Fractional order mathematical model for B.1.1.529 SARS-Cov-2 Omicron variant with quarantine and vaccination

In this paper, a fractional order nonlinear model for Omicron, known as B.1.1.529 SARS-Cov-2 variant, is proposed. The COVID-19 vaccine and quarantine are inserted to ensure the safety of host population in the model. The fundamentals of positivity and boundedness of the model solution are simulated. The reproduction number is estimated to determine whether or not the epidemic will spread further in Tamilnadu, India. Real Omicron variant pandemic data from Tamilnadu, India, are validated. The fractional-order generalization of the proposed model, along with real data-based numerical simulations, is the novelty of this study.

176 A Retrospective Analysis of Non-Muscle Invasive Bladder Cancer (NMIBC) Follow-Up Using Flexible Cystoscopy and the Role of the Charlson Co-Morbidity Index (CCI) in Improving Follow Up

Aim

1. A retrospective analysis of NMIBC follow-up using flexible cystoscopy during COVID-19.

2. Charlson Co-Morbidity Index (CCI) as a method of improving follow up.

Method

Online patient records were reviewed for 153 patients who attended Ayr University Hospital between 01/02/2020 and 01/05/ 2020 for check cystoscopy. We recorded the patients risk category and the number of months lapsed since their previous scope. Follow up schedules were compared with current NICE guidelines. CCI for each patient was calculated.

Results

The majority of the patients sampled had follow up adherent to NICE guidelines. Deviations were secondary to ‘allocation to an incorrect follow up schedule’, ‘late follow up’ and ‘non-compliance’. Incorrect allocation was due to both human error and clinical judgement. Clinical judgement included frail patients thought not to benefit from their current intensive schedule and patients with areas of suspicion warranting an earlier check. CCI scores ranged from 2–11. 25% of had a Charlson score of >6 - this predicts a 0% 10-year survival.

Conclusions

We hypothesise that patients with a CCI > 6 should be considered for less intensive follow up. Their co-morbid status makes them likely unsuitable for intervention if reoccurrence was identified.We are pleased with our current adherence to NICE guidelines. We recognise areas for improvement and have raised these at local meetings. We hope that the CCI can be used to ensure we practice realistic medicine and act in the best of the patient when deciding to follow up.

Brainfood cluster

Brainfood cluster The mission of EBRA brainfood is to increase awareness of the importance of research exploring the bidirectional links between brain health and nutrition, including the mediating systems, and to use this knowledge to identify novel nutritional, neuropsychological and neuropharmacological intervention strategies. The BRAINFOOD cluster builds new bridges across research disciplines and strengthens links to relevant stakeholders across Europe, including those involved in health and food policy. It gathers experts on brain health and nutrition that by combining and integrating strengths and complimentary expertise has the volume and capacity to develop novel intervention strategies that improve brain health of European citizens, working together with public health and the food industry. BRAINFOOD is built upon an existing network that includes: 1 Discovery, with expertise in human genetics, metabolomics, nutrition, the microbiome and brain health that utilizes existing data from a variety of population and disease cohorts across the lifespan and aims to propose testable hypotheses; 2 Mechanism, with expertise in animal models, metabolomics, the microbiome and neuroscience that tests hypothesis of how the microbiome and nutrients impact on performance in different behavioral domains; 3 Experimental medicine, with expertise in psychiatry, neurology and nutrition with capacity to run randomized controlled trials; 4 Implementation, with expertise in dissemination and policy making and behavior change, to ensure that EU citizens benefit from novel insights gained in the project.

0317 Impact of Recurrent Partial Sleep Loss Combined with Acute Exercise on Circulating and Adipose Tissue Levels of Leptin, Adiponectin and Ghrelin in Healthy Young Individuals

Introduction

Chronic sleep loss and aerobic exercise have opposing effects on body weight maintenance. The effects of sleep loss on circulating levels of the orexigenic hormone ghrelin and the anorexigenic hormone leptin have been extensively studied. In contrast, how these changes interact with acute exercise, and whether these changes are reflected at the tissue level, remains poorly understood.

Methods

In a randomized, 2 session, crossover design, 16 normal-weight young men were studied following three nights of partial sleep deprivation (4.25 hr sleep opportunity each night) and three nights of normal sleep (8.5-h sleep opportunity), monitored in a sleep laboratory. Each condition was followed by 30 min of intense morning ergometer cycling. Plasma levels of leptin and ghrelin, as well adipose tissue mRNA levels of leptin and adiponectin, were measured before and after each exercise intervention.

Results

In response to acute exercise, circulating levels of both leptin (ANOVA time effect: P<0.001) and ghrelin (time: P<0.001) decreased immediately (+15 min), and remained significantly lower +30, +60 and +240 min post exercise for leptin (all P<0.05), and up until +30 min post exercise for ghrelin. These effects were seen regardless of sleep condition (ANOVA sleep condition: P>0.10). In adipose tissue, mRNA expression of leptin and adiponectin was not different between the sleep conditions (ANOVA sleep condition: P>0.10). In contrast, mRNA levels of leptin decreased (P=0.017), whereas adiponectin mRNA increased (P=0.010) 3.5 hours post vs. pre exercise. The decrease in leptin in response to exercise appeared to mainly occur following sleep loss (P=0.066) and not after normal sleep (P=0.38).

Conclusion

Our results suggest that both circulating and adipose tissue levels of appetite-regulating hormones are altered in response to acute aerobic exercise, in a manner that does not depend on prior sleep history. Whether these findings apply to older, female, or metabolically ill individuals - and whether they may differ in response to circadian misalignment, or evening exercise - remains to be established.

Support

The Swedish Society for Medical Research, the Swedish Society of Medicine, the Swedish Research Council and the Göran Gustafsson; Swedish Brain; Åke Wiberg and NovoNordisk Foundations.

A multicentre, randomised controlled trial to compare the clinical and cost-effectiveness of Lee Silverman Voice Treatment versus standard NHS Speech and Language Therapy versus control in Parkinson's disease: a study protocol for a randomised controlled trial

BACKGROUND

Parkinson's disease (PD) affects approximately 145,519 people in the UK. Speech impairments are common with a reported prevalence of 68%, which increase physical and mental demands during conversation, reliance on family and/or carers, and the likelihood of social withdrawal reducing quality of life. In the UK, two approaches to Speech and Language Therapy (SLT) intervention are commonly available: National Health Service (NHS) SLT or Lee Silverman Voice Treatment (LSVT LOUD®). NHS SLT is tailored to the individuals' needs per local practice typically consisting of six to eight weekly sessions; LSVT LOUD® comprises 16 sessions of individual treatment with home-based practice over 4 weeks. The evidence-base for their effectiveness is inconclusive.

METHODS/DESIGN

PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Five hundred and forty-six people with idiopathic PD, reporting speech or voice problems will be enrolled. We will exclude those with a diagnosis of dementia, laryngeal pathology or those who have received SLT for speech problems in the previous 2 years. Following informed consent and completion of baseline assessments, participants will be randomised in a 1:1:1 ratio to no-intervention control, NHS SLT or LSVT LOUD® via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Participants randomised to the intervention groups will start treatment within 4 (NHS SLT) or 7 (LSVT LOUD®) weeks of randomisation.

PRIMARY OUTCOME

Voice Handicap Index (VHI) total score at 3 months. Secondary outcomes include: VHI subscales, Parkinson's Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5 L; ICECAP-O; resource utilisation; adverse events and carer quality of life. Mixed-methods process and health economic evaluations will take place alongside the trial. Assessments will be completed before randomisation and at 3, 6 and 12 months after randomisation. The trial started in December 2015 and will run for 77 months. Recruitment will take place in approximately 42 sites around the UK.

DISCUSSION

The trial will test the hypothesis that SLT is effective for the treatment of speech or voice problems in people with PD compared to no SLT. It will further test whether NHS SLT or LSVT LOUD® provide greater benefit and determine the cost-effectiveness of both interventions.

TRIAL REGISTRATION

International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ID: 12421382. Registered on 18 April 2016.

Rotation therapy for maniacs, melancholics and idiots: theory, practice and perception in European medical and literary case histories

This article examines the development and use of rotation therapy in the emerging field of psychiatry at the beginning of the 19th century, and the cross-fertilization between British, Irish, German, French and other European proponents of 'Cox's Swing'. Its short-lived popularity is linked to prevalent Enlightenment thought, to the development of an industrial and technological society, to the modern medical theories of irritability, and to the new practice of 'moral management' of the mentally ill. Case studies documenting the use of the Swing are considered from these perspectives, and are compared with contemporary public reactions in the form of publications in newspapers and of a literary text by German Romantic author Ludwig Achim von Arnim.

Preventing wrong tooth extraction: experience in development and implementation of an outpatient safety checklist

Extraction of the wrong tooth or teeth is a serious and avoidable clinical error causing harm to the patient. All NHS Trusts in England are required to use a surgical safety checklist in operating theatres to prevent incorrect site surgery and ensure safe management of patients. However, the majority of patients have dental extractions and other oral surgical procedures undertaken on an outpatient basis and these patients are also at risk of having an incorrect site surgical procedure such as a wrong tooth extraction. We describe our experience in developing, introducing and refining a surgical safety checklist for outpatient oral surgery along with the key strategic actions needed to ensure effective cultural change and optimum patient safety in the outpatient setting.

Multicentre randomised controlled study comparing carvedilol with variceal band ligation in the prevention of variceal rebleeding

BACKGROUND & AIMS

Rebleeding after an initial oesophageal variceal haemorrhage remains a significant problem despite therapy with band ligation, non-selective β-blockers or a combination of these. Carvedilol is a vasodilating non-selective β-blocker with alpha-1 receptor and calcium channel antagonism. A recent study has suggested it is effective in the prevention of a first variceal bleed. Our aim was to compare oral carvedilol with variceal band ligation (VBL) in the prevention of rebleeding following a first variceal bleed.

METHODS

Patients who were stable 5 days after presentation with a first oesophageal variceal haemorrhage and had not been taking β-blockers were randomised to oral carvedilol or VBL. Patients were followed-up after one week, monthly, then every 3 months. The primary end point was variceal rebleeding on intention-to-treat analysis.

RESULTS

64 patients were randomised, 33 to carvedilol and 31 to VBL. 58 (90.6%) patients had alcohol related liver disease. Age and Child-Pugh score were similar in both groups at baseline. Median follow-up was 26.3 (interquartile range [IQR] 10.2-46.6)months. Compliance was 68% and 65% for carvedilol and VBL respectively (p=0.993) and serious adverse events between the two groups were similar (p=0.968). Variceal rebleeding occurred during follow-up in 12 (36.4%) and 11 (35.5%) patients in the carvedilol and VBL groups, respectively (p=0.857), with 9 (27.3%) and 16 (51.6%) deaths in each group, respectively (p=0.110).

CONCLUSIONS

Carvedilol is not superior to VBL in the prevention of variceal rebleeding. The trend to a survival benefit for patients taking this drug compared with those undergoing banding requires further exploration.

The use of GNSS technology to identify lambing behaviour in pregnant grazing Merino ewes

This current study investigated whether pre-lambing behavioural changes could be identified with the use of global navigation satellite system (GNSS) technology. GNSS devices were deployed on 20 pregnant Merino ewes grazing a 1.6 ha paddock and their lambing activity was compared with the metrics derived from the spatial data. The aims were to evaluate the lambing event using the following three separate metrics: (1) mean daily speed (MDS) of ewes 7 days before and to 7 days after lambing, inclusive (n = 12); (2) mean hourly speed (MHS) 12 h before and 12 h after lambing, inclusive (n = 9); and (3) the mean distance the lambing ewe to her peers in the 7 days before and the 7 days after lambing (mean distance to peers (MDP); n = 9), inclusive. There was a significant (P < 0.01) difference between pre- and post-lambing MDS with average ± se MDS pre-lambing being faster than post-lambing (0.051 ± 0.0004 vs 0.047 ± 0.0005 m/s). Pre- and post-lambing MHS differed significantly (P < 0.05), with mean ± s.e. MHS pre-lambing being faster than post-lambing (0.049 ± 0.002 vs 0.038 ± 0.002 m/s). Mean distance to peers indicated that at the time of lambing, ewes were significantly (P < 0.01) further from their peers than at either pre- or post-lambing (83.6 ± 14.59 vs 35.2 ± 2.82 vs 35.6 ± 1.68 m). Despite MDS and MHS metrics indicating significant changes pre- and post-lambing, neither metric was able to identify the time of lambing. The MDP metric could not identify differences pre- and post-lambing but was useful at predicting lambing. The current study found that MDS and MHS metrics have the potential to determine a ‘trigger’ point that could identify parturition and therefore could be used to determine the day of lambing. Therefore, further research is required to determine if a combination of these metrics could identify pre-lambing activity that would enable informed management decisions to be made.

Clinical challenges in the implementation of a tomotherapy service for head and neck cancer patients in a regional UK radiotherapy centre

OBJECTIVE

Intensity-modulated radiotherapy (IMRT) is increasingly being used to treat head and neck cancer cases.

METHODS

We discuss the clinical challenges associated with the setting up of an image guided intensity modulated radiotherapy service for a subset of head and neck cancer patients, using a recently commissioned helical tomotherapy (HT) Hi Art (Tomotherapy Inc, WI) machine in this article. We also discuss the clinical aspects of the tomotherapy planning process, treatment and image guidance experiences for the first 10 head and neck cancer cases. The concepts of geographical miss along with tomotherapy-specific effects, including that of field width and megavoltage CT (MVCT) imaging strategy, have been highlighted using the first 10 head and neck cases treated.

RESULTS

There is a need for effective streamlining of all aspects of the service to ensure compliance with cancer waiting time targets. We discuss how patient toxicity audits are crucial to guide refinement of the newly set-up planning dose constraints.

CONCLUSION

This article highlights the important clinical issues one must consider when setting up a head and neck IMRT, image-guided radiotherapy service. It shares some of the clinical challenges we have faced during the setting up of a tomotherapy service. Implementation of a clinical tomotherapy service requires a multidisciplinary team approach and relies heavily on good team working and effective communication between different staff groups.

Back pain in a Bangladeshi worker in Iraq

Pyogenic Spinal Infection (PSI) is an uncommon disorder encompassing a broad spectrum of diseases including septic spondylodiscitis, osteomyelitis, epidural and paravertebral abscess formation. Presentation can be vague and highly variable but usually includes back pain and fever. Whilst predisposing factors, such as trauma and diabetes can often be identified a pathogenic organism may not be identified in up to a half of all cases leading to significant delay in both accurate diagnosis and effective treatment. Precise spinal imaging is essential and includes plain X-ray, CT and preferably MRI. The treatment of PSI can be conservative (including antibiotics); however, spinal surgery may be required for the complications in up to 50% of cases, with varying degrees of success. We present a challenging case of PSI encountered in a locally-employed 42-year-old Bangladeshi civilian working in Iraq. Despite obvious resource limitations available within a Role 2 Field Hospital, clinical suspicion coupled with repeat spinal CT was pivotal in obtaining the diagnosis. The patient was repatriated to Bangladesh for MRI and definitive surgical treatment.

Randomised double-blind, placebo-controlled trial of the effects of the 'party pills' BZP/TFMPP alone and in combination with alcohol

The objective of this study was to determine the clinical effects of party pills containing benzylpiperazine (BZP) and trifluoromethylphenylpiperazine (TFMPP) when taken alone and in combination with alcohol. The study was a randomised, double-blind, placebo-controlled trial conducted in a hospital-based clinic in Wellington, New Zealand. Thirty-five volunteers who had previously used party pills containing BZP were included in this trial. Participants received one of the following four treatments: 300 mg/74 mg BZP/TFMPP and placebo, 300 mg/74 mg BZP/TFMPP and 57.6 g (6 units) alcohol, placebo and 57.6 g (6 units) alcohol and double placebo. The primary outcome variable was a measure of driving performance, the standard deviation of lateral position (SDLP) measured at 6.5 h. Secondary measures included adverse events, cardiovascular effects, psychological function and delayed effects on sleep. The study was stopped early, after 35 of the planned 64 subjects had undertaken testing, because of severe adverse events that occurred in four of 10 BZP/TFMPP-only subjects, three of seven combined BZP/TFMPP and alcohol subjects, none of the 6 placebo subjects, and none of the 12 alcohol-only subjects. The overall rate of severe adverse events (defined as causing considerable interference with usual activity and/or rated by subject as severe) in those receiving BZP/TFMPP was seven of 17 (41.2%, 95% CI 18.4-67.1). The severe events included agitation, anxiety, hallucinations, vomiting, insomnia and migraine. BZP/TFMPP significantly improved the driving performance, decreasing SDLP at -4.2 cm (95% CI -6.8 to -1.6, P = 0.002). The effect of alcohol was to increase SDLP: 2.3 cm (95% CI -0.3 to 4.9, P = 0.08). BZP/TFMPP also resulted in increased heart rate and blood pressure and in difficulty in getting to sleep. BZP/TFMPP alone or with alcohol carries a significant risk of severe adverse events when taken in similar doses to those recommended by manufacturers.

Structural differences in arbuscular mycorrhizal symbioses: more than 100 years after Gallaud, where next?

This review commemorates and examines the significance of the work of Isobel Gallaud more than 100 years ago that first established the existence of distinct structural classes (Arum-type and Paris-type) within arbuscular mycorrhizal (AM) symbioses. We add new information from recent publications to the previous data last collated 10 years ago to consider whether any patterns have emerged on the basis of different fungal morphology within plant species or families. We discuss: (1) possible control exerted by the fungus over AM morphology; (2) apparent lack of plant phylogenetic relationships between the classes; (3) functions of the interfaces in different structural classes in relation to nutrient transfer in particular; and (4) the occurrence of plants with both of the major classes, and with intermediate AM structures, in different plant habitats. We also give suggestions for future research to help remove uncertainties about the functional and ecological significance of differences in AM morphology. Lastly, we urge retention of the terms Arum- and Paris-type, which are now well recognised by those who study AM symbioses.

The Arum-Paris continuum of mycorrhizal symbioses

•  A survey of 12 plants colonized by six species of arbuscular mycorrhizal fungi was conducted to explore the diversity of Arum and Paris mycorrhizal structures. •  Surveyed root material was sectioned both longitudinally and transversely, double-stained and mycorrhizal structures were identified. A detailed time course experiment using four plant, and four fungal species, was used to investigate the sequential development of hyphae, arbuscules, hyphal coils, arbusculate coils and vesicles. •  The survey indicated that there was a continuum of mycorrhizal structures ranging from Arum to Paris, depending upon both the host plant and the fungus. The time course showed that total colonization increased, and that the establishment of the various mycorrhizal structures did not appear to change greatly over time. •  It was concluded that identification of fungal structures and their subsequent development into morphological types is not easily defined. Visual inspection of root squashes is not always adequate, especially where transverse sections are needed to determine if longitudinal hyphae are inter or intracellular; this is essential to distinguish intermediate types.

Improvement in cholestasis associated with total parenteral nutrition after treatment with an antibody against tumour necrosis factor alpha

BACKGROUND

Many patients receiving long-term total parenteral nutrition (TPN) develop liver disease; cholestasis is common and may be severe. Antitumour necrosis factor alpha (TNFalpha) antibodies have recently been used in order to treat Crohn's disease, but their effect on cholestasis in humans has not been previously described.

CASE REPORT

A 45-year-old woman had complicated Crohn's disease with multiple fistulae and only 1 m of residual small bowel. She had been receiving TPN for 2.5 years when she developed cholestasis which worsened despite adjustments to her TPN regimen. Infliximab, an anti-TNFalpha antibody, was given with the aim of treating an enterocutaneous fistula, but it also produced a marked biochemical and histological improvement in the TPN-related cholestasis.

CONCLUSIONS

Anti-TNFalpha antibodies appeared in this case to improve TPN-related cholestasis. This implies that TNFalpha may play an important role in the development of this condition.

Exposure of hospitality workers to environmental tobacco smoke

OBJECTIVE

To determine quantitatively the extent of exposure of hospitality workers to environmental tobacco smoke (ETS) exposure during the course of a work shift, and to relate these results to the customer smoking policy of the workplace.

SUBJECTS

Three categories of non-smoking workers were recruited: (1) staff from hospitality premises (bars and restaurants) that permitted smoking by customers; (2) staff from smokefree hospitality premises; and (3) government employees in smokefree workplaces. All participants met with a member of the study team before they began work, and again at the end of their shift or work day. At each meeting, participants answered questions from a standardised questionnaire and supplied a saliva sample.

MAIN OUTCOME MEASURES

Saliva samples were analysed for cotinine. The difference between the first and second saliva sample cotinine concentrations indicated the degree of exposure to ETS over the course of the work shift.

RESULTS

Hospitality workers in premises allowing smoking by customers had significantly greater increases in cotinine than workers in smokefree premises. Workers in hospitality premises with no restrictions on customer smoking were more highly exposed to ETS than workers in premises permitting smoking only in designated areas.

CONCLUSIONS

Overall, there was a clear association between within-shift cotinine concentration change and smoking policy. Workers in premises permitting customer smoking reported a higher prevalence of respiratory and irritation symptoms than workers in smokefree workplaces. Concentrations of salivary cotinine found in exposed workers in this study have been associated with substantial involuntary risks for cancer and heart disease.

Cross walls in arbuscular trunk hyphae form after loss of metabolic activity

•  A time-course of Allium porrum colonized by Glomus coronatum examined the formation of cross walls in arbuscular trunk hyphae in relation to the development and senescence of arbuscules. •  Mycorrhizal structures visualized using nitroblue tetrazolium as a vital stain indicated metabolically active arbuscules and intercellular hyphae with counterstaining by acid fuchsin. The intrahyphal location and intact nature of cross walls was examined using confocal microscopy. Their presence was correlated with the metabolic status of the mycorrhizal unit (i.e. arbuscule branches, arbuscular trunk hypha and intercellular hypha) using an interdependence magnified intersects technique (IMIT). •  Loss of metabolic activity was observed first from arbuscule branches, then from trunk hypha and lastly from intercellular hyphae. Cross walls were seen in trunk hyphae of many inactive arbuscules. The incidence of cross walls increased with time and was associated with loss of activity. •  Observations suggest cross walls appeared after loss of metabolic activity in arbuscule branches in several plant-fungal combinations. The implications of cross-wall formation for mechanisms of transfer of nutrients between fungus and plant are discussed.

The double helix is dehydrated: evidence from the hydrolysis of acridinium ester-labeled probes

A highly chemiluminescent reporter molecule, acridinium ester (AE), was tethered to single-stranded oligonucleotide probes and hybridized to complementary as well as mismatched target sequences. When tethered to single-stranded probes, AE was readily hydrolyzed by water or hydroxide ion. In contrast, when hybridized to a complementary target, hydrolysis of the AE probe was markedly inhibited. Mismatches near AE eliminated the ability of the double helix to strongly inhibit AE hydrolysis. To establish the molecular basis for these remarkable hydrolysis properties of AE-labeled probes, the binding and hydrolysis mechanisms of AE-labeled probes were examined. When tethered to single- or double-stranded nucleic acids, hydrolysis of AE was found to proceed by generalized base catalysis in which a base abstracts a proton from water and the resulting hydroxide ion then hydrolyzes AE. Analysis of the hydrolysis rates of AE bound to DNA revealed that AE binds the minor groove of DNA and that its hydrolysis is inhibited by low water activity within the minor groove of the helix. Depending upon the sequence of the DNA, the water activity of the minor groove was estimated to be at least 2-4-fold lower than bulk solution. Hydrolysis measurements of AE tethered to RNA as well as RNA/DNA hybrids argued that the grooves of these double helices are also dehydrated relative to bulk solution. Remarkably, mismatched bases, regardless of their structure or sequence context, enhanced hydrolysis of AE by inducing hydration of the double helix that spread approximately five base pairs on either side of the mismatch.

Using neural networks to automatically detect brain tumours in MR images

Computer vision has been applied to many medical imaging problems with the aim of providing clinical tools to aid medical professionals. We present work being carried out to develop one such system to automatically detect a specific type of brain tumour from head MR images. The tumour under consideration is an acoustic neuroma, which is a benign tumour occurring in the acoustic canals. The hybrid system developed integrates neural networks with more conventional techniques used for computer vision tasks. A database of MR images from 50 patients has been assembled and the acoustic neuromas present in the images have been labelled by hand. Using this data, neural networks (MLPs) have been developed to classify the images at the pixel level to achieve a targeted segmentation. The data used to train and test the MLPs developed, consists of the grey levels of a square of pixels, the pixel to be classified being the centre pixel, together with its global position in the image. The initial pixel level segmentation is refined by a series of conventional techniques. It is combined with an edge-region based segmentation and a morphological operation is applied to the result. This processing produces clusters of adjacent regions, which are considered to be candidate tumour regions. For each possible combination of these regions, features are measured and presented to neural networks which have been trained to identify structures corresponding to acoustic neuromas. Using this approach, all the acoustic neuromas are identified together with three false positive errors.

Towards equity in long-term care

There are considerable similarities and overlap in the levels of disability and dependency between those who receive home-based-long-term care and those who receive long-term care on a residential basis. These similarities are demonstrated from analysis of clients of the Western Domiciliary Care and Rehabilitation Service. When services are costed, it is shown that there is a very large discrepancy in the levels of government support that clients of home-based care agencies attract compared to residents in subsidised hostels and nursing homes. This paper discusses the need for parity of funding to care providers and recognition of the economic value of the contributions of carers. It considers principles for the development of a casemix model for home-based care analogous to the Care Aggregated Module/Standard Aggregated Module (CAM)/(SAM) model applying to nursing home care.

Clinical effects of recent cocaine use on patients with acute schizophrenia

OBJECTIVE

Dopamine function has been hypothesized to be involved in both producing schizophrenic symptoms and mediating cocaine's reinforcing properties. As a result, cocaine abuse in schizophrenic patients may be seen as a natural experiment that may alter the phenomenology and neurobiology of schizophrenia. This report concerns the clinical effects of cocaine abuse and cessation in schizophrenic patients at two times: when patients presented to the psychiatric emergency service and again after 4 weeks of hospitalization.

METHOD

The subjects were 15 cocaine-abusing and 22 cocaine-abstaining schizophrenic patients. Diagnostic assessments were performed with the Structured Clinical Interview for DSM-III-R--Patient Version, which uses DSM-III-R criteria. All of the patients were assessed at both times with the Brief Psychiatric Rating Scale, the Scale for the Assessment of Positive Symptoms, and the Scale for the Assessment of Negative Symptoms.

RESULTS

Cocaine-abusing schizophrenic patients showed fewer negative signs and more anxiety/depression at the hospital-admission assessment than their nonabusing counterparts. At retest, no group differences were detected in patients' negative signs or mood symptoms. Severity of positive symptoms was equal at both testing sessions.

CONCLUSIONS

The significant difference in negative signs and mood symptoms at admission assessment was attributed to the neurobiological impact of cocaine. The role of psychostimulants in schizophrenic patients is discussed.

Transfer of phosphate from fungus to plant in VA mycorrhizas: calculation of the area of symbiotic interface and of fluxes of P from two different fungi to A Allium porrum L

The aim of the work described in this paper was to calculate the fluxes of phosphate (P) across the intraradical interfaces between two vesicular-arbuscular mycorrhizal fungi [Glomus mosseae (Nicol. & Gerd.) Gerdemann and Trappe and Glomus sp.' City Beach'(WL'M 16)] and Allium porrum L. The inflows of P into roots via the fungi were calculated from inflows into mycorrhizal and non-mycorrhizal plants for four harvest periods up to 84 d. The areas of interface between intercellular hyphae and roots, and arbuscules and roots were calculated for the same harvest periods using image analysis of sections in which the fungus was stained with nitroblue tetrazolium. The imagination of the arbuscular interface was calculated using methods based on previously published data. The fungi colonized the roots to approximately the same extent (% infection), but G. mosseae produced more intercellular hyphae and arbuscules, and hence larger interfacial areas than Glomus sp. City Beach (WUM 16). Hyphal inflows were higher for Glomus sp. City Beach (WUM 16) than G. mosseae for all except the last harvest period, but because of the lower interfacial areas, fluxes via this fungus were higher (3-7-12-8 nmol m-² s-¹ ) than for G, mosseae (0-8-3-2 nmol nmol m-² s-¹ . These fluxes are in the same range as values for P influx into plant cells and considerably larger than efflux from the fungal hyphae of ecto and ericoid mycorrhizal fungi measured in cultured mycelia. We conclude that enhanced efflux from the fungus must be essential for symbiotic phosphorus uptake by plants via VA mycorrhizal fungi.

Distribution of VA mycorrhizal entry points near the root apex: Is there an uninfectible zone at the root tip of leek or clover?

This paper re-examines the question of the susceptibility of plant roots to infection by vesicular-arbuscular mycorrhizal fungi, particularly near the root apex. The cumulative distributions of the observed distance between the root apex and the most apical mycorrhizal entry points are compared with expected distributions based on (i) a random distribution of successful encounters between hypha and root and (ii) an uninfectible apical region (of length Z_o ). Data for both Allium porrum L. (leek) and Trifolium subterraneum L. (clover) are well fitted by the expected distributions and in the majority of cases (17/31) the best fit is obtained with zero Z_o , with 8 additional cases being best fitted by values of Z_o of 1 mm or less. Even where the best fits are obtained with values of Z_o greater than zero, the distribution using Z_o = 0 is still within the confidence limits for the data. These findings indicate that in neither species is there clear evidence for a subapical region that is immune to infection. The fact that there are short uninfected lengths immediately behind the apex is interpreted as representing a delay between an encounter and a detectable infection. Other consistent deviations of the data from the theoretical distributions are discussed. Fitting the distributions yields values for the frequency of infection (A). These are compared for the two host plants at different propagule densities. The values for leek are much lower than for clover. In both species there are increases in A with increases in propagule density which are consistent with earlier findings.

Eustachian tube dysfunction in children with ragweed hayfever during natural pollen exposure

The role of upper respiratory allergy in the pathogenesis of otitis media with effusion (OME) is an interesting but still unresolved issue. In order to investigate this further, fifteen children with ragweed hayfever were studied for the development of eustachian tube obstruction (ETO), utilizing the nine-step pressure-swallow test, prior to, during, and after seasonal exposure to ragweed pollen. Daily symptom-medication diaries were maintained and serial physical examinations were performed. ETO was found in 60% of the ragweed sensitive children during natural pollen exposure. The development of ETO was found to correlate with ragweed skin test wheal size and daily patient symptom-medication scores (SMS) during pollen exposure. Treatment of hayfever symptoms with pseudoephedrine and/or chlorpheniramine did not prevent most patients from developing ETO. Despite the prevalence of ETO in the study group, only one child developed evidence of middle ear effusion. These findings suggest that children with ragweed hayfever develop eustachian tube (ET) dysfunction during natural pollen exposure. Seasonal allergy induced ETO is not, however, by itself sufficient to produce middle ear effusion.

Aerodynamic studies of cleft-palate speech

The aerodynamic oral-nasal factors related to the speech of two groups of cleft-palate children were evaluated. One group presented hypernasality and the other group presented normal nasal resonance. The aerodynamic parameters evaluated were oral pressure, nasal flow, and flow-pressure ratio (nasal flow/oral pressure). Oral temperature readings were also obtained. These parameters were evaluated under three conditions (1) blowing, (2) vocalizing the vowel /i/, and (3) reading eight sentences representing two different rhythm patterns, two types of consonant loadings, and two conditions of syllable stress. The findings revealed significant differences between the hypernasal and normal resonance groups in flow-pressure ratio, oral pressure, and nasal flow while subjects were reading sentences. However, only a small proportion of the variability in these aerodynamic measurements could be accounted for based on the classification of hypernasality or normal nasal resonance. Oral-nasal aerodynamic studies done during speaking activity are more useful clinically than blowing activity or saying vowel sounds. No aerodynamic differences were noted between the two groups for the different rhythm and stress patterns and phonemic loadings within the sentences used.

Dental attitudes and behavior related to vertical social mobility by marriage

Following a dental examination of 5-year-old children, the mothers of 367 of them were interviewed. In 262 cases there was sufficient information relating to the social class of both the mother's husband and her father to enable the relationship between social mobility by marriage and the mother's dental attitudes and behavior to be assessed. The results showed that the views of mothers who moved from one social group to another fell between those of the mothers who were static in each of those two groups. Those mothers who were downward mobile had less favorable attitudes than those who had remained in the higher social group but more favorable than those who had always been in the lower social group. The reverse trend was found in upward mobile mothers. A notable exception to this pattern was the group who moved from social Class III into Class I or II. These mothers exhibited attitudes and behavior which were even more favorable than the static social Class I or II mothers. The similarity of these results to those of others in different fields is discussed.