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Background Iron deficiency (ID) is common in patients with chronic kidney disease (CKD). Intravenous (IV) iron in heart failure leads to improvement in exercise capacity and improvement in quality-of-life measurements; however, data in patients with CKD are lacking. Methods The Iron and the Heart Study was a prospective double blinded randomised study in non-anaemic CKD stages 3b-5 patients with ID which investigated whether 1000 mg of IV iron (ferric derisomaltose (FDI)) could improve exercise capacity in comparison to placebo measured at 1 and 3 months post infusion. Secondary objectives included effects on haematinic profiles and haemoglobin, safety analysis and quality of life questionnaires (QoL). Results We randomly assigned 54 patients mean (SD) age for FDI (n = 26) 61.6 (10.1) years vs placebo (n = 28; 57.8 (12.9) years) and mean eGFR (33.2 (9.3) vs. 29.1 (9.6) ml/min/1.73m2) at baseline, respectively. Adjusting for baseline measurements, six-minute walk test (6MWT) showed no statistically significant difference between arms at 1 month (p = 0.736), or 3 months (p = 0.741). There were non-significant increases in 6MWT from baseline to 1 and 3 months in the FDI arm. Haemoglobin (Hb) at 1 and 3 months remained stable. There were statistically significant increases in ferritin (SF) and transferrin saturation (TSAT) at 1 and 3 months (p Conclusion This study demonstrated a short-term beneficial effect of FDI on exercise capacity, but it was not significant despite improvements in parameters of iron status, maintenance of Hb concentration, and numerical increases in functional capacity and quality of life scores. A larger study will be required to confirm if intravenous iron is beneficial in iron deficient non-anaemic non-dialysis CKD patients without heart failure to improve the 6MWT. Trial registration European Clinical Trials Database (EudraCT) No: 2014-004133-16 REC no: 14/YH/1209 Date First Registered: 2015-02-17 and date of end of trail 2015-05-23 Sponsor ref R1766 and Protocol No: IHI 141

Background and Aims Iron deficiency is common in patients with CKD due to inadequate dietary intake of iron, poor iron absorption from the gut, and increased iron losses from the body. In addition to preventing anaemia, iron is also important for normal heart function, being involved in processes that generate a necessary continuous energy supply. Post hoc analysis of studies of people with iron deficiency and advanced CKD suggest treatment with intravenous iron leads to improvement in heart function and feeling of wellbeing. The aim of the study was to investigate whether intravenous (IV) iron could improve exercise capacity in comparison to placebo over 3 months in non-anaemic CKD patients who have iron deficiency. Method The Iron and the Heart Study was a prospective double blinded explorative randomized, multi-centre study designed to assess the effect of IV iron supplementation (ferric derisomaltose/iron isomaltoside 1000 (FDI); Monofer®) in iron deficient but not anaemic patients with advanced CKD on functional status. Adults with established CKD stages 3b-5 and serum ferritin (SF) < 100mcg/L and/or transferrin saturation (TS) Results Between October 2016 and April 2018, 54 individuals from 3 UK centres were randomized to FDI (n=26; mean age 61.6 (10.1) years) or placebo (n=28; mean age 57.8 (12.9) years). Mean serum creatinine (167.0 (40.2) vs. 204.9 (67.3) and eGFR (32.1 (9.6) vs. 29.1 (9.6)) at baseline were similar in FDI and placebo groups respectively. Adjusting for baseline 6MWT, the 6MWT at 1-month showed no statistically significant difference between groups (p=0.736) (Figure), and no significant difference at 3 months (p=0.741). The absolute mean change from baseline to 1 month and 3 months, showed no statistically significant differences between group (p=0.952_, p=0.895). There was no statistically significant difference between groups in Hb at 3-months (p=0.152) but there were statistically significant differences in SF and TS, which both increased post FDI infusion at 1 and 3 months; p Conclusion The Iron and the Heart Trial showed a significant increase in iron parameters and maintenance of Hb concentration in iron treated patients. There was a numerical increase in functional capacity at 1-month and to lesser extent at 3 months post iron infusion. This finding was not significant, which reflects the limited sample size and possible differences in population during randomisation with the large difference in 6MWT at baseline. A larger study will be required to demonstrate a possible short-term functional benefit on exercise capacity of IV iron in CKD patients with biochemical functional or absolute iron deficiency without anaemia.

Background Anaemia is common in haemodialysis (HD) patients and associated with significant morbidity and mortality. Intravenous (IV) iron combined with erythropoiesis-stimulating agents (ESA) is the mainstay treatment of anaemia in these patients. The comparative efficacy and risk of adverse events with IV iron preparations have been assessed in only a few trials. Methods This was a retrospective observational study in 2 centres designed to compare the safety and efficacy of iron sucrose (IS-Venofer®) versus iron isomaltoside (IIM-Diafer®) in haemodialysis patients. The study included patients currently on dialysis and receiving Venofer who were switched to Diafer® and monitored for at least 12 months for each iron preparation. Results A total of 190 patients were included and had a mean age of 65.8 years (SD ± 15.5). Non-inferiority was confirmed with no change in mean haemoglobin per mg of iron administered over a 12-month period. In total there were 41,295 prescriptions of iron isomaltoside and 14,685 of iron sucrose with no difference in the number of reported adverse events during the study period (7 each, none were severe). There was a statistically significant effect on Hb over time after conversion, including adjustment for multiple comparisons. There were significant improvements in ferritin over time, which remained at 6 months (P P = 0.02). The EPO dose did not differ significantly after month 0 in patients switched to IIM. Conclusions This study demonstrates the comparative safety and efficacy of iron isomaltoside versus iron sucrose, with similar dosing schedules in dialysis patients. Iron isomaltoside is non-inferior to iron sucrose in maintaining Hb in patients on regular haemodialysis/haemodiafiltration with no difference in the number of reported adverse events.

Background: Iron deficiency (ID) is common in patients with chronic kidney disease (CKD) due to an inadequate dietary intake of iron, poor absorption from the gut and increased iron losses. In addition to preventing anaemia, iron is important for normal heart function, being involved in processes that generate a necessary continuous energy supply. Treatment with intravenous (IV) iron has been suggested to lead to improvement in heart function and well-being in people with ID and CKD. In the Iron and the Heart Study, we hypothesized that IV iron treatment will primarily improve exercise capacity and may secondarily impact the feeling of well-being in comparison to placebo over 3 months in non-anaemic CKD patients who have ID. Methods: This was a prospective double-blinded explorative randomized, multi-centre study designed to compare the effects of IV iron supplementation and placebo in iron-deficient but not anaemic patients with established CKD stages 3b-5 on functional status, and in addition cardiac structure and function. The study included 54 adults with serum ferritin (SF) Results: Between October 2016 and April 2018, 55 from 326 individuals from 3 UK centres attended screening and were randomized. The mean (SD) age was 59.6 (11.7) years, 26 (48%) patients were male, the majority were Caucasians (42; 78%), and 32 (59%) were non-smokers. The mean (SD) body mass index was 30.3 (6.5); SF was 66.3 (44.1) µg/L, TS was 20.1 (7.4) % and Hb was 128.7 (10.1) g/L at randomization for the whole group. Mean (SD) serum creatinine was 186.7 (58.6) µmol/L, estimated glomerular filtration rate was 31.1 (9.6) mL/min/1.73 m2 and urinary albumin and protein/creatinine ratios 60.9 (133.3) and 83.8 (128.4) mg/mmol respectively. The mean (SD) C-reactive protein was 5.0 (4.4) mg/L and the mean (SD) 6-minute walk distance at baseline was 401.2 (120.2) m. Conclusion: The Iron and the Heart Trial will provide important information on the short-term effects of IV iron treatment in CKD patients with ID without anaemia on measures of exercise capacity, quality of life and mechanistic data on myocardial structure and function. Trial Registration: European Clinical Trials Database (No. 2014-004133-6; REC no. 14/YH/1209; Sponsor ref. R1766).

Herpesvirus-induced disease is one of the most lethal factors which leads to high mortality in HIV/AIDS patients. EBV, also known as human herpesvirus 4, can transform naive B cells into immortalized cells in vitro through the regulation of cell cycle, cell proliferation, and apoptosis. EBV infection is associated with several lymphoma and epithelial cancers in humans, which occurs at a much higher rate in immune deficient individuals than in healthy people, demonstrating that the immune system plays a vital role in inhibiting EBV activities. EBV latency infection proteins can mimic suppression cytokines or upregulate PD-1 on B cells to repress the cytotoxic T cells response. Many malignancies, including Hodgkin Lymphoma and non-Hodgkin’s lymphomas occur at a much higher frequency in EBV positive individuals than in EBV negative people during the development of HIV infection. Importantly, understanding EBV pathogenesis at the molecular level will aid the development of novel therapies for EBV-induced diseases in HIV/AIDS patients.

Nail salon technicians face chronic exposure to volatile organic compounds (VOCs), which can lead to adverse health outcomes including cancer. In this study, indoor levels of formaldehyde, as well as benzene, toluene, ethylbenzene and xylene, were measured in 6 Colorado nail salons. Personal exposure VOC measurements and health questionnaires (n = 20) were also performed; questionnaires included employee demographics, health symptoms experienced, and protective equipment used. Cancer slope factors from the United States Environmental Protection Agency (US EPA) and anthropometric data from the Centers for Disease Control and Prevention were then used to estimate cancer risk for workers, assuming 20-yr exposures to concentrations of benzene and formaldehyde reported here. Results show that 70% of surveyed workers experienced at least one health issue related to their employment, with many reporting multiple related symptoms. Indoor concentrations of formaldehyde ranged from 5.32 to 20.6 μg m−3, across all 6 salons. Indoor concentrations of toluene ranged from 26.7 to 816 μg m−3, followed by benzene (3.13–51.8 μg m−3), xylenes (5.16–34.6 μg m−3), and ethylbenzene (1.65–9.52 μg m−3). Formaldehyde levels measured in one salon exceeded the Recommended Exposure Limit from the National Institute for Occupational Safety and Health. Cancer risk estimates from formaldehyde exposure exceeded the US EPA de minimis risk level (1 × 10−6) for squamous cell carcinoma, nasopharyngeal cancer, Hodgkin's lymphoma, and leukemia; leukemia risk exceeded 1 × 10−4 in one salon. The average leukemia risk from benzene exposure also exceeded the US EPA de minimis risk level for all demographic categories modeled. In general, concentrations of aromatic compounds measured here were comparable to those measured in studies of oil refinery and auto garage workers. Cancer risk models determined that 20-yr exposure to formaldehyde and benzene concentrations measured in this study will significantly increase worker's risk of developing cancer in their lifetime.

Background Dialysis in elderly patients (>80-years-old) carries a poor prognosis, but little is known about the most effective vascular access method in this age group. An arteriovenous fistula (AVF) is both time-consuming and initially expensive, requiring surgical insertion. A central venous catheter (CVC) is initially a cheaper alternative, but carries a higher risk of infection. We examined whether vascular access affected 1-year and 2-year mortality in elderly patients commencing haemodialysis. Methods Initial vascular access, demographic and survival data for elective haemodialysis patients >80-years was collated using regional databases. A cohort of conservatively managed patients was included for comparison. A log-rank test was used to compare survival between groups and a chi-square test was used to compare 1-year and 2-year survival. Results 167 patients (61% male) were included: CVC (101), AVF (25) and conservative management (41). Mean age (median) of starting haemodialysis (eGFR ≤10mL/min/1.73m2): CVC; 83.4 (2.3) and AVF; 82.3 (1.8). Mean age of conservatively managed patients reaching an eGFR ≤10mL/min/1.73m2 was 85.8 (3.6). Mean (median) survival on dialysis was 2.2 (1.8) years for AVF patients, 2.1 (1.2) for CVC patients, and 1.5 (0.9) for conservatively managed patients (p = 0.107, controlling for age/sex p = 0.519). 1-year and 2-year mortality: AVF (28%/52%); CVC (49%/57%), and conservative management (54%/68%). There was no significant difference between the groups at 1-year (p = 0.108) or 2-years (p = 0.355). Conclusion These results suggest that there is no significant survival benefit over a 2-year period when comparing vascular access methods. In comparison to conservative management, survival benefit was marginal. The decision of whether and how (choice of their vascular access method) to dialysis the over 80s is multifaceted and requires a tailored, multidisciplinary approach.

Study design Histologic analysis of spine development in cartilage-specific knockout mice. Objective To evaluate the role hyaluronan produced by hyaluronan synthase-2 (Has2) in spine development. Summary of background data The Has2 gene is responsible for most hyaluronan production throughout the body, including the skeleton. However, it is not possible to study the involvement of hyaluronan in skeletal development using constitutive Has2 knockout mice, as the embryonic mice die early before skeletal development has occurred. This problem can be overcome by the use of cartilage-specific knockout mice. Methods Mice possessing floxed Has2 genes were crossed with mice expressing Cre recombinase under control of the type II collagen promoter to generate cartilage-specific Has2 knockout mice. Spine development was studied by histology. Results Knockout mice died near birth and displayed severe abnormality in skeletal development. The spine showed defects in vertebral body size and the formation of the intervertebral discs. There was no evidence for the formation of an organized primary center of ossification within the vertebrae, and the appearance and organization of the hypertrophic chondrocytes was abnormal. Although no organized endochondral ossification appeared to be taking place, there was excessive bone formation at the center of the vertebrae. There was also a generalized increased cellularity of the vertebral cartilage and a corresponding decrease in the abundance of extracellular matrix. The nucleus pulposus of the intervertebral discs were less flattened than in the control mice and possessed an increased amount of large vacuolated cells. Remnants of the notochord could also be seen between adjacent discs. Conclusion Hyaluronan production by Has2 is essential for normal vertebral and intervertebral disc development within the spine, and the absence of this synthase impairs the organization of both soft and hard tissue elements.

Work under the project entitled "Geologic Sequestration Training and Research," was performed by the University of Alabama at Birmingham and Southern Company from December 1, 2009, to June 30, 2013. The emphasis was on training of students and faculty through research on topics central to further development, demonstration, and commercialization of carbon capture, utilization, and storage (CCUS). The project had the following components: (1) establishment of a laboratory for measurement of rock properties, (2) evaluation of the sealing capacity of caprocks, (3) evaluation of porosity, permeability, and storage capacity of reservoirs, (4) simulation of CO{sub 2} migration and trapping in storage reservoirs and seepage through seal layers, (5) education and training of students through independent research on rock properties and reservoir simulation, and (6) development of an advanced undergraduate/graduate level course on coal combustion and gasification, climate change, and carbon sequestration. Four graduate students and one undergraduate student participated in the project. Two were awarded Ph.D. degrees for their work, the first in December 2010 and the second in August 2013. A third graduate student has proposed research on an advanced technique for measurement of porosity and permeability, and has been admitted to candidacy for the Ph.D. The fourth graduatemore » student is preparing his proposal for research on CCUS and solid waste management. The undergraduate student performed experimental measurements on caprock and reservoir rock samples and received his B.S.M.E. degree in May 2012. The "Caprock Integrity Laboratory," established with support from the present project, is fully functional and equipped for measurement of porosity, permeability, minimum capillary displacement pressure, and effective permeability to gas in the presence of wetting phases. Measurements are made at ambient temperature and under reservoir conditions, including supercritical CO{sub 2}. During the course of the project, properties of 19 samples provided by partners on companion projects supported by NETL were measured, covering a range of permeabilities from 0.28 ndarcy to 81 mdarcy. Reservoir simulations were performed for injection of 530,000 tonnes of CO{sub 2} through a single well into the Middle Donovan formation in Citronelle Dome, in southwest Alabama, over 40 years, followed by migration and trapping for 10,000 years, using the TOUGH2 and TOUGHREACT software packages from Lawrence Berkeley National Laboratory. It was estimated that 50 kg CO{sub 2}/m{sup 3} of formation would be converted to mineral phases within the CO{sub 2} plume during that time. None of the sand units considered for CO{sub 2} storage in Citronelle Dome have thickness exceeding the estimated critical CO{sub 2} column height (Berg, 1975) at which seepage might begin, through their confining shale layers. A model for leakage through caprock, based on work by Hildenbrand et al. (2004), including a functional relationship between capillary pressure and the effective permeability to gas in the presence of a wetting phase, demonstrated the sensitivity of long-term storage to caprock permeability and thickness. A traditional course on coal combustion was augmented with material on climate change, coal gasification, and carbon sequestration. A total of 49 students completed the course during two offerings, in Fall 2010 and Fall 2012. It has become a popular advanced elective course in the Department of Mechanical Engineering.« less

Introduction: The Renal NSF advocates correction of anaemia in chronic kidney disease patients. Oral iron is often insufficient, while intravenous supplementation replenishes and maintains iron stores. There is a need to administer high doses of iron in a single rapid infusion to enable efficient costs, effective utilisation of time for patients and staff and optimal use of resources. Methods: We performed a prospective study of consecutive patients referred for iron dextran (Cosmofer) therapy. This was administered over 2 h 40 min compared with the normal regime of 4–6 h. Blood pressure was recorded throughout administration. Adverse drug reactions were recorded over 2 weeks. Serum ferritin, haemoglobin and estimated glomerular filtration rate were measured at baseline and 3 months. Results: One hundred patients (59 male, mean age 69 years), received a median dose of 1,000 mg Cosmofer in a median time of 2 h 40 min. Mean serum ferritin rose from 178 at baseline to 413 µg/l (p < 0.001). Mean haemoglobin rose by 1.5 g/dl (p < 0.001). There was no decline in estimated glomerular filtration rate after 3 months. No adverse reactions were noted. Conclusion: We demonstrated that accelerated administration of iron dextran is safe and effective with no short-term effects on renal function. This resulted in a time saving of approximately 67 hours.

INTRODUCTION Screening for prostate cancer with serum prostate specific antigen (PSA) remains a controversial topic. The UK NHS Executive has issued extensive guidance stressing the importance of adequate counselling prior to performing this test. This study aims to assess men's knowledge of the PSA test at the time of their referral and their attitude towards screening. PATIENTS AND METHODS A total of 219 men referred to urology via the ‘fast track’ prostate cancer service were recruited into the study. Of these, 191 were referred from primary care and 28 from secondary care. All men completed a questionnaire regarding their knowledge and expectation of the test. RESULTS The response rate for completed questionnaires was 100%. Overall, 91 (41.5%) men were aware that their PSA had been performed prior to referral and only 79 (36%) men understood why the test was being done. Patients referred from secondary care appeared to be better informed. Despite these figures, 175 (80%) men said they would recommend PSA testing to a friend or colleague, and 196 (89%) men said the test should be broadly publicised. CONCLUSIONS Nearly two-thirds of the men referred to urology with an elevated PSA were unaware that they had even had their PSA done. Information about the limitations of PSA testing and the consequence of a positive test result had been deficient. Informed counselling for the PSA test should form part of the consultation of any physician intending to undertake this test whether for lower urinary tract symptoms or for prostate cancer screening.

In 1992 I broke my foot and had to help myself around with the aid of crutches, first with two sticks and then progressing to one. It was a nasty shock when I realised that many of the safety guidelines we advocate for people at work or leisure were totally inappropriate and unhelpful in that situation.

Serum activities of creatine kinase (CK) and its isoenzymes were monitored before and 16 to 20 hours after a variety of surgical procedures and cardioversion. Changes in total CK and CK MM activities in the surgical patients were consistent with the extent of trauma; changes in these activities in the cardioversion patients were more variable, ranging from —2 to 1829 U/l, and were unrelated to the applied electrical force. CK MB activity was unchanged after cystoscopy but rose moderately in 60 % of patients after cholecystectomy, in 43 % of patients requiring only implantation of a new pacemaker box, and in 87 % of patients after implantation of an entire pacemaker system. No increase exceeded 6U/l. Fifty per cent of patients requiring cardioversion showed rises; the maximum value was 40·9 U/l.

Blood and urine samples from 252 Sudanese children were investigated for their aflatoxin content by high-performance liquid chromatography. The children comprised 44 with kwashiorkor, 32 with marasmic kwashiorkor, 70 with marasmus, and 106 age-matched, normally nourished controls. Aflatoxins were detected more often and at higher concentrations in sera from children with kwashiorkor than in the other malnourished and control groups. Aflatoxicol, a metabolite of aflatoxins B1 and B2, was detected in the sera of children with kwashiorkor and marasmic kwashiorkor but not in the controls and only once in a marasmic child. The difference between children with kwashiorkor or marasmic kwashiorkor and those in the control or marasmus groups was significant. Urinary aflatoxin was most often detected in children with kwashiorkor but their mean concentration was lower than in the other groups. Aflatoxicol was not detected in urine in any group. These findings suggest either that the children with kwashiorkor have a greater exposure to aflatoxins or that their ability to transport and excrete aflatoxins is impaired by the metabolic derangements associated with kwashiorkor. The presence of aflatoxicol in the sera of children with kwashiorkor but not in the others suggests a difference in metabolism between the two groups. Further studies are needed, and measurement of aflatoxins in the food eaten by these children is already underway.

Hypocapnia was induced in dogs lightly anaesthetized with nitrous oxide and fentanyl. Measurements were made of estimated renal plasma flow (ERPF), glomerular filtration rate, vascular resistance and urine production. During the (short) duration of the experiments hypocapnia was found to be associated with ERPF twice that during normocapnia. Glomerular filtration rate and urine output were increased by hypocapnia in an approximately similar proportion, whilst renal vascular resistance halved. Though some of the experimental animals had a degree of metabolic acidosis this was thought not to have greatly influenced the results.

A patient suffering from chronic carbon dioxide retention with persistent pneumothorax, following spontaneous rupture of an emphysematous bulla, underwent thoracotomy. The surgical and anaesthetic management are reported.

Autopsy liver specimens from Nigeria and South Africa obtained from three kwashiorkors, three marasmic-kwashiorkors and one marasmic child were analysed for the presence of aflatoxins using both high performance liquid chromatography and thin layer chromatography. Significant levels of aflatoxin B1 were found in the livers of the three kwashiorkor children. Aflatoxicol was detected in the liver of one marasmic-kwashiorkor and a small quantity of aflatoxin M1 in the liver of another. No aflatoxins were found in the livers of the third marasmic-kwashiorkor or the marasmic child. These findings extend recent clinical observations that indicate an association between aflatoxins and kwashiorkor.

Part II. cliff section extending 900 yards south of the harbour. In pursuance of my plan of describing sections in this neighbourhood which are likely to be closed to the geologist, it is desirable that some account should be given of the cliff-section which lies immediately to the south of the Harbour at Bridlington Quay, as this is already partly hidden. I have therefore drawn to scale a section of the cliff for a distance of 900 yards from the South Pier, as is shown in the accompanying plate, and this I now supplement, as before, with a description and notes of some deductions I have drawn whilst at work on the section. Over the extent covered by my section and for about 500 yards beyond it, a private individual, the owner of the land abutting on the cliff, has obtained foreshore rights from the Board of Trade, with the avowed intention of reclaiming and defending his property by the erection of a long line of sea-defences. As a first instalment of this work, a concrete wall was commenced four years ago near the South Pier, and carried across the beach for a distance of 750 feet; but having been based on a soft laminated clay, (No. 4 of section), its foundations have slipped upwards and outwards in places; and it is now in a very unsatisfactory condition. I suppose it is owing to this cause that the work has been suspended. The waste of the cliff along this section has always been very rapid, but since the wall was built, ...

Introduction. At the outset I may at once state that with regard to these notes, while I hope hereby to render available some fresh information respecting the White Chalk of Yorkshire, there will be no attempt on my part to deal adequately with the whole subject. My chief aim will be to supply details which may forward and lighten the labours of its future investigators. My knowledge of the deposit is the result of the somewhat desultory observations made during the leisure hours of the twenty busy years which I spent in the vicinity of Flamborough Head. I commenced to collect fossils from this grand range of cliffs while still a school boy, and am glad even yet to enjoy occasionally the keen relish of the collector on the discovery of a “good specimen” in these rocks. As time went on I began to realise that in spite of the past labours of Phillips, Barrois, Blake, and Mortimer, there remained the necessity for a vast amount of patient and somewhat tedious investigation before our knowledge of the Yorkshire Chalk could be placed on a really satisfactory basis; and this led me to make measurements and records of some of the sections. Probably if I had remained much longer in the locality, and no other worker had come forward, I should eventually have taken the subject seriously in hand, and should have tried to submit the Upper and Middle Chalk to the same thorough study as Mr. W. Hill has accorded, ...

Introduction. —In writing the last paper of this series in 1883, I surmised that with it the series would probably close, but since that time events have happened which render it advisable that I should add one more part, making the fourth. In doing so, I think it will be profitable first to glance at the ground already covered by these papers. The primary object of the series was, as stated in Part I., to describe sections in the neighbourhood of Bridlington, which were ‘likely to be destroyed, either by artificial or natural means,’ to give careful sketches where the beds seemed complicated or unusual, and in all cases to give as clear and unbiassed a description as I could, so as to preserve any information the section might contain, for the benefit and use of future geologists. But, while thus describing the sections in their entirety, I aimed in each case to give prominence to some particular member of the section, generally selecting the feature which was best developed, and by this method I hoped in time to compass the whole of the drifts, and supply full details regarding every part of them. In pursuance of this plan, I described in Part I., published in the Proceedings for 1881,* the cliff-section opposite the Alexandra Hotel, now concealed by a sea-wall, and dealt in that paper principally with the cause of the curiously ragged junction of the Purple Boulder-clay with the overlying gravels. In Part II., published in the Proceedings ...

SUMMARYAflatoxin analyses were undertaken on sera and urines of 41 children admitted to a rural hospital in Kenya with kwashiorkor, marasmus, marasmic kwashiorkor or normal nutrition (Wellcome Classification). Aflatoxins were detected most frequently and at highest concentrations in the sera of kwashiorkors who, conversely, showed aflatoxins least frequently in their urine and in concentrations that were disproportionately low compared with serum/urine aflatoxin levels in other groups. These findings indicate altered aflatoxin metabolism in kwashiorkor and support the hypothesis that there are special relationships between aflatoxins and kwashiorkor.

Aflatoxin analysis of blood and urine by high performance liquid chromatography in 584 Sudanese children is reported. The results in 404 malnourished children comprising 141 kwashiorkor, 111 marasmic kwashiorkor and 152 with marasmus are compared with 180 age-matched controls and correlated with clinical findings. The aflatoxin detection rate and mean concentration were higher in serum of children with kwashiorkor than the other groups. The difference between the detection rate in kwashiorkor and controls was significant (p less than 0.05). The aflatoxin detection rate in urine was highest in the marasmic kwashiorkor group and the mean concentration was higher in the marasmic kwashiorkor and marasmic groups than in the kwashiorkor and control groups. There were important differences in the detection of certain aflatoxins between the groups. Aflatoxicol was detected in the sera of 16 (11.6%) kwashiorkor, in six (6.1%) marasmic kwashiorkor, but in none of the controls and only once in marasmus. These differences are highly significant (p less than 0.0001). The ratio of AFB1 to AFM1 was higher in the sera and urines of kwashiorkors than in controls, suggesting that the normal transformation of AFB1 to AFM1 may be impaired in kwashiorkor with consequent increase in transformation of AFB1 to aflatoxicol. The study therefore provides evidence of differences in the metabolism of aflatoxins in children with kwashiorkor compared with children with other forms of malnutrition and normally nourished children and confirms the association between aflatoxins and kwashiorkor contained in a preliminary report on this work.

The Suzy Lamplugh Trust was set up after the headlined disappearance of a young estate agent, the author of the article and founder of the trust is Suzy Lamplugh′s mother. Aggression and violence in the workplace are discussed; women are seen not to be the risk factor of popular myth. Violence at work is a people problem. The Trust′s work includes research, publicity and the organisation of workplace training. The core of training is twofold: psychological (dealing with anxiety, attitudes and assertiveness) and practical (dealing with avoidance, anticipation and appropriate physical control of aggressors).

Aflatoxins have been commonly found as toxic contaminants of human food in the tropics. They have been detected in the milk of aflatoxin fed animals mainly in the form of Aflatoxin Mi and M2. A study in the United States has shown that aflatoxins cross the complex porcine placenta and exert adverse biological effects on piglets.

The use of a Mapleson ‘E’ circuit for controlled ventilation is described and its function investigated. Twelve Labrador dogs were anaesthestised and ventilated using an ‘air piston’. Fresh gas flows to attain low, normal or high arterial levels of carbon dioxide were found to be independent of minute volume, providing a relatively large tidal volume is used to minimise the ratio of anatomical dead space to tidal volume (VDanat/Vt). At normocapnia economy of fresh gas usage is demonstrated.

Aflatoxin analysis of 40 percutaneous needle liver biopsies in 27 children with protein-energy malnutrition and 13 children with miscellaneous liver disease in The Sudan is reported. Aflatoxins B1, B2 and aflatoxicol were detected in 5 of the 16 biopsies from kwashiorkor but in none of 11 biopsies from marasmus or marasmic kwashiorkor. Aflatoxins G1, G2 and M2 were detected in 5 of 12 children with chronic liver disease. A very high concentration of aflatoxicol was found in a breast-fed infant with neonatal hepatitis of unknown etiology.

Breast milk from 99 Sudanese mothers was analysed for aflatoxins. Aflatoxins M1 and/or M2 were detected in 37 of the milks. No other aflatoxin was detected. M1 occurred alone in 13 milks, (mean 19.0 pg/ml), M2 in 11 milks (mean 12.2 pg/ml), and in 13 samples both M1 and M2 were detected. There appeared to be a linear relationship between M1 and M2 where both were excreted. No aflatoxin was detected in subcutaneous abdominal wall fat removed during Caesarian section from 15 women, but was present in three out of 14 bloods taken during anaesthesia. The presence of aflatoxins in mothers' milk showed no correlation with duration of lactation, the infants' nutrition, presence of aflatoxin in mothers' blood, or the infant's blood and urine. It is concluded that some Sudanese women excrete aflatoxins in breast-milk at levels similar to or higher than those considered safe in animal milk, for human consumption.