Novel Approaches to Multidrug-Resistant Infections in Cystic Fibrosis

Patients with cystic fibrosis (CF) often develop respiratory tract infections with pathogenic multidrug-resistant organisms (MDROs) such as methicillin-resistant Staphylococcus aureus, and a variety of gram-negative organisms that include Pseudomonas aeruginosa, Burkholderia sp., Stenotrophomonas maltophilia, Achromobacter xylosoxidans, and nontuberculous mycobacteria (NTM). Despite the introduction of new therapies to address underlying cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction, MDRO infections remain a problem and novel antimicrobial interventions are still needed. Therapeutic approaches include improving the efficacy of existing drugs by adjusting the dose based on differences in CF patient pharmacokinetics/pharmacodynamics, the development of inhaled formulations to reduce systemic adverse events, and the use of newer beta-lactam/beta-lactamase combinations. Alternative innovative therapeutic approaches include the use of gallium and bacteriophages to treat MDRO pulmonary infections including those with extreme antibiotic resistance. However, additional clinical trials are required to determine the optimal dosing and efficacy of these different strategies and to identify patients with CF most likely to benefit from these new treatment options.

Evaluation of a Virtual Reality-Based Open Educational Resource Software

OBJECTIVES

Virtual reality (VR) teaching methods have potential to support medical students acquire increasing amounts of knowledge. EVENT (Easy VR EducatioN Tool) is an open educational resource software for immersive VR environments, which is designed for use without programming skills. In this work, EVENT was used in a medical student VR course on pancreatic cancer.

METHODS

Medical students were invited to participate in the course. Before and after VR simulation, participants completed a multiple-choice knowledge assessment, with a maximum score of 10, and a VR experience questionnaire. The primary endpoint compared pre- and post-VR simulation test scores. Secondary endpoints included usability and factors that could affect learning growth and test results.

RESULTS

Data from 117 of the 135 participating students was available for analysis. Student test scores improved by an average of 3.4 points (95% CI 3.1-3.7, P < 0.001) after VR course. The secondary endpoints of gender, age, prior knowledge regarding the medical subject, professional training completed in the medical field, video game play, three-dimensional imagination skills, or cyber-sickness had no major impact on test scores or final ranking (top or bottom 25%). The 27 students whose post-VR simulation test scores ranked in the top 25% had no prior experience with VR. The average System Usability Scale score was 86.1, which corresponds to an excellent outcome for user-friendliness. Questionnaire responses post-VR simulation show students (81.2% [95/117]) interest in more VR options in medical school.

CONCLUSIONS

We present a freely available software that allows for the development of VR teaching lessons without programming skills.

A Novel Zinc (II) Porphyrin Is Synergistic with PEV2 Bacteriophage against Pseudomonas aeruginosa Infections

Pseudomonas aeruginosa (PsA) is an opportunistic bacterial pathogen that causes life-threatening infections in individuals with compromised immune systems and exacerbates health concerns for those with cystic fibrosis (CF). PsA rapidly develops antibiotic resistance; thus, novel therapeutics are urgently needed to effectively combat this pathogen. Previously, we have shown that a novel cationic Zinc (II) porphyrin (ZnPor) has potent bactericidal activity against planktonic and biofilm-associated PsA cells, and disassembles the biofilm matrix via interactions with eDNA In the present study, we report that ZnPor caused a significant decrease in PsA populations in mouse lungs within an in vivo model of PsA pulmonary infection. Additionally, when combined with an obligately lytic phage PEV2, ZnPor at its minimum inhibitory concentration (MIC) displayed synergy against PsA in an established in vitro lung model resulting in greater protection of H441 lung cells versus either treatment alone. Concentrations above the minimum bactericidal concentration (MBC) of ZnPor were not toxic to H441 cells; however, no synergy was observed. This dose-dependent response is likely due to ZnPor's antiviral activity, reported herein. Together, these findings show the utility of ZnPor alone, and its synergy with PEV2, which could be a tunable combination used in the treatment of antibiotic-resistant infections.

1226 A MULTI-DISCIPLINARY APPROACH TO TRANSFORMING EYE CARE SERVICES FOR CARE HOME RESIDENTS

Introduction

Care home residents can have variable access to eye care services and treatments. We developed a collaborative approach between optometrists, care homes, and primary and secondary care to enable personalised patient-centred care.

Objective

To develop and evaluate an integrated model of eye care for care home residents.

Methods

Small scale plan-do-study-act (PDSA) service tests were completed in three care-homes in Southwark (2 residential, 1 nursing) between November 2021 to May 2022. Processes were compared to historical feedback and hospital-based ophthalmology clinic attendances (Mar 2019-2020). Hospital-like assessments were piloted at two care homes for feasibility and acceptability. Further piloting utilised usual domiciliary optometry-led assessment with multidisciplinary meeting access (including optometrist, GP, geriatrician, ophthalmologist and care home nurse) to reduce duplication of assessments and to evaluate MDM processes and referral rates.

Results

Examination was 100% successful at home (visual acuity and pressure measurement) compared to hospital outpatients (71.7% success visual acuity, 54.5% pressures). Examination was faster than in hospital settings (16 minutes vs 45 minutes-1 hour). Residents were away from usual activities for 32 minutes vs 6 hours for hospital visits including transport. Residents were less distressed with home-based assessments. Did-Not-Attend (DNA) rates reduced (26.7% to 0%), secondary care discharge rates improved (8.4% to 32%). Hospital eye service referral were indicated in 19% -23%, half of which were for consideration of cataract surgery. Alternative conservative plans were agreed at MDM for nursing home residents who were clinically too frail or would not have been able to comply with treatments avoiding 33% unnecessary referrals.

Conclusions

Home-based eye care assessments appear better tolerated and are more efficient for residents, health and care staff. Utilising an MDM for optometrists to discuss residents with ophthalmologists and wider MDT members enabled personalised patient-centred decision-making. Future work to test this borough wide is in progress.

IFN- Is Protective in Cytokine Release Syndrome-associated Extrapulmonary Acute Lung Injury

The mechanisms by which excessive systemic activation of adaptive T lymphocytes, as in cytokine release syndrome (CRS), leads to innate immune cell-mediated acute lung injury (ALI) or acute respiratory distress syndrome, often in the absence of any infection, remains unknown. Here, we investigated the roles of IFN-γ and IL-17A, key T-cell cytokines significantly elevated in patients with CRS, in the immunopathogenesis of CRS-induced extrapulmonary ALI. CRS was induced in wild-type (WT), IL-17A- and IFN-γ knockout (KO) human leukocyte antigen-DR3 transgenic mice with 10 μg of the superantigen, staphylococcal enterotoxin B, given intraperitoneally. Several ALI parameters, including gene expression profiling in the lungs, were studied 4, 24, or 48 hours later. Systemic T-cell activation with staphylococcal enterotoxin B resulted in robust upregulation of several chemokines, S100A8/A9, matrix metalloproteases, and other molecules implicated in tissue damage, granulocyte as well as agranulocyte adhesion, and diapedesis in the lungs as early as 4 hours, which was accompanied by subsequent neutrophil/eosinophil lung infiltration and severe ALI in IFN-γ KO mice. These pathways were significantly underexpressed in IL-17A KO mice, which manifested mildest ALI and intermediate in WT mice. Neutralization of IFN-γ worsened ALI in WT and IL-17A KO mice, whereas neutralizing IL-17A did not mitigate lung injury in IFN-γ KO mice, suggesting a dominant protective role for IFN-γ in ALI and that IL-17A is dispensable. Ruxolitinib, a Janus kinase inhibitor, increased ALI severity in WT mice. Thus, our study identified novel mechanisms of ALI in CRS and its differential modulation by IFN-γ and IL-17A.

Novel Approaches to Multidrug-Resistant Infections in Cystic Fibrosis

Patients with cystic fibrosis (CF) often develop respiratory tract infections with pathogenic multidrug-resistant organisms (MDROs) such as methicillin-resistant Staphylococcus aureus, and a variety of gram-negative organisms that include Pseudomonas aeruginosa, Burkholderia sp., Stenotrophomonas maltophilia, Achromobacter xylosoxidans, and nontuberculous mycobacteria (NTM). Despite the introduction of new therapies to address underlying cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction, MDRO infections remain a problem and novel antimicrobial interventions are still needed. Therapeutic approaches include improving the efficacy of existing drugs by adjusting the dose based on differences in CF patient pharmacokinetics/pharmacodynamics, the development of inhaled formulations to reduce systemic adverse events, and the use of newer beta-lactam/beta-lactamase combinations. Alternative innovative therapeutic approaches include the use of gallium and bacteriophages to treat MDRO pulmonary infections including those with extreme antibiotic resistance. However, additional clinical trials are required to determine the optimal dosing and efficacy of these different strategies and to identify patients with CF most likely to benefit from these new treatment options.

Epidermal Growth Factor Receptor Inhibition Is Protective in Hyperoxia-Induced Lung Injury

Aims

Studies have linked severe hyperoxia, or prolonged exposure to very high oxygen levels, with worse clinical outcomes. This study investigated the role of epidermal growth factor receptor (EGFR) in hyperoxia-induced lung injury at very high oxygen levels (>95%).

Results

Effects of severe hyperoxia (100% oxygen) were studied in mice with genetically inhibited EGFR and wild-type littermates. Despite the established role of EGFR in lung repair, EGFR inhibition led to improved survival and reduced acute lung injury, which prompted an investigation into this protective mechanism. Endothelial EGFR genetic knockout did not confer protection. EGFR inhibition led to decreased levels of cleaved caspase-3 and poly (ADP-ribosyl) polymerase (PARP) and decreased terminal dUTP nick end labeling- (TUNEL-) positive staining in alveolar epithelial cells and reduced ERK activation, which suggested reduced apoptosis in vivo. EGFR inhibition decreased hyperoxia (95%)-induced apoptosis and ERK in murine alveolar epithelial cells in vitro, and CRISPR-mediated EGFR deletion reduced hyperoxia-induced apoptosis and ERK in human alveolar epithelial cells in vitro. Innovation. This work defines a protective role of EGFR inhibition to decrease apoptosis in lung injury induced by 100% oxygen. This further characterizes the complex role of EGFR in acute lung injury and outlines a novel hyperoxia-induced cell death pathway that warrants further study.

Conclusion

In conditions of severe hyperoxia (>95% for >24 h), EGFR inhibition led to improved survival, decreased lung injury, and reduced cell death. These findings further elucidate the complex role of EGFR in acute lung injury.

Bacteriophage therapy for infections in CF

Pseudomonas aeruginosa and Staphylococcus aureus are bacterial pathogens frequently associated with pulmonary complications and disease progression in cystic fibrosis (CF). However, these bacteria increasingly show resistance to antibiotics, necessitating novel management strategies. One possibility is bacteriophage (phages; bacteria-specific viruses) therapy, where lytic phages are administered to kill target bacterial pathogens. Recent publications of case reports of phage therapy to treat antibiotic-resistant lung infections in CF have garnered significant attention. These cases exemplify the renewed interest in phage therapy, an older concept that is being newly updated to include rigorous collection and analysis of patient data to assess clinical benefit, which will inform the development of clinical trials. As outcomes of these trials become public, the results will valuable gauge the potential usefulness of phage therapy to address the rise in antibiotic-resistant bacterial infections. In addition, we highlight the further need for basic research to accurately predict the different responses of target bacterial pathogens when phages are administered alone, sequentially, or as mixtures (cocktails), and whether within-cocktail interactions among phages hold consequences for the efficacy of phage therapy in patient treatment.

Supportive technology in collaborative research: proposing the STiCR framework

INTRODUCTION

Achieving a standard of clinical research at the pinnacle of the evidence pyramid is historically expensive and logistically challenging. Research collaboratives have delivered high-impact prospective multicentre audits and clinical trials by using trainee networks with a range of enabling technology. This review outlines such use of technology in the UK and provides a framework of recommended technologies for future studies.

METHODS

A review of the literature identified technology used in collaborative projects. Additional technologies were identified through web searches. Technologies were grouped into themes including access (networking and engagement), collaboration and event organisation. The technologies available to support each theme were studied further to outline relative benefits and limitations.

FINDINGS

Thirty-three articles from trainee research collaboratives were identified. The most frequently documented technologies were social media applications, website platforms and research databases. The Supportive Technologies in Collaborative Research framework is proposed, providing a structure for using the technologies available to support multicentre collaboration. Such technologies are often overlooked in the literature by established and start-up collaborative project groups. If used correctly, they might help to overcome the physical, logistical and financial barriers of multicentre clinical trials.

Volatile Compounds Associated with Spoilage of Vacuum-Packaged Sliced Luncheon Meat by Brochothrix thermosphacta

By using gas chromatography-mass spectrometry, seven volatile compounds were identified in vacuum-packaged sliced corned beef spoiled by Brochothrix thermosphacta under aerobic conditions. Acetoin and diacetyl appeared to be of major sensory significance.

The role of taste and appetite regulation in the understanding of overweight and obesity. Proceedings of the 16th Aschauer Soiree, 26th April 2008

Overweight and obesity have developed into major illnesses in most Western societies and significantly contribute to the financial burden of modern public health systems. Almost daily, new therapeutic proposals are published in the lay press, and also the scientific literature has increased dramatically in recent years. E.g., when searching MEDLINE (1966 - May 2008 (1)), the key word "obesity" meanwhile appears in more than 108,000 articles. Primary focus however, is put upon aspects of treatment, neglecting the role of taste and appetite regulation. Combining keywords like "obesity + treatment" results in over 50.000 citations, "obesity + diet" in over 23.000, "obesity + energy + expenditure" in over 13.000 citations (even "obesity + gastric + bypass" still evoke 2.600 citations), whereas "obesity + appetite + regulation" result in some 3.000, "obesity + NPY" - neuropeptid Y being one of the major chemical stimulators of appetite - evoke some 500 and "obesity + Arc + nucleus" - the arcuate nucleus being the anatomical centre of appetite regulation - no more than 370 scientific publications. The apparent scarcity of literature about taste and appetite regulation and the amazing lack of interest in neuronal information processing in overweight and obesity, has prompted the authors to brainstorm new aspects of the world-wide derailment of weight control.

Patients' views of causes of aggression by patients and effective interventions

OBJECTIVE

The authors studied patients' perceptions of the causes of aggression by patients and their recommendations for interventions to prevent assaultive behavior.

METHODS

A total of 92 inpatient and outpatient veterans, the majority of whom had a psychiatric diagnosis and some a medical diagnosis, answered questions in individual interviews about whether they had ever witnessed an assault.

RESULTS

Fifty-two participants had witnessed aggression. Participants' answers about the causes of patient-to-patient and patient-to-staff aggression were categorized into internal factors-cognition, feelings, and symptoms-and interpersonal stressors, such as personality conflicts and abrasive words. The majority of causes identified were in the category of interpersonal stressors-67 percent for patient-to-patient aggression and 60 percent for patient-to-staff aggression. The participants' answers about suggested interventions to prevent both types of aggression were categorized as individual patient, cooperative patient-staff, and staff interventions. For patient-to-patient aggression, 52 percent of the interventions suggested were for staff. This proportion was 74 percent for patient-to-staff aggression. For both types of aggression, only 10 percent of the suggested interventions involved patient-staff cooperation.

CONCLUSIONS

The participants indicated that both patients and staff play important parts in causing and in intervening to prevent violence. This information can be used to help plan programs to prevent and intervene in aggressive behavior.

Age effects on interrelationships between lung volume and heart rate during standing

To determine the effects of aging and posture on the relationship between respiration and heart rate (HR), we collected 5 min of lung volume and R-R interval data from 7 young (27 +/- 3 yr, mean +/- SD) and 10 old (69 +/- 6 yr) healthy humans during spontaneous breathing while they were supine (SU) and standing (ST). Lung volume and HR power spectra and transfer functions between lung volume and HR were estimated. Age and position effects and age-position interactions were determined by analysis of variance for repeated measures. Older subjects had a lower and more variable respiration rate (P < 0.03, P < 0.04), but both age groups exhibited decreased rate of respiration and increased tidal volume with ST (P < 0.05, P < 0.005). ST decreased lung volume-to-HR transfer function magnitude in both groups (P < 0.07). The more marked age-related differences were in phase angle. Both SU and ST phase angles were greater in older subjects (P < 0.003). ST decreased phase angle in young but increased phase angle in older subjects (P < 0.001). In conclusion, respiration, and respiration-HR interrelationships are altered by aging, with increased time delays between lung volume and HR and altered relationships with ST.

Age and autonomic effects on interrelationships between lung volume and heart rate

To determine effects of aging and autonomic input on interrelationships between respiratory and heart rate variability, we collected 5 min of lung volume of R-R interval data from 7 young [27 +/- 3(SD) yr] and 10 older (69 +/- 6 yr) healthy supine humans before and after double pharmacological autonomic blockade with propranolol (0.2 mg/kg iv) and atropine (0.04 mg/kg iv). Estimates of respiratory and heart rate power spectra and linear transfer functions between the two groups were generated by Fourier analysis. Age, double blockade effects, the age-drug interactions were determined by analysis of variance for repeated measures. Basal R-R intervals were unaffected by age. Double blockade decreased R-R intervals and variability in both age groups (P < 0.0001), but R-R intervals decreased less in older than in young subjects (P < 0.0001). In contrast, basal respiratory intervals and standard deviation were greater in older subjects (P = 0.05) and were unaffected by double blockade in young and older subjects. Lung volume-to-heart rate spectral coherence was highest at frequencies associated with respiration and greater in young than in older subjects (P < 0.07). Double blockade decreased lung volume-to-heart rate variability transfer function magnitude (P < 0.007) and increased phase angle (P < 0.02) without age effects or age-drug interactions. In conclusion, heart rate, respiration, and respiration-heart rate interrelations are altered by aging, and double autonomic pharmacological blockade does not eliminate all age-related differences.

Dose requirements, efficacy and side effects of morphine and pethidine delivered by patient-controlled analgesia after gynaecological surgery

We have compared the dose requirements and side effects of morphine with those of pethidine when administered by patient-controlled analgesia in 40 patients (ASA I-II, 20-65 yr) after elective total abdominal hysterectomy. Patients were allocated randomly, in a double-blind manner, to receive either morphine (bolus dose 2 mg, lockout time 10 min) or pethidine (bolus dose 20 mg, lockout time 10 min) for postoperative pain relief. Mean 24-h morphine and pethidine consumption was 70 (SEM 6.2) mg and 660 (67.8) mg, respectively (ratio 1:9.4). There were no significant differences in postoperative sedation, nausea, pain relief and patient satisfaction (VAS 0-100 mm), and requirements for antiemetics. Four patients receiving pethidine were withdrawn because of postoperative confusion and one receiving morphine because of intractable nausea and vomiting. The 95% confidence interval for this difference between the groups for VAS scores of sedation, nausea and pain were approximately 30 mm.

Cervical cancer in Kerala: a hospital registry-based study on survival and prognostic factors

The survival experience of 452 cervical cancer patients registered during 1984 by the hospital registry of the Regional Cancer Centre, Trivandrum, Kerala, India, is described in this paper. Eighty per cent of the patients completed the prescribed treatment, which was predominantly radiotherapy. The vital status of each patient was established by scrutiny of case records and by reply-paid postal enquiries. The observed survival rates were estimated by the Kaplan-Meier method and prognostic factors were assessed using Cox's proportional hazards regression analysis. The overall 5 year observed survival rate was 47.4% (95% CI, 41.6-52.9%). Socioeconomic status, performance status and the clinical stage of disease emerged as independent predictors of survival. Low survival was associated with advanced stages of disease, low socioeconomic status and poor performance status. The problems in studying survival from cancer in developing countries and the strategies used to improve follow-up rates in India are discussed. It is stressed that trends in survival rates may be used to evaluate cancer control programmes in developing countries in the absence of reliable mortality statistics and, even when mortality data are available, survival rates are valuable comparative statistics. Earlier detection by improving the awareness of the population and the physicians will improve survival rates, but a more effective and prudent approach would be to prevent invasive cervical cancer, and thereby reduce mortality, by implementing feasible and effective screening programmes in India.

Intershift goes visual

The staff of Unit 71, Rockeyview Hospital, Calgary, have developed a visual intershift reporting system that has proven to be so satisfactory many hospital units have adopted it. Historically, intershift report had been accomplished by the outgoing shift taping their report and the incoming shift listening to the total report.

Implementation of a multimodality program

Economic changes in the health care system have presented a unique opportunity for radiographers and other imaging personnel. Hospital administrators are becoming aware of the advantages of employing multiskilled technologists. The single-skilled technologist must recognize the benefits of additional education and overcome the negative perceptions of the profession. A well-conceived educational program developed and managed by a continuing education department will provide not only the required didactic and clinical courses to ensure competency, but also recognized credentialing for each modality.

Stress and arousal during pregnancy and childbirth

Sixty primigravidae were assessed on the short form of the Stress-Arousal Adjective Check List (SACL) at the commencement of the third trimester of pregnancy. Fifty-four of these were also administered the SACL in the labour ward and at three days after birth. On the first assessment the mean levels for the group of mothers were above normative levels of stress but not normative levels of arousal. In labour there was a significant increase in stress accompanied by a significant decrease in arousal. On the third day stress and arousal means were at approximately normative levels. Of those women stressed antenatally, four-fifths were also stressed in labour and half were stressed postnatally. Correlates of stress and arousal are examined and the utility of the measures discussed.

Psychological adjustment to coronary artery surgery

In a study of psychological adjustment to coronary artery bypass surgery 23 patients who underwent surgery were seen pre-operatively, prior to discharge and one year after surgery. A comparison sample of 19 patients not tested pre-surgically was contacted by postal questionnaire one year post-operatively. An hierarchical grouping analysis carried out on seven outcome variables yielded a two-group solution for the study sample and this was replicated in the comparison sample. Group 1 indicated change for the better and Group 2 change for the worse since surgery. Discriminant function analysis of 23 pre-operative and operative variables for the first sample indicated ability to cope with stressful events and neuroticism were significant predictors of outcome. Patients in the comparison sample did not differ from the study sample in outcome measures, indicating no effect of assessment prior to operation for the study sample.

High-performance liquid chromatographic analysis of chlorophenols in cardboard food containers and related materials

A technique has been developed for the extraction of a clean concentrate of chlorophenols from cardboard food containers and adhesives of the type used in their manufacture. A simple, reversed-phase, isocratic high-performance liquid chromatographic (HPLC) system employing an optimised mobile phase permitted the separation of nineteen different phenols. The use of a carefully selected internal standard permitted the estimation of (sub) parts per million levels of pentachlorophenol, 2,3,4,6-tetrachlorophenol and 2,4,6-trichlorophenol in several samples of adhesives and various sections of cardboard food containers. Pentachlorophenol (50 ng) and 2,4,6-trichlorophenol (20 ng) gave significant HPLC peaks, readily permitting their detection in parts per billion from 100-g samples.

Eye-movements and sequential tracking in dyslexic and control children

The efficiency of eye-movements while tracking sequential lights was compared for 15 dyslexic children and 15 controls, matched on age and non-verbal intelligence. Contrary to Pavlidis (1981), no significant differences were found between the two groups on two measures of efficiency. A hierarchical cluster analysis did not demonstrate unique patterns of errors for dyslexics, with the exception of a single female dyslexic.

Selecting intelligence tests for studies of dyslexic children

Teachers were asked to select control children of comparable general ability to dyslexic children in their classes and differences between these two groups were examined. Manual Expression from the Illinois Test of Psycholinguistic Ability, Picture Completion, and Block Design from the WISC-R did not differ across groups. Picture Arrangement and Object Assembly from WISC-R showed differences between migrants and Australians but not between dyslexics and controls. Peabody Picture Vocabulary Test and Comprehension from WISC-R showed differences for both the migrancy and dyslexia variables. Cattell Culture-fair, Visual Association from the Illinois Test of Psycholinguistic Ability, and Mazes from WISC-R showed differences only between 45 dyslexics and 53 controls. The difficulty in determining the appropriateness of specific tests to determine specific learning disability is discussed.

Individual differences in life-style response to coronary artery bypass surgery

Fifty-three patients who had undergone coronary artery bypass surgery 12 to 27 months previously were given four standard personality questionnaires and asked to write about the main effects the operation had on their life-styles. These responses were then content analysed. Although hierarchical grouping analysis indicated that the responses could best be classified into four groups, only three distinct response profiles emerged. The first group described mainly adverse consequences of surgery; the other three groups described the effects of surgery as beneficial. Personality test data suggested that individual personality and coping style considerably influence a patient's perception of surgical outcome, and that this perception is largely independent of cardiac symptoms.

Comparison of writing and drawing performance of dyslexic boys

A group of 10 dyslexic boys and 10 control boys matched for age and nonverbal IQ were asked to draw a person and to write about their favourite television program. The two groups did not differ on mean raw scores or time taken on the drawing but differed in number of spelling errors and writing time. The ratios of spelling/number of words written and grammatical errors/number of words written differed for the groups. The former measure was reliable at 8-mo. retest for dyslexics and the latter was reliable at 8 mo. for controls. Correlations between measures showed a different pattern for the dyslexics and controls.

Augmentation-reduction and pain experience

The role of augmentation-reduction in pain tolerance and threshold was examined using Petrie's (1967) criteria for classification of subjects. 14 augmenters did not differ from 14 reducers on pain tolerance and threshold. Trait anxiety correlated with both pain tolerance and threshold, but state anxiety did not.

The structure and stereochemistry of Edulan I and II and the stereochemistry of the 2,5,5,8a-Tetramethyl-3,4,4a,5,6,7,8,8a-octahydro-2H-1-benzopyrans

Edulan I and 11, two important trace components of the juice of passionfruit Passiflora edulis (Sims), were shown by micro-reaction g.l.c., by micro-spectrometry (m.s., N.M.R., i.r. and u.v.) and by com- parison with synthetic products to be the epimeric 2,5,5,8a- tetramethyl-3,5,6,8a-tetrahydro-2H-1-benzopyrans (8a) and (8b). The relative configurations of these isomers were established by their con- version into the stereoisomeric 2,5,5,8a-tetramethyl-3,4,4a,5,6,7,8,8a- octahydro-2H-1-benzopyrans (6a,b) and (6c,d) respectively. The evidence leading to the assignment of the relative stereochemistry to the tetramethyloctahydrobenzopyrans is presented.

Two-part stimulus integration and specific reading disability

29 dyslexics and 29 control children were presented with two halves of a black cross, one-half being presented at varying interstimulus intervals after the other half. Both dichoptic and binocular presentations were used and separation thresholds were at greater interstimulus intervals for the dichoptic condition. Dyslexics had thresholds at greater intervals than controls. These differences were significant and there was no significant interaction of group by dichoptic condition. The relative magnitudes of difference between dyslexics and controls were as previously reported by Stanley and Hall (1973) and support the notion that dyslexics have longer visual persistence than controls.