The Unmet Needs of Stroke Survivors and Stroke Caregivers: A Systematic Narrative Review.

INTRODUCTION: Facilitating stroke survivors and their caregivers to lead a fulfilling life after stroke requires service providers to think about their different needs. Poor post stroke care may lead to unmet needs in stroke survivors and stroke caregivers. This may compromise them in leading their lives optimally after stroke. OBJECTIVES & METHODOLOGY: This systematic narrative review examines articles published from 1990 to 2017, generated from Ovid, MEDLINE, CINAHL, and PubMed. The search was also supplemented by an examination of reference lists for related articles via Scopus. We included 105 articles. FINDINGS: We found that the type of unmet needs in stroke survivors and the contributing factors were substantially different from their caregivers. The unmet needs in stroke survivors ranged from health-related needs to re-integration into the community; while the unmet needs in stroke caregivers ranged from information needs to support in caring for the stroke survivors and caring for themselves. Additionally, the unmet needs in both groups were associated with different factors. CONCLUSION: More research is required to understand the unmet needs of stroke survivors and stroke caregivers to improve the overall post-stroke care services.

Assessment of micro-scale anaerobic digestion for management of urban organic waste: A case study in London, UK.

This paper describes the analysis of an AD plant that is novel in that it is located in an urban environment, built on a micro-scale, fed on food and catering waste, and operates as a purposeful system. The plant was built in 2013 and continues to operate to date, processing urban food waste and generating biogas for use in a community café. The plant was monitored for a period of 319days during 2014, during which the operational parameters, biological stability and energy requirements of the plant were assessed. The plant processed 4574kg of food waste during this time, producing 1008m3 of biogas at average 60.6% methane. The results showed that the plant was capable of stable operation despite large fluctuations in the rate and type of feed. Another innovative aspect of the plant was that it was equipped with a pre-digester tank and automated feeding, which reduced the effect of feedstock variations on the digestion process. Towards the end of the testing period, a rise in the concentration of volatile fatty acids and ammonia was detected in the digestate, indicating biological instability, and this was successfully remedied by adding trace elements. The energy balance and coefficient of performance (COP) of the system were calculated, which concluded that the system used 49% less heat energy by being housed in a greenhouse, achieved a net positive energy balance and potential COP of 3.16 and 5.55 based on electrical and heat energy, respectively. Greenhouse gas emissions analysis concluded that the most important contribution of the plant to the mitigation of greenhouse gases was the avoidance of on-site fossil fuel use, followed by the diversion of food waste from landfill and that the plant could result in carbon reduction of 2.95kg CO2eq kWh-1 electricity production or 0.741kg CO2eq kg-1 waste treated.

Is food allergen analysis flawed? Health and supply chain risks and a proposed framework to address urgent analytical needs.

Food allergy is an increasing problem for those affected, their families or carers, the food industry and for regulators. The food supply chain is highly vulnerable to fraud involving food allergens, risking fatalities and severe reputational damage to the food industry. Many facets are being pursued to ameliorate the difficulties including better food labelling and the concept of thresholds of elicitation of allergy symptoms as risk management tools. These efforts depend to a high degree on the ability reliably to detect and quantify food allergens; yet all current analytical approaches exhibit severe deficiencies that jeopardise accurate results being produced particularly in terms of the risks of false positive and false negative reporting. If we fail to realise the promise of current risk assessment and risk management of food allergens through lack of the ability to measure food allergens reproducibly and with traceability to an international unit of measurement, the analytical community will have failed a significant societal challenge. Three distinct but interrelated areas of analytical work are urgently needed to address the substantial gaps identified: (a) a coordinated international programme for the production of properly characterised clinically relevant reference materials and calibrants for food allergen analysis; (b) an international programme to widen the scope of proteomics and genomics bioinformatics for the genera containing the major allergens to address problems in ELISA, MS and DNA methods; (c) the initiation of a coordinated international programme leading to reference methods for allergen proteins that provide results traceable to the SI. This article describes in more detail food allergy, the risks of inapplicable or flawed allergen analyses with examples and a proposed framework, including clinically relevant incurred allergen concentrations, to address the currently unmet and urgently required analytical requirements. Support for the above recommendations from food authorities, business organisations and National Measurement Institutes is important; however transparent international coordination is essential. Thus our recommendations are primarily addressed to the European Commission, the Health and Food Safety Directorate, DG Santé. A global multidisciplinary consortium is required to provide a curated suite of data including genomic and proteomic data on key allergenic food sources, made publically available on line.

Increased prevalence of autoimmune diseases in functional gastrointestinal disorders: case-control study of 23471 primary care patients.

BACKGROUND: There is increasing evidence that impaired mucosal defence mechanisms are implicated in the pathogenesis of the functional gastrointestinal disorders (FGIDs), allowing inappropriate immune activation. AIM: To test the hypothesis that an excess of autoimmune disorders among sufferers, using a large primary care database to examine this. METHODS: Cases were diagnosed with FGIDs - irritable bowel syndrome (IBS), functional dyspepsia (FD), chronic idiopathic constipation (CIC), and multiple FGIDs. Controls were those without FGIDs. Prevalence of autoimmune disorders was compared between cases and controls using odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: We included 23,471 patients (mean age 51.4 years, 66.1% female). Prevalence of autoimmune disorders was greater among all FGIDs, compared with controls without. In those with FD (OR 1.35; 95% CI 1.12-1.63), CIC (OR 1.75; 95% CI 1.11-2.75), or multiple FGIDs (OR 1.49; 95% CI 1.25-1.77) this was statistically significant after controlling for age and gender. Rheumatological autoimmune disorders were significantly more frequent in those with FD (OR 1.44; 95% CI 1.15-1.80), CIC (OR 1.84; 95% CI 1.08-3.13), or multiple FGIDs (OR 1.53; 95% CI 1.24-1.88), after controlling for age and gender. However, endocrine autoimmune disorders were no more frequent in those with FGIDs, after controlling for age and gender. CONCLUSIONS: In a large sample of primary care patients, there was a significantly higher prevalence of autoimmune disorders among those with FD, CIC, or multiple FGIDs not explained by differences in age or gender. We were unable to control for concomitant drug use, which may partly explain this association.

Transcriptional regulators transforming growth factor-ß1 and estrogen-related receptor-α identified as putative mediators of calf rumen epithelial tissue development and function during weaning.

Molecular mechanisms regulating rumen epithelial development remain largely unknown. To identify gene networks and regulatory factors controlling rumen development, Holstein bull calves (n=18) were fed milk replacer only (MRO) until 42 d of age. Three calves each were euthanized at 14 and 42 d of age for tissue collection to represent preweaning, and the remaining calves were provided diets of either milk replacer + orchard grass hay (MH; n=6) to initiate weaning without development of rumen papillae, or milk replacer + calf starter (MG; n=6) to initiate weaning and development of rumen papillae. At 56 and 70 d of age, 3 calves from the MH and MG groups were euthanized for collection of rumen epithelium. Total RNA and protein were extracted for microarray analysis and to validate detected changes in selected protein expression, respectively. As expected, calves fed MRO had no rumen papillae and development of papillae was greater in MG versus MH calves. Differentially expressed genes between the MRO diet at d 42 (preweaning) versus the MG or MH diets at d 56 (during weaning) were identified using permutation analysis of differential expression. Expression of 345 and 519 transcripts was uniquely responsive to MG and MH feeding, respectively. Ingenuity Pathway Analysis (Qiagen, Redwood City, CA) indicated that the top-ranked biological function affected by the MG diet was the cell cycle, and TFGB1, FBOX01, and PPARA were identified as key transcriptional regulators of genes responsive to the MG diet and associated with development of rumen papillae. Increased expressions of TGFB1 mRNA and protein in response to the MG diet were confirmed by subsequent analyses. The top-ranking biological function affected by the MH diet was energy production. Receptors for IGF-1 and insulin, ESRRA, and PPARD were identified by ingenuity pathway analysis as transcriptional regulators of genes responsive to the MH diet. Further analysis of TGFB1 and ESRRA mRNA expression in rumen epithelium obtained from a separate ontogenic study of Holstein calves (n=26) euthanized every 7d from birth to 42 d of age showed increases in transcript expression with advancing age, supporting their roles in mediating rumen epithelial development and function during weaning. Additional evaluation of gene expression in the rumen epithelium of adult cows ruminally infused with butyrate also suggested that observed changes in ESRRA mRNA expression in developing calf rumen may be mediated by increased butyrate concentration. Our results identify TGFB1 and ESRRA as likely transcriptional regulators of rumen epithelial development and energy metabolism, respectively, and provide targets for modulation of rumen development and function in the growing calf.

Physiological POSSUM as an indicator for long-term survival in vascular surgery.

OBJECTIVES: We investigated whether the POSSUM physiology score, originally designed as an indicator for 30-day mortality for comparative audit, could be used as an indicator of long-term survival in vascular surgery practice. METHODS: Data from 184 different vascular procedures conducted between 1989 and 2000, containing survival data for each patient of 10 years or longer, were analysed retrospectively. Parameters collected were the pre-operative physiological and the operative severity POSSUM score, gender, and type of procedure. Multivariate analyses were performed using Cox regression method and, on the basis of their physiological POSSUM score grouping, Kaplan-Meier analysis was performed for estimation of overall survival. RESULTS: Both an increase in physiological POSSUM score (hazard ratio [HR] 1.050, 95% confidence interval [CI] 1.031 to 1.070) and one of its components, age (HR 1.025, 95% CI 1.006 to 1.045; p = 0.009), were shown to be indicators of long-term all-cause mortality. The sample's mean physiological POSSUM score of 21 was then used as a cut-off point to categorise low and high-risk vascular surgery patients. Median survival in the low-risk group was 70 months (95% CI 56-86 months), whereas in the high-risk group this was 17 months (95% CI 3-31 months). CONCLUSION: The physiological POSSUM score, including patient age, is an indicator of long-term survival of patients with vascular disease. This may help in choosing the appropriate vascular intervention.

Use of fluorescent tagging for assessment of environmental cleaning and disinfection in a veterinary hospital.

Environmental cleaning was assessed at a small animal veterinary referral hospital and associated primary healthcare facility. A convenience sample of surfaces was contaminated with fluorescent dye, and then cleaning was assessed 24 hours later by UV light visualisation. Five hundred sixty-three sites were assessed; however, 70 sites were unable to be evaluated 24 hours later because equipment had been removed or because rooms were occupied at the time of re-evaluation. Overall, dye was removed from 212/493 (43%) of sites. Site-specific rates ranged from 14% (computer keyboards and mice, 9/66 site cleaned) to 81% (examination tables, 44/54 sites cleaned). There was a significant difference in the prevalence of successful cleaning by general location (P < 0.0001) and surface type (P < 0.0001). Environmental tagging was an easy and low-cost tool to assess cleaning practices. Results prompted further infection control investigations to explain selected deficiencies, leading to identification of inadequacies in protocols and practices. Environmental tagging may be a useful infection control tool for establishing baseline cleaning rates, identifying deficiencies in protocols, evaluating the effects of interventions and education of personnel.

Bias in iterative reconstruction of low-statistics PET data: benefits of a resolution model.

Iterative image reconstruction methods such as ordered-subset expectation maximization (OSEM) are widely used in PET. Reconstructions via OSEM are however reported to be biased for low-count data. We investigated this and considered the impact for dynamic PET. Patient listmode data were acquired in [(11)C]DASB and [(15)O]H(2)O scans on the HRRT brain PET scanner. These data were subsampled to create many independent, low-count replicates. The data were reconstructed and the images from low-count data were compared to the high-count originals (from the same reconstruction method). This comparison enabled low-statistics bias to be calculated for the given reconstruction, as a function of the noise-equivalent counts (NEC). Two iterative reconstruction methods were tested, one with and one without an image-based resolution model (RM). Significant bias was observed when reconstructing data of low statistical quality, for both subsampled human and simulated data. For human data, this bias was substantially reduced by including a RM. For [(11)C]DASB the low-statistics bias in the caudate head at 1.7 M NEC (approx. 30 s) was -5.5% and -13% with and without RM, respectively. We predicted biases in the binding potential of -4% and -10%. For quantification of cerebral blood flow for the whole-brain grey- or white-matter, using [(15)O]H(2)O and the PET autoradiographic method, a low-statistics bias of <2.5% and <4% was predicted for reconstruction with and without the RM. The use of a resolution model reduces low-statistics bias and can hence be beneficial for quantitative dynamic PET.

Increased maternal Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) associated with older age at diagnosis of Type 1 diabetes in offspring.

AIMS: Obesity and insulin resistance have been linked to rising incidence and earlier onset of Type 1 diabetes. Inherited differences in insulin action might also influence the evolution of Type 1 diabetes.Our aim was to determine whether parental BMI and insulin resistance influences age of onset of Type 1 diabetes in their offspring. METHODS: BMI standard deviation score and age at diagnosis of Type 1 diabetes was examined in 227 children, and in 206 of these was compared with local matched control subjects. Non-diabetic parents of a subgroup of 80 children with Type 1 diabetes were recruited. Parental BMI was compared with local adult control subjects. The relationship between parental BMI, waist-hip ratio, homeostasis model assessment of insulin resistance (HOMA-IR), leptin and adiponectin levels and age at diagnosis of Type 1 diabetes in offspring was examined. RESULTS: We found no relationship between age at diagnosis of Type 1 diabetes in children and BMI standard deviation score (P = 0.5). Children with Type 1 diabetes and their parents were heavier than matched control subjects (mean BMI standard deviation score sd in children = 0.66 1.06 vs. 0.32 1.16 in control subjects, P = 0.002; mean parental BMI sd 27.7 0.4 vs. 25.5 0.4 kg /m2 in control subjects; P < 0.0001). Maternal HOMA-IR accounted for 20% of variation in age at diagnosis (P < 0.001) with increasing maternal insulin resistance associated with later age at diagnosis of Type 1 diabetes. CONCLUSIONS: Childrenwith Type 1 diabetes and their parents have an increased BMI at diagnosis.Maternal insulin resistance is associated with later onset of Type 1 diabetes in children.

Development and validation of a variance model for dynamic PET: uses in fitting kinetic data and optimizing the injected activity.

The precision of biological parameter estimates derived from dynamic PET data can be limited by the number of acquired coincidence events (prompts and randoms). These numbers are affected by the injected activity (A(0)). The benefits of optimizing A(0) were assessed using a new model of data variance which is formulated as a function of A(0). Seven cancer patients underwent dynamic [(15)O]H(2)O PET scans (32 scans) using a Biograph PET-CT scanner (Siemens), with A(0) varied (142-839 MBq). These data were combined with simulations to (1) determine the accuracy of the new variance model, (2) estimate the improvements in parameter estimate precision gained by optimizing A(0), and (3) examine changes in precision for different size regions of interest (ROIs). The new variance model provided a good estimate of the relative variance in dynamic PET data across a wide range of A(0)s and time frames for FBP reconstruction. Patient data showed that relative changes in estimate precision with A(0) were in reasonable agreement with the changes predicted by the model: Pearson's correlation coefficients were 0.73 and 0.62 for perfusion (F) and the volume of distribution (V(T)), respectively. The between-scan variability in the parameter estimates agreed with the estimated precision for small ROIs (<5 mL). An A(0) of 500-700 MBq was near optimal for estimating F and V(T) from abdominal [(15)O]H(2)O scans on this scanner. This optimization improved the precision of parameter estimates for small ROIs (<5 mL), with an injection of 600 MBq reducing the standard error on F by a factor of 1.13 as compared to the injection of 250 MBq, but by the more modest factor of 1.03 as compared to A(0) = 400 MBq.

Pilot randomised controlled trial of occupational therapy to optimise independence in Parkinson's disease: the PD OT trial.

OBJECTIVE: To perform a pilot trial of occupational therapy (OT) to optimise functional independence in Parkinson disease (PD) to assess accrual/withdrawal rates, acceptability, outcome measures, and inform sample-size calculation. METHOD: Non-demented patients with idiopathic PD and difficulties with activities of daily living (ADL) were recruited provided they had not received OT in the last 2 years and/or physiotherapy in the last year. Patients were randomised to immediate OT or OT after completion of the trial. Patients randomised to OT were assessed at home by an experienced therapist and then received six home treatment sessions over 2 months. Interventions were targeted at functional independence and mobility goals. Outcome measures were: Nottingham Extended Activity of Daily Living Scale, Rivermead Mobility Index, Unified Parkinson's Disease Rating Scale ADL scale, Parkinson's Disease Questionnaire 39, EuroQol-EQ-5D, Hospital Anxiety and Depression Scale, and health economics analysis. RESULTS: 39 patients (25 male; mean age 73 years) were recruited from four centres over 16 months. The mean difference in NEADL at 8 months was 3.5 (95% CI -3.2 to 10.2). The mean difference in PDQ-39 Summary Score was 3.8 (95% CI -4.94 to 12.6). There were strong correlations between the PDQ-39 and other outcomes. The intervention was acceptable to patients, with a low withdrawal rate and good questionnaire completion. CONCLUSION: Randomisation to a trial of OT in PD is feasible. NEADL and PDQ-39 are relevant outcomes and provided data to inform sample size for an adequately powered randomised trial for which there is pressing need.

An assessment of the in vivo efficacy of the glycogen phosphorylase inhibitor GPi688 in rat models of hyperglycaemia.

BACKGROUND AND PURPOSE: Studies in cultured hepatocytes demonstrate glycogen synthase (GS) activation with glycogen phosphorylase (GP) inhibitors. The current study investigated whether these phenomena occurred in vivo using a novel GP inhibitor. EXPERIMENTAL APPROACH: An allosteric GP inhibitor, GPi688, was evaluated against both glucagon-mediated hyperglycaemia and oral glucose challenge-mediated hyperglycaemia to determine the relative effects against GP and GS in vivo. KEY RESULTS: In rat primary hepatocytes, GPi688 inhibited glucagons-mediated glucose output in a concentration dependent manner. Additionally GP activity was reduced and GS activity increased seven-fold. GPi688 inhibited glucagon-mediated hyperglycaemia in both Wistar (65%) & obese Zucker (100%) rats and demonstrated a long duration of action in the Zucker rat. The in vivo efficacy in the glucagon challenge model could be predicted by the equation; % glucagon inhibition=56.9+34.3[log ([free plasma]/rat IC50)], r=0.921). GPi688 also reduced the blood glucose of obese Zucker rats after a 7 h fast by 23%. In an oral glucose tolerance test in Zucker rats, however, GPi688 was less efficacious (7% reduction) than a glycogen synthase kinase-3 (GSK-3) inhibitor (22% reduction), despite also observing activation (by 45%) of GS in vivo. CONCLUSIONS AND IMPLICATIONS: Although GP inhibition can inhibit hyperglycaemia mediated by increased glucose production, the degree of GS activation induced by allosteric GP inhibitors in vivo, although discernible, is insufficient to increase glucose disposal. The data suggests that GP inhibitors might be more effective clinically against fasting rather than prandial hyperglycaemic control.

Inequalities in coronary revascularisation during the 1990s: evidence from the British regional heart study.

OBJECTIVE: To investigate the influence of age and social circumstances on probability of revascularisation among British men. DESIGN: Prospective population based study SETTING: 24 medium sized British towns, none of which contained a hospital undertaking coronary artery bypass surgery. SUBJECTS: 5814 surviving participants of the BRHS (British regional heart study), aged 52-73 years, with no history of revascularisation when responding to a questionnaire in November 1992. MAIN OUTCOMES: Incident coronary revascularisations, as documented in general practitioner records, over the following 7.1 years and coronary angiography investigations reported by men in a further questionnaire in November 1996. RESULTS: 160 men underwent at least one revascularisation during this period (4.2/1000 person-years). In multifactorial analysis, which included adjustment for incidence of major coronary heart disease or angina, a lower incidence of revascularisation was found among men aged over 65 years in November 1992 (hazard ratio 0.62, 95% confidence interval (CI) 0.44 to 0.87), among men with manual occupations (0.73, 95% CI 0.53 to 1.02), among men living in households possessing no car (0.44, 95% CI 0.24 to 0.80) or one car (0.60, 95% CI 0.42 to 0.87) compared with two or more cars, among council tenants (0.49, 95% CI 0.25 to 0.97), and among men living outside southern England (0.71, 95% CI 0.51 to 0.99). Only car ownership was related to the incidence of diagnostic angiography: the odds ratio for angiography for those owning fewer than two cars was 0.62 (95% CI 0.42 to 0.89). CONCLUSION: During the 1990s, there were major inequalities in the probability of undergoing coronary revascularisation between British men according to socioeconomic status, age, and geographic location.

Overweight and obesity and the burden of disease and disability in elderly men.

OBJECTIVE: To examine the prevalence of disease burden and disability associated with overweight and obesity in men aged 60-79 y and to assess whether the current WHO weight guidelines are appropriate in the elderly. DESIGN: Cross-sectional survey 20 y after enrollment. SETTING: General practices in 24 British towns. PARTICIPANTS: In total, 4232 men aged 60-79 y (77% of survivors) with measured weight and height. MAIN OUTCOME MEASURES: Cardiovascular (CV) risk factors, prevalence of diabetes, cardiovascular disease, cancer, disability and regular medication. RESULTS: In total, 17% of the men were obese (body mass index (BMI) >/=30 kg/m(2)) and a further 52% were overweight (BMI 25-29.9 kg/m(2)). Prevalence of hypertension, low HDL-cholesterol, high triglycerides and insulin resistance and the prevalence of most disease outcomes increased with increasing degrees of overweight/obesity. Men in the normal weight range (18.5-24.9 kg/m(2)) had the lowest prevalence of ill health. Compared with normal weight men, obese men showed a two-fold risk of major CVD (odds ratio (OR)=1.96, 95% CI 1.44-2.67) and locomotor disability (OR=2.26, 95% CI 1.66, 3.09) and were nearly three times as likely to have diabetes, CV interventions or to be on CV medication. Over 60% of the prevalence of high insulin resistance was attributable to overweight and obesity as was over a third of diabetes and hypertension, a quarter of locomotor disability and a fifth of major CVD. CONCLUSION: In elderly men, overweight and obesity are associated with a significantly increased burden of disease, in particular CV-related disorders and disability. The current guidelines for overweight and obesity appear to be appropriate in elderly men.

Sexual networking among married men with wives of child bearing age in Ibadan City, Nigeria: report of a pilot study.

Following the Beijing Conference, it is desirable to empower men to play a more active and responsive role in promoting the health of family members and preventing disease. This cross sectional, community-based, ex-post factor, pilot study was designed to find out if traditional norms affect marital sexuality and also to identify sociodemographic factors associated with sexual networking among men. A total of 416 married men whose wives had delivered a baby in the last 36 months prior to the study were interviewed from randomly selected clusters in Ibadan, Nigeria. Of this number, the majority 336 (80.8%) had sex with pregnant wife in the last pregnancy and proportion of married men who had sex in the pregnancy with wives reduced modestly with increasing age of the men. With regards to sexual networking in pregnancy, 207 (49.8%) men reported having sex with someone else when wife was pregnant. Of this number 95 (45.9%) had it with steady girl friends, 56 (27.0%) with new girl friends, 50 (24.2%) with another wife and 6 (2.9%) with commercial sex workers. The prevalence for having sex with someone else in this period was lower in men from the higher socio-economic class (HSEC) when compared with the lower socio-economic class (LSEC)(chi2 = -9.89, P < 0.001). The middle socio-economic class also had a lower rate than the lower socio-economic class (chi2 = 6.28, P < 0.01). In addition, men with post secondary/University education had significantly lower rates for networking when their wives were pregnant compared with men of lower educational attainment (P < 0.05). Three hundred and eleven men (74.8%) reported that they observed some period ofpostpartum abstinence (PPA) with recently delivered wife, which ranged from 5 days to 72 months (Median was 7.5 months). The highest PPA rates were seen in men with no formal education, those from lower SEC and in men who embraced traditional religions. Issues that have to be addressed in more detail in the follow up study include understanding why men network as traditional proscriptions are generally not adhered to. Determining the relationship between length of postpartum abstinence and sexual networking and implication of this behaviour in the spread of sexually transmitted diseases and fertility control if postpartum abstinence period is significantly reduced or increased. In this regard, qualitative research as well as quantitative research should be carried out so that the entire study is not left within the realm of a quantitative study, which may be inadequate for explaining social and demographic data.

Use and rationale of a multicompartment microcassette for site-specific biopsies of the prostate in a consecutive cohort of men.

The collection of prostate biopsies into individual or site-specific specimen containers has not been performed routinely because of concerns of time, cost and lack of additional clinical value. This report evaluates the first ever use of a multicompartment microcassette for the collection and processing of site-specific prostate biopsies.Site-specific prostate biopsies were taken in sequential men suspected to have prostate cancer and collected in a multicompartment microcassette, which holds six biopsies and fits within a standard specimen container. Estimates were made of the cost and time savings compared with biopsies collected in individual specimen containers. In 88 men evaluated, use of the multicompartment microcassette saved time (72% reduction) and cost (83% reduction) with the added ability of easy identification of the site of each prostate biopsy. The multicompartment microcassette is a convenient, time- and cost-effective container for the collection of site-specific prostate biopsies.

Valuing the donor more than the donation.

The "valuing the donor more than the donation" approach is based on a respect for each individual donor and their needs. In order for the long-term value of the donor/charity partnership to be realized, there must first be an appreciation of the need for a carefully cultivated relationship.

The attitude of courts in England to compensation for post-traumatic epilepsy.

The attitudes of courts in England to the assessment of damages for post-traumatic epilepsy have dramatically changed over the last 20-30 years. In assessing damages for post-traumatic epilepsy the courts are faced with a number of considerations: epilepsy can appear several years after the injury; epilepsy is not a homogeneous condition; the eventual prognosis is unknown; the epilepsy may not have been directly due to the trauma; and epilepsy affects life expectancy and employment. Damages were originally fixed at the point of compensation, and these rather crude calculations led to both over- and under-compensation. This situation was improved in 1985, when courts were permitted to award damages on the assumption that epilepsy would not occur or worsen, and further damages should these assumptions prove to be incorrect. The courts in England still depend, however, upon the evidence of expert witnesses chosen by the plaintiff and defendant. A tension thus exists between the duty of expert witnesses to the court and the understandable inclination of expert witnesses to support the party that has instructed them. The Woolf report has led to changes in the responsibilities of expert witnesses, and will hopefully remedy many of the inconsistencies and inequities that occur.