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This paper describes the epidemiology of coronavirus disease 2019 (COVID-19) in Northern Ireland (NI) between 26 February 2020 and 26 April 2020, and analyses enhanced surveillance and contact tracing data collected between 26 February 2020 and 13 March 2020 to estimate secondary attack rates (SAR) and relative risk of infection among different categories of contacts of individuals with laboratory confirmed severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Our results show that during the study period COVID-19 cumulative incidence and mortality was lower in NI than the rest of the UK. Incidence and mortality were also lower than in the Republic of Ireland (ROI), although these observed differences are difficult to interpret given considerable differences in testing and surveillance between the two nations. SAR among household contacts was 15.9% (95% CI 6.6%–30.1%), over 6 times higher than the SAR among ‘high-risk’ contacts at 2.5% (95% CI 0.9%–5.4%). The results from logistic regression analysis of testing data on contacts of laboratory-confirmed cases show that household contacts had 11.0 times higher odds (aOR: 11.0, 95% CI 1.7–70.03,P-value: 0.011) of testing positive for SARS-CoV-2 compared to other categories of contacts. These results demonstrate the importance of the household as a locus of SARS-CoV-2 transmission, and the urgency of identifying effective interventions to reduce household transmission.

In Northern Ireland there are concerns about candidaemia, with rates higher than those reported in England and Wales. Our aim was to explore the epidemiology of candidaemia during a 10 year period and the clinical management upon suspicion of cases during a one year enhanced investigation in Northern Ireland.Candidaemia reports to the Public Health Agency were validated during 2002-2011 and used to examine incidence and antifungal sensitivity trends (during 2007-2011). A clinical proforma was used to collate information for all patients with candidaemia in 2011.The majority (96%) of isolates were captured through voluntary laboratory reporting. There was a year-on-year increase in candidaemia from 2002-2011, from 80 to 131 episodes (incidence rate ratio 1.09 95% CI 1.05-1.13). Rates were highest in males under 1 year and over 75 years. 83/98 (85%) of case notes were available from candidaemia patients during 2011. The most prevalent risk factors were patients on total parenteral nutrition (26 people, 31.3%), surgery in the two months prior to the candidaemia (25 people, 30.1%), significant steroid use in the previous 3 months (24 people, 28.9%) and active neoplastic disease (23 people, 27.7%),This study confirmed an increase in candidaemia rates over time, with the observed incidence in 2011 higher than England and Wales. We identified areas for improvement around the clinical management of candidaemia. We recommend raising the awareness of guidelines for fundoscopy, echocardiography and central venous catheter removal.

SummaryIn a double-blind, partial cross-over study of 141 patients with mild to moderate hypertension, chlorthalidone 50 mg was compared with chlorthalidone 50 mg/ triamterene 50 mg combination treatment. The study assessed clinical efficacy in the reduction of blood pressure, and safety with regard to serum potassium concentration and adverse reactions. Both treatment regimens were found to offer equivalent therapeutic success, but the decrease in serum potassium concentration was significantly less with the combination treatment than with chlorthalidone alone.

A randomized, double-blind, parallel-group, 6-week study was undertaken to compare the efficacy and tolerability of once or twice daily administration of the selective serotonin reuptake inhibitors paroxetine and fluoxetine. After a 1-week placebo wash-out, patients suffering from DSM-III major depression and with a score of 18 or more on the 21-item Hamilton Rating Scale for Depression (HRSD) received either paroxetine or fluoxetine. The patients were assessed for efficacy using the HRSD, Montgomery-Asberg Depression Rating Scale and Clinical Global Impression; for tolerability, adverse events were elicited by the use of a non-leading question and a side effects checklist. The groups of patients were comparable on entry to the study. One hundred patients were recruited into the study, of whom 78 were evaluable for the efficacy analysis. Paroxetine and fluoxetine showed comparable efficacy at the end of the 6-week treatment period, but a statistically significant difference in the number of responders at week 3 in favour of paroxetine was observed. This could suggest an earlier onset of action with paroxetine. Also, associated anxiety symptoms were significantly reduced on paroxetine compared with fluoxetine at week 3. Patients on paroxetine reported fewer adverse events than those on fluoxetine. The most commonly reported adverse events were nausea and vomiting in both groups.

Using an effective index model, we calculate the eigenvalue equation for a large array of evanescent-wave-coupled multistripe lasers. The special cases of symmetric and antisymmetric modes for both the index- and gain-guided lasers are treated in detail. The main findings are 1) weak index-guided coupling, with small differences in optical confinement factors, and 2) stronger gain-guided coupling, with parameter-dependent selection of the mode symmetry having higher gain.

The waveguide modes have been calculated for the separated multiclad-layer stripe geometry laser recently described by Ishikawa et al. Our analysis includes coupling of the mode within the stripe to both guiding and antiguiding modes outside the stripe. Mode losses larger than previously estimated have been calculated, but they are within acceptable limits and are comparable to or smaller than losses in a similar CSP laser.

The joints referred to are those in which the load is transferred wholly by friction between the connected parts produced by clamping them together with tensioned bolts. An experimental study of the distribution of the traction stresses over the surfaces in contact using a photoelastic frozen stress model is described. A distribution of traction and of in-plane stresses in the plate is obtained for an actual joint by a finite-element analysis. Both methods indicate the presence, at loads below the slip load, of clearly defined regions of slip and adhesion, and of localities of high traction and in-plane stresses, which are of significance in the study of the fatigue behaviour of grip bolted joints.

Fatigue tests on a large number of double cover plate butt joints showed that the cause of failure in the majority of cases was by cracks originating in an annular area of fretting damage around the bolt hole. The nature of the fretting is discussed and the variation with load amplitude of the size of the annular area is described. Several well defined patterns of fatigue cracking were observed. These are described and their associated crack origins classified and related to the joint geometry and load levels.

The experiments showed that it is possible to successfully design a socket using a computer based socket model. Variability of results, however indicates the existence of shortcomings. These were identified as inadequacies in the caliper method used to measure the stumps; inability to make the sockets total contact; lack of flexibility of the design process in the Round #1 computer CASD system. It was shown by results of the MERU fittings that an iterative procedure in the hands of an inexperienced person would lead to a degree of success comparable to that achieved by experienced persons using judgement. Also indicated was that experienced prosthetists were able to transfer their skills to the CASD system. This is indicated by the fact that they achieved 5 Class IV results with 8 sockets as compared to 2 Class IV results with 10 sockets achieved by the inexperienced operator.

Neurotropin was found to reduce brain oedema in an experimental model of brain infarction in the guinea-pig. A randomized double-blind controlled trial with Neurotropin was performed in 220 patients admitted within 24 h after an acute ischemic stroke. 35 of the neurotropin and 41 of the placebo-randomized patients had to be excluded. 10 included patients in the neurotropin and 13 in the placebo-treated group died within the study period of 15 days. A better clinical outcome was observed in the 65 included surviving neurotropin compared with the 56 placebo-treated patients. The size of the infarct and of the oedema zones was significantly more decreased on CT scans from Day 11 compared with Day 3 after stroke in the neurotropin than in the placebo treated group. Neurotropin is helpful in treating brain oedema, related to acute ischemic stroke.

The plastic quadrilateral socket has a high anterior brim which can cause considerable discomfort in some patients, especially when seated. A simple modification to the anterior brim is described allowing a female patient with a huge abdominal hernia a considerable degree of comfort when both sitting and standing. The creation of a large radius producing a wide area for adequate pressure relief proved valuable. This might be considered for patients with less pendulous abdomens who find conventional methods inadequate.

KIE: Members of groups such as ACT UP (AIDS Coalition to Unleash Power) risk arrest and criminal charges to protest laws and policies they view as unjust to persons with AIDS. Spiers, a founding member of ACT UP, discusses the rationale behind the tactics of civil disobedience employed by AIDS activists. He argues that civil disobedience is justified by American political and legal traditions, and by the federal government's lack of response to the needs of its citizens. Spiers warns that while AIDS protests have been nonviolent and characterized by conscientious planning and execution, violence cannot be ruled out as a "political act born of desperation."