Impact of antibiotic restrictions: the patient's perspective.

When patients seek medical help, they expect to be protected and that healthcare decisions preserve their safety - they expect to receive more benefit than harm. Harm can be caused through both action and inaction, for example by failing to provide adequate therapy because of cost constraints. Restrictions on the use of antibiotics that prevent or discourage the use of the best available treatment may jeopardise the health/recovery of patients, and undermine their trust in their doctor. What the public and patients may be less clear about is the complex interplay between competing priorities; providing quality care vs. ensuring cost efficiencies in a public healthcare system, which is under increasing pressure to deliver comprehensive care. As new technology becomes available, and the need for and expectations of healthcare increase, the pressure on governments to manage soaring healthcare costs may impact on the care that patients receive, as individuals, from their doctor. Patients vary in their desire to be involved in decisions about their treatment. Some are happy to trust the professionals; others want information from various sources, an open dialogue about the options and the ultimate right to make the best choice for themselves. Governments are keen to have more empowered patients, in the belief that this will drive up standards of care and increase patient satisfaction. This may result in greater pressure from patients for the best treatments to be made available.

A cost analysis on the pattern of asthma prescribing in the UK.

There is a need to establish the proportion of adult asthmatics at each step of the recommended asthma management guidelines, the cost of their prescribed treatment, and a revised cost of treatment assuming patients who were suboptimally controlled were moved up a step. Actual prescription and cost figures and a theoretical projection of an ideal scenario was calculated from a sample of general practices in Great Britain from the Doctors Independent Network. They comprised 102 nationally distributed practices and 17,206 adult patients with a diagnosis of, and prescription related to, asthma recorded between October 1993 and March 1994. Ninety-one per cent of patients received treatment within a recognized step of the guidelines. Of these, 80% were at steps 1 and 2. Employing excess inhaled beta-agonist use as a proxy for control of asthma, between 55% and 69% of patients at Steps 1-3 should receive treatment at a higher step. This could lead to an increased expenditure of up to Pound Sterling 4.66 per adult patient per month. This would imply a rise in the annual UK cost of antiasthma prescriptions for adults from Pound Sterling 388m to a possible Pound Sterling 533m. The United Kingdom Government audit commission has suggested that current expenditure on asthma treatment appears to be insufficient. Using an entirely different approach this study has confirmed that a significant increase in asthma prescribing costs is likely to be needed if optimal control of asthma is to be achieved.

Development basis of phenotypic variation in egg production in a colonial ascidian: primary oocyte production versus oocyte development.

Colonies of the ascidian Botryllus schlosseri (a cyclical hermaphrodite) exhibit extreme variability in egg production, and there is a large genetic component to this phenotypic variation. Therefore, the developmental bases of variation among different genotypes was investigated. Colonies differing in egg production (assayed as number of eggs per asexual bud) were cultured in a common garden experiment, and buds were collected and fixed early in the reproductive cycle. The buds were serially sectioned, and the number and size of the oocytes in the developing ovaries were determined for the different genotypes. Because the buds were collected prior to the onset of vitellogenesis, they contained oocytes at the three previtellogenic stages. In reproductive colonies (>0.7 eggs per bud), there were negative relationships between the final number of eggs per bud and (1) the total number of oocytes present, (2) the number of stage 1 oocytes present, and (3) the number of stage 2 oocytes present. There was no relationship between these parameters in nonreproductive colonies (<0.3 eggs per bud). In contrast, the number of stage 3 oocytes per bud was positively correlated with the final number of eggs per bud in both reproductive and nonreproductive colonies. In reproductive animals there was a negative relationship between the total number of oocytes per bud and the percentage of oocytes at stage 3 in oogenesis. A principal component analysis revealed that a single vector equally weighted for the number of eggs per bud, the total number of oocytes per bud, and the percentage of oocytes at stage 3 accounted for 84% of the observed variation in reproductive colonies. These data indicate that the phenotypic variation in egg production among the B. schlosseri colonies in the Damariscotta River, Maine, is controlled by genetic variation in both the number of oocytes that populate developing ovaries, and the percentage of oocytes that reach stage 3 in oogenesis.

Evidence for low temperatures and biologic diversity in cretaceous high latitudes of australia.

A diverse terrestial biota inhabited polar latitudes during the Cretacous, 105 to 130 Ma (million years ago), along what is now the southeast coast of Australia This biota, from rocks in the Otway and Strzelecki groups, cnsisted of more than 150 taxa of vertebrates, invertebrates, and plants. Oxygen isotope ratios in diagenetic calcite suggest that mean annual temperatures were most likely less than 5 degrees C, and rings present in the fossil araucarian-podocarp-ginko woods indicate saonality. Southeastern Austalia, thus, seems to have had a cool, seasonal, nontropical climate. Dinosaurs that have been recovered are up to five species and three genera of hypsilophodontids, all of which were endemic, and three species of theropods. The occurrence of Allosaurus sp. and labyrinthodont amphibians, which had become extinct elsewhere in the Jurassic, indicate that isolation may have allowed extended surival of these taxa in Australia. In that dinosaurs coped with high latitude for at least 65 million years [Valaginian to Albian time in Australia and Campanian to Maastrictian time (80 to 65 Ma) in Alaska] suggests that cold and darkness may not have been prime factors bringing about the extinction of dinosaurs and some other groups at the Cretaceous-Tertiary boundary, unless they were prolonged.