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Within aquaculture, prebiotics are composed of complex carbohydrate molecules that cannot be digested by the fish directly but are metabolised by the microbial communities within the host gut, with the desire that "healthy" bacterial species are promoted with subsequently improved performance of the fish, there are likely some direct responses of intestinal cells to these dietary components. The sources and processing of prebiotics, which fall under the overarching theme of "functional feeds" are highly varied between species and types of prebiotics administered. How these feeds exert their effect, and the host responses are hard to determine, but new technologies and the development of high-throughput technologies (omics) are enabling the mechanisms and methods of action to be further understood. The recent advances in the availability of 'omics' technologies with the transition from single gene assays to microarray and RNA-seq in fish health have enabled novel functional ingredients to be analysed. This review will focus on recent studies on targeted gene expression and 'omics' technologies to characterize immune responses. Comparisons between the immunomodulatory effect of different prebiotics have been made and specific examples of how transcriptomics techniques have been used to identify immune responses to prebiotics are given.

Background COPD increases the risk of osteoporosis and international guidelines recommend that such patients undergo fracture risk assessment, referral for densitometry and appropriate management. We aimed to identify if patients admitted to our hospital with COPD exacerbation underwent assessment and were prescribed bone protection medication. Methods All admissions with COPD exacerbation to an Irish level 2 hospital between July 2020 and July 2021 were identified. The discharge summaries were screened for information regarding the presence of fracture risk and bone health assessment. Discharge prescriptions were examined for calcium, vitamin d and anti-osteoporosis medications. Radiology reports were screened for fragility fractures. Results Between July 2020–2021, there were 3,840 presentations to the medical assessment unit. Forty-six patients were admitted with a diagnosis of COPD exacerbation, mean age 72 (56% female). Seventy eight percent were classified as having GOLD Stage D disease with 28% receiving long term oxygen therapy. Mean number of hospitalisations per year per patient was 1.91 ± 1.2. Forty-three percent had laboratory evidence of bone health assessment during admission. Only 50% of patients were discharged on vitamin d replacement; 22% on calcium supplementation and 4% on osteoporotic medications. Regarding previous fractures, 9% had evidence of fragility fracture described on radiology reports, this was not mentioned on any hospital discharge letter. Conclusion This study suggests that opportunities for bone health assessment and intervention may be under recognised in COPD patients. Ways to improve this may include proformas and visual aids to prompt assessment and documentation of bone health, further education to increase awareness and greater access to densitometry resources in the community. In conclusion, this study highlights that further attention to patients’ bone health assessment and commencement of appropriate treatment is warranted. Admission to hospital or clinic review for such patients provide important opportunities for intervention.

Background The Dying with Dignity Bill is potential legislation that would permit terminally ill people to avail of medical assistance to die in certain circumstances. It would give a medical practitioner the legal right to provide assistance to a qualifying person to end their life, thus changing the medical landscape as we know it. This project aimed to assess current understanding in non-consultant hospital doctors (NCHDs) of the Dying with Dignity Bill. Methods An online survey was distributed to NCHD’s across a range of disciplines to ascertain current knowledge of the Dying with Dignity Bill. Descriptive analysis of data was conducted on Excel. Results The survey was completed by 80 NCHDs. Of respondents 67.5% (n = 54) of respondents had heard of the Bill and 32.5% (n = 26) of them knew what it was. The Bill had not been read by 88% (n = 71) of respondents. Fifty seven per cent (n = 46) did not understand what was entailed in the Bill. The majority agreed (61.3%; n = 49) that it would impact their work as a clinician. Some 70.1% (n = 56) agreed that legislation was needed in this area. The majority answered neutral (45%; n = 35) that their profession were consulted in the creation of the Bill. It is believed that the Bill will not require a vote however 48% (n = 37) believed it would. However, the majority (72.7%, n = 56) answered correctly that the Bill had not been enacted yet. This Bill does not define the length of a ‘terminal illness’ yet 36.8% (n = 28) believed it to be within six months. It also states that it is the practitioner’s role to decide when somebody is palliative and only 54.5% (n = 42) knew this. Conclusion The Dying with Dignity Bill is poorly understood by NCHDs, despite it potentially having an impact on the role of hospital doctors in Ireland. Discussion and involvement of NCHD’s in the potential formation of this Bill is crucial.

Background At a major trauma centre in the South of Ireland, all older adults admitted with hip and other fragility fractures are co-managed by the Orthopaedic & Orthogeriatric services with an average of over 500 hip fractures a year. A recent publication by described improving calcium and protein intake by using dairy foods as a readily accessible intervention that reduces the risk of falls and fractures in aged care residents. Foods used included cheese, yoghurt and milk being described as “low cost” and “palatable”. Other dairy alternatives such as ice-cream are not used as not protein or calcium rich. In Ireland high calorie-high protein ice-cream is widely available (10g protein, 220 kcal/100g serving). Methods A point prevalence survey relating to the preference of calcium and/or protein rich food ‘snacks’ was completed on 20 inpatients in hospital with a hip or other fragility fracture. Survey Questions: (1) Would an additional calcium and/or protein rich food snack be acceptable to you?; (2) Which food snack would you prefer: a serving of milk, cheese, yogurt, or ice-cream?; (3) What time would you prefer to eat an additional snack? Morning, afternoon, or evening? Results The majority of participants (95%; 19/20) replied an additional snack would be acceptable. With reference to snack preference: 35% (7/20) would prefer a serving of yoghurt, 30% (6/20) ice-cream, 25% (5/20) cheese and only 10% (2/20) would prefer milk. The majority said they would prefer to be offered a snack in the afternoon (55%; 11/20). Conclusion Our inpatient population would benefit from the addition of such snacks to optimise recovery and bone health. Patient preference needs to inform any dietary or menu modifications. Following our survey, in addition to calcium and vitamin D supplementation, high-protein high-calorie ice-cream is offered and prescribed to patients if eating less than 50% of their energy dense meals.

Liger is a second generation near-infrared imager and integral field spectrograph (IFS) for the W. M. Keck Observatory that will utilize the capabilities of the Keck All-sky Precision Adaptive-optics (KAPA) system. Liger operates at a wavelength range of 0.81 {\mu}m - 2.45 {\mu}m and utilizes a slicer and a lenslet array IFS with varying spatial plate scales and fields of view resulting in hundreds of modes available to the astronomer. Because of the high level of complexity in the raw data formats for the slicer and lenslet IFS modes, Liger must be designed in conjunction with a Data Reduction System (DRS) which will reduce data from the instrument in real-time and deliver science-ready data products to the observer. The DRS will reduce raw imager and IFS frames from the readout system and provide 2D and 3D data products via custom quick-look visualization tools suited to the presentation of IFS data. The DRS will provide the reduced data to the Keck Observatory Archive (KOA) and will be available to astronomers for offline post-processing of observer data. We present an initial design for the DRS and define the interfaces between observatory and instrument software systems., Comment: 12 pages, 4 figures, 2 tables

Aims The purpose of this study was to identify the number of pregnancies affected by pre-gestational diabetes in the Republic of Ireland; to report on pregnancy outcomes and to identify areas for improvement in care delivery and clinical outcomes. Methods Healthcare professionals caring for women with pre-gestational diabetes during pregnancy were invited to participate in this retrospective study. Data pertaining to 185 pregnancies in women attending 15 antenatal centres nationally were collected and analysed. Included pregnancies had an estimated date of delivery between 1 January and 31 December 2015. Results The cohort consisted of 122 (65.9%) women with Type 1 diabetes and 56 (30.3%) women with Type 2 diabetes. The remaining 7 (3.8%) pregnancies were to women with maturity-onset diabetes of the young (MODY) (n = 6) and post-transplant diabetes (n = 1). Overall women were poorly prepared for pregnancy and lapses in specific areas of service delivery including pre-pregnancy care and retinal screening were identified. The majority of pregnancies 156 (84.3%) resulted in a live birth. A total of 103 (65.5%) women had a caesarean delivery and 58 (36.9%) infants were large for gestational age. Conclusions This audit identifies clear areas for improvement in delivery of care for women with diabetes in the Republic of Ireland before and during pregnancy.

We are building an image slicer integral field unit (IFU) to go on the IMACS wide-field imaging spectrograph on the Magellan Baade Telescope at Las Campanas Observatory, the Reformatting Optically-Sensitive IMACS Enhancement IFU, or ROSIE IFU. The 50.4" x 53.5" field of view will be pre-sliced into four 12.6" x 53.5" subfields, and then each subfield will be divided into 21 0.6" x 53.5" slices. The four main image slicers will produce four pseudo-slits spaced six arcminutes apart across the IMACS f/2 camera field of view, providing a wavelength coverage of 1800 Angstroms at a spectral resolution of 2000. Optics are in-hand, the first image slicer is being aluminized, mounts are being designed and fabricated, and software is being written. This IFU will enable the efficient mapping of extended objects such as nebulae, galaxies, or outflows, making it a powerful addition to IMACS., 12 pages, 9 figures, 2 tables, submitted to SPIE

Farmed caridean shrimps can experience starvation periods attributable to disease outbreaks or adverse environmental conditions. The hepatopancreas, or perigastric organ, of decapods, being the principal organ for storage of nutrients that can be mobilized during non-feeding periods, plays a fundamental role during starvation. We studied the ultrastructural changes in the perigastric organ of whiteleg shrimp Litopenaeus vannamei (Boone, 1931), a commonly farmed species, during starvation and refeeding. Starvation induced a progressive increase of cellular immunity (haemocytic infiltration, both hyaline and granular and/or semigranular haemocytes), necrosis (swelling of organelles and cytolysis), and autophagy (formation of phagophores, autophagosomes, autolysosomes, and multivesicular and residual bodies). The complete depletion of lipid droplets and a few signs of apoptosis (chromatin condensation and nuclear fragmentation) were also observed during starvation. Refeeding resulted in a partial recovery of the perigastric organ. Findings demonstrate the capacity of the perigastric organ to recover when refed for ten days after five days of starvation. Longer starvation periods severely affect the perigastric organ, causing potential economic losses to famers.

Pre-gestational diabetes mellitus (PGDM) is associated with adverse outcomes. We aimed to examine pregnancies affected by PGDM; report on these pregnancy outcomes and compare outcomes for patients with type 1 versus type 2 diabetes mellitus; compare our findings to published Irish and United Kingdom (UK) data and identify potential areas for improvement.Between 2016 and 2018 information on 679 pregnancies from 415 women with type 1 Diabetes Mellitus and 244 women with type 2 diabetes was analysed. Data was collected on maternal characteristics; pregnancy preparation; glycaemic control; pregnancy related complications; foetal and maternal outcomes; unscheduled hospitalisations; congenital anomalies and perinatal deaths.Only 15.9% of women were adequately prepared for pregnancy. Significant deficits were identified in availability and attendance at pre-pregnancy clinic, use of folic acid, attaining appropriate glycaemic targets and appropriate retinal screening. The majority of pregnancies (n = 567, 83.5%) resulted in a live birth but the large number of infants born large for gestational age (LGA) (n = 280, 49.4%), born prematurely 37 weeks and requiring neonatal intensive care unit (NICU) admission continue to be significant issues.This retrospective cohort study identifies multiple targets for improvements in the provision of care to women with pre-gestational DM which are likely to translate into better pregnancy outcomes.

Pathology in penaeid shrimps relies on histology, which is subjective, time-consuming and difficult to grade in a reproducible manner. Automated image analysis is faster, objective and suitable for routine screening; however, it requires standardized protocols. The first critical step is proper fixation of the target tissue. Bell & Lightner's (A Handbook of Normal Penaeid Shrimp Histology, 1988, The World Aquaculture Society, Baton Rouge) fixation protocol, widely used for routine histology of paraffin sections, is not optimized for image analysis, and no protocol for frozen sections is described in the available literature. Therefore, the aim of this study was to optimize fixation of the hepatopancreas (HP) from whiteleg shrimp (Penaeus vannamei) for both paraffin and frozen sections using a semiquantitative scoring system. For paraffin sections, four injection volumes and three injection methods were compared, for frozen sections, four freezing methods and four fixation methods. For paraffin sections, optimal fixation was achieved by increasing threefold the fixative volume recommended by Bell and Lightner, from 10% to 30% of the shrimp body weight, combined with single injection into the HP. Optimal fixation for frozen sections was achieved by freezing the cephalothorax with liquid nitrogen, followed by fixation of the section with 60% isopropanol. These optimized methods enable the future use of image analysis and improve classical histology.

Intensive care units (ICU) in Irish academic centres are known to fare as well as their international counterparts. Our aim in this study was to characterise the role and outcomes of an ICU in a smaller Irish hospital and to compare these to international best practice. We reviewed admissions of patients to the ICU of St. Luke’s Hospital, Kilkenny. Patient demographics, indications for admission, and outcomes were all recorded and analysed. Sequential organ failure assessment (SOFA) scores were calculated. Forty-three patients were included in our study, 33 (76.7 %) of which were emergency admissions. Median length of stay was 2 days. The observed mortality rate in our cohort was 20.9 %. The median SOFA score in patients admitted was 7. Higher median SOFA scores on admission were predictive of mortality. The ICU occupancy rate during the duration of our study was 98 %, with only 15 (35.7 %) of admissions to ICU occurring within core working hours. Critical care can be provided safely and in line with current best practice in smaller Irish hospitals. There is a cohort of patients for whom care may be best provided in a tertiary centre, how best to provide for these patients will likely be achieved by early identification (e.g. with SOFA score). Bed capacity issues remain problematic.

When galaxies merge, gas accretes onto both central supermassive black holes. Thus, one expects to see dual active galactic nuclei (AGNs) in a fraction of galaxy mergers. Candidates for galaxies containing dual AGNs have been identified by the presence of double-peaked narrow [O III] emission lines and by high spatial resolution images of close galaxy pairs. 30% of double-peaked narrow [OIII] emission line SDSS AGNs have two spatial components within a 3″ radius. However, spatially resolved spectroscopy is needed to confirm these galaxy pairs as systems with double AGNs. With the Keck 2 Laser Guide Star Adaptive Optics system and the OSIRIS near-infrared integral field spectrograph, we obtained spatially resolved spectra for SDSS J095207.62+255257.2, confirming that it contains a Type 1 and a Type 2 AGN separated by 4.8 kpc (=1.0″). We performed similar integral field and long-slit spectroscopy observations of more spatially separated candidate dual AGNs and will report on the varied results. By assessing what fraction of radio-quiet double-peaked emission line SDSS AGNs are true dual AGNs, we can better constrain the statistics of dual AGNs and characterize physical conditions throughout these interacting AGNs.

Despite the increasing use of novel molecular techniques in pathology, histology remains the standard method for monitoring tissue alterations and for assessing pathology. Histopathological evaluation is generally laborious and subjective with risk of discrepancies in semi-quantitative scoring between pathologists. In contrast, computer-assisted image analysis (CAIA) is potentially faster, more objective and thus suitable for routine screening. Limited research has been carried out on CAIA in crustacean histopathology, and the methods described were not fully automated. Therefore, the aim of this study was to develop CAIA in whiteleg shrimp (Penaeus vannamei) for the study of the hepatopancreas. Paraffin sections were immunohistochemically stained with monoclonal antibodies WSH8 against haemocytes and counterstained with Mayer's haematoxylin for detection of haemocytes and B-cell vacuoles, and modified toluidine blue protocol was used for detection of F-cells; frozen sections were stained with Oil Red O for detection of lipid droplets within R-cells. Visiopharm® software was used to develop and validated protocols for the quantification of morphological parameters (areas of haemocyte infiltration, F-cells, B-cell vacuoles, lipid droplets and their ratios to total tissue area and total lumen area). These protocols enable the future use of CAIA for determination of the nutritional and pathological condition of this organ.

We measure the long-term systematic component of the astrometric error in the GeMS MCAO system as a function of field radius and Ks magnitude. The experiment uses two epochs of observations of NGC 1851 separated by one month. The systematic component is estimated for each of three field of view cases (15'' radius, 30'' radius, and full field) and each of three distortion correction schemes: 8 DOF/chip + local distortion correction (LDC), 8 DOF/chip with no LDC, and 4 DOF/chip with no LDC. For bright, unsaturated stars with 13 < Ks < 16, the systematic component is < 0.2, 0.3, and 0.4 mas, respectively, for the 15'' radius, 30'' radius, and full field cases, provided that an 8 DOF/chip distortion correction with LDC (for the full-field case) is used to correct distortions. An 8 DOF/chip distortion-correction model always outperforms a 4 DOF/chip model, at all field positions and magnitudes and for all field-of-view cases, indicating the presence of high-order distortion changes. Given the order of the models needed to correct these distortions (∼8 DOF/chip or 32 degrees of freedom total), it is expected that at least 25 stars per square arcminute would be needed to keep systematic errors at less than 0.3 milliarcseconds for multi-year programs. We also estimate the short-term astrometric precision of the newly upgraded Shane AO system with undithered M92 observations. Using a 6-parameter linear transformation to register images, the system delivers ∼0.3 mas astrometric error over short-term observations of 2-3 minutes., Adaptive Optics Systems IV, June 22-27, 2014, Series: Proceedings of SPIE; no. 9148

We describe the design and first-light early science performance of the Shane Adaptive optics infraRed Camera-Spectrograph (ShARCS) on Lick Observatory's 3-m Shane telescope. Designed to work with the new ShaneAO adaptive optics system, ShARCS is capable of high-efficiency, diffraction-limited imaging and low-dispersion grism spectroscopy in J, H, and K-bands. ShARCS uses a HAWAII-2RG infrared detector, giving high quantum efficiency (>80%) and Nyquist sampling the diffraction limit in all three wavelength bands. The ShARCS instrument is also equipped for linear polarimetry and is sensitive down to 650 nm to support future visible-light adaptive optics capability. We report on the early science data taken during commissioning., 9 pages, 7 figures. Presented at SPIE Astronomical Telescopes + Instrumentation conference, paper 9148-118

Background: Patients with chronic cardiac failure (CCF) have abnormal vascular responses. Bradykinin (BK) is thought to contribute to the vasodilator effects of ACE inhibitors, but the effect of BK itself in patients with CCF has not been examined. Methods: We studied the responses to infused BK at 10, 30 and 100 pmol min−1 in patients with CCF (n-10) and controls (n-10). The slope of the dose-response curve was used for comparisons between the groups. Forearm blood flow (FBF) was measured by venous occlusion plethysmography. Results: Following BK, vasodilatation was observed in both groups as the slopes were positive in all, but the difference between the groups was not significant (P-0.77). The study was repeated with the co-administration of 4 μmol min−1 of NG-monomethyl l-arginine (l-NMMA). The vasodilator response to BK was reduced in both groups, and the effect was somewhat greater in the patient group (P-0.23). The vasodilator response to the endothelium-independent vasodilator sodium nitroprusside was slightly less in the patient group (P-0.08). The patients only then underwent repeat infusion of BK before and after a single oral dose of captopril 12.5 mg or placebo. Following captopril, the vasodilator response to BK was unchanged when compared to placebo (difference between slopes, P-0.53). Conclusions: BK produces dose-dependent vasodilatation in both patients with CCF and controls; there was no difference in the responses, which were antagonised by l-NMMA and therefore in part NO (endothelium)-dependent. The responses were also unchanged after administration of an ACE inhibitor (captopril).

The haemodynamic hypothesis for the pathogenesis of diabetic microangiopathy argues that an initial increase in microvascular blood flow leads to microvascular sclerosis and disturbed autoregulation. Endothelin-1 (ET-1) is an endothelium-derived vasoconstrictor peptide that contributes to basal vascular tone. Impairment of the vasoconstrictor response to ET-1 could result in hyperperfusion and subsequent microvascular damage. The purpose of this study was to determine whether vascular responses to ET-1 are impaired in patients with non-insulin-dependent diabetes mellitus (type 2 diabetes). Ten patients with type 2 diabetes and nine control subjects underwent brachial artery cannulation. Forearm blood flow was measured using strain-gauge venous occlusion plethysmography. ET-1 in three doses of 5, 10, and 20 pmol/min and 0.9% saline placebo was infused in a balanced double-blind randomised manner. Vascular smooth muscle function also was assessed using sodium nitroprusside. Control subjects showed vasoconstriction to ET-1 of 5 (p0.05), 10 (p0.05), and 20 pmol/min (p0.01). In the diabetic group, there was no significant response to ET-1 at 5 pmol/min (p0.05); however, significant vasoconstriction developed at 10 and 20 pmol/min (p0.01). There was a significant difference in response to ET-1 at 5 pmol/min between the diabetic and control groups (p0.05). Responses to sodium nitroprusside were similar in both groups (p0.05). Patients with type 2 diabetes have a blunted vasoconstrictor response to ET-1 despite preserved vascular smooth muscle function.

Objective—To study underlying vascular responses in chronic heart failure in patients without ACE inhibitor treatment, and to compare them with age matched controls. Design—Forearm blood flow was studied using venous occlusion plethysmography in patients with chronic heart failure (n = 12) and matched controls (n = 13), after infusion of L-NMMA (a nitric oxide synthase inhibitor), glyceryl trinitrate (an endothelium independent vasodilator), and serotonin (an endothelium dependent vasodilator). Results—L-NMMA produced significant vasoconstriction in normal subjects (forearm blood flow reduced by 24%), but not in patients (6%; difference between groups p

Objective To identify possible causes of inaccuracy in the use of the Hawksley random-zero sphygmomanometer and methods that could reduce this. Methods Four Hawksley random-zero sphygmomanometers were compared with a standard sphygmomanometer under static conditions. Two methods (standard and rapid) were used to release pressure from the inflated cuff with pressures recorded by independent blinded observers. The rate at which the hand valve released pressure was analysed. The effects of varying filling times and pressures on the size of the final zero correction were investigated. Results The Hawksley devices all under-recorded pressure compared with that measured by using a standard machine. A rapid means of pressure release approximately halved this error in each case. Pressure release through the hand valve was shown to have a characteristic and prolonged exponential decay. Using low filling times and pressures reduced the observed range of zeros seen, with the production of a correlation between the size of the zero and the inflation pressure used. Conclusion These findings suggest that overestimation of the final zero correction is a common and major source of error in the use of the Hawksley sphygmomanometer. A simple change in the design of the final pressure release would improve the machine's reliability in clinical usage. The machine's zero mechanism is susceptible to unintentional misuse. Such misuse could occur when the machine is used in accordance with current sphygmomanometry guidelines.

Quality of life (QOL) analysis provides a unique insight into the global impact of drug therapy as seen from the patient’s perspective. Because of their relative novelty, these measurements have been preferentially applied to more recently developed drugs. There are little data of this type available for most of the more established heart failure agents.

The Lick Observatory 3-meter telescope has a history of serving as a testbed for innovative adaptive optics techniques. In 1996, it became one of the first astronomical observatories to employ laser guide star (LGS) adaptive optics as a facility instrument available to the astronomy community. Work on a second-generation LGS adaptive optics system, ShaneAO, is well underway, with plans to deploy on telescope in 2013. In this paper we discuss key design features and implementation plans for the ShaneAO adaptive optics system. Once again, the Shane 3-m will host a number of new techniques and technologies vital to the development of future adaptive optics systems on larger telescopes. Included is a woofer-tweeter based wavefront correction system incorporating a voice-coil actuated, low spatial and temporal bandwidth, high stroke deformable mirror in conjunction with a high order, high bandwidth MEMs deformable mirror. The existing dye laser, in operation since 1996, will be replaced with a fiber laser recently developed at Lawrence Livermore National Laboratories. The system will also incorporate a high-sensitivity, high bandwidth wavefront sensor camera. Enhanced IR performance will be achieved by replacing the existing PICNIC infrared array with an Hawaii 2RG. The updated ShaneAO system will provide opportunities to test predictive control algorithms for adaptive optics. Capabilities for astronomical spectroscopy, polarimetry, and visible-light adaptive optical astronomy will be supported.

Aims To determine the role of nitric oxide (NO) in forearm reactive hyperaemia in healthy human subjects. Methods Ten healthy subjects aged 19–34 years underwent brachial artery cannulation. Forearm circulatory arrest was achieved by means of an upper arm cuff inflated to 200 mmHg for 5 min. The blood flow responses during reactive hyperaemia were measured using venous occlusion plethysmography following a 10 min intra-arterial influsion of 8 μmol min−1N-monomethyl l-arginine (-NMMA) and following matching placebo administered in random order. Results were analysed by repeated measures anova and t-tests. Results -NMMA resulted in a significant reduction of basal forearm blood flow indicating inhibition of basal NO release (P=0.005). There was no significant difference between the blood flow responses during reactive hyperaemia following -NMMA and placebo (P=0.97). Conclusions Nitric oxide production does not make a significant contribution to the vasodilatation associated with reactive hyperaemia in the human forearm.

Erythromycin is a macrolide antibiotic often used in cases of penicillin allergy. When used intravenously, adverse effects ranging from discomfort at the injection site to severe cardiac arrhythmias are described [1]. Such reactions are most commonly associated with bolus injections or rapid infusion rates. The manufacturers recommend a continuous slow intravenous infusion to avoid such side effects [2]. We report three cases where erythromycin was wrongly administered as an intravenous bolus injection. All cases were reported to the Irish Medicines Board.

Vasodilation to acetylcholine is mediated at least in part by endothelium-derived hyperpolarising factor (EDHF) which causes membrane hyperpolarisation by activating potassium channels. It is however uncertain which potassium channel mediates this effect. The aim of this study was to determine the role of the potassium-ATP (K(+)-ATP) channel in mediating endothelium-dependent vascular responses to acetylcholine.In 10 healthy volunteers acetylcholine, an endothelium-dependent vasodilator, and sodium nitroprusside as a control assessing endothelium-independent vasodilatation were infused into the non-dominant brachial artery. Forearm blood flow (FBF) in response to each dose was measured by strain-gauge venous occlusion plethysmography. The K(+)-ATP channel blocker glipizide (2.5 mg) was then administered orally. After 45 min the infusions with FBF measurements were repeated.Acetylcholine (P0.01) and sodium nitroprusside (P0.01) both caused an increase in FBF. There was no significant difference in vascular responses to acetylcholine (P0.05) or sodium nitroprusside (P0.05) following K(+)-ATP channel blockade.The K(+)-ATP channel does not modulate forearm arteriolar endothelium-dependent responses in healthy volunteers and therefore does not play a role in membrane hyperpolarisation.

The involvement of cyclooxygenase-derived substances in the forearm arteriolar responses to serotonin was determined in 10 healthy male volunteers. Serotonin was infused in five incremental doses (0.003-30 micrograms min-1) for 2 min each into the brachial artery of the non-dominant forearm. Forearm blood flow (FBF) responses to each dose were measured by strain-gauge venous occlusion plethysmography. The cyclooxygenase inhibitor indomethacin (100 mg) was administered orally following the serotonin infusions. After 90 min the serotonin infusions were repeated and FBF responses measured. Serotonin caused a biphasic response with vasodilatation occurring at low doses (0.003-3 micrograms min-1, P < 0.01) and vasoconstriction occurring at the highest dose (P < 0.01). There was no significant difference in vascular response to serotonin following cyclooxygenase inhibition. In conclusion, cyclooxygenase products are not involved in the forearm vascular responses to serotonin in healthy human subjects.

Microvascular disease is an important cause of morbidity in diabetes. There is evidence that impaired autoregulation of blood flow is involved in the pathogenesis of diabetic microangiopathy. The vascular endothelium plays a central role in the regulation of vascular tone. Endothelin (ET)-1 is a potent endothelium-derived vasoconstrictor substance that contributes to basal vascular tone. Impaired vasoconstriction in response to endogenous ET could result in hyperperfusion and subsequent microvascular damage. The purpose of our study was to determine whether vascular responses to locally administered ET-1 are impaired in NIDDM. Nine patients with NIDDM and 12 control subjects underwent cannulation of the nondominant brachial artery. Forearm blood flow (FBF) was measured at baseline and during the drug infusion using strain-gauge venous occlusion plethysmography. ET-1 (5 pmol/min) was infused for 60 min at a rate of 1 ml/min. FBF was measured during the first 5 min of the infusion and at 5-min intervals thereafter. Results were expressed as change in FBF from baseline (ml.100 ml−1 · min−1) and were analyzed using repeated measures analysis of variance and Dunnett's test of multiple comparisons. Control subjects showed a gradual onset of vasoconstriction in response to ET-1, which reached maximum at 35 min (1.1 ml.100 ml−1 · min−1; P < 0.01). There was no reduction in FBF in response to ET-1 in the diabetic group. The differences between the diabetic and control groups were significant (P < 0.03). In conclusion, ET-1 infused locally at 5 pmol/min does not cause vasoconstriction in patients with NIDDM.

Endothelin-1 has potent vasoconstrictor and vasopressor actions contributing to basal vascular tone and maintenance of blood pressure acting predominantly through endothelin-A receptors. Endothelin antagonists may be of value in the treatment of hypertension and heart failure. However, the role of endothelin-1 in the regulation of vascular tone and the potential benefits of endothelin antagonists in non-insulin-dependent diabetes mellitus (Type II diabetes) are less clear. Vasoconstriction to exogenous endothelin-1 is impaired in Type II diabetes. The purpose of this study was to determine whether vasoconstriction to endogenous endothelin-1 acting through the endothelin-A receptor is impaired in Type II diabetes. In ten patients with Type II diabetes and nine controls the endothelin-A receptor antagonist BQ123 was infused intra-arterially at 100 nmol/min for 60 min followed by normal saline for 30 min. Forearm blood flow was measured using venous occlusion plethysmography. Control subjects showed gradual onset of vasodilation in response to BQ123 (P0.001). Diabetic subjects, however, showed no significant response (P0.05). There was a significant difference between the diabetic and control groups (P0.05). Blockade of the endothelin-A receptor is associated with impaired vasodilation in Type II diabetes indicating vasoconstriction to endogenous endothelin-1 mediated by the endothelin-A receptor is impaired.

Most massive galaxies contain supermassive black holes (SMBHs) in their cores. When galaxies merge, gas is driven to nuclear regions and can accrete onto the central black hole. Thus one expects to see dual AGN in a fraction of galaxy mergers. Candidates for galaxies containing dual AGN have been identified by the presence of double-peaked narrow [O III] emission lines and by high spatial resolution images of close galaxy pairs. Spatially-resolved spectroscopy is needed to confirm these galaxy pairs as systems with spatially-separated double SMBHs. With the Keck 2 Laser Guide Star Adaptive Optics system and the OSIRIS near-infrared integral field spectrograph, we obtained spatially-resolved spectra for SDSS J09527.62+255257.2, a radio-quiet quasar shown by previous imaging to consist of a galaxy and its close (1.0") companion. We find that the main galaxy is a Type 1 AGN with both broad and narrow AGN emission lines in its spectrum, while the companion galaxy is a Type 2 AGN with narrow emission lines only. The two AGN are separated by 4.8 kpc, and their redshifts correspond to those of the double peaks of the [O III] emission line seen in the SDSS spectrum. Line diagnostics indicate that both components of the double [O III] emission lines are due to AGN photoionization. These results confirm that J0952+2552 contains two spatially-separated AGN. As one of the few confirmed dual AGN at an intermediate separation of < 10 kpc, this system offers a unique opportunity to study galaxy mergers and their effect on black hole growth.

0953-6205/$ see front matter © 2007 European Federation of Internal Medicine doi:10.1016/j.ejim.2007.11.004 Median HbA1C was 6.7% (5.4–11.5%). 35 (55.6%) snore. 18 patients (28.6%) are frequently tired after waking while 22 (34%) are frequently tired during wake time. 2 patients reported falling asleep while driving. Using the BQ 35 (56%) of patients were at high risk of OSAS. The ANC placed 8 (13%), 23 (37%) and 31 (50%) in the low, intermediate and high probability groups respectively. A significant correlation was found between the Epworth score and the BQ (p=0.0005) but not the ANC.

Endothelin-1 has potent vasoconstrictor and vasopressor actions contributing to basal vascular tone and maintenance of blood pressure acting predominantly through endothelin-A receptors. Endothelin antagonists may be of value in the treatment of hypertension and heart failure. However, the role of endothelin-1 in the regulation of vascular tone and the potential benefits of endothelin antagonists in non-insulin-dependent diabetes mellitus (Type II diabetes) are less clear. Vasoconstriction to exogenous endothelin-1 is impaired in Type II diabetes. The purpose of this study was to determine whether vasoconstriction to endogenous endothelin-1 acting through the endothelin-A receptor is impaired in Type II diabetes. In ten patients with Type II diabetes and nine controls the endothelin-A receptor antagonist BQ123 was infused intra-arterially at 100 nmol/min for 60 min followed by normal saline for 30 min. Forearm blood flow was measured using venous occlusion plethysmography. Control subjects showed gradual onset of vasodilation in response to BQ123 (P < 0.001). Diabetic subjects, however, showed no significant response (P > 0.05). There was a significant difference between the diabetic and control groups (P < 0.05). Blockade of the endothelin-A receptor is associated with impaired vasodilation in Type II diabetes indicating vasoconstriction to endogenous endothelin-1 mediated by the endothelin-A receptor is impaired.

The scheduling of surgical procedures in hospitals is examined in the context of an optimisation problem. The solution procedure proposed uses simulated annealing to find improved solutions. An assessment of current practice reveals that customising of any automated procedure will be necessary as the constraints used to describe the problem are often hospital specific.

The theoretical and experimental analysis of fast passage phenomena in rotational spectroscopy is described in the pressure broadened limit. The phenomenon of Stark sweeping fast passage is carefully distinguished from the phenomena of transient absorption and transient emission that were treated earlier. We show that the observed response at the detector after Stark sweeping a molecular resonance through a fixed oscillator is a combination of off‐resonance absorption and the beat between the fixed oscillator and the emission from the fast passage induced polarization.

Stark switching microwave experiments on transient absorption and transient emission that allow the measurement of T1 and T2 in the J = 0→1 transition in OCS are described. The results from the transient absorption experiments are T1 = (26±4) × 10−6 sec · mtorr and T2 = (33±7) × 10−6 sec · mtorr. The results of the transient emission experiments give T2 = (31±3) × 10−6 sec · mtorr. Thus, T1 = T2 within the experimental uncertainties. We also demonstrate the effects of π/2 and π pulses by using Stark switching.