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As the life expectancy of patients with cystic fibrosis has increased, greater attention has been paid towards the diagnosis and management of the longer term consequences of the condition. A recognised but rare complication of the disease is the development of secondary amyloidosis. Whilst deposition of amyloid protein has been reported in a high proportion of patients with cystic fibrosis at post-mortem [1] and Serum Amyloid A protein has been shown to correlate with disease activity and response to antibiotics [2], the manifestation of clinical disease remains extremely uncommon. The prognosis for patients with amyloid secondary to cystic fibrosis in published reports has been historically bleak [3-6], however there may be novel approaches in the era of biological therapies. The theoretical potential for an increase in the incidence of secondary amyloid amongst the population of cystic fibrosis patients who are experiencing much longer lifespans means that it is worthwhile to consider the condition and its possible treatments in more detail. We report a case and a review of the literature.

Background: An ageing population and health-care advances mean that patients have increasingly complex medical health and social needs, requiring a multidisciplinary team. However, despite working as an interprofessional team, team members still largely train in professional silos. Furthermore health-care professionals report a poor understanding of the skills of colleagues from different professions. This article describes the set up and outcomes of a novel interprofessional bedside teaching programme. Methods: An in-centre interprofessional teacher training course was established to facilitate interprofessional bedside teaching, along with supported ward-based sessions to apply the skills. Results: Three in-centre courses and five workplace sessions have run, with forty-five and twenty-eight interprofessional participants respectively. Statistically significant improvements in confidence facilitating interprofessional teaching were seen, with participants more likely to teach at the bedside and involve the multidisciplinary team. Conclusions: This article shows evidence of a teaching programme which improves the confidence of the multidisciplinary team in facilitating interprofessional bedside teaching.

Summary1. Okinawan horses, goats, pigs, ducks, and chickens were inoculated intravenously with the virus of Japanese B encephalitis in order to obtain additional data regarding their role as natural reservoirs of disease.2. Virus was recovered from the blood of pigs and ducks 24 hours after intravenous inoculation and was probably present for a longer period in chickens.3. Two of 3 inoculated pigs died with characteristic signs of encephalitis while the third recovered after a long illness of a similar nature. Virus was not recovered from the brains of the animals which died. The other species showed no clinical evidence of infection.4. Complement-fixing antibodies in experimental animals rapidly reached high levels, whereas neutralizing antibody levels rose more slowly.

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Registered nursery operators on Virginia were surveyed to determine the potential utilization of yardwaste compost (YWC) from a proposed statewide yardwaste composting system. Respondents reported using 94,000 yd3 of potting medium, 36,000 yd3 of peat in containers, and 9000 yd3 of peat for field soil amendment, and retailing 144,000 yd3 of organic materials per year. Many of the respondents indicated that YWC could be used as a substitute for peat or other organic materials in potting mixes (56%), field-grown nursery crops (54%), and lawn establishment (21%), and more than 30% were interested in selling retail. Nursery operators (30%) expressed interest in contracting with municipalities to do the composting and using or marketing it directly.

IX. Summary and Conclusions 1. Studies of the bionomics of Anopheles walkeri Theobald were made during the summers of 1935 to 1941 at Reelfoot Lake, Tennessee. A. walkeri is a species of wide distribution throughout eastern North America, but is abundant only in certain rather restricted areas. At Reelfoot Lake, light-trap collections of adults over a period of five years showed that this species formed about 38.5% of the total anopheline population. 2. At Reelfoot Lake, Anopheles walkeri breeds in thick, shaded emergent vegetation. The larvae were most frequently found among cut-grass sheltered by willows or button-bushes. However, with changing water-levels, breeding occurred in other situations, such as partly submerged beds of smartweed, skullcap, water-hoarhound, and hemp-vine. 3. Observations on dispersal showed that Anopheles walkeri could be taken in light-traps at distances of 1½ and 2 miles from the nearest breeding places. 4. Anopheles walkeri were found resting during the daytime in dark, extremely moist situations. The favorite resting site was upon the dark shaded bases of mature cut-grass, but if deprived of shelter here they could be found in the dark sanctuary of the shoreline button-bushes and the flooded forest. They were usually found resting a few inches above the water surface, only occasionally above moist mud, and very infrequently in drier places. Females engorged with fresh blood were found resting temporarily near the moist floor of barns and occasionally in human dwellings. 5. Under experimental conditions, the number of Anopheles walkeri penetrating into houses depended greatly upon the illumination and appeared to vary roughly with the intensity of light at the point of entrance. The presence or absence of human beings within the dwelling did not appear to have much influence. Under natural conditions, Anopheles walkeri was found in dwellings much less frequently than Anopheles quadrimaculatus, and then only in poorly screened houses with some degree of illumination. 6. A single specimen of 2,003 Anopheles walkeri was found infected with an unidentified species of Plasmodium. Three of 1,171 Anopheles quadrimaculatus examined at the same time were infected with plasmodia. Further evidence will be required to incriminate Anopheles walkeri as a malaria vector of real menace to human populations, although many of its habits point definitely in this direction. 7. Specific differences in halter coloration, scales of palpi and proboscis, and salivary glands were found to exist between Anopheles walkeri and the closely related Anopheles quadrimaculatus, in addition to the other distinguishing characters that are already common knowledge. 8. The so-called “winter egg” of Anopheles walkeri was laid at Reelfoot Lake during September 1–15, 1937 and September 16–23, 1939. Other observations on the physiology of the species showed that it was more susceptible to heat than Anopheles quadrimaculatus, but both species showed increased resistance when fed on sugar solution or blood. Light-trap collections showed that large numbers of Anopheles walkeri were in flight only at temperatures above 75°, with one unaccountable exception. Finally, let us consider the bionomics of Anopheles walkeri in relation to the transmission of human malaria. This species is found in parts of the United States where malaria exists in endemic form, such as the southeastern states and the lower Mississippi valley. Perhaps of equal significance is its presence in northern regions from which the tides of malaria have ebbed, but where the brief, devastating epidemic is still a menace. Anopheles walkeri exhibits a fastidious discrimination with regard to breeding places, but multiplies bountifully where favorable ones exist. The adults disperse for at least two miles in quest of food. They bite fiercely, even in bright daylight if near their moist resting places, and feed on man and domestic animals with equal avidity where both are available. The species appears to be considerably more phototropic than A. quadrimaculatus and its entrance into houses may be facilitated by the introduction of modern electric lighting into rural areas. Lastly, Anopheles walkeri has been shown to be a host of at least two species of human malarial parasite. On the other hand, it frequently bites the more available domestic animals and does not enter dwellings as readily as A. quadrimaculatus. From the observations on the physiology, one sees that it is a delicate species and cannot long survive the conditions imposed upon most mosquitoes who choose to enter houses—and attempt to leave. Also to our knowledge, malaria is not yet known to exist where this species is the only anopheline. In areas of endemic malaria in this country where both A. walkeri and A. quadrimaculatus are found, the latter is apparently the important vector. We have seen then that the effectiveness of Anopheles walkeri as a potential vector of human malaria depends on the maintenance of an exceptionally favorable environment and ample opportunity for contact with humans. These conditions are fulfilled at Reelfoot Lake. Where they have developed in regions formerly free from malaria, the introduction of the parasite by present shifting populations may reveal Anopheles walkeri as a vector of importance.

Summary Examination of 38 individuals on Okinawa, in whom a diagnosis of Japanese B encephalitis had been made ten to twelve months previously, revealed that 11 had clinically detectable neurological sequelae. These included abnormalities of mental status and motor function. In only three patients was there a severely incapacitating disability.

Filariasis due to Wuchereria bancrofti (Cobbold) is endemic on Okinawa and available evidence indicates its probable presence throughout the southern Ryukyu Islands (1, 2). The infection is characterized by a high degree of nocturnal microfilarial periodicity, with the greatest density of microfilariae appearing in the peripheral blood between 8:00 p.m. and 4:00 a.m. (1000 to 0400) (3, 4, 5). The incidence of microfilaremia in the native population of Okinawa during the period April through July, 1945, as determined by examination of thick blood films or by the Knott concentration technique (6), was found to range from approximately ten to thirty percent in various groups (4, 5, 7). In general inhabitants of the rural districts were reported to show a higher incidence of microfilaremia than observed in groups of civilians evacuated from relatively urban areas in the southern part of the island.

Excerpt A fatal case of aplastic anemia has recently been observed in which idiosyncracy to phenurone (acetylurea) appears to have been the cause or precipitating factor. Phenurone shows considerab...

Three cases of eosinophilic meningitis were observed in 1969 on Okinawa, in the Ryukyu Islands between 26°04′ and 26°51½′ North latitude. Each of the patients exhibited a clinical picture similar to that seen in Angiostrongylus cantonensis infections elsewhere in the Pacific Ocean area and Southeast Asia. Infection by this metastrongylid nematode is endemic in populations of Rattus norvegicus and Rattus rattus in Okinawa and certain other islands of the southern Ryukyus. In the cases in man, there had been exposure to infection by direct contact with an intermediate host, the abundant snail Achatina fulica, in one instance by deliberate ingestion in the raw state, but other modes of transmission were not excluded. These are the first suspected cases of angiostrongyliasis in man in the Ryukyu Islands and, to our knowledge, the only such cases in the subtropics at this latitude that have been reported.