Spatial comparison of London's three waves of Spanish Flu.

England and Wales experienced three waves of influenza during the 1918/19 Spanish Flu pandemic. A previous analysis showed that these three waves had fundamentally different spatial and temporal characteristics. This present study compares London's experience of the three waves to discern possible geographic differences on a metropolitan level. Borough mortality data for each wave were normalized and then scaled, with spatial autocorrelation techniques displayed by GIS software and analysed for each wave. Registrar General in England and Wales reporting provided data concerning measures of 'health' and 'wealth' for each metropolitan borough. Spearman's rank correlation determined the correlation of each wave's mortality to each of the other waves including the 'health,' 'wealth' and population density factors. The comparisons showed that there is a spatial difference among the waves. The first two are spatially similar, with both exhibiting 'random' autocorrelation patterns, while the third wave exhibits a 'clustered' pattern. The borough mortality of the first two waves strongly correlated with each other, with both having similar 'health,' 'wealth' and population density factors. However, the third wave's mortality did not correlate with any of the first two and actually behaved in an opposite manner with regard to the 'health,' 'wealth,' and population density factors. These results do not appear in the literature and create new opportunities for research to explain London's mortality during the Spanish Flu pandemic of 1918/19.

Spatial comparison of herald and main waves in London's nineteenth-century cholera epidemics.

Nineteenth-century London experienced four extraordinarily severe summertime cholera epidemics. Three were preceded by less severe non-summer outbreaks. Twenty-first-century research hypothesizes them as herald waves of potentially new cholera strains. This study examined the geographical characteristics of these herald waves and compared them to their subsequent main waves to determine if there was a geographical component to the significant difference in wave severity. Cholera mortality data for London's parishes and registration districts were extracted from contemporaneous records. The data were normalized and scaled. Each epidemic wave was divided into two segments for analysis. A Spearman's rank correlation was used to assess the relationship between a herald and its subsequent main wave. Geospatial analytical tools were used to determine and display each segment's geographic distribution pattern using autocorrelation techniques to determine its central point. Results show that the herald wave of each epidemic shared characteristics similar to its following main wave. Central-point locations were similar and Spearman's rank coefficients showed high degrees of correlation. Autocorrelation results were similar, with one exception reflecting an appalling anomalous cholera outbreak at an institution for children. Because of the demonstrated similarity of each epidemic's herald and main waves, this study did not detect a spatial characteristic that could explain the observed difference in severity between the studied heralds and mains.

Information assimilation and distribution challenges and goals for real and virtual journals.

The distribution of biomedical information was transfigured over three centuries ago with the introduction of scientific journals. This enabled the widespread dissemination of data to global audiences and greatly facilitated not only the advance of science but amplified the interaction between investigators despite their different locations. This process continued to expand in a linear fashion prior to the emergence of the Internet. The latter system has prompted a phenomenal augmentation of information accessibility, and its ever-expanding use has resulted in an exponential increase in the demand for digital technology and online resources. This technology has achieved unprecedented acceptance in the scientific domain and enabled publishers to expeditiously produce and distribute journal contents online. Such unparalleled access to information has sparked incendiary debate within the scientific community and among journal publishers in regard to numerous issues. It is thus much debated as to who has the right to "own" or control intellectual property, whether information should be made freely available to the online global community, how to gauge the legitimacy and authenticity of published research, and the need to reexamine the feasibility and profitability of paper journals in consideration of the digital, online formats that continue to gain popularity. To assess the current status of the situation, a meeting of journal editors, research scientists, and publishing executives was held in Constance, Germany, on June 26, 2004, to discuss these issues and formulate strategies and recommendations for the future of biomedical publishing. Herewith we provide a summation (manifesto) of the meeting's proceedings and provide a consensus opinion with the aim of illuminating the subject and also proposing some putative solutions for the major challenges that currently confront the scientific and publishing community.

Evaluation and management of patients with recurrent peptic ulcer disease after acid-reducing operations: a systematic review.

This systematic review examines the evidence for commonly employed strategies of managing patients with recurrent ulcer disease after acid-reducing operations. Particular attention is given to recent evidence relating Helicobacter pylori (H. pylori ) and nonsteroidal anti-inflammatory drugs (NSAIDs) to ulcer recurrence after operative therapy. MEDLINE word searches of the literature from 1966 to 2001 identified 895 articles that cross-reference the terms "peptic ulcer disease (PUD)," "surgery," and "recurrence." Articles were selected for systematic review of evidence relating incomplete vagotomy, NSAIDs, and H. pylori to postoperative ulcer recurrence and evidence supporting common medical and surgical strategies. The relationship between incomplete vagotomy and recurrent ulcer disease is suggested by randomized controlled trials and well-designed prospective case series. The evidence that NSAID use is an important pathogenic factor in recurrent ulcer disease includes the relationship between NSAIDs and primary PUD, the occurrence of NSAID-induced ulcers in patients taking proton pump inhibitors, and case series demonstrating virulent ulcer disease in patients taking aspirin despite prior acid-reducing operations. The relationship between H. pylori infection and postoperative ulcer recurrence remains uncertain despite multiple controlled trials and well-designed case series that have documented high rates of H. pylori infection in postoperative patients. The initial management of patients with recurrent ulcer disease after acid-reducing operations consists of a protein pump inhibitor or a histamine-2 receptor antagonist and antibiotics directed at H. pylori, if present. Evidence for this regimen includes prospective randomized trials demonstrating the efficacy of cimetidine in healing ulcers after acid-reducing operations and prospective, randomized studies documenting the efficacy of histamine-2 receptor antagonists and protein pump inhibitors in the management of patients with primary PUD. The critical role that H. pylori infection plays in primary PUD and the minimal risks associated with H. pylori eradication strongly support the initiation of antibiotic therapy when H. pylori is present. The principal indication for operative management of recurrent PUD is the occurrence of ulcer complications that cannot be managed by medical or endoscopic means. The operative management of patients with failed acid-reducing operations is based on ulcer recurrence rates and morbidity and mortality rates in randomized and nonrandomized prospective trials of patients with primary PUD and retrospective case series of patients undergoing remedial operative procedures after various failed acid-reducing operations.