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This paper explores the potential of collaborative group facilitation between therapists and peer workers in mental health. A case study of co-practice between a music therapist and a peer worker is used to illustrate how lived experience expertise can enrich and complement therapeutic groups. The paper aims to begin a discussion around collaborative group facilitation within mental health practice and to advocate for continued development of collaborative practice between peer workers and therapists. Experiences of collaboration are explored through the case study provided using a synthesis of the authors' reflections and dialogue. The importance of role negotiation, role definition, and open communication around changing roles and boundaries are discussed as key considerations for beginning collaborations, as well as the establishment and maintenance of a foundation of trust and support within the working relationship.

Limited evidence supports the use of early endpoints to evaluate the success of initial treatment of extranodal NK/T-cell lymphoma (ENKTCL) in the modern era. We aim to analyze progression-free survival at 24 months (PFS24) and subsequent overall survival (OS) in a large-scale multicenter cohort of patients. 1790 patients were included from the China Lymphoma Collaborative Group (CLCG) database. Subsequent OS was defined from the time of PFS24 or progression within 24 months to death. OS was compared with age- and sex-matched general Chinese population using expected survival and standardized mortality ratio (SMR). Patients who did not achieve PFS24 had a median OS of 5.3 months after progression, with 5-year OS rate of 19.2% and the SMR of 71.4 (95% CI, 62.9–81.1). In contrast, 74% patients achieved PFS24, and the SMR after achieving PFS24 was 1.77 (95% CI, 1.34–2.34). The observed OS rate after PFS24 versus expected OS rate at 5 years was 92.2% versus 94.3%. Similarly, superior outcomes following PFS24 were observed in early-stage patients (5-year OS rate, 92.9%). Patients achieving PFS24 had excellent outcome, whereas patients exhibiting earlier progression had a poor survival. These marked differences suggest that PFS24 may be used for study design and risk stratification in ENKTCL.

The aim of this study is to explore learners’ intention to return to the electronic environment through the use of wikipages. The survey is based on students’ participation in a collaborative group project over a one semester course on business information systems. A research model based on the extended Technology Acceptance Model (TAM) has been proposed to investigate what factors will influence learners’ continuance participation in the electronic learning environment. 75% of students returned the questionnaire and the data analysis results based on the extended TAM Shows that the learners’ intention to return to the electronic learning environment was highly associated with their attitude towards the electronic learning tool and the affection associated with the tool.

In 2019, the Lewy Body Dementia Association formed an Industry Advisory Council to bring together a collaborative group of stakeholders with the goal of accelerating clinical research into Lewy body dementia treatments. At the second annual meeting of the Industry Advisory Council, held virtually on June 18, 2020, the key members presented ongoing and planned efforts toward the council’s goals. The meeting also featured a discussion about the effects of the COVID-19 pandemic on Lewy body dementia clinical research, lessons learned from that experience, and how those lessons can be applied to the design and conduct of future clinical trials. This report provides a brief summary of the meeting proceedings with a focus on efforts to improve and adapt future Lewy body dementia clinical research.

Group awareness tools (GATs) are used to enhance awareness among students in online collaborative settings. GATs display awareness information of group processes, so students have a shared understanding of the collaboration. They also encourage students to share their opinions regarding their group processes, which externalizes unspoken awareness information and facilitates group regulation activities. The current study observed how students generated awareness information when being guided by a GAT. The primary aim of the study was to investigate the contents of student-generated awareness information collected from the evaluations of group processes and reflections about the collaboration process. A case study, drawing upon both qualitative and quantitative data, was conducted in the study. The results suggested the validity of student-generated awareness information, and its application in evaluating collaborative group processes. Students’ reflections also identified successful as well as disadvantageous aspects of group processes in three themes: communication, efficient work processes, and commitment. Overall, the findings suggested that student-generated awareness information can reveal the real status of collaborative group process. Successful and disadvantageous aspects of group processes were discussed from the students’ perspectives.

Introduction The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) randomized controlled trial (RCT) was the first study to prospectively enroll and randomize orthopedic oncology patients in multiple centers internationally. The objective of this study was to describe recruitment patterns, to examine the differences in enrollment across different PARITY sites, and to identify variables associated with differing levels of recruitment. Methods Data from this study was obtained from the PARITY trial Methods Center and records of correspondence between the Methods Center and recruiting sites. We performed descriptive statistics to report the recruitment patterns over time. We compared recruitment, time to set up, and time to enroll the first patient between North American and international sites, private and public healthcare models, and the presence or absence of research personnel. Two-tailed non-paired t tests were performed to test average monthly recruitment rates between groups. Results A total of 602 patients from 36 North American and 12 international sites were recruited from 2013 to 2019. North American sites were able to become fully enrollment-ready at an average of 19.5 months and international sites at an average of 27 months. Once enrolling, international sites were able to enroll 0.59 patients per/month whereas North American sites averaged a monthly recruitment rate of 0.2 patients/month once enrolling. Sites with research personnel reached enrollment-ready status at an average of 19.3 months and sites without research support at an average of 30.3 months. Once enrolling, the recruitment rate was 0.28 patients/month and 0.2 patients per month for sites with and without research support, respectively. Publicly funded sites had a monthly enrollment of 0.4 patients/month whereas privately funded sites had a monthly enrollment rate of 0.17 patients/month. Conclusions As a collaborative group, the PARITY investigators increased the pace of recruitment throughout the trial, likely by increasing the number of active sites. The longer time to start-up at international sites may be due to the complex governing regulations of pharmaceutical trials. Nevertheless, international sites should be considered essential as they recruited significantly more patients per month once active. The absence of research support personnel may lead to delays in the time to start-up. The results of the current study will provide guidance for choosing which sites to recruit for participation in future collaborative clinical trials in orthopedic oncology and other surgical specialties. Trial registration ClinicalTrials.gov NCT01479283. Prospectively registered on November 24, 2011

Background Recent advances in radiotherapy techniques have allowed ablative doses to be safely delivered to inoperable liver tumors. In this setting, proton beam radiotherapy (PBT) provides the means to escalate radiation dose to the target volume while sparing the uninvolved liver. This study evaluated the safety and efficacy of hypofractionated PBT for liver tumors, predominantly hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). Methods We evaluated the prospective registry of the Proton Collaborative Group for patients undergoing definitive PBT for liver tumors. Demographic, clinicopathologic, toxicity, and dosimetry information were compiled. Results To date, 63 patients have been treated at 9 institutions between 2013 and 2019. Thirty (48%) had HCC and 25 (40%) had ICC. The median dose and biological equivalent dose (BED) delivered was 58.05 GyE (range 32.5–75) and 80.5 GyE (range 53.6–100), respectively. The median mean liver BED was 13.9 GyE. Three (4.8%) patients experienced at least one grade ≥ 3 toxicity. With median follow-up of 5.1 months (range 0.1–40.8), the local control (LC) rate at 1 year was 91.2% for HCC and 90.9% for ICC. The 1-year LC was significantly higher (95.7%) for patients receiving BED greater than 75.2 GyE than for patients receiving BED of 75.2 GyE or lower (84.6%, p = 0.029). The overall survival rate at 1 year was 65.6% for HCC and 81.8% for ICC. Conclusions Hypofractionated PBT results in excellent LC, sparing of the uninvolved liver, and low toxicity, even in the setting of dose-escalation. Higher dose correlates with improved LC, highlighting the importance of PBT especially in patients with recurrent or bulky disease.

SummaryShamash and colleagues describe how their supra-regional germ cell tumour multidisciplinary team achieved standardisation of treatment and improved survival. We discuss some of the insights the study provides into prioritising complex patients, streamlining processes, the use of telemedicine, and the centrality of good data collection to continuous quality improvement.

This paper focusses on how researching is done through reflections about, or at a meta-level to, the practice over time of an enactivist mathematics education researcher. How are the key concepts of enactivist theory (ZDM Mathematics Education, doi: 10.1007/s11858-014-0634-7 , 2015) applied? This paper begins by giving an autobiographical account of the author’s engagement with enactivist ideas and the development of enactivist research projects. The rest of the paper then discusses principles of the design of enactivist followed by four themes of learning, observing, interviewing and find-ing(s). The spelling, find-ing(s), draws attention to the findings of enactivist research being processes not objects. In the case of the collaborative research group used as an exemplar throughout the paper, for instance, the find-ing(s) shed light onto the journeys of professional development travelled by the members of the group as they develop their teaching.

Collaborative inhibition refers to when people working together remember less than their predicted potential. The most common explanation for this effect is the retrieval-disruption hypothesis during collaborative recall. However, several recent studies have obtained conflicting results concerning this hypothesis. In the current study, item similarity was manipulated in Experiment 1 by requiring participants to study overlapping or non-overlapping unrelated wordlists. The unstructured instructions were then manipulated during a turn-taking recall task between conditions. The results showed that collaborative inhibition occurred for both overlapping and non-overlapping conditions. Subsequently, response competition during collaborative recall, in addition to item similarity, was manipulated in Experiment 2, and the results showed that when collaborative group members were instructed to recall in turn and monitor their partner’s recall (the medium- and high-response-competition conditions), collaborative inhibition occurred. However, no such effect was shown when collaborative group members were instructed not to communicate with each other, but to simply recall in turn while in a group (low-response-competition condition). Together, these results suggest that the conflicts between the findings of the aforementioned studies were probably caused by differing instructions, which induced response competition in collaborative settings. Aside from retrieval-disruption, other possible mechanisms underlying collaborative inhibition were also discussed.

The papers in this issue present innovative approaches to analyzing the roles of individuals in small-group collaborations supported by computer technologies. In reading these articles, you may find it interesting to consider the ways in which their methods conceptualize the relationship of collaborative group learning to the roles of its individual participants. Taken together, these studies envision and explore a space of possible strategies for analyzing the multi-level phenomena of collaborative learning, sometimes coding utterances of individuals and at other times characterizing group trajectories. They each push the boundaries of CSCL research in various ways. Although they can be read as primarily proposing analytic procedures, they also contribute to theory and technology. Perhaps highlighting their nuanced stances on the issue of unit-of-analysis in probing learning data can help to reveal their contributions to the advance of CSCL as a vision and as a field. It is often difficult to determine where overall progress is being made in CSCL research and practice. Statistical indicators in comparative reviews tend to be overwhelmed by the diversity of theories and methodologies applied in research and by the variety of pedagogies adopted in practice. In both researcher and teacher communities, there are new participants entering with training in traditional disciplines as well as long-time participants still working within old paradigms. Folk theories derived from common sense linger on and may obscure the visibility of innovations in scientific theory, methodology or pedagogy. Folk theories of minds and learning still influence classroom practice. According to Bruner (1996) and Bereiter (2002), teachers’ pedagogy is often deeply affected by everyday intuitive Intern. J. Comput.-Support. Collab. Learn. (2014) 9:365–370 DOI 10.1007/s11412-014-9204-9

The paper assumes a theoretical-empirical interface exists between top-down (structural concepts) and bottom-up (cognitive mechanisms and socio-cultural interactions) approaches to collective memory. Both deal with collaborative group accounts, material culture such as artefacts and representational re-descriptive technologies. Anthropology has shown how communal life was based on story telling, rituals, artefacts, routine practices constitutive of daily life representational re-descriptions and the reproduction of implicit and explicit emotional normative belief systems embedded in kinship and social network relations.

This paper reports on a self-study undertaken by the author to better understand the educational practices of scaffolding in pre-service teachers’ collaborative group work. The method included student interviews, conversations with a critical friend, and the researcher’s diary. The self-study allowed for fine-tuning theoretical understanding and practical implementation of scaffolding in students’ small group work. While the study confirmed my expectations that facilitation of the students’ group work was useful for them to understand content and develop collaborative skills, the students’ emphasis on the emotional side of scaffolding was a surprising find. It was also interesting to note that the needs of emotional scaffolding in mature age students were different to those of high school graduates, which related to their self-confidence and their understanding of the role of the lecturer in assisting with their academic work.

This paper employs bibliometric methods to observe collaboration patterns of scientific publications in biotechnology, information and computer technology, future energy, and nanotechnology among different institutions in Taiwan. The results show primary domestic and international collaborative patterns, the effect of collaborative papers on the world-wide average, collaborative networks, and the distribution of institutions on global map. The findings suggest that domestic collaboration in each area is higher in proportion than international collaboration. Biotechnology leads in both domestic and international collaborative percentage. Among cooperative benchmarking countries, the US and China are the main partners. Collaboration among research institutes and universities is the most frequent collaborative pattern in each area except biotechnology, which tends to occur between hospitals and universities. On average, international collaborative papers tend to have greater effect, except in nanotechnology. Academia Sinica collaborated frequently with foreign institutes in each research field. A further analysis on how each collaborative group forms is recommended, especially collaboration among the Triple-Helix relationships.

In this article, we present a re-framing of teacher development that derives from our convictions regarding the enactive approach to cognition and the biological basis of being. We firstly set out our enactivist stance and then distinguish our approach to teacher development from others in the mathematics education literature. We show how a way of working that develops expertise runs through all mathematics education courses at the University of Bristol, and distil key principles for running collaborative groups of teachers. We exemplify these principles further through analysis of one group that met over 2 years as part of a research project focused on the work of Gattegno. We provide evidence for the effectiveness of the group in terms of teacher development. We conclude by arguing that the way of working in this group cannot be separated from the history of interaction of participants.

Two experiments tested the effects of encoding manipulations on group recall and on the magnitude of collaborative inhibition. Collaborative inhibition refers to the phenomenon where by a collaborative group recalls less than do the same number of individuals who work alone and then have their nonredundant responses pooled. Participants studied categorized word lists once or three times (Experiment 1) or under conditions of full versus divided attention (Experiment 2). Study repetition both improved retrieval organization in recall and attenuated collaborative inhibition, and divided attention encoding both reduced retrieval organization in recall and eliminated collaborative inhibition. These experiments are the first to focus on encoding variables and to show that collaborative inhibition can vary as a function of encoding manipulations.

Findings from the 2005 Early Breast Cancer Trialists Collaborative Group overview of the effects of more extensive local therapy on breast cancer survival provide strong evidence supporting a causal link between local-regional cancer control and subsequent breast cancer survival. This article reviews the evidence supporting this link and discusses both the conditions that must be met for improved local-regional therapy to confer a survival benefit and the potential magnitude of the survival benefit from improved local-regional therapy.

The US Food and Drug Administration-led Critical Path Initiative, launched in 2004, has resulted in an array of activities focused on the sciences that support the development of human medical products.(1) These activities include the development of new scientific tools, such as in vitro testing, qualified biomarkers of drug safety, and innovative new methods in study design and data analysis.(2) As a result of the Critical Path Initiative and enormous advances in the field of membrane transporters, the International Transporter Consortium was formed.

Some ideas coming from Multi Criteria Decision Aid are here extended to group decision. We present a logical model in order to reflect the degree of truth of the following predicate “group G considers that option x is at least as good as y.” The proposal considers the strength of the majority using its number and the intensity of its preference, and it also acknowledges the importance of the minorities of a certain numerical significance that manifest an intense disagreement with the predicate of the outranking. The effects of the “majority dictatorship” are restricted. Since it considers simultaneously the strength of the majority, the importance of unhappy minorities, and the intensity of the preference/opposition, this model exhibits desirable qualities of the classic methods by Condorcet and Borda. This model can be used to solve problems regarding selection, ranking, classification, and sorting. Various examples are given, which show the quality of the solutions that were obtained.

The Adjuvant Colon Cancer Endpoints (ACCENT) Group is an international, collaborative, individual-patient data analysis now including 20,898 patients enrolled in 18 adjuvant therapy trials for resected stage II and stage III colon cancer, spanning the years 1977 to 1999. This article discusses the proceedings published and presented since the inception of the ACCENT Group in 2003, which notably include the evaluation of 3-year disease-free survival as an acceptable end point in adjuvant studies, particularly in stage III colon cancer, and an improved understanding of the time-dependent patterns of failure and benefit of adjuvant therapy.

Technology should support and enhanceour ability towork, learn, andmakedecisions. These activities naturally involve collaboration and communication, yet the personal computers we use to carry them out are traditionally individualized. This special issue addresses the design and extension of adaptive individual user technology to support complex collaborative processes involving information sharing, communication, and collaborative group work. Recent integration efforts have successfully combined collaborative and communication services with multi-user tools to create environments that enable individuals to communicate and share information. Examples of such environments include computer-supported collaborative workspaces, distributed learning management systems, online communities of interest, and peer-to-peer systems. While these environments enable collaboration, they provide no guarantee that timely productive collaboration occurs and proceeds effectively. Such assurance requires more substantial effort in understanding how the collaboration process is shaped by the individuals’ characteristics, behaviors, and relationships, and how to support their dynamic interaction. Models of groups, collaboration, and communities collect and structure the

This paper tracks the individual development of metacognition in two five year old children over an academic year as they engage in a cognitive acceleration through science education programme CASE@KS1. Using qualitative analysis and case study methods it demonstrates how collaborative group work with small children impacts on the development of their individual metacognitive processing. Important variables that facilitate or hinder this development are teased out and relationships between the groups and the individual are analysed. Difficulties with the concept of metacognition and in particular how to assess and measure it are discussed. A framework of analysis based on verbal interactions is developed from the early theories of metacognition and this is combined with an in-depth grounded analysis. This approach provides insight into what we can mean when we speak of young children being metacognitive.

In this paper we present a novel approach to fault-tolerant group membership for use predominantly in collaborative computing environments. As an exemplar, we use the Collaborative Computing Transport Layer which offers reliable atomic multicast capabilities for use in collaborative environments such as the Collaborative Computing Frameworks (CCF). Specific design goals of the approach are the elimination of processing overhead due to heartbeats, support for partial failures and extensibility. These goals are satisfied in an approach, termed Collaborative Group Membership (CGM), which uses a quiescent weak failure detector and two election based algorithms to form consensus on the membership of a failing group. Failure detection operates through a reliable multicast primitive and as such eliminates the need for explicit keep-alive packets; thus in a failure free environment, CGM imposes no overhead.

To study the epidemiology of childhood-onset (Type I) insulin-dependent diabetes mellitus in Europe, the EURODIAB collaborative group in 1988 established prospective, geographically-defined registers of all children diagnosed with Type I diabetes under 15 years of age. This report is based on 24,423 children, registered by 36 centres, with complete participation during the period 1989-1998 and representing most European countries with a population coverage of approximately 20 million children.Multiple sources of ascertainment were used to validate the level of ascertainment. Trends in Type I diabetes incidence during the period were analysed using Poisson regression with the results from the 36 centres pooled into nine regions.The standardised average annual incidence rate of Type I diabetes varied more than tenfold between centres. Overall, the annual increase in incidence was 3.2% (95%-CI: 2.7%, 3.7%), being highest for children in the 0-4-year age-group 4.8% (3.8%, 5.9%) and lowest for children in the 10-14-year age group 2.1 % (1.4%, 2.8%). However, the absolute increases in Type I diabetes were roughly similar in the three age-groups of 0-4, 5-9 and 10-14 years. Central Eastern Europe showed the highest increase whereas Sardinia and Northern Europe (except Finland) showed no evidence of an increase. For all age-groups relatively fewer cases had disease onset during the summer months, especially the 10-14-year age-group.The extremely large range of incidence rates within Europe has been confirmed. The incidence rate is generally increasing but is more pronounced in some regions than in others. Seasonality at disease onset is apparent even in the youngest age-group.

This practice report profiles the author's use of collaborative writing techniques in a dual-diagnosis drug and alcohol treatment program. Examples of typical patient-generated collaborative poems are provided. The author concludes that collaborative group poetry, when effectively facilitated, can generate a meaningful process-discussion toward values clarification. Furthermore, group-writing exercises can be converted to individual writing exercises, enabling patients to continue the process of values clarification through poetry written outside of the group setting.

On the basis of an Early Breast Cancer Trialists' Collaborative Group meta-analysis, it has been suggested that the controversy over post-mastectomy radiotherapy (PMRT) for women with 1–3 involved lymph nodes should end. However, the meta-analysis lacks appropriate sample size, stratification, and uses outdated systemic regimens. Thus, the debate should continue.

Objective: Carvedilol, a β-adrenoceptor blocking agent with additional α1-adrenoceptor blocking properties, has been shown to improve left ventricular function in chronic heart failure (CHF). However, its effect on mortality has recently been the subject of controversial discussion. The aim of this meta-analysis is to review the data on mortality from two large study programs (the US Carvedilol Heart Failure Study and the study by the Australia/New Zealand Heart Failure Research Collaborative Group) on additional carvedilol treatment in CHF standard therapy and to analyse the design and limitations of the individual studies.

Since 1994, we have been involved in the design and use of a series of WWWhbased environments to support collaborative group work for students in a technical university in The Netherlands. These environments, and the course rehdesign that accompanies each new environment, began in April 1994 and continue to the present (March 1998). What are the major issues emerging from this stream of experiences? What are the major lessons we have learned about the design and deployment of WWWhbased environments to support collaborative learning in project groups in higher education? How has HCI (humanhcomputer interaction) research informed our work? These questions will be addressed in this paper. One conclusion is that HCI research needs to become more focused on supporting HHD (humanhhuman dialogue) than on humanh computer interaction in order to better support collaborative learning in higher education. © IFIP, published by Kluwer Academic Publishers

Earlier we reported (Basden, Basden, Bryner, ...Thomas, 1997) that, in comparison with nominal groups (three people tested individually), three-person collaborative groups recalled fewer presented words but intruded more nonpresented words. In the present research, Experiment 1 showed that when presented words were associatively related to critical nonpresented words, collaboration inhibited recall of presented words but did not influence recall of critical nonpresented words. Experiment 2 showed that with categorized lists, recall of high taxonomic frequency critical nonpresented words was greater for collaborative groups than for nominal groups. Collaboration did not inhibit recall of presented words, presumably because guessing supplemented recall in collaborative groups. Greater false recall in collaborative than in nominal groups appears to result from activation of superordinate-to-item associations rather than item-to-item associations.

The National Institute of General Medical Sciences of the National Institutes of Health recently established a collaborative group of scientists, called the Pharmacogenetics Research Network. Central to the network is a shared, state-of-the-art data repository, the Pharmacogenetics Knowledge Base (PharmGKB), which is housed at Stanford University. Network investigators deposit pharmacogenetic data into PharmGKB, after all individually identifying information has been removed. Contents of PharmGKB will be freely accessible to the scientific community, with the goal of forging new links between gene variation and drug response. An open scientific meeting was held recently to introduce the research community to the network and to invite academic and industry-based researchers to deposit data into PharmGKB. Featured at the meeting were summaries of research progress to date, as well as discussions of issues intimately related to pharmacogenetics research, namely ethics and relations with the biotechnology and pharmaceutical industries.

The International Collaborative Group on Hereditary NonPolyposis Colorectal Cancer (ICG-HNPCC) is 14 years old. It was conceived in Jerusalem in August 1989 during the 2nd International Conference on Gastrointestinal Cancer organized by Paul Rozen. During this meeting, Giuseppe Cristofaro of Brindisi, Italy, proposed to Henry T. Lynch (Figure 1) that they should form a group of interested colleagues throughout the world to study HNPCC and to form multiple collaborations in the interest of investigating the genetic, clinical and pathologic aspects of the disease. Henry T. Lynch, Jane Lynch, Patrick Lynch, Jukka-Pekka Mecklin, Giuseppe Cristofaro, Jim St. John and Hans Vasen then met informally and agreed that this idea was quite logical given the growing interest in HNPCC. We reasoned that the syndrome’s genotypic and phenotypic heterogeneity would require the study of large numbers of families with detailed pedigrees. These studies would involve meticulous clinical histories, molecular genetics, pathology, surveillance, and management concerns, as well as genetic counseling, in order to grasp a better understanding of the disorder and, most importantly, to benefit the high risk patients and families. Further discussion and announcement about the establishment of the ICG-HNPCC took place in November 1989 at a plenary session of an International Meeting on Colorectal Cancer sponsored by Joji Utsunomiya in Kobe, Japan (see Figure 2).

This study examined the long-term stability of Type A behavior pattern in the Western Collaborative Group Study for 1180 surviving participants in a 27-year follow-up examination during 1986-1987. Subjects were readministered the Structured Interview (SI), originally developed for this study and first administered at intake in 1960-1961. Subjects were also given the Jenkins Activity Survey (JAS) and were asked to evaluate their behaviors currently and in the past using two short descriptions of Type A and Type B behaviors. Analyses of changes in global SI ratings, JAS score, and self-ratings showed no relationships between self-perceived changes reported in questionnaires and observed changes when assessed by the SI. Using the SI ratings, 61% of subjects retained their initial classification and 39% of subjects were rated differently, with a higher percentage of those originally typed B being rerated as A than A being rerated as B. Type B subjects rerated as A were significantly younger, retired earlier, reported better health, and were less likely to have been in a managerial or professional position than the subjects who changed from A to B.

This paper reports the results of a study organized by the Istituto Superiore di Sanità (Rome, Italy) and carried out in collaboration with several national laboratories. Its aim was to ascertain whether diagnostic kits for detecting anti-HIV antibodies in human serum can also be used to detect the same antibodies in human immunoglobulins. Thirty-three lots of immunoglobulins supplied by six pharmaceutical companies present in Italy were examined using different procedures. On the basis of the results of this study it can be concluded that i. anti-HIV antibodies can be detected in immunoglobulins by means of commercial reagents; ii. a preliminary dilution of immunoglobulin samples should not be made; iii. Western blot method appears to be the 'reference' test; however, competitive EIA tests are equally valuable if a negative control made up of anti-HIV-negative Igs is employed; iv. Igs examination for anti-HIV antibody represents an indirect control on a correct donors' screening procedure.

The Collaborative Group on Hormonal Factors in Breast Cancer has brought together and reanalysed about 90% of the worldwide epidemiological evidence on the relation between risk of breast cancer and use of hormone replacement therapy (HRT). Data on 52,705 women with breast cancer and 108,411 women without breast cancer from 51 studies in 21 countries were collected, checked and analysed centrally. Among current users of HRT or those who ceased use 1–4 years previously, the relative risk of having breast cancer diagnosed increased by a factor of 1.023 (95% confidence interval [CI] 1.011–1.036; 2P = 0.002) for each year of use; the relative risk was 1.35 (95% CI 1.21–1.49; 2P = 0.00001) for women who had used HRT for 5 years or longer (average duration of use in this group 11 years). Five or more years after cessation of HRT use, there was no significant excess of breast cancer overall or in relation to duration of use. There was no marked variation in the results according to hormonal type or dose but little information was available about long durations of use of any specific preparation. Cancers diagnosed in women who had ever used HRT tended to be less advanced clinically than those diagnosed in never-users. In North America and Europe the cumulative incidence of breast cancer between the ages of 50 and 70 in never-users of HRT is about 45 per 1,000 women. The cumulative excess numbers of breast cancers diagnosed between these ages per 1,000 women who began use of HRT at age 50 and used it for 5, 10 and 15 years respectively, are estimated to be 2 (95% CI 1–3), 6 (95% CI 3–9) and 12 (95% CI 5–20). Whether HRT affects mortality from breast cancer is not known.

Patients with type 2 diabetes mellitus who have severe hypoglycemia are at increased risk of major macrovascular and microvascular events and death, report researchers from the ADVANCE Collaborative Group.

Sir The conclusion of the Collaborative Group on Hormonal Factors in Breast Cancer (Collaborative Group on Hormonal Factors and Breast Cancer, 2002) that cigarette smoking has little or no independent effect on the risk of developing breast cancer may not be warranted. Several recent studies of breast cancer risk suggest that a positive association with smoking may emerge 30–40 years after commencement (Terry and Rohan, 2002), particularly among chronic heavy smokers. There is also evidence to suggest that smoking prior to a first full-term pregnancy may be an important exposure (Russo et al, 1982; Band et al, 2002; Terry and Rohan, 2002). In addition, an increasing number of studies suggest that a possitive association between smoking and breast cancer risk may be stronger among (or limited to) women with certain genotypes (Terry and Rohan, 2002). To what extent the Collaborative Group's examination of smoking as ‘ever vs never’ or ‘current vs never’ could account for such possible time-dependent or genetic associations is unclear. The possibility of an association between cigarette smoking and breast cancer risk among certain groups of women should not be ruled out based solely on the Collaborative Group's analyses.

The collaborative group chemotherapy studies of the National Bladder Cancer Project are summarized with regard to intravesical and systemic agents. The necessity for longitudinal observations and data collection in all cases of bladder cancer, and not just those receiving chemotherapy, is also stressed.