Haslemere Hospital

Fungicides continue to be essential for the effective control of plant diseases. New classes of fungicides with novel modes of action are being developed in the 1990s. These include the strobilurins, phenylpyrroles, anilinopyrimidines, phenoxyquinolines, and compounds that trigger defense mechanisms in the plant. For the foreseeable future, new toxophores will be identified through a process of random screening, with natural products representing a rich source of fungicide leads. Progress is being made in the development of high-throughput screens comprised of target enzyme sites or cell-based assays; these techniques will improve the probability of discovery. Following the identification of suitable leads, biorational design is used to optimize specific properties. In vivo glasshouse screens and field trials are expected to remain the dominant methods for characterizing new compounds. Low toxicity to humans and wildlife, low environmental impact, low residues in food, and compatibility with integrated pest management (IPM) programs are increasingly important considerations in the selection of fungicides for development.

This review provides a basis for substantiating both kinetically and pathologically the differences between chrysotile and amphibole asbestos. Chrysotile, which is rapidly attacked by the acid environment of the macrophage, falls apart in the lung into short fibers and particles, while the amphibole asbestos persist creating a response to the fibrous structure of this mineral. Inhalation toxicity studies of chrysotile at non-lung overload conditions demonstrate that the long (>20 µm) fibers are rapidly cleared from the lung, are not translocated to the pleural cavity and do not initiate fibrogenic response. In contrast, long amphibole asbestos fibers persist, are quickly (within 7 d) translocated to the pleural cavity and result in interstitial fibrosis and pleural inflammation. Quantitative reviews of epidemiological studies of mineral fibers have determined the potency of chrysotile and amphibole asbestos for causing lung cancer and mesothelioma in relation to fiber type and have also differentiated between these two minerals. These studies have been reviewed in light of the frequent use of amphibole asbestos. As with other respirable particulates, there is evidence that heavy and prolonged exposure to chrysotile can produce lung cancer. The importance of the present and other similar reviews is that the studies they report show that low exposures to chrysotile do not present a detectable risk to health. Since total dose over time decides the likelihood of disease occurrence and progression, they also suggest that the risk of an adverse outcome may be low with even high exposures experienced over a short duration.

Summary This paper describes and evaluates a new solid‐state recording hand‐held cone penetrometer developed for in‐situ soil studies. Force is measured by a strain‐gauged transducer, and depth by an accurate optical system. Data for up to 20 penetrations per plot are stored and processed within the instrument in the field. The new penetrometer has been evaluated in field and soil tank experiments in comparison with three widely contrasting existing penetrometers ranging from a simple hand‐held penetrometer to a trailer‐mounted power‐driven instrument. The results indicated that the simple hand‐held penetrometer gave appreciably different cone resistance profiles from the other instruments. In particular, spurious ‘treatment effects’ obtained from the tillage experiment were shown to be due to inadequate instrument performance. The new solid‐state recording hand‐held penetrometer gave results comparable with those obtained from the more complex trailer‐mounted instrument and another hand‐held recording penetrometer.

Space-based tracking technology using low-cost miniature tags is now delivering data on fine-scale animal movement at near-global scale. Linked with remotely sensed environmental data, this offers a biological lens on habitat integrity and connectivity for conservation and human health; a global network of animal sentinels of environmental change. Space-based tracking technology using low-cost miniature tags is now delivering data on fine-scale animal movement at near-global scale. Linked with remotely sensed environmental data, this offers a biological lens on habitat integrity and connectivity for conservation and human health; a global network of animal sentinels of environmental change. In September 2020, a tag on the back of a Eurasian blackbird (Turdus merula) tagged in Belarus, that had migrated to its wintering grounds in Albania, switched on its transmitter as the International Space Station (ISS) passed 410 km above. The tag sent global positioning system (GPS) location data on the bird´s recent whereabouts as well as onboard sensor data, which the International Cooperation for Animal Research Using Space (ICARUS) receiver aboard the Russian Zvezda Module of the ISS picked up and returned to scientists back on Earth [1.Belyaev M. et al.Development of technology for monitoring animal migration on Earth using scientific equipment on the ISS RS.in: Proceedings of the 27th Saint Petersburg International Conference on Integrated Navigation Systems (ICINS), St. Petersburg, Russia. 2020Crossref Scopus (6) Google Scholar] (Figure 1). While only 223 bytes in size, this transmission rang in a new epoch for space-based Earth observations and biological sensing. The new system, based on digital Internet of Things (IoT) technology, will allow the relay of position and behavior from myriad low-cost, miniaturized tracking tags (now 4g, soon 3g, optionally solar powered) at almost global scale and in near-real time. A connected global system of thousands of mobile ‘animal sensors’ has the potential to provide a quantum leap for the biological understanding and monitoring of our planet. The environmental associations of animals that drive their movements, finely tuned by evolution, offer an unrivalled biological lens into these habitats themselves. This concept flips the traditional satellite-based Earth observation paradigm: rather than globe-orbiting sensors capturing images of the planet’s surface for subsequent interpretation, animals, through countless individual movement decisions, seek out their preferred conditions, sensing the quality and health of ecosystems in real time (Figure 2). Realizing this capability, however, requires engagement from agencies and scientists worldwide to support decentralized coordinated data collection and, to catalyze this engagement, a global demonstration campaign. The blackbird’s data transmission was a long-anticipated milestone (https://www.icarus.mpg.de) [1.Belyaev M. et al.Development of technology for monitoring animal migration on Earth using scientific equipment on the ISS RS.in: Proceedings of the 27th Saint Petersburg International Conference on Integrated Navigation Systems (ICINS), St. Petersburg, Russia. 2020Crossref Scopus (6) Google Scholar]. With a new transmission scheme, two-way communication, and mass-produced hardware, ICARUS has not only reduced the size and cost of tracking tags but also increased the number that can be monitored concurrently. Through the ability to simultaneously return data from millions of ‘wearables for wildlife’, ICARUS complements existing satellite (Argos, Iridium) and ground-based (e.g., GSM, IoT) networks to dramatically expand the number and diversity of animals that can be tracked. The initial drive for animal tracking has come from animal behavior and migration research. Earlier generations of GPS tags revealed previously unknown migration paths and seasonal gatherings, identified vital corridors and refugia in conservation, and documented important epidemiological links [2.Kays R. et al.Terrestrial animal tracking as an eye on life and planet.Science. 2015; 348: eaaa2478Crossref Scopus (721) Google Scholar,3.Hussey N.E. et al.Aquatic animal telemetry: a panoramic window into the underwater world.Science. 2015; 348: 1255642Crossref PubMed Scopus (715) Google Scholar,10.Tian H. et al.Avian influenza H5N1 viral and bird migration networks in Asia.Proc. Natl. Acad. Sci. U. S. A. 2015; 112: 172-177Crossref PubMed Scopus (123) Google Scholar]. Data growth and collaboration have enabled some of the first comparative studies discovering behavioral adjustments to human land use [4.Tucker M.A. et al.Moving in the Anthropocene: global reductions in terrestrial mammalian movements.Science. 2018; 359: 466-469Crossref PubMed Scopus (487) Google Scholar] and changes of movements across the Arctic due to climate change [5.Davidson S.C. et al.Ecological insights from three decades of animal movement tracking across a changing Arctic.Science. 2020; 370: 712-715Crossref PubMed Scopus (35) Google Scholar]. In addition, they have stimulated excitement about the emergence of an entirely new type of animal sentinel-based evidence supporting biodiversity conservation in a rapidly changing world [6.Rutz C. et al.COVID-19 lockdown allows researchers to quantify the effects of human activity on wildlife.Nat. Ecol. Evol. 2020; 4: 1156-1159Crossref PubMed Scopus (219) Google Scholar,7.Jetz W. et al.Essential biodiversity variables for mapping and monitoring species populations.Nat. Ecol. Evol. 2019; 3: 539-551Crossref PubMed Scopus (150) Google Scholar,11.Turner W. Sensing biodiversity.Science. 2014; 346: 301-302Crossref PubMed Scopus (148) Google Scholar]. Unlike the caged canary in the coal mine, free-ranging animals pick their own paths and are thus naturally intelligent sensors, fine-tuned by evolution. They actively seek out, or avoid, a set of environmental conditions and show distinct reactions to unusual weather, storms, and some natural disasters [8.Wikelski M. Tertitski G. Living sentinels for climate change effects.Science. 2016; 352: 775-776Crossref PubMed Scopus (23) Google Scholar]. When linked to concurrently remotely sensed data from satellites, and through sensors’ onboard tags, their movement tracks record individually encountered environmental conditions. This enables an unprecedented quantification of the habitat use, environmental niches and ecological boundaries of animals and, with baseline data in place, real-time monitoring of change. Thereby, tracked animals can add essential biological meaning to the vast, ongoing remote-sensing data collection and act as canaries in the coal mine set free: signalers and sentinels of environmental conditions through their selection, avoidance, or death. The satellite–animal interlink could extend to active digital handholding: satellites could be tasked with following particular individuals for extra information or, in real time, tune into those showing abnormal behavior or sudden avoidance of places expected to be suitable. Agencies or conservation groups could receive alerts if typically used habitats or conservation areas are suddenly avoided or cause death (e.g., due to illegal encroachment or hunting). Such a system would substantially enhance ecological-change detection from remotely sensed signals, complementing existing data and approaches, for example, for remotely sensed deforestation alerts or spatially fixed conservation technology, such as camera traps. Imagine a representative set of 100 000 animals from 500 species equipped with space-based GPS tracking tags that deliver half-hourly data. At a 3g tag size, such a system is able to address around 40% of birds and over 50% of mammals (i.e., a total of ca 7000 potential species) and hundreds of species of crocodiles, turtles, and large lizards (for a 5% weight limit). This expanded hyper-speciose taxonomic (and geographic) scope opens an entirely new phase of animal-based Earth observation. Deploying this many tags is certainly a challenge, but remember, the ISS-tracked blackbird was preceded by tens of thousands of blackbirds equipped with leg bands instead. Thanks to a vast international network of volunteers, ca 3.5 million individual birds have been captured and marked every year since 1960, globally [9.Kestenholz M. et al.Bird Ringing for Science and Conservation. EURING, 2011Google Scholar] (with <1% ever resighted or recovered to provide a second data point), and probably hundreds of thousands of mammals. While not all species will be straightforward or justifiable targets for GPS tags, the potential set is large enough to enable ecologically representative and global coverage. Past experience and initial ICARUS interest suggest that wildlife agencies, non-governmental organizations, scientists, and bird banders would carry the large majority of deployments, with coordination and targeted campaigns needed to ensure coverage. The International Bio-Logging Society (https://www.bio-logging.net) could play a role in supporting such a global coordination. With a receiver in place, tag hardware cost at scale decreasing to US$100 or less each, and a yearly redeployment of 50 000 new tags, this results in a US$10–15 million annual cost, tremendous value added to environmental satellite missions at a small fraction of their typical cost. We expect that, combined with other data on traits and behaviors, space–time–environment information from thousands of species will enable a more functional interpretation of the ecosystem consequences of biodiversity. Across scales of organismal organization, but also across space and time, these measurements will allow pinning down of the plasticity and adaptive potential around realized change in animal niches and space use. The detailed capture of individual lifetime tracks, when linked with environmental and individual phenotypic and genomic data, provides an unprecedented tool for evolutionary study and offers new life-history, geospatial, and environmental niche dimensions for specimens archived or exhibited in museums. For potential animal reservoirs of infectious diseases, Earth observation with animal sensors can help to identify potential hotspots of disease transmission and map and monitor the potential for long-distance and cross-border transmissions [10.Tian H. et al.Avian influenza H5N1 viral and bird migration networks in Asia.Proc. Natl. Acad. Sci. U. S. A. 2015; 112: 172-177Crossref PubMed Scopus (123) Google Scholar]. Tracking of individuals with antibodies offers epidemiologists the potential to pinpoint the location of the true hosts of zoonotics such as Ebola and coronavirus disease 2019 (COVID-19). With so many animals tracked, many intriguing stories will emerge about individual animals that will have the potential to capture the imagination of people worldwide. The tracked animals provide the daily drama that can be part of digitally-rich media campaigns around tagged individuals that support education and discovery, and can engage citizen scientists to collect ancillary observations, enriching the data record even further. The potential to adopt and follow single individuals and their fates can connect people to biodiversity issues, both at their doorstep and far away, and support educational uses and conservation funding. Realizing these opportunities will require the engagement of and contributions from government agencies, the science community, and beyond. At agency level, a shift in traditional perceptions and approaches to Earth observation and monitoring will be required, together with interagency collaboration among and within nations. The ICARUS ground-to-space IoT is designed to be an open system for any organization to join and augment the global readout capacity or leverage for an improved system. The success of the presented vision will also rely on global collaboration and coordination of biodiversity monitoring among sovereign territories. With the GEO Biodiversity Observation Network (https://geobon.org) and its associated research community, international platforms and scientific principles for globally coordinated and integrated biodiversity monitoring are in place. Through model-based integration with other biodiversity data in platforms such as Map of Life (https://mol.org), the envisioned animal-based Earth observation can inform Essential Biodiversity Variables and indicators for the tracking of progress toward international goals on maintaining ecological integrity and connectivity or provide management-relevant short-term forecasting [7.Jetz W. et al.Essential biodiversity variables for mapping and monitoring species populations.Nat. Ecol. Evol. 2019; 3: 539-551Crossref PubMed Scopus (150) Google Scholar]. As tag deployments will rely on individual scientist’s participation, a willingness to follow agreed data standards and share data is vital. Effective Earth observation via animals will thus require development and openness around new data-sharing and -use models, including the near-immediate sharing of limited anonymized information that near-real time monitoring and model-based short-term forecasting depend on. Community engagement is needed to develop effective approaches for the citation of tracking data to support appropriate attribution and recognition. As one scales this vision to a truly global endeavor, challenges certainly remain, including sufficient capacity to support best scientific practice, benefit sharing, and the engagement of regional and local stakeholders. With the ICARUS system now online, a globally coordinated ‘100 000 animal sentinels’ campaign is possible and would establish an unrivalled bioenvironmental baseline record. With the larger community engaged, it would be the start of ongoing real-time sensing of living conditions on Earth by animals themselves. Akin to hyperspectral remote sensing systems [12.Schimel D. et al.Prospects and pitfalls for spectroscopic remote sensing of biodiversity at the global scale.in: Remote Sensing of Plant Biodiversity. Springer, 2020: 503-518Crossref Scopus (9) Google Scholar], it would realize hyper-speciose, and thus multifaceted, in situ biological Earth observation. No interests are declared. Biological Earth observation with animal sensors: (Trends in Ecology and Evolution , 293–298; 2022)Jetz et al.Trends in Ecology & EvolutionMay 21, 2022In BriefSix supporting authors were omitted from the article ‘ Biological Earth observation with animal sensors ´ when it was published. The corrected supporting author list appears below. We apologise for this oversight. Full-Text PDF Open Access

There is much debate about the relative roles of poultry movements and wild bird movements in the spread of highly pathogenic avian influenza H5N1. This article looks at the problem from an ornithologic perspective. Outbreaks in wild birds are examined in relation to three scenarios of possible wild bird involvement in virus transmission. These scenarios are examined separately for five phases of the outbreak that began in 1997 and which has recently become more dynamic in terms of virus spread. Most outbreaks in wild birds seem to reflect local acquisition of infection from a contaminated source, followed by rapid death nearby. Outbreaks in Europe in early 2006 indicate that the virus can be spread further by wild birds and thus that they can become infected and travel varying distances before dying, and probably passing the infection to other wild birds before death. There is only limited evidence that some wild birds can carry the virus asymptomatically, and no evidence from wild bird outbreaks that they have done so over long distances on seasonal migration routes. Other potential sources of infection and evidence for asymptomatic infection in wild birds are discussed, and the need for more ornithologic input into epidemiological studies of HPAI H5N1 is highlighted.

Until recently, the main indication for pelvic vein embolization (PVE) in women was to treat pelvic venous congestion syndrome (PVC) but increasingly, patients with refluxing pelvic veins associated with leg varicosities are also being treated. A more unusual reason for PVE is to treat pelvic venous malformations, although such lesions may be treated with sclerotherapy alone. Embolotherapy for treating PVC has been performed for many years with several published studies included in this review, whilst an emerging indication for PVE is to treat lower limb varicosities associated with pelvic vein reflux. Neither group, however, has been subjected to an adequate randomized, controlled trial. Consequently, some of the information presented in this review should be considered anecdotal (level III evidence) at this stage, and a satisfactory 'proof' of clinical efficacy remains deficient until higher-level evidence is presented. Furthermore, a wide range of techniques not accepted by all are used, and some standardization will be required based on future mandatory prospective studies. Large studies have also clearly shown an unacceptably high recurrence rate of leg varicose veins following venous surgery. Furthermore, minimally or non-invasive imaging is now revealing that there is a refluxing pelvic venous source in a significant percentage of women with de novo leg varicose veins, and many more with recurrent varicosities. Considering that just over half the world's population is female and a significant number of women not only have pelvic venous reflux, but also have associated leg varicosities, minimally invasive treatment of pelvic venous incompetence will become a common procedure.

Understanding of ecologic factors favoring emergence and maintenance of highly pathogenic avian influenza (HPAI) viruses is limited. Although low pathogenic avian influenza viruses persist and evolve in wild populations, HPAI viruses evolve in domestic birds and cause economically serious epizootics that only occasionally infect wild populations. We propose that evolutionary ecology considerations can explain this apparent paradox. Host structure and transmission possibilities differ considerably between wild and domestic birds and are likely to be major determinants of virulence. Because viral fitness is highly dependent on host survival and dispersal in nature, virulent forms are unlikely to persist in wild populations if they kill hosts quickly or affect predation risk or migratory performance. Interhost transmission in water has evolved in low pathogenic influenza viruses in wild waterfowl populations. However, oropharyngeal shedding and transmission by aerosols appear more efficient for HPAI viruses among domestic birds.

House dust mite sensitivity is very common in patients with bronchial asthma, yet dust mite avoidance frequently receives little attention in clinical management. It is likely that any reduction in allergen levels associated with routine cleaning is insufficient to allow clinical improvement. In the present study the acaricide pirimiphos methyl is shown to reduce the levels of Dermatophagoides pteronyssinus, antigen P1 in homes. Following a single application the level of antigen P1 in dust from carpets was reduced by up to 73% and by more than 50% in soft furnishings. Serial sampling showed a reduction for 6 weeks under conditions where carpets and chairs treated with solvent showed a progressive rise in allergen level. Furthermore the survival of mites in cultures or infested carpet segments was markedly inhibited, with antigen P1 accumulation reduced by greater than 90%. These results suggest major reductions in house dust mite allergen levels in the home can be achieved.

Hypoglycaemia and its consequences represent a significant risk for many people who have type 2 diabetes, and hypoglycaemia is currently under-recognised and commonly avoidable. Current clinical guidelines recommend the targeting of tight glycaemic control and this strategy may also be associated with an increased risk of hypoglycaemia. Hypoglycaemia impacts on morbidity, mortality and quality of life of people with type 2 diabetes, and improved recognition of the symptoms of hypoglycaemia will allow effective treatment and reduce the risk of progression to more severe episodes. A common cause of hypoglycaemia in people with type 2 diabetes is glucose-lowering medication, in particular, those which raise insulin independently of ambient glucose concentration such as sulphonylureas and exogenous insulin. The recently published National Institute for Health and Clinical Excellence guideline recommends the use of Dipeptidyl peptidase-4 inhibitors or thiazolidinediones (glitazones) as alternative second-line therapy instead of a sulphonylurea in those patients who are at significant risk of hypoglycaemia and its consequences.

Comprehensive toxicological studies of the herbicide acetochlor are presented and discussed. Although it gave a negative profile of responses in the many toxicity tests conducted there were some findings that prompted further investigation. First, although non-mutagenic in the Salmonella assay, acetochlor was clastogenic to mammalian cells treated in vitro. This clastogenic potential was not expressed in vivo in four rodent cytogenetic assays (bone marrow and germ cells). Second, although acetochlor gave a negative response in rat liver UDS assays when tested at the acute MTD, gavage administration of a single, supra-MTD dose (2000 mg/kg) gave a weak positive assay response. This dose-level (2000 mg/kg) was necrotic to the liver, depressed hepatic glutathione levels by up to approximately 80%, altered the metabolism of acetochlor, and was associated with up to 33% lethality. In contrast, reference liver genotoxins such as DMN, DMH and 2AAF were shown to elicit UDS in the absence of such effects, and at approximately 400 x lower dose-levels. Finally, microscopic nasal polypoid adenomas were induced in the rat when acetochlor was administered for two years at the maximum tolerated dose (MTD). The tumours were not life-threatening, they did not metastasize, and no DNA damage was induced in the nasal cells of rats maintained on a diet containing the MTD of acetochlor for either 1 or 18 weeks (comet assay). In order to probe the mechanism of action of these high dose toxicities a series of chemical and genetic toxicity studies was conducted on acetochlor and a range of structural analogues. These revealed the chloroacetyl substructure to be the clastogenic species in vitro. Although relatively inert, this substituent is preferentially reactive to sulphydryl groupings, most evidently, to glutathione (GSH). Similar chemical reactivity and clastogenicity in vitro was observed for two related chemicals bearing a chloroacetyl group, both of which have been defined as non-carcinogens in studies reported by the US.NTP. These collective observations indicate that the source of the clastogenicity of acetochlor in vitro is also the source of its rapid detoxification in the rat in vivo, via reaction with GSH. Metabolic studies of acetochlor are described which reveal the formation of a series of GSH-associated biliary metabolites in the rat that were not produced in the mouse. The metabolism of acetochlor in the rat changes with increasing dose-levels, probably because of depletion of hepatic GSH. It is most likely that a rat-specific metabolite is responsible for the rat nasal tumours observed uniquely at elevated dose-levels. The absence of genetic toxicity to the nasal epithelium of rats exposed acutely or subchronically to acetochlor favours a non-genotoxic mechanism for the induction of these adenomas. The observation of a time- and dose-related increase in S-phase cells in the nasal epithelium is consistent with this conclusion. Despite some confusion caused by the early use of perilethal gavage administrations of acetochlor to rodents, and supra-MTD dietary concentrations in some of the chronic studies, the available MTD data are consistent with acetochlor not posing a genetic or carcinogenic hazard to humans.

The evaluation of the occupational exposure of agricultural workers to pesticides is an integral part of the risk assessment for product safety and regulatory purposes. At present, there is no internationally accepted, harmonized approach to this exposure evaluation. This paper reviews the currently available methods for the measurement of exposure to, and absorption of, pesticides by workers involved in their use and in associated agricultural activities. Biological monitoring is recommended as the most precise means of estimating the absorbed dose of a pesticide, particularly if supported by human metabolism and pharmacokinetic data. A 'whole-body' sampling method is recommended for the measurement of dermal exposure. For concurrent exposure and biological monitoring a refined 'whole-body' method is recommended which involves the use of clothing representing that which workers normally wear under the prevailing conditions. A personal air sampling method is recommended for the measurement of inhalation exposure, to collect the 'inspirable' fraction (and/or, where necessary, vapour component) of pesticide. These ambient exposure monitoring methods may be conducted simultaneously with biological monitoring. Guidelines are proposed for the conduct of field studies to evaluate exposure to, and absorption of, pesticides to satisfy the requirements of regulatory authority and other organizations.

This paper reviews outbreaks of Asian-lineage highly pathogenic avian influenza virus (HPAIV) H5N1 in wild birds since June 2006, surveillance strategies, and research on virus epidemiology in wild birds to summarize advances in understanding the role of wild birds in the spread of HPAIV H5N1 and the risk that infected wild birds pose for the poultry industry and for public health. Surveillance of apparently healthy wild birds ("active" surveillance) has not provided early warning of likely infection for the poultry industry, whereas searches for and reports of dead birds ("passive" surveillance) have provided evidence of environmental presence of the virus, but not necessarily its source. Most outbreaks in wild birds have occurred during periods when they are experiencing environmental, physiologic, and possibly psychological stress, including adverse winter weather and molt, but not, apparently, long-distance migration. Examination of carcasses of infected birds and experimental challenge with strains of HPAIV H5N1 have provided insight into the course of infection, the extent of virus shedding, and the relative importance of cloacal vs. oropharyngeal excretion. Satellite telemetry of migrating birds is now providing data on the routes taken by individual birds, their speed of migration, and the duration of stopovers. It is still not clear how virus shedding during the apparently clinically silent phase of infection relates to the distance travelled by infected birds. Mounting an immune response and undertaking strenuous exercise associated with long migratory flights may be competitive. This is an area where further research should be directed in order to discover whether wild birds infected with HPAIV H5N1 are able or willing to embark on migration.

BACKGROUND: Computerized decision support systems (DSS) have mainly focused on improving clinicians' diagnostic accuracy in unusual and challenging cases. However, since diagnostic omission errors may predominantly result from incomplete workup in routine clinical practice, the provision of appropriate patient- and context-specific reminders may result in greater impact on patient safety. In this experimental study, a mix of easy and difficult simulated cases were used to assess the impact of a novel diagnostic reminder system (ISABEL) on the quality of clinical decisions made by various grades of clinicians during acute assessment. METHODS: Subjects of different grades (consultants, registrars, senior house officers and medical students), assessed a balanced set of 24 simulated cases on a trial website. Subjects recorded their clinical decisions for the cases (differential diagnosis, test-ordering and treatment), before and after system consultation. A panel of two pediatric consultants independently provided gold standard responses for each case, against which subjects' quality of decisions was measured. The primary outcome measure was change in the count of diagnostic errors of omission (DEO). A more sensitive assessment of the system's impact was achieved using specific quality scores; additional consultation time resulting from DSS use was also calculated. RESULTS: 76 subjects (18 consultants, 24 registrars, 19 senior house officers and 15 students) completed a total of 751 case episodes. The mean count of DEO fell from 5.5 to 5.0 across all subjects (repeated measures ANOVA, p < 0.001); no significant interaction was seen with subject grade. Mean diagnostic quality score increased after system consultation (0.044; 95% confidence interval 0.032, 0.054). ISABEL reminded subjects to consider at least one clinically important diagnosis in 1 in 8 case episodes, and prompted them to order an important test in 1 in 10 case episodes. Median extra time taken for DSS consultation was 1 min (IQR: 30 sec to 2 min). CONCLUSION: The provision of patient- and context-specific reminders has the potential to reduce diagnostic omissions across all subject grades for a range of cases. This study suggests a promising role for the use of future reminder-based DSS in the reduction of diagnostic error.

ABSTRACT In 2005 and 2006, highly pathogenic avian influenza H5N1 infected wild birds or poultry in at least 55 countries in Asia, Europe, and Africa. Scientists still have limited understanding of how these wild birds were infected and of how the virus behaves in a field setting. Better ecological and ornithological data are essential to resolve these uncertainties. At present, information on species identity, location and habitat, and sampling and capture methodology, as well as details of the affected bird populations, are inadequate or lacking for most incidents of H5N1 in wild birds. Greater involvement by ornithologists and ecologists, who have extensive experience in conducting field research on wild animals, is vital to improve our ability to predict outbreaks and reduce the environmental and socioeconomic impacts of H5N1 avian influenza.

This study was designed to measure potential dermal and respiratory exposure of agricultural workers during the application of a typical herbicide, 2,4-dichlorophenoxy acetic acid, with five types of application equipment commonly used in the United Kingdom. The workers were monitored during filling and loading operations and during spray application. Potential dermal exposure was higher during mixing and loading all tractor-powered sprayers than during spraying. Potential dermal exposure from tractor-powered sprayers fitted with conventional hydraulic nozzles was lower than from knapsack sprayers, with exposure from a tractor-powered sprayer fitted with controlled-droplet application equipment intermediate in this regard. There was no difference in potential dermal exposure between tractor-mounted and tractor-drawn sprayers fitted with conventional hydraulic nozzles. The hands were the most highly exposed part of the body during mixing and loading operations for all sprayers, and during spraying with tractor-powered sprayers. The lower legs of the workers were exposed principally when knapsack sprayers were used. For all five sprayers, potential respiratory exposure, where detectable at all, was negligible compared with potential dermal exposure.

The advent, largely in the past two decades, of highly-active but expensive pesticides, has been accompanied by the realization that most spraying operations are inefficient, wasteful, potentially hazardous to non-target organisms, and dependent on a plentiful supply of clean water. ULV techniques, particularly those using spinning-disc sprayers, have already radically changed spray technology. Charged-particle sprayers such as the Electrodyn may completely transform it.

BACKGROUND: Diagnostic error is a significant problem in specialities characterised by diagnostic uncertainty such as primary care, emergency medicine and paediatrics. Despite wide-spread availability, computerised aids have not been shown to significantly improve diagnostic decision-making in a real world environment, mainly due to the need for prolonged system consultation. In this study performed in the clinical environment, we used a Web-based diagnostic reminder system that provided rapid advice with free text data entry to examine its impact on clinicians' decisions in an acute paediatric setting during assessments characterised by diagnostic uncertainty. METHODS: Junior doctors working over a 5-month period at four paediatric ambulatory units consulted the Web-based diagnostic aid when they felt the need for diagnostic assistance. Subjects recorded their clinical decisions for patients (differential diagnosis, test-ordering and treatment) before and after system consultation. An expert panel of four paediatric consultants independently suggested clinically significant decisions indicating an appropriate and 'safe' assessment. The primary outcome measure was change in the proportion of 'unsafe' workups by subjects during patient assessment. A more sensitive evaluation of impact was performed using specific validated quality scores. Adverse effects of consultation on decision-making, as well as the additional time spent on system use were examined. RESULTS: Subjects attempted to access the diagnostic aid on 595 occasions during the study period (8.6% of all medical assessments); subjects examined diagnostic advice only in 177 episodes (30%). Senior House Officers at hospitals with greater number of available computer workstations in the clinical area were most likely to consult the system, especially out of working hours. Diagnostic workups construed as 'unsafe' occurred in 47/104 cases (45.2%); this reduced to 32.7% following system consultation (McNemar test, p < 0.001). Subjects' mean 'unsafe' workups per case decreased from 0.49 to 0.32 (p < 0.001). System advice prompted the clinician to consider the 'correct' diagnosis (established at discharge) during initial assessment in 3/104 patients. Median usage time was 1 min 38 sec (IQR 50 sec-3 min 21 sec). Despite a modest increase in the number of diagnostic possibilities entertained by the clinician, no adverse effects were demonstrable on patient management following system use. Numerous technical barriers prevented subjects from accessing the diagnostic aid in the majority of eligible patients in whom they sought diagnostic assistance. CONCLUSION: We have shown that junior doctors used a Web-based diagnostic reminder system during acute paediatric assessments to significantly improve the quality of their diagnostic workup and reduce diagnostic omission errors. These benefits were achieved without any adverse effects on patient management following a quick consultation.

Depression is common among people with multiple sclerosis (MS). Research suggests that treatments for depression are effective in this population, though few patients appear to access these treatments. Our objectives were to consider whether persons with MS and significant depressive symptoms, prompted to seek treatment by letter, did so, what professionals they consulted, and the benefits of any treatment obtained. A total of 495 individuals with MS (401 female; 94 male), aged 22-65 years (mean: 45.8 years), were surveyed in three phases at yearly intervals. Significant depressive symptoms were found over the three phases (50-60.2%). Despite a high prevalence of depressive symptoms, few participants sought treatment, even though prompted to do so. Where treatment was sought, general practitioners remained the principal group consulted. Contrary to previous reports of the efficacy of treatment in clinical trials, no strong support for this was found. Future research needs to consider why the majority of people with MS do not seek treatment for depression, and why interventions, which are not clinical trials, seem to lack effectiveness.

Click to increase image sizeClick to decrease image sizeKey words: Laboratory testssoil microflora

Journal Article The Catholic encyclopaedia Get access E. W. Swanton E. W. Swanton 1Educational Museum, Haslemere, Surrey Search for other works by this author on: Oxford Academic Google Scholar Notes and Queries, Volume 192, Issue 8, 19 April 1947, Page 174, https://doi.org/10.1093/nq/192.8.174a Published: 19 April 1947