Influence of less than full-time or full-time on totality of training and subsequent consultant appointment in anaesthesia.

Changes in medical training have increased the popularity of less than full-time training. However, there are no data on the impact on training time or consultant workforce. We reviewed a three-year cohort of trainees via the Royal College of Anaesthetist's training and recruitment databases. Eighty-eight (96%) less than full-time trainees and 677 (95%) full-time trainees were appointed to a substantive consultant post (p = 0.82). Three (3%) less than full-time trainees and 12 (2%) full-time trainees gained part-time consultant posts (p < 0.001). Average length of training (years, months, days) was 8 y, 5 m, 6 d (median (IQR [range]) 5 y, 0 m, 14 d (4 y, 11 m, 29 d - 9 y, 8 m, 3 d [4 y, 2 m, 18 d - 12 y, 0 m, 0 d]) for full-time and 10 y, 8 m, 23 d (median (IQR [range]) 7 y, 3 m, 28 d (6 y, 7 m, 24 d - 11 y, 1 m, 23 d [4 y, 11 m, 29 d - 11 y, 9 m, 10 d]) for less than full-time trainees. The average length of training for both groups is significantly longer than the seven years used in workforce planning.

Fish assemblages associated with oil industry structures on the continental shelf of north-western Australia.

This study provides the first assessment of fish associations with oil and gas structures located in deep water (85-175 m) on Australia's north-west continental shelf, using rare oil industry video footage obtained from remotely operated vehicles. A diverse range of taxa were observed associating with the structures, including reef-dependent species and transient pelagic species. Ten commercially fished species were observed, the most abundant of which was Lutjanus argentimaculatus, with an estimated biomass for the two deepest structures (Goodwyn and Echo) of 109 kg.

Retrospective review of cerebral mycotic aneurysms in 26 patients: focus on treatment in strongly immunocompromised patients with a brief literature review.

BACKGROUND AND PURPOSE: Cerebral mycotic aneurysms are a rare and deadly type of aneurysm that have no definitive treatment guidelines. Our purpose was to retrospectively review known or suspected cases of CMA in order to identify patient populations that may be associated with higher morbidity and mortality. We hope that the identification of patients with these risk factors will lead to early stratification upon presentation, and more urgent treatment of their CMAs. We also hoped to identify any benefit or complication that was specific to either the endovascular or neurosurgical repair of CMAs. MATERIALS AND METHODS: A retrospective multi-institutional study was performed examining cases of CMA during a 15-year period. Patients were considered strongly immunocompromised if there were long-term severely immunocompromised states: AIDS, chemotherapy, or steroid immunosuppression. Patients were excluded if angiographic findings suggested an alternative diagnosis or if an infectious etiology was unknown. Antibiotics were considered "noninvasive treatment." Endovascular and neurosurgical repair were considered "invasive treatment." Data were recorded by reviewing electronic medical records and imaging reports. RESULTS: Twenty-six patients with 40 CMAs were included. Three patients were considered strongly immunocompromised and presented with 4 CMAs, which demonstrated larger average size and more rapid growth; 3 of these patients' aneurysms were treated invasively in the acute period, with the one that was not ruptured causing death. Technical success (aneurysm occlusion without rupture or recanalization) and clinical success (no neurologic complication attributable to the intervention) were obtained equally endovascularly and neurosurgically. Clipping was aborted in favor of coiling for 1 patient. Anticoagulation needed reversal before 2 patients underwent craniotomy for clipping after valve replacement. For CMAs treated with antibiotics alone with angiographic follow-up (n=11), initial aneurysm size was unrelated to persistence and 64% completely regressed. CONCLUSIONS: We recommend initial invasive treatment for CMAs in strongly immunocompromised patients. Testing for underlying immunocompromised states is warranted in patients with CMAs. Endovascular treatment is favored over neurosurgical treatment in patients requiring acute cardiac valve repair due to delays with anticoagulation reversal.

Evidence of sustained populations of a small reef fish on artificial structures. Does depth affect production on artificial reefs?

The length frequencies and age structures of resident Pseudanthias rubrizonatus (n = 407), a small protogynous serranid, were measured at four isolated artificial structures on the continental shelf of north-western Australia between June and August 2008, to determine whether these structures supported full (complete size and age-structured) populations of this species. The artificial structures were located in depths between 82 and 135 m, and growth rates of juveniles and adults, and body condition of adults, were compared among structures to determine the effect of depth on potential production. All life-history stages, including recently settled juveniles, females and terminal males, of P. rubrizonatus were caught, ranging in standard length (L(s)) from 16·9 to 96·5 mm. Presumed ages estimated from whole and sectioned otoliths ranged between 22 days and 5 years, and parameter ±s.e. estimates of the von Bertalanffy growth model were L(∞) = 152 ± 34 mm, k = 0·15(±0·05) and t(0) = -1·15(±0·15). Estimated annual growth rates were similar between shallow and deep artificial structures; however, otolith lengths and recent growth of juveniles differed among individual structures, irrespective of depth. The artificial structures therefore sustained full populations of P. rubrizonatus, from recently settled juveniles through to adults; however, confirmation of the maximum age attainable for the species is required from natural populations. Depth placement of artificial reefs may not affect the production of fish species with naturally wide depth ranges.

Inheritance of two different alleles of the low-density lipoprotein (LDL)-receptor gene carrying the recurrent Pro664Leu mutation in a patient with homozygous familial hypercholesterolaemia.

Familial hypercholesterolaemia (FH) is caused by mutations in the low-density lipoprotein (LDL)-receptor gene that result in impaired clearance of plasma LDL and increased risk of coronary heart disease. Numerous different mutations have been found in FH patients worldwide, the majority of which are infrequent in out-bred populations and account for 2% or less of patients with the disorder in large cohorts. Thus, it was surprising to find that two homozygous FH patients referred to a single hospital in the UK were both apparently homozygous for the Pro664Leu mutation. One, an Asian patient, was a true homozygote. The other, of English origin, had inherited two different alleles of the LDL-receptor gene with the same mutation from unrelated parents, as inferred from the haplotype of polymorphic markers. A third, clinically homozygous FH patient, despite being the offspring of first cousins, had inherited one 'Asian' Pro664Leu allele, but an allele with a 1-bp deletion in exon 5 from the other parent. The Pro664Leu mutation in the LDL-receptor gene has now been described in heterozygous patients of very different ethnic origin and is associated with different haplotypes, suggesting that the same base change at a CpG may have recurred as many as six times.

Standardized hemodialysis prescriptions promote inadequate treatment in patients with large body mass.

BACKGROUND: Although a relation between the adequacy of hemodialysis and mortality has been established, hemodialysis prescription is rarely individualized precisely in adults with end-stage renal disease in the United States. OBJECTIVE: To test whether persons who receive standardized hemodialysis prescriptions have an increased risk for inadequate hemodialysis with increasing body mass. DESIGN: Cross-sectional study. SETTING: Four ambulatory hemodialysis facilities in Brooklyn, New York. PATIENTS: 214 patients receiving hemodialysis. Patients were sorted by body weight into quartiles (groups 1 through 4, in ascending order). MEASUREMENTS: Urea reduction ratio (percentage reduction in blood urea nitrogen concentration after a hemodialysis session), prescribed length of hemodialysis, and body weight quartile at the start of the study. Urea reduction ratio was measured at the start of the study and at weeks 4, 8, and 12, and a mean value was calculated for each patient. Inadequate hemodialysis was defined by a urea reduction ratio of 65% or less. RESULTS: Women had a higher mean urea reduction ratio (72% +/- 6%) than men (67.6% +/- 7%) (P < 0.001). The urea reduction ratio was inversely related to body weight (r = -0.47; P = 0.001). It was greater in group 1 (74% +/- 5.2%) than in group 2 (70% +/- 5.7%), group 3 (68% +/- 5.8%), or group 4 (66% +/- 8.4%) (P < 0.05). Logistic regression done with a urea reduction ratio of 65% or less as the outcome variable showed that the odds of receiving inadequate hemodialysis were increased 3.5-fold in men (95% CI, 1.53-fold to 8-fold; P = 0.003), 10-fold in group 3 (CI, 2.1-fold to 50.3-fold; P = 0.003), and 13-fold in group 4 (CI, 2.6-fold to 61.6-fold; P = 0.001). CONCLUSIONS: Standardized hemodialysis prescriptions result in inadequate hemodialysis in many patients who weigh more than 68.2 kg.

Metabolism of benzothiazole. I. Identification of ring-cleavage products.

1. The metabolic fate of benzothiazole in guinea pig has been investigated following i.p. administration at a dose of 30 mg/kg. 2. Five ring-cleavage products were identified in urinary extracts by g.l.c.-mass spectra. By reference to authentic compounds the three major metabolites were shown to be 2-methylmercaptoaniline (I), 2-methylsulphinylaniline (II) and 2-methylsulphonylaniline (III). On the basis of the mass spectrometric evidence the remaining two metabolites were postulated to be 2-methylsulphinylphenylhydroxylamine (IV) and 2-methylsulphonylphenylhydroxylamine (V). 3. I, II and III were present in conjugated and unconjugated forms; IV and V were identified only after hydrolysis with sulphatase.

Theophylline assay on Kodak Ektachem DTSC--performance and interference by structurally-related compounds and salicylate.

Theophylline was measured with a Kodak Ektachem DTSC using its property of uncompetitive inhibition of alkaline phosphatase. Within- and between-batch reproducibility was satisfactory. Agreement with consensus mean values on quality assessment samples was good as was agreement on patients' samples with a high performance liquid chromatography reference method and an automated fluorescence polarisation immunoassay. At therapeutic theophylline concentrations, no interference was seen with caffeine, theobromine, 1,7-dimethylxanthine, 1,3-dimethyluric acid or 3-propylxanthine. 3-methylxanthine (a theophylline metabolite) gave a positive bias but the concentrations of this metabolite found in serum are such that the clinical significance of this finding is questionable. Salicylate at concentrations which might be found during therapy for paediatric rheumatoid arthritis also gave a positive bias.

Astronomical imaging with infrared array detectors.

History shows that progress in astronomy often stems directly from technological innovation and that each portion of the electromagnetic spectrum offers unique insights into the nature of the universe. Most recently, the widespread availability of infrared-sensitive two-dimensional array detectors has led to dramatic improvements in the capabilities of conventional ground-based observatories. The impact of this new technology on our understanding of a wide variety of phenomena is illustrated here by infrared pictures of star-forming regions, of nebulae produced by the late stages of stellar evolution, of the nucleus of our own galaxy(the Milky Way), and of activity in other galaxies.