Facial recognition lock technology for social care settings: A qualitative evaluation of implementation of facial recognition locks at two residential care sites

Background

There is limited literature on security and access for social care settings despite policy highlighting importance, and no published research exploring facial recognition lock technology (FRLT) for potential improvements. This study explored FRLT device implementation, use, barriers and benefits.

Methods

One residential care home with 43 older adults and 68 staff members (Site A), and one supported living facility caring for six individuals with mental health issues with 18 staff members (Site B) were provided with FRLT for six months. Nine pre-implementation staff interviews explored existing access and security perceptions. Ten post-implementation staff interviews and one staff focus group were conducted; all were analysed using content analysis to understand, alongside process mapping, the use and impact of the FRLT. Interview participants included site care staff and other visiting healthcare professionals. We additionally report feedback from the technology developers to demonstrate impact of industry-academia collaboration.

Results

Pre-implementation interviews highlighted issues with current pin-pad or lock-box systems, including; code sharing; code visibility, ineffective code changes, security issues following high staff turnover, lack of efficiency for visitors including NHS staff and lack of infection control suggesting requirement for innovation and improvement. Pre-implementation interviews showed openness and interest in FRLT, although initial queries were raised around cost effectiveness and staff skills. Following implementation, good levels of adoption were achieved with 72% and 100% (49/68 and 18/18) of staff members uploading their face at the two sites, and 100% of residents at Site B using the system (6/6). Additionally, Site B made a positive procurement decision and continues to discuss wider rollout. Post implementation interviews suggested FRLT was useful and acceptable for improving security and access. Benefits identified included staff/visitor time saving, enhanced security, team ease of access, resident autonomy and fewer shared touch points. Integration was suggested including with fire alarm systems, staff clocking in/out, and Covid monitoring to improve usefulness. The developers have since responded to feedback with design iterations.

Conclusion

We identified concerns on security and access in social care settings, which warrant further exploration and research. FRLT could increase resident autonomy and reduce staff burden, particularly considering frequent multi-agency health and care visits.

A Computer-Assisted Register and Information System for Diabetes

A new computer-assisted follow-up register and information system has been developed for patients with diabetes. The task of collecting and coding clinical information has been simplified, and methods of working in clinics have been adjusted to fit closely with the design of the new system.

A flexible program suite includes statistical programs which allow clinical audit and evaluation of long term care to be carried out on demand. The system, which is on-line, operates under DSM 11 (DEC MUMPS) on a PDP 11/44 computer and, for hospital work, includes a video display unit and printer in the outpatient clinic and hospital ward.

Registration of patients in the system may be carried out from either a hospital clinic or general practice. The clinical data base, completed at registration or review for each patient, is used to generate three computer-printed structured medical records .for use by hospitals, general practitioners and patients.

The system can be used to provide (a) more reliable and effective record-keeping for patients and doctors, (b) automatic clinical audit for individuals or groups of patients, (c) data for long-term evaluation of care and other clinical research.

Fludarabine with pharmacokinetically guided IV busulfan is superior to fixed-dose delivery in pretransplant conditioning of AML/MDS patients

We hypothesized that IV Busulfan (Bu) dosing could be safely intensified through pharmacokinetic (PK-) dose guidance to minimize the inter-patient variability in systemic exposure (SE) associated with body-sized dosing, and this should improve outcome of AML/MDS patients undergoing allogeneic stem cell transplantation (allo-HSCT). To test this hypothesis, we treated 218 patients (median age 50.7 years, male/female 50/50%) with fludarabine (Flu) 40 mg/m² once daily ×4, each dose followed by IV Bu, randomized to 130 mg/m² (N=107) or PK-guided to average daily SE, AUC of 6,000 µM-min (N=111), stratified for remission-status, and allo-grafting from HLA-matched donors. Toxicity and graft vs. host disease (GvHD) rates in the groups were similar; the risk of relapse or treatment-related mortality remained higher in the fixed-dose group throughout the 80-month observation period. Further, PK-guidance yielded safer disease-control, leading to improved overall and progression-free survival, most prominently in MDS-patients and in AML-patients not in remission at allo-HSCT. We conclude that AML/MDS patients receiving pretransplant conditioning treatment with our 4-day regimen may benefit significantly from PK-guided Bu-dosing. This could be considered an alternative to fixed dose delivery since it provides the benefit of precise dose delivery to a predetermined SE without increasing risk(s) of serious toxicity and/or GvHD.

Bevacizumab/high-dose chemotherapy with autologous stem-cell transplant for poor-risk relapsed or refractory germ-cell tumors

BACKGROUND

High-dose chemotherapy (HDC) using sequential cycles of carboplatin/etoposide is curative for relapsed germ-cell tumors (GCT). However, outcomes of high-risk patients in advanced relapse remain poor. We previously developed a new HDC regimen combining infusional gemcitabine with docetaxel/melphalan/carboplatin (GemDMC), with preliminary high activity in refractory GCT. Given the high vascular endothelial growth factor expression in metastatic GCT and the synergy between bevacizumab and chemotherapy, we studied concurrent bevacizumab and sequential HDC using GemDMC and ifosfamide/carboplatin/etoposide (ICE) in patients with poor-risk relapsed or refractory disease.

PATIENTS AND METHODS

Eligibility criteria included intermediate/high-risk relapse (Beyer Model), serum creatinine ≤ 1.8 mg/dl and adequate pulmonary/cardiac/hepatic function. Patients received sequential HDC cycles with bevacizumab preceding GemDMC (cycle 1) and ICE (cycle 2). The trial was powered to distinguish a target 50% 2-year relapse-free survival (RFS) from an expected 25% 2-year RFS in this population.

RESULTS

We enrolled 43 male patients, median age 30 (20-49) years, with absolute refractory (N = 20), refractory (N = 17) or cisplatin-sensitive (N = 6) disease, after a median 3 (1-5) prior relapses. Disease status right before HDC was unresponsive (N = 24, progressive disease 22, stable disease 2), partial response with positive markers (PRm(+)) (N = 8), PRm(-) (N = 7) or complete response (N = 4). Main toxicities were mucositis and renal. Four patients (three with baseline marginal renal function) died from HDC-related complications. Tumor markers normalized in 85% patients. Resection of residual lesions (N = 13) showed necrosis (N = 4), mature teratoma (N = 2), necrosis/teratoma (N = 3) and viable tumor (N = 4). At median follow-up of 46 (9-84) months, the RFS and overall survival rates are 55.8% and 58.1%, respectively.

CONCLUSIONS

Sequential bevacizumab/GemDMC-bevacizumab/ICE shows encouraging outcomes in heavily pretreated and refractory GCT, exceeding the results expected in this difficult to treat population.

CLINICALTRIALSGOV

NCT00936936.

Optimal translational swimming of a sphere at low Reynolds number

Swimming velocity and rate of dissipation of a sphere with surface distortions are discussed on the basis of the Stokes equations of low-Reynolds-number hydrodynamics. At first the surface distortions are assumed to cause an irrotational axisymmetric flow pattern. The efficiency of swimming is optimized within this class of flows. Subsequently, more general axisymmetric polar flows with vorticity are considered. This leads to a considerably higher maximum efficiency. An additional measure of swimming performance is proposed based on the energy consumption for given amplitude of stroke.

Social discrimination in Japanese quail Coturnix japonica chicks genetically selected for low or high social reinstatement motivation

Japanese quail chicks of two lines genetically selected for low levels of social reinstatement behaviour (LSR) or high levels of social reinstatement behaviour (HSR) were housed in groups of three. The approach/avoidance tendencies of an individual chick from each group towards a familiar cagemate and a stranger from another group placed at opposite ends of a runway were measured at 7 days of age. Quail chicks of both genetic lines preferentially approached, spent longer near, and showed shorter mean distances from the cagemate than the stranger. Irrespective of stimulus type, the HSR quail generally showed shorter approach latencies, spent longer within 15 cm of the goal boxes, made more entries into these areas, and travelled further during the test than did their LSR counterparts. These findings demonstrated that Japanese quail chicks, of two genetic lines reared in small groups, successfully discriminated between familiar cagemates and strangers. They also suggest that there are no straightforward relationships between underlying social motivation and social preferences.

Intravenous BU plus Mel: an effective, chemotherapy-only transplant conditioning regimen in patients with ALL

We investigated the administration of i.v. BU combined with melphalan (Mel) in patients with ALL undergoing allogeneic hematopoietic SCT. Forty-seven patients with a median age of 33 years (range 20-61) received a matched sibling (n=27) or matched unrelated donor transplant (n=20) for ALL in first CR (n=26), second CR (n=13), or with more advanced disease (n=8). BU was infused daily for 4 days, either at a fixed dose of 130 mg/m² (5 patients) or using pharmacokinetic (PK) dose adjustment (42 patients), to target an average daily area-under-the-curve (AUC) of 5000 μmol/min, determined by a test dose of i.v. BU at 32 mg/m². This was followed by a rest day, then two daily doses of Mel at 70 mg/m². Stem cells were infused on the following day. The 2-year OS, PFS and non-relapse mortality (NRM) rates were 35% (95% confidence interval (CI), 23-51%), 31% (95% CI, 21-48%) and 37% (95% CI, 23-50%), respectively. Acute NRM at 100 days was favorable at 12% (95% CI, 5-24%); however, the 2-year NRM was significantly higher for patients older than 40 years, 58% vs 20%, mainly due to GVHD.

Clofarabine combined with busulfan provides excellent disease control in adult patients with acute lymphoblastic leukemia undergoing allogeneic hematopoietic stem cell transplantation

We investigated the safety and early disease control data for i.v. busulfan (Bu) in combination with clofarabine (Clo) in patients with acute lymphoblastic leukemia undergoing allogeneic hematopoietic stem cell transplantation (SCT). Fifty-one patients (median age, 36 years; range, 20-64 years) received a matched sibling (n = 24), syngeneic (n = 2), or matched unrelated donor transplant (n = 25) for acute lymphoblastic leukemia in first complete remission (n = 30), second complete remission (n = 13), or active disease (n = 8). More than one-half of the patients had a high-risk cytogenetic profile, as defined by the presence of t(9;22) (n = 17), t(4;11) (n = 3), or complex cytogenetics (n = 7). Clo 40 mg/m(2) was given once daily, with each dose followed by pharmacokinetically dosed Bu infused over 3 hours daily for 4 days, followed by hematopoietic SCT 2 days later. The Bu dose was based on drug clearance, as determined by the patient's response to a 32-mg/m(2) Bu test dose given 48 hours before the high-dose regimen. The target daily area under the receiver-operating characteristic curve was 5500 μM/min for patients age <60 years and 4000 μM/min for those age ≥60 years. The regimen was well tolerated, with a 100-day nonrelapse mortality rate of 6%. With a median follow-up of 14 months among surviving patients (range, 6-28 months), the 1-year overall survival, disease-free survival, and nonrelapse mortality rates were 67% (95% confidence interval [CI], 55%-83%), 54% (95% CI, 41%-71%), and 32% (95% CI, 16%-45%), respectively. For patients undergoing SCT in first remission, these respective rates were 74%, 64%, and 25%. Our data indicate that the combination of Clo and Bu provides effective disease control while maintaining a favorable safety profile.

The effects of fasting duration on gastric emptying in man, an exploration of the role of the endocannabinoid system and inter-individual responsiveness

BACKGROUND

In animal studies, gut vagal afferent neurons express cannabinoid (CB1) receptors, whose expression is increased by fasting. We aimed to explore the possibility that similar effects might be relevant in man in controlling gastric emptying.

METHODS

Fourteen healthy volunteers underwent measurements of gastric emptying using the (13) C acetate breath test, after either a nutrient (skimmed milk) or non-nutrient (water) meal following both a 12 and 24 h fast. Further gastric emptying studies were performed with and without the CB1 receptor antagonist Rimonabant (20 mg or 80 mg). Because of the inter-individual variations observed, two subjects underwent additional studies with and without Rimonabant to determine intra-individual consistency. Gastric emptying was evaluated as cumulative C13 : C12 ratio values, measured at 5 min intervals for 30 min.

KEY RESULTS

In the group as a whole, fasting duration slowed gastric emptying for both the nutrient [120 ± 30 (mean ± SD) vs 101 ± 34, P < 0.05] and non-nutrient [226 ± 62 vs 177 ± 47, P < 0.05] meals, but there was no effect of Rimonabant. However, there was consistent inter individual variation; thus while 12 subjects showed a slowing, two (14%) exhibited accelerated gastric emptying for both the nutrient and the non-nutrient meal after 24 h fasting and in one of whom, Rimonabant consistently reversed the fasting effect on the non-nutrient meal.

CONCLUSIONS & INFERENCES

Extended fasting alters the gastric emptying of liquid meals but there are consistent differences between individuals. Where there is an accelerated response to fasting, Rimonabant appears to reverse the effect.

Pandemic H1N1 Influenza Infection and Vaccination in Humans Induces Cross-Protective Antibodies that Target the Hemagglutinin Stem

Most monoclonal antibodies (mAbs) generated from humans infected or vaccinated with the 2009 pandemic H1N1 (pdmH1N1) influenza virus targeted the hemagglutinin (HA) stem. These anti-HA stem mAbs mostly used IGHV1-69 and bound readily to epitopes on the conventional seasonal influenza and pdmH1N1 vaccines. The anti-HA stem mAbs neutralized pdmH1N1, seasonal influenza H1N1 and avian H5N1 influenza viruses by inhibiting HA-mediated fusion of membranes and protected against and treated heterologous lethal infections in mice with H5N1 influenza virus. This demonstrated that therapeutic mAbs could be generated a few months after the new virus emerged. Human immunization with the pdmH1N1 vaccine induced circulating antibodies that when passively transferred, protected mice from lethal, heterologous H5N1 influenza infections. We observed that the dominant heterosubtypic antibody response against the HA stem correlated with the relative absence of memory B cells against the HA head of pdmH1N1, thus enabling the rare heterosubtypic memory B cells induced by seasonal influenza and specific for conserved sites on the HA stem to compete for T-cell help. These results support the notion that broadly protective antibodies against influenza would be induced by successive vaccination with conventional influenza vaccines based on subtypes of HA in viruses not circulating in humans.

THE MAINTENANCE OF A NORMAL PLASMA PROTEIN CONCENTRATION IN SPITE OF REPEATED PROTEIN LOSS BY BLEEDING

1. Experiments on five dogs are described consisting in the daily removal of blood plasma in amount from 25 to 100 cc. the red cells being returned to the circulation in Locke's solution. In no case was there a significant drop in plasma protein concentration. 2. A gravimetric method for the determination of total plasma protein is described. 3. A case is reported of cirrhosis of the liver in which over 10 gm. of protein daily was lost in the ascitic fluid during a period of 7 months without any lowering of plasma protein concentration. 4. The constancy of the plasma protein level and the adequacy of the mechanism of regeneration is pointed out.

[Not Available]

Introduction:

E-Learning methods such as webcasting are being used increasingly in healthcare education, including that of nurses and midwives. Webcasting means live synchronous broadcasting over the internet, where students participate simultaneously in text ‘chat room’ interactive discussions when logged on to a webpage where they can see and hear a presentation such as a PowerPoint lecture, a list of other participants, and access ‘chat rooms’.

Aims:

This paper reports student participation and satisfaction with the use of webcasting in a third year undergraduate nursing and midwifery research methods module in one higher education institution faculty of health and social work in the southwest of England, with students from distributed geographical locations.

Materials and Methods:

Students chose either webcasts or face-to-face lectures. Following each of the four webcasts, a web-based evaluation questionnaire was administered in a cross-sectional survey design.

Results:

Two thirds of students took part in webcasts and found them to be an acceptable teaching and learning strategy. Travel and cost savings were noted through not travelling to the main university campus, and these were statistically significantly correlated with students’ perception of gaining from the module and their overall satisfaction with webcasting. Across the four webcasts 5446 purposeful messages were posted indicating engagement with the material under study.

Conclusions and Recommendations:

Webcasting is an effective teaching and learning strategy which is popular with students, allows remote access to teaching and learning, and offers time and cost savings to students. Further research is required to investigate the educational potential of this new technology.

A critical review of fear tests used on cattle, pigs, sheep, poultry and horses

Fear is arguably the most commonly investigated emotion in domestic animals. In the current review we attempt to establish the level of repeatability and validity found for fear tests used on cattle, pigs, sheep and goats, poultry and horses. We focus the review on the three most common types of fear tests: the arena test (open field), the novel object test, and the restraint test. For some tests, e.g. tonic immobility in poultry, there is a good and broad literature on factors that affect the outcome of the test, the validity of the test and its age dependency. However, there are comparatively few of these well defined and validated tests and what is especially missing for most tests is information on the robustness, i.e., what aspects can be changed without affecting the validity of the tests. The relative absence of standardized tests hampers the development of applied ethology as a science.

Prognostic analysis of tumour angiogenesis, determined by microvessel density and expression of vascular endothelial growth factor, in high-risk primary breast cancer patients treated with high-dose chemotherapy

In contrast to early breast cancer, the prognostic effect of tumour angiogenesis in tumours with advanced axillary spread has been less studied. We retrospectively analysed the effect of microvessel density (MVD) and vascular endothelial growth factor (VEGF) by immunohistochemistry on the outcome of 215 patients treated uniformly within prospective trials of high-dose chemotherapy for 4-9 and >/=10 positive nodes, and followed for a median of 9 (range 3-13) years. Microvessel density was associated with epidermal growth factor receptor (EGFR) expression (P<0.001) and tumour size (P=0.001). Vascular endothelial growth factor overexpression (51% of patients) was associated with overexpression of EGFR (P=0.01) and HER2 (P<0.05), but not with MVD (P=0.3). High MVD was associated with worse relapse-free survival (74 vs 44%, P<0.001) and overall survival (76 vs 44%, P<0.001). Vascular endothelial growth factor overexpression had no effect on outcome. Multivariate analyses showed a prognostic effect of MVD independently of other known prognostic factors in this patient population. In conclusion, tumour angiogenesis, expressed as MVD, is a major independent prognostic factor in breast cancer patients with extensive axillary involvement.

High nitrogen during growth reduced glucoraphanin and flavonol content in broccoli (Brassica oleracea var. italica) heads

Broccoli (Brassica oleracea var. italica) heads are commonly consumed in the Western diet and frequent consumption is thought to help protect against certain cancers and cardiovascular disease. Broccoli heads contain relatively high levels of glucosinolates and flavonols, thought to be the key phytochemicals that contribute to the health benefits gained upon consumption. In this study, we investigated the effect of applied nitrogen (N) at either 0, 15, 30 or 60 kg/ha, or 30, 60, 90 or 150 kg/ha with applied sulfur (S) at 50 or 100 kg/ha on the glucosinolates glucoraphanin, glucobrassicin and progoitrin, and the flavonols quercetin and kaempferol in broccoli cv. Marathon florets. Trials were conducted in two sites in either heavy clay or sandy loam to also assess the effect of soil type on phytochemical content. Application rates were based around recommended N and S applications for this crop in south-east Australia. N applications over 30 kg/ha caused a decrease in the content of glucoraphanin (18–34%) and both flavonols (20–38%). Progoitrin content was not affected while glucobrassicin increased by up to 44% with N applications >30 kg/ha. S applications of 50 or 100 kg/ha had no significant effect on either glucosinolates or flavonols. Crop yield (fresh weight), however, was significantly depressed (up to 40%) by N applications below 60 kg/ha. Fresh weight was also significantly depressed in plants grown in heavy clay compared with plants grown in a sandy loam, and phytochemical content increased, possibly due to a concentration effect. Therefore, low N applications to optimise phytochemicals may be only commercially useful if growers are producing mini-broccoli heads, as levels required to optimise phytochemical content (<30 kg/ha) also caused a significant decline in yield.

Long-term comparison of rituximab treatment for refractory systemic lupus erythematosus and vasculitis: Remission, relapse, and re-treatment

OBJECTIVE

Current treatments for systemic lupus erythematosus (SLE) and vasculitis contribute to mortality and incapacity and are only partially effective; thus, newer therapies are clearly needed. Depletion of B cells has led to disease control in patients with autoimmune disorders. We sought to assess the long-term efficacy and safety of a B cell-depleting therapy in patients with SLE and patients with vasculitis.

METHODS

In a prospective study with a median followup of 24 months, 11 patients with active or refractory SLE and 11 patients with active or refractory antineutrophil cytoplasmic antibody-associated vasculitis (AAV) received a course of therapy with rituximab (an anti-CD20 monoclonal antibody) along with a single dose of intravenous cyclophosphamide.

RESULTS

Remission followed rapid B cell depletion, with response rates of 100% among the 11 patients with SLE (6 patients had a complete response, and 5 patients had a partial response) and 91% among the 11 patients with AAV (9 patients had a complete response, and 1 patient had partial remission). A renal response occurred in all 6 patients with lupus nephritis. Clinical improvement was accompanied by significant reductions in the daily dose of prednisolone. Relapse occurred in 64% of the patients with SLE and in 60% of those with AAV. B cell return preceded relapse in the majority of patients, and further treatment with rituximab proved effective. IgG and IgM levels were maintained in the normal range. The incidence of infective complications was low; however, infusion reactions were common, and human antichimeric antibodies developed in 5 of 14 patients.

CONCLUSION

B cell depletion offers the prospect of sustained disease remission and improved disease control combined with low toxicity in patients with active or refractory SLE or AAV. Relapse following treatment is common, but re-treatment is rapidly effective.

The primary amine metabolite of sibutramine stimulates lipolysis in adipocytes isolated from lean and obese mice and in isolated human adipocytes

Sibutramine is a satiety-inducing serotonin-noradrenaline reuptake inhibitor that acts predominantly via its primary and secondary metabolites. This study investigates the possibility that sibutramine and/or its metabolites could act directly on white adipose tissue to increase lipolysis. Adipocytes were isolated by a collagenase digestion procedure from homozygous lean (+/+) and obese-diabetic OB/OB mice, and from lean nondiabetic human subjects. The lipolytic activity of adipocyte preparations was measured by the determination of glycerol release over a 2-hour incubation period. The primary amine metabolite of sibutramine M2, caused a concentration-dependent stimulation of glycerol release by murine lean and obese adipocytes (maximum increase by 157+/-22 and 245+/-16%, respectively, p<0.05). Neither sibutramine nor its secondary amine metabolite M1 had any effect on lipolytic activity. Preliminary studies indicated that M2-induced lipolysis was mediated via a beta-adrenergic action. The non-selective beta-adrenoceptor antagonist propranolol (10 (-6) M) strongly inhibited M2-stimulated lipolysis in lean and obese murine adipocytes. M2 similarly increased lipolysis by isolated human omental and subcutaneous adipocytes (maximum increase by 194+/-33 and 136+/-4%, respectively, p<0.05) with EC50 values of 12 nM and 3 nM, respectively. These results indicate that the sibutramine metabolite M2 can act directly on murine and human adipose tissue to increase lipolysis via a pathway involving beta-adrenoceptors.

Solvation pressure in chloroform

Molecular dynamics (MD) simulations of chloroform vapor and liquid at normal temperature and pressure and liquid under hydrostatic pressure are presented, giving bond lengths and vibrational frequencies as functions of pressure. The change in bond lengths between vapor and liquid at normal temperature and pressure is consistent with a pressure equivalent to the cohesive energy density (CED) of the liquid, supporting the solvation pressure model which predicts that solvated molecules or nanoparticles experience a pressure equal to the CED of the liquid. Experimental data for certain Raman frequencies of chloroform in the vapor phase, in the liquid, and in the liquid under pressure are presented and compared to MD. Results for C-Cl vibrational modes are in general agreement with the solvation pressure model whereas frequencies associated with the C-H bond are not. The results demonstrate that masking interactions exist in the real liquid that can be reduced or eliminated in simplified simulations.

Effect of different forms of information produced for cancer patients on their use of the information, social support, and anxiety: randomised trial

OBJECTIVE

To explore the hypothesis that different methods of selecting and printing information for cancer patients could improve emotional support by affecting interaction with others, and so lead to improved psychological wellbeing.

DESIGN

Randomised trial with eight groups (three factors, 2x2x2). Data collected at recruitment and three month follow-up.

PARTICIPANTS

400 patients starting radiotherapy, of whom 325 with breast or prostate cancer and complete anxiety and depression data were included in the analysis.

INTERVENTIONS

Printed booklets: half had only general information from CancerBACUP about each patient's cancer and half had personalised information from the patient's medical record plus selected general information; half were composed of information chosen interactively by the patient and half were produced automatically with a larger volume of material; and half had additional advice on anxiety management and half did not.

MAIN OUTCOME MEASURES

Patients' views of the information, use of their booklets with others; change in reported social support; change in anxiety and depression.

RESULTS

The larger booklets produced automatically were more likely to be found useful and to tell patients something new and less likely to be seen as too limited than the booklets produced interactively, but they were also more likely to overwhelm some patients. Personalised booklets were more likely than general booklets to tell patients something new. There was no difference in patients' perceived understanding of their cancer by any of the intervention factors. Patients with personalised information were more likely to show their booklets to others and to think it helped in discussing their cancer or its treatment. There were no major differences in social support, anxiety, or depression by any intervention factors.

CONCLUSIONS

Patients were more likely to show personalised information to their confidants than general information. Further research is needed into the effects of sharing information on patients' social support and anxiety. Trial registration US Government Clinical Trials Database NCT00127465.

Is neighbourhood deprivation a risk factor for gestational diabetes mellitus?

AIMS

To assess the relationship between neighbourhood deprivation and the rate of gestational diabetes mellitus (GDM) using routinely collected data from a clinical information system, in Plymouth, UK.

METHODS

Between 1 January 1996 and 31 December 1997, 3933 women residing within the Plymouth Primary Care Trust (PCT) were screened for GDM using indices of neighbourhood deprivation and prevalence of GDM. Areas (n = 43) were classified according to the Townsend index, measuring material deprivation. Pregnant women with and without GDM were compared.

RESULTS

The prevalence of GDM was 1.7%[95%, confidence interval (CI) 1.20, 2.11]. The prevalence of GDM ranged from 1.05% (95% CI 0.60, 1.70) in the most deprived to 2.10% (95%, CI 1.34, 3.13), in the least deprived neighbourhood. Crude rates decreased by 50%[relative prevalence (RP) (95% CI) 0.50 (0.27, 0.94); P = 0.06] amongst those living in the most-deprived compared with those living in the least-deprived areas. Using a stepwise binary logistic regression model, older age at delivery significantly increased the risk of developing GDM. [RP (95%, CI) 1.09, (1.04, 1.13)]. Townsend deprivation score had no significant independent association with GDM when other covariates were considered.

CONCLUSION

These data suggest that the neighbourhood context in which women live has no impact on the risk of GDM. Diabet.

AML-loaded DC generate Th1-type cellular immune responses in vitro

BACKGROUND

The generation of AML-specific T-lymphocyte responses by leukemia-derived DC has been documented by multiple investigators and is being pursued clinically. An obstacle to widespread use of this strategy is that it has not been possible to generate leukemic DC from all patients, and an alternative approach is needed if the majority of leukemia patients are to receive therapeutic vaccination in conjunction with other treatment protocols.

METHODS

In the present study, we generated DC from CD14-selected monocytes isolated from healthy donor PBPC and loaded them with a total cell lysate from AML patient blasts.

RESULTS

Immature in vitro-derived DC exhibited robust phagocytic activity, and mature DC demonstrated high expression of CD80, CD83, CD86 and the chemokine receptor CCR7, important for DC migration to local lymph nodes. Mature, Ag-loaded DC were used as APC for leukemia-specific cytotoxic T-lymphocyte (CTL) induction and demonstrated cytotoxic activity against leukemic targets. CTL lysis was Ag-specific, with killing of both allogeneic leukemic blasts and autologous DC loaded with allogeneic AML lysate. HLA-matched controls were not lysed in our system.

DISCUSSION

These data support further research into the use of this strategy as an alternative approach to leukemia-derived DC vaccination.

Adrenocortical responses of Japanese quail to a routine weighing procedure and to tonic immobility induction

Tonic immobility (TI) is induced by brief manual restraint, and it is a commonly used test of fearfulness, particularly in poultry. However, in view of increasing ethical concerns about experimentation on living animals, there is a need to ensure that the tests used do not elicit unacceptable distress. In the United Kingdom, there is some debate as to whether TI should be classified as a regulated experimental procedure that requires a Home Office license to experiment on living animals under the Animals (Scientific Procedures) Act of 1986. The present study compared plasma corticosterone (PC) concentrations in undisturbed Japanese quail (controls) with those exposed to the induction of TI or those exposed to a routine weighing procedure. Circulating PC concentrations were higher following TI induction or weighing than in the controls, but the 2 treatments elicited similar adrenocortical responses. Further, the PC levels found here were lower than those reported elsewhere when quail were exposed to crating, transport, or mechanical immobilization stressors. We therefore concluded that the induction of TI might be best regarded as a mild stressor. Furthermore, studies using this technique can identify ways of alleviating fear and thereby improving well-being. Collectively, we believe that the use of TI is justified, and it does not require classification as a regulated procedure in the United Kingdom or elsewhere.

Rotational diffusion of colloidal particles near confining walls

We study the rotational diffusion of a spherical colloid confined in a narrow channel between parallel plane hard walls. The walls damp translational diffusion much more than rotational diffusion so that there is expected to be little translation-rotation coupling. Using a recent calculation of the nonisotropic rotational mobilities arising from the hydrodynamic interactions with the walls, we set up the rotational Smoluchowski equation for either a particle with a permanent dipole moment or a polarizable particle with axisymmetric polarizabilities subject to an external electric field. Using the Smoluchowski equation dynamics we calculate the time-correlation functions of orientation that are measured in depolarized light scattering for the cases of no external field, external field normal to the walls, and external field parallel to the walls. The decay of correlations is shown to be given by a weighted sum of decaying exponentials and can be characterized by an initial and a mean characteristic decay time. The weights and decay rates of each component and the characteristic decay times are studied numerically for a range of field strengths. The nonisotropic rotational mobilities make these decay times highly sensitive to the distance of the particle from the confining walls. This position dependence can be used as a method of measuring the rotational mobilities or, conversely, the rate of decay of correlations can be used as a probe of particle position between the confining walls.

Autologous transplantation followed closely by reduced-intensity allogeneic transplantation as consolidative immunotherapy in advanced lymphoma patients: a feasibility study

We report outcomes in advanced lymphoma patients (n = 32) who enrolled in a trial of prospectively planned combined autologous/reduced-intensity transplantation (RIT) (n = 25) or who received RIT shortly after prior autografting because of high relapse risk or progressive disease (n = 7). Nine patients on the autologous/RIT transplant protocol did not proceed to planned RIT because of patient choice (n = 4), disease progression (n = 3), toxicity (n = 1), or no adequate donor (n = 1). Among the 23 other patients, RIT was started a median of 59 days (range 31-123) after autologous transplant. Fifteen patients had related donors, five patients had unrelated donors, and three patients had cord blood donors. Among all patients completing RIT, the median overall survival time was 385 days (95% CI 272-792), and the median relapse-free survival time was 157 days (95% CI 119-385). At the time of reporting, six patients (26%) remain alive and three patients (13%) remain alive without relapse. The 100-day transplant-related mortality (TRM) was 9% among all patients and was 0% among matched sibling donors. Overall TRM was 43%. Tandem transplant is feasible in advanced lymphoma with low early TRM. However, practical challenges associated with the strategy were significant and high levels of late TRM due to graft-versus-host disease and infections suggest that modifications of the procedure will be needed to improve outcomes and patient retention.

Spherical particle in Poiseuille flow between planar walls

We study a spherical mesoparticle suspended in Newtonian fluid between plane-parallel walls with incident Poiseuille flow. Using a two-dimensional Fourier transform technique we obtain a symmetric analytic expression for the Green tensor for the Stokes equations describing the creeping flow in this geometry. From the matrix elements of the Green tensor with respect to a complete vector harmonic basis, we obtain the friction matrix for the sphere. The calculation of matrix elements of the Green tensor is done in large part analytically, reducing the evaluation of these elements to a one-dimensional numerical integration. The grand resistance and mobility matrices in Cartesian form are given in terms of 13 scalar friction and mobility functions which are expressed in terms of certain matrix elements calculated in the spherical basis. Numerical calculation of these functions is shown to converge well and to agree with earlier numerical calculations based on boundary collocation. For a channel width broad with respect to the particle radius, we show that an approximation defined by a superposition of single-wall functions is reasonably accurate, but that it has large errors for a narrow channel. In the two-wall geometry the friction and mobility functions describing translation-rotation coupling change sign as a function of position between the two walls. By Stokesian dynamics calculations for a polar particle subject to a torque arising from an external field, we show that the translation-rotation coupling induces sideways migration at right angles to the direction of fluid flow.

The management of orbital cysts associated with congenital microphthalmos and anophthalmos

AIMS

To study the management of the orbital cysts present in a group of patients with anophthalmos and microphthalmos.

METHODS

A retrospective study of 34 patients (40 orbits) treated for orbital cyst associated with microphthalmos and anophthalmos.

RESULTS

The two largest treatment groups comprised 17 orbits (42.5%) where the cyst was removed surgically and 17 orbits (42.5%) where the cyst was retained and conformers were used. The remaining cases comprised two orbits (5%) where the cyst was aspirated initially; two orbits (5%) with large cysts which will need to be excised after further orbital growth; one orbit (2.5%) in which a silicone expander was used initially, and one orbit (2.5%) in which a mildly microphthalmic eye had some vision and was monitored but required no surgery.

CONCLUSION

In this study 33 out of 34 patients had a good cosmetic result which illustrates that the orbital cyst in microphthalmos or anophthalmos performs a useful role in socket expansion and that the majority of patients with this condition can expect a good cosmetic outcome.

Nonmyeloablative allogeneic hematopoietic stem cell transplantation for congenital sideroblastic anemia

Congenital sideroblastic anemia (CSA) is a dyserythropoietic disorder that leads to transfusion dependency and subsequent iron overload. Nonmyeloablative allogeneic hematopoietic stem cell transplantation (NST) was performed for a patient with CSA, who had contraindications to conventional allografting. Conditioning was fludarabine, low-dose total body irradiation and antithymocyte globulin, followed by peripheral blood stem cell transplant. Cyclosporine and mycophenolate mofetil were used for graft-versus-host disease prophylaxis. Complete donor chimerism was observed day +131. Early after transplant, the patient became transfusion independent, allowing a regular phlebotomy program. On day +190, refractory lactic acidosis followed by fatal cardiovascular collapse developed, without evidence of infection. Data from this case demonstrates that NST may correct the erythropoietic defect of CSA.

Early T-maze behavior and broiler growth

In the laboratory and at a commercial farm in Argentina, chicks that showed a short latency to exit a T-maze (LEX) (HP, high performance) gained more weight than those with a longer LEX (LP, low performance). The present study re-examined this relationship and evaluated additional T-maze measures using broilers reared in quasi-intensive, environmentally controlled conditions. In the T-maze, a mirror strategically placed at the end of a corridor stimulates the test chick to leave the isolation chamber (start box) and to move toward its reflection. Having done so, it can then see other birds and thereby be further stimulated to completely exit the maze. However, when a test bird hesitates or stops at the mirror, its performance categorization may be confounded. Herein, the T-maze performance of 3-d-old broiler chicks was assessed using three different measurements: 1) the latency to exit the start box (LEB), 2) the latency to reach the mirror section of the maze (LRM), and 3) LEX. The fastest (top 25%) and slowest (bottom 25%) of the birds within a sex and within each of the three T-maze criteria were classified as HP and LP chicks, respectively. The relationships between these measures and body weight were examined in 4-, 42-, and 56-d-old males and females. Irrespective of the T-maze classification criteria used, HP and LP chicks had similar body weights at 4 d of age. However, chicks classified as HP according to LEB or LRM measures were heavier at 42 and 56 d of age than LP ones (P < 0.02 for all comparisons). These differences were apparent in both sexes. On the other hand, there were no detectable differences in body weight at the latter ages between chicks categorized as HP or LP according to their LEX scores. The present results indicate that 1) broiler chicks that exit the T-maze start box and reach the mirror quickly subsequently grow faster than their slower LP counterparts and 2) LEB and LRM are better predictors of growth than the LEX value used in previous studies.

Interferon-gamma for delayed pulmonary toxicity syndrome resistant to steroids

Delayed pulmonary toxicity syndrome, characterized by interstitial pneumonia and pulmonary fibrosis, is common following high-dose bischloroethylnitrosourea (BCNU) (carmustine, [1,3-bis (2-chloroethyl)-1-nitrosourea]) containing chemotherapeutic regimens. Depending upon the treatment protocol, it may develop in over 70% of patients. Early and aggressive corticosteroid treatment leads to improvement in the majority of patients. However, up to 8% of affected patients may fail to respond to corticosteroids and develop progressive respiratory failure leading to death. No alternatives to corticosteroids have thus far been shown useful. We report the symptomatic and physiological improvement of a patient with severe steroid-resistant delayed pulmonary toxicity syndrome, following treatment with interferon-gamma.

Components of feed efficiency in broiler breeding stock: is improved feed conversion associated with increased docility and lethargy in broilers?

Two trials were conducted to test the hypothesis that broilers classified as good rather than poor feed converters (low vs. high feed-to-gain ratios, respectively) would show decreased activity (increased lethargy) and reduced fear of human caretakers. In both trials birds were reared to juvenile selection age when the 192 males with the "best" breast and leg conformation were placed into individual bird cages (46 x 60 cm), and their feed conversion ratio (FCR) was measured. In trial 1, birds remained in the cages for 7 d for assessment of feed conversion. During the feed conversion testing period, the birds were subjected to three behavioral tests. First, approach-avoidance responses to a novel object placed in the feeder were observed when feeding would be expected. Second, behavior patterns of individual birds were assessed by recording feeding, drinking, walking pecking, preening, standing, and resting. Third, the 20 birds showing the best FCR and the 20 showing the worst were induced into tonic immobility (TI). Feed conversion was not related to either the novel object or the TI measures of fearfulness. Neither was FCR related to feeding, drinking, walking, or pecking. However, FCR was positively correlated with both standing and preening and negatively correlated with resting behavior. In trial 2, the FCR test lasted for 11 d. The birds were assessed for behavioral patterns (feeding, drinking, walking, pecking, preening, standing, and resting) as in the previous trial. As in trial 1, FCR was positively correlated with standing and negatively correlated with resting behavior. Contrary to expectations, the results of these two studies suggest that broilers with good FCR were actually less lethargic and no more fearful than those that showed poor FCR values.

The familial contribution to non-syndromic ocular coloboma in south India

AIMS

To identify the proportion of familial cases of isolated ocular colobomatous malformations in a case series from south India.

METHODS

Children with ocular coloboma without systemic features were recruited from multiple sources in Andhra Pradesh, India. Their families were traced, pedigrees drawn, and family members examined.

RESULTS

56 probands, 25 females (44.6%) and 31 males (57.4%) with a colobomatous malformation were identified. In 12 cases (21.4%) another family member was affected. The risk to siblings was 3.8%. The parents were consanguineous in 25 cases (44.6%).

CONCLUSIONS

21.4% of cases of isolated ocular coloboma in this highly consanguineous population of south India were familial, with both autosomal dominant and autosomal recessive mechanisms likely in different families.