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IntroductionA health and lifestyle advisor service embedded within primary care was piloted in Kingston-upon-Hull from January 2021. We aimed to evaluate the first two years of service delivery by identifying patient demographics referred to the service, reason for referral, determine uptake and retention rates, and monitor individual lifestyle-related risk factor changes following discharge.MethodsAnonymised data were extracted from the SystmOne database for all patients referred to the service between January 2021 and January 2023.ResultsIn the initial two years of the service, 705 unique patients were referred at a mean rate of ∼29 per month. Each unique patient received a median (robust median absolute deviation; [MAD]) of 3 (Steel N, et al 2018) planned consultations prior to discharge over this period. The majority of referrals were for symptom management and health promotion purposes (95%). Of those referred, 69% attended their appointments, and 14% did not attend. The majority of referrals were white British (55%), however, the service did receive a substantial number of referrals from minority ethnic groups, with only 67% of referrals speaking English as their main language. Eighteen distinct languages were spoken. Most referrals were classified as class I obese (59.4%). Across initial and final appointments, median (robust MAD) systolic blood pressure was 130 (15) mmHg and 130 (15) mmHg, and median (robust MAD) waist circumference was 103.0 (13.3) cm and 101.0 (13.3) cm.ConclusionThe evaluation highlighted the demand for this service embedded within primary care settings in Kingston-upon-Hull. Service engagement was evident, and a large proportion of those who engaged were from minority ethnic groups. A high proportion of referrals presented with obesity and/or hypertension which requires further investigation.

IntroductionThe COVID-19 pandemic and attendant lockdowns have had a substantial negative effect on alcohol consumption and physical activity globally. Pre-pandemic evidence in the adult population suggests that higher levels of physical activity were associated with higher levels of drinking, but it is unclear how the pandemic may have affected this. Therefore, this study aims to assess the association between alcohol consumption and physical activity in a UK cohort established during the COVID-19 pandemic.MethodsAnalyses utilized data from the Health Behaviours during the COVID-19 pandemic (HEBECO) study involving 2,057 UK adults (≥18 years). Participants completed self-report measures of alcohol consumption [frequency, quantity, frequency of heavy episodic drinking (HED) and AUDIT-C score] and physical activity [moderate-vigorous physical activity (MVPA), frequency of muscle strengthening activity (MSA) and sedentary behaviour] between November 2020 and January 2021. Ordinal logistic regression models were conducted, adjusting for sociodemographic factors.ResultsFifteen percent of the sample reported abstinence from drinking. Overall, 23.4% of participants drank ≥4 times/week, 13.9% drank more than 6 units/single drinking occasion (HED), 7.5% reported HED daily/almost daily and 4.2% scored ≥11 on AUDIT-C. MSA 3 days/week compared with no MSA was significantly associated with higher odds of alcohol frequency [OR (95 CI%) = 1.41 (1.04-1.91)], quantity [OR (95 CI%) = 1.38 (1.02-1.87)], HED [OR (95 CI%) = 1.42 (1.05-1.94)] and possible dependence [OR (95 CI%) = 1.47 (1.05-2.06)]. The association of MVPA and sedentary behaviour with drinking measures was not significant (p>0.05).ConclusionIn contrast with previous research, MSA rather than aerobic physical activity was associated with increased alcohol consumption during the COVID-19 pandemic. It is conceivable that during lockdown while drinking was used as a coping strategy, limited opportunities for aerobic exercise made MSA a more convenient form of physical activity. To guide public health interventions, more research is required to examine the temporal relationship between different forms of physical activity and alcohol consumption.

IntroductionA metabolic equivalent (MET) is one of the most common methods used to objectively quantify physical activity intensity. Although the MET provides an 'objective' measure, it does not account for inter-individual differences in cardiorespiratory fitness. In contrast, 'relative' measures of physical activity intensity, such as heart rate reserve (HRR), do account for cardiorespiratory fitness. The purpose of this systematic review with meta-regression was to compare measures of absolute and relative physical activity intensity collected during walking.MethodsA systematic search of four databases (SPORTDiscus, Medline, Academic Search Premier and CINAHL) was completed. Keyword searches were: (i) step* OR walk* OR strid* OR "physical activity"; (ii) absolute OR "absolute intensity" OR mets OR metabolic equivalent OR actigraph* OR acceleromet*; (iii) relative OR "relative intensity" OR "heart rate" OR "heart rate reserve" OR "VO2 reserve" OR VO2* OR "VO2 uptake" OR HRmax* OR metmax. Categories (i) to (iii) were combined using 'AND;' with studies related to running excluded. A Bayesian regression was conducted to quantify the relationship between METs and %HRR, with Bayesian logistic regression conducted to examine the classification agreement between methods. A modified Downs and Black scale incorporating 13 questions relative to cross-sectional study design was used to assess quality and risk of bias in all included studies.ResultsA total of 15 papers were included in the systematic review. A comparison of means between absolute (METs) and relative (%HRR, %HRmax, %VO2R, %VO2max, HRindex) values in 8 studies identified agreement in how intensity was classified (light, moderate or vigorous) in 60% of the trials. We received raw data from three authors, incorporating 3 studies and 290 participants. A Bayesian random intercept logistic regression was conducted to examine the agreement between relative and absolute intensity, showing agreement in 43% of all trials. Two studies had identical relative variables (%HRR) totalling 240 participants included in the Bayesian random intercept regression. The best performing model was a log-log regression, which showed that for every 1% increase in METs, %HRR increased by 1.12% (95% CI: 1.10-1.14). Specifically, the model predicts at the lower bound of absolute moderate intensity (3 METs), %HRR was estimated to be 33% (95%CI: 18-57) and at vigorous intensity (6 METs) %HRR was estimated to be 71% (38-100).ConclusionThis study highlights the discrepancies between absolute and relative measures of physical activity intensity during walking with large disagreement observed between methods and large variation in %HRR at a given MET. Consequently, health professionals should be aware of this lack of agreement between absolute and relative measures. Moreover, if we are to move towards a more individualised approach to exercise prescription and monitoring as advocated, relative intensity could be more highly prioritised.

The Atlantic humpback dolphin (Sousa teuszii) is a critically endangered cetacean species endemic to coastal Atlantic waters of Africa. Its preference for shallow coastal habitat renders it vulnerable to incidental capture (bycatch) in non-selective fishing gears as well as to habitat degradation from all forms of coastal development. Although past and ongoing research has shed light on the distribution and conservation status of the species in a few locations, it is still poorly understood throughout most of the 19 countries in its 7000 km long range. From 2020 onward, international and regional collaboration to increase awareness and promote conservation action has intensified. These efforts, while in the early stages, exemplify the IUCN Species Survival Commission’s Assess-Plan-Act Conservation Cycle. While concrete conservation gains have not yet been achieved, efforts are being made to fill knowledge gaps and to broaden and motivate the network of international, regional, national, and local stakeholders that are actively engaged in marine and coastal conservation actions at multiple levels. The authors assess the strengths and weaknesses of the current approaches and identify elements that may be useful for other species with ranges spanning multiple countries where resources and capacity for conservation action are limited.

A small evidence base supports the use of virtual reality in professional soccer, yet there is a lack of information available on perceptions and desire to use the technology from those employed at professional soccer clubs. Therefore, the aim of the study was to compare and quantify the perceptions of virtual reality use in soccer, and to model behavioural intentions to use this technology. This study surveyed the perceptions of coaches, support staff, and players in relation to their knowledge, expectations, influences and barriers of using virtual reality via an internet-based questionnaire. To model behavioural intention, modified questions and constructs from the Unified Theory of Acceptance and Use of Technology were used, and the model was analysed through partial least squares structural equation modelling. Respondents represented coaches and support staff (n = 134) and players (n = 64). All respondents generally agreed that virtual reality should be used to improve tactical awareness and cognition, with its use primarily in performance analysis and rehabilitation settings. Generally, coaches and support staff agreed that monetary cost, coach buy-in and limited evidence base were barriers towards its use. In a sub-sample of coaches and support staff without access to virtual reality (n = 123), performance expectancy was the strongest construct in explaining behavioural intention to use virtual reality, followed by facilitating conditions (i.e., barriers) construct which had a negative association with behavioural intention. Virtual reality has the potential to be a valuable technology within professional soccer although several barriers exist that may prevent its widespread use.

The primary aims of this study were to examine the effects of bio-banding players on passing networks created during 4v4 small-sided games (SSGs), while also examining the interaction of pitch size using passing network analysis compared to a coach-based scoring system of player performance. Using a repeated measures design, 32 players from two English Championship soccer clubs contested mixed maturity and bio-banded SSGs. Each week, a different pitch size was used: Week 1) small (36.1 m2 per player); week 2) medium (72.0 m2 per player); week 3) large (108.8 m2 per player); and week 4) expansive (144.50 m2 per player). All players contested 12 maturity (mis)matched and 12 mixed maturity SSGs. Technical-tactical outcome measures were collected automatically using a foot-mounted device containing an inertial measurement unit (IMU) and the Game Technical Scoring Chart (GTSC) was used to subjectively quantify the technical performance of players. Passing data collected from the IMUs were used to construct passing networks. Mixed effect models were used with statistical inferences made using generalized likelihood ratio tests, accompanied by Cohen's local f2 to quantify the effect magnitude of each independent variable (game type, pitch size and maturation). Consistent trends were identified with mean values for all passing network and coach-based scoring metrics indicating better performance and more effective collective behaviours for early compared with late maturation players. Network metrics established differences (f2 = 0.00 to 0.05) primarily for early maturation players indicating that they became more integral to passing and team dynamics when playing in a mixed-maturation team. However, coach-based scoring was unable to identify differences across bio-banding game types (f2 = 0.00 to 0.02). Pitch size had the largest effect on metrics captured at the team level (f2 = 0.24 to 0.27) with smaller pitch areas leading to increased technical actions. The results of this study suggest that the use of passing networks may provide additional insight into the effects of interventions such as bio-banding and that the number of early-maturing players should be considered when using mixed-maturity playing formats to help to minimize late-maturing players over-relying on their early-maturing counterparts during match-play.

BACKGROUND:Recent concerns have cast doubt over the effectiveness of cardiac rehabilitation [CR] programmes for improving cardiorespiratory fitness [CRF] in patients with a history of cardiac disease in the United Kingdom [UK]. We aimed to characterise the weekly progression of exercise training dose over an 8-week Phase III CR programme as we felt this may be partly responsible for the lack of improvement in CRF reported in previous studies. DESIGN:Observational study. METHODS:We evaluated a community-based Phase III CR programme in the UK. During each training session, patients wore an Apple Watch and the weekly progression of exercise training dose/load was quantified. The analysis was based on 332 individual training sessions. Exercise intensity [% heart rate reserve] during the cardiovascular [CV] exercise training component [%HRR-CV], CV training duration; estimated changes in cardiorespiratory fitness [change in estimated metabolic equivalents (METs)]; session rating of perceived exertion [sRPE], sRPE training load [sRPE-TL], and exercise training impulse [TRIMP] were evaluated. RESULTS:Thirty cardiac patients [83% male; age [SD] 67.0 [10.0] years; body mass index [SD] 28.3 [4.6] kg∙m-2] were recruited to an 8-week programme [16 sessions in total]. Bayesian repeated-measures ANOVA indicated anecdotal evidence for the alternative hypothesis for changes in %HRR-CV (BF10 = 0.61), sRPE (BF10 = 1.1), and change in estimated METs (BF10 = 1.2) during CR. Conversely, Bayesian repeated-measures ANOVA showed extreme evidence for changes in CV training duration (BF10 = 2.438e+26), TRIMP (BF10 = 71436), and sRPE-TL (BF10 = 779570). CONCLUSION:The key exercise training principle of progressive overload was only partially applied. Increases observed in exercise dose were due to increases in the duration of CV training, rather than combined with increases in exercise intensity [%HRR-CV and sRPE]. Accordingly, allied health professionals must ensure that exercise intensity is more consistently progressed to optimise the exercise stimulus and improvements in CRF and patient outcomes.

IntroductionInvestigate the effectiveness of short-term heat acclimation (STHA), over 5-days (permissive dehydration), on an intermittent sprint exercise protocol (HST) with females. Controlling for menstrual cycle phase.Materials and MethodsTen, moderately trained, females (Mean [SD]; age 22.6 [2.7] y; stature 165.3 [6.2] cm; body mass 61.5 [8.7] kg; V.⁢O2⁢peak 43.9 [8.6] mL⋅kg–1⋅min–1) participated. The HST (31.0°C; 50%RH) was 9 × 5 min (45-min) of intermittent exercise, based on exercise intensities of female soccer players, using a motorized treadmill and Wattbike. Participants completed HST1 vs. HST2 as a control (C) trial. Followed by 90 min, STHA (no fluid intake), for five consecutive days in 39.5°C; 60%RH, using controlled-hyperthermia (∼rectal temperature [Tre] 38.5°C). The HST3 occurred within 1 week after STHA. The HST2 vs HST3 trials were in the luteal phase, using self-reported menstrual questionnaire and plasma 17β-estradiol.ResultsPre (HST2) vs post (HST3) STHA there was a reduction at 45-min in Tre by 0.20°C (95%CI −0.30 to −0.10°C; d = 0.77); T¯s⁢k (−0.50; −0.90 to −0.10°C; d = 0.80); and T¯b (−0.25; −0.35 to −0.15°C; d = 0.92). Cardiac frequency reduced at 45-min (−8; −16 to −1 b⋅min–1; d = 1.11) and %PV increased (7.0; −0.4 to 14.5%: d = 1.27). Mean power output increased across all nine maximal sprints by 56W (−26 to 139W; d = 0.69; n = 9). There was limited difference (P > 0.05) for these measures in HST1 vs HST2 C trial.DiscussionShort-term heat acclimation (5-days) using controlled-hyperthermia, leads to physiological adaptation during intermittent exercise in the heat, in moderately trained females when controlling for menstrual cycle phase.

This paper presents a novel approach, adaptive spectrum noise cancellation (ASNC), for motion artifacts removal in photoplethysmography (PPG) signals measured by an optical biosensor to obtain clean PPG waveforms for heartbeat rate calculation. One challenge faced by this optical sensing method is the inevitable noise induced by movement when the user is in motion, especially when the motion frequency is very close to the target heartbeat rate. The proposed ASNC utilizes the onboard accelerometer and gyroscope sensors to detect and remove the artifacts adaptively, thus obtaining accurate heartbeat rate measurement while in motion. The ASNC algorithm makes use of a commonly accepted spectrum analysis approaches in medical digital signal processing, discrete cosine transform, to carry out frequency domain analysis. Results obtained by the proposed ASNC have been compared with the classic algorithms, the adaptive threshold peak detection and adaptive noise cancellation. The mean (standard deviation) absolute error and mean relative error of heartbeat rate calculated by ASNC is 0.33 (0.57) beats min-1 and 0.65%, by adaptive threshold peak detection algorithm is 2.29 (2.21) beats min-1 and 8.38%, by adaptive noise cancellation algorithm is 1.70 (1.50) beats min-1 and 2.02%. While all algorithms performed well with both simulated PPG data and clean PPG data collected from our verity device in situations free of motion artifacts, ASNC provided better accuracy when motion artifacts increase, especially when motion frequency is very close to the heartbeat rate.

BackgroundIn recent years, criticism of the percentage range approach for individualised exercise prescription has intensified and we were concerned that sub-optimal exercise dose (especially intensity) may be in part responsible for the variability in the effectiveness of cardiac rehabilitation (CR) programmes in the United Kingdom (UK). The aim was to investigate the fidelity of a structured Phase III CR programme, by monitoring and quantifying exercise training intensity.DesignObservational study.MethodsThe programme comprised 16 sessions over 8 weeks, where patients undertook an interval, circuit training approach within national guidelines for exercise prescription (40-70% heart rate reserve [HRR]). All patients wore an Apple Watch (Series 0 or 2, Watch OS2.0.1, Apple Inc., California, USA). We compared the mean % heart rate reserve (%HRR) achieved during the cardiovascular training component (%HRR-CV) of a circuit-based programme, with the %HRR during the active recovery phases (%HRR-AR) in a randomly selected cohort of patients attending standard CR. We then compared the mean %HRR-CV achieved with the minimal exercise intensity threshold during supervised exercise (40% HRR) recommended by national governing bodies.ResultsThirty cardiac patients (83% male; mean age [SD] 67 [10] years; BMI 28.3 [4.6] kg∙m-2) were recruited. We captured 332 individual training sessions. The mean %HRR-CV and %HRR-AR were 37 (10) %, and 31 (13) %, respectively. There was weak evidence to support the alternative hypothesis of a difference between the %HRR-CV and 40% HRR. There was very strong evidence to accept the alternative hypothesis that the mean %HRR-AR was lower than the mean %HRR-CV, median standardised effect size 1.1 (95%CI: 0.563 to 1.669), with a moderate to large effect.ConclusionMean exercise training intensity was below the lower limit of the minimal training intensity guidelines for a Phase III CR programme. These findings may be in part responsible for previous reports highlighting the significant variability in effectiveness of UK CR services and poor CRF improvements observed from several prior investigations.

Background: The relationship between perceived social support and continuous positive airway pressure remains understudied among individuals with obstructive sleep apnea. The aim of this prospective cohort study was to determine if baseline perceived social support and subtypes predict regular continuous positive airway pressure use after 1month of therapy., Methods: Adults with obstructive sleep apnea initiating continuous positive airway pressure therapy were recruited from sleep clinics in New York City. Demographics, medical history, and comorbidities were obtained from patient interview and review of medical records. Objective continuous positive airway pressure adherence data was collected at the first clinical follow-up., Results: Seventy-five participants (32% female; non-Hispanic Black 41%; mean age of 56 ± 14years) provided data. In adjusted analyses, poorer levels of overall social support, and subtypes including informational/emotional support, and positive social interactions were associated with lower continuous positive airway pressure use at 1month. Relative to patients reporting higher levels of support, participants endorsing lower levels of overall social support, positive social interaction and emotional/informational support had 1.6 hours (95% CI: 0.5,2.7, hours; p = .007), 1.3 hours (95% CI: 0.2,2.4; p = .026), and 1.2 hours (95% CI: 0.05,2.4; p = .041) lower mean daily continuous positive airway pressure use at 1month, respectively., Conclusion: Focusing on social support overall and positive social interaction particularly, could be an effective approach to improve continuous positive airway pressure adherence in patients at risk of suboptimal adherence., Competing Interests: Declaration of conflicts of interest The authors declare no competing interests., (Copyright © 2023 National Sleep Foundation. All rights reserved.)

Background: Although racial and ethnic differences in CPAP adherence for OSA are widely established, no studies have examined the influence of perceived racial discrimination on CPAP usage, to our knowledge., Research Question: (1) Do Black adults with OSA report experiencing greater amounts of discrimination than non-Hispanic White adults? (2) Is discrimination associated with poorer CPAP adherence over time, independent of self-identified race? (3) Does discrimination mediate the relationship between self-identified Black race and CPAP usage?, Study Design and Methods: In this prospective study, Black and non-Hispanic White adults with OSA initiating CPAP were enrolled from two sleep centers and completed questionnaires including sociodemographics, perceived discrimination, daytime sleepiness, insomnia symptoms, and depressive symptoms. Perceived discrimination was measured using the Everyday Discrimination Scale (EDS). Black and White group comparisons for baseline sociodemographic variables, sleep symptoms, and perceived discrimination were performed with Student t test or χ 2 /Fisher exact test, as appropriate. A linear regression model was completed with self-identified Black race and EDS total score as the primary independent variables of interest and mean daily CPAP usage at 30 and 90 days serving as the dependent outcomes. This regression modeling was repeated after adjusting for psychosocial variables known to be associated with CPAP usage. EDS total score was explored as a potential mediator of the association between self-identified Black race and mean daily CPAP adherence at 30 and 90 days., Results: The sample for this analysis consisted of 78 participants (31% female, 38% Black) with a mean age of 57 ± 14 years. Sixty percent of the Black adults reported they experienced racial discrimination at least a few times each year. Relative to White adults, Black adults were also more likely to indicate more than one reason for discrimination (27% vs 4%, P = .003). Adjusting for discrimination, self-identified Black race was associated with 1.4 (95% CI, -2.3 to -0.4 h; P = .006) and 1.6 (95% CI, -2.6 to -0.6 h; P = .003) fewer hours of mean daily CPAP usage at 30 and 90 days, respectively. In the fully adjusted model, a 1-unit change in the total discrimination score (more discrimination) was associated with a 0.08-h (95% CI, 0.01-0.15 h; P = .029) and 0.08-h (95% CI, 0.01-0.16 h; P = .045) change in mean daily CPAP usage at 30 and 90 days, respectively., Interpretation: Adults with OSA who encountered racial discrimination experienced greater decrement in CPAP usage than those who did not experience racial discrimination., Competing Interests: Financial/Nonfinancial Disclosures None declared., (Copyright © 2023 American College of Chest Physicians. All rights reserved.)

Novel ideas are needed to increase adherence to antihypertensive medication. The current study used data from the Counseling African Americans to Control Hypertension (CAATCH) study, a sample of 442 hypertensive African Americans, to investigate the mediating effects of expectation of hypertension care, social support, hypertension knowledge, and medication adherence, adjusting for age, sex, number of medications, diabetes, education, income, employment, insurance status, and intervention. Sixty-six percent of patients had an income of $20,000 or less and 56% had a high school education or less, with a mean age of 57 years. Greater expectation of care was associated with greater medication adherence (P=.007), and greater social support was also associated with greater medication adherence (P=.046). Analysis also showed that expectation of care mediated the relationship between hypertension knowledge and medication adherence (P<.05). Expectation of care and social support are important factors for developing interventions to increase medication adherence among blacks., (© 2015 Wiley Periodicals, Inc.)

Objectives: To address donor attitudes and reasons for selecting either laparoscopic or open donor nephrectomy (LDN, ODN), as despite the increased interest in laparoscopic procedures, organ donation continues to lag behind the demand for organs, and many new initiatives have failed to reduce the gap., Patients and Methods: This case series comprised a 10-year review of medical records and a transplant database on donor demographics, analgesic requirements, postoperative complications and length of hospital stay. A structured telephone interview was conducted for all live donors to evaluate donor awareness, reasons for selecting LDN and the psychosocial impact of DN on donors' rehabilitation., Results: Between 1995 and 2004, 38 LDN and 38 ODN were carried out; 70% were women in both groups, with a respective mean age of 44.4 and 47.1 years. Three LDNs were converted to ODN due to technical difficulties. The mean operative duration for LDN (194.8 min) was 78 min longer than for ODN (116.8 min). As expected, the mean analgesia requirement and length of hospital stay was less for LDN than ODN, by 55.4 mg of morphine equivalent and 2.3 days. Although all renal donors were aware of the option of LDN, one patient chose ODN due to safety concerns. The primary source of donor information was derived predominantly from the donor assessment process. The main reason for choosing LDN was the earlier return to work (54%), followed by less postoperative pain (33%). In general, there was minimal psychosocial impact after renal transplantation and the overall donor experience was very positive (85%)., Conclusion: LDN has remained a safe, less-invasive but effective technique for allograft procurement, with minimal morbidity. Overall, there is less postoperative pain and fewer surgical complications, and an earlier return to normal functioning. The level of satisfaction with the whole renal donation process was very positive, with minimal psychosocial impact.

Background: The increasing experience with renal allotransplantation has led to continuing development in vascular surgical techniques. These improvements have enabled complex ex vivo renal artery surgery and renal autotransplantation to be performed. The aims of the present study were to describe the results achieved with renal autotransplantation and ex vivo renal artery reconstruction (RAR) at the Newcastle Transplant Unit, John Hunter Hospital, and to review the current indications for such surgery., Methods: A retrospective review was performed of patients who required renal autotransplantation with or without RAR at John Hunter Hospital, between 1991 and 1999. Data were obtained from the Newcastle Transplant Unit and the Medical Record Department of John Hunter Hospital., Results: Two patients required ex vivo RAR and renal autotransplantation for severe fibromuscular dysplasia (FMD) complicated by stenoses and renal artery branch aneurysms. The third patient required autotransplantation for bilateral retroperitoneal fibrosis. There was one postoperative complication of pelviureteric junction obstruction that was treated successfully with a temporary ureteric stent. All patients demonstrated normal graft function and were normotensive on follow up, which ranged from 2.5 to 5 years., Conclusion: The present review confirms the long-term benefits of ex vivo RAR and renal autotransplantation that have been demonstrated by previous studies. In transplant units experienced with this surgery it has been shown to be a successful and durable technique for the treatment of a variety of vascular, urologic and other diseases.

We studied 15 patients with histologically proved multifocal carcinoma in situ of the bladder who were in remission at a mean followup of 21 months after induction intravesical chemotherapy with mitomycin C. These patients have been followed for a further 28 months, for a total mean duration of 49 months. Of the 15 patients 4 suffered new areas of carcinoma in situ, including 3 who subsequently required cystectomy (2 after unsuccessful intravesical bacillus Calmette-Guerin therapy and 1 with a simultaneous invasive tumor). One patient underwent transurethral resection of the prostate for carcinoma in situ of the prostatic urethra, which subsequently was shown to be limited to mucosa and not involving the deeper ducts nor the stroma. Of the remaining 11 patients 1 died of unrelated disease and 2 suffered recurrent papillary transitional cell carcinoma treated successfully with a combination of intravesical bacillus Calmette-Guerin therapy and resection. The other 8 patients have remained free of tumor. None of the 15 patients had metastatic cancer. We believe that these results support the durability of response after induction mitomycin C therapy. We stress the necessity for prolonged close followup to detect recurrent tumor and to avoid metastatic disease.

Whole bloods from weaned lambs with severe selenium responsive unthriftiness usually contain <5 ng Se/ml. Mildly or moderately affected lambs have blood levels of 5-10 ng/ml. Selenium responsive infertility in ewes appears to be associated with whole blood selenium levels below 10 ng/ml.

We report a case of an isolated cardiac metastasis from squamous cell carcinoma of the bladder. The incidence and difficulty in the diagnosis of myocardial deposits from bladder tumors are discussed.

Calculus formation is a rare complication of a Meckel's diverticulum. These calculi may cause a mechanical small-bowel obstruction--Meckel stone ileus--an extremely rare mode of presentation of a Meckel's diverticulum. A case in which this has occurred is reported--only the fifth such occasion that this has happened.

How do faculty deal with a student grievance? When a student fails clinically and appeals that failure, how can faculty respond? The author presents a case history of a student grievance and describes statutory and case law, which underlie the practice of nurse educators.

We report a case of xanthogranulomatous pyelonephritis in a renal allograft. The kidney was not removed and there was an initial response to antibiotic therapy, with amelioration of toxicity and improvement in renal function. However, the kidney failed 10 months later in association with histological changes of chronic rejection.

In grasses and clovers the highest concentrations of selenium were found in the leaves. The selenium content of different species in spring pastures on the same soil type did not vary widely although the slower growing and more deeply rooting species contained higher levels. The concentration of selenium in a pasture varied with time of the year, the lower levels being usually associated with conditions that stimulated rapid growth of the herbage, although factors other than growth rate were also involved. Lucerne appeared to be unusual in that in some areas it accumulated much higher levels of selenium than was found in other associated species. A very wide variation in levels of selenium in pastures growing on different soils has been observed 3-1500 ng/g). Selenium-responsive unthriftiness in grazing lambs occurred where the selenium content of spring pastures was <20 ng/g. Pastures containing >30 ng/g were apparently adequate while intermediate levels were probably marginally deficient.

One hundred patients were prospectively randomised into two groups to receive either a single dose of 1 g ampicillin and 80 mg gentamicin pre-operatively or no antibiotic prophylaxis. The incidence of breakage in the continuity of the closed drainage system was documented. All patients with urinary tract infection (UTI), catheterisation, clinical prostatic carcinoma, neurogenic bladder and bladder tumours were excluded. UTIs, bacteraemia and fever were noted. There were 7 late exclusions. The incidence of UTI in the control and antibiotic groups was 16 and 17% respectively. No blood cultures were positive. There were no significant differences in the incidence of fever between the two groups. A break in the closed drainage system occurred in 13 patients. Fifteen of the 93 developed UTI. A break in the closed drainage system occurred in 7 of the 15 patients (40%) with UTI. Of the 78 patients without UTI, 8 had a break (10%). This difference was highly significant. We recommend that less emphasis be placed on prophylactic antibiotics and more on avoiding breakage of the closed system in the prevention of UTI after transurethral resection of the prostate (TURP) in the low risk situation.

We studied 19 consecutive patients with biopsy proved carcinoma in situ of the bladder who had received 8 weekly doses of 30 mg. intravesical mitomycin C. Followup with cystoendoscopy, biopsy and cytology studies every 3 months ranged from 6 to 48 months, with an average of 21 months. A complete initial response was achieved in 15 patients, 11 of whom have remained free of tumor with no further therapy. The 4 patients who failed to respond to initial therapy subsequently were free of tumor after further intravesical mitomycin C (2), excision (1) or doxorubicin (1). Three patients died of unrelated diseases. Only 1 patient has had metastatic transitional cell carcinoma. No patient had undergone cystectomy or radiotherapy. These data indicate that mitomycin C achieves a high initial response in patients with carcinoma in situ of the bladder and maintains this control in many patients for months or years.