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Introduction Classical primary preventive cardiovascular disease (CVD) risk algorithms, such as the Framingham risk score and the widely used QRISK score in the UK, predate large-scale deep-phenotyped biomedical research resources. There is therefore the opportunity to identify novel predictors. In addition, whilst CVD risk profiling is well studied in the context of primary prevention, there is a paucity of data examining risk in regard to secondary prevention. Purpose To identify independent predictors of repeat coronary artery revascularisation, following index coronary angioplasty. Methods The UK Biobank is a large prospective multicentre study which recruited over 500,000 participants in the UK aged 37–73 years at entry between 2006–2010. Data are derived from an array of physical measurements, self-reported measures and biological samples, together with longitudinal linkage to hospital inpatient records and death registries. Procedural codes were used to identify patients who had undergone first coronary angioplasty from 2006 onwards. Repeat revascularisation (RR) was defined as angioplasty or bypass grafting occurring at least 9 months after the index angioplasty, in order to preclude instances of staged revascularisation and in-stent restenosis. Data were censored at January 2021 or date of death as appropriate. Results A total of 12,853 participants underwent a first coronary angioplasty during the study period, with 1,394 (10.8%) requiring RR over a median follow-up of 6.5 years. The average age was 64 years in the RR cohort and 1117 (80%) were male. Univariate analyses confirmed a number of established associations with RR, including for example diabetes mellitus and hypertension. Median lipoprotein(a) concentrations were 27.6 vs. 30.3nmol/L in the RR group, p=0.066. Cox regression analyses (n=7,216) incorporating 21 biometric and clinical parameters demonstrated that lipoprotein(a) >80nmol/L was one of six independent predictors of time to RR (HR 1.24, p=0.006), independent of other lipids. The strength and significance of this association persisted when the number of covariates was reduced to include only other lipids and classical cardiovascular risk parameters. LDL, HDL, and triglyceride levels were not significant predictors in this model. Conclusions Lipoprotein(a) is identified as a major independent driver of RR. However current European Society of Cardiology guidance does not recommend measurement of Lipoprotein(a) in the context of progressive coronary artery disease. Furthermore, it is known that strategies such as lifestyle advice and statins – recommended in all patients with established coronary artery disease - do no reduce lipoprotein(a), whilst niacin and PCSK9 inhibitors do have a significant effect. Indications for lipoprotein(a) measurement must therefore be broadened, so that specific treatments to lower it can be instituted in order to reduce the burden of progressive coronary artery disease. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Herefordshire Heart Fund

Introduction Data from the SYNTAX and EXCEL trials have previously demonstrated increased morbidity and mortality following repeat revascularisation (RR). However real-world RR rates following index PCI are poorly defined, particularly in the 'late' context of restenosis of bystander disease and de novo lesions. Purpose To identify independent predictors of RR and evaluate its prognostic impact in an unselected cohort of patients following first PCI. Methods The UK Biobank is a large prospective multicentre study which recruited over 500,000 participants in the UK aged 37–73 years at entry between 2006–2010. Data are derived from an array of physical measurements, self-reported measures and biological samples, together with longitudinal linkage to hospital inpatient records and death registries. Procedural codes (OPCS-4) were used to identify patients who had undergone first PCI from 2006 onwards. RR was defined as PCI or CABG occurring at least 9 months after the index PCI, in order to preclude instances of staged revascularisation and in-stent restenosis. Data were censored at January 2021 or date of death as appropriate. Non-parametric tests are used throughout. Results A total of 12,853 participants underwent a first PCI during the study period, with 1,394 (10.8%) requiring RR over a median follow-up of 6.5 years. Of these, 1188 underwent PCI whilst 206 were elected to CABG. The average age was 64 years in the RR cohort and 1117 (80%) were male. Univariate analyses confirmed a number of established associations with RR, including for example diabetes mellitus and hypertension. Median lipoprotein(a) concentrations were 27.6 vs. 30.3nmol/L in the RR group, p=0.066. Cox regression analyses incorporating 21 biometric and clinical parameters demonstrated that lipoprotein(a) was an independent predictor of time to RR, independent of other lipids (Table 1). The strength of this association persisted when the number of covariates was reduced to include only other lipids and classical cardiovascular risk parameters. In Kaplan-Meier analyses, RR was associated with lower all-cause mortality (Figure 1). Further multivariate time-to-event analyses confirmed this association (HR 0.59, 95% CI 0.47–0.75, p Conclusions Lipoprotein(a) is identified as a major independent driver of RR. In contrast to recent trial data focussing on left main stem and multivessel disease, unselected patients undergoing RR 9 or more months following index PCI attain prognostic benefit as assessed in multivariate analyses. The findings support an invasive approach, whether with PCI or CABG, in progressive coronary artery disease following initial PCI. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): 1. The Herefordshire Heart Fund, UK. 2. Postgraduate Medical Bursary, Wye Valley NHS Trust, UK. Table 1Figure 1

Sometime within the next decade, driverless vehicles will join conventional vehicles, which are operated by human drivers, on the roads of the United States. Even if driverless vehicles are adopted only gradually and partially, their introduction onto roadways still will have numerous legal ramifications. How soon and how smoothly driverless vehicles merge onto U.S. roads and highways will depend, in part, on how the legal system resolves the many legal issues implicated by these vehicles. Driverless vehicles will inherit a framework of laws designed for conventional vehicles. Some states already have begun to make minor modifications to this framework to account for the unique capabilities and concerns associated with driverless vehicles. In the future, these intersections of the law and driverless technologies will grow increasingly numerous and complicated. This digest has been prepared to assist policymakers in anticipating, working through, and resolving the legal policy issues that may be associated with driverless vehicles. It provides policymakers with an introduction to how civil and criminal liability may adhere to driverless vehicles, the implications of these vehicles for privacy and security, how these vehicles are likely to become subject to and potentially alter prevailing automobile insurance regimes, and other related topics.

Keywords: monoclonal B cell lymphocytosis; B cell lymphocytosis; hypogammaglobulinaemia; infection

Autonomous vehicles are just beginning to emerge on roads and highways all over the world. The autonomous vehicle prototypes available now provide some clues to understanding how law will apply to this developing technology. There appear to be several types of autonomous vehicles. Most of the experimental autonomous vehicles tend to be either self-contained or interconnected or some combination of these two types. Another category of autonomous vehicles, a self-willed autonomous vehicle, appears only in fiction - often fantasy or horror stories about vehicles run amok or falling in love with humans. More benign self-willed vehicles include Herbie the Love Bug and Chitty Chitty Bang Bang. Until the singularity, when machines are smarter than humans are, self-willed autonomous vehicles are likely to exist in our imaginations, rather than on the roads.It is not clear what the market for autonomous vehicles will be. Driving enthusiasts will probably avoid them. However, differently abled persons, such as persons with disabilities, as well as children and the elderly are likely to find autonomous vehicles especially attractive.Autonomous vehicles may possibly appeal to commuters, who find long daily commutes over boring roads tedious. However, whether ordinary consumers will be inclined to purchase autonomous vehicles remains a matter of speculation.In very general terms, autonomous vehicles are self-driving cars operated by artificial intelligence using automated controls and, usually, GPS. Internal vehicle sensors constantly monitor the car’s mechanical operation - such as its speed, steering, braking, and the like. The differences between the self-contained and interconnected autonomous vehicles lie in the ways in which the two types assess the dynamic driving environment on the roads where they travel.Self-contained autonomous vehicles gather and keep all information within the vehicle. They collect data from outward facing sensors (cameras, lidar, radar, etc.) to visualize and predict the changing roadway situation around the moving car. Most of the self-contained autonomous vehicle prototypes require that roadways on which these vehicles travel be mapped in advance by a human driver.On the other hand, the interconnected type of autonomous vehicle relies on real-time communications from other vehicles or the roadside to provide data about what is happening in the roadway environment in which it operates. Interconnected autonomous vehicles do not require pre-mapped routes, but rather rely on data about the driving environment that is communicated into the vehicle from outside sources.These technical differences result in a number of interesting legal questions that may have different answers depending on the type of autonomous vehicle. How should legal rules determine civil and criminal legal liability, for example, when an autonomous vehicle breaks a traffic rule or damages another’s vehicle or is involved in vehicular manslaughter? Products liability could be placed on the manufacturer or seller of the vehicle, on the hardware provider, or on the maker of the software used by the vehicle’s artificial intelligence. Privacy rights, insurance law, and regulatory jurisdiction have yet to be determined. As autonomous vehicles’ new, innovative transportation technology develops, the law also will need to innovate.

Plain chest radiographs from a one in six random sample of the workforce of the asbestos industry at Wittenoom, Western Australia between 1943 and 1966 have been classified for degree of profusion and pleural thickening by two independent observers according to the 1980 UICC-ILO Classification of Radiographs for the pneumoconioses to clarify the effect of degree of radiological abnormality on survival. A total of 1106 subjects were selected. Each subject's age, cumulative exposure to crocidolite, and time since first exposure were determined from employment records, the results of a survey of airborne concentrations of fibres > 5 mu in length conducted in 1966, and an exposure rating by an industrial hygienist and an ex-manager of the mine and mill at Wittenoom. By the end of 1986 193 subjects had died. Conditional logistic regression was used to model the relative risk of death in five separate case-control analyses in which the outcomes were deaths from: (1) all causes, (2) malignant mesothelioma, (3) lung cancer, (4) asbestosis, and (5) other causes excluding cancer and asbestosis. Up to 20 controls per case were randomly chosen from all men of the same age who were not known to have died before the date of death of the index case. After adjustment for exposure and time since first exposure, there were significant and independent effects of radiographic profusion and pleural thickening on all cause mortality. The effect of profusion was largely a result of the effect on mortality from malignant mesothelioma and asbestosis but not lung cancer. The effect of pleural thickening was greatest on mortality from other causes, mainly ischaemic heart disease. This study has shown that degree of radiographic abnormality has an independent effect on mortality from malignant mesothelioma, asbestosis, and all causes even after allowing for the effects of age, degree of exposure, and time since first exposure.

BACKGROUND Total-body irradiation, followed by hematopoietic system rescue by bone marrow transplantation (BMT), has been found to improve the response of patients with multiple myeloma to treatment with melphalan. The problems of nonhematopoietic toxicity from whole-body irradiation might be circumvented by using a bone-seeking radiopharmaceutical, such as samarium-153 ethylenediaminetetramethylene phosphonate (153Sm-EDTMP), to ablate the bone marrow. PURPOSE A mouse model system for multiple myeloma was used to evaluate the potential therapeutic efficacy of sequential therapy with 153Sm-EDTMP, melphalan, and BMT. METHODS Female C57BL/KaLwRij mice were inoculated with 8 x 10(5) 5T33 murine myeloma cells. Treatment protocols were begun 3 or 10 days later, when the myeloma was either confined to bone marrow or disseminated in liver, spleen, and lymph nodes, simulating human multiple myeloma. 153Sm, a potent beta particle-emitting radioisotope of short half-life (46.7 hours), was linked to the bone-seeking chelate EDTMP. Animals in the first treatment group were each given 22.5 MBq 153Sm-EDTMP via the jugular vein (day 3 or 10), followed by 18.5 mg/kg melphalan (maximum tolerated dose) given intraperitoneally 5 days later (day 8 or 15) and syngeneic BMT another 2 days later (day 10 or 17). Survival in groups of six to 10 animals for each time series was compared with that in mice left untreated (control cohort), in mice treated with 153Sm-EDTMP alone (day 3 or 10), or in mice treated with melphalan alone (day 8 or 15). The hematopoietic systems of animals in the latter two treatment groups recovered full function, obviating the necessity of BMT. The end point was onset of paraparesis, at which time the animals were immediately killed by carbon dioxide asphyxiation. RESULTS Median survival in untreated control animals was 23 days in those with localized disease and 24 days in those with disseminated myeloma. Treatment with 153Sm-EDTMP alone improved survival to a median of 29 days when commenced on day 3 and 30 days when begun on day 10. Melphalan treatment alone improved the median survival to 31 days for animals with localized myeloma and 34 days in animals with disseminated disease. Additional improvement in survival to a median of 42 days was achieved in animals treated 3 days after tumor inoculation with sequential 153Sm-EDTMP, melphalan, and BMT; median survival was 40 days using this regimen in animals with disseminated myeloma. CONCLUSIONS Animals in all three treatment protocols survived longer than those left untreated after inoculation with myeloma cells (P < .001). Sequential treatment with 153Sm-EDTMP, melphalan, and BMT was significantly more effective than single-agent treatment (P < .01). No evidence of radiotoxicity was detected in nonhematopoietic organs. IMPLICATIONS The survival advantage conferred by our sequential treatment protocol suggests its potential clinical usefulness in the treatment of multiple myeloma and other hematologic malignancies in humans.

C. Left arm Cat (10,000 BAU/mL) 6 3000 AU 2400 AU Dog (1:20) 2 0.1 mL 0.08 mL Phenolated buffered 2 N/A N/A A 19-year-old man with a history of allergic rhinoconjunctivitis and who was receiving monthly subcutaneous allergen immunotherapy (SCIT) presented with an unusual delayed local reaction. The patient had previously tolerated 17 months of SCIT buildup and 3 months of maintenance immunotherapy in 3 separate injections (Tables I and II) with only large local reactions. In this instance, he had large local reactions approximately 1 hour after injections (2 in the right arm 5 cm apart and 1 in the left arm). Six to 7 hours later, he noticed multiple vesicles on the right arm just below the lower injection site. The patient returned to our clinic with bullous lesions at this site approximately 24 hours after inoculation with 0.4 mL of a 1:1 concentration of extract that contained weeds, ragweed, molds, and dust mites (Tables I and II) near the end of our ragweed season. He had received the same dose the previous month due to a large, painful local reaction from his prior maintenance dose of 0.5 mL. The patient had severe pruritus around the bullae and no tenderness, burning, or any systemic symptoms. There were no associated extrinsic factors on the day of presentation (physical exercise, trauma, or concomitant viral infection) or before the injections. He had no recent travel. His medical history was significant for unspecified mitochondrial metabolism disorder. There was no prior personal or family history of bullous dermatitis. He was not taking any medications known to cause bullae, nor was he using any topical medications. Results of a physical examination were significant for a 10 10-mm bulla just inferior to the lower injection site, and below this was a larger 25 25-mm bulla with surrounding erythema, which measured 31 33 mm (Figure 1). The differential diagnosis included infection, such as bullous impetigo, and delayed local hypersensitivity reaction. The patient was started on cephalexin 500 mg twice daily for 10 days and prednisone 40 mg once daily for 3 days. The following day, Dermatology lanced the bullae, and fluid was sent for Gram stain and culture. Results of the Gram stain showed no organisms. The culture eventually showed no growth. No skin biopsy was obtained. When the patient was evaluated 1 month saline solution

Patterns of affective comorbidity with substance abuse are examined in a sample of 156 adolescent psychiatric inpatients, ages 13 to 18 years old. Affective disorders, including adjustment disorder with depressed mood, were observed in 51.3% of patients. A total of 30.7% of patients had comorbid major depression. In both males and females, secondary major depressive disorder was more common than its primary form. In this population, the primary-secondary paradigm did not predict either acute remission for depressive symptoms or distinct family history of comorbid disorders. Consistent with previous studies of adults, significantly more females had comorbid affective disorder and significantly more males had conduct disorder.

The medical charts of 150 consecutive admissions of dually diagnosed substance abusing adolescents admitted to a psychiatric hospital were examined to determine the extent and characteristics of maltreatment. Results indicated that 61% of the sample experienced or had a history that warranted suspicion of past and/or current maltreatment. Physical abuse was the most frequent form of maltreatment, followed by sexual abuse and neglect. Thirty-seven percent of patients experienced multiple forms of maltreatment. Maltreated patients had significantly more hospitalizations than their nonmaltreated counterparts on the same unit. Moreover, the age of maltreated patients was significantly lower than nonmaltreated patients, perhaps indicating an earlier age of onset of psychiatric illness and/or substance abuse. Analyses of parental substance abuse and psychiatric history among the maltreated and nonmaltreated groups revealed no significant findings. Results are discussed in terms of the following: (1) increased risk of subsequent substance abuse in maltreated children; (2) need for systematic assessment of child maltreatment in psychological or psychiatric evaluations; and (3) importance of treatment to deal with abuse or neglect as part of a comprehensive substance abuse intervention strategy.

To the editor: We read the MINAP analysis by Horne et al 1 with great interest. The authors speculated that the high rates of re-infarction might be related to the administration of the lytic and anti-thrombotic treatment within the pre-hospital environment. Data from our local audit of pre-hospital tenectaplase …

Thirty three pairs of chest radiographs taken up to 10 years apart were obtained for 33 subjects suffering from asbestosis who had applied for compensation to the Pneumoconiosis Medical Board of Western Australia. Multiple films from the period before the first radiograph in each pair, from the intervening period between the two, and from the period subsequent to the second radiograph were also available and all films were read by two independent readers according to the 1980 ILO classification of pneumoconiosis. Films were read twice as side by side pairs ten years apart, twice as two separate randomly ordered films ten years apart, and once as part of the full series of all available chest radiographs on each subject to assess which method provided the best consistency (between reader variation) and repeatability (within reader variation). Judging by consistency, the full series method performed as well as either of the other methods when assessing radiographic changes and significantly better when assessing the level of profusion of small opacities. There was little to choose between the other two methods either judging by consistency or repeatability, which could not be estimated for the full series method. Use of all available films for a subject is recommended for assessing single films, as in a prevalence study, as well as for documenting change in a longitudinal study.

High transmit/receive (Tx/Rx) isolation of phased-array systems on board future US Navy ships is critical to preserving the performance of these systems. The advanced multifunction radio frequency (AMRFC) Testbed is a one-of-a-kind phased-array system that was evaluated to determine the level of Tx/Rx isolation for certain scan angles. The effective-radiated power (ERP) of the AMRFC Tx array was also evaluated to verify the emission characteristics under certain conditions. The preliminary results of evaluating the Tx/Rx isolation and ERP are discussed in this paper.

Liver metastases cause the majority of deaths from colorectal cancer and response to chemotherapy is poor. Intrahepatic arterial 90Y-microspheres may induce tumour regression but the beta-radiation dose is variable and cannot be determined in patients. The 81 keV gamma emission of holmium-166 (166Ho) was used to determine, by single photon emission computed tomographic (SPECT) imaging, the beta-radiation absorbed dose to normal liver in pigs following intrahepatic arterial administration of 166Ho-microspheres. The SPECT system was calibrated with anthropomorphic liver phantoms containing known activity concentrations of 166Ho-chloride. The relationship of SPECT counts to phantom activity concentration was linear with a correlation coefficient of r = 0.996. The SPECT pattern of liver distribution following successive administrations of tracer activities of 166Ho-microspheres was similar. The ratio of initial to total SPECT estimates of mean activity concentration in regions of interest, from which anatomically matched biopsy samples were later obtained and counted in an ionization chamber, showed good correlation (r = 0.924). Prospective SPECT dosimetry performed on a tracer activity of 166Ho-microspheres predicted the total administered activity required to deliver a prescribed radiation absorbed dose of 25 Gy to the liver within an error of +/- 8%. This study demonstrates the feasibility of prospective control of the absorbed radiation dose to the critical normal organ by SPECT dosimetry on a tracer dose of 166Ho-microspheres prior to administration of a therapy dose.

Although the majority of trauma patients are discharged home rather than to a rehabilitation facility, the timeliness of their return to function (RTF) has received little study. The present prospective study attempted to identify those factors that would predict delayed RTF. The study group consisted of patients admitted to a level I trauma center for at least 24 hours, who were of working age (18-64 years), who passed a cognitive screening examination, and who were discharged home. Demographic data and psychological profiles were collected on all participants. Patients were followed by telephone at approximately 1 1/2, 3, and 6 months after discharge. Five hundred seventy patients were entered into the study; complete follow-up data were available for 441. Statistical methods were modeled after survival analysis using a proportional hazards multiple regression to identify variables prognostic of RTF time. This type analysis is independent of time, providing a "risk" of RTF at any point in time after the injury. It also allowed the calculation a relative hazards ratio (RHR), which quantifies the impact of a prognostic variable on RTF time. Injury Severity Score (ISS) and age were found to be associated with RTF (p < 0.0001 for each). After correcting for ISS and age, five additional factors were found to be associated with RTF. Higher educational level and living in a non-family household were associated with faster RTF. Less than 100% income replacement by disability income, pre-injury hostility, and litigation related to the injury were associated with slower RTF. There were a number of other demographic, work-related, and psychosocial factors that were not related with RTF.(ABSTRACT TRUNCATED AT 250 WORDS)

Malignant neoplasia of the lung or pleura is a com mon and serious complication of exposure to asbes tos1 and necessitates careful surveillance of those at risk. The assessment of a pulmonary mass lesion after exposure to asbestos is complicated by the occurrence of pulmonary "pseudotumours." These result from pleural fibrosis and entrapment of the lung parenchyma (Blesovsky's syndrome.23). We report asymmetric rapidly progressive fibrosis of the upper lobe of the lung as another cause of apparent lung malignancy after exposure to asbestos.

Some Cretaceous rhythmic sedimentation, such as the Colorado Greenhorn Formation deposited in the western interior seaway (U.S.), may have been produced by cyclic precipitation intensity change, responding to orbitally produced insolation forcing. To test this hypothesis, a general circulation model was forced with the seasonal maximum and minimum insolation calculated from assumed Cretaceous orbital parameters. Geographic comparisons for July and January of surface temperature, surface pressure, and precipitation were prepared. For January, maximum land-sea contrast produced an increase of more than 6 mm/day precipitation over the interior seaway. However, the July maximum simulation did not produce precipitation increase despite an anticipated monsoonlike circulation over the region. North America appears to be very arid during Cretaceous northern hemisphere summer.

Sixty-two infants and children were examined during the first 12 months in which computer assisted tomography was available at the Sir Charles Gairdner Hospital, and our early local experience is presented. All ten tumours were correctly diagnosed. Diagnostic features are discussed. Seventeen cases showed ventricular dilatation. The difficulties in assessment of marginal hydrocephalus and in differentiation of communicating from non-communicating hydrocephalus are outlined. Less commonly encountered lesions and their diagnostic features are enumerated.

Patients receiving anticoagulant therapy may present with the clinical features of small-bowel obstruction due to intramural haemorrhage of the bowel. Four patients with this syndrome are described, and the clinical problems in diagnosis and management are discussed. Awareness of this complication is necessary so that the diagnosis can be confirmed by barium studies of the small bowel, particularly in patients in whom other anticoagulant complications such as haematuria, bruising and increased prothrombin time are absent. Once the diagnosis is established, treatment is by conservative rather than operative methods.

Presently available techniques for rendering commonly used catheters nonthrombogenic are discussed. The desirability of such catheters is shown and the excellent protection offered demonstrated.That such catheters are able to with-stand dry storage and heat moulding is suggested, but further work in this direction will be required.The desirability of using as fine a diameter catheter as possible in any arterial work is again demonstrated.The wisdom of simultaneous bilateral femoral artery catheterization is questioned.

Associated Diseases Hiatal Hernia It is generally held that hiatal hernia is an integral part of the mucosal ring and that the presence of a ring constitutes definite evidence of hiatus hernia.3,10,57, 67 Since most mucosal rings are located at the squamocolumnar junction, and the rings are always seen well above the diaphragmatic shadow, MacMahon et al.21 argued that hiatal hernia is always associated with a ring. However, this conclusion assumes that the squamocolumnar junction corresponds to the junction of the stomach and esophagus. There is evidence to suggest that this may not be so.29,30, 68 In proved cases of hiatal hernias, . . .

Four cases of volvulus of the colon amongst the demented population on the female side of a mental hospital have been described. Aetiological factors stressed were the high incidence in long-standing mental hospital patients, the relationships to diet and constipation, a preponderance in men, the location of the condition almost exclusively in the sigmoid area of the colon in the elderly patients and frequently a previous history of intestinal dysfunction. It has been suggested that the increased use of tranquilizers predisposes to constipation, is likely to mask symptomatology, and that many of the demented patients in whom volvulus is likely to occur have lost the bowel habit and require habit training. The importance of this and other forms of treatment in relationship to the care of the elderly in institutions was stressed.

During a retrospective survey of patients with pulmonary shadows and blood eosinophilia between the years 1965 and 1980, 42 patients were found with allergic bronchopulmonary fungal disease. Eleven of these had no clinical evidence of asthma. Three of these 11 had hypersensitivity to fungi other than Aspergillus sp. In the absence of asthma there was some difficulty in making a diagnosis, particularly where collapse of the upper lobe occurred in middle-aged or elderly patients and bronchogenic carcinoma was presumed responsible. We suggest that the term allergic bronchopulmonary aspergillosis be replaced by allergic bronchopulmonary fungal disease, the diagnosis be considered in patients with lung disease and blood eosinophilia even in the absence of asthma, and a wider range of fungal allergens be used for skin and precipitin tests.

Adequate control of special nuclear material (SNM) implies a basic knowledge of the quantities of SNM processed through or contained within a fuels processing facility with sufficient accuracy that diversion of the SNM for deleterious purposes can be detected in a timely manner. This report to the Lawrence Livermore Laboratory (LLL) describes the primary process streams containing plutonium that are handled routinely within a spent fuel reprocessing plant and conversion facility. As an aid in implementing the objectives of the accountability system in a realistic situation, the Allied General Nuclear Services (AGNS) reprocessing plant now under construction near Barnwell, South Carolina, was chosen as the study model. The AGNS plant processes are discussed in detail emphasizing those portions of the process that contain significant quantities of plutonium. The unit processes within the separations plant, nitrate storage, plutonium product facility and the analytical laboratory are described with regard to the SNM control system currently planned for use in the facilities. A general discussion of laboratory techniques, nondestructive assay and process instrumentation for plutonium process and product material from a reprocessing plant is included. A comprehensive discussion is given of holdup measurements in plutonium recycle facilities. A brief preliminary overview is presentedmore » of alternative processing strategies for LWR fuel. An extensive review and summary of modeling efforts for liquid-liquid extraction cycles is included. A comprehensive bibliography of previous modeling efforts is covered.« less

Serial plain chest radiographs of 384 men who worked at the Wittenoom crocidolite mine and mill between 1943 and 1966 and who applied for pneumoconiosis compensation between 1948 and 1982 have been examined independently by two trained observers for pleural disease using the 1980 ILO-UICC classification of radiographs to record width and extent of pleural disease. Radiographs covering follow up periods of from two to 38 years were examined (median number of films per subject was nine). The degree of crocidolite exposure was estimated from employment records and a survey of airborne fibre concentrations performed in 1966. Agreement between the observers on the presence and degree of pleural disease in the final film for each subject was moderately close (Kendall's tau B = 0.62) and was least for subjects with thickening less than 5 mm in width. Diffuse pleural thickening extending for greater than 50% of the lateral chest wall was the most common type recorded by both observers. Minor pleural thickening frequently progressed in extent along the lateral chest wall but progression beyond 5 mm in thickness was less common. Pleural plaques were not seen to progress beyond their initial thickness or extent. The rate of onset of thickening in this population increased continually from the time of first exposure and also increased slightly with age. There was evidence that the level of total cumulative exposure to crocidolite increased the rate of onset of pleural thickening in the period between five and 15 years after first exposure. Rate of progression of established thickening was greatest in subjects who first developed thickening early after first exposure. The relative rate of progression decreased slowly with time from first signs of thickening and there was no evidence of any progression more than 15 years after onset.

Serial plain chest radiographs taken between 1943 and 1982 for 280 claimants for compensation for asbestosis and 32 claimants for malignant pleural mesothelioma from the Wittenoom asbestos industry were reviewed by two observers to identify diffuse pleural thickening and pleural effusion. A pleural effusion which appeared and resolved within two years without radiographic or clinical evidence of underlying malignancy, infection or cardiac failure was seen in 15 cases by reader 1 and 24 cases by reader 2. Eighteen cases of effusion, determined from clinical records to be caused by malignant pleural mesothelioma, were seen by reader 1 and 20 by reader 2. The latent periods between commencing work and the first radiograph showing effusion were much shorter for subjects with benign asbestos pleural effusion than for subjects with effusion due to malignant pleural mesothelioma, although there was considerable overlap in the range. The longest latent period for benign asbestos pleural effusion was 22 years and the shortest period for effusion due to malignant pleural mesothelioma was 12 years. The latent period for benign asbestos pleural effusion was inversely related to total cumulative exposure, whereas that for effusion due to malignant pleural mesothelioma was significantly shorter for subjects who had worked in the mill than for those who had worked in the mine. A long latent period and a history of working in the mill were significant discriminators for a malignant as opposed to a benign basis for an effusion. The appearance of a benign asbestos pleural effusion appeared to be a risk factor for the severity of subsequent diffuse pleural thickening.(ABSTRACT TRUNCATED AT 250 WORDS)

Pseudo-obstruction of the colon is a rare form of diffused or segmental dilatation of the colon nonassociated with an obstructive lesion. It usually accompanies or follows other major illnesses in elderly patients. The abdominal radiographs are very helpful in differentiating this form of ileus from a chronic mechanical obstruction of the colon and in evaluating its complications. The abdominal radiographs of 14 patients with pseudo-obstruction of the colon were reviewed, and the radiographic findings associated with this condition were evaluated.

Sixty eight impotent men underwent corpora cavernosography and corpora cavernosal pressure measurements during saline infusion. Nineteen of the men had internal pudendal arteriograms. Correlation between the cavernosograms and saline infusion induced pressure measurements was "good" in 56/66(84%), "approximate" in 5/66(8%) and there was no correlation in 5/66(8%). Two patients were excluded for technical reasons. The spread of results and the good correlation of the two tests speaks for the accuracy of the method. It was of value in diagnosis and will be of paramount importance if veno occlusive surgery becomes a reliable method of treatment.

This study compares the relationship between lung function and radiological abnormality in 46 subjects with asbestosis and 38 subjects with cryptogenic fibrosing alveolitis. Radiographs were graded separately by two observers according to the 1980 International Labour Organisation criteria for classification of the pneumoconioses. The correlation between the transfer factor of the lungs and the radiographic profusion of small parenchymal opacities was found to be greater in subjects with asbestosis than in subjects with cryptogenic fibrosing alveolitis. At any level of radiological profusion transfer factor was higher in cases with asbestosis than in cases with fibrosing alveolitis. As pleural thickening is seen commonly in asbestosis and may influence lung volumes and the ratio of transfer factor to effective alveolar volume, the results of these measurements were compared only in the cases showing absent or minimal pleural thickening. Both of these variables were higher in the subjects with asbestosis. The results indicate that despite pathological, functional and radiographic similarities, lung function for a given degree of radiographic parenchymal abnormality is better in subjects with asbestosis than in subjects with cryptogenic fibrosing alveolitis, and that changes in the plain chest x-ray appearances in asbestosis correlate more closely with the results of lung function tests.

An estimate has been made of the prevalence of unrecognised pneumoconiosis in former crocidolite workers from Wittenoom, Western Australia. All plain chest radiographs relating to a one in six random sample (1025 men) of all former Wittenoom workers who had never entered a compensation claim to the Pneumoconiosis Medical Board of Western Australia were sought from Perth teaching hospitals and from the Perth Chest Clinic where compulsory examination of all workers in the mining industry takes place. Radiographs were recovered for 83% of the men and read independently by two observers. By means of logistic regression analysis a current prevalence of parenchymal abnormality (defined as a radiographic profusion of small opacities of category 1/0 or greater on the ILO classification) of nearly 20% was calculated after adjustment for age, time since first exposure, and cumulative exposure level. One hundred men randomly selected from those known to be alive in the sample were invited to attend for a new radiographic examination. Seventy four men attended and the predicted prevalence was confirmed. It is estimated from these data that there were between 450 and 900 former Wittenoom workers in Australia at the end of 1980 who had radiographic abnormality consistent with pneumoconiosis but had not claimed compensation or had asbestosis diagnosed. The data are consistent with there being no threshold dose of crocidolite exposure for the development of radiographic abnormality in this group.

The course of pulmonary asbestosis and its determinants have been examined in 280 applicants for compensation among former workers of the crocidolite mine and mill at Wittenoom Gorge, Western Australia. Serial chest radiographs accrued over more than 3 decades were graded for parenchymal disease separately by two observers according to the 1980 ILO Classification of Radiographs for Pneumoconioses and without knowledge of exposure histories or compensation details. In 136 subjects whose median duration of exposure was 37 months, radiographic asbestosis appeared between 1 and 34 yr after initial exposure and then progressed continuously. Total exposure to asbestos and time from first exposure to the appearance of definite radiographic asbestosis were significant determinants of the rate of progression of profusion of radiographic abnormality. Asbestosis should be considered to be an active disease even 3 decades after exposure has ended.

Anomalies in the ratio of transfer factor to effective alveolar volume as an indicator of pulmonary gas exchange in cases of asbestosis may be related to diffuse pleural thickening. To examine the effect of pleural disease on gas transfer the plain chest radiographs of patients with asbestosis were assessed by two observers for profusion of parenchymal opacities and extent of pleural disease and the results were related to lung function. In 30 cases of category 1 profusion of parenchymal abnormality (according to the ILO international classification of radiographs for pneumoconiosis) transfer factor was independent of the degree of pleural thickening. The ratio of transfer factor to effective alveolar volume correlated directly with the degree of pleural thickening as alveolar volume fell with increasing severity of pleural disease. The results indicate that correcting transfer factor for alveolar volume does not provide an accurate reflection of severity of diffuse parenchymal fibrosis in patients with asbestosis and even minor pleural disease.

The survival of 354 claimants for compensation for pulmonary asbestosis among former workers of the Wittenoom crocidolite mine and mill in Western Australia has been examined. There were 118 deaths up to December 1982. The median time between start of work and claim for compensation was 17 years. The standardised mortality ratio (SMR) for deaths from all causes was 2.65 (p less than 0.0001). The SMR for pneumoconiosis was 177.2 (p less than 0.0001), bronchitis and emphysema 2.6 (p = 0.04), tuberculosis 44.6 (p less than 0.0001), respiratory cancer (including five deaths from malignant pleural mesothelioma) 6.4 (p less than 0.0001), gastrointestinal cancer 1.6 (p = 0.22), all other cancers 1.6 (p = 0.17), heart disease 1.4 (p = 0.07), and all other causes 2.18 (p = 0.004). Plain chest radiographs taken within two years of claiming compensation were found for 238 subjects and were categorised independently by two observers according to the International Labour Organisation criteria without knowledge of exposure or compensation details. Profusion of radiographic opacities, age at claiming compensation, work in the Wittenoom mill, and degree of disability awarded by the pneumoconiosis medical board were significant predictors of survival, but total estimated exposure to asbestos was not. Radiographic profusion and degree of disability were, however, predictable by total exposure. The median survival from claim for compensation was 17 years in subjects with ILO category 1 pneumoconiosis, 12 years in category 2, and three years in category 3.