Injection immunotherapy. British Society for Allergy and Clinical Immunology Working Party.

A working party of the British Society for Allergy and Clinical Immunology has reviewed the role of specific allergen immunotherapy in the treatment of allergic disease and produced a position statement summarising the available evidence for efficacy and safety. The working party recommends specific allergen immunotherapy for treating summer hay fever uncontrolled by conventional medication and for wasp and bee venom hypersensitivity. It is not recommended for asthma or for allergic rhinitis due to other allergens. For the recommended indications the risk:benefit ratio is acceptable provided patients are carefully selected; in particular, patients with asthma should be excluded as they are especially vulnerable to adverse reactions. Injections should be given only by doctors experiences in this form of treatment in a clinic where full resuscitative facilities are immediately available. Provided patients remain symptom free a 60 minute observation period after injection is sufficient to detect all serious adverse reactions.     

Conducting clinical research in the new NHS: the model of cancer. United Kingdom Coordinating Committee on Cancer Research.

The United Kingdom Coordinating Committee on Cancer Research represents the major organizations funding cancer research in the United Kingdom. The deliberations of a working party convened by the committee to evaluate recently expressed concerns that the changes in the NHS threaten research, especially clinical trials to evaluate new treatments, are reported. A survey of contributors to trials coordinated by the committee showed that half are now experiencing difficulties in continuing to participate in clinical trials. The two major problems identified were lack of time and of staff, especially for NHS staff in non-teaching hospitals. Recent changes in junior doctors'' hours and proposed reductions in the length of time for training will exacerbate this. It is possible to identify the direct and indirect excess costs of conducting research in the NHS, but currently the mechanism does not exist to designate funds specifically for this purpose. Consultation with the regional directors of research and development confirmed that the service increment for teaching and research is not the solution for this. Proposals are made to secure future clinical research in the NHS, including finance, indemnity, the licensing of new drugs, the greater use of nurse counsellors, and the value of cancer registries.     

The role of prefrontal cortex in working memory: examining the contents of consciousness.

Working memory enables us to hold in our ''mind''s eye'' the contents of our conscious awareness, even in the absence of sensory input, by maintaining an active representation of information for a brief period of time. In this review we consider the functional organization of the prefrontal cortex and its role in this cognitive process. First, we present evidence from brain-imaging studies that prefrontal cortex shows sustained activity during the delay period of visual working memory tasks, indicating that this cortex maintains on-line representations of stimuli after they are removed from view. We then present evidence for domain specificity within frontal cortex based on the type of information, with object working memory mediated by more ventral frontal regions and spatial working memory mediated by more dorsal frontal regions. We also propose that a second dimension for domain specificity within prefrontal cortex might exist for object working memory on the basis of the type of representation, with analytic representations maintained preferentially in the left hemisphere and image-based representations maintained preferentially in the right hemisphere. Furthermore, we discuss the possibility that there are prefrontal areas brought into play during the monitoring and manipulation of information in working memory in addition to those engaged during the maintenance of this information. Finally, we consider the relationship of prefrontal areas important for working memory, both to posterior visual processing areas and to prefrontal areas associated with long-term memory.     

Adult advanced cardiac life support: the European Resuscitation Council guidelines 1992 (abridged). European Resuscitation Council Working Party.

The European Resuscitation Council, established in 1990, is committed to saving lives by improving standards of cardiopulmonary resuscitation across Europe and coordinating the activities of interested organisations and individuals. In this regard the council has successfully brought together physicians and surgeons from eastern and western Europe and, in addition, has established relations with the American Heart Association and equivalent organisations in Canada, Australia, and South Africa. A main objective of the European Resuscitation Council is to produce guidelines for cardiopulmonary and cerebral resuscitation, and in this paper members of a working party of 14 experts from 11 countries set out an abridged version of the council''s guidelines for adult advanced cardiac life support. The council hopes that the guidelines and accompanying algorithms will serve as a ready use "how to do it" for ordinary practitioners and paramedics inside and outside hospital.     

Confirmation of death.

A working party set up to study the problems surrounding the confirmation of death investigated current practice by means of a questionnaire sent to a random sample of accident and emergency departments in district general hospitals. Of the 38 replying, 24 said that bodies were examined in the ambulance, four in the accident and emergency department, and 10 in both. Answers to the other questions also suggest that the present procedures are in general unsatisfactory, and some dissatisfaction was expressed by departments. The individuals and organisations consulted were unanimous that confirmation of death should not be carried out in the ambulance. A change of practice would, however, create practical problems. The working party recommends therefore that the standard practice should be for all bodies to be properly examined by a doctor in the accident and emergency department, and that funds should be made available for any building alterations and increase in staff made necessary by such changes.     

Reflections on supply-demand mismatch in dialysis services in Ontario.

The population-based dialysis rate in Ontario more than doubled between 1981 and 1992; yet there is concern about over-loaded facilities, delayed treatment and denial of dialysis through nonreferral and implicit rationing. A working party involving several stakeholders has been established in Ontario to address these issues. However, clinical policy making concerning dialysis services is impeded in all provinces by a lack of information. The causes of the moderately large variations in dialysis rates from province to province remain unclear. The exact extent and risks of delayed therapy have not been well defined. Dialysis protocols vary inexplicably among centres, and cost data on different methods of providing dialysis are limited. Many steps could be taken in Ontario and other provinces to generate a better information base for planning and managing dialysis services. Predialysis clinics with outreach programs could help to ensure equitable access to this life-saving therapy. Criteria for choosing modes and intensities of renal-replacement therapy must be reviewed. In areas of clear disagreement and uncertainty, patients could be randomly assigned to different protocols and outcomes studied. In areas of agreement, the criteria should be standardized. Advance directives may help ascertain patients'' wishes concerning the initiation or continuation of dialysis, and more accurate data on prognosis of different patient subgroups would aid in early identification of patients in a hopelessly deteriorating situation. Last, studies comparing the "output" (e.g., hours on hemodialysis) per dollar of different dialysis units and modalities are also needed to ensure that all facilities are opening efficiently without compromising patient outcomes.     

Guidelines for paediatric life support. Paediatric Life Support Working Party of the European Resuscitation Council.

The paediatric life support working party of the European Resuscitation Council was set up in 1992 with the aim of producing guidelines for basic and advanced paediatric resuscitation that would be acceptable throughout Europe. The commonest cause of cardiac arrest in children is problems with the airway. The resulting difficulties in breathing and the associated hypoxia rapidly cause a severe bradycardia or asystole. In contrast, adults have primary cardiac events resulting in ventricular fibrillation. This important difference in the pathogenesis of paediatric and adult cardiac arrest is reflected in these European Resuscitation Council guidelines, which complement those already published for adults.     

The Rise of Partisanship and Super-Cooperators in the U.S. House of Representatives

It is widely reported that partisanship in the United States Congress is at an historic high. Given that individuals are persuaded to follow party lines while having the opportunity and incentives to collaborate with members of the opposite party, our goal is to measure the extent to which legislators tend to form ideological relationships with members of the opposite party. We quantify the level of cooperation, or lack thereof, between Democrat and Republican Party members in the U.S. House of Representatives from 1949–2012. We define a network of over 5 million pairs of representatives, and compare the mutual agreement rates on legislative decisions between two distinct types of pairs: those from the same party and those formed of members from different parties. We find that despite short-term fluctuations, partisanship or non-cooperation in the U.S. Congress has been increasing exponentially for over 60 years with no sign of abating or reversing. Yet, a group of representatives continue to cooperate across party lines despite growing partisanship.     

Differential diagnosis in patients with disorders of the patellofemoral joint.

Anterior knee complaints are difficult diagnostic problems. It cannot be overstated that the most important information available is to be found in the patient''s history. Onset, quality, and quantity of symptoms must be assessed. This information is then synthesized to determine the specific functional disabilities resulting from the patient''s anterior knee disorder. Once a history is obtained, a consistent, methodical physical examination can be performed to narrow the differential diagnosis. Radiographic evaluation is used to further hone the differential or to confirm the most likely diagnosis. Ultimately, a specific working diagnosis is selected and treatment is tailored to changing the underlying structural or biomechanical abnormalities that led to the patient''s complaints.     

Management for doctors. Getting the best from people.

To get the best out of people the McGregor Theory ''Y'' manager will be supportive and collaborative rather than controlling. The aim will be to appoint staff to properly designed jobs and to motivate them by working with them and agreeing joint goals, by encouraging self development and appropriate training, and by being both firm and fair. In essence this manager will care about colleagues and see them as a resource to be nurtured rather than competitors to be undermined or costs to be cut. If the doctor in the case study had been treated in this way perhaps he might still be motivated and treating British patients instead of going to Saudi Arabia where he feels more greatly valued both as an individual and a professional.     

Management guidelines in essential hypertension: report of the second working party of the British Hypertension Society.

Several important new issues have arisen in the management of patients with hypertension. A working party of the British Hypertension Society has therefore reviewed available intervention studies on anti-hypertensive treatment and made recommendations on blood pressure thresholds for intervention, on non-pharmacological and pharmacological treatments, and on treatment goals. This report also provides guidelines on blood pressure measurement, essential investigations, referrals for specialist advice, follow up, and stopping treatment.     

Use of personal medical records for research purposes.

The established practice of doctors using medical records for research purposes is threatened by the recent proposed guidelines from the Department of Health, the BMA, and the European Commission. The European Commission has proposed that explicit consent should be obtained from each patient before his or her medical records can be used; the proposals from the Department of Health and the BMA would require all research that needs access to personal medical records to be submitted to an ethics committee. We believe that these proposals would seriously impair an entire category of research and suggest therefore that another set of guidelines, proposed by a Royal College of Physicians'' working group, should be used to modify the proposals. The guidelines of the working group encourage the use of medical records for research and ensure that such use can be made in a confidential manner without causing harm.     

Epidemiological and statistical aspects of the AIDS epidemic: introduction

In 1988, a government working party studied estimates of incidence and prevalence of numbers of acquired immunodeficiency syndrome (AIDS) cases. They investigated a series of epidemiological, statistical and mathematical problems associated with predicting trends in incidences of AIDS. This paper introduces a series of papers that give a fuller and more technical exposition of the appendixes of that working party report. The papers provide a brief background to the current state of knowledge on the epidemiology of the infection and the disease; a deterministic model for human immunodeficiency virus (HIV) transmission in the male homosexual community in England and Wales is introduced. Back-projection methods are studied in two papers, following the distribution of the incubation period of the disease. The concept of minimum size of the epidemic is introduced. Mathematical functions to describe the spread of HIV infection are refined by using past trends in the incidence of AIDS to estimate values for some parameters. Survival times for AIDS patients from the point of diagnosis are considered and evidence for changes in male homosexual sexual behaviour is studied; lag-time from the point of diagnosis to the report of the case is also examined. There is a comparative analysis of the AIDS epidemic in various European countries. The incubation period of HIV in patients with haemophilia A and B infections and the problems associated with making predictions for different at-risk groups or small subgroups based on geographical area are discussed. Reasons for fluctuation between the number of reported cases from month to month are provided.     

Knowledge in perception and illusion.

Following Hermann von Helmholtz, who described visual perceptions as unconscious inferences from sensory data and knowledge derived from the past, perceptions are regarded as similar to predictive hypotheses of science, but are psychologically projected into external space and accepted as our most immediate reality. There are increasing discrepancies between perceptions and conceptions with science''s advances, which makes it hard to define ''illusion''. Visual illusions can provide evidence of object knowledge and working rules for vision, but only when the phenomena are explained and classified. A tentative classification is presented, in terms of appearances and kinds of causes. The large contribution of knowledge from the past for vision raises the issue: how do we recognize the present, without confusion from the past. This danger is generally avoided as the present is signalled by real-time sensory inputs-perhaps flagged by qualia of consciousness.     

Collecting morbidity data in general practice: the Somerset morbidity project.

OBJECTIVE--To collect a valid, complete, continuous, and representative database of morbidity presenting to primary care and to use the data to help commission services on the basis of local need and effectiveness. SETTING--Computerised general practices in Somerset. METHODS--Participating general practices were selected to be representative of the district health authority population for general practice and population characteristics. All conditions presented at face to face consultations were assigned a Read code and episode type and the data were regularly validated. Data were sent by modem from the practices via a third party to the health authority each week. MAIN OUTCOME MEASURES--Proportion of consultations coded and accuracy of coding. RESULTS--11 practices agreed to participate. Validations for completeness during April 1994 to March 1995 revealed that 96.4% of the records were coded; 94% of the 1090 records validated had appropriate episode types and 87% appropriate Read codes. The results have been used to help formulate the health authority''s purchasing plans and have enabled a change in the local contracts for surgery for glue ear. CONCLUSIONS--The project has shown the feasibility of establishing a network of practices recording and reporting the morbidity seen in primary care. Early indications are that the data can be useful in evidence based purchasing.     

Protein C deficiency: summary of the 1995 database update.

The coagulation cascade is controlled by several anticoagulant safeguards that avoid excessive clot formation. Disorders of these anticoagulant mechanisms are an important health problem, as they lead to increased risk of thromboembolism. Protein C deficiency is probably the most extensively studied abnormality in natural anticoagulants. Under the auspices of the Subcommittee on Plasma Coagulation Inhibitors of the Scientific and Standardization Committee of the International Society of Thrombosis and Haemostasis a working party of researchers maintains a database of mutations that have been characterized in the protein C gene. The 1995 update of this database comprises 331 entries that describe 160 unique mutational events. Here essential features of the database are reviewed.     

Segmented political assimilation: perceptions of racialized opportunities and Latino immigrants' partisan identification

Abstract

To account for Latino immigrants' assimilation into the American political mainstream, I derive social psychological factors from the contextual notion of ‘modes of incorporation’ in the segmented assimilation literature. These social psychological factors, perceptions of racialized opportunities (PROPs), relate to immigrants' adoption of political party identities (i.e. Democrat, Republican). I test these PROPs factors utilizing the 2006 Latino National Survey (N=5,717 immigrant Latino respondents). Multinomial logistic regressions predicting party identification, compared to either ‘Don't Know’ or ‘Don't Care’ options, indicate that PROPs are significantly related to Latino immigrants' identification as either Democrats or Republicans. High levels of identification with perceived white opportunities are related to Republican identity and high levels of identification with perceived black opportunities differentiate Democrats from Republicans.     

Hubs with network motifs organize modularity dynamically in the protein-protein interaction network of yeast

Background

It has been recognized that modular organization pervades biological complexity. Based on network analysis, ‘party hubs’ and ‘date hubs’ were proposed to understand the basic principle of module organization of biomolecular networks. However, recent study on hubs has suggested that there is no clear evidence for coexistence of ‘party hubs’ and ‘date hubs’. Thus, an open question has been raised as to whether or not ‘party hubs’ and ‘date hubs’ truly exist in yeast interactome.

Methodology

In contrast to previous studies focusing on the partners of a hub or the individual proteins around the hub, our work aims to study the network motifs of a hub or interactions among individual proteins including the hub and its neighbors. Depending on the relationship between a hub''s network motifs and protein complexes, we define two new types of hubs, ‘motif party hubs’ and ‘motif date hubs’, which have the same characteristics as the original ‘party hubs’ and ‘date hubs’ respectively. The network motifs of these two types of hubs display significantly different features in spatial distribution (or cellular localizations), co-expression in microarray data, controlling topological structure of network, and organizing modularity.

Conclusion

By virtue of network motifs, we basically solved the open question about ‘party hubs’ and ‘date hubs’ which was raised by previous studies. Specifically, at the level of network motifs instead of individual proteins, we found two types of hubs, motif party hubs (mPHs) and motif date hubs (mDHs), whose network motifs display distinct characteristics on biological functions. In addition, in this paper we studied network motifs from a different viewpoint. That is, we show that a network motif should not be merely considered as an interaction pattern but be considered as an essential function unit in organizing modules of networks.     

Achievable standards, benchmarks for reporting and criteria for evaluating cervical cytopathology

Summary of the report of a working party set up by the Royal College of Pathologists, British Society for Clinical Cytology (BSCC) and NHS Cervical Screening Programme (NHSCSP) which is circulated with this issue of Cytopathology and is also available as an NHSCSP document.     

Attendance and non-attendance for breast screening at the south east London breast screening service.

OBJECTIVES--To ascertain the reasons for a low rate of response for breast screening. DESIGN--All relevant aspects of the organisational process examined, including general practitioners'' notes. Non-responders visited and interviewed. SETTING--An inner city breast screening service working on the model advocated by the Forrest report. SUBJECTS--288 Women aged 50-64 registered with several general practices and invited for screening by post. MAIN OUTCOME--Determination of factors important for success of breast screening programmes. RESULTS--After five women were excluded by their general practitioners the response rate was 129 out of 283 (46%), but 99 (35%) of the women did not receive their invitations because of inaccuracies in the family practitioner committee''s database and general practitioners failing to check women''s addresses completely. CONCLUSIONS--Increased rates of response will depend on enabling general practitioners to check addresses and on an increased awareness of the importance of information.