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This paper addresses the subject of letters to the editor as one of the longest standing forums for public discussion and debate by ordinary citizens. To show how the voice of ordinary citizens is presented in letters to the editor during national election campaigns over a period of ten years (2008, 2013 & 2017), we are focusing on the Austrian Kronen Zeitung: A newspaper with an exceptionally high market share of up to 40% during the examination period, a heavy focus on the letters section with three pages per day, and a self-declared willingness to take a stance, especially during election periods. Based on a quantitative content analysis of 530 letters to the editor and 525 articles in the politics section as well as survey data from the Austrian national election study on the political positions of the Kronen Zeitung’s readers, we find that letters to the editor in the Kronen Zeitung do not reflect, but complement the articles in the politics section. The tone of the letters is more negative than that of news articles, but the letters closely reflect the readers’ political positions, therefore offering identification with the paper.

Highlights • Evidence synthesis (including systematic reviews, scoping reviews, and more) involves many complementary areas of expertise: methods, information retrieval, statistics, and clinical knowledge. • Few individual peer reviewers have all the requisite knowledge to evaluate all aspects of evidence synthesis manuscripts. • Segmented peer review as proposed by Dinakaran et al offers a good solution to the challenges of rigorously peer reviewing evidence synthesis manuscripts.

This report updates concepts on hypertension management in patients with diabetes. It focuses on clinical outcomes literature published within the last 3 years and incorporates these observations into modifications of established guidelines. While the fundamentals of treatment and goal blood pressures remain unchanged, approaches to specific patient-related issues has changed. This update focuses on questions such as what to do when a patient has an elevated potassium level when therapy is initiated and whether combinations of agents that block the renin-angiotensin system still be used. In addition, there are updates from trials, just published and in press, that focus on related management issues influencing cardiovascular outcomes in persons with diabetes. Last, an updated algorithm is provided that incorporates many of the new findings and is suggested as a starting point to achieve blood pressure goals.

In a recent issue of the Journal of Clinical Microbiology, Kunin and Buesching (1) describe a novel technique to diagnose common urinary pathogens in office-collected samples. Using a three-layer circular sandwich with filter paper as the solid-phase dilution device, it was possible to pick up members of the family Enterobacteriaceae and staphylococci from urine specimens. The technology was standardized by monitoring the penetration of microbes through the filter paper onto MacConkey or Trypticase soy medium seeded onto a template. As a control to the sandwich technology, serial 10-fold dilutions of various organisms were cultured on the surfaces of agar plates. The sensitivity and specificity with 487 urine samples for gram-negative bacteria or with 405 samples for gram-positive bacteria were excellent. There is no information on any residual antimicrobial (AM) activity in 892 specimens. However, it would be pertinent to standardize the technology for urine samples with residual AM activity. Bacteriuria and AM activity are often encountered during clinical practice. Recent investigations of AM activity in Taiwan pointed to such an activity in 55.5% of 112 patients on their arrival at an emergency department (2). Furthermore, AM activity was also evident in 25.1% of 203 internal medicine outpatients, 7.6% of 471 high school students, and 7.4% of 202 people at a center for senior citizens. There was no correlation between the bacterial counts and sterility of a specimen and its AM activity. Residual AM activity in urine was likely to interfere in the three-layer sandwich technique during filtration of microbes onto culture medium. Antibacterial substances block the filter paper pores, lowering the number of microbes that filter through. The differently sized AMs may clog the pores in an unspecified manner. Any differential concentration of an antibacterial agent on the culture medium after filtration through the clogged filter paper would adversely affect sensitivity and specificity. Such an effect should be determined by soaking antibacterial agents and microbes onto filter paper. Well-designed experiments to address blockage of filter paper pores or any differential inhibition of bacterial growth are desirable. Such experiments would guarantee that concurrent bacteriuria and AM activity in urine would not interfere with a correct diagnosis, even in areas where AM drugs are freely available and histories of patients tend to be unreliable (2).

The present study directly compared prices of more and less nutritious foods within given categories in US supermarkets.Foods selected from six supermarkets in Jackson County were categorized using the five criteria of the Nutrition Detectives™ (ND) programme and an item-to-item cost comparison was made using posted prices. The nutritional quality of foods was distinguished using the clues of the ND nutrition education programme for elementary-school children and validated using the Overall Nutritional Quality Index.Supermarkets in Jackson County, MO, USA.Not applicable.The average price of the item for more nutritious foods did not differ significantly from that of less nutritious foods overall ($US 2·89 (sd $US 0·74) v. $US 2·85 (sd $0·68), P = 0·76). More nutritious breads cost more than less nutritious breads ($US 3·36 (sd $ US 0·28) v. $US 2·56 (sd $US 0·80, P = 0·03), whereas more nutritious cereals ($US 2·46 (sd $US 0·69) v. $US 3·50 (sd $US 0·30), P0·01) and cookies ($US 2·76 (sd $US 0·50) v. $US 3·40 (sd $US0·28), P0·01) cost less.Our findings indicate that it is possible to choose more nutritious foods within many common categories without spending more money and suggest that making small improvements in dietary choices does not invariably cost more.

We all know that chest diseases are very common in the elderly. In a recent issue of the BMJ Bugeja et al 1 noted that there were no original research papers published in Thorax between 1 June 1996 and 1 June 1997 that were specific to elderly people (⩾75 years), and that during this time elderly people were excluded unjustifiably in 39 relevant papers in Thorax . Research in elderly people is difficult, more time consuming, and may be more expensive. The biology of old age differs from middle or young age, and …

The clinical competence of doctors needs to be defined and assessed in relation to the circumstances of individual practice, in terms of knowledge and skills, both clinical and communicative, as well as attitudes and behaviour. The need to identify the role of the medical practitioner in the context of team working is important and this position requires the skills of diagnosis, synthesis of information and prioritisation of investigation and treatment. Completion of training and acquisition of the Certificate of Completion of Specialist Training (CCST) lead to inclusion in the Specialist Register thus defining the specialist; elevation of a specialist to consultant status in the NHS requires the potential to acquire with maturity, both of person and experience, the confidence to take responsibilities for handling difficult situations, to manage uncertainties in clinical encounters and to guide younger doctors in their careers.

Candidemia studies have documented geographic differences in rates and epidemiology, underscoring the need for surveillance to monitor trends. We conducted prospective candidemia surveillance in Brazil to assess the incidence, species distribution, frequency of antifungal resistance, and risk factors for fluconazole-resistant Candida species. Prospective laboratory-based surveillance was conducted from March 2003 to December 2004 in 11 medical centers located in 9 major Brazilian cities. A case of candidemia was defined as the isolation of Candida spp. from a blood culture. Incidence rates were calculated per 1,000 admissions and 1,000 patient-days. Antifungal susceptibility tests were performed by using the broth microdilution assay, according to the Clinical and Laboratory Standards Institute guidelines. We detected 712 cases, for an overall incidence of 2.49 cases per 1,000 admissions and 0.37 cases per 1,000 patient-days. The 30-day crude mortality was 54%. C. albicans was the most common species (40.9%), followed by C. tropicalis (20.9%) and C. parapsilosis (20.5%). Overall, decreased susceptibility to fluconazole occurred in 33 (5%) of incident isolates, 6 (1%) of which were resistant. There was a linear correlation between fluconazole and voriconazole MICs (r = 0.54 and P0.001 [Spearman's rho]). This is the largest multicenter candidemia study conducted in Latin America and shows the substantial morbidity and mortality of candidemia in Brazil. Antifungal resistance was rare, but correlation between fluconazole and voriconazole MICs suggests cross-resistance may occur.

At times, there are reasons for authors to make a formal statement of retraction of work they publish in biomedical journals. This study examines 235 retracted articles and looks at the reasons for these retractions and citations to the articles subsequent to retraction. The primary reasons for retraction are error of various kinds (such as problems with method or sample, including contamination of samples) and misconduct. The 235 articles are cited a total of 2,034 times after retraction. This set of citations can be divided into two groups: citations that appear in journals included in the Abridged Index Medicus and those that appear in other journals included in MEDLINE. While most of the citations in these two groups of journals can be categorized as "implicitly positive," 275 make explicitly positive mention of retracted articles. The implications for continued citation for biomedical research and clinical practice are discussed.

I applaud Dr Herxheimer's attempt to encourage authors to make a rational decision about where to send their scientific papers (October 2001, JRSM, p. 515). It will certainly be an improvement on the present method which (according to accounts given on our courses) is based on the principle of starting with the journal with the highest impact factor, and then working down. However, I am not sure that Herxheimer's model is the answer. He encourages authors to decide on the basis of where they want to publish; surely a more sensible solution is to decide, using all the available evidence, which journal is most likely to accept the article. Getting a paper published is essentially a sales activity, and the most effective sales people are those who consider the needs of the market rather than their own.

To evaluate the surface expression of triggering receptor on myeloid cell 1 (TREM-1), class II major histocompatibility complex molecules (HLA-DR), and the expression of the splicing variant (svTREM-1) of TREM-1 in septic patients and those subjected to major abdominal surgery.Using flow cytometry, we examined the surface expression of TREM-1 and HLA-DR in peripheral blood monocytes from 11 septic patients, 7 elective gastrointestinal surgical patients, and 10 healthy volunteers. svTREM-1 levels were analyzed by RT-PCR.Basal expression of TREM-1 and HLA-DR in healthy volunteers was 35.91+/-14.75 MFI and 75.8+/-18.3%, respectively. In septic patients, TREM-1 expression was 59.9+/-23.9 MFI and HLA-DR expression was 44.39+/-20.25%, with a significant difference between healthy and septic groups (P0.05) for both molecules. In the surgical patients, TREM-1 and HLA-DR expressions were 56.8+/-20.85 MFI and 71+/-13.8% before surgery and 72.65+/-29.92 MFI and 72.82+/-22.55% after surgery. TREM-1 expression was significantly different (P = 0.0087) between the samples before and after surgery and svTREM-1 expression was 0.8590+/-0.1451 MF1, 0.8820+/-0.1460 MF1, and 2.210+/-0.7873 MF1 in the healthy, surgical (after surgery) and septic groups, respectively. There was a significant difference (P = 0.048) in svTREM-1 expression between the healthy and surgical groups and the septic group.TREM-1 expression is increased during systemic inflammatory conditions such as sepsis and the postoperative phase. Simultaneous low expression of HLA-DR molecules correlates with the severity of illness and increases susceptibility to infection. Additionally, TREM-1 expression is distinctly different in surgical patients at different stages of the inflammatory response before and after surgery. Thus, surface TREM-1 appears to be an endogenous signal during the course of the inflammatory response. svTREM-1 expression is significantly increased during sepsis, appearing to be an indicator of severity of illness. Together, these data indicate that TREM-1 may play an important role in establishing and amplifying the systemic inflammatory response. TREM-1, HLA-DR, and svTREM-1 expression analysis can provide useful diagnostic and prognostic indicators during SIRS, CARS, and sepsis.