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Background: One common mode of lead failure is insulation breach, which may result in myopotential noise and device malfunction. "Pseudo-unipolarization" of bipolar pacing stimuli, as observed from a routine 12-lead electrocardiogram (ECG) due to stimulus current leak, has been observed with insulation breaches., Objective: We sought to characterize this electrocardiographic finding to detect this type of lead malfunction., Methods: A total of 138 transvenous leads were analyzed, including 88 with known malfunction and 50 normal leads. The amplitude of a bipolar pacing stimulus on the ECG was recorded and compared with a control data set of newly implanted leads with bipolar stimuli normalized for output., Results: The malfunction group consisted of 61% right atrium and 39% right ventricle leads with mean pacing output of 2.74 V at 0.5 ms. There was a significant difference in ECG bipolar stimulus amplitudes at time of identification of failure (7.89 ± 7.56 mm/V; P < .001) compared with those of normal leads (0.86 ± 0.41 mm/V). Receiver operating characteristic curve for the prediction of lead malfunction based on absolute ECG amplitude displayed an area under the curve of 0.93 (95% CI, 0.891-0.969). When normalized for programmed stimulus output, a cutoff of 5 mm/V demonstrated a sensitivity of 91% and a specificity of 92% (area under the curve, 0.967; 95% CI, 0.938-0.996)., Conclusion: The maximum amplitude of a bipolar pacing stimulus on the ECG is significantly lower in normal functioning leads compared with those with known malfunction. This simply derived variable demonstrated good accuracy at identifying lead failure due to insulation breach., Competing Interests: Disclosures The authors have no conflicts of interest to disclose., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

There is increasing effort in science to support disaster risk management (DRM) and climate change adaptation in urban environments. It is now common for research calls and projects to reference coproduction methods and science uptake goals. This paper identifies lessons for researchers, research funders, and research users wishing to enable useful, useable, and used science based on the perspectives of research users in urban planning from low- and middle-income countries. DRM-supporting science is viewed by policy actors as: complicated and poorly communicated; presenting inadequate, partial, and outdated information; misaligned with policy cycles; and costly to access and inadequately positioned to overcome the policy barriers that hinder integration of DRM into urban planning. Addressing these specific concerns points to more systematic collection and organisation of data and enhancement of supporting administrative structures to facilitate better sight of human vulnerability and its link to development decision-making and wider processes of urban risk creation., (© 2024 The Author(s). Disasters published by John Wiley & Sons Ltd on behalf of ODI.)

This review paper explores post-prandial glycemia in type 2 diabetes. Post-prandial glycemia is defined as the period of blood glucose excursion from immediately after the ingestion of food or drink to 4 to 6 hours after the end of the meal. Post-prandial hyperglycemia is an independent risk factor for cardiovascular disease with glucose "excursions" being more strongly associated with markers of oxidative stress than the fasting or pre-prandial glucose level. High blood glucose is a major promoter of enhanced free radical production and is associated with the onset and progression of type 2 diabetes. Oxidative stress impairs insulin action creating a vicious cycle where repeated post-prandial glucose spikes are key drivers in the pathogenesis of the vascular complications of type 2 diabetes, both microvascular and macrovascular. Some authors suggest post-prandial hyperglycemia is the major cause of death in type 2 diabetes. Proper management of post-prandial hyperglycemia could yield up to a 35% cut in overall cardiovascular events, and a 64% cut in myocardial infarction. The benefits of managing post-prandial hyperglycemia are similar in magnitude to those seen in type 2 diabetes patients receiving secondary prevention with statins - prevention which today is regarded as fundamental by all practitioners. Given all the evidence surrounding the impact of post-prandial glycemia on overall outcome, it is imperative that any considered strategy for the management of type 2 diabetes should include optimum dietary, pharma, and lifestyle interventions that address glucose excursion. Achieving a low post-prandial glucose response is key to prevention and progression of type 2 diabetes and cardiometabolic diseases. Further, such therapeutic interventions should be sustainable and must benefit patients in the short and long term with the minimum of intrusion and side effects. This paper reviews the current literature around dietary manipulation of post-prandial hyperglycemia, including novel approaches. A great deal of further work is required to optimize and standardize the dietary management of post-prandial glycemia in type 2 diabetes, including consideration of novel approaches that show great promise., Competing Interests: ADM has received research funding from the MRC, NIHR, Jon Moulton Charitable Foundation, Fractyl, Gila, Randox and Novo Nordisk. ADM is a shareholder in the Beyond BMI clinic, which provides clinical obesity care. ADM reports personal fees from Lilly, personal fees from Astra Zeneca, personal fees from Boehringer Ingelheim, personal fees from Currax, personal fees from Algorithm, during the conduct of the study. NG reports personal fees from Heartland Food Products Group, personal fees from Eli Lilly, personal fees from Boehringer Ingelheim, grants from Oviva, during the conduct of the study. Dr Mo Al-Qaisi reports being director and sole shareholder of Ziro Foods Ltd, outside the submitted work. The authors report no other conflicts of interest in this work., (© 2024 Shibib et al.)

Introduction: We aimed to analyze the long-term cost of overactive bladder third-line treatments., Methods: This insurance claims review analyzed the 2015 to 2020 MarketScan (MKS) claims data set subjects age ≥ 18, diagnosis of overactive bladder (OAB) using ICD-9/ICD-10 codes and receipt of treatment for percutaneous tibial nerve stimulation, sacral neuromodulation (SNM), or botulinum A. Age, gender, treatment types, and cost were extracted. Treatment costs were aggregated at the level of patient and treatment type for total payment and patient contribution by combining copay, coinsurance, and deductible. We used the Wilcoxon rank-sum test for continuous and chi-square test for categorical variables. SAS v9.4 was used for analyses. Significance was set at P < .05., Results: We identified 17,755 patients from the commercial claims MKS and 10,912 patients from the Medicare supplemental (MDC) database with mean age 50.7±11.1 and 75.5±7.6 years, respectively, who underwent ≥ 1 third-line OAB treatment. Patients receiving third-line treatment were predominantly female (84.9%, MKS, 74.8%, MDC). Long-term costs over a 15-year period were estimated. Percutaneous tibial nerve stimulation is the most expensive in terms of total net payment ($105,337.50 MKS, $94,102.50 MDC) and patient contribution ($9177.60 MKS, $3921.00 MDC). Total net payment for botulinum A was $67,968 (MSK), $54,261 (MDC), and patient contribution cost was $2850 (MSK), $1110 (MDC). The most cost-effective option was SNM in terms of both total net payment ($5179.10 MKS, $6099.00 MDC) and patient contribution ($59.10 MKS, $60.00 MDC)., Conclusions: SNM was the most cost-effective third-line treatment for OAB looking over a 15-year period in terms of both total net payment and patient contribution.

Introduction: To date, the 21 st Century has witnessed key developments in the management of diabesity (a conflation of obesity and Type 2 Diabetes Mellitus [T2D]), including Glucagon Like Peptide 1 (GLP1) receptor agonist therapies, and recently the 'designer' GLP1 Poly-agonist Peptides (GLP1PPs)., Areas Covered: A PubMed search of published data on the GLP1PP class of therapies was conducted. The gut-brain axis forms complex multi-directional interlinks that include autonomic nervous signaling, components of the gut microbiota (including metabolic by-products and gram-negative cell wall components [e.g. endotoxinaemia]), and incretin hormones that are secreted from the gut in response to the ingestion of nutrients. The development of dual-incretin agonist therapies includes combinations of the GLP1 peptide with Glucose-dependent Insulinotropic Polypeptide (GIP), Glucagon (Gcg), Cholecystokinin (CCK), Peptide YY (PYY), and Glucagon-Like Peptide 2 (GLP2). Triple incretin agonist therapies are also under development., Expert Opinion: At the dawn of a new era in the therapeutic management of diabesity, the designer GLP1PP class holds great promise, with each novel combination building on a preexisting palimpsest of clinical data and insights. Future innovations of the GLP1PP class will likely enable medically induced weight loss and glycemic control in diabesity to rival or even out-perform those resulting from bariatric surgery.

Background: Hepatobiliary cancers are notoriously difficult to detect, frequently leading to diagnosis in later stages of disease when curative treatment is not an option. The currently used biomarkers such as AFP (alpha-fetoprotein) and CA19.9 lack sensitivity and specificity. Hence, there is an unmet need for an alternative biomarker., Aim: To evaluate the diagnostic accuracy of volatile organic compounds (VOCs) for the detection of hepatobiliary and pancreatic cancers., Methods: A systematic review of VOCs' use in the detection of hepatobiliary and pancreatic cancers was performed. A meta-analysis was performed using the software R. Heterogeneity was explored through meta-regression analysis., Results: A total of 18 studies looking at 2296 patients were evaluated. Pooled sensitivity and specificity of VOCs for the detection of hepatobiliary and pancreatic cancer were 0.79 (95% CI, 0.72-0.85) and 0.81 (97.5% CI, 0.76-0.85), respectively. The area under the curve was 0.86. Meta-regression analysis showed that the sample media used contributed to heterogeneity. Bile-based VOCs showed the highest precision values, although urine and breath are preferred for their feasibility., Conclusions: Volatile organic compounds have the potential to be used as an adjunct tool to aid in the early diagnosis of hepatobiliary cancers.

This paper explores how claims for transformative adaptation toward more equitable and sustainable societies can be assessed. We build on a theoretical framework describing transformative adaptation as it manifests across four core elements of the public-sector adaptation lifecycle: vision, planning, institutional frameworks, and interventions. For each element, we identify characteristics that can help track adaptation as transformative. Our purpose is to identify how governance systems can constrain or support transformative choices and thus enable targeted interventions. We demonstrate and test the usefulness of the framework with reference to three government-led adaptation projects of nature-based solutions (NBS): river restoration (Germany), forest conservation (China), and landslide risk reduction (Italy). Building on a desktop study and open-ended interviews, our analysis adds evidence to the view that transformation is not an abrupt system change, but a dynamic complex process that evolves over time. While each of the NBS cases fails to fulfill all the transformation characteristics, there are important transformative elements in their visions, planning, and interventions. There is a deficit, however, in the transformation of institutional frameworks. The cases show institutional commonalities in multi-scale and cross-sectoral (polycentric) collaboration as well as innovative processes for inclusive stakeholder engagement; yet, these arrangements are ad hoc, short-term, dependent on local champions, and lacking the permanency needed for upscaling. For the public sector, this result highlights the potential for establishing cross-competing priorities among agencies, cross-sectoral formal mechanisms, new dedicated institutions, and programmatic and regulatory mainstreaming., Supplementary Information: The online version contains supplementary material available at 10.1007/s10113-023-02066-7., Competing Interests: Conflict of interestThe authors declare no competing interests., (© The Author(s) 2023.)

Over the past 50 years, many countries around the world have faced an unchecked pandemic of obesity and type 2 diabetes (T2DM). As best practice treatment of T2DM has done very little to check its growth, the pandemic of diabesity now threatens to make health-care systems economically more difficult for governments and individuals to manage within their budgets. The conventional view has been that T2DM is irreversible and progressive. However, in 2016, the World Health Organization (WHO) global report on diabetes added for the first time a section on diabetes reversal and acknowledged that it could be achieved through a number of therapeutic approaches. Many studies indicate that diabetes reversal, and possibly even long-term remission, is achievable, belying the conventional view. However, T2DM reversal is not yet a standardized area of practice and some questions remain about long-term outcomes. Diabetes reversal through diet is not articulated or discussed as a first-line target (or even goal) of treatment by any internationally recognized guidelines, which are mostly silent on the topic beyond encouraging lifestyle interventions in general. This review paper examines all the sustainable, practical, and scalable approaches to T2DM reversal, highlighting the evidence base, and serves as an interim update for practitioners looking to fill the practical knowledge gap on this topic in conventional diabetes guidelines., Competing Interests: Dr Mo Al-Qaisi reports involvement in the innovation start up Ziro Fibre Ltd, which is focused on diabesity reversal using functional appetite quenching drinks and digital behaviour change. The remaining authors report no conflicts of interest in this work., (© 2022 Shibib et al.)

COVID-19 recovery is an opportunity to enhance life chances by Building Back Better, an objective promoted by the UN and deployed politically at national level. To help understand emergent and intentional opportunities to Build Back Better, we propose a research agenda drawing from geographical thinking on social contracts, assemblage theory and the politics of knowledge. This points research towards the ways in which everyday and professional knowledge cocreation constrains vision and action. Whose knowledge is legitimate, how legitimacy is ascribed and the place of science, the media and government in these processes become sites for progressive Building Back Better., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Climate change is a severe global threat. Research on climate change and vulnerability to natural hazards has made significant progress over the last decades. Most of the research has been devoted to improving the quality of climate information and hazard data, including exposure to specific phenomena, such as flooding or sea-level rise. Less attention has been given to the assessment of vulnerability and embedded social, economic and historical conditions that foster vulnerability of societies. A number of global vulnerability assessments based on indicators have been developed over the past years. Yet an essential question remains how to validate those assessments at the global scale. This paper examines different options to validate global vulnerability assessments in terms of their internal and external validity, focusing on two global vulnerability indicator systems used in the WorldRiskIndex and the INFORM index. The paper reviews these global index systems as best practices and at the same time presents new analysis and global results that show linkages between the level of vulnerability and disaster outcomes. Both the review and new analysis support each other and help to communicate the validity and the uncertainty of vulnerability assessments. Next to statistical validation methods, we discuss the importance of the appropriate link between indicators, data and the indicandum. We found that mortality per hazard event from floods, drought and storms is 15 times higher for countries ranked as highly vulnerable compared to those classified as low vulnerable. These findings highlight the different starting points of countries in their move towards climate resilient development. Priority should be given not just to those regions that are likely to face more severe climate hazards in the future but also to those confronted with high vulnerability already., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Head-to-head comparative data for the postoperative care of patients undergoing left atrial ablation procedures are lacking., Objective: We sought to investigate complication and readmission rates between patients undergoing same-day (SD) or next-day (ND) discharges for ablative procedures in the left atrium, primarily atrial fibrillation (AF)., Methods: Two electrophysiology centers simultaneously perform left atrial ablations with differing discharge strategies. We identified all patients who underwent left atrial ablation from August 2017 to August 2019 (n = 409) undergoing either SD (n = 210) or ND (n = 199) discharge protocols. We analyzed any clinical events that resulted in procedural abortion, extended hospitalization, or readmission within 72 hours., Results: The primary endpoint of complication and readmission rate was similar between SD and ND discharge (14.3% vs 12.6%, p = 0.665). Rates of complications categorized as major (2.4% vs 3.0%, p = 0. 776) and minor (11.9% vs 9.5%, p = 0.524) were also similar.Multivariable regression modeling revealed no significant correlation between discharge strategy and complication/readmission occurrence (OR 1.565 [0.754 - 3.248], p = 0.23), but a positive association of hypertension and procedure duration (OR 3.428 [1.436 - 8.184], p = 0.006) and (OR 1.01 [1 - 1.019], p = 0.046) respectively., Conclusions: Left atrial ablation complication and readmission rates were similar between SD and ND discharge practices. Hypertension and procedural duration were associated with increased complication rates irrespective of discharge strategy. These data, which represent the first side-by-side comparison of discharge strategy, suggests same-day discharge is safe and feasible for left atrial ablation procedures.

The Sendai Framework for Disaster Risk Reduction 2015-2030 and the United Nations' Sustainable Development Goals call for action to build back better in ways that leave no one behind. At the same time, ensuring a local voice is increasingly central to humanitarian engagement. These aims contrast with limited analysis of how local actors might be supported in these respects during response and recovery, and how far recommendations are specific or generalisable across richer and poorer national contexts. The paper begins by comparing lessons learnt by survivors and community organisations in Sint Maarten, Dutch Caribbean, following a high-income state-led response to Hurricane Irma in 2017 with the priorities of lower income, humanitarian-led endeavours. The differences reveal the importance of economic resources as the basis for individual self-reliance and a fragmented civil society with limited leadership ambitions in Sint Maarten. Strong cross-cultural alignment nevertheless allows for a globally-relevant and yet contextually-sensitive framework for survivor-led action and reconstruction., (© 2019 The Authors Disasters © 2019 Overseas Development Institute.)

Many African towns and cities face a range of hazards, which can best be described as representing a "spectrum of risk" of events that can cause death, illness or injury, and impoverishment. Yet despite the growing numbers of people living in African urban centres, the extent and relative severity of these different risks is poorly understood. This paper provides a rationale for using a spectrum of methods to address this spectrum of risk, and demonstrates the utility of mixed-methods approaches in planning for resilience. It describes activities undertaken in a wide-ranging multi-country programme of research, which use multiple approaches to gather empirical data on risk, in order to build a stronger evidence base and provide a more solid base for planning and investment. It concludes that methods need to be chosen in regard to social, political economic, biophysical and hydrogeological context, while also recognising the different levels of complexity and institutional capacity in different urban centres. The paper concludes that as well as the importance of taking individual contexts into account, there are underlying methodological principles - based on multidisciplinary expertise and multi-faceted and collaborative research endeavours - that can inform a range of related approaches to understanding urban risk in sub-Saharan Africa and break the cycle of risk accumulation., (The information, practices and views in this article are those of the author(s) and do not necessarily reflect the opinion of the Royal Geographical Society (with IBG). © 2018 The Authors. Area published by John Wiley & Sons Ltd on behalf of Royal Geographical Society (with the Institute of British Geographers).)

Resilience is a ubiquitous term in disaster risk management and is an increasingly prominent concept in early discussions focused on elaborating the post-2015 international policy landscape. Riddled with competing meanings and diverse policy implications, however, it is a concept caught between the abstract and operational. This paper provides a review of the rise to prominence of the concept of resilience and advances an elaboration of the related concepts of resistance, incremental adjustment and transformation. We argue that these concepts can contribute to decision-making by offering three distinct options for risk management policy. In order to deliberately and effectively choose among these options, we suggest that critical reflexivity is a prerequisite, necessitating improved decision-making capacity if varied perspectives (including those of the most vulnerable) are to be involved in the selection of the best approach to risk management., (© 2014 The Author(s). Disasters © Overseas Development Institute, 2014.)

The ventral hypothalamus acts to integrate visceral and systemic information to control energy balance. The basic helix-loop-helix transcription factor neurogenin-3 (Ngn3) is required for pancreatic β-cell development and has been implicated in neuronal development in the hypothalamus. Here, we demonstrate that early embryonic hypothalamic inactivation of Ngn3 (also known as Neurog3) in mice results in rapid post-weaning obesity that is associated with hyperphagia and reduced energy expenditure. This obesity is caused by loss of expression of Pomc in Pomc- and Cart-expressing (Pomc/Cart) neurons in the arcuate nucleus, indicating an incomplete specification of anorexigenic first order neurons. Furthermore, following the onset of obesity, both the arcuate and ventromedial hypothalamic nuclei become insensitive to peripheral leptin treatment. This conditional mouse mutant therefore represents a novel model system for obesity that is associated with hyperphagia and underactivity, and sheds new light upon the roles of Ngn3 in the specification of hypothalamic neurons controlling energy balance.

The neuroendocrine hypothalamus regulates a spectrum of essential biological processes and underlies a range of diseases from growth failure to obesity. While the exploration of hypothalamic function has progressed well, knowledge of hypothalamic development is poor. In particular, very little is known about the processes underlying the genesis and specification of the neurons in the arcuate and ventromedial nuclei. Recent studies demonstrate that the proneural basic helix-loop-helix transcription factor Mash1 is required for neurogenesis and neuronal subtype specification in the ventral hypothalamus. We demonstrate here that Ngn3, another basic helix-loop-helix transcription factor, is expressed in mitotic progenitors in the arcuate and ventromedial hypothalamic regions of mouse embryos from embryonic days 9.5-17.5. Genetic fate mapping and loss of function studies in mice demonstrate that Ngn3+ progenitors contribute to subsets of POMC, NPY, TH and SF1 neurons and is required for the specification of these neuronal subtypes in the ventral hypothalamus. Interestingly, while Ngn3 promotes the development of arcuate POMC and ventromedial SF1 neurons, it inhibits the development of NPY and TH neurons in the arcuate nuclei. Given the opposing roles of POMC and NPY neurons in regulating food intake, these results indicate that Ngn3 plays a central role in the generation of neuronal populations controlling energy homeostasis in mice., (Copyright © 2010 Elsevier Inc. All rights reserved.)

This paper develops a framework based on procedural, methodological and ideological elements of participatory vulnerability and risk assessment tools for placing individual approaches within the wide range of work that claims a participatory, local or community orientation. In so doing it draws on relevant experience from other areas of development practice from which the disasters field can learn. Participatory disaster risk assessments are examined for their potential to be empowering, to generate knowledge, to be scaled up, to be a vehicle for negotiating local change and as part of multiple-methods approaches to disaster risk identification and reduction. The paper is a response to an international workshop on Community Risk Assessment organised by ProVention Consortium and the Disaster Mitigation for Sustainable Livelihoods Programme, University of Cape Town. The workshop brought together practitioners and academics to review the challenges and opportunities for participatory methodologies in the field of disaster risk reduction. In conclusion the contribution made by participatory methodologies to global disaster risk reduction assessment and policy is discussed.

The neuroendocrine hypothalamus regulates a number of critical biological processes and underlies a range of diseases from growth failure to obesity. Although the elucidation of hypothalamic function has progressed well, knowledge of hypothalamic development is poor. In particular, little is known about the processes underlying the neurogenesis and specification of neurons of the ventral nuclei, the arcuate and ventromedial nuclei. The proneural gene Mash1 is expressed throughout the basal retrochiasmatic neuroepithelium and loss of Mash1 results in hypoplasia of both the arcuate and ventromedial nuclei. These defects are due to a failure of neurogenesis and apoptosis, a defect that can be rescued by ectopic Ngn2 under the control of the Mash1 promoter. In addition to its role in neurogenesis, analysis of Mash1(-/-), Mash1(+/-), Mash1(KINgn2/KINgn2), and Mash1(KINgn2/+) mice demonstrates that Mash1 is specifically required for Gsh1 expression and subsequent GHRH expression, positively regulates SF1 expression, and suppresses both tyrosine hydroxylase (TH) and neuropeptide Y (NPY) expression. Although Mash1 is not required for propiomelanocortin (POMC) expression, it is required for normal development of POMC(+) neurons. These data demonstrate that Mash1 is both required for the generation of ventral neuroendocrine neurons as well as playing a central role in subtype specification of these neurons.

Reducing losses to weather-related disasters, meeting the Millennium Development Goals and wider human development objectives, and implementing a successful response to climate change are aims that can only be accomplished if they are undertaken in an integrated manner. Currently, policy responses to address each of these independently may be redundant or, at worst, conflicting. We believe that this conflict can be attributed primarily to a lack of interaction and institutional overlap among the three communities of practice. Differences in language, method and political relevance may also contribute to the intellectual divide. Thus, this paper seeks to review the theoretical and policy linkages among disaster risk reduction, climate change and development. It finds that not only does action within one realm affect capacity for action in the others, but also that there is much that can be learnt and shared between realms in order to ensure a move towards a path of integrated and more sustainable development.

Objective: Many studies have reported the use of attenuation-corrected positron emission tomography with 18F-fluorodeoxyglucose (FDG PET) with full-ring tomographs to differentiate between benign and malignant pulmonary nodules. We sought to evaluate FDG PET using a partial-ring tomograph without attenuation correction., Methods: A retrospective review of PET images from 77 patients (range 38-84 years of age) with proven benign or malignant pulmonary nodules was undertaken. All images were obtained using a Siemens/CTI ECAT ART tomograph, without attenuation correction, after 185 MBq 18F-FDG was injected. Images were visually graded on a 5-point scale from "definitely malignant" to "definitely benign," and lesion-to-background (LB) ratios were calculated using region of interest analysis. Visual and semiquantitative analyses were compared using receiver operating characteristic analysis., Results: Twenty lesions were benign and 57 were malignant. The mean LB ratio for benign lesions was 1.5 (range 1.0-5.7) and for malignant lesions 5.7 (range 1.2-14.1) (p < 0.001). The area under the ROC curve for LB ratio analysis was 0.95, and for visual analysis 0.91 (p = 0.39). The optimal cut-off ratio with LB ratio analysis was 1.8, giving a sensitivity of 95% and a specificity of 85%. For lesions thought to be "definitely malignant" on visual analysis, the sensitivity was 93% and the specificity 85%. Three proven infective lesions were rated as malignant by both techniques (LB ratio 2.6-5.7)., Conclusions: FDG PET without attenuation correction is accurate for differentiating between benign and malignant lung nodules. Results using simple LB ratios without attenuation correction compare favourably with the published sensitivity and specificity for standard uptake ratios. Visual analysis is equally accurate.

In the extensively explored areas of professionalization, domestic ideology, and the relationships between women and medicine, the debate on the British case has given little consideration to issues of identity arising for the male medical practitioner as a result of family life. For the early modern period, these issues can be seen as among a broad-ranging set of problems posed by the female gender connotations of the medical role. Such problems were most pronounced for the élite physicians who sought membership of the London College of Physicians. Their attitudes and dilemmas are important because of their influence, over the long term, on the criteria for professionalization. Using biographical data, a contrast can be shown between the dynastic ideals of physicians, which stressed the male line, and the high incidence among such physicians of celibacy, childlessness, and small families. Families of origin of physicians, on the other hand, tended to be large. Assumptions about the role of women in medical care, especially in clerical and gentry families, entail a recognition of the possible influence of female relatives on the vocations of male physicians. Given the low status of women's work, physicians developed ambivalences which affected the construction of their identities, their families, and the passing on of their skills.

What will be the role of the traditional quality assurance professional in healthcare's total quality management process? The author portrays what the hospital quality department might look like in the future and suggests how the quality assurance professional can prepare for this transition.