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Purpose People with HIV (PWH) are at increased risk for developing atherosclerotic cardiovascular disease (ASCVD). The primary objective of this study was to evaluate adherence to guideline recommendations on statin use in PWH for both primary and secondary ASCVD prevention in a single healthcare institution. Methods A retrospective chart review was performed to evaluate statin use for cardiovascular risk reduction in PWH 40 to 75 years of age at an HIV clinic over a 1-year evaluation period. The study included patients who met one of the 4 criteria for statin therapy defined in the “ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.” Patient demographics were collected and a 10-year ASCVD risk score was calculated. Results A total of 432 PWH were evaluated for statin therapy; 205 patients (47.5%) met criteria for statin therapy. The majority of patients were male, the average age was 58 years, and the average time since HIV diagnosis was 19 years. The mean ASCVD risk score was 14.2%. Only 79 patients (38.5%) who met criteria were prescribed statin therapy, and only 45 (56.9%) were prescribed statin therapy of appropriate intensity. Use of ART pharmacokinetic enhancer was low and did not affect statin prescribing. Multivariable analysis found that age, diabetes, clinical ASCVD, and an appointment with a pharmacist clinician prescriber predicted statin utilization. A high ASCVD risk score (>20%) did not predict statin treatment. Conclusion Statin prescribing is low in PWH, who are at increased risk for ASCVD. Future research in PWH should focus on improving ASCVD risk assessment and exploring causes for statin underprescribing.

Background and Aims Although water exchange may improve adenoma detection compared with CO2, it is unclear whether water is a better medium to fill the lumen during withdrawal and visualize the mucosa. Total underwater colonoscopy (TUC) involves the use of water exchange with the air valve off during insertion followed by the inspection of the mucosa under water. Our goal was to compare miss rates for TUC with standard CO2 for polyps and adenomas using a tandem colonoscopy design. Methods We randomized participants to undergo tandem colonoscopies using TUC or CO2 first. In TUC, water exchange was performed during insertion, and withdrawal was performed under water. For the CO2 colonoscopy, both insertion and withdrawal were performed with CO2. The main outcomes were miss rates for polyps and adenomas for the first examination calculated as the number of additional polyps/adenomas detected during the second examination divided by the total number of polyps/adenomas detected for both examinations. Inspection times were calculated by subtracting the time for polypectomy, and care was taken to keep the times equal for both examinations. Results A total of 121 participants were randomized with 61 having CO2 first. The overall miss rate for polyps was higher for the TUC-first group (81/237; 34%) compared with the CO2-first cohort (57/264; 22%) (P = .002). In addition, the overall miss rate for all adenomas was higher for the TUC-first group (52/146; 36%) compared with the CO2 group (37/159; 23%) (P = .025). However, 1 of the 3 endoscopists had higher polyp/adenoma miss rates for CO2, but these were not statistically significant differences. The insertion time was longer for TUC than for CO2. After adjusting for times, participant characteristics, and bowel preparation, the miss rate for polyps was higher for TUC than for CO2. Conclusions We found that TUC had an overall higher polyp and adenoma miss rate than colonoscopy performed with CO2, and TUC took longer to perform. However, TUC may benefit some endoscopists, an issue that requires further study. (Clinical trial registration number: NCT03231917 .)

Colorectal cancer (CRC) is a global public health threat. The lifetime risks of an individual developing or dying from CRC are approximately 5% and 2.5%, respectively; worldwide, there are an estimated 1.4 million new cases and 700,000 deaths annually. The fundamental aim of screening for CRC is to decrease CRC risk and mortality. CRC is amenable to screening and is a largely preventable cancer, through the detection and removal of precancerous polyps. Several different strategies for CRC screening exist, each with advantages and limitations pertaining to effectiveness, risk, cost, and availability. Modern screening strategies emphasize the importance of prevention and risk stratification, grouping patients into average- and high-risk categories. The final common pathway for all screening programs is colonoscopy; hence, the effectiveness of screening depends heavily on the availability of high-quality colonoscopy. This chapter will provide an overview of CRC epidemiology, and present screening and surveillance approaches in average-risk and high-risk individuals.

We determined tissue localization, shedding patterns, virus carriage, antibody response, and aerosol transmission of Porcine epidemic diarrhea virus (PEDV) following inoculation of 4-week-old feeder pigs. Thirty-three pigs were randomly assigned to 1 of 3 groups for the 42-day study: inoculated (group A; n = 23), contact transmission (group B; n = 5), and aerosol transmission (group C; n = 5). Contact transmission occurred rapidly to group B pigs whereas productive aerosol transmission failed to occur to group C pigs. Emesis was the first clinical sign noted at 3 days postinoculation (dpi) followed by mild to moderate diarrhea lasting 5 more days. Real-time PCR detected PEDV in fecal and nasal swabs, oral fluids, serum, and gastrointestinal and lymphoid tissues. Shedding occurred primarily during the first 2 weeks postinoculation, peaking at 5–6 dpi; however, some pigs had PEDV nucleic acid detected in swabs collected at 21 and 28 dpi. Antibody titers were measurable between 14 and 42 dpi. Although feces and intestines collected at 42 dpi were PEDV negative by PCR and immunohistochemistry, respectively, small intestines from 70% of group A pigs were PCR positive. Although disease was relatively mild and transient in this age group, the results demonstrate that 4-week-old pigs are productively infected and can sustain virus replication for several weeks. Long-term shedding of PEDV in subclinically affected pigs should be considered an important source for PEDV transmission.

Yellow dwarf (YD) disease is one of the most destructive diseases of cereals worldwide. Wheat (Triticum aestivum L.)-Thinopyrum intermedium 7E(7D) substitution line P29 carries resistance to YD, known as Bdv3, that originates on the long arm of chromosome 7E of Th. intermedium, and the resistance was introgressed into wheat chromosome 7D as T7DS.7DL-7EL in the translocation lines P961341 and P98134. Until now, quantification of YD viruses in cereal crops was usually done by enzyme-linked immunosorbent assay (ELISA), which is time consuming and laborious. To facilitate this analysis, SSR-Bdv3, a diagnostic molecular marker, was developed in this study. The transmission of the Th. intermedium segment with Bdv3 was investigated using the SSR-Bdv3 marker and ELISA in F 2 and testcross progeny derived by crossing two wheat-Th. intermedium translocation lines to four common wheat cultivars. A Th. intermedium chromosome 7E segment in the translocation line P98134 was preferentially transmitted through male gametes in all of its crosses with the four wheat cultivars. However, the transmission frequency of the Th. intermedium 7E segment in another wheat-Th. intermedium translocation line, P961341, varied in different genetic backgrounds. The F2 populations from reciprocal crosses of Chinese Spring and P961341 showed good fits to the expected ratio of 1: 2: 1. In this study, male preferential transmission for either chromosome 7E or chromosome 7D was observed in the progeny derived by crossing P961341 to other wheat cultivars.

This document is the first update of the American College of Gastroenterology (ACG) colorectal cancer (CRC) screening recommendations since 2000. The CRC screening tests are now grouped into cancer prevention tests and cancer detection tests. Colonoscopy every 10 years, beginning at age 50, remains the preferred CRC screening strategy. It is recognized that colonoscopy is not available in every clinical setting because of economic limitations. It is also realized that not all eligible persons are willing to undergo colonoscopy for screening purposes. In these cases, patients should be offered an alternative CRC prevention test (flexible sigmoidoscopy every 5-10 years, or a computed tomography (CT) colonography every 5 years) or a cancer detection test (fecal immunochemical test for blood, FIT).

Fusarium head blight (FHB), caused by the fungi Fusarium g raminearum and Fusarium culmorum , is a worldwide disease of wheat ( Triticum aestivum L.). The Chinese cultivar Ning 7840 is one of a few wheat cultivars with resistance to FHB. GeneCalling™, an open-architecture mRNA-profiling technology, was used to identify differentially expressed genes induced or suppressed in spikes of Ning 7840 after infection by F. graminearum. One hundred and twenty-five cDNA fragments representing transcripts differentially expressed in wheat spikes were identified. Based on BLASTN and BLASTX analyses, putative functions were assigned to some of the genes: 28 were assigned functions in primary metabolism and photosynthesis, 7 were involved in defense response, 14 were involved in gene expression and regulation, 24 encoded proteins associated with structure and protein synthesis, 42 lacked homology to sequences in the database, and 3 were similar to cloned multidrug resistance or disease resistance proteins. Of particular interest in this study were genes associated with resistance and defense against pathogen infection. Real-time quantitative reverse-transcription PCR indicated that of 51 genes tested, 19 showed 2-fold or greater induction or suppression in infected Ning 7840 in comparison with the water-treated control. The remaining 32 genes were not significantly induced or suppressed in infected Ning 7840 compared with the control. Subsequently, these 19 induced or suppressed genes were examined in the wheat line KS24-1, containing FHB resistance derived from Lophopyrum elongatum , and Len, an FHB-susceptible wheat cultivar. The temporal expression of some of these sequences encoding resistance proteins or defense-related proteins showed FHB (resistance specific) induction, suggesting that these genes play a role in protection against toxic compounds in plant–fungus interactions. On the basis of comprehensive expression profiling of various biotic or abiotic stress response genes revealed by quantitative PCR in this study and other supporting data, we hypothesized that the plant–pathogen interactions may be highly integrated into a network of diverse biosynthetic pathways.

Introduction: Vascular disease is driven by systemic inflammation that can arise from sites distal to the affected coronary or cerebral vessels. The objective of this study is to characterize the inflammatory potential of serum from patients with coronary artery disease (CAD) using cultured endothelial cells as a biosensor of the circulating milieu. Methods: Serum samples from CAD patients (N=48) and healthy control subjects (N=50) were incubated with primary human coronary artery endothelial cells at a 1:10 dilution for 4h, following by isolation of the cellular RNA. Alteration of inflammation-responsive elements (adhesion molecules and cytokines) was assessed on a gene expression level. Specific indicators included intercellular adhesion molecule-1 (ICAM), vascular cell adhesion molecule-1 (VCAM), and interleukin-8 (IL-8). Additionally, the serum samples from the CAD patients and healthy individuals were quantitatively analyzed for IL-1β, IL-6, IL-8, and TNF-α using an electrochemical luminescence platform. Results: For the CAD subjects’ serum, the mean values of ICAM, VCAM, and IL-8 expression were all elevated compared to healthy control subjects (p Conclusions: As yet uncharacterized circulating factors in the serum of CAD patients appear to activate endothelial cells. This assay paradigm performed well in terms of discriminating patients with CAD compared to healthy subjects, with greater range and specificity than specific inflammatory markers.

We have designed and synthesized by solution methods two simple two-helix bundles based on a conformationally constrained cyclo-dipeptide template to the side chains of which two short, 2,2,6,6-tetramethylpiperidine-1-oxyl-4-amino-4-carboxylic acid spin-monolabeled, 310-helical peptides are covalently tethered. The preferred conformation of the appended chains has been assessed by FTIR absorption. The conclusions are corroborated by an X-ray diffraction analysis of one of the terminally blocked pentapeptide tails. For the first time, a solvent-dependent, inter-helix interaction has been monitored by conventional ESR spectroscopy on fully synthetic peptide systems. Half-field ESR measurements of these side-chain-substituted templates provided an experimental average distance between the two labels that is in good accord with that determined in a molecular modeling study.

While the utility of assessing past research is widely recognised, few studies have focused on the funding body as the unit of evaluation. This study focused on individual funding bodies in one field of research, malaria: the results are presented of a survey of both the international financial inputs and the publications that resulted. Some major funding organisations obtained more apparent productivity from their investment than did others, although the leading funding bodies all supported papers that were more highly cited than the average for the field. The mean number of funding bodies acknowledged on more highly cited papers was greater than that for the complete set of papers, suggesting that the presence of multiple funding is positively correlated with citation performance. Other subjective methods of assessment involving surveys of expert opinion are also discussed. Copyright , Beech Tree Publishing.

The users or benefiraries of research seem set to play an increasing role in the scientific system. Limited government funding combined with the growing view that publicly funded researchers should pay more attention to the needs of society mean that users as well as scientists should be involved in setting broad research priorities. Peer review, the traditional mechanism for making decisions on the allocation of research funds, is poorly equipped to consider user views and broader issues of scientific strategy, including the distribution of resources across fields. In the study described here, a number of new concepts and methodological tools have been developed for the combined inuolvment of users and researchers in determining priorities for strategic research in Public sector finding agencies. The study focuses on the scientiic work funded by the UK Natural ,Environment Research Council.

With an increasing proportion of individuals surviving until the seventh or eighth decade of life, diagnosis and treatment of elderly patients has become commonplace. Chronic airways obstruction is very prevalent in adults, and because asthma may not develop until later age and is frequently accompanied or obscured by other complications, it often goes unrecognized. Failure to diagnose asthma in a timely fashion unnecessarily increases the socioeconomic burden of asthma. In a recent survey to assess the functional status of a population 65 years of age or more, asthmatic patients had more problems with activities of daily living and a greater assessment of poor health, in comparison with a control group matched for age and sex. 36 Asthma very definitely changes the quality of life of many patients in this age group. Asthma may be a continuum of disease from childhood to adulthood, but asthma in the elderly may present unique diagnostic and therapeutic challenges to the clinician. In contrast to the younger asthma patient, the elderly asthma patient is more likely to have other illnesses and associated therapies that must be considered and managed. A clinical understanding of disease–disease, disease–drug, and drug–drug interactions between asthma and other associated illnesses is imperative. 3 This article focuses on the major diseases, drugs, and drug interactions that challenge us when treating asthma in the older patient (Table 1).

The tetradentate dianionic Schiff base ligand Bu4salophenH2 reacts with [RhCl(C2H4)2]2 and NR4OH (R = n-Bu, Et) to produce the complexes RhR(Bu4salophen) (1, R = n-Bu; 2, R = Et), which undergo pho...

Many patients present with symptoms suspected to be allergic in origin that ultimately turn out to be illnesses unrelated to allergic disease. As there are a number of upper and lower respiratory manifestations of endocrinopathies that may cause confusion with allergic diseases, a review of these illnesses is helpful for the clinician (Table 1). Hypothyroidism is the most common masquerader, causing nonallergic rhinitis, upper airway obstruction, or even a decline in central respiratory drive. 6 An increase in central respiratory drive associated with thyrotoxicosis can present with dyspnea as its major clinical manifestation. Although the emphasis of this article is on thyroid diseases, other afflictions of the endocrine system that present as impostors are included. Acute hypoparathyroidism following thyroid surgery may lead to symptoms of laryngeal stridor and muscle weakness. Diabetes mellitus, the most prevalent of the metabolic diseases, is frequently complicated by infections that may pose as allergic disease of either the upper or lower respiratory tract.

White-collar workers were surveyed approximately three months and six months following layoffs. Approximately half of the respondents received extensive outplacement assistance while the remaining respondents, not having formal outplacement available, participated in an informal social support group sponsored by the community. Results indicate that individuals receiving formal outplacement training had higher job search self-efficacy and were more optimistic regarding recovery from job loss than were those going to the informal social support group. While no differences were observed between the two groups on the number of job offers received after three months, members of the social support group appear to have the advantage in finding jobs comparable to their previous jobs. These findings and their implications are discussed.

Strategic planning and priority-setting have become inevitable for UK research funding agencies in the 1990's. But it is an activity which is viewed with some suspicion by the scientific community, in which it is an aphorism that discovery cannot be planned. There is considerable interest therefore, in the promise offoresight analysis as an alternative to conventional strategic planning.

Locomoting-to-reach is a basic perception/action behavior that requires visual information for the control of both locomotion and reaching components. We investigated the visual information and the control strategies used to guide both the head and the hand on approach to a target in a locomotion-to-reach task. In this study, participants were required to locomote in the dark to a lit target in three different conditions: monocular vision/target with image size, binocular vision/target with image size, and binocular vision/point-light target (without image size). In task one, participants brought their eyes to the target. In task two, participants brought their outstretched hand to the target. Movement trajectories for both tasks were analyzed. Results show that participants were significantly more accurate when binocular information was present. In both tasks, participants were found to use a proportional rate control strategy rather than a constant \( \dot{\tau} \) strategy. In the walk-to-reach task, they used monocular and/or binocular τ information to guide the head and then switched to using relative disparity τ to guide the hand to final target acquisition, switching when the hand centric τ became less than the head centric τ. Dynamical models of the information and control strategies were used to perform simulations that were found to fit the data well. The conclusion is that proportional rate control is used sequentially with head centric, then hand-centric τ-based information, using at each moment the τ with the smallest value.

This study examines how two aspects of formalization of grievance procedures affect grievance procedure effectiveness: written versus oral presentation of grievance and the level of union and management authorized to resolve grievances at the first step. Several demographic variables were controlled for: size of bargaining unit, percentage of organization represented, number of grievances filed, and industry. A sample of 46 firms, representing a broad cross-section of unionized companies in the private sector, was obtained with the help of the American Arbitration Association. Results indicate that more formal grievance procedures (e.g., written presentation) are positively related to resolution rates at the first step. The number of grievances field and the size of the bargaining unit were positively related to total resolution rates prior to arbitration.

We provide a solution to a major problem in visually guided reaching. Research has shown that binocular vision plays an important role in the online visual guidance of reaching, but the visual information and strategy used to guide a reach remains unknown. We propose a new theory of visual guidance of reaching including a new information variable, tau(alpha) (relative disparity tau), and a novel control strategy that allows actors to guide their reach trajectories visually by maintaining a constant proportion between tau(alpha) and its rate of change. The dynamical model couples the information to the reaching movement to generate trajectories characteristic of human reaching. We tested the theory in two experiments in which participants reached under conditions of darkness to guide a visible point either on a sliding apparatus or on their finger to a point-light target in depth. Slider apparatus controlled for a simple mapping from visual to proprioceptive space. When reaching with their finger, participants were forced, by perturbation of visual information used for feedforward control, to use online control with only binocular disparity-based information for guidance. Statistical analyses of trajectories strongly supported the theory. Simulations of the model were compared statistically to actual reaching trajectories. The results supported the theory, showing that tau(alpha) provides a source of information for the control of visually guided reaching and that participants use this information in a proportional rate control strategy.

This study examines two aspects of formalization of grievance procedures: written vs oral presentation of grievance and level of union and management authorized to resolve grievances. Results indic...

The molecular motion of poly(oxymethylene) in dilute phenol solution is studied by using the coupled spin relaxation of a methylene group ( 13 CH 2 ). The motional anisotropy is smaller than those measured for hydrocarbon chains in solution. Unlike the hydrocarbons, poly(oxymethylene) is most stable in the gauche conformer, which leads to helical chain configurations. The smaller anisotropy may reflect the lack of correlated motions of a few vonds in the polymer chain

To the Editor: Dr Meyer states (1) that the new American College of Gastroenterology Guidelines for Colorectal Cancer Screening 2008 (2) "do not even agree with the previous ACG guidelines." In fact, the earlier American College of Gastroenterology (ACG) guidelines (3), published in 2000, also recommended colonoscopy as the preferred screening test and were the first to do so. The American Society for Gastrointestinal Endoscopy (4) and the National Comprehensive Cancer Network (5) each subsequently endorsed colonoscopy as the preferred screening test. The fact that there are not enough colonoscopists to perform screening colonoscopy is debatable (6), but the guideline states (2) that "it is recognized that colonoscopy is not available in every clinical setting because of economic limitations. It is also recognized that not all eligible individuals are willing to undergo screening colonoscopy for screening purposes." Alternative screening strategies and their rationales are discussed in detail in the guidelines (2). The ACG continues to endorse the US Multi-Society on Colorectal Cancer screening guidelines (7), which present a menu of screening options. However, there is no evidence that offering multiple options increases the number of patients who get screened, and the approach of offering a preferred option may actually result in higher screening rates (8,9). Furthermore, the approach endorsed by the ACG in 2000 is closer to what is actually done in clinical practice (10) in the United States than any of the "menu-of-options" approaches to screening (7,11). These rationales are discussed in detail in the guidelines. With regard to the issue of the guidelines being self-serving, the ACG endorsed the use of computed tomography (CT) colonography in the Multi-Society Task Force guidelines (7) as an alternative to colonoscopy and again in the ACG guidelines as an alternative option in patients unwilling to undergo colonoscopy (2). In contrast, the US Prevantive Services Task Force declined to recommend any function of CT colonography in screening (11). Although the guidelines may be interpreted by some as self-serving, that does not negate the substantial evidence that a high-quality colonoscopy remains the most effective colorectal cancer screening strategy available, or that large-scale colonoscopy screening programs exist now in Germany, Italy, and Poland.

The structure of the chemically synthesized C-terminal region of the human agouti related protein (AGRP) was determined by 2D 1H NMR. Referred to as minimized agouti related protein, MARP is a 46 residue polypeptide containing 10 Cys residues involved in five disulfide bonds that retains the biological activity of full length AGRP. AGRP is a mammalian signaling molecule, involved in weight homeostasis, that causes adult onset obesity when overexpressed in mice. AGRP was originally identified by homology to the agouti protein, another potent signaling molecule involved in obesity disorders in mice. While AGRP's exact mechanism of action is unknown, it has been identified as a competitive antagonist of melanocortin receptors 3 and 4 (MC3r, MC4r), and MC4r in particular is implicated in the hypothalamic control of feeding behavior. Full length agouti and AGRP are only 25% homologous, however, their active C-terminal regions are approximately 40% homologous, with nine out of the 10 Cys residues spatially conserved. Until now, 3D structures have not been available for either agouti, AGRP or their C-terminal regions. The NMR structure of MARP reported here can be characterized as three major loops, with four of the five disulfide bridges at the base of the structure. Though its fold is well defined, no canonical secondary structure is identified. While previously reported structural models of the C-terminal region of AGRP were attempted based on Cys homology between AGRP and certain toxin proteins, we find that Cys spacing is not sufficient to correctly determine the 3D fold of the molecule.

The recently isolated trichogin GA IV is a 10 amino acid, Aib-rich peptide with potent membrane-modifying properties. The peptide is too short to span lipid bilayers, so the mechanism by which trichogin GA IV interacts with biological membranes is unknown. The crystal structure has been solved, but there is much less information on the peptide's conformation in solution. This problem is addressed by examining the electron spin resonance (ESR) of single and double TOAC-labeled trichogin GA IV analogues, where TOAC is a rigid nitroxide amino acid and serves as an Aib analogue. The doubly labeled peptides, trich-1,4, -4,8 and -1,8, represent all possible trichogin GA IV analogues containing two Aib → TOAC substitutions. ESR in MeOH at 200 K of the g ≈ 2 spectral region suggests that the N-terminus from residues one through four adopts a helical structure similar to that observed in the crystal. However, the central and C-terminal regions appear to be structurally heterogeneous. To further resolve the solutio...

The relationship between the tobacco industry and the biomedical research community is not an easy one. Not only is smoking tobacco harmful to health but there is a belief that the companies will attempt to silence researchers whose findings are unpalatable. Consequently there is suspicion that researchers who accept money from the tobacco industry, whether directly from a company or from a charitable foundation financed by the industry, are compromising their integrity. There has been denigration of those who accepted funds from the UK Health Promotion Research Trust (HPRT), a charity set up by the tobacco industry in 1983 to finance research into how to promote healthy lifestyles. Recently, the UK Cancer Research Campaign sought to restrict funding going to the University of Cambridge because of its acceptance of an endowed chair in international relations from BAT Industries plc. But how widespread in the UK is the practice of accepting tobacco money for biomedical research? The source of data was the Wellcome Trust’s Research Outputs Database, a collection of records of some 185 000 UK biomedical papers covered in the Science Citation Index or Social Sciences Citation Index in the serial literature from 1988–94, and selected on the basis of being in biomedical journals or having biomedical keywords in their addresses. They have been inspected to determine their sources of funding as given in the acknowledgements section or, for intramural funding, from their addresses. A search was made for records with funding from the major tobacco companies and consortia, including the HPRT and the Tobacco Products Research Trust (TPRT), which was set up at almost the same time to research into the health effects of tobacco. A geographical analysis was made of the addresses on the basis of UK postcodes and other countries represented, and other funding bodies such as government agencies and medical charities were recorded for each paper. The level of the research was determined from the journal in which the paper was published on the basis of the system developed by CHI Research Inc: 1=clinical observation; 2=clinical mix; 3=clinical investigation; and 4=basic research. Over the 7 years, there were 269 papers acknowledging support from the tobacco industry for tobacco-related research, or from the HPRT. The respective numbers were 140 and 129; there was no overlap. The map shows the geographical distribution of the papers: it is evident that the practice of accepting tobacco money was widespread and of the UK’s medical schools only Glasgow does not feature on either list. But the two sets of papers differed greatly. The tobacco-related research was co-funded by many other organisations, 30% by medical charities and 61% by governments (both UK and foreign), with an average of 3·7 funders per paper. But the 129 HPRT papers had on average only 1·9 funders and for 57% the HPRT was the sole source of funding. The tobacco-related papers were also much more international, with 18% of the addresses from outside the UK compared with 2% for the HPRT papers. The mean research level of the tobacco-related papers was 2·9, which is a remarkably high average value, indicating that much of the work was basic research; by contrast the mean research level for the HPRT papers was 1·9, so this work was more clinical; some of the papers were in social science journals which were not classified by CHI Research. The numbers of papers funded by the tobacco industry have declined somewhat from their peak in 1991 and are likely to reduce sharply over the next 2–3 years as funding from both the TPRT and the HPRT (originally £8 million and £11 million respectively) is exhausted and they cease operation. There is no evidence that authors’ propensity to acknowledge tobacco funding is less than for other sources. The final report of the TPRT listed 44 papers recorded in the Research Outputs Database. Of these, 37 acknowledged the TPRT, or 84%, a similar percentage to the rate of acknowledgement of charity and research-council grants.

An audit of international activity in malaria research highlights the need for a more concerted research effort.

The Wellcome Trust has recently carried out a scientific audit of its funding of immunology research. The strategy used for the audit aimed to build on the traditional field review by the provision of quantitative, systematic analysis that could support expert opinion. This paper presents some of the findings of the Wellcome Trust audit, focusing in particular on the quantitative analysis of outputs in the field.

The safety and patient acceptance of two preparations of modified (reduced and alkylated) immune globulin for intravenous use were evaluated; one preparation was formulated as a 5% solution in 10% maltose (IGIV-maltose), the other did not contain maltose (IGIV). In this double-blind trial each of 29 immunodeficient patients received three consecutive monthly infusions (100 or 150 mg/kg immune globulin) of one preparation before being crossed over to the other. Only 3 of 29 patients had adverse reactions when on IGIV-maltose, compared with 22 who had side-effects during infusions of IGIV (p0.001). Adverse reactions were recorded during 3 of 87 IGIV-maltose infusions and during 51 infusions with the maltose-free IGIV (p0.001). 27 patients expressed preference for IGIV-maltose. IGIV-maltose seems safe and will permit rapid infusion of large doses of immune globulin, thus improving the management of patients with antibody deficiency diseases.