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Summary This report defines four levels of care required for the management of adult patients with haematological malignancies and marrow failure (acute and chronic leukaemias, lymphomas, myelodysplastic and myeloproliferative disorders, myeloma and severe aplastic anaemia). The higher levels of care require increasing specialist expertise, staffing and resources. Staffing includes both the medical, nursing and scientific/laboratory professions and other support staff. Resources include ward provision, bed numbers, equipment, laboratory and radiotherapy facilities, pharmacy, support services and research. Blood transfusion services and their organisation are discussed separately. The guidelines indicate to providers and purchasers the issues to be considered in placing contracts for the care of these patients. A glossary of terms is provided for purchasers.

In a sustainable development context, the storm water reuse in industry seems a promising and original alternative, but few experiences exist. A project, sponsored by the European Community and the Artois-Picardie Water Agency, has been carried out by the Renault MCA factory in Maubeuge, demonstrating that it can be profitable, in certain conditions, to reuse storm water in industrial processes. This article summarises this experience, and presents a decision making tool (SIRRUS) that has been developed in this framework by Anjou Recherche (Vivendi Water) to evaluate, on the basis of simple criteria, if this experience is or is not reproducible on a given site, and how much time is necessary to pay the investment back. Its application and different results are also discussed.

Vertical-cavity surface-emitting lasers (VCSELs) are complex multi-layer structures whose operating characteristics are highly sensitive to variations in layer thickness and composition. We have made non-destructive measurements of the thickness of GaAs/AlAs layers in three wafer-sized VCSEL substructures, consisting of partial distributed Bragg reflectors, grown by metal-organic vapour-phase epitaxy. A range of techniques were investigated and compared, including reflectance, photo-modulated reflectance, spectroscopic ellipsometry and high-resolution x-ray diffraction. The results obtained from each technique for the layer thicknesses are equal to each other to within ±~1%. The precision of the optical techniques is as good as, and sometimes better than, direct measurements made using destructive cross-sectional transmission electron microscopy.

Two InGaAs/GaAs/AlAs vertical-cavity surface emitting laser (VCSEL) structures have been studied by conventional reflectance (R) and photomodulated reflectance (PR) spectroscopies at \ensuremath{\sim}300 K and \ensuremath{\sim}80 K. Growth variations across the samples (2%) give rise to smooth changes in the cavity mode energy so that it can be tuned through the position of resonance with the quantum well (QW) ground-state exciton, by varying the position of measurement. The R spectra show the cavity mode but at best only a weak excitonic feature. In contrast, the PR shows two prominent and distinct signals, and there is a strong enhancement (up to 40 times) at resonance. A theory has been developed for the PR modulation of the coupled cavity and exciton modes, based on energy dependent Seraphin coefficients. This was used to fit all the PR spectra simultaneously in each complete set of position dependent measurements, using seven parameters, only one of which, the cavity mode energy, varied significantly. The resulting cavity mode and excitonic energies do not clearly show an anticrossing behavior near resonance, implying only a weak exciton-cavity coupling. The ability of PR to detect, in a nondestructive manner, both the cavity and exciton modes, and the extent to which they are in resonance, suggests it could be extremely useful in the characterization of VCSEL structures near their operating temperature.

Urethral calculi are extremely rarely reported in Caucasian females and are usually associated with an anatomical abnormality such as a diverticulum or a stricture. Ureteric calculi can move to become lodged in the urethra, although this is rare in women because of their short urethral length. We present a case of a 55-year-old woman presenting with urinary retention secondary to an obstructing upper tract calculus that had moved into the urethra. Four years previously, the patient had been diagnosed with chronic pelvic pain following a primary posterior vaginal wall repair. Following treatment of the obstructing calculus, her symptoms of pelvic pain completely resolved. We report a very unusual case that highlights the importance of investigating chronic pelvic pain. This patient’s symptom of vaginal pain, though highly localized, was caused by pathology elsewhere in the pelvis. Alternative diagnoses should be sought for such patients and investigation performed to detect any nonvisible hematuria.

Optical reflectivity spectra are useful in assessing the structure of vertical-cavity surface-emitting lasers (VCSELs) but show little of the nature of the active quantum well (QW). Here we use photomodulated reflectance to identify a region of an epitaxial wafer with optimal cavity-QW alignment. AlInGaP-AlGaAs visible VCSEL devices fabricated from this region lased well, compared with devices from a nearby control piece of the wafer which failed to lase at all.

High quality radioactive beams have recently made possible the measurement of (d,p) reactions on unstable nuclei in inverse kinematics, which can yield information on the development of single-neutron structure away from stability, and are of astrophysical interest due to the proximity to suggested r-process paths. The Oak Ridge Rutgers University Barrel Array (ORRUBA) is a new high solid-angular coverage array, composed of two rings of silicon detectors, optimized for measuring (d,p) reactions. A partial implementation has been used to measure (d,p) reactions on nuclei around the N = 82 shell closure.

BACKGROUND--A study was undertaken to investigate the accuracy of typing of a series of bronchial carcinomas by experienced pathologists with an interest in lung cancer from the examination of bronchoscopic biopsy specimens. METHODS--Eighty bronchial biopsy specimens showing positive results for bronchial carcinoma were circulated to five pathologists, who recorded diagnostic criteria and diagnosis for each. Diagnoses were then compared with the diagnosis agreed from the resection specimen corresponding to each biopsy specimen. A "non-small cell carcinoma, not further specified" classification group was introduced for small biopsy specimens. RESULTS--A diagnostic accuracy of 75% was achieved for squamous cell carcinomas, 66% for small cell carcinomas, and 50% for adenocarcinomas. There was diagnostic confusion between small cell and non-small cell carcinoma in less than 10% of cases. The introduction of a non-specific non-small cell classification improved diagnostic accuracy by 10-15% for each non-small cell tumour group. CONCLUSIONS--There are appreciable inaccuracies in applying the World Health Organisation's 1981 classification of lung cancer to the diagnosis of bronchial carcinoma from small biopsy specimens and these inaccuracies have been measured. They can be diminished by introducing a less specific "non-small cell" category for use with this sort of biopsy material. Care should be taken not to overinterpret small biopsy specimens in lung cancer.

In a double-blind crossover trial, the effect of a new mucolytic drug, the sodium salt of 2-mercaptoethane sulfonic acid (Mistabron) (6 ml, 200 mg per milliliter) was compared with 0.9% sodium chloride (6 ml) over 16 consecutive days in 31 sub;ects with chronic bronchitis. Drugs were assigned randomly and were self-administered by nebulization. Pulmonary function measurements were made pre-nebulization, 5 minutes, and 45 to 60 minutes after nebulization each day. Symptomatic assessment of cough, sputum production, and dyspnea were recorded daily. No changes attributable to either treatment were noted in blood pressure, electrocardiographic tmcings, chest radiographs, blood chemistries, and urinalyses during the study. Pulmonary function tests (which included whole body plethysmography) showed clinically insignificant changes, though most subjects claimed to have experienced clinical improvement after taking 2-mercaptoethane sUlfonic acid. Sputum production was measured in the last 18 patients who entered the study, and 2-mercaptoethane sulfonic acid consistently resulted in greater production than saline. The difference was significant (p = 0.001). It is concluded that 2-mercaptoethane sulfonic acid (20%) is as safe as an equivalent volume of normal saline administered by inhalation to subjects with chronic bronchitis, and that it is a more effective mucolytic agent.

A case of a 69 year old man in whom hypertrophic gastritis was associated with the carcinoid syndrome is reported. Concentrations of prostaglandin E2 were increased in plasma, gastric juice, gastric mucosa and urine. He had marked hypochlorhydria in response to pentagastrin stimulation (Peak acid output (PAO) pg:0.2 mmol/h). After successful hepatic arterial embolisation of the metastases (as indicated by an 85% decrease in 24 h urinary 5-HIAA) the concentrations of prostaglandin E2 decreased in the plasma, gastric juice and gastric mucosa. The gastric mucosal hypertrophy regressed and secretion of acid in response to pentagastrin returned (PAO pg:9.0 mmol/h). These findings suggest that the carcinoid tumour was producing a substance which stimulated increased local synthesis of prostaglandin E2 in the gastric mucosa, with concomitant gastric mucosal hypertrophy and inhibition of gastric acid secretion.

A scoring system for the assessment of fine needle aspirates of benign and malignant breast lesions was devised which showed a positive correlation (r = 0.67) between the scores obtained from the fine needle aspirates from ductal carcinomas and the Bloom and Richardson-type scores for their paired excision biopsy specimens. This system permitted grades II and III ductal breast carcinoma to be distinguished reliably from grade I tumours but no correlation with the lymph node state of patients with breast carcinoma was shown. Some overlap between the scores for grade I ductal carcinomas and some benign lesions was found, and this underlines a need for caution in the reporting of such equivocal aspirates. No cytological features that distinguished reliably ductal from lobular carcinoma were identified but the same spectrum of severity of cytological abnormality in the ductal and lobular carcinoma aspirates was seen. This system may be of prognostic value in the assessment of lobular carcinoma which has hitherto defied histological grading.

The South West Universities Regional Computer Centre (SWURCC) was established in 1975 to meet the needs of the ‘big batch’ users at University College Cardiff, the University of Wales Institute of Science and Technology and the Universities of Exeter, Bath and Bristol. All user work reaches SWURCC’s twin ICL 2980 system via X.25 links. Apart from the mixed scientific batch workload a user terminal service based on X.29 offers editing and job submission facilities. Our basic philosophy includes the provision of a consistent and reliable user interface, comprehensive documentation, high quality software, adoption of standards and a strong inclination towards manufacturer supplied and supported solutions rather than the ‘do it yourself’ approach.

Design, safety features and performances are described of a manipulandum for precise studies of human motor function.

Benzquinamide HC1, a new antiemetic agent, was studied in twelve healthy volunteers. Each subject received intravenously both benzquinamide (0.7 mg/kg) and placebo in a randomized, double–blind crossover manner. Cardiac output and arterial pressure, arterial blood gases, respiration (tidal volume and rate), and oxygen consumption were measured twice before drug administration and at 5, 10, 20 and 30 min after injection. Intra–arterial pressure increased significantly (P

Recent measurements with radioactive beams at ORNL’s Holifield Radioactive Ion Beam Facility (HRIBF) have prompted evaluations of the structure and reactions of unstable nuclei that play an important role in stellar explosions. The evaluation work focuses on reactions involving unstable nuclei and their associated level structures. To determine the astrophysical impact of these evaluations and other new nuclear physics results, it is vital to rapidly and accurately process and incorporate them into astrophysics models. We discuss the development of a new computational infrastructure that streamlines this process, and is available online at nucastrodata.org. This site also hyperlinks all available nuclear data sets relevant for nuclear astrophysics studies. Features of the suite and future developments are described.