). Aim: To measure frailty, review its prevalence in older patients presenting to ED and compare characteristics and outcomes of frail patients with their non-frail counterparts. Design: Patient characteristics were recorded using symphony® electronic data systems. SHARE-FI assessed frailty. Cognition, delirium and 6 and 12 months outcomes were reviewed. Methods: A prospective cohort study was completed of those aged≥70 presenting to ED over 24h, 7 days a week. Results: Almost half of 198 participants (46.7%, 93/198) were classified as frail, but this was not associated with a significant difference in mortality rates (OR 0.89, 95% CI 0.58-1.38, P=0.614) or being alive at home at 12 months (OR 1.07, 95% CI 0.72-1.57, P=0.745). Older patients were more likely to die (OR 2.34, 95% CI 1.30-4.21, P=0.004) and less likely to be alive at home at 12 months (OR 0.49, 95% CI 0.23-0.83, P=0.009). Patients with dementia (OR 0.24, P=0.005) and on ≥5 medications (OR 0.37, 95% CI 0.16-.87, P=0.022) had a lower likelihood of being alive at home at 12 months. Conclusions: Almost half of the sample cohort was frail. Older age was a better predictor of adverse outcomes than frailty as categorized by the SHARE-FI. SHARE-FI has limited predictability when used as a frailty screening instrument in the ED. [ABSTRACT FROM AUTHOR]

Background: Studies have demonstrated that a significant minority of older persons presenting to acute hospital services are cognitively impaired; however, the impact of dementia on long-term outcomes is less clear. Aim: To evaluate the prevalence of dementia, both formally diagnosed and hitherto unrecognised in a cohort of acutely unwell older adults, as well as its impact on both immediate outcomes (length of stay and in-hospital mortality) and 12-month outcomes including readmission, institutionalisation and death. Design: Prospective observational study. Methods: 190 patients aged 70 years and over, presenting to acute hospital services underwent a detailed health assessment including cognitive assessment (standardised Mini Mental State Examination, AD8 and Confusion Assessment Method for the Intensive Care Unit). Patients or informants were contacted directly 12 months later to compile 1-year outcome data. Dementia was defined as a score of 2 or more on the AD8 screening test. Results: Dementia was present in over one-third of patients (73/190). Of these patients, 36% (26/73) had a prior documented diagnosis of dementia with the remaining undiagnosed before presentation. The composite outcome of death or readmission to hospital within the following 12 months was more likely to occur in patients with dementia (73% (53/73) vs. 58% (68/117), P=0.043). This finding persisted after controlling for age, gender, frailty status and medical comorbidities, including stroke and heart disease. Conclusion: A diagnosis of dementia confers an increased risk of either death or further admission within the following 12 months, highlighting the need for better cognitive screening in the acute setting, as well as targeted intervention such as comprehensive geriatric assessment. [ABSTRACT FROM AUTHOR]

Introduction Stroke is a leading cause of morbidity. Current guidelines advise maximum of 4.5 hours post symptom onset for thrombolysis, and 24 hours for thrombectomy. (1) Delay between symptom onset and treatment is associated with an inferior outcome. Thrombolysis is available in 27 Irish centers. Average rate of thrombolysis is 11%. (3) Fewer than half of stroke patients arrived in hospital within three hours of symptom onset in 2019. (4) Median door-to-needle time is 48 minutes. Method FAST calls in Tallaght University Hospital, from 2/7/19–1/7/21, were included in this analysis (n = 594). Results 160 FAST calls took place pre-Covid (20/month), and 434 post-Covid (27.12/month). Time of symptom onset was recorded in 390 cases. Time patients last seen well was known in 185 cases, unknown time of onset in 19. After review by the stroke clinician, FAST imaging was obtained in 78% of cases (n = 464). Of these, 34 cases of FAST imaging were performed for inpatients. Average time from registration to CT was 35:24 minutes pre covid, and 45:52 minutes post. 9.7% of patients were thrombolysed. The median door-to-needle time was 41 minutes pre-Covid(n = 21, 2.625/month), and 54 minutes after (n = 37, 2.3/month). Thrombectomy was performed in 46 cases. 222 patients were diagnosed with an ischaemic stroke, 50 had TIA and 48 had haemorrhagic strokes. Other diagnoses included migraine (6.7%, n = 40), seizures (6.7%, n = 40) and Bells Palsy (3.7%, n = 22). 55% (n = 330) of cases were registered to ED with FAST call between the hours of 9 am-5 pm. 27% (n = 161) of cases occurred during the night shift. Conclusion The median door-to-needle times were below national median pre-Covid, and longer post-pandemic, with an increase in the rate of presentation in the same time-frame. This report highlights the effect of the pandemic on time-critical patient interventions in stroke and the need to stratify services to respond to structural challenges. [ABSTRACT FROM AUTHOR]

Introduction: Research across the past 4 decades has supported a cross-sectional association between adult cigarette smoking and lower fruit and vegetable consumption (FVC), and emerging research suggests higher FVC may predict cessation. Among youth, findings are limited to a few cross-sectional studies with somewhat mixed results. Here we evaluated the FVC-smoking association among youth both cross-sectionally and longitudinally. Methods: We analyzed data from a subsample of the National Longitudinal Survey of Youth 1979: Child and Young Adult. The subsample included adolescents aged 14-18 years at baseline in the year 2004. Multivariable cross-sectional analyses assessed whether baseline FVC was associated with smoking frequency among ever-smokers (n = 578). Longitudinally, the study assessed whether baseline FVC predicted smoking progression among baseline never-smokers who tried a cigarette by 4-year follow-up (n = 388). Multivariable regression models adjusted for age, gender, race/ethnicity, parental education, and health behavior orientation. Results: Cross-sectionally, youth who consumed fruit ≥2 times per day were 53% less likely (RR = 0.47; p < .05) than those who typically did not consume fruit to be in a higher smoking frequency category. Longitudinally, the fruit consumption and smoking association was not significant (RR = 0.61; p = .282). There were no significant associations observed between vegetable consumption and smoking. Conclusions: Fruit consumption, but not vegetable consumption, was inversely associated with smoking frequency cross-sectionally but not longitudinally. Further research is needed to provide information on the consistency of the FVC-smoking relationship among youth and may help to elucidate possible explanatory mechanisms. [ABSTRACT FROM AUTHOR]

Background: The analysis of routinely collected hospital data informs the design of specialist services for at-risk older people.Aim: Describe the outcomes of a cohort of older emergency department (ED) attendees and identify predictors of these outcomes.Design: retrospective cohort study.Methods: All patients aged 65 years or older attending an urban university hospital ED in January 2012 were included (N = 550). Outcomes were retrospectively followed for 12 months. Statistical analyses were based on multivariate binary logistic regression models and classification trees.Results: Of N = 550, 40.5% spent ≤6 h in the ED, but the proportion was 22.4% among those older than 81 years and not presenting with musculoskeletal problems/fractures. N = 349 (63.5%) were admitted from the ED. A significant multivariate predictor of in-hospital mortality was Charlson comorbidity index [CCI; odds ratio = 1.19, 95% confidence interval: 1.07, 1.34, P = 0.002]. Among patients who were discharged from ED without admission or after their first in-patient admission (N = 499), 232 (46.5%) re-attended ED within 1 year, with CCI being the best predictor of re-attendance (CCI ≤ 4: 25.8%, CCI > 5: 60.4%). Among N = 499, 34 (6.8%) had died after 1 year of initial ED presentation. The subgroup (N = 114) with the highest mortality (17.5%) was composed by those aged >77 years and brought in by ambulance on initial presentation.Conclusions: Advanced age and comorbidity are important drivers of outcomes among older ED attendees. There is a need to embed specialist geriatric services within frontline services to make them more gerontologically attuned. Our results predate the opening of an acute medical unit with specialist geriatric input. [ABSTRACT FROM AUTHOR]

Nursing home (NH) residents represent the frailest group of older people, and providing gerontologically attuned care that addresses these frailties is often a challenge within the emergency department (ED). This study sought to prospectively profile acutely unwell NH residents in order to clarify some of the challenges of providing emergency care to this group. Over an 18-week period, we prospectively reviewed all NH residents presenting to the ED of an urban university teaching hospital. Relevant data were retrieved by direct physician review (as part of a comprehensive geriatric assessment in the ED), collateral history from NH staff and primary carers, and review of electronic records. There were 155 ED visits by 116 NH residents. Their mean age was 80.3 (±9.6) years. High pre-morbid levels of dependency were reflected by a mean Barthel Index of 34.1 (±20) and almost two-thirds had a pre-existing diagnosis of dementia. One-third of visits were during ‘normal’ working hours. Patients were reviewed by their regular NH doctor pre-transfer for 36% of visits. Using accepted international criteria, over half of the visits were deemed ‘potentially preventable’. Unwell NH residents have complex medical needs. The decision to refer these patients to the ED is often made by ‘out of hours’ general practitioners and their initial care in the ED is directed by physicians with limited experience in geriatric medicine. Most referrals to the ED are potentially preventable but this would require enhancements to the package of care available in NHs. [ABSTRACT FROM AUTHOR]

When groups of related bacterial genomes are compared, the number of core genes found in all genomes is usually much less than the mean genome size, whereas the size of the pangenome (the set of genes found on at least one of the genomes) is much larger than the mean size of one genome. We analyze 172 complete genomes of Bacilli and compare the properties of the pangenomes and core genomes of monophyletic subsets taken from this group. We then assess the capabilities of several evolutionary models to predict these properties. The infinitely many genes (IMG) model is based on the assumption that each new gene can arise only once. The predictions of the model depend on the shape of the evolutionary tree that underlies the divergence of the genomes. We calculate results for coalescent trees, star trees, and arbitrary phylogenetic trees of predefined fixed branch length. On a star tree, the pangenome size increases linearly with the number of genomes, as has been suggested in some previous studies, whereas on a coalescent tree, it increases logarithmically. The coalescent tree gives a better fit to the data, for all the examples we consider. In some cases, a fixed phylogenetic tree proved better than the coalescent tree at reproducing structure in the gene frequency spectrum, but little improvement was gained in predictions of the core and pangenome sizes. Most of the data are well explained by a model with three classes of gene: an essential class that is found in all genomes, a slow class whose rate of origination and deletion is slow compared with the time of divergence of the genomes, and a fast class showing rapid origination and deletion. Although the majority of genes originating in a genome are in the fast class, these genes are not retained for long periods, and the majority of genes present in a genome are in the slow or essential classes. In general, we show that the IMG model is useful for comparison with experimental genome data both for species level and widely divergent taxonomic groups. Software implementing the described formulae is provided at http://github.com/rec3141/pangenome. [ABSTRACT FROM PUBLISHER]

Introduction: Pregnant women often underreport their smoking status and extent of secondhand smoke (SHS) exposure. Biomarker confirmation is the recommended method to assess smoking behaviors and SHS exposure in both mothers and infants.Objectives: The primary aims are to (a) examine the relationship between smoking behaviors and SHS exposure in mother-baby couplets using maternal and infant hair nicotine and maternal urine cotinine analyses and (b) determine whether there is an association between maternal and infant hair nicotine samples obtained shortly after birth.Discussion: A cross-sectional study with a multiethnic sample of 210 mother-baby couplets assessing SHS exposure.Results: The level of maternal hair nicotine (MHN) was significantly different among three groups: nonsmoking, nonsmoking/passive exposed, and smoking (p < .0001), with nonsmoking and nonexposed women having the lowest level. Urine cotinine was strongly associated with self-reported smoking status (rho = .88; p < .0001). Maternal and infant hair nicotine were correlated, although MHN correlated more strongly with smoking status (rho = .46, p < .0001) than infant hair nicotine (rho = .39, p < .0001).Conclusions: MHN was a more precise biomarker of prenatal SHS exposure than infant hair nicotine; mothers' urine cotinine was strongly correlated with self-reported smoking status. [ABSTRACT FROM AUTHOR]

We present a description of the design and usage of a new synoptic pipeline and data base model for time series photometry in the VISTA Data Flow System (VDFS). All UK Infra-Red Telescope Wide Field Camera (UKIRT) data and most of the VISTA main survey data will be processed and archived by the VDFS. Much of these data are multi-epoch, useful for finding moving and variable objects. Our new data base design allows the users to easily find rare objects of these types amongst the huge volume of data being produced by modern survey telescopes. Its effectiveness is demonstrated through examples using Data Release 5 of the UKIRT Deep Infrared Sky Survey (UKIDSS-Deep Extragalactic Survey (DXS) and the Wide Field Camera standard star data. The synoptic pipeline provides additional quality control and calibration to these data in the process of generating accurate light curves. We find that per cent of stars and per cent of galaxies in the UKIDSS-DXS with mag are variable with amplitudes mag. [ABSTRACT FROM AUTHOR]

We present the case of a 39-year-old white man with a Myobacterium avium-intracellulare pulmonary infection found to have a CD4+ count of 172 cells/mm3 and diagnosed subsequently with idiopathic CD4+ lymphopenia (ICL). After receiving clathromycin for 4 months with minimal improvement, the patient was started on pegylated subcutaneous interleukin (IL)-2 at 600 000 units daily. Later, he received incrementally higher pegylated IL-2 doses until he reached a maintenance dose 3 months later of 11 million units weekly divided into three equal doses. After 5 months of therapy, the patient's chronic cough resolved completely, sputum cultures became negative for Myobacterium avium-intracellulare and the CD4+ T cell count increased to 553 cells/mm3. After 35 months of well-tolerated IL-2 treatments and no recurrence of any opportunistic infections, IL-2 treatment was stopped. CD4+ counts 6 and 9 months after discontinuing IL-2 treatment were 596 and 378 cells/mm3 respectively, and he remains asymptomatic. This report supports IL-2 treatment for ICL-associated opportunistic infections as a safe and potentially efficacious treatment option, especially when combined with more traditional treatment regimens. [ABSTRACT FROM AUTHOR]

The UKIDSS Galactic Plane Survey (GPS) is one of the five near-infrared Public Legacy Surveys that are being undertaken by the UKIDSS consortium, using the Wide Field Camera on the United Kingdom Infrared Telescope. It is surveying 1868 deg2 of the northern and equatorial Galactic plane at Galactic latitudes in the J, H and K filters and a ∼200-deg2 area of the Taurus–Auriga–Perseus molecular cloud complex in these three filters and the 2.12 μm (1–0) H2 filter. It will provide data on sources. Here we describe the properties of the data set and provide a user's guide for its exploitation. We also present brief Demonstration Science results from DR2 and from the Science Verification programme. These results illustrate how GPS data will frequently be combined with data taken in other wavebands to produce scientific results. The Demonstration Science comprises six studies. (1) A GPS- Spitzer-GLIMPSE cross-match for the star formation region G28.983−0.603 to identify YSOs. This increases the number of YSOs identified by a factor of 10 compared to GLIMPSE alone. (2) A wide-field study of the M17 nebula, in which an extinction map of the field is presented and the effect of source confusion on luminosity functions in different subregions is noted. (3) H2 emission in the ρ Ophiuchi dark cloud. All the molecular jets are traced back to a single active clump containing only a few protostars, which suggests that the duration of strong jet activity and associated rapid accretion in low-mass protostars is brief. (4) X-ray sources in the nuclear bulge. The GPS data distinguishes local main-sequence counterparts with soft X-ray spectra from nuclear bulge giant counterparts with hard X-ray spectra. (5) External galaxies in the zone of avoidance. The galaxies are clearly distinguished from stars in fields at longitudes . (6) IPHAS-GPS optical–infrared spectrophotometric typing. The versus diagram is used to distinguish A–F type dwarfs, G dwarfs, K dwarfs and red clump giants in a field with high reddening. [ABSTRACT FROM AUTHOR]

We describe the WFCAM Science Archive, which is the primary point of access for users of data from the wide-field infrared camera WFCAM on the United Kingdom Infrared Telescope (UKIRT), especially science catalogue products from the UKIRT Infrared Deep Sky Survey. We describe the database design with emphasis on those aspects of the system that enable users to fully exploit the survey data sets in a variety of different ways. We give details of the database-driven curation applications that take data from the standard nightly pipeline-processed and calibrated files for the production of science-ready survey data sets. We describe the fundamentals of querying relational databases with a set of astronomy usage examples, and illustrate the results. [ABSTRACT FROM AUTHOR]

The First Data Release (DR1) of the United Kingdom Infrared Telescope Infrared Deep Sky Survey (UKIDSS) took place on 2006 July 21. The UKIDSS is a set of five large near-infrared surveys, covering a complementary range of areas, depths and Galactic latitudes. The DR1 is the first large release of survey-quality data from the UKIDSS and includes 320 deg2 of multicolour data to (Vega) , complete (depending on the survey) in three to five bands from the set ZYJHK, together with 4 deg2 of deep JK data to an average depth . In addition, the release includes a similar quantity of data with incomplete filter coverage. In JHK, in regions of low extinction, the photometric uniformity of the calibration is better than 0.02 mag in each band. The accuracy of the calibration in ZY remains to be quantified, and the same is true of JHK in regions of high extinction. The median image full width at half-maximum across the data set is 0.82 arcsec. We describe changes since the Early Data Release in the implementation, pipeline and calibration, quality control, and archive procedures. We provide maps of the areas surveyed, and summarize the contents of each of the five surveys in terms of filters, areas and depths. The DR1 marks completion of 7 per cent of the UKIDSS seven-year goals. [ABSTRACT FROM AUTHOR]

This paper defines the UKIRT Infrared Deep Sky Survey (UKIDSS) Early Data Release (EDR). UKIDSS is a set of five large near-infrared surveys being undertaken with the United Kingdom Infrared Telescope Wide Field Camera (WFCAM). The programme began in 2005 May and has an expected duration of 7 yr. Each survey uses some or all of the broad-band filter complement ZY JHK. The EDR is the first public release of data to the European Southern Observatory (ESO) community. All worldwide releases occur after a delay of 18 months from the ESO release. The EDR provides a small sample data set, ∼50 deg2 (about 1 per cent of the whole of UKIDSS), that is a lower limit to the expected quality of future survey data releases. In addition, an EDR+ data set contains all EDR data plus extra data of similar quality, but for areas not observed in all of the required filters (amounting to ∼220 deg2). The first large data release, DR1, will occur in mid-2006. We provide details of the observational implementation, the data reduction, the astrometric and photometric calibration and the quality control procedures. We summarize the data coverage and quality (seeing, ellipticity, photometricity, depth) for each survey and give a brief guide to accessing the images and catalogues from the WFCAM Science Archive. [ABSTRACT FROM AUTHOR]

Pleurotin is a naphthoquinone antibiotic originally isolated from Pleurotus griseus. Two pleurotin producing strains of Hohenbuehelia atrocaerulea have been identified, which, on solid substrate fermentation for 2 months yield 1–2 mg/l of the antibiotic. Described here is the lengthy developmental process which resulted in a production protocol being developed which reliably yields pleurotin from liquid fermentation at >300 mg/l. Critical to obtaining this increase in titer was inclusion in the media of an aqueous extract of alder wood. [ABSTRACT FROM AUTHOR]

Aims: To investigate the number of Escherichia coli in runoff derived directly from fresh cowpats and to determine if the E. coli are attached to dense particles, in flocs or as individual cells. Methods and Results: Three cowpats were collected monthly from the same farm for 13 months and the number of E. coli in them estimated. A rainfall simulator was used to generate runoff from the individual cowpats, which was fractioned to determine the transported state of any E. coli present. The number of E. coli in the cowpat runoff was highly variable and was strongly correlated with the number of E. coli in the cowpat. Only a small percentage (approx. 8%) of the E. coli in runoff were attached to dense (>1·3 g ml−1) particles and there was no evidence of flocculation of the cells. Conclusions: Escherichia coli in runoff from cowpats are transported predominantly as individual cells. Significance and Impact of the Study: Mitigation strategies to reduce the number of faecal bacteria in overland flow from agricultural land need to be designed to trap single bacterial cells. [ABSTRACT FROM AUTHOR]

Aims: To quantify and derive statistical relationships with which to predict the delivery of faecal bacteria (Escherichia coil) to a pastoral stream, by overland flow. Methods and Results: A large-scale (1050 m²) rainfall simulator, located upon a steep (18°) grazed hillside in New Zealand, was used to simulate 11 heavy rainfall events. Overland flow was generated and sampled throughout each event, before discharging to a headwater stream. The samples were subsequently analysed to determine the concentration of E. coil. Statistical analysis showed that the time elapsed since the last period of grazing was a statistically significant predictor of both the total number (load) and concentrations of E. coil in overland flow. Between 105 and 108 E. coil per m² of hillside were delivered to the stream within overland flow during each event, and peak concentrations ranged between 10³ and 107 most probable number per 100 ml. Conclusions: Under heavy rainfall on steep pastoral land, overland flow can transport substantial levels of faecal bacteria to streams. Under such conditions, it is unlikely that vegetated buffer strips will be particularly effective at attenuating bacteria within overland flow. Significance and Impact of the Study: This work has improved understanding of the importance of overland flow as a process contributing to the contamination of pastoral streams by faecal bacteria. In addition, the predictive relationships derived can be incorporated within catchment models. [ABSTRACT FROM AUTHOR]

ABSTRACT The variability in the infrared to millimetre emission from microquasar GRS 1915+105 is believed to be dominated by the system's relativistic jet. In this paper we develop a time-dependent version of the jet emission model of Blandford & Königl and apply it to the oscillations in the infrared and millimetre emission from GRS 1915+105 observed recently by Fender & Pooley. The resulting model provides a reasonable description of the observed flux oscillations from GRS 1915+105. From a fit of the observed time lag between the flux peaks in the infrared and millimetre emission together with the flux normalization, we were able to determine the model parameters for the GRS 1915+105 jet. We find that to achieve the observed flux levels with the model requires an unphysically large electron density within the jet. We therefore conclude that the Blandford & Königl model cannot explain these observations, either because it does not provide the correct description of the emission from microquasar jets, or because the observed emission variations do not originate in the jet. [ABSTRACT FROM AUTHOR]

Aims To take appropriate account of duration of follow-up in estimating age-specific associations of ‘usual’ blood pressure and cholesterol with death from coronary heart disease.Methods and Results Blood pressure and cholesterol were measured in 18841 men at entry to the Whitehall study, and coronary heart disease mortality was recorded during a 26-year period. Biennial re-measurements of these risk factors in the Framingham study were used to obtain period-specific corrections for ‘regression dilution’. For coronary heart disease deaths at ages 40–64, 65–74 and 75+ years in the Whitehall study, the mean times since baseline were 9, 15, and 21 years, respectively. In uncorrected analyses of coronary heart disease risk in each age range, a 10mmHg lower systolic blood pressure at baseline was associated with proportional risk reductions of only 19%, 14% and 10%, respectively (P<0·001 for trend with age). After period-specific correction for regression dilution, a 10mmHg lower usual systolic blood pressure about 5 years before coronary heart disease death was associated with risk reductions of 25%, 23% and 21%, respectively (trendP =0·1). Similarly, a 1mmol.l−1 lower blood cholesterol was associated with proportional reductions in coronary heart disease risk of 21%, 17% and 11% (trendP <0·001) in uncorrected analyses, by contrast with proportional reductions of 27%, 26% and 21% (trend P=0·5) after period-specific correction.Conclusions After making appropriate allowance for the longer interval between baseline measurements and death at older ages, reductions in the risk of coronary heart disease death associated with differences in usual levels of blood pressure or cholesterol at some particular fixed time prior to death were about as great in old age as in middle age. [ABSTRACT FROM PUBLISHER]

In attempting to increase the reliability of clover contribution in clover/ryegrass systems it is important to understand the roles of (1) specific traits of the clover genotype (2) climate and (3) their interactions in determining clover behaviour in swards. Overwintering and spring growth of white clover (cultivars AberHerald and Huia) grown in binary mixtures with perennial ryegrass were measured at 12 European sites ranging in latitude from Reykjavik, Iceland (64°30' N) to Pordenone, Italy (46°30' N). In the overwintering period, tiller density of the grass was assessed and detailed morphological and chemical measurements were made on the clover at each sampling time. During the growing season, the clover contribution to total available biomass was recorded. Detailed climatic data were available at all sites. The annual growth cycle of swards was divided into four functional periods (spring, summer, autumn and winter). Within each functional period community responses were modelled. The models incorporated independent biotic variables characterizing each community within each site at the start of the period and independent variables characterizing the climate at each site during the period. The models were linked dynamically by taking, as response variable(s) for a functional period, the independent biotic variable(s) of the succeeding period. In general, the modelling strategy was successful in producing a series of biologically meaningful linked models. Essential prerequisites for this were (a) the establishment of a well-devised common protocol prior to the experiment and (b) the extensive gradients of climatic and other variables obtained by using numerous sites. AberHerald generally performed as well as, or better than, Huia throughout the annual cycle across the range of climatic conditions encountered, and especially under low temperature conditions in winter and autumn. Clover leaf area index appeared to be a key variable in determining clover performance over winter and through the following growing season. Grass tiller density had a strong negative effect on clover content in spring but only at low temperatures. This emphasizes the importance of a high clover leaf area index in autumn as the main biotic factor related to spring clover content in milder conditions. The importance of climatic variables in the models is their use in explaining the reliability of the contribution of clover in clover/ryegrass systems. Temperature was the primary climatic determinant of clover response in all periods, having a direct effect on clover content and leaf area index or mediating the effect of the associate species. Radiation strongly influenced clover dynamics during winter and spring but not in the other periods, possibly because it was confounded with the effect of higher temperature. Precipitation was positively related to clover growth during spring and autumn and was related to tiller density in a complex manner during autumn and winter. [ABSTRACT FROM AUTHOR]

A common experimental protocol was followed at 12 sites in Europe to study the development of two clover cultivars (AberHerald and Huia) grown in association with a ryegrass cultivar throughout their annual cycle. The duration of the experiment was between 1 and 3 years at each site. Detailed information about the morphogenesis and carbohydrate reserves of white clover during winter and the subsequent productivity of clover plants during the growing season was collected. Yield of the companion ryegrass was also measured at several harvests during the growing season and grass tiller density was recorded several times during winter. There was wide variation among sites and between years in climatic conditions, in the growth characteristics and chemical composition of the two cultivars, and in the tiller density of the ryegrass. The relative performance of the two cultivars varied among sites but AberHerald generally outperformed Huia. Major changes in plant characteristics (morphology, population size, chemical composition, etc.) occurred during overwintering. This paper presents a preliminary analysis of the effects of site, clover cultivar and sward age (years) on various plant characteristics. It is established that the data provide a unique basis for modelling the effects of a wide range of environmental conditions and plant properties on the performance of white clover in mixed swards. A modelling approach that seeks to replace site and year by climatic variables characterizing each site by year combination is developed in two companion papers. [ABSTRACT FROM AUTHOR]

A double-blind trial ot the effect of transfer factor on multiple sclerosis patients was carried out. In a series of fifty-six multiple sclerosis patients treated with monthly injections of either transfer factor or placebo for 1 year, no beneficial effect of transfer factor was noted. In addition, none of the immunological and serological parameters studied (measles migration inhibition, measles HI titre or CSF immunoglobulin) changed as a result of transfer factor therapy. Histocompatibility typing and CSF IgG/TP ratios were correlated with the disease activity. Of interest was the finding that the presence of the DW2 antigen, when unassociated with HLA-B7 antigen, appeared to correlate with the mildest form of disease activity. [ABSTRACT FROM AUTHOR]

A microdilution broth technique was used to determine susceptibility of 105 strains of Gram-positive bacteria to cefazolin and tobramycin, alone and in combination. Strains and numbers tested were: enterococci (26), non-enterococcal streptococci (12), coagulase-positive staphylococci (37), and coagulase-negative staphylococci (30). The enterococci showed less resistance to cefazolin by MIC (46%) than by MBC (85%). The non-enterococcal streptococci (groups A, B, D, non-groupable) were generally susceptible by both MIC and MBC. All coagulase-positive staphylococci were highly susceptible to cefazolin by MIC but a few strains (16%) were resistant by MBC. Most of the coagulase-negative staphylococci were sensitive (90%) by both MIC and MBC estimations. The coagulase-positive staphylococci were generally susceptible by MIC to tobramycin (84%). However, this pattern was quite altered by MBC (46% susceptible). The coagulase-negative strains were generally resistant (67%) by both MIC and MBC. All streptococci were resistant by both MIC and MBC to tobramycin. The combination of antibiotics was synergistic against 36.2% and 58.1% of all bacteria studied by MIC and MBC, respectively. The pattern of increased numbers showing synergy by MBC was observed in all groups. [ABSTRACT FROM PUBLISHER]

The Oxford Cholesterol Study is a randomized placebo-controlled trial designed primarily to assess the effects of simvastatin on blood cholesterol levels and side-effects in preparation for a large, long-term trial of the effects of cholesterol-lowering drug therapy on mortality. At present there is only limited evidence from randomized comparisons of the effects of HMG-CoA reductase inhibitors, such as simvastatin, on thrombogenic, as distinct from atherogenic, pathways in coronary heart disease. The present sub-study was carried out to assess the effects of simvastatin on a range of haemostatic variables, as well as on free fatty acids and on lipoprotein fractions not studied in detail previously.At an average of about 2 years after starting study treatment, non-fasting blood samples were obtained from a sequential sample of 162 participants who had been randomly allocated to receive 40 mg (54 patients) or 20 mg (57 patients) daily simvastatin or matching placebo treatment (51 patients). Only patients who reported taking their study treatment and who were not known to be diabetic or to be taking some other lipid lowering treatment were to be included. The principal comparisons were to be of those allocated simvastatin (i.e. 20 and 40 mg doses combined) vs those allocated placebo.Among patients allocated simvastatin, marginally significant lower factor VII antigen levels (12·10%±6·08 of standard; 2P<0·05) and non-significantly lower factor VII coagulant activity (8·24%±4·99 of standard) and fibrinogen concentrations (0·10±0·08 g.l−1) were observed. In contrast, plasminogen activator inhibitor activity was significantly higher (2·62±1·03 IU; 2P<0·01) among patients allocated simvastatin. No significant differences were seen in the other haemostatic factors studied (e.g. prothrombin fragment 1·2, factor XII and C$$$ inhibitor). Total free fatty acid concentration was marginally significantly reduced (2P=0·02) with simvastatin, but none of the reductions in individual free fatty acids was significant. Lipoprotein fractions were only measured among patients allocated 40 mg daily simvastatin or placebo. Compared with placebo, simvastatin produced significant decreases not only in LDL cholesterol (1·74±0·15 mmol.1−1; 2P<0·0001) but also in VLDL cholesterol (0·28±0·08 mmol.1−1; 2P<0·001) and IDL cholesterol (0·17±0·03 mmol.1−1; 2P<0·0001). There were also lower triglyceride levels associated with LDL (0·07±0·01 mmol.1−1; 2P<0·0001), IDL (0·03±0·01 mmol.1−1; 2P<0·01) and VLDL (0·27±0·14; 2P=0·05).The effects of simvastatin on haemostatic variables appear to be far less marked than its lipid effects. Given the associations of haemostatic factors with coronary heart disease incidence, larger randomized comparisons of the HMG-CoA re1ductase inhibitors (and of the newer fibrates, which may produce greater effects) are needed to provide more reliable estimates of the extent to which they influence these variables. [ABSTRACT FROM PUBLISHER]

The purpose of this randomized controlled study was to assess the haemodynamic effects, safety and tolerability in acute myocardial infarction (AMI) of one month of oral captopril, one month of oral isosorbide mononitrate and 24 h of intravenous magnesium. It was carried out in four United Kingdom and six Polish hospitals in consecutive phases; oral captopril vs oral mononitrate vs placebo were compared among 400 patients in a ‘three-way’ study; and then oral captopril vs placebo and oral mononitrate vs placebo were compared among 474 patients in ‘2×2’ and ‘2 × 2 × 2’ factorial studies (with 208 patients in the latter study also randomized between intravenous magnesium and open control). The factorial studies differed from the three-way study in that one group of patients was allocated both oral captopril and oral mononitrate, a higher maintenance dose of captopril was used (following the same initial dose), and once daily controiled-release mononitrate was used. In the three-way study, the mean of the lowest systolic blood pressures recorded during the first 4 h after randomization were (mmHg ± standard error): 104 ± 2 captopril vs 105 ± 1 mononitrate vs 112 ±2 placebo (P<0.001 for captopril or for mononitrate vs placebo), and in the factorial studies were 105 ± 1 captopril vs 110 ± 1 placebo (P<0.01) and 106 ± 1 mononitrate vs 108 ±1 placebo (NS). There was an excess of hypotension recorded among patients allocated active treatment (captopril>mononitrate>placebo) and there was a small, but significant, excess of cardiogenic shock with captopril compared with control in the factorial study. However, in these studies, neither captopril nor mononitrate were associated with any overall increase in the incidence of hypotension considered severe enough to lead to treatment being stopped. No other serious complications were observed, and compliance with study tablets at hospital discharge was not significantly different between the active and placebo groups. Patients allocated magnesium in the 2 × 2 × 2 factorial study had a slightly lower mean systolic blood pressure just after the initial 15 min bolus injection (126 ± 2 magnesium vs 134 ± 3 control; P<0.05) but there were no significant differences during the subsequent 24 h maintenance infusion period. Apart from some facial flushing, magnesium did not appear to be associated with any complications. These pilot studies indicate that, although the study treatment regimens produced moderate early reductions in blood pressure, they were all generally well tolerated when started in the acute phase of MI. [ABSTRACT FROM PUBLISHER]

We report the results of a randomized single-centre study designed to assess the effects of simvastatin on blood lipids, blood biochemistry, haematology and other measures of safety and tolerability in preparation for a large-scale multicentre mortality study. Six hundred and twenty-one individuals considered to be at increased risk of coronary heart disease were randomized, following a 2-month placebo ‘run-in’ period, to receive 40 mg daily simvastatin, 20 mg daily simvastatin or matching placebo. Their mean age was 63 years, 85% were male, 62% had a history of prior myocardial infarction (MI), and the mean baseline total cholesterol was 7·0 mmol. 1. Median follow-up in the present report is 3·4 years. Eight weeks after randomization, 40 mg daily simvastatin had reduced non-fasting total cholesterol by 29·2% ± 1·1 (2·03 ± 0·08 mmol. 1)and 20 mg daily simvastatin had reduced it by 26·8% ± 1·0 (1·87 ± 0·07 mmol. 1). Almost all of tile difference in total cholesterol at 8 weeks was due to the reduction in LDL cholesterol (40·8±1·6 and 38·2%±1·4 among patients allocated 40mg and 20mg of simvastatin daily respectively), but simvastatin also reduced triglycerides substantially (19·0% and 17·3%) and produced a small increase in HDL cholesterol (6·4% and 4·8%). These effects were largely sustained over the next 3 years, with 40 mg daily simvastatin producing a slightly greater reduction in total cholesterol at 3 years (25·7%±1·9 reduction) than did 20 mg daily simvastatin (22·2%±1·8). There were no differences between the treatment groups in the numbers of reports of ‘possible adverse effects’ of treatment or of a range of different symptoms or conditions (including those related to sleep or mood) recorded at regular clinic follow-up. Mean levels of alanine aminotransferase, aspartate aminotransferase and creatine kinase were slightly increased by treatment, but there were no significant difference between the treatment groups in the numbers of patients with significantly elevated levels. A slightly lower platelet count in the simvasatin group was the only haematological difference from placebo, with no difference in the numbers of patients with low platelet counts. In summary, the simvastatin regimens studied produced large sustained reductions in total cholesterol, LDL cholesterol and triglyceride and small increases in HDL cholesterol. They were well tolerated, with no evidence of serious side-effects during the first 3 years of this study. Consequently, simvastatin provides an opportunity to conduct large randomized studies that assess the effects of cholesterol lowering on total mortality and on cause-spec mortality. Even with such an effective cholesterol lowering treatment, however such mortality studies will still need to be prolonged and to involve some tens of thousands of patients at substantial risk of coronary heart disease if clear evidence is to emerge. [ABSTRACT FROM PUBLISHER]

To determine the ovarian response to a fixed dose of gonadotrophin-releasing hormone (GnRH) administered s.c. at four different pulse frequencies, 20 patients with hypothalamic amenorrhoea were treated over 41 cycles using a dose of 200 ng/kg/pulse. These patients were randomly assigned to receive GnRH at pulse frequencies of 60, 90, 120 or 180 min. GnRH was administered s.c using portable infusion pumps. Subjects were paid volunteers with a diagnosis of hypothalamic amenorrhoea. All patients had low to less than detectable serum concentrations of luteinizing hormone and follicle stimulating hormone on 8 h serial sampling, and normal serum concentrations of prolactin and androgen, including andro-stenedione, testosterone and dihydroepiandrosterone sulphate. Six of the 20 patients were enrolled in the protocol to achieve a pregnancy, while 14 were volunteers using a barrier method of contraception. Highest ovulation rates were achieved using pulse frequencies of 90 and 120 min (60 and 88% of cycles respectively). Ovulation occurred significantly less often with frequencies of 60 and 180 min (12 and 38% respectively; P ≤ 0.05). Pregnancy was achieved in four of the six patients who desired a pregnancy at pulse frequencies of 90 (three out of three) and 120 (one out of one) min. No pregnancies occurred at pulse frequencies of 60 (none out of one) and 180 (none out of one) min. When ovulatory cycles were considered, oestradiol concentrations were not different among pulse frequencies but varied significantly between ovulatory and anovulatory cycles. Integrated luteal progesterone concentrations for 90 and 120 min frequencies (118.26 ± 25.89 and 125.15 ± 32.10 ng/ml/luteal phase respectively) were significantly higher than for 60 and 180 min (80.1 ± 48.2 and 42.75 ± 26.48 ng/ml/luteal phase respectively). Ovulation may be induced by a broad range of pulse frequencies. Pulse frequencies of 90 or 120 min for s.c GnRH appear to induce more reliably the sequence of follicular development, ovulation and normal luteal function than frequencies of either 60 or 180 min. Significantly higher ovulation rates occurred at 90 and 120 min by s.c administered GnRH. [ABSTRACT FROM PUBLISHER]

During the past 25 years, 24 randomized trials of intravenous (IV) fibrinolytic treatment have been reported, involving a total of some 6000 patients in the acute phase of myocardial infarction. Most tested IV streptokinase (SK), but a few tested IV urokinase (UK). In the past 2 or 3 years numerous small randomized trials of intracoronary (IC) SK have been started, 9 of which, involving a total of about 1000 such patients have been reported. Because all of these IV and IC trials were small (the largest including only 747 patients), their separate results appear contradictory and unreliable. But, an overview of the data from these trials indicates that IV treatment produces a highly significant (22%±5%, (P<0.001) reduction in the odds of death, an even larger reduction in the odds of reinfarction, and an absolute frequency of serious adverse effects to set against this that is much smaller than the absolute mortality reduction. The apparent size of the mortality reduction in the IV trials was similar whether anticoagulants were compulsory or optional, whether treatment was in a coronary cure unit or an ordinary ward and, surprisingly, whether treatment began early ( <6 h from onset of symptoms) or late (generally 12–24 h). In addition, there was no evidence that UK was more effective than the less expensive SK, or that, despite their technical complexity, the new IC regimes were more effective than the old IV regimes. Even the IV schedules that have been studied in randomized trials were, however, quite complex, and the IC schedules were far more so. Perhaps partly because of this, none of them is widely used. If so, then some much simpler, and hence more widely practicable, IV SK regimes should be developed and tested. For example, a simple one hour high-dose IV SK infusion, without anticoagulation, will successfully convert virtually all of the available plasminogen into plasmin. But, it may be several years before the net effects on mortality of any more widely practicable IV SK regimes can be agreed unless many of the hospitals that do not wish routinely to use IC regimes or the complex previous IV regimes will collaborate in multicentre randomized trials that can, if necessary, continue rapid intake until some tens of thousands of patients have been randomized, and some thousands of deaths have been observed among the control and treated patients. The same, of course, may be true for any other fibrinolytic regimes (e.g. infusion of tissue plasminogen activator) if their net effects on mortality are comparable to those of IV SK. [ABSTRACT FROM PUBLISHER]

Objective While the use of validity testing in neuropsychological assessments to assist in differentiation between epileptic seizures (ES) and psychogenic non-epileptic events (PNEE) is becoming common, validity considerations regarding symptom self-reporting is seldom examined. This study seeks to add clarity by examining performance validity tests (PVT), and self-report measures of emotional symptoms and daily functioning, in a sample of those with either ES or PNEE. Methods Patients: Consecutive Veteran patients referred to an epilepsy monitoring unit for evaluation of intractable seizures, and subsequently diagnosed with ES (32) or PNEE (75). A fixed battery of psychological (Beck Depression Inventory-II, Patient Competency Rating Scale, Quality of Life in Epilepsy) and PVT (Test of Memory Malinger, Word Memory Test) measures were administered as part of a broader neuropsychological assessment. Patients were classified by both their diagnostic, and PVT pass/fail, statuses (PNEEpass, PNEEfail, & ESpass – ESfail was too small to analyze). Results PNEE reported more severe symptoms/impairments than ES (each p <.01) when ignoring PVT results. Importantly, when PVTs were considered, PNEEfail reported worse symptoms/impairments than PNEEpass (each p <.01), and PNEEpass and ESpass did not differ on emotional distress (p =.07). Conclusions Those with PNEE who fail PVTs report worse psychological distress and functional abilities than both those who pass and those with ES. This is likely due to symptom exaggeration. Validity testing should thus be considered a crucial component of assessment of these individuals: if invalid self-reporting is not accounted for, clinicians put themselves at risk for coming to faulty conclusions while more parsimonious explanations are available. [ABSTRACT FROM AUTHOR]

A case of melanosis coli in a girl of 4 years is described. The condition is usually considered a disease of the aging bowel. In this case there was a history of constipation, and anthracene abuse. [ABSTRACT FROM PUBLISHER]

This is a study of the use of myocutaneous flaps by general surgeons in a district general hospital over a 5 year period, and shows that such work can be satisfactorily performed by general surgeons. [ABSTRACT FROM PUBLISHER]

Extended abstract of a paper presented at Microscopy and Microanalysis 2010 in Portland, Oregon, USA, August 1 – August 5, 2010. [ABSTRACT FROM PUBLISHER]

A case of persistent tricuspid incompetence due to acute myocardial infarction is described. Review of the literature has revealed no similar case. [ABSTRACT FROM PUBLISHER]

OBJECTIVES: The present study examined, prospectively and within the context of stress experienced in the natural environment, whether situational control served as a mediator between perceived social support and caregiver's mood. METHODS: Data came from baseline assessments of individuals participating in health promotion interventions for women caregivers. Participants were 49 female caregivers of dementia patients who monitored their own acute psychological states during the day. RESULTS: Results revealed that although the occurrence of a situational stressor increased negative mood, greater perceived support reduced the detrimental impact of a stressor on negative mood. Moreover, path analyses revealed that changes in situational control partially mediated the relationship between perceived support and stress-induced negative mood changes. However, changes in control did not serve as a mediator in analyses focused on happiness. DISCUSSION: Results suggest that caregivers with greater perceived support were less emotionally reactive to stress occurring in their natural environments because of, in part, sustained or increased situational control. [ABSTRACT FROM AUTHOR]