SARS-CoV-2 transmission risk for common group activities and settings: a living scoping review

BACKGROUND

While the modes of transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are well studied, the risk of transmission in various group settings or activities is less clear. This living scoping review aims to summarize the risk factors of coronavirus disease 2019 (COVID-19) spread in common group activities (e.g. social gatherings) or settings (e.g. schools, hospitals, shared workplaces) to understand the drivers of transmission and to inform a risk assessment profile tool for use of rapid antigen detection tests.

METHODS

We systematically searched electronic databases, MEDLINE and Embase, from January 2019 until February 2022. We included studies that evaluated the risk of SARS-CoV-2 transmission in activities and settings, deemed strategically important to government departments in Ireland, provided by the Department of Health (Ireland) Expert Advisory Group on Rapid Testing.

RESULTS

After screening 14 052 records, data from 139 studies were narratively synthesized. The risk was consistently reported as 'high' for large social events (e.g. weddings) and indoor sports, working in healthcare settings and shared workplaces, working/living in residential settings and travelling via public transportation. Most studies were from healthcare settings, with common risk factors including close contact with COVID-19 cases, working in high-risk departments and inappropriate use of personal protective equipment. For other settings and activities, lack of infection prevention and control practices reportedly contributed to infection transmission.

CONCLUSION

The heterogeneity across studies and lack of direct information on dominant variants, preventive measures, vaccination coverage necessitates further research on transmission risk within group activities to inform infection prevention and control measures.

Performance of different rapid antigen testing strategies for SARS-CoV-2: A living rapid review

BACKGROUND

Rapid antigen detection tests (RADTs) for SARS-CoV-2 testing offer several advantages over molecular tests, but there is little evidence supporting an ideal testing algorithm. We aimed to examine the diagnostic test accuracy (DTA) and the effectiveness of different RADT SARS-CoV-2 testing strategies.

METHODS

Following PRISMA DTA guidance, we carried out a living rapid review and meta-analysis. Searches were conducted in Ovid MEDLINE® ALL, Embase and Cochrane CENTRAL electronic databases until February 2022. Results were visualized using forest plots and included in random-effects univariate meta-analyses, where eligible.

RESULTS

After screening 8010 records, 18 studies were included. Only one study provided data on incidence outcomes. Seventeen studies were DTA reports with direct comparisons of RADT strategies, using RT-PCR as the reference standard. Testing settings varied, corresponding to original SARS-CoV-2 or early variants. Strategies included differences in serial testing, the individual collecting swabs and swab sample locations. Overall, specificity remained high (>98%) across strategies. Although results were heterogeneous, the sensitivity for healthcare worker-collected samples was greater than for self-collected samples. Nasal samples had comparable sensitivity when compared to paired RADTs with nasopharyngeal samples, but sensitivity was much lower for saliva samples. The limited evidence for serial testing suggested higher sensitivity if RADTs were administered every 3 days compared to less frequent testing.

CONCLUSIONS

Additional high-quality research is needed to confirm our findings; all studies were judged to be at risk of bias, with significant heterogeneity in sensitivity estimates. Evaluations of testing algorithms in real-world settings are recommended, especially for transmission and incidence outcomes.

Distance Traveled by Patients Globally to Access Radiotherapy: A Systematic Review

PURPOSE/OBJECTIVE(S)

This systematic review aims to investigate the global travel patterns of patients seeking radiotherapy and examines the distance traveled by patients and its impact on secondary outcomes such as travel time and survival. The findings of this review will provide crucial information on barriers to accessing radiotherapy and inform the development of patient-centered care strategies aimed at improving access to this important form of treatment.

MATERIALS/METHODS

A comprehensive search of four databases was conducted from June to August 2022. Studies were included if they were observational, retrospective, or randomized/non-randomized, published between June 2000 and June 2022, and reported the distance traveled globally for the treatment of malignant or benign disease. Studies were excluded if they did not report travel distance or were not written in English.

RESULTS

A total of 176 studies were included. Most of the studies (69.9%) were conducted in North America, with the majority (68.7%) in the United States. The treatment modalities varied with external beam radiation therapy being the most common (17.0%). The most common disease site was breast (26.7%). Of the included studies, 49 reported the mean distance traveled for radiation therapy. The shortest mean distance was reported in the United States at 4.83 miles, while the longest was reported in Iran at 276.5 miles. It was observed that patients living in countries outside the United States traveled greater distances for radiation therapy than those living within the U.S. Additional factors such as urban vs. rural residence and treatment modality were also found to impact the distance traveled for radiation therapy. Our results indicate a wide range of travel times, with approximately half of the studies reporting values greater than 1 hour, which was the case for 100% of the studies on low-income populations (n = 4). Out of 176 studies, only 15% discussed patient survival and reported conflicting results between travel distance and survival rates, regardless of treatment, disease site, or country of origin.

CONCLUSION

This systematic review is the most comprehensive to date on the global travel patterns of patients seeking radiotherapy. Results show that travel distances varied, but overall, patients in the U.S. traveled shorter distances for radiation therapy than those living outside the country. Treatment center location, patient residence, and treatment modality impacted patient travel distance, but the patterns were inconsistent. These findings emphasize the importance of considering the distance traveled as a barrier to receiving radiotherapy and highlight the need for strategies to improve patient access and prioritize patient-centered care.

A survey of final year pharmacy undergraduates’ mentorship experience

Introduction

The General Pharmaceutical Council (GPhC) Standard 7.3 for the initial education and training of pharmacists1 states student pharmacists and trainee pharmacists must have access to pharmacy professionals to provide professional support and guidance by acting as role models and mentors. Four mentoring programmes exist for Brighton University undergraduates, available virtually in addition to external mentoring programmes, such as Royal Pharmaceutical Society (RPS) mentoring programme. Chang et al2 studied RPS mentoring participants and found previous positive experiences inspired participants to participate in their programme. This work investigates 2021/2022 final year Brighton University pharmacy undergraduate mentoring experience.

Aim

To survey final year pharmacy undergraduates’ mentorship experience.

Methods

An online survey consisting of 5-point Likert-scale statements and closed-ended questions, was designed, piloted, and distributed using the JISC online survey platform to final year Brighton University pharmacy undergraduates. Data collected included awareness of mentorship programmes, whether undergraduates had previous mentorship experience, and attitudes towards mentoring using 12 Likert-scale statements each for respondents who were mentors, mentees, and those with no mentoring experience. The data were quantitively analysed using Microsoft Excel version 16.58 and the JISC online survey platform. The 5-point Likert Scale questions were analysed by calculating a weighted average. Ethics approval was received from the Brighton University School of Applied Sciences Research Ethics Committee.

Results

48 undergraduates completed the survey. 13 (27%) had previous experience mentoring. This sample was comprised of 8 undergraduates with mentor experience and 10 undergraduates with mentee experience. Four undergraduates had both mentor and mentee experience. In total, 63% (n=39) respondents were aware of the University’s mentoring programmes, 32 (60%) were aware of external mentoring programmes available with 45% (n=24) citing the RPS mentoring programme. A total of 75% (n=6) mentors and 70% (n=7) mentees reported that mentoring aided their professional development. All (n=8) undergraduates who were mentors and 80% (n=8) mentees reported that this was a beneficial experience. Three quarters (n=6) of those who were a mentor and 60% (n=6) who were mentees reported that this improved their employability skills. The main challenge found by mentors and mentees was the amount of time needed to undertake these roles. 16 (46%) undergraduates with no mentoring experience agreed that participating in a mentoring programme would be too much time and effort, 28 (80%) would prefer if their mentor/mentee was from or following the same professional background as them and 20 (57%) agreed they would consider signing up for a mentorship programme if offered to them.

Discussion/Conclusion

Limitations included a low response, but results obtained were sufficient to highlight issues. Although most undergraduates were found to be aware of benefits of a mentorship programme, these should be promoted further, with realism around time mentoring takes, and opportunities scoped to incorporate time for mentoring in undergraduates’ timetables. Many undergraduates still lack mentoring experience and are not aware of mentoring programmes. Establishing mentoring arrangements within the final year with trainee pharmacists could be a mechanism to address the undergraduate’s preference of mentoring arrangements with the same professional background.

References

1. GPhC. Standards for the initial education and training of pharmacists2021 [cited 2021 10/11/2021]:[16-32 pp.]. Available from: https://www.pharmacyregulation.org/sites/default/files/document/standards-for-the-initial-education-and-training-of-pharmacists-january-2021_0.pdf

2. Chang H, Desselle S, Canedo J, Mantzourani E. Reflections of mentors and mentees on a national mentoring programme for pharmacists in the United Kingdom: An examination into organisational culture and systems. Research in Social and Administrative Pharmacy. 2021.

Development of a risk assessment profile tool to determine appropriate use of SARS-CoV-2 rapid antigen detection tests for different activities and events in Ireland, since October 2021

We describe the development of a risk assessment profile tool that incorporates data from multiple domains to help determine activities and events where rapid antigen detection tests (Ag-RDT) could be used to screen asymptomatic individuals to identify infectious cases as an additional mitigation measure to reduce transmission of SARS-CoV-2. The tool aims to stratify, in real time, the overall risk of SARS-CoV-2 transmission associated with common activities and events, and this can be matched to an appropriate Ag-RDT testing protocol.

Non-fatal opioid overdose, naloxone access, and naloxone training among people who recently used opioids or received opioid agonist treatment in Australia: The ETHOS Engage study

BACKGROUND

Overdose is a major cause of morbidity and mortality among people who use opioids. Naloxone can reverse opioid overdoses and can be distributed and administered with minimal training. People with experience of overdose are a key population to target for overdose prevention strategies. This study aims to understand if factors associated with recent non-fatal opioid overdose are the same as factors associated with naloxone access and naloxone training in people who recently used opioids or received opioid agonist treatment (OAT).

METHODS

ETHOS Engage is an observational study of people who inject drugs in Australia. Logistic regression models were used to estimate odds ratios for non-fatal opioid overdose, naloxone access and naloxone training.

RESULTS

Between May 2018-September 2019, 1280 participants who recently used opioids or received OAT were enrolled (62% aged >40 years; 35% female, 80% receiving OAT, 62% injected drugs in the preceding month). Recent opioid overdose (preceding 12 months) was reported by 7% of participants, lifetime naloxone access by 17%, and lifetime naloxone training by 14%. Compared to people receiving OAT with no additional opioid use, recent opioid, benzodiazepine (preceding six months), and hazardous alcohol use was associated with recent opioid overdose (aOR 3.91; 95%CI: 1.68-9.10) and lifetime naloxone access (aOR 2.12; 95%CI 1.29-3.48). Among 91 people who reported recent overdose, 65% had never received take-home naloxone or naloxone training.

CONCLUSIONS

Among people recently using opioids or receiving OAT, benzodiazepine and hazardous alcohol use is associated with non-fatal opioid overdose. Not all factors associated with non-fatal overdose correspond to factors associated with naloxone access. Naloxone access and training is low across all groups. Additional interventions are needed to scale up naloxone provision.

Measurement of the Positive Muon Anomalous Magnetic Moment to 0.46 ppm

We present the first results of the Fermilab National Accelerator Laboratory (FNAL) Muon g-2 Experiment for the positive muon magnetic anomaly a_{μ}≡(g_{μ}-2)/2. The anomaly is determined from the precision measurements of two angular frequencies. Intensity variation of high-energy positrons from muon decays directly encodes the difference frequency ω_{a} between the spin-precession and cyclotron frequencies for polarized muons in a magnetic storage ring. The storage ring magnetic field is measured using nuclear magnetic resonance probes calibrated in terms of the equivalent proton spin precession frequency ω[over ˜]_{p}^{'} in a spherical water sample at 34.7 °C. The ratio ω_{a}/ω[over ˜]_{p}^{'}, together with known fundamental constants, determines a_{μ}(FNAL)=116 592 040(54)×10^{-11} (0.46 ppm). The result is 3.3 standard deviations greater than the standard model prediction and is in excellent agreement with the previous Brookhaven National Laboratory (BNL) E821 measurement. After combination with previous measurements of both μ^{+} and μ^{-}, the new experimental average of a_{μ}(Exp)=116 592 061(41)×10^{-11} (0.35 ppm) increases the tension between experiment and theory to 4.2 standard deviations.

Rapid diagnosis of seasonal Influenza virus and cohorting of hospitalised patients on a 'flu ward'. A prospective analysis of outcomes

BACKGROUND

The influenza season of 2017/2018 was burdensome in comparison to previous years. In patient management of seasonal influenza patients is poorly described.

AIM

To assess the impact of managing influenza patients on a dedicated influenza ward on antimicrobial use and duration, and length of stay (LOS).

METHODS

A prospective cohort study from Jan 1st to Feb 28th 2018. Patients diagnosed with influenza in the Emergency Department (ED) were cohorted under infectious disease (ID) or a general internal medicine (GIM) firms on a 35 bed influenza ward. At times of maximum capacity some patients were managed on other wards by other firms 'non flu ward'.

FINDINGS

91 patients were admitted to the influenza ward from ED (64 ID, 27 GIM), 38 had influenza A. Patients managed by ID were more likely to be switched to oral antibiotics sooner median 3 vs 5 days p=.049. Antibiotic duration was shorter for patients managed by the ID firm median 7 vs 9 days p=.016. LOS was shorter for patients managed by the ID firm on the flu ward vs 'non flu ward', median 5 vs 9 days p=.007. No significant difference was seen between ID and GIM LOS on the flu ward, median 5 vs 7 days p=0.30.

CONCLUSION

Influenza patients managed by an infectious disease service on an influenza ward had reduced length of intravenous (IV) and total antimicrobial use compared to a GIM service and had reduced LOS compared to the standard of care, 'non flu ward' influenza patients.

Assessing the quality of routine HIV testing data in the community setting 'COBATEST Network'

The COBATEST Network of Community-Based Voluntary Counselling and STI/HIV Testing (CBVCT) services was created to standardise monitoring and evaluation of CBVCT services across Europe. This study aims to assess the quality of data collected in the network from 2015 to 2016. A survey was completed by 34 COBATEST Network members and an evaluation was performed of data quality based on three dimensions: transcription validity, completeness and consistency. The weakest area that we identified was data management processes. Only 8.8% of services had a written procedure to address data quality errors, 29.4% had procedures in place to resolve discrepancies and 35.3% performed quality control. We found that 41.2% of services utilised the COBATEST data, 11.8% made decisions based on the COBATEST data and 61.8% analysed their data in an independent manner for internal purposes. We conclude that while services have reliable data to support planning and management of services, improvements to quality procedures would ensure data are translated into evidence. This evidence would support further expansion of CBVCT services in the EU/EEA, including the integration of CBVCT-generated data into national surveillance systems.

Managing the 'seamless service': Primary Care Groups in the new NHS

This paper reports on empirical work examining the consequences for the development of the role of Primary Care Groups of the shift from competition (in the internal market) to relationships based on collaboration and partnership. Previous work (Conway and Willcocks, 1998; Willcocks and Conway, 1999) firstly developed a conceptual framework emphasizing the development of relationships between Primary Care Groups and their key stakeholders (for example, Health Authorities, Local Authorities and Trusts) and, secondly, sought to test this framework empirically through case study analysis of two Primary Care Groups in the north of England. This paper takes the research further and focuses on one of these Primary Care Groups, providing an in-depth analysis of particular issues such as the rationale for the particular configuration of this organization and the chosen working arrangements, the role and function of the Board and individual members, and the problems encountered in the first year of operation.

Replication dynamics of the yeast genome

Oligonucleotide microarrays were used to map the detailed topography of chromosome replication in the budding yeast Saccharomyces cerevisiae. The times of replication of thousands of sites across the genome were determined by hybridizing replicated and unreplicated DNAs, isolated at different times in S phase, to the microarrays. Origin activations take place continuously throughout S phase but with most firings near mid-S phase. Rates of replication fork movement vary greatly from region to region in the genome. The two ends of each of the 16 chromosomes are highly correlated in their times of replication. This microarray approach is readily applicable to other organisms, including humans.

Responding to diversity: the Primary Care Group in the NHS

The paper attempts to examine the development of Primary Care Groups in the NHS, utilising a conceptual framework taken from relationship marketing. In particular, it looks at a framework representing the complex relationships between the Primary Care Group and a diverse range of internal and external stakeholders and the implications of these relationships. It reports the preliminary findings of an ongoing, in-depth case study of two Primary Care Groups; with data collected from in-depth interviews with a small number of key stakeholders. The results, so far, suggest the importance of developing and maintaining longer-term relationships with a range of partners, both internal and external. It recommends that Primary Care Groups should develop strategies to work closely with these stakeholders, as an essential underpinning to developing continuous improvement in performance, quality and "user" retention.

Ceramide-dependent regulation of p42/p44 mitogen-activated protein kinase and c-Jun N-terminal-directed protein kinase in cultured airway smooth muscle cells

Previous studies have demonstrated that a number of biochemical actions of ceramide are mediated through protein kinase signalling pathways, such as p42/p44 mitogen-activated protein kinase (p42/p44 MAPK) and c-Jun N-terminal directed protein kinase (JNK). Ceramide-activated protein kinases, such as the kinase suppressor of Ras (KSR) and protein kinase Czeta (PKCzeta), are involved in the regulation of c-Raf, which promotes sequential activation of MEK-1 and p42/p44 MAPK in mammalian cells. However, in cultured airway smooth muscle (ASM) cells, neither KSR nor PKCzeta are involved in the C2-ceramide (C2-Cer)-dependent activation of this kinase cascade. Instead, we found that C2-Cer utilises a novel pathway involving tyrosine kinases, phosphoinositide 3-kinase (PI3K) and conventional PKC isoform(s). We also found that despite its ability to stimulate p42/p44 MAPK, C2-Cer inhibited platelet-derived growth factor (PDGF)-stimulated DNA synthesis. The possibility that growth arrest could be mediated by JNK was discounted on the basis that PDGF, as well as ceramide, stimulated JNK in these cells. Therefore, growth arrest in response to ceramide is mediated by an alternative mechanism.

Physostigmine challenge before and after chronic cholinergic blockade in elderly volunteers

BACKGROUND

As a test of possible muscarinic up-regulation, the cortisol response to intravenous (i.v.) physostigmine (an anticholinesterase) was measured in 9 elderly volunteers before and after chronic cholinergic blockade with the muscarinic cholinergic antagonist scopolamine.

METHODS

Each of the 9 elderly control subjects was given two physostigmine (0.5 mg i.v.) infusions separated by 21 doses of nightly scopolamine (1.2 mg p.o.). No scopolamine was administered the night before infusions, and glycopyrrolate (0.2 mg i.v.) was administered prior to physostigmine, to block its peripheral effects. Vital signs were monitored and blood samples were collected at six time points surrounding the physostigmine infusion (-10, +10, +20, +30, +50, and +70 min). Behavioral measures and cognitive tests were administered prior to and 30 min after the physostigmine.

RESULTS

The cortisol response to physostigmine was greater after the second (post-chronic scopolamine) infusion study compared to the first (p < .05) as measured by an area under the curve analysis of all time points. When individual time points were compared, the mean cortisol response was significantly increased after the second physostigmine infusion at the +50- and +70-min time points (p < .05). There were no significant changes in behavioral rating scales, cognitive tests, or vital signs between the two physostigmine infusion study days.

CONCLUSIONS

This study demonstrates increased hypothalamic-pituitary-adrenocortical axis responsivity to a central nervous system cholinergic stimulus after chronic muscarinic blockade in 9 elderly control subjects. It also gives further evidence to support previous suggestions of muscarinic plasticity, specifically postsynaptic up-regulation, in the aging brain following exposure to chronic anticholinergic treatment.

Antimutagenic activity of chemical fractions isolated from a commercial soybean processing by-product

Commercial products of agronomic crop plants may become a reliable and inexpensive source of phytonutrients, such as antimutagenic food supplements. We previously demonstrated that PCC, an ethanol extract of a commercial soybean processing by-product, was able to repress induced genomic DNA damage, whole cell clastogenicity, and point mutation in mammalian cells. In this paper we separated PCC into a series of chemically defined fractions and determined their ability to repress induced mutagenic damage in Chinese hamster lung cells, Chinese hamster ovary cells and human lymphocytes. Fraction PCC70 (PCC 70% methanol eluate) contained the flavonoids from PCC and daidzin and genistin repressed 2-acetoxyacetylaminofluorene (2AAAF)-induced DNA damage measured with single cell gel electrophoresis. Genistein, however, enhanced the genotoxic impact of 2AAAF. Fraction PCC100 (PCC 100% methanol eluate) had the greatest level of antigenotoxic activity against 2AAAF in CHO cells and repressed the genotoxic capacity of the dietary carcinogen 2-amino-3-methylimidazo-(4,5-f)quinoline (IQ) in human lymphocytes. These data indicate that commercial soybean products and by-products may be a source of chemoprotective food additives.

Adherence and compliance in the management of asthma: 2

The first article (Vol 7(21): 1313-15) in this two-part article examining the role of compliance in asthma management, discussed the concept of adherence to treatment. In this article, the role of the healthcare professional in improving adherence is discussed in greater depth. When attempting to improve patients' adherence to treatment, the healthcare professional must adopt a number of roles, e.g. counsellor, educator, negotiator and problem-solver. Practical advice and information is provided to facilitate an improved therapeutic alliance between professional and patient, with the emphasis on achieving shared goals.

Adherence and compliance in the management of asthma: 1

This article explores the issues surrounding compliance with treatment in patients with asthma. Epidemiological data (Pendleton, 1991) suggest that although overall mortality rates from asthma are falling, this is not the case in the adolescent and young adult age groups. Also, there has been little impact on morbidity figures for the disease. All of this is set against an expenditure of 430 Pounds billion per annum on asthma medication. It would appear that patients are not complying with the prescribed treatment. This article examines the reasons for possible non-adherence with therapy and suggests that healthcare professionals must review their attitudes to this problem. The next article will examine in more detail issues relating to patients' adherence.

A genome-wide transcriptional analysis of the mitotic cell cycle

Progression through the eukaryotic cell cycle is known to be both regulated and accompanied by periodic fluctuation in the expression levels of numerous genes. We report here the genome-wide characterization of mRNA transcript levels during the cell cycle of the budding yeast S. cerevisiae. Cell cycle-dependent periodicity was found for 416 of the 6220 monitored transcripts. More than 25% of the 416 genes were found directly adjacent to other genes in the genome that displayed induction in the same cell cycle phase, suggesting a mechanism for local chromosomal organization in global mRNA regulation. More than 60% of the characterized genes that displayed mRNA fluctuation have already been implicated in cell cycle period-specific biological roles. Because more than 20% of human proteins display significant homology to yeast proteins, these results also link a range of human genes to cell cycle period-specific biological functions.

The Australian Multicenter Trial of Growth Hormone (GH) Treatment in GH-Deficient Adults

GH treatment in adults with GH deficiency has numerous beneficial effects, but most studies have been small. We report the results of an Australian multicenter, randomized, double-blind, placebo-controlled trial of the effects of recombinant human GH treatment in adults with GH deficiency. GH deficiency was defined as a peak serum GH of < 5 mU/liter in response to insulin-induced hypoglycemia. Patients were randomly assigned to receive either GH (0.125 U/kg per week for 1 month and 0.25 U/kg per week for 5 months) or placebo. After 6 months, all patients received GH. The primary end points were biochemical responses, body composition, quality of life, and safety. One hundred sixty-six patients (72 females and 91 males) with a mean age of 40 +/- 1 yr (+/- SEM; range 17-67 yr) were recruited. Serum insulin-like growth factor-I (IGF-I) increased from a standard deviation score of -2.64 +/- 0.27 (range -8.8 +3.82; n = 78) to +1.08 +/- 2.87 (range -7.21 to +6.42) at 6 months in the GH/GH group; 38% of the whole group were above the age-specific reference range following treatment [17.6% and 68.9% with subnormal (< 2 SD) or normal (+/- 2 SD) pretreatment levels, respectively]. Fasting total cholesterol (P = 0.042) and low-density lipoprotein cholesterol (P = 0.006) decreased over the first 6 months. Fat-free mass increased in the first 6 months whether measured by bioelectrical impedance (P < 0.001) or dual energy x-ray absorptiometry (DEXA; P < 0.001). Total-body water increased in the first 6 months whether measured by bioelectrical impedance (P < 0.001) or deuterium dilution (P = 0.002). Fat mass measured by DEXA (P < 0.001), skinfold thicknesses (P < 0.001), and waist/hip ratio (P = 0.001) decreased in the first 6 months. Most changes in body composition were complete by 3 months of treatment and maintained to 12 months. Whole-body bone mineral density (BMD) (by DEXA) was unaffected by GH treatment. Self-reported quality of life was considered good before treatment, and beneficial treatment effects were observed for energy, pain, and emotional reaction as assessed by the Nottingham Health Profile. In the initial 6 months, adverse effects were reported by 84% of patients in the GH and 75% in the placebo group, with more symptoms relating to fluid retention in the GH group (48% vs. 30%; P = 0.016). Such symptoms were mild and resolved in 70% of patients despite continued treatment. Resting blood pressure did not change over the initial 6 months. In summary, GH treatment in adults with GH deficiency resulted in 1) prominent increases in serum IGF-I at the doses employed, in some cases to supraphysiological levels; 2) modest decreases in total- and low-density lipoprotein cholesterol, together with substantial reductions in total-body and truncal fat mass consistent with an improved cardiovascular risk profile; 3) substantial increases in lean tissue mass; and 4) modest improvements in perceived quality of life. The excessive IGF-I response and side-effect profile suggests that lower doses of GH may be a required for prolonged GH treatment in adults with severe GH deficiency.

Home intravenous therapy for bronchiectasis patients

Home intravenous therapy is the fastest growing area of health care in the USA and the Netherlands. This article examines the introduction of this form of treatment for a specific client group by the respiratory unit at the Glenfield Hospital.

Breathing and feeling: capnography and the individually meaningful psychological stressor

This article briefly discusses capnography and the use of individually meaningful psychological stressors (IMPS) to provoke episodes of acute hyperventilation. Guidelines are provided on history taking, and a strategy for using IMPS with ongoing capnographic monitoring is described, together with a proposal for diagnostic criteria. Diagnosis of hyperventilation using IMPS and capnography can help to demonstrate that feelings, breathing, and symptoms are all interlinked, and may help to suggest appropriate targets for therapy.

The use of fluorescence in-situ hybridisation to clarify abnormal Y chromosomes in two infertile men

OBJECTIVE

To characterise the structurally abnormal Y chromosomes present in two infertile men by means of the molecular technique of fluorescence in-situ hybridisation (FISH).

METHODS

Both men were phenotypically normal and had azoospermia. In Case 1 the karyotype with routine cytogenetics was 46,XX; in Case 2 it was complex, with 3 cell lines--45,X/46,X,i(Yp)/46,X,+?del(Y)(q11). We used probes from the Y chromosome and FISH to clarify these karyotypes.

RESULTS

In Case 1 a translocation of Y chromosome to the X chromosome was identified with FISH--t(X;Y). In Case 2, an isochromosome of the short arm of the Y chromosome was confirmed in one cell line, and another cell line was shown to contain a small Y chromosome with heterochromatic deletion. These findings explained the underlying pathogenesis in both cases.

CONCLUSIONS

Molecular investigation with FISH should become part of the routine investigation of infertile men with an abnormal Y chromosome.

Difficulties in managing a case of stupor

Stupor is a rare and dramatic presentation of a number of neurological and psychiatric conditions which can cause problems in both diagnosis and management. A case is described which illustrates these difficulties.

Rehabilitation approaches to children with osteogenesis imperfecta: a ten-year experience

Twenty-five children with severe osteogenesis imperfecta were followed and treated with physical and occupational therapy for a mean of five years, two months, 80% since the first two years of life. According to their highest achieved motor skill, they fell into three groups: (A) able to stand in braces, (B) able to ambulate short distances without braces, and (C) able to ambulate in the community without assistance. Preventable functional impairment is caused in group A by shoulder joint and hand contractures and upper extremity weakness, group by hip flexion and plantar flexion contractures of the feet, shoulder joint contractures, and upper extremity weakness, and group C by poor lower extremity joint alignment, impaired balance, and low endurance. Appropriate rehabilitation strategies have led to slow, continued functional improvement in the majority of patients. Results of the ten-year retrospective study suggest that clinical groupings based in part on functional needs will enable the clinician to provide optimal rehabilitation services.