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Scarcity of freshwater pushes countries impacted by climate change to investigate new sources of supply. Desalination plants powered by renewable energy can be the solution for a tropical developing country. Collection and treatment of seawater to produce freshwater generate an imbalanced water mass. In the case of a Reverse Osmosis Desalination Plant which pumps seawater to produce freshwater and brine as waste, the most important factor is the seawater quality, only available by observation. The design of a plant and its execution will depend on factors such as ambient temperature, salinity, and TDS. The main needs for a good multi-probe marine observation system are low energy consumption, simple monitoring, and coverage of a large area. For the sake of autonomy and ease of use, a functional and robust circuit can be set up using calibrated probes, micro-controllers, and small programmable boards. The use of programmable boards and connected probes are set up as network ‘nodes’ to send in-situ data measured from the water body. These nodes send the data using radio signal with LoRa protocol to a ‘gateway’ to store or transfer them. The parameters were measured at different time intervals, water depths, and distances from the coastline to observe how said factors affect the measurements. The results from the data collected are used to compare ocean modelling and satellite data. We present in this study the implementation of a long-range wireless autonomous sensor network and first validation tests in Jamaica and how it fills lack of information for a desalination project. Results indicate a good correlation between measure, modelling, and remote sensor. LoRa P2P network allows at an affordable price continuous monitoring of remote areas with great autonomy and resilience; results showed a successful transmission of > 80% within the network.

The study presents the levels and enrichment factors of heavy metals in soils of southern Nigeria that have received significant impact of crude oil spillage. The results revealed that the concentrations of heavy metals in the examined soils fitted into levels found in agricultural soils except for cadmium. Heavily impacted sites showed elevated levels of heavy metals compared to less impacted sites and background levels. The mean enrichment factors for Cd, Cu, Cr, Pb, Mn, Ni, and Zn were 37.3, 2.8, 14.4, 14.0, 0.77, 5.4, and 1.27 for topsoil and 37.5, 1.30, 7.81, 1.59, 4.12, and 1.28 for subsoil, respectively. This clearly indicates that there is gradual build-up of heavy metals in these soils as a result of the oil spillage and related anthropogenic activities in this area.

Chronic wasting disease (CWD) is a unique transmissible spongiform encephalopathy (TSE) of mule deer ( Odocoileus hemionus), white-tailed deer ( O. virginianus), and Rocky Mountain elk ( Cervus elaphus nelsoni). The natural history of CWD is incompletely understood, but it differs from scrapie and bovine spongiform encephalopathy (BSE) by virtue of its occurrence in nondomestic and free-ranging species. CWD has many features in common with scrapie, including early widespread distribution of disease-associated prion protein (PrPd) in lymphoid tissues, with later involvement of central nervous system (CNS) and peripheral tissues. This distribution likely contributes to apparent efficiency of horizontal transmission and, in this, is similar to scrapie and differs from BSE. Clinical features and lesions of CWD are qualitatively similar to the other animal TSEs. Microscopically, marked spongiform lesions occur in the central nervous system (CNS) after a prolonged incubation period and variable course of clinical disease. During incubation, PrPd can be identified in tissues by antibody-based detection systems. Although CWD can be transmitted by intracerebral inoculation to cattle, sheep, and goats, ongoing studies have not demonstrated that domestic livestock are susceptible via oral exposure, the presumed natural route of exposure to TSEs. Surveillance efforts for CWD in captive and free-ranging cervids will continue in concert with similar activities for scrapie and BSE. Eradication of CWD in farmed cervids is the goal of state, federal, and industry programs, but eradication of CWD from free-ranging populations of cervids is unlikely with currently available management techniques.

Appendicular osteosarcoma (OSA) is the most common primary bone tumour in dogs, and the prognosis with standard of care therapy of amputation and adjunctive chemotherapy is generally poor, with median survival times of 1 year. The ability of neoplastic cells to maintain their telomere length, by either telomerase activity or alternate methods, is an important step in tumour development and malignancy. The purpose of this study was to determine the presence of telomerase activity in canine OSA. To evaluate the frequency of alternative lengthening of telomeres in canine OSA, we have used the telomeric repeat amplification protocol in five canine cell lines and in six samples taken from clinical patients at the time of amputation. Our results reveal the presence of telomerase activity in 100% of canine OSA cell lines and 83% of clinical samples evaluated. This is in contrast to human OSA where 25-40% expression levels of telomerase are reported. Importantly, our results not only suggest that canine OSA may serve as a good model for aggressive telomerase-positive forms of human OSA but also that antitelomerase therapy strategies for treatment of canine OSA may be more successful than in the treatment of majority of human patients with OSA.

This paper reports on a case of massive death (an estimated 400-500 dead animals) due to X. chlorochroa poisoning in a herd of elks found at the Red Rim in Carbon County, Wyoming, USA. Highlight of the report focused on the clinical aspects, histopathological findings as well as toxicological studies done on X. chlorochroa.

Chronic wasting disease (CWD) has recently emerged in North America as an important prion disease of captive and free-ranging cervids (species in the deer family). CWD is the only recognized transmissible spongiform encephalopathy (TSE) affecting free-ranging species. Three cervid species, mule deer (Odocoileus hemionus), white-tailed deer (O. virginianus), and Rocky Mountain elk (Cervus elaphus nelsoni), are the only known natural hosts of CWD. Endemic CWD is well established in southern Wyoming and northern Colorado, and has been present in this 'core area' for two decades or more. Apparently CWD has also infected farmed cervids in numerous jurisdictions, and has probably been endemic in North America's farmed deer and elk for well over a decade. Several free-ranging foci distant to the Colorado-Wyoming core area have been discovered since 2000, and new or intensified surveillance may well identify even more foci of infection. Whether all of the identified captive and free-ranging foci are connected via a common original exposure source remains undetermined. Some of this recently observed 'spread' may be attributable to improved detection or natural movements of infected deer and elk, but more distant range extensions are more likely caused by movements of infected captive deer and elk in commerce, or by some yet unidentified exposure risk factor. Research on CWD over the last 5 years has resulted in a more complete understanding of its pathogenesis and epidemiology. CWD is infectious, transmitting horizontally from infected to susceptible cervids. Early accumulation of PrP(CWD) in alimentary tract-associated lymphoid tissues during incubation suggests agent shedding in feces or saliva as plausible transmission routes. Residual infectivity in contaminated environments also appears to be important in sustaining epidemics. Improved tests allow CWD to be reliably diagnosed long before clinical signs appear. Implications of CWD are not entirely clear at this time. Natural transmission to humans or traditional domestic livestock seems relatively unlikely, but the possibility still evokes public concerns; impacts on wildlife resources have not been determined. Consequently, where CWD is not known to occur surveillance programs and regulations that prevent or reduce the likelihood that CWD will be introduced into these jurisdictions should be encouraged. Where CWD is known to occur, affected jurisdictions are conducting surveillance to estimate and monitor trends in geographic distribution and prevalence, managing deer and elk populations in attempts to limit spread, and developing and evaluating techniques for further controlling and perhaps eradicating CWD. Programs for addressing the challenges of CWD management will require interagency cooperation, commitment of funds and personnel, and applied research. Chronic wasting disease (CWD) is perhaps the most enigmatic of the naturally occurring prion diseases. Although recognized as a transmissible spongiform encephalopathy (TSE) since the late 1970s (Williams and Young 1980, 1982), interest in and concern about CWD has only recently emerged. CWD most closely resembles scrapie in sheep in most respects, but recent media and public reaction to CWD has been more reminiscent of that afforded to bovine spongiform encephalopathy (BSE) less than a decade ago. Yet, with the exception of transmissible mink encephalopathy (TME), CWD is the rarest of the known animal TSEs: fewer than 1,000 cases have been diagnosed worldwide, and all but two of these occurred in North America. CWD is unique among the TSEs in that it affects free-living species (Spraker et al. 1997; Miller et al. 2000). The three natural host species for CWD, mule deer (Odocoileus hemionus), white-tailed deer (O. virginianus), and Rocky Mountain elk (Cervus elaphus nelsoni), are all in the family Cervidae and native to North America. Like scrapie, CWD is contagious: epidemics are self-sustaining in both captive and free-ranging cervid populations (Miller et al. 1998, 2000). The geographic extent of endemic CWD in free-ranging wildlife was initially thought to be quite limited and its natural rate of expansion slow; however, recent investigations have revealed that CWD has been inadvertently spread much more widely via market-driven movements of infected, farmed elk and deer. Both the ecological and economic consequences of CWD and its spread remain to be determined; moreover, public health implications remain a question of intense interest. Here, we review current understanding of CWD, its implications, and its management.

Study objective: To evaluate methods for calculating life expectancy in small areas, for example, English electoral wards. Design: The Monte Carlo method was used to simulate the distribution of life expectancy (and its standard error) estimates for 10 alternative life table models. The models were combinations of Chiang or Silcocks methodology, 5 or 10 year age intervals, and a final age interval of 85+, 90+, or 95+. Setting: A hypothetical small area experiencing the population age structure and age specific mortality rates of English men 1998–2000. Participants: Routine mortality and population statistics for England. Main results: Silcocks and Chiang based models gave similar estimates of life expectancy and its standard error. For all models, life expectancy was increasingly overestimated as the simulated population size decreased. The degree of overestimation depended largely on the final age interval chosen. Life expectancy estimates of small populations are normally distributed. The standard error estimates are normally distributed for large populations but become increasingly skewed as the population size decreases. Substitution methods to compensate for the effect of zero death counts on the standard error estimate did not improve the estimate. Conclusions: It is recommended that a population years at risk of 5000 is a reasonable point above which life expectancy calculations can be performed with reasonable confidence. Implications are discussed. Within the UK, the Chiang methodology and a five year life table to 85+ is recommended, with no adjustments to age specific death counts of zero.

The processes which give rise to emerging infectious diseases of wildlife can be categorised as follows: ecosystem alterations of anthropogenic or natural origin; movement of pathogens or vectors, via human or natural agency; and changes in microbes or in the recognition of emerging pathogens due to advances in the techniques of epidemiology. These are simplistic divisions because factors influencing the emergence of diseases of wild animals generally fall into more than one category. Mycoplasmosis among passerines is related to habitat changes and artificial feeding resulting in increased bird densities and subsequent disease transmission. The origin of this strain of Mycoplasma gallisepticum is not known. Hantavirus infections in rodents have emerged due to human-induced landscape alterations and/or climatic changes influencing population dynamics of hantavirus reservoir hosts, with disease consequences for humans. Movement of pathogens or vectors is a very important process by which diseases of wildlife expand geographic range. Although the origin of caliciviruses of rabbits and hares is somewhat obscure, their movement by humans, either deliberately or accidentally, has greatly expanded the distribution of these viruses. Rabies is an ancient disease, but geographic expansion has occurred by both natural and anthropogenic movements of wild animals. Human movement of amphibians may explain the distribution of the highly pathogenic chytrid fungus around the world. Newly recognised paramyxoviruses may reflect both changes in these pathogens and the development of techniques of identification and classification. Many more such examples of emerging diseases will arise in the future, given the extensive alterations in landscapes world-wide and movements of animals, vectors and pathogens. Those who study and diagnose diseases of wildlife must be alert for emerging diseases so that the impact of such diseases on wild animals, domestic animals and humans can be minimised.

Chronic wasting disease (CWD) has emerged as an important disease of wildlife in North America. The disease is a unique member of the transmissible spongiform encephalopathies (TSEs) or prion diseases, which naturally affect only a few species. Of the TSEs, CWD is the only one found in free-ranging species. However, interest in CWD has recently grown, by association with the better-known TSEs such as variant Creutzfeldt-Jakob disease of humans and bovine spongiform encephalopathy. Knowledge of the geographic distribution of CWD, though still limited, has greatly improved since the mid-1990s as a result of surveillance in free-ranging deer and elk and in commercially owned Rocky Mountain elk (Cervus elaphus nelsoni), and the disease has now been found in multiple areas of the plains and Rocky Mountain foothills of western North America. Studies of the biology and natural history of CWD over recent years have resulted in a better understanding of the pathogenesis and epidemiology of the disease. Early involvement of the lymphoid tissues of the alimentary tract during the incubation period of CWD suggests plausible routes for agent exit from an infected individual, such as in faeces or saliva. Chronic wasting disease is laterally transmitted and environmental contamination may play an important role in local maintenance of the disease. Studies on the epidemiology of CWD have led to the development of models to help explain the history of CWD and to simulate future impacts on deer and elk populations. Diagnostic tests have been improved, allowing diagnosis early in the incubation period, long before the appearance of clinical disease. Surveillance techniques and programmes have been developed and instituted by wildlife management agencies for free-ranging deer and elk and by state and federal agricultural agencies for privately-owned elk. During the 1990s, perceptions of TSEs have altered dramatically; perhaps most remarkably, the goal of global eradication of all prion diseases is now being discussed.

Physician job satisfaction has been linked to various patient care and health system outcomes. A survey instrument that concisely measures physicians' satisfaction with various job facets can help diverse stake-holders to better understand and manage these outcomes.To document the development and validation of a multidimensional physician job satisfaction measure and separate global satisfaction measures.Self-administered questionnaire: Physician Worklife Survey (PWS).A pilot study employed a national American Medical Association Masterfile sample of US primary care physicians and random samples from four states. Responses (n = 835; 55% return rate) were randomly assigned to developmental (n = 560) or cross-validation (n = 275) samples. A national sample (n = 2,325; 52% response rate) of physicians was used in a subsequent validation study.A 38-item, 10-facet satisfaction measure resulting from factor and reliability analyses of 70 pilot items was further reduced to 36 items. Reliabilities of the 10 facets ranged from .65 to .77. Three scales measuring global job, career, and specialty satisfaction were also constructed with reliabilities from .84 to .88. Results supported face, content, convergent, and discriminant validity of the measures.Physician job satisfaction is a complex phenomenon that can be measured using the PWS.

Changes in the demographic, specialty, and employment sector composition of medicine have altered physicians' jobs, limiting autonomy and reducing morale. Because physician job satisfaction has been linked to clinical variables, better measurement might help to ameliorate conditions linked to medical disaffection, possibly improving health care.To document conceptual development, item construction, and use of content experts in designing multidimensional measures of physician job satisfaction and global satisfaction scales for assessing physicians' job perceptions across settings and specialties.Using previous research, physician focus groups, secondary analysis of survey data, interviews with physician informants, and a multispecialty physician expert panel, distinct job facets and statements representing those facets were developed.Facets from previously validated instruments included autonomy, relationships with colleagues, relationships with patients, relationships with staff, pay, resources, and status. New facets included intrinsic satisfaction, free time away from work, administrative support, and community involvement. Physician status items were reconfigured into relationships with peers, patients, staff, and community, yielding 10 hypothetical facets. Global scales and items were developed representing satisfaction with job, career, and specialty.A comprehensive approach to assessing physician job satisfaction yielded 10 facets, some of which had not been previously identified, and generated a matching pool of items for subsequent use in field tests.

Physicians who incorporate a community perspective into their clinical practice can provide more effective care, but little is known about the type of training that helps physicians include this perspective. This study examines associations between physicians' current level of involvement in their communities and a range of prior educational experiences.We obtained data from 247 recently graduated primary care physicians through a nationwide mail survey. Physicians described their community-related training experiences during medical school and residency. They also described their current involvement in each of 4 domains of community work. Associations between different training experiences and physicians' current community involvement were examined.Subjects generally reported limited community-related training. Physicians who did receive training in content relevant to a given community domain were significantly more involved in that domain as practicing physicians. Rotating in rural locations and having a mentor active in the community also were associated with greater current community involvement.These data provide evidence that formal training experiences can influence how actively physicians will later interact with their communities. We should provide medical students and residents with educational content in all 4 domains of community work, place them in carefully selected locations, and arrange mentor relationships.

Certain neurochemical and connectional characteristics common to extended amygdala and the nucleus accumbens shell suggest that the two represent a single functional-anatomical continuum. If this is so, it follows that the outputs of the two structures should be substantially similar. To address this, projections from the caudomedial shell and central nucleus of the amygdala, a key extended amygdala structure, were demonstrated in Sprague-Dawley rats with different anterograde axonal tracers processed separately to exhibit distinguishable brown and blue-black precipitates. The caudomedial shell projection is strong in the ventral pallidum and along the medial forebrain bundle through the lateral preopticohypothalamic continuum into the ventral tegmental area, distal to which it thins abruptly. The central nucleus projects strongly to the bed nucleus of the stria terminalis and the sublenticular extended amygdala, but substantially to the lateral hypothalamus only at levels behind the rostral part of the entopeduncular nucleus. Innervation of the ventral tegmental area by the central amygdala is minimal, but the lateral one-third of the substantia nigra, pars compacta and an adjacent lateral part of the retrorubral field receive substantial central amygdala input. Central amygdaloid projections are robust in caudal brainstem sites, such as the reticular formation, parabrachial nucleus, nucleus of the solitary tract and dorsal vagal complex, all of which receive little input from the accumbens. The substantial differences in the output systems of the caudomedial shell of accumbens and central amygdala suggest that the two represent distinct functional-anatomical systems.

Striatal tissue concentrations of neurotensin, expression of neurotensin/neuromedin N (NT/N) mRNA, and numbers of neurotensin-immunoreactive neurons are increased by d-amphetamine (amph), which stimulates dopamine release in the striatum, and haloperidol (hal), a dopamine receptor antagonist with high affinity for D2-like receptors. The possibility that the effects of these drugs involve distinct subpopulations of striatal neurons was addressed in this study, in which the relative numbers and distributions of striatal neuron profiles containing neurotensin immunoreactivity and/or NT/N mRNA were compared following administrations of hal, amph, hal and amph co-administered, and vehicle. Fourteen striatal subterritories in caudate-putamen, nucleus accumbens, and olfactory tubercle were evaluated. Amph produced increases in the expression of neurotensin preferentially in the ventromedial and caudodorsal subterritories of the caudate-putamen, the rostrobasal cell cluster and lateral shell of the nucleus accumbens, and the olfactory tubercle. Haloperidol produced increased neurotensin expression in much of dorsal and ventral striatum, most prominently in the rostral, dorsomedial and ventrolateral quadrants of the caudate-putamen, and in the rostrobasal cell cluster, rostral pole, medial and lateral shell of the nucleus accumbens and the olfactory tubercle. The numbers of neurons responding to amph and hal in all subterritories following co-administration of the two drugs were significantly less than the summed numbers responding individually to amph and hal. Furthermore, in the subterritories where immunohistochemically detectable responses elicited by amph exceeded those produced by hal, co-administration of the two drugs resulted in responses comparable to those elicited by hal given alone. It is suggested that some of the reported anti-dopaminergic behavioral effects of basal ganglia neurotensin may be attenuated in conditions of reduced dopamine neurotransmission.

To assess whether manuscripts received by JAMA in 1991 possessed differing peer review and manuscript processing characteristics, or had a variable chance of acceptance, associated with the gender of the participants in the peer review process.Retrospective cohort study of 1851 research articles.JAMA editorial office.Eight male and five female JAMA editors, 2452 male and 930 female reviewers, and 1698 male and 462 female authors.Statistically significant gender bias.Female editors were assigned manuscripts from female corresponding authors more often than were male editors (P.001). Female editors used more reviewers per manuscript if sent for other review. Male reviewers assisted male editors more often than female editors, and male reviewers took longer to return manuscripts than did their female counterparts (median, 25 vs 22 days). Content reviewer recommendations were independent of corresponding author and review gender, while male statistical reviewers recommended the highest and lowest categories more frequently than did female statistical reviewers (P.001). Manuscripts handled by female editors were rejected summarily at higher rates (P.001). Articles submitted to JAMA in 1991 were not accepted at significantly different rates based on the gender of the corresponding author or the assigned editor (P.4).Gender differences exist in editor and reviewer characteristics at JAMA with no apparent effect on the final outcome of the peer review process or acceptance for publication.

Replication of bluetongue virus (BTV) in leukocytes from the blood of sheep, cattle, elk, and mule deer inoculated with BTV serotype 10 or 17 was assessed by immunocytochemical staining and dot blot northern hybridization to determine if differences in the prevalence of infection in this blood fraction might account for the differences in clinical disease among these species. Viremia was confirmed by virus isolation in all inoculated animals. Analysis of leukocytes with monoclonal antibodies specific for BTV proteins revealed low numbers of infected leukocytes in only 2 sheep 8 days after inoculation with BTV serotype 10. Most of the cells expressing BTV were identified morphologically as monocytes; approximately 10% of infected cells were lymphocytes. Bluetongue virus was not detected by use of dot-blot hybridization on samples of blood. Our results suggest that differential infection of leukocytes does not account for the pronounced differences in clinical signs and pathologic changes among ruminants.

The known host range of naturally-occurring transmissible spongiform encephalopathies has expanded in recent years to include wild ruminants. Chronic wasting disease (CWD) occurs in mule deer (Odocoileus hemionus hemionus) and Rocky Mountain elk (Cervus elaphus nelsoni) in Colorado and Wyoming, United States of America. These species belong to the family Cervidae. Cases have occurred primarily in captive animals but a few affected free-ranging animals have been identified. Clinical disease in both species is characterised by progressive weight loss, behavioural alterations and excessive salivation. In deer polydipsia and polyuria also commonly occur. Significant lesions are confined to the central nervous system and consist of spongiform change in grey matter, intraneuronal vacuolation, astrocytosis and amyloid plaques. Inflammatory reaction is absent. The origin of this disease is not known. In contrast to the cases of spongiform encephalopathy recognised in five species of antelope (family Bovidae) in British zoological parks, which are an extension of the current bovine spongiform encephalopathy epizootic, CWD is not the result of food-borne exposure to the infectious agent. CWD appears to be maintained within captive populations by lateral and, possibly, maternal transmission. Spongiform encephalopathies in wild ruminants are currently geographically isolated and involve relatively small numbers of animals. However, these potentially transmissible diseases could be of greater importance in the future and should be viewed with concern in the light of international movements of wild ruminants and the current expansion of the game farming and ranching industry in many parts of the world.

OBJECTIVE--To measure the unmet need of patients with regular urinary incontinence (incontinence twice or more a month) treatable by a nurse. DESIGN--Self completed postal questionnaire and randomised controlled trial of assessment and intervention by a nurse. SETTING--One urban and one rural general practice in Somerset. SUBJECTS--7300 adults randomly selected from 10,300 aged 35 and over on the combined practice lists. 515 women and 185 men with regular incontinence were offered assessment and treatment, of whom 134 women and 49 men had no intervention for three months (historical controls). They then joined the assessment and treatment programme. INTERVENTION--Four sessions of pelvic floor exercises and bladder retraining supervised by non-specialist nurse who had taken a three week course on assessing and treating uncomplicated incontinence. MAIN OUTCOME MEASURES--Number of patients desiring treatment; self reported cure, improvement, or deterioration in continence after three months. RESULTS--The questionnaire achieved a 79% response. Validated responses showed a prevalence of 4.4% in men and 16.4% in women aged 35-64. 315 (45%) of the 700 patients offered assessment refused it and seven had moved away or died, 64 men and 41 women were referred to their general practitioner. 197 of 292 treated women (68%) reported cure or improvement compared with seven (5%) of controls. 22 of the 86 men desiring treatment were suitable for intervention by the nurse. Seventeen were cured or improved compared with none of the men in the control group. CONCLUSIONS--About half the people with regular urinary incontinence took up the offer of treatment (9.2% of women and 3.4% of men in the study population). This condition can be effectively managed by a nurse with limited training.

A review of the United Kingdom (UK) multiple sclerosis (MS) literature suggests that over the last three decades prevalence and estimated incidence rates have increased, while mortality rates have been declining. UK mortality data over a 30 year period have been studied to examine temporal and geographical variations, to estimate changes in survival, and to examine the relationship between mortality and morbidity trends. The study has shown an overall decline in mortality throughout the UK of approximately 25% over the 30 year period ending in 1983, and a reduction in the mortality differential between Scotland, and England and Wales, but no positive correlation has been found between mortality and morbidity. The overall decline in death rate in females was 23% and in males 30% over the 30 years of the survey. The total number of deaths declined by 39% between the five year periods 1954-58 and 1979-83 in Scotland compared with a 10% decline for England and Wales. Estimated median age of death increased from 52 to 59 years and the improvement in survival over the period of study was similar for both countries and is unlikely to have contributed to the reduction in mortality differential. Within England and Wales regional mortality rates did not show a clear north-south gradient. The decline in the mortality differential between Scotland and England (if not artefactual) may provide an important aetiological clue in the search for the cause of multiple sclerosis, and the rate of decline suggests an environmental rather than a genetic aetiology.

Most people who write or speak about the Soviet Union like to start with an apt quotation from Lenin. I shall resist the temptation. Instead I shall quote Trotsky, since he is unfashionable and does not get much of an airing these days. But it was indeed Trotsky who encapsulated the whole essence of military morale when he wrote: First of all you must build the morale of your own troops. Then you must look to the morale of your civilian population. Then, and only then, when these are in good repair should you concern yourself with the enemy’s morale. And the best way to destroy the enemy’s morale is to kill him in large numbers. There’s nothing more demoralising that that.

EDITOR, - Allocating resources according to the health needs of the population remains one of the central values of the NHS.1 Ken Judge and Nicholas Mays have reviewed some of the weaknesses associated with the current method of allocation but do not fully explain the fundamental flaw in the use of the age-cost curve.2 The reason for using an age factor is that elderly people are widely believed to have greater health needs than younger people, and the underlying assumption is that all elderly people have the same health needs. To test this hypothesis we examined the relation between the proportion of elderly people (aged over 65) in the population and the proportion of pensioners who were aged over 75 and living alone for the 28 districts in South Thames region, using 1991 census data. Our analysis showed a highly significant inverse relation between the variables (correlation coefficient r=-0.49, r2=0.24, …

National allocation of resources to regional health authorities and by them to districts is now determined by a weighted capitation formula. The national formula was derived from regression analysis, with hospital utilisation as an index of need for health care--a method which has fundamental limitations. This paper argues that the search for an empirically based resource allocation formula of high precision in the name of promotion of equity is largely fruitless given the impossibility of measuring the true need for, and costs of, providing health care, especially with the limited data available. The inclusion of measures of social deprivation is also poorly thought out. The availability of data from the 1991 census, which included a question regarding long-standing illness, together with the intention of the Department of Health to review the weighted capitation formula using this information may stimulate much work but little light. It is essential that the impact of resource allocation formulas is justifiable on grounds other than the composition of any particular formula.

It has been proposed that electrophysiological changes following coronary artery occlusion result from inhibition of the adenine nucleotide translocase and that these changes can be reduced by carnitine infusion or reproduced by infusion of K+-atractyloside. In the present study, we recorded bipolar electrograms during serial 3- to 5-min occlusions of the left anterior descending coronary artery in open-chest, anesthetized dogs. DL-Carnitine (100-200 mg/kg iv) prior to coronary artery occlusion did not significantly alter ischemia-induced electrogram changes. L-Carnitine (100 mg/min ia) distal to the site of occlusion during coronary artery occlusion partially reversed ischemia-induced electrogram changes, but these effects resembled those produced by intra-arterial infusion of NaCl. During normal perfusion, intra-arterial infusion of K+-atractyloside (750 mumol/10 min) or equimolar KCl produced similar reversible flattening of perfused zone electrograms. Sodium atractyloside (750 mumol/10 min ia) did not produce electrogram changes. We conclude that 1) carnitine does not attenuate ischemia-induced electrogram changes in this model and 2) K+-atractyloside-induced electrogram changes are primarily due to K+.

1. The effect of 7 consecutive days of strenuous exercise, hill-walking, on water balance and distribution was studied in five subjects. The exercise was preceded and followed by 3 control days. The diet was fixed throughout but water was allowed ad libitum. 2. Packed cell volume was measured daily. Serum electrolytes and arginine vasopressin were measured twice daily. Daily water, sodium and potassium balances were calculated. 3. During exercise there was a fall in packed cell volume, reaching a maximum of 11% by day 5 and a retention of sodium reaching a cumulative maximum of 358 mmol by day 6. During and immediately after exercise there was a retention of potassium, reaching a total of 120 mmol by day 3 after stopping exercise. 4. There was a loss of 650 ml of water on day 1 of exercise, followed by a modest retention reaching a cumulative maximum of 650 ml on day 5 of exercise. 5. Neither arginine vasopressin nor serum electrolyte concentrations were affected by exercise. 6. From the packed cell volume, sodium and water balances it was calculated that by day 5 of exercise there was an increase in plasma volume of 0·68 litre (22%), an increase in interstitial fluid volume of 2·0 litres (17%) and a decrease in intracellular fluid volume of 1·8 litres (8%). 7. These changes, together with the clinical observation of facial and ankle oedema during the experiment, suggest that continuous exercise may cause oedema and thus may be a factor in the aetiology of high-altitude oedema.

The ventilatory and heart rate responses to exercise were studied in four experienced high-altitude climbers at sea level and during a 6-wk period above 4,500 m to discover whether their responses to hypoxia were similar to those of high-altitude natives. Comparison was made with results from four scientists who lacked their frequent exposure to extreme altitude. The climbers had greater Vo2max at sea level and altitude but similar ventilatory responses to increasing exercise. On acute hypoxia at sea level their ventilatory response was less than that of scientists. Their heart rate response did not differ from that of scientists at sea level, but with acclimatization the reduction in response was significantly greater. Alveolar gas concentrations were similar after acclimatization, but climbers achieved these changes more rapidly. The increase in hematocrit was similar in the two groups. It is concluded that these climbers, unlike high-altitude residents, have cardiorespiratory responses to exercise similar to those of other lowlanders except that their ventilatory response was lower and the reduction in their heart rate response was greater.

A system for calibrating and using a group of dc and ac standards has been developed at NBS to meet increasing needs for greater accuracy in the measurement of direct and rms alternating voltages at audio frequencies. With a group of saturated cells, a universal ratio set as a potentiometer, a simplified self-calibrating volt box, and a new differential-thermocouple ac-dc comparator, an accuracy of 10 ppm can be obtained for direct voltage measurements and 40 ppm for rms alternating voltage measurements between 20 and 20 000 c/s, in terms of the direct volt and the ac-dc transfer standards maintained at NBS.

The ac-dc differences of a reference group of thermoelements have been evaluated at audio frequencies to a few parts per million (ppm) at currents from 5 to 20 mA. A technique for comparing the ac-dc differences of two thermoelements with an uncertainty of about 2 ppm has been developed. Two 5 mA thermoelements are used with a plug-in set of resistors of computable reactances to form thermal voltage converters for voltage measurements. With this same technique adjacent ranges of these converters can be compared to step up from 0.5 to 500 V to better than 10 ppm.

Thyroxine-binding globulin (TBG) levels were found to be significantly lower in 40 thyrotoxic patients than in 70 healthy subjects. A similar mean fall in TBG of 18% was produced by administration of 'physiological' doses of triiodothyronine to healthy volunteers. However, intramuscular injection of thyroid-stimulating hormone (TSH) had no consistent effect on the level of TBG as measured up to 4 days after injection. These findings are believed to explain the anomalous results described by earlier workers. It is suggested that TBG concentration is regulated by unknown mechanisms subject to the influence of many hormones, including triiodothyronine.

(1932). The Moslems in Tunisia. Journal of The Royal Central Asian Society: Vol. 19, No. 4, pp. 653-666.