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ObjectiveThe aim of this paper is to describe the stages undertaken to generate the items and conceptual framework of a new electronic personal assessment questionnaire for vascular conditions.DesignA mixed methods study: First a survey of vascular clinicians was completed to identify the most common conditions treated in vascular clinics and wards. Quantitative systematic reviews were done to identify validated patient-reported outcome measures (PROMs) for direct inclsuion in the new instrument. However, due to scarcity of validated PROMs, the items of the new instrument were mainly based on a large qualitative study of patients and systematic reviews of the qualitative evidence . This was followed by a quantitative clinicians’ consensus study and, finally, a qualitative face validity study with patients.ParticipantsVascular patients participated in the primary qualitative study and the face validity study. In the qualitative study, 55 patients were interviewed, and for the face validity, 19 patients gave feedback. Twelve clinicians completed the survey and 13 completed two cycles of the clinicians’ consensus study.ResultsThe items and scales in the electronic personal assessment questionnaire for vascular conditions (ePAQ-VAS) were generated based on the results of five systematic reviews evaluating existing PROMs for possible inclusion in ePAQ-VAS, five systematic reviews of qualitative evidence, a primary qualitative study involving 55 patients and clinicians’ input. One hundred and sixty-eight items were initially generated, of which 59 were eliminated by the expert panel due to repetition. The instrument was divided into one generic and three disease-specific sections (abdominal aortic aneurysm, carotid artery disease and lower limb vascular conditions). In each section, items were grouped together into putative scales. Fifty-five items were grouped across eight scales; the remaining items were kept as individual items, because of relevance to service users.ConclusionsThis multidimensional electronic questionnaire covers the most common vascular conditions. This is particularly important for patients presenting with mixed symptoms or multiple conditions. This tool captures symptomatology, health related quality of life (HRQoL) and other clinically relevant data, such as experience with services and comorbidities.

Background: Clozapine formulation has been shown to affect plasma concentrations of clozapine and norclozapine. Changes in formulation might result in toxicity or treatment failure. Methods: We identified, from electronic records, patients who switched from clozapine tablets to oral liquid or vice versa and compared plasma concentrations before and after the switch. Results: We identified 13 patients with 85 blood samples who changed formulation of clozapine. Overall mean standardized clozapine plasma level was 0.67 mg/l daily dose on liquid and 0.87 mg/l daily dose on tablets ( p = 0.035). Conclusion: Use of clozapine liquid results in lower plasma clozapine concentration than the same dose of tablets.

Capsule Long-distance migrant birds show less favourable trends than sedentary/short-distance species. Aims To use breeding bird surveys to contrast population trends amongst common species according to their migration pattern. Methods Changes in abundance of 62 Danish breeding sedentary, short-distance (Europe/North Africa) or long-distance (trans-Saharan) migrants were described by fitting log linear regression models to point-count census data gathered during 1976–2005. Results Trans-Saharan migrants declined by 1.3% per annum during this period, while short-distance migrants and sedentary species increased by 1.4% and 1.0% per annum, respectively. There were no significant decadal declines amongst species using different summer breeding habitats, except for wetlands, and there was no consistent variation in trends associated with wintering regions or habitats or diet. Conclusions More information is urgently needed on diet, feeding ecology, habitat requirements, winter distribution and intra-African m...

Corn buntings Miliaria calandra were abundant throughout arable agricultural landscapes in Europe, but have catastrophically declined since the mid 1970s with changes in farming practice and now give serious conservation cause for concern. Corn buntings declined in Denmark during 1976-1993, but (almost unique in Europe) have since increased (by up to 11% per annum) in some areas without specific conservation recovery actions. Based on breeding bird surveys in the mid 1990s, highest corn bunting densities occurred on mixed agriculture in west Denmark (Jylland); the species was rarer or absent in regions of highest arable land cover. Corn bunting density and extent of rotational and permanent grassland were correlated, but not with spring sown barley (all known to constitute important corn bunting winter habitat). The extent of spring barley rapidly declined in Denmark during the 1980s, but since 1990, most counties have since shown 2-3% annual increases in this crop, except in Nordjylland, where high densities of corn buntings have remained stable. Elsewhere in Jylland, corn buntings have increased in counties supporting highest densities during the mid 1990s, contrasting stable or declining trends in south and east Denmark where densities were originally lower. After dramatic decreases everywhere in Denmark, corn buntings retain highest breeding densities associated with mixed agriculture, especially where grassland and spring sown barley remained in greatest extent. Although purely based on land use correlation and bird surveillance, these results show an association between mixed farming and favourable conservation status of a species now red-listed throughout much of Europe. Further investigations of habitat use at small spatial scales and throughout the annual cycle are urgently required to better enlighten specific recommendations for wider applicability of guidelines for corn bunting recovery actions elsewhere.

M-tropic HIV strains gain access to their host cell via interaction of the viral envelope protein gp120 with the CCR5 coreceptor and CD4 located on the host cell. Inhibition of this event has been shown to reduce viral fusion and entry into cells in vitro. In the present study we describe the development of a novel cell/cell fusion assay that both mimics the viral/cell fusion process and allows quantification of this event. The assay has been characterized both biochemically, using selective antibodies, and pharmacologically, using selective CCR5 antagonists, and has been shown to be selective for examining the interaction of viral gp120 with hCCR5/hCD4. In addition, compound pIC 50 data obtained from this cell/cell fusion assay correlates well (r 2 = 0.7274) with data obtained from an HIV-1 replication assay. Furthermore, this assay has the added ability to simultaneously determine compound toxicity, thus allowing rapid determination of active, non-toxic compounds. In conclusion, the cell/cell fusion ass...

A thin, 87 year old, white woman presented with absolute constipation that had lasted for three days, abdominal pain, and vomiting. She also complained of a severe pain in her right thigh radiating to the knee. She had no preceding bowel symptoms, but she reported bouts of vomiting and abdominal pain lasting several days for the previous 18 months. The patient was unsure of recent weight loss. She lived alone and was independent, although her daughter helped with shopping. Medical history included osteoporosis and occasional dyspepsia. The patient had no history of any abdominal surgery. Medications were weekly risedronate and daily omeprazole. On examination she had a distended and tender abdomen with no palpable masses or hernias. Bowel sounds were high pitched and “tinkling.” She also demonstrated right sided painful hip flexion. Abdominal radiography revealed dilated loops of small bowel suggestive of obstruction, and computed tomography of the abdomen was requested (fig 1⇓). Fig 1 Computed tomogram of the patient’s abdomen ### Short answers

M-tropic HIV strains gain access to their host cell via interaction of the viral envelope protein gp120 with the CCR5 coreceptor and CD4 located on the host cell. Inhibition of this event has been shown to reduce viral fusion and entry into cells in vitro. In the present study we describe the development of a novel cell/cell fusion assay that both mimics the viral/cell fusion process and allows quantification of this event. The assay has been characterized both biochemically, using selective antibodies, and pharmacologically, using selective CCR5 antagonists, and has been shown to be selective for examining the interaction of viral gp120 with hCCR5/hCD4. In addition, compound pIC50 data obtained from this cell/cell fusion assay correlates well (r2 = 0.7274) with data obtained from an HIV-1 replication assay. Furthermore, this assay has the added ability to simultaneously determine compound toxicity, thus allowing rapid determination of active, non-toxic compounds. In conclusion, the cell/cell fusion assay developed has been demonstrated to be a suitable surrogate assay that can be used to assess the effects of compounds on gp120/CCR5/CD4 mediated viral fusion into host cells.

The seventh edition of The Compleat Parish Officer was published anonymously in 1734 and reprinted by the Wiltshire Family History Society in 1996. The largest section of this manual concerns the role of the parish constable. “Men of substance, and not of the meaner sort” were elected annually by their neighbours whether they liked it or not. People refusing to serve in this unattractive office were liable to prosecution at the assizes and fines in the lord of the manor's court. Some of the …

Hummingbirds need a lot of food in the evening. Then they roost and drop their body temperature. This bedtime calorie load and reduced metabolic rate enables them to survive the night. We had just moved a few blocks across a suburb in the north of San Diego. Some young relatives of my German wife visited us almost immediately in a new house that was in chaos. An afternoon project was to obtain and install a new hummingbird feeder (I could not bear to harm …

The spatial, habitat and dietary overlap of two breeding goose species was studied in Sassendalen, Svalbard, in summer 2003 based on abundance within 500 × 500-m grid squares and faecal diet analyses during pre-breeding, nesting and post-hatching periods. More than half of all Pink-footed Geese Anser brachyrhynchus occurred in the absence of Barnacle Geese Branta leucopsis during nesting and post-hatching periods compared to c. 20% when concentrated by pre-breeding snow cover. In contrast, only 5% of Barnacle Geese were observed in the absence of Pink-footed Geese pre-breeding, 15% during nesting, and 35% post-hatching. Among six defined habitat types, Barnacle Geese resorted more to ‘upland’ habitats during pre-breeding and nesting and to lowland lakes post-hatching when compared to Pink-footed Geese. Although Pink-footed Geese showed less change in seasonal habitat preference, many shifted to the river valley bottom post-hatching, giving access to open water (predator avoidance) and lush green vegetation (foraging for goslings). The smallest extent of distributional overlap between the two species occurred post-hatching, but each species was also highly restricted by snow cover during pre-nesting. The greatest extent of overlap in distribution and diet occurred during incubation, when large dietary variation between different breeding valleys reflected local food availability around nests (probably a result of nest-site preference rather than food selection per se ). Whether this means that increased interactions within and between the two goose species with future increases in local density are most likely to be manifest at this stage of the summer is impossible to determine without knowledge of available food resources and manipulative experiments. More detailed investigations of the effects of foraging by both species on plant structure, quality and community composition are necessary to predict likely outcomes of future changes in population densities of both species.