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The mechanisms responsible for sediment resuspension and transport by nonlinear internal waves (NLIWs) remain poorly understood largely due to a dearth of detailed field measurements. We present novel observations of the turbulent benthic boundary‐layer (BBL) beneath trains of NLIWs of depression in the ocean. At the 250 m deep, low‐gradient (<0.2%) continental shelf site the BBL was near well mixed to an average height of about 10 m above the bottom. Above this bottom mixing‐layer, stratification constrained the extent of vertical sediment transport. NLIWs drove sediment transport by a combination of bed‐stress intensification, turbulent transport, and a vertical pumping mechanism associated with the compression and subsequent expansion of the mixing‐layer. There was no evidence that the observed dynamics were associated with a global instability, as proposed in previous studies. The results have implications for cross‐shelf mass transport and highlight future challenges for measuring and modeling boundary‐layer processes within shelf seas. Plain Language Summary: With wave heights reaching 100 m, nonlinear internal waves generate some of the strongest ocean currents on the world's continental shelves. These extreme currents penetrate down to the seabed, where they greatly enhance sediment resuspension, eject sediments high into the water column, and generate some of the strongest forces on subsea engineered structures. These waves likely redistribute settled biological material, dense plastics, and sediment‐sorbed hydrocarbons on the continental shelf. Despite their significance, the details of these processes remain inadequately understood, owing to the challenges of detailed near‐bed observation and equally the challenges of configuring laboratory and computational experiments to be representative of ocean conditions. We present new detailed near‐bed observations under 70 m nonlinear internal waves in the ocean. The observations (1) show how these waves enhanced resuspension and transport of sediments; (2) identify a potential pathway for transport of terrestrial material from the continent toward the abyss; and (3) highlight some future challenges for modeling these processes in computer simulations of the ocean. Key Points: Novel observations of the oceanic benthic boundary‐layer structure provide unique insight into sediment transport under NLIWs of depressionSediment transport is explained by strong turbulence and pumping by the NLIW without recourse to complex instability mechanismsThe findings have implications for cross‐shelf transport, RANS ocean modeling, and DNS/LES modeling of NLIWs in the ocean [ABSTRACT FROM AUTHOR]

Non‐linear internal waves (NLIW) are important to processes such as heat transfer, nutrient replenishment and sediment transport on continental shelves. Our unique field observations of shoaling NLIW of elevation revealed a variety of different wave shapes, varying from relatively symmetric waves, to waves with either steepened leading‐ or trailing‐faces; many had evidence of trapped cores. The wave shape was related to the position of maximum density overturns and diapycnal mixing. We observed both shear (where sheared currents overcome the stabilizing effects of stratification) and convective (where the local velocity exceeds the wave propagation speed) instabilities. The elevated diapycnal mixing (>10−3 m2s−1) and heat flux (>500 Wm−2) were predominantly local to the NLIW of elevation packets, and were transported onshore 10s kilometers with the wave packets. We demonstrate that wave steepness may be a useful bulk property for the parameterization of wave‐averaged diapycnal heat flux. Plain Language Summary: Predicting the distribution of constituents such as nutrients, heat, sediment and pollutants on the continental shelf is key to processes such as: the safe operation of offshore infrastructure; understanding the variation in primary productivity; the prediction of marine heat waves; and environmental impact assessments of new activities. Non‐linear internal waves, waves that travel within the stratified water column, are likely to have a significant impact on constituent transport; however, they are poorly understood. Here we present unique observations that quantify the properties of a class of these nonlinear internal waves, known as waves of elevation. These waves can break in a similar way to surface waves at the beach, leading to dramatic increases in turbulent mixing over horizontal length scales of 10s kilometers. We have used our observations to define the amount of vertical heat transport induced by the breaking waves as a function of wave steepness. The vertical heat transport can be used as a proxy to estimate the vertical nutrient transport. This study has made a step change in quantifying the impact of NLIW of elevation on vertical transport. Key Points: Nonlinear internal waves of elevation can form both convective and shear instabilities, resulting in enhanced diapycnal mixing and heat fluxBreaking continues as the nonlinear waves propagate onshore, influencing diapycnal mixing and vertical heat flux over 10s of kilometersThe elevated heat flux associated with the nonlinear internal waves of elevation increases with the wave steepness [ABSTRACT FROM AUTHOR]

We describe a framework for the simultaneous estimation of model parameters in a partial differential equation using sparse observations. Markov Chain Monte Carlo sampling is used in a Bayesian framework to estimate posterior probability distributions for each parameter. We describe the necessary components of this approach and its broad potential for application in models of unsteady processes. The framework is applied to three case studies, of increasing complexity, from the field of cohesive sediment transport. We demonstrate that the framework can be used to recover posterior distributions for all parameters of interest and the results agree well with independent estimates (where available). We also demonstrate how the framework can be used to compare different model parameterizations and provide information on the covariance between model parameters. Plain Language Summary: We describe a framework for the simultaneous estimation of multiple unobserved parameters by combining observations of a tracer with a numerical model. This framework uses Bayesian inference techniques established in statistical literature to estimate the unobserved parameters of interest used in the model with uncertainty quantification. We explain the key components of this framework in simple terms to encourage its use for analyzing other unsteady processes and performing quantitative inference on parameters that are difficult or impossible to measure directly. We then demonstrate the framework's efficacy by applying it to three case studies from the field of cohesive sediment transport that all use the transport equation (advection‐diffusion). Inferred parameter values show good agreement with independent estimates, where available. Key Points: Probabilistic framework to estimate unobserved erosion model parameters using sparse measurements collected above the seabedGeneral approach can be updated with any model parameterization and quantitatively comparedThe framework is applicable to many similar data sets with both unsteady or quasi‐steady forcing and response [ABSTRACT FROM AUTHOR]

Background: Psychological illness occurring in association with hyperemesis gravidarum (HG) has been widely reported.Objective: To determine if there is a higher incidence of psychological morbidity in women with HG compared with women without significant nausea and vomiting in pregnancy.Search Strategy: PubMed, MEDLINE, Embase and PsychINFO were searched up to September 2015.Selection Criteria: Articles referring to psychological morbidity in relation to HG. For meta-analysis case-control studies using numerical scales to compare psychological symptoms.Data Collection and Analysis: Articles were independently assessed for inclusion by two reviewers and methodology was appraised using the Newcastle Ottawa Scale. Comparison was made using the standard mean difference (SMD) in symptom scale scores.Main Results: In all, 59 articles were included in the systematic review, 12 of these were used in the meta-analysis. Meta-analysis of depression scale scores demonstrated a very large effect with statistically significantly higher depression scale scores in women with HG (SMD 1.22; 95% CI 0.80-1.64; P ≤ 0.01) compared with controls. Meta-analysis of anxiety scores demonstrated a large effect with statistically significantly higher anxiety disorder scale scores in women with HG (SMD 0.86; 95% CI 0.53-1.19; P ≤ 0.01). In both analyses significant heterogeneity was identified (depression and HG I2  = 94%, P ≤ 0.01; anxiety and HG I2  = 84%, P = 0.02).Conclusions: Our systematic review and meta-analysis have shown a significantly increased frequency of depression and anxiety in women with HG. The findings should prompt service development for women with HG that includes provision of psychological care and support.Tweetable Abstract: Meta-analysis demonstrates an increase in #PsychologicalMorbidity in women with #HyperemesisGravidarum. [ABSTRACT FROM AUTHOR]

Objectives: Ectopic pregnancy (EP) is a major high‐risk outcome following a pregnancy of unknown location (PUL) classification. Biochemical markers are used to triage PUL as high vs low risk to guide appropriate follow‐up. The M6 model is currently the best risk‐prediction model. We aimed to update the M6 model and evaluate whether performance can be improved by including clinical factors. Methods: This prospective cohort study recruited consecutive PUL between January 2015 and January 2017 at eight units (Phase 1), with two centers continuing recruitment between January 2017 and March 2021 (Phase 2). Serum samples were collected routinely and sent for β‐human chorionic gonadotropin (β‐hCG) and progesterone measurement. Clinical factors recorded were maternal age, pain score, bleeding score and history of EP. Based on transvaginal ultrasonography and/or biochemical confirmation during follow‐up, PUL were classified subsequently as failed PUL (FPUL), intrauterine pregnancy (IUP) or EP (including persistent PUL (PPUL)). The M6 models with (M6P) and without (M6NP) progesterone were refitted and extended with clinical factors. Model validation was performed using internal–external cross‐validation (IECV) (Phase 1) and temporal external validation (EV) (Phase 2). Missing values were handled using multiple imputation. Results: Overall, 5473 PUL were recruited over both phases. A total of 709 PUL were excluded because maternal age was < 16 years or initial β‐hCG was ≤ 25 IU/L, leaving 4764 (87%) PUL for analysis (2894 in Phase 1 and 1870 in Phase 2). For the refitted M6P model, the area under the receiver‐operating‐characteristics curve (AUC) for EP/PPUL vs IUP/FPUL was 0.89 for IECV and 0.84–0.88 for EV, with respective sensitivities of 94% and 92–93%. For the refitted M6NP model, the AUCs were 0.85 for IECV and 0.82–0.86 for EV, with respective sensitivities of 92% and 93–94%. Calibration performance was good overall, but with heterogeneity between centers. Net Benefit confirmed clinical utility. The change in AUC when M6P was extended to include maternal age, bleeding score and history of EP was between −0.02 and 0.01, depending on center and phase. The corresponding change in AUC when M6NP was extended was between −0.01 and 0.03. At the 5% threshold to define high risk of EP/PPUL, extending M6P altered sensitivity by −0.02 to −0.01, specificity by 0.03 to 0.04 and Net Benefit by −0.005 to 0.006. Extending M6NP altered sensitivity by −0.03 to −0.01, specificity by 0.05 to 0.07 and Net Benefit by −0.005 to 0.006. Conclusions: The updated M6 model offers accurate diagnostic performance, with excellent sensitivity for EP. Adding clinical factors to the model improved performance in some centers, especially when progesterone levels were not suitable or unavailable. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Aim To describe characteristics associated with statin prescribing for the primary prevention of cardiovascular disease in people with newly diagnosed diabetes. Methods Data from the Scottish Care Information-Diabetes Collaboration data set for 2006-2008 were used. This data set contains socio-demographic and prescribing data for over 99% of people with diagnosed diabetes in Scotland. Analyses were conducted on people aged over 40 years diagnosed with Type 1 or Type 2 diabetes between 2006 and 2008 with complete data and no previous history of cardiovascular or statin prescription. Logistic regression was used to calculate odds ratios for statin prescription in the 2 years following diagnosis of diabetes. Results There were 7157 men and 5601 women who met the inclusion criteria, 68% of whom had a statin prescription recorded in the 2 years following diagnosis of diabetes. The proportions receiving statins were lower above 65 years of age in men and 75 years of age in women. People with Type 1 diabetes had lower odds of receiving statins than people with Type 2 diabetes [odds ratio (95% CI) 0.42 (0.29-0.61) for men and 0.48 (0.28-0.81) for women, after adjustment for age, BMI, smoking status, cholesterol level and deprivation]. Higher total cholesterol, BMI and being a current smoker were associated with greater odds of statin prescription. Conclusion Approximately one third of the study population had no record of statin prescription during the 2 years after diagnosis of diabetes. Cardiovascular disease risk reduction opportunities may be missed in some of these people. [ABSTRACT FROM AUTHOR]

During the past decade, there has been a dramatic increase in the number of thoracic surgical procedures carried out in the UK. The current financial climate dictates that more efficient use of resources is necessary to meet escalating demands on healthcare. One potential means to achieve this is through the introduction of enhanced recovery protocols, designed to produce productivity savings by driving reduction in length of stay. These have been promoted by government bodies in a number of surgical specialties, including colorectal, gynaecological and orthopaedic surgery. This review focuses on aspects of peri-operative care that might be incorporated into such a programme for thoracic anaesthesia, for which an enhanced recovery programme has not yet been introduced in the UK, and a review of the literature specific to this area of practice has not been published before. We performed a comprehensive search for published work relating to the peri-operative management and optimisation of patients undergoing thoracic surgery, and divided these into appropriate areas of practice. We have reviewed the specific interventions that may be included in an enhanced recovery programme, including: pre-optimisation; minimising fasting time; thrombo-embolic prophylaxis; choice of anaesthetic and analgesic technique and surgical approach; postoperative rehabilitation; and chest drain management. Using the currently available evidence, the design and implementation of an enhanced recovery programme based on this review in selected patients as a package of care may reduce morbidity and length of hospital stay, thus maximising utilisation of available resources. [ABSTRACT FROM AUTHOR]

Summary 1. We review some of the classic literature on geomorphology and ecology of streams in an effort to examine how theoretical developments in these aquatic sciences have influenced the way fresh flowing waters are classified. Our aim was to provide a historical examination of conceptual developments related to fluvial classification, and to discuss implications for conservation planning and resource management. 2. Periods of conceptual influences can be separated into three overlapping phases each distinguished by theoretical, analytical or technological advances: (i) early Darwinian perspectives; (ii) the quantitative revolution; and, (iii) age of the computer, hierarchy and scale. 3. During the first phase, stream geomorphologists were largely influenced by Darwinian metaphors. The study of stream origin and change through time became more important than the study of stream systems themselves. The idea that streams progress deterministically through successive stages of development seemed to create a veil, most prevalently in North America, that barred analysis of the full scope of variability in these systems for over 50 years. 4. The quantitative revolution brought about many new ideas and developments, including the laws of stream numbers. This period focused on predictive and mechanistic explanations of stream processes, setting the stage for physically based stream classifications that assume that streams can be restored by engineering their physical characteristics. 5. In the most recent 'age of the computer', concepts from the fields of geographic information science and landscape ecology have been incorporated into stream ecology and aquatic classification. This has led to investigations in stream and aquatic ecosystems at hierarchical spatial scales and along different dimensions (upstream/downstream, riparian/floodplain, channel/ground water and through time). Yet, in contrast to terrestrial landscapes, flowing waters are not as easily classified into spatially nested hierarchical regions wherein upper levels can be subdivided into smaller and smaller regions at finer spatial scales. Riverscapes are perhaps best described as directionally nested hierarchies: aquatic elements further downstream cannot be rendered equivalently to elements upstream. Moreover, fully integrated aquatic ecosystem classifications that incorporate lake and river networks, wetlands, groundwater reservoirs and upland areas are exceedingly rare. 6. We reason that the way forward for classification of flowing waters is to account for the directionally nested nature of these networks and to encode flexibility into modern digital freshwater inventories and fluvial classification models. [ABSTRACT FROM AUTHOR]

The article presents a study on relaxation-contraction-relaxation cycle of active labor calculating the change in myometrial blood flow using three-dimensional (3D) power Doppler angiography. It presents the methods used in the study in which transabdominal 3D power Doppler ultrasound imaging and 3D datasets were acquired. Findings show a significant decrease of myometrial blood flow during the uterine contraction.

Background Although recommendations about the treatment of obesity have been well documented, there is little research into how obese individuals view the outcomes of dietary treatment. It has been suggested that patient involvement in evaluating treatment outcomes may help target issues to assist with the ongoing improvement of dietetic services. The aim of this qualitative study was to collect patients’ views on the dietetic service, the treatment outcomes in terms of lifestyle change and the impact that attending the dietetic service had on their lives in order to improve dietetic treatment, and to assist in the selection of appropriate outcome measurements in the future. Methods Semi-structured interviews were conducted with 24 obese patients attending dietetic clinics in Ayrshire, West of Scotland for weight management (advice on healthy eating and physical activity to achieve an energy deficit). Patients’ views were transcribed, grouped and coded using content analysis. Results Views included the importance of attending the dietitian for support to achieve weight management and a need to ‘feel accountable to someone’. Interviewees valued information provided regarding diet, physical activity, behavioural strategies and the risks of obesity. Patients described the impact of obesity on their lives and identified changes to their lifestyles and health since attending the dietitian. They also identified barriers to change, e.g. feeling frustrated and overwhelmed about the changes necessary. Conclusion This study extends the current knowledge of patients’ views of their treatment outcomes, which may be important in helping dietitians devise appropriate patient-centred outcome measures. However, as this is a small sample, further long term research into a wider range of current and discharged patients’ views is required. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although recommendations about the treatment of obesity have been well documented, there is little research into how obese individuals view the outcomes of dietary treatment. It has been suggested that patient involvement in evaluating treatment outcomes may help target issues to assist with the ongoing improvement of dietetic services. The aim of this qualitative study was to collect patients' views on the dietetic service, the treatment outcomes in terms of lifestyle change and the impact that attending the dietetic service had on their lives in order to improve dietetic treatment, and to assist in the selection of appropriate outcome measurements in the future. METHODS: Semi-structured interviews were conducted with 24 obese patients attending dietetic clinics in Ayrshire, West of Scotland for weight management (advice on healthy eating and physical activity to achieve an energy deficit). Patients' views were transcribed, grouped and coded using content analysis. RESULTS: Views included the importance of attending the dietitian for support to achieve weight management and a need to 'feel accountable to someone'. Interviewees valued information provided regarding diet, physical activity, behavioural strategies and the risks of obesity. Patients described the impact of obesity on their lives and identified changes to their lifestyles and health since attending the dietitian. They also identified barriers to change, e.g. feeling frustrated and overwhelmed about the changes necessary. CONCLUSION: This study extends the current knowledge of patients' views of their treatment outcomes, which may be important in helping dietitians devise appropriate patient-centred outcome measures. However, as this is a small sample, further long term research into a wider range of current and discharged patients' views is required. [ABSTRACT FROM AUTHOR]

Aims To compare glucose control over 18 months between rosiglitazone oral combination therapy and combination metformin and sulphonylurea in people with Type 2 diabetes. Methods RECORD, a multicentre, parallel-group study of cardiovascular outcomes, enrolled people with an HbA1c of 7.1–9.0% on maximum doses of metformin or sulphonylurea. If on metformin they were randomized to add-on rosiglitazone or sulphonylurea (open label) and if on sulphonylurea to rosiglitazone or metformin. HbA1c was managed to ≤ 7.0% by dose titration. A prospectively defined analysis of glycaemic control on the first 1122 participants is reported here, with a primary outcome assessed against a non-inferiority margin for HbA1c of 0.4%. Results At 18 months, HbA1c reduction on background metformin was similar with rosiglitazone and sulphonylurea [difference 0.07 (95% CI −0.09, 0.23)%], as was the change when rosiglitazone or metformin was added to sulphonylurea [0.06 (−0.09, 0.20)%]. At 6 months, the effect on HbA1c was greater with add-on sulphonylurea, but was similar whether sulphonylurea was added to rosiglitazone or metformin. Differences in fasting plasma glucose were not statistically significant at 18 months [rosiglitazone vs. sulphonylurea −0.36 (−0.74, 0.02) mmol/l, rosiglitazone vs. metformin −0.34 (−0.73, 0.05) mmol/l]. Increased homeostasis model assessment insulin sensitivity and reduced C-reactive protein were greater with rosiglitazone than metformin or sulphonylurea (all P ≤ 0.001). Body weight was significantly increased with rosiglitazone compared with sulphonylurea [difference 1.2 (0.4, 2.0) kg, P = 0.003] and metformin [difference 4.3 (3.6, 5.1) kg, P < 0.001]. Conclusions In people with diabetes, rosiglitazone in combination with metformin or sulphonylurea was demonstrated to be non-inferior to the standard combination of metformin + sulphonylurea in lowering HbA1c over 18 months, and produces greater improvements in C-reactive protein and basal insulin sensitivity but is also associated with greater weight gain. [ABSTRACT FROM AUTHOR]

Mantle cell lymphoma (MCL), characterised by t(11;14)(q13;q32), has a poor prognosis. Many cases have additional cytogenetic abnormalities, and often have a complex karyotype. Fluorescence in situ hybridisation (FISH) was used to study 60 cases with leukaemic presentation of MCL, to determine the frequency, clinical correlations and prognostic impact of a panel of molecular cytogenetic abnormalities: 17p13 ( TP53 locus), 13q14, 12 p11·1-q11 (centromere), 6q21 and 11q23. CD38 expression, of prognostic value in chronic lymphocytic leukaemia (CLL), was also studied, and correlations with clinical and cytogenetic abnormalities sought. Eighty per cent of cases had at least one abnormality in addition to t(11;14). Deletions at 17p13 ( TP53) and 13q14 were most frequent and involved the majority of the leukaemic clone. Cases with TP53 deletion were more likely to have splenomegaly and marked leucocytosis (>30 × 109/l), and less likely to have lymphadenopathy than those without deletion. Deletions at 11q23 and 6q21 were associated with extranodal disease. 13q14 and 11q23 deletions showed a trend towards worse prognosis by univariate analysis. In multivariate analysis, deletions at 13q14 and 6q21 were independent predictors of poor outcome. Deletion at 17p13 did not show prognostic impact in this series. CD38, positive in two-thirds of cases, was associated with male gender and nodal disease but not with any cytogenetic abnormality, or with survival. [ABSTRACT FROM AUTHOR]

In this review, we critically evaluate the evidence for local IgE production in allergic rhinitis mucosa and the concept of local allergy in non-atopic idiopathic rhinitis. Significantly, fewer studies have focused on the disease pathways associated with non-allergic rhinitis compared with their allergic counterparts. Recently, there's been a revival of the hypothesis concerning the existence of local tissue-specific allergic disease confined to the nasal mucosa of some systemically non-atopic rhinitis subjects. Providing the evidence for local mucosal IgE production in allergic rhinitis is a pre-requisite to reviewing its existence in non-allergic rhinitis. In addition, practical and theoretical approaches useful in the detection of allergy in non-allergic rhinitis will be discussed. Furthermore, successful therapeutic regimens used in the treatment of non-allergic rhinitis will be examined as these could provide an insight into the underlying pathophysiology of this common but poorly understood disease. [ABSTRACT FROM AUTHOR]

ABSTRACT Effects of microstructural modifications, that are a consequence of adding minor grain boundary strengthening elements (C, Hf), on the fatigue response of an experimental single crystal superalloy have been studied. Investigations show that in the modified alloys, as a consequence of the casting process, the population of pores is reduced, but the average pore size increases and larger pores occur close to the fatigue sample surface. Such porosity changes in the modified alloys are an important contributor to their low cycle fatigue (LCF) properties. At the high stress range of LCF tests undertaken, the growth of cracks initiates from pores and their location in the modified alloys are responsible for decreased fatigue lives. At lower stress ranges, crack initiation consumes a considerable proportion of fatigue life. Since crack initiation involves strain localisation at or near the specimen surface where there is interaction with the environment, the population of pores near the specimen surface and the increased length of the tests plays a significant role in governing fatigue lives. The modified alloys benefit from their lower density of pores in the vicinity of the free surface, and tend to have comparable fatigue lives to that of the base alloy at the lower stress level. [ABSTRACT FROM AUTHOR]

Examines the historical aspects of red cell agglutination. Individuals who contributed to the study of the topic; Published works about red cell agglutination.

Whilst conducting a randomised controlled trial into the effects of combination anti-emetics, we endeavoured to confirm that our patient groups were matched using the predictive scoring systems for postoperative nausea and vomiting (PONV) and postoperative vomiting (POV) reported in the literature. One hundred and seventy-seven female patients attending for day case gynaecological surgery were studied and their individual risks of PONV and POV were calculated using four predictive models for PONV and two predictive models for POV. The scoring systems were then evaluated to see if agreement existed between them using the method described by Bland and Altman. Bias and 95% limits of agreement were calculated for each combination. Agreement between scoring systems was poor. As the scoring systems gave widely divergent predictions, we concluded that the predictive risk for PONV or POV would be dependent upon the scoring system chosen, thus limiting their usefulness in this role. [ABSTRACT FROM AUTHOR]

Summary Whilst conducting a randomised controlled trial into the effects of combination anti-emetics, we endeavoured to confirm that our patient groups were matched using the predictive scoring systems for postoperative nausea and vomiting (PONV) and postoperative vomiting (POV) reported in the literature. One hundred and seventy-seven female patients attending for day case gynaecological surgery were studied and their individual risks of PONV and POV were calculated using four predictive models for PONV and two predictive models for POV. The scoring systems were then evaluated to see if agreement existed between them using the method described by Bland and Altman. Bias and 95% limits of agreement were calculated for each combination. Agreement between scoring systems was poor. As the scoring systems gave widely divergent predictions, we concluded that the predictive risk for PONV or POV would be dependent upon the scoring system chosen, thus limiting their usefulness in this role. [ABSTRACT FROM AUTHOR]

Summary A postal survey was sent to all anaesthetic departments in the UK to identify current practice and gain insight into anaesthetists' attitudes regarding the use of anaesthetic rooms for induction of general anaesthesia. Replies were received from 247 (88%) departments. Of these, 10 (4%) departments routinely anaesthetise all patients in theatre. The main reason for change was patient safety. Of those who routinely use the anaesthetic room for induction of anaesthesia, only 5% have made provision to change to in-theatre induction. An estimated £30 million has been spent on equipping anaesthetic rooms since 1994; with the result that 91% of departments where anaesthetic room induction occurs, now have monitoring that complies with the current Association of Anaesthetists of Great Britain and Ireland guidelines. The majority of the respondents who use anaesthetic rooms perceived induction in theatre to result in reduced efficiency, increased patient anxiety, a worse teaching environment and no improvement in patient safety. This was in contrast to the attitudes of respondents from hospitals where in-theatre induction occurs. Only 9.7% of all respondents believed that clinical governance would necessitate a change to anaesthetizing all patients in theatre compared to 25% who believed that the increasing costs of monitoring equipment would lead to a change. Overall 79% of respondents prefer to use the anaesthetic room, 16% prefer in-theatre induction and 5% expressed no preference. However, of those who routinely anaesthetise in theatre, 70% thought it to be preferable. [ABSTRACT FROM AUTHOR]

Summary In a prospective, double-blind, randomised, placebo-controlled trial, we have compared the effects of midazolam co-induction with propofol predosing on the induction dose requirements of propofol in elderly patients. We enrolled 60 patients aged > 70 years, attending for urological surgery. The patients were allocated randomly to one of three groups, to receive either midazolam 0.02 mg.kg-1 , propofol 0.25 mg.kg-1 , or normal saline 2 ml (placebo) 2 min prior to induction of anaesthesia using propofol 1% infusion at 300 ml.h-1 . The propofol dose requirements for induction were recorded for two end-points (loss of verbal contact and insertion of an oropharyngeal airway). Cardiovascular parameters were recorded at 1-min intervals for each patient until induction was complete. The midazolam group showed a significant reduction in propofol dose requirements for induction (p = 0.05) compared to the placebo group. The propofol group did not show a significant dose reduction compared to placebo. There were no demonstrable differences in terms of improved cardiovascular stability between groups. We conclude that propofol predosing does not significantly reduce the induction dose of propofol required in the elderly, and there were no cardiovascular benefits to either midazolam co-induction or propofol predosing in the elderly. [ABSTRACT FROM AUTHOR]

Focuses on the identification of anesthetic gas cylinders. Attachment of oxygen regulator to the air cylinder; Implication of the gas cylinder arrangement for oxygen delivery; Considerations in the fitting of oxygen regulator.

Abstract Aims To evaluate the clinical efficacy and safety of rosiglitazone as a once daily treatment for Type 2 diabetes mellitus (DM). Methods Three hundred and sixty-nine patients with Type 2 DM (mean age 63 years; mean body mass index (BMI) 29.4 kg/m2) were enrolled in a double-blind, parallel group, placebo-controlled, dose-ranging study. Patients were randomly assigned to receive placebo or rosiglitazone at doses of 4, 8, or 12 mg daily for 8 weeks. Results At 8 weeks, fasting plasma glucose (FPG) decreased significantly in the rosiglitazone 4 mg, 8 mg, and 12 mg groups (-0.9, -2.0 and -1.7 mmol/l; P = 0.0003, < 0.0001, and < 0.0001, respectively) compared with placebo (+0.4 mmol/l). The improvements in FPG were dose ordered for 4 and 8 mg/day. The 12 mg/day dose produced no additional improvement. There were small decreases in haemoglobin and haematocrit in the rosiglitazone treatment groups. The overall incidence of adverse experiences was similar in all treatment groups, including placebo with no evidence of hypoglycaemia or hepatotoxicity. Conclusions Rosiglitazone improves glycaemic control when given once daily to treat Type 2 diabetes mellitus and is well tolerated at doses up to and including 12 mg. [ABSTRACT FROM AUTHOR]

Attempts to examine association between diabetes mellitus and hearing loss. Dependence of cochlear homeostasis on oxidative phosphorylation; Pathogenesis of diabetic neuropathy; Comparison of audiometric and temporal bone findings of several diabetics and controls; Periodic acid-Schiff positive thickening of the basement membrane; Latency of brainstem auditory evoked potential.

Mucociliary transport relies not only on co-ordinated ciliary activity but on mucus and its specific rheological properties. The rheological and viscoelastic properties of mucus are determined by its complex polymeric structure and degree of hydration. Mucus does not behave like a simple Newtonian fluid but is non-Newtonian, with heterogeneous viscoelastic properties. An alteration in mucus rheology can significantly affect the mechanical coupling of the cilia with the overlying mucus. The mucociliary apparatus has an important role in maintaining the integrity of the nasal airway and paranasal sinuses as well as that of the rest of the respiratory tract. The mucociliary clearance rate was first studied in the 18306.¹ Studies of the relationship between the properties of mucus and mucociliary clearance rate date from 1956 when Dalhamn described mucostasis following the inhalation of irritant gases in rats.² He concluded that the composition and quality of the secretions are important factors. Further studies looking at the rheology of mucus and mucociliary clearance rate together were done by Carson et al. in 1966³ using the cat trachea. Ewert[sup 4] reviewed the literature and concluded that one of the prerequisites for normal mucus flow is an intact blood and nerve supply to the mucosa. This implied that in-vivo studies are particularly important in the measurement of mucus flow rate. The ciliary beat has two components, the effective and the recovery stroke. The effective stroke occurs with the cilium perpendicular to the cell surface with its tip in contact with the mucus. The mucus layer acts as a coupler which transfers momentum from the tips of the cilia to the loads (Figure 1). When the cilia contact the mucus they tend to bend backwards and if this bend is too great because of excessive mucus viscosity the system does not work effectively. The cilia beat efficiently at 10.8 Hz (SD0.7)[sup 6]. If there is an inadequate quantity of mu... [ABSTRACT FROM AUTHOR]

Freeze-branding of young trout with metal stamps dipped in liquid nitrogen was investigated for use in experimental work. Good results were obtained when the procedure was standardized as follows: stamp cooled for 30 sec, applied for 4 sec with a pressure of 20–30g. Certain letters were better than others and brands were retained for over 5 months at water temperatures that are normal for trout. [ABSTRACT FROM AUTHOR]

Medication and surgery are often complementary in the treatment of rhinosinusitis. Surgery is often reserved for patients who have not responded to medical treatment. Where there is a significant mechanical obstruction of the airway or sinus ostea medical management is unlikely to succeed on its own. For those with a coexisting allergic rhinitis who need surgery, the maintenance of any improvement in the nasal airway or sinus drainage will partially depend on good compliance with medical treatment postoperatively. No condition illustrates the adage that ‘to be a good surgeon you have to be a good physician’ better than allergic rhinitis. Perhaps it should also be said that ‘to be a good physician you should recognize when surgery has a role to play’. [ABSTRACT FROM AUTHOR]

In a longitudinal study in which 59 first-born middle class children were observed in the company of other children of the same age and with their mothers, a high frequency of attacks on other children by children nearly two years old was correlated with absent or delayed response by the mother to the child's crying after falls, etc. Other aspects of mother's or child's behaviour were examined but all failed to explain away this correlation. Some routes by which the correlation could have arisen from immediate influences of the child's behaviour upon the mother were also excluded. Thus it was not true that "tough" kids fight a lot and stop crying quickly. Nor did mothers respond less to children who cried often. [ABSTRACT FROM AUTHOR]

Although most falls do not result in serious physical injury, they can contribute to a loss of confidence and mobility which can culminate in a significant reduction in quality of life. Furthermore, the potential to fall is often increased when an individual is institutionalized because of frailty or confusion. The purpose of the study was, therefore, to establish whether a structured intervention would assist in preventing falls in an acute setting. This pre-test/post-test study was carried out over a 12-month period. Interventions included risk assessment, an alert system, reinforcing preventive actions, staff education and ongoing audits and feedback. Initial analysis of the data and comparison of fall rates indicated a significant reduction in the rate of falls between the pre- and post-intervention phases, although subsequent statistical analysis did not identify any significant relationships. It must be noted that no controls existed for extraneous variables, although patient profiles varied minimally during the period of the study. Outcomes include: a reduction in fall numbers and rates, enhanced staff morale with ownership of the programme, provision of a learning experience for staff (on which to build), and the fostering of a professional approach to improving the quality of patient care. [ABSTRACT FROM AUTHOR]

We have found that amino acid residues necessary for Clq and FcγR binding of human IgGl are located in the N-terminal region of the CH2 domain, residues 231--238, using a matched set of engineered antibodies based on the anti-HLA-DR antibody L243. Changing the leucine 235 in the CH2 region of IgG3 and IgG4 to glutamic acid was already known to abolish FcγRl binding. We have confirmed this for IgG1 and also found a concomitant abolition of human complement lysis with retention of FcγRIII-mediated function. Changing the glycine at 237 to alanine of IgG1 also abolished FcγRl binding and reduced human complement lysis and FcγRIII-mediated function. Exchanging the whole region 233-236 with the sequence found in human IgG2, abolished FcγRI binding and human complement lysis and reduced FcγRIII-mediated function of IgG1. In contrast, a change in the previously described C1q-binding motif, from lysine at 320 to alanine, had no effect on IgG1-mediated complement lysis. [ABSTRACT FROM AUTHOR]

The strength of the bond between 125I-labelled Clq and immune complexes, Fc piece, dextran sulphate, polyglutamic acid and polylysine has been investigated. The binding of Clq to Fc piece, small molecular weight (< 10,000) dextran sulphate, polyglutamic acid and polylysine have values for the functional affinity constant (Ko) in the range 0.2-1.5 × 104 M-1. In contrast, the binding of Clq to immune complexes and large molecular weight polyions (> 100,000 is much greater and lies in the range 3×107 - 4×108 M-1. The differences in the binding constants between the two groups can be explained if the Fc piece and small molecular weight compounds bind to only 1 head of the Clq molecule but the immune complexes and large molecules bind to 2 heads. There are probably 6 binding sites on the Clq molecule for dextran sulphate. The enhancement of the binding affinity of Clq by reduction in ionic strength and the reaction with polyions, indicate that ionic groups are present near or within the binding sites. [ABSTRACT FROM AUTHOR]

The strength of the bond between 125I-labelled Clq and immune complexes, Fc piece, dextran sulphate, polyglutamic acid and polylysine has been investigated. The binding of Clq to Fc piece, small molecular weight (< 10,000) dextran sulphate, polyglutamic acid and polylysine have values for the functional affinity constant (Ko) in the range 0.2-1.5 × 104 M-1. In contrast, the binding of Clq to immune complexes and large molecular weight polyions (> 100,000 is much greater and lies in the range 3×107 - 4×108 M-1. The differences in the binding constants between the two groups can be explained if the Fc piece and small molecular weight compounds bind to only 1 head of the Clq molecule but the immune complexes and large molecules bind to 2 heads. There are probably 6 binding sites on the Clq molecule for dextran sulphate. The enhancement of the binding affinity of Clq by reduction in ionic strength and the reaction with polyions, indicate that ionic groups are present near or within the binding sites. [ABSTRACT FROM AUTHOR]

Objectives: To investigate and compare post-traumatic stress (PTS), depression and anxiety in women and their partners over a 9-month period following miscarriage or ectopic pregnancy.Methods: This was a prospective cohort study. Consecutive women and their partners were approached in the early pregnancy units of three hospitals in central London. At 1, 3 and 9 months after early pregnancy loss, recruits were e-mailed links to surveys containing the Hospital Anxiety and Depression Scale and the Post-traumatic Stress Diagnostic Scale. The proportion of participants meeting the screening criteria for moderate or severe anxiety or depression and PTS was assessed. Mixed-effects logistic regression was used to analyze differences between women and their partners and their evolution over time.Results: In total, 386 partners were approached after the woman in whom the early pregnancy loss had been diagnosed consented to participate, and 192 couples were recruited. All partners were male. Response rates were 60%, 48% and 39% for partners and 78%, 70% and 59% for women, at 1, 3 and 9 months, respectively. Of the partners, 7% met the criteria for PTS at 1 month, 8% at 3 months and 4% at 9 months, compared with 34%, 26% and 21% of women, respectively. Partners also experienced lower rates of moderate/severe anxiety (6% vs 30% at 1 month, 9% vs 25% at 3 months and 6% vs 22% at 9 months) and moderate/severe depression (2% vs 10% at 1 month, 5% vs 8% at 3 months and 1% vs 7% at 9 months). The odds ratios for psychological morbidity in partners vs women after 1 month were 0.02 (95% CI, 0.004-0.12) for PTS, 0.05 (95% CI, 0.01-0.19) for moderate/severe anxiety and 0.15 (95% CI, 0.02-0.96) for moderate/severe depression. Morbidity for each outcome decreased modestly over time, without strong evidence of a different evolution between women and their partners.Conclusions: Some partners report clinically relevant levels of PTS, anxiety and depression after pregnancy loss, though to a far lesser extent than women physically experiencing the loss. © 2020 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Brow-raising is a common and simple part of facial expression in man and it occurs in several social situations. Eyebrow-raising was very much more common in the "hidden" situation, along with searching. The difference did not change with subsequent experience of either situation. It is concluded that non-social brow-raising is elicited by eliciting visual searching. This report describes an experiment designed to test whether searching evokes brow-raising. It deals with distinctions between visual searching, surprise and curiosity.

Estimates have been made of the value of the equilibrium constant and of the heterogeneity index of the reaction between anti-D and Rh positive red cells, using anti-D immunoglobulin preparations made from pools of donor plasma. The values of the equilibrium constant all fell within the range 1 × 108 to 10 × 108 l/mole, and in eighteen of the twenty-five samples the values fell within the narrow range of 2 × 108 to 4 × 108 l/mole. Estimates of the value of the heterogeneity index varied from 0.5 to 0.8. Calculations made using these values of the equilibrium constant indicate that if 200 µg of anti-D from each preparation were injected into an Rh-negative recipient with approximately 3 ml of R1r cells in the circulation, between 8 and 28 per cent (average 17 per cent) of the D antigen sites on the red cells would be bound by anti-D if equilibrium conditions were reached. [ABSTRACT FROM AUTHOR]

The reactivity of native IgM anti-B and of the monomer subunits with B cells was investigated using 125I-labelled antibody. A proportion of the monomers produced by mercaptoethanol treatment retained antibody activity, but the value of the equilibrium constant of the subunits was reduced by a factor of 36–170 compared to that of the native IgM molecule. It is concluded that native IgM anti-B is attached to red cells by at least two combining sites and evidence is given which indicates that IgM anti-A behaves similarly. [ABSTRACT FROM AUTHOR]

The rate constants for association and dissociation, and the equilibrium constants, were determined for 125I-labelled anti-A and anti-B of both IgG and IgM molecular types. The following results and conclusions were obtained: 1. The equilibrium constants were within the range 0·6 × 108–13·0 × 108 l/mole, and were of the same order for both IgG and IgM antibodies. 2. The initial rate constants for association were in the range 2·1 × 105–4·8 × 105 1/mole/sec, and the energy of activation (Ea) 6700–9000 cal/mole. These results indicate that the rate of association is approaching the limit set by the rate of diffusion of the reactants. 3. The initial rate constants for dissociation were 1 × 10-4–5 × 10-4/sec and Ea = 20,000–36,000 cal/mole. These latter values suggest that more than one bond must be broken simultaneously during dissociation. 4. Ionic strcngth and pH changcs have only a minor effect on the constants; this indicates absence of ionic groups on A and B antigen sites. 5. The changes in enthalpy were -5400 to -21,800 cal/mole; the reactions are mainly enthalpy driven and this accounts for the fact that anti-A and anti-B agglutination titres increase as the temperature is decreased. 6. There was heterogeneity of the values of the standard change in free energy, enthalpy and entropy within each example of antibody. 7. The approximate concentrations of antibody at the end-points of the agglu- tination titres were: for IgG antibody, 0·2 μg/ml; for IgM antibody, 0·01 μg/ml. [ABSTRACT FROM AUTHOR]

A method is described for estimating the concentration and equilibrium constant of the blood group antibody, anti-D. The principle of the method is based on the fact that the reaction between anti-D and red cells is reversible and obeys the law of mass action. D-positive red cells at five different concentrations were added to aliquots of antisera containing anti-D and the reaction allowed to come into equilibrium. The amount of anti-D bound to the red ceils in each case was estimated using 125I-labelled anti-γ-globulin. The results of these estimates were then analysed according to two derivations of the law of mass action. Twenty-one examples of antisera containing anti-D were examined and the estimated range of values was as follows: concentration, 0.3–7.2 μg/ml; equilibrium constant, 1.4 × 107 to 1.2 × 109 l/mole; index of heterogeneity, a = 0.6–0.9.

Ten previously untransfused Rh(D)-negative subjects were given an intravenous injection of approximately 0·3 ml of Rh(D)-positive red cells and at about the same time, or 24-48 hours previously, were given an intramuscular injection of 1-1000 μg of anti-D. Following the injection of the red cells there was a variable period before the onset of red cell destruction; when the antibody was injected at the same time as the red cells the delay was due partly to the time taken for the antibody to reach the circulation; when the antibody was injected at least 24 hours before the red cells there was still some delay due to the time required for the antibody to be taken up by the red cells; the delay before the onset of a maximum rate of red cell destruction varied from about 0·2 hours following the injection of 1000 μg of antibody to approximately 100 hours following the injection of 1 μg. The maximum rate of red cell destruction was calculated to be approximately proportional to the square root of the amount of antibody on the cells. After the injection of the smallest amount of antibody (1 μg) the amount on the red cells was calculated to be about 0·03 μg/ml corresponding to about ten molecules of antibody per cell. This dose produced clearance with a T½ of the order of 100 hours. The significance of these observations in relation to protection against Rh-immunization is briefly discussed. [ABSTRACT FROM AUTHOR]

The effect of pH and ionic strength on the reaction between anti-D and erythrocytes was investigated using 1311-labelled antibody. The following observations were made. 1. The association constant of the reaction was influenced by the pH of the suspending medium. The highest values were obtained in the pH range 6·0–8·0. The association constant was considerably reduced above and below these values. 2. There was considerable heterogeneity of the rate of dissociation of the antigen-antibody complex at pH values below 6·0 3. The antibody was separated into fractions which, at neutral pH, had different rate constants for dissociation. 4. The rate of association between anti-D and erythrocytes was greatly increased by a reduction in the ionic strength of the suspending medium. [ABSTRACT FROM AUTHOR]

The article discusses a factorial study of patient attitudes toward mental illness and psychiatric hospitalization. In recent years there have been several investigations consistently demonstrating that social class and ethnic-cultural factors covary with incidence and treatment of psychiatric illness. The present investigators share the view of A.B. Hollingshead and F.C. Redlich that the attitudes and values of patients are an integral part of the demonstrated correlations. Factor analysis is frequently used on the assumption that this statistical procedure will result in a simplified description of variables.

Objective: The M6 risk-prediction model was published as part of a two-step protocol using an initial progesterone level of ≤ 2 nmol/L to identify probable failing pregnancies (Step 1) followed by the M6 model (Step 2). The M6 model has been shown to have good triage performance for stratifying women with a pregnancy of unknown location (PUL) as being at low or high risk of harboring an ectopic pregnancy (EP). This study validated the triage performance of the two-step protocol in clinical practice by evaluating the number of protocol-related adverse events and how effectively patients were triaged.Methods: This was a prospective multicenter interventional study of 3272 women with a PUL, carried out between January 2015 and January 2017 in four district general hospitals and four university teaching hospitals in the UK. The final pregnancy outcome was defined as: a failed PUL (FPUL), an intrauterine pregnancy (IUP) or an EP (including persistent PUL (PPUL)). FPUL and IUP were grouped as low-risk and EP/PPUL as high-risk PUL. Serum progesterone and human chorionic gonadotropin (hCG) levels were measured at presentation in all patients. If the initial progesterone level was ≤ 2 nmol/L, patients were discharged and were asked to have a follow-up urine pregnancy test in 2 weeks to confirm a negative result. If the progesterone level was > 2 nmol/L or a measurement had not been taken, hCG level was measured again at 48 h and results were entered into the M6 model. Patients were managed according to the outcome predicted by the protocol. Those classified as 'low risk, probable FPUL' were advised to perform a urine pregnancy test in 2 weeks and those classified as 'low risk, probable IUP' were invited for a scan a week later. When a woman with a PUL was classified as high risk (i.e. risk of EP ≥ 5%) she was reviewed clinically within 48 h. One center used a progesterone cut-off of ≤ 10 nmol/L and its data were analyzed separately. If the recommended management protocol was not adhered to, this was recorded as a protocol deviation and classified as: unscheduled visit for clinician reason, unscheduled visit for patient reason or incorrect timing of blood test or ultrasound scan. The classifications outlined in the UK Good Clinical Practice (GCP) guidelines were used to evaluate the incidence of adverse events. Data were analyzed using descriptive statistics.Results: Of the 3272 women with a PUL, 2625 were included in the final analysis (317 met the exclusion criteria or were lost to follow-up, while 330 were evaluated using a progesterone cut-off of ≤ 10 nmol/L). Initial progesterone results were available for 2392 (91.1%) patients. In Step 1, 407 (15.5%) patients were classified as low risk (progesterone ≤ 2 nmol/L), of whom seven (1.7%) were ultimately diagnosed with an EP. In 279 of the remaining 2218 women with a PUL, the M6 model was not applied owing to protocol deviation or because the outcome was already known (usually on the basis of an ultrasound scan) before a second hCG reading was taken; of these patients, 30 were diagnosed with an EP. In Step 2, 1038 women with a PUL were classified as low risk, of whom eight (0.8%) had a final outcome of EP. Of 901 women classified as high risk at Step 2, 275 (30.5%) had an EP. Therefore, 275/320 (85.9%) EPs were correctly classified as high risk. Overall, 1445/2625 PUL (55.0%) were classified as low risk, of which 15 (1.0%) were EP. None of these cases resulted in a ruptured EP or significant clinical harm. Sixty-two women participating in the study had an adverse event, but no woman had a serious adverse event as defined in the UK GCP guidelines.Conclusions: This study has shown that the two-step protocol incorporating the M6 model effectively triaged the majority of women with a PUL as being at low risk of an EP, minimizing the follow-up required for these patients after just two visits. There were few misclassified EPs and none of these women came to significant clinical harm or suffered a serious adverse clinical event. The two-step protocol incorporating the M6 model is an effective and clinically safe way of rationalizing the management of women with a PUL. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

The article discusses the analysis regarding the upper bound of limit torque for regular polygonal shafts. The shaft's original plane transverse sections remain plane and simply rotate relative to each other with no axial separation. It explains the justification of the requirements of the limit theorems of plasticity through the acceptable simplification for an upper bound calculation.

Background: Providing effective weight management to adults with intellectual disabilities is necessary to challenge the high rates of obesity. The aim of this process evaluation was to explore the feasibility of conducting a full‐scale clinical trial of the TAKE 5 multi‐component weight management programme. Methods: The study was a 12‐month pilot cluster‐randomised controlled trial. Adults with intellectual disabilities and obesity were randomised to either TAKE 5, which included an energy deficit diet (EDD) or Waist Winners Too, based on health education principles. A mixed‐methods process evaluation was conducted focussing on the reach, recruitment, fidelity, implementation, dose (delivered/received) and context. Results: The study successfully recruited adults with intellectual disabilities. Both weight management programmes were delivered with high fidelity and implemented as intended. Only one weight management programme, TAKE 5, demonstrated potential efficacy in reducing body weight and body composition. The effectiveness was largely attributed to the EDD and social support from carers. Conclusions: The extensive process evaluation illustrated that a full‐scale trial of a multi‐component programme including an EDD is feasible and an acceptable approach to weight management for adults with intellectual disabilities and obesity. [ABSTRACT FROM AUTHOR]

An abstract of the article "Mid-trimester subchorionic hematoma; maternal and neonatal morbidity data," by N. Mitchell-Jones and colleagues is presented.

Background High-intensity resistance training ( HIRT) programmes are increasingly popular amongst personal trainers and those attending gymnasiums. We report the experience of exertional rhabdomyolysis ( ER) at two tertiary hospitals in Melbourne, Australia. Aims To compare the clinical outcomes of ER with other causes of rhabdomyolysis. Methods Retrospective cross-sectional study of patients presenting with a serum creatine kinase ( CK) of greater than 25 000 units/L from 1 September 2013 to 31 August 2014 at two tertiary referral hospitals in Melbourne, Australia. Records were examined to identify care measures implemented during hospital stay, clinical outcomes during admission and on subsequent follow up. Results Thirty four cases of rhabdomyolysis with a CK of greater than 25 000 units/L (normal range: 20-180 units/L) were identified during the 12-month study period. Twelve of the 34 cases (35%) had ER with 10 of 12 related to HIRT. No acute kidney injury, intensive care admission or death were seen among those with ER. All cases were managed conservatively, with 11 admitted and 9 receiving intravenous fluids only. In contrast, patients with rhabdomyolysis from other causes experienced significantly higher rates of intensive care admission (64%, P = 0.0002), acute kidney injury (82%, P = 0.0001) and death (27%, P = 0.069). Conclusion ER resulting from HIRT appears to have a benign course compared with rhabdomyolysis of other aetiologies in patients with a serum CK greater than 25 000 units/L. Conservative management of ER appears to be adequate, although this requires confirmation in future prospective studies. [ABSTRACT FROM AUTHOR]

An abstract of the article "Comparison of placental blood flow in the third trimester of normal and diabetic pregnancy using a novel stereological 3D power Doppler technique," by N. W. Jones and colleagues is presented.

An abstract of the conference paper "The intra-observer reliability of measurements of whole placental vascularity made using quantitative 3D power Doppler angiography," by M. Parra-Cordero and colleagues is presented.