Evaluation of the ACR and SLICC classification criteria in juvenile-onset systemic lupus erythematosus: a longitudinal analysis.

Objectives The Systemic Lupus International Collaborating Clinics (SLICC) group proposed revised classification criteria for systemic lupus erythematosus (SLICC-2012 criteria). This study aimed to compare these criteria with the well-established American College of Rheumatology classification criteria (ACR-1997 criteria) in a national cohort of juvenile-onset systemic lupus erythematosus (JSLE) patients and evaluate how patients' classification criteria evolved over time. Methods Data from patients in the UK JSLE Cohort Study with a senior clinician diagnosis of probable evolving, or definite JSLE, were analyzed. Patients were assessed using both classification criteria within 1 year of diagnosis and at latest follow up (following a minimum 12-month follow-up period). Results A total of 226 patients were included. The SLICC-2012 was more sensitive than ACR-1997 at diagnosis (92.9% versus 84.1% p < 0.001) and after follow up (100% versus 92.0% p < 0.001). Most patients meeting the SLICC-2012 criteria and not the ACR-1997 met more than one additional criterion on the SLICC-2012. Conclusions The SLICC-2012 was better able to classify patients with JSLE than the ACR-1997 and did so at an earlier stage in their disease course. SLICC-2012 should be considered for classification of JSLE patients in observational studies and clinical trial eligibility.

Hematologic complications in a patient with Glycine soja polyagglutination following fresh frozen plasma transfusion.

CONCLUSIONS: Polyagglutination is a rare and underdiagnosed condition, characterized by agglutination of red blood cells(RBCs) with almost all ABO-compatible adult sera. Polyagglutination can occur when a cryptantigen is exposed on RBCs via microbial enzyme activity. Becausenearly all adults naturally produce antibodies against cryptantigens, transfusion of plasma can cause unexpected hemolysis and hematologic complications, such as thrombocytopenia and disseminated intravascular coagulation, in patients whose cryptantigens are exposed. We report a case of Glycine soja polyagglutination occurring in a 60-year-old African-American man with disseminated methicillin-resistant Staphylococcus aureus (MRSA) infection. Prior to transfusion, the patient developed severe anemia of unknown etiology. Following transfusion of 3 units of fresh frozen plasma (FFP), his RBC count could not be determined for 24 days because of RBC agglutination in his blood sample. In addition, the FFP transfusion correlated with the rapid development of severe, transfusionrefractory thrombocytopenia and anemia. The perplexed clinical team consulted the blood bank. A direct antiglobulin test demonstrated 1+ mixed-field reactivity with both monoclonal anti-IgG and anti-C3d. Lectin panel testing showed reactivity with only Glycine soja, confirming the condition. Subsequently, plasma components were avoided, and RBC and platelet (PLT) components were washed prior to transfusion. After a 44-day hospitalization involving the transfusion of 22 units of RBCs and 13 units of PLTs, the patient was discharged to a long-term care facility. The patient's confounding hematologic complications can best be explained by polyagglutination, which developed secondary to the severe MRSA infection. The FFP transfusion likely passively transferred antibodies that bound to the patient's RBC cryptantigens, leading to RBC agglutination and anemia. The development of severe thrombocytopenia may be related to cryptantigen exposure on the patient's PLTs. Although difficult to identify, polyagglutination needs to be recognized to appropriately manage hemotherapy. The purpose of this case study is to report hematologic complications following FFP transfusion in a patient with Glycine soja polyagglutination, a rarely described condition.

Academic potential and cognitive functioning of long-term survivors after childhood liver transplantation.

This cross-sectional study assessed intellect, cognition, academic function, behaviour, and emotional health of long-term survivors after childhood liver transplantation. Eligible children were >5 yr post-transplant, still attending school, and resident in Queensland. Hearing and neurocognitive testing were performed on 13 transplanted children and six siblings including two twin pairs where one was transplanted and the other not. Median age at testing was 13.08 (range 6.52-16.99) yr; time elapsed after transplant 10.89 (range 5.16-16.37) yr; and age at transplant 1.15 (range 0.38-10.00) yr. Mean full-scale IQ was 97 (81-117) for transplanted children and 105 (87-130) for siblings. No difficulties were identified in intellect, cognition, academic function, and memory and learning in transplanted children or their siblings, although both groups had reduced mathematical ability compared with normal. Transplanted patients had difficulties in executive functioning, particularly in self-regulation, planning and organization, problem-solving, and visual scanning. Thirty-one percent (4/13) of transplanted patients, and no siblings, scored in the clinical range for ADHD. Emotional difficulties were noted in transplanted patients but were not different from their siblings. Long-term liver transplant survivors exhibit difficulties in executive function and are more likely to have ADHD despite relatively intact intellect and cognition.

Inclusion of COVID-19 as a topic in an undergraduate biotechnology course.

The novelty of the COVID-19 disease has paved the way to numerous scientific studies that aim to further understand its biology, and to different strategies that disseminate this information to promote public awareness. One of the strategies that the academe can employ is the inclusion of COVID-19 as a topic in a basic biotechnology course. This not just helps students better understand this disease, but it also makes them an effective medium in the dissemination of relevant COVID-19 knowledge.

Effects of polystyrene micro/nanoplastics on liver cells based on particle size, surface functionalization, concentration and exposure period.

Micro/nanoplastics (MP/NP) contaminate our food and drinking water but their impact on human health has not been well-documented. The liver is one of the first organs that ingested MP/NP encounter and it has a major role in the clearance of xenobiotics. Therefore, the effects of polystyrene MP/NP on liver HepG2 cells were studied. Cellular responses to particles of various sizes (50-5000 nm) and surface functionalization (aminated, carboxylated or non-functionalized) were determined at different concentrations (0.1-100 µg/mL) and exposure periods (1-24 h). Smaller sized particles were internalized by HepG2 cells more avidly than larger particles regardless of functionalization; the highest uptake being for 50 and 100 nm aminated particles at lower concentrations. Confocal microscopy images of cells corroborated quantitative uptake results. Aminated particles were more toxic to the cells than carboxylated or non-functionalized particles. Among aminated particles smaller particles (50 and 100 nm) were more detrimental to cell viability compared to larger particles (1000 or 5000 nm) with toxicity increasing with concentration. Treatment with the particles for 4 h increased intracellular concentrations of Caspase-3 by 1.5-2.8 fold, but 24 h exposure to the particles attenuated this increase in Caspase-3 concentrations. A slight trend of higher Caspase-3 concentration in cells treated with larger particles (500-5000 nm) compared to smaller particles (50-200 nm) was observed, indicating that larger particles are more likely to direct cells toward apoptotic cell death upon 4 h exposure. Exposure of cells to large PS particles (500-5000 nm) upregulated interleukin-8 and the effect was enhanced at 24 h. Overall, the study demonstrated that smaller aminated particles were most toxic to hepatocytes, but larger particles induced apoptotic cell death or an inflammatory response depending on the length of exposure.

Uptake and toxicity of polystyrene micro/nanoplastics in gastric cells: Effects of particle size and surface functionalization.

Toxicity of micro or nanoplastics (MP/NP) in aquatic life is well-documented, however, information about the consequences of exposure to these particles in terrestrial species is scarce. This study was used to evaluate the uptake and/or toxicity of polystyrene MP/NP in human gastric cells, comparing doses, particle sizes (50, 100, 200, 500, 1000 or 5000 nm) and surface functionalization (aminated, carboxylated or non-functionalized). In general, the uptake of 50 nm particles was significantly higher than 1000 nm particles. Among the 50 nm particles, the aminated particles were more avidly taken up by the cells and were cytotoxic at a lower concentration (≥ 7.5 µg/mL) compared to same sized carboxylated or non-functionalized particles (≥ 50 µg/mL). High toxicity of 50 nm aminated particles corresponded well with significantly high rates of apoptosis-necrosis induced by these particles in 4 h (29.2% of total cells) compared to all other particles (≤ 16.8%). The trend of apoptosis-necrosis induction by aminated particles in 4 h was 50 > 5000 > 1000 > 500 > 200 > 100 nm. The 50 nm carboxylated or non-functionalized particles also induced higher levels of apoptosis-necrosis in the cells compared to 100, 1000 and 5000 nm particles with same surface functionalization but longer exposure (24 h) to 50 nm carboxylated or non-functionalized particles significantly (p<0.0001) increased apoptosis-necrosis in the cells. The study demonstrated that the toxicity of MP/NP to gastric cells was dependent on particle size, dose surface functionalization and exposure period.

An In Vitro Comparison of Estrogenic Equivalents Per Serving Size of Some Common Foods.

The public assumes that some foods, such as milk and ground beef from cattle receiving steroidal implants, are associated with estrogenic hormones, while other foods are presumed "safe" or nonestrogenic. Here, we investigate these assumptions by assessing the relative estrogenic activity of a serving size of four foods: skim milk (8 oz), rice (48 g dry wt) in cooking bag, ground beef patties from steers raised with or without hormone implantation (quarter lb each, 114 g), and tofu burgers (isocaloric to beef burger, 198 g), using an in vitro assay (E-Screen). Mean picogram (pg) estradiol equivalents (E2Eqs) on a serving basis were as follows: skim milk 120; rice 400; rice prepared in cooking bag 370; rice boiling bag alone 4 pg per bag, ground beef burger (obtained from the tissue of cattle that had received no hormone implants) 389, beef burger (obtained from cattle that had received hormone implant) 384, and tofu burger 1,020,000. Rice E2Eqs were highly variable, but the plastic cooking bags provided by the manufacturer added negligible E2Eqs. The source of estrogenic activity in rice may have been due to contamination with the mycotoxin zearalenone. The E-Screen E2Eqs of tofu burger extracts agreed with those predicted based on chemical concentrations of the most estrogenic component times their E2Eq factor. While a tofu burger contained around three times the estrogenic activity of a daily dose of estrogen replacement therapy (125 mg, Premarin®, 303,000 pg); the other foods--a quarter pound ground beef burger at approximately equal calorie count, a serving of milk, or rice, were all at least 750-fold less estrogenic. PRACTICAL APPLICATION: When consuming the recognized serving size of a food, how much estrogenic activity can we expect? While the public assumes that some foods, such as milk and ground beef from cattle receiving steroidal implants, are associated with estrogenic hormones, other foods are presumed "safe" or nonestrogenic. Using one assay, a tofu burger contained three times the estrogenic activity of a dose of hormone replacement therapy commonly prescribed for women after hysterectomy or menopause (Premarin®); while other foods--a quarter pound ground beef burger at approximately equal calorie count, a serving of milk, or rice, were all at least 750-fold less estrogenic.

Oral exposure of male and female mice to formulations of organophosphorous pesticides: congenital malformations.

Birth outcome was studied in pre-partum litters of mice exposed to oral doses of organophosphorous pesticides at low and high concentrations before mating. Exposed and unexposed pregnant dams were delivered by Caesarean section 1 day before partum, the fetuses were collected, counted and weighed, and the numbers of resorptions were recorded. Live litter sizes were non-significantly higher in all the exposed groups compared with the control group. The numbers of resorptions were significantly higher in all the exposed groups than in the comparison groups. The incidence of intra-uterine growth retardation was significantly higher in all the exposed groups than in the comparison groups. The incidences of congenital malformations were significantly higher in the exposed groups than in one or more of the comparison groups for the defects of the ears, eyes, jaws, brain, and tongue in all the exposed groups. Low set microtia, cataract or open eyelids, microcephaly or anencephaly, maxillary or mandibular hypoplasia, and protruding tongue were observed in all groups, but the numbers were significantly higher in the exposed groups compared with one or more of the comparison groups. Curled or missing tail and intra-auricular septal or intra-ventricular septal defects were observed in higher numbers in the groups in which both the males and the females were exposed than in the comparison groups. Male:female sex ratios were significantly higher in the groups in which males only and females only were exposed.

Reversible blindness secondary to severe diabetic ketoacidosis.

We present a case of sudden-onset reversible blindness secondary to severe diabetic ketoacidosis. The exact mechanism is not fully understood but is postulated to be due to uncoupling of retinal electrical transmission in a severe acidic environment. This report adds to the small number of reported cases of reversible blindness secondary to severe diabetic ketoacidosis and serves to raise awareness of this unusual diagnosis. It should be considered in patients who present with acute-onset reversible bilateral blindness only after other causes are excluded via detailed retinal examination and cranial imaging.

Atmospheric metal pollution monitored by spherical moss bags: a case study of Armadale.

To supplement epidemiological investigations into the mortality from respiratory cancer in the small industrial town of Armadale, central Scotland, spherical moss bags were used to study the deposition of atmospheric metal pollution there during a period of 17 months. High concentrations of most metals were found in areas close to the local steel foundry. High concentrations of some metals were also found in the north/northeast of the town. Temporal variations in the metal deposition patterns during the survey-period were observed. By means of statistical analyses, those metals were indicated which were probably emitted from the steel foundry. The scientific and financial advantages of using this method of low technology sampling in epidemiological studies are discussed.

Low sex ratios of births in areas at risk from air pollution from incinerators, as shown by geographical analysis and 3-dimensional mapping.

Previous research in environmental and occupational health has suggested that fluctuations in the sex ratios of births might provide a useful early warning to the possible health effects of toxins or other stresses in the environment. To examine further this hypothesis, we investigated the sex ratios of births in an area in central Scotland which contained two incineration plants. Analyses of the sex ratios, at various levels of geographical detail and using 3-dimensional mapping techniques, in the residential areas at risk from airborne pollution from these incinerators showed locations with statistically significant excesses of female births.

PIP: Researchers calculated sex ratios of births for the 3 control areas and 4 comparison areas of Falkirk District in central Scotland based on 1975-1983 birth records to determine if abnormal sex ratios of births occurred in areas at risk from airborne pollution from 2 incinerators in the Larbert area. These incinerators had stopped operating before the study began in the early 1990s. A significant excess of female births occurred in 1 of the most at risk areas in both 1975-1979 and 1980-1983 (p.05). Further another at risk area also had excess female births, but the excess was not significant. The other at risk area had an excess of male births, again not a significant excess. Yet there were no significant differences between the total at risk areas and the comparison areas. Computer mapping analysis revealed a definite northeast-southwest axial pattern of excess female births. A possible explanation for the lack of complete uniformity in excess female births may be that the incinerators' plumes contained several pollutants and different toxins change the sex ratios in different ways. Besides wind direction, particulate size, and weather conditions influenced fall out of particulates differently. Other researchers have shown that some pollutants affect metabolism of rapidly dividing cells of gonadal and fetal tissues. For example, a study of workers' exposure to the nematocide DBCP suggested damage to the spermatozoa bearing the Y chromosome. This study's researchers have found similar associations between airborne pollution and abnormal sex ratios. If indeed airborne pollution exposure influences sex ratios, the presence of abnormal sex ratios can be used as a screening procedure to forewarn medical and environmental health authorities of health hazards.

Ischaemic heart disease: trends in mortality in Hong Kong, 1970-89.

STUDY OBJECTIVE: To describe the time trends for ischaemic heart disease (IHD) mortality in Hong Kong between 1970 and 1989, and to examine these trends in relation to the risk factors for IHD. DESIGN: A descriptive epidemiological study of time trends using mortality and population data from the Hong Kong Census and Statistics Department. Direct standardisation using the world population was made to adjust for the changing age structure. Log-linear analyses for trends were performed for the whole period and separately for 1970-79 and 1980-89. The cohort effect was studied by regrouping the data into five year groups according to the year of birth. The influences of risk factors, including hypertension, diet, and smoking, on the time trends of IHD were explored. The role of improved hospital treatment of myocardial infarction on the trends of mortality from categories of IHD was also examined. SETTING: The total Hong Kong population, 1970-89. MAIN RESULTS: The substantial and steady decline of IHD mortality seen in most western countries in the past two decades was not observed in Hong Kong, which showed a plateau or slowly decreasing trend only in the past decade for both women and men. The decreasing trends were more apparent in the younger age groups, especially for women. Cohort analysis showed no significant cohort effect in men, but women born more recently had a lower mortality. Trends of risk factors did not show any close relationship with the mortality trends of IHD, except that a decrease in cigarette smoking might have contributed to the slight decrease in IHD mortality in recent years. Better detection and wider availability of treatment for hypertension might also have contributed to the decrease in IHD mortality. CONCLUSIONS: Hong Kong started to show a slow decline in IHD mortality during the 1980s, about one to two decades later than in other western countries and with the decreasing trend less pronounced. The reasons for this decline are not clear. More detailed information from systematic, population based surveys on life style and risk factors for IHD among the general population are needed.

Morbidity among farm workers in a desert country in relation to long-term exposure to pesticides.

OBJECTIVES: Farm workers chronically exposed to low levels of pesticides seldom show signs and symptoms of clinical significance. This study investigates subclinical morbidity patterns among male farm workers in a desert country. METHODS: Migrant-established farm workers (N=226) were compared with referents (N=226) and with new farm workers (N=92) who had just entered the country to work on farms. Acetylcholinesterase activity was measured, the aiming test and digit symbol test were applied, and a morbidity profile was collected with a questionnaire. RESULTS: The erythrocyte acetylcholinesterase activity and hemoglobin-adjusted erythrocyte acetylcholinesterase activity were significantly depleted in the established farm workers. The results of the aiming and digit symbol tests were also significantly lower for the established farm workers. For the morbidity profile, irritated conjunctiva (47.3%), watery eyes (52.2%), blurred vision (63.3%), dizziness (55.2%), headache (63.7%), muscular pain (61.1%), and weakness (76.6%) were reported by established farm workers in statistically significantly higher numbers than by the referents and new farm workers. CONCLUSIONS: Morbidity patterns, such as the health complaints and objective parameters suggested in this study, would be suitable as criteria for identifying farm workers most at risk from pesticide toxicity and as criteria for initiating measures to control and reduce exposure.

Spatial and temporal patterns of airborne metal pollution: the value of low technology sampling to an environmental epidemiology study.

To investigate an epidemic of respiratory cancer in Armadale, central Scotland, its air pollution was studied. During a period of 18 months, low technology samplers were exposed at 47 sites in the town to monitor the local variations in contamination by atmospheric metals. The samplers were two types of lichen and two types of moss, one of each type being a transplant and the other an in situ sampler. Following each exposure, the comparability of the samplers' uptake and retention of the metals was assessed. The sources of the metals and the effects of environmental variables on the pollution patterns were investigated through statistical analyses of spatial and temporal trends in the data. The spatial patterns of the metals indicated the steel foundry in the town as the major source of most of the pollutants. The temporal patterns, although less statistically significant, suggested the pollution might have been affected by some meteorological factors and by the foundry's output, but not by the output of the other main industry in the town, i.e. a brickworks. The types of sampler showed a general similarity of pollution pattern, but with some differences which indicated that some types of sampler were more suitable than others for particular forms of survey. Low technology sampling can provide information about short-distance and short-term changes in the patterns of airborne pollution by metals, thereby assisting the interpretation of epidemiological patterns of respiratory disease.

The geography of the community sex ratios for young children in Newfoundland.

Abnormalities of the sex ratio of births may be linked with environmental factors, including diet and pollutants in the general or occupational environments, which in turn can cause ill-health. To examine this relationship in the Province of Newfoundland and Labrador, where a geographical imbalance of mortality has already been identified, we examined the geographical distribution of sex ratios (boys/girls x 100) of young children (0-4 years) in the communities of the Province during recent years. The individual communities of the 1976 and 1981 censuses were assigned to contiguous regions and their component districts. The numbers in the appropriate age-groups in the communities in these two census years were used to calculate a mean sex ratio for each community; each community was allocated, according to the value of its ratio, to one of four predefined categories of ratio. From the numbers of communities belonging to these various categories of sex ratio in the regions and districts, the community sex ratios of these areas (i.e. regions and districts) were derived. As a preliminary assessment of the relationship between sex ratios and mortality, a small group of communities with the highest sex ratios was selected, and the mean standardized mortality ratios (SMRs) for all deaths in those communities were calculated. The community sex ratios of regions and districts declined from east to west. The difference in the ratios between the Avalon region (in the most easterly part of the Province) and the southwest region was statistically significant. Districts with high ratios were frequent, particularly those on the Avalon peninsula in the south-east of the island, whereas low ratios were more frequent on the south-west coast of the island, and a low ratio was also found for the only inland district. Of the communities with statistically reliable numbers, the township of Makkovik in Labrador had the highest sex ratio (100 x 50/25 = 200). The SMR of that community during 1976-82 was statistically elevated at 218. In the small group of communities studied, however, high sex ratios from census data for individual communities were not reliable predictors of high SMRs. Further work is required to clarify the inter-relationships between the sex ratios of the census data, the sex ratios of births, the mortality rates and environmental factors.

Toxicity from ragwort and fat cow syndrome, or from industrial chemicals: the value of epidemiological analysis for interpreting clinico-pathological findings.

When livestock in close proximity to industries develop signs of ill-defined disease, toxic effects from industrial pollution should be considered in the differential diagnosis. In establishing the final diagnosis, epidemiological methods should be applied to supplement the clinical and pathological techniques. This viewpoint is illustrated by two case-histories describing episodes of cattle disease in central Scotland. A long-established and successful dairy herd in central Scotland sustained severe morbidity and mortality amongst animals which had grazed on a field beside a recently established dump which contained wastes from a chemical waste incinerator. An official investigation concluded that the episode of disease was the result of ragwort poisoning; this diagnosis was reached on clinical and pathological grounds only. A similarly unexpected and severe epidemic occurred a few years later in another dairy herd, about 1 km further away from that incinerator (which was also within 100 m of a municipal incinerator). The official investigation, which again focused on clinical and pathological criteria, led to the diagnosis of fat cow syndrome. In the first episode, contaminated water drained from the chemical waste dump on to the cows' field; in the second episode, the relevant field was affected by airborne pollution from the two waste incinerators mentioned earlier. In both episodes, the epidemiological features, which were not examined systematically by the original investigators, were consistent with the hypothesis that these episodes resulted from exposures to toxic contaminants.

Hepatic injury and disturbed amino acid metabolism in mice following prolonged exposure to organophosphorus pesticides.

Chronic occupational exposure to organophosphorus and carbamate-type pesticides significantly inhibits acetylcholinesterase activity and causes morbidity. This study on mice was designed to evaluate their amino profile and to identify signs of hepatic dysfunction following their chronic exposure to mixtures of organophosphorus pesticides. Laboratory mice were exposed to a formulated mixture of the six organophosphorus pesticides (Dimethoate, Chlorpyrifos, Profenofos, Pirimiphos methyl, Triazophos and Dimethoate) most commonly used in agriculture in this region of the Middle East. Doses (10% of LD50 of the mixture) were given once a week by gavage in corn oil for 7 weeks; the control group was given only corn oil. At the end of the exposure period, mice were culled and blood samples were collected to determine erythrocyte acetylcholinesterase activity, biochemical markers of liver function and concentrations of serum amino acids. Erythrocyte acetylcholinesterase activity and total serum proteins decreased significantly in the exposed group. Serum concentrations of alanine aminotransferase and aspartate aminotransferase, alanine, glutamic acid, glycine, isoleucine, leucine, methionine, ornithine, proline, serine, threonine and valine were significantly increased in the exposed mice, while serum levels of cystine were decreased significantly. There were also non-significant increases in serum alkaline phosphatase, gama-glutamyl transpeptidase and some of the other amino acids. Chronic exposure to mixtures of organophosphorus pesticides is associated with decreased acetylcholinesterase activity, hepatic dysfunction and disturbance of amino acids profile. Biochemical indices of hepatocellular injury and disturbed amino acid metabolism may be of value as markers of chronic exposure to such pesticides.

Health care needs in the Tai Po district of Hong Kong initial indications from a population-based study.

The objective of this study was to obtain a representative profile of residents in Tai Po district, Hong Kong, with regard to their health status, health service use and socio- demographic characteristics. From October 1992 to February 1993, a cross-sectional telephone survey of 7573 Tai Po residents was undertaken. Acute illness episodes in the past month, chronic illness history, and treatment choices for acute and chronic illnesses were used as outcomes. Socio-demographic data were also obtained. Seventeen per cent of respondents reported having acute illness in the previous month, 66% of whom attended private clinics; 5.2% reported having chronic illness, 58.5% of whom attended public clinics. Most (88.5%) acute illness sufferers who used Western medical services for acute illness did so within Tai Po, while 52.7% of chronic illness sufferers used services outside of the district. Older, female, and lower income respondents were more likely to use public clinics. These preliminary findings help to reflect the health needs of residents in Tai Po.

Factors associated with the utilization of traditional Chinese medicine in a small town in Hong Kong.

The practice of Traditional Chinese Medicine (TCM) is largely unregulated in Hong Kong. Yet, as previous studies have shown, a sizable segment of the population consults TCM practitioners for health problems. This paper uses health care utilization data from a telephone health survey of 847 adult subjects in Tai Po District who had suffered from acute illness in the past month, to examine the profile of TCM users in the District. Women, older residents, unemployed workers, low skill laborers, current smokers and subjects dissatisfied with the quality of private sector clinics were significantly more likely to consult TCM practitioners.

Soil arsenic in Armadale, Scotland.

As part of an investigation into the high mortality from lung cancer and the high sex ratios of births in Armadale, central Scotland, concentrations of arsenic were measured in soil cores from 48 sites in Armadale and 6 sites in a comparison town. Concentrations in Armadale were substantially higher than those in the comparison town, and many of the highest range of values were in that part of the town where the epidemiological abnormalities of lung cancer and of birth sex ratios were most pronounced. The study indicated that clues to the etiology of high rates of disease in small areas could be sought most profitably if close links were maintained between epidemiological and environmental investigations.