Automated tools for identifying the causes of anaemia in general practices are particularly advantageous for patients who do not fit the typical profile.

BACKGROUND: The Dutch guideline algorithm for the analysis of anaemia in patients of general practitioners (GPs) was programmed in a Clinical Decision Support system (CDS-anaemia) to support the process of diagnosing the cause of anaemia in the laboratory. This research aims to assess the supplementary benefit provided by the automated algorithm in various demographic categories, including different sexes, age groups and severities of anaemia, in comparison to the manual diagnostic approach employed by GPs. METHODS: This was a retrospective cohort study of 5399 primary care patients where the cause of anaemia was diagnosed by GPs with or without the aid of CDS-anaemia within the age groups 18-44, 45-64, 65-79 and 80 and older. Anaemia was defined according to the Dutch College of General Practitioners (DCGP) guideline. Causes of anaemia were based on the DCGP guidelines with the corresponding blood tests. By calculation of rate ratios and percentage differences of the determined cause of anaemia we evaluated the effect of the diagnostic algorithm. RESULTS AND CONCLUSION: The percentage patients in which an underlying cause of anaemia was found increased 34 and 46 percentage points in males and females, respectively, when GPs were supported by CDS-anaemia compared to GPs who were not supported by CDS-anaemia. The highest increase in percentage points when CDS-anaemia was used, was found in younger- and middle-aged males and mild or moderate anaemia.

Polypharmacy Rates among Patients over 45 years

Polypharmacy, defined as receipt of ≥5 medications in any one month, is often associated with potentially inappropriate prescribing and adverse drug interactions. High levels of polypharmacy have been observed internationally and in Ireland. The Health Service Executive Primary Care Reimbursement Services (HSE-PCRS) pharmacy claims database for the GMS eligible population was used. We conducted Chi-square tests to determine the statistical significance of perceived differences in medication use among patients aged ³ 45 years. Our results establish a national benchmark for polypharmacy in gender and various age categories in the HSE-PCRS. Of the 794,628 individuals aged ≥45 years with at least one claim in 2013, 64.3% (510,946) had polypharmacy, with higher rates among women (67.0% - 293,886 - compared to 60.8% of men - 216,444). Patients aged 45-54 years were less likely to have polypharmacy (38.6% - 69,934) compared to those aged 75 years old (82.6% - 197,565). The high levels of polypharmacy are of interest, and suggest that monitoring and evaluation of patients' medication regimes may be required to ensure appropriateness.

Fertility, segregation at a herbicide-resistance locus, and genome structure in BC hybrids from two important weedy Amaranthus species.

Field studies have established high potential for hybridization between two important and often coexisting weedy species, Amaranthus hybridus and Amaranthus tuberculatus. Prezygotic reproductive barriers between these species are believed to be limited to pollen competition and availability. A greenhouse study showed that a herbicide-resistance gene (ALS) from A. hybridus could be introgressed into an advanced A. tuberculatus background (BC2). However, evidence is lacking in support of such transfer in nature. Postzygotic reproductive barriers may minimize, if not preclude, natural introgression. Indeed, A. hybridus xA. tuberculatus hybrids are characterized by reduced fertility and even floral neuterism. The purpose of this study was to assess hybrid fertility in the BC1 generation and its relationship with genome structure and segregation at ALS. Fertility was assessed by measuring seed output and by pollen evaluation, and segregation at ALS was determined via a molecular marker system. The two parental species have the same ploidy (2n = 32) but differ in DNA content (2C) values, with A. tuberculatus chromosomes being on average 29% greater than those of A. hybridus. Given that most (98%) BC(1)s were homoploid, 2C values were used as indicators of relative genomic constitution. Fertility in the BC1 generation was greater than that of F1s, and 3% of BC1s had seed output similar to that of the parental species. Fertility in the BC1 did not correlate (in a strict way) with reconstitution of parental genomes. Hybrid sterility appeared to be controlled by relatively few loci. Heterozygosity at ALS was negatively correlated with fertility. Also, the A. tuberculatus ALS allele was not observed in the A. hybridus sexual condition, monoecism. Linkage of ALS to a locus associated (directly or via epistasis) with hybrid sterility may explain the fertility penalty observed with ALS introgression. Moreover, this linkage might explain why sequenced herbicide-resistance ALS alleles from sympatric A. tuberculatus and A. hybridus populations show independent evolution.

Syngeneic consecutive rat spleen transplantation bearing infantile testis.

Seventy-seven Lewis adult rats received autologous testicular implants in the spleen. These spleens were retransplanted in a consecutive transplant fashion as we described earlier. Some were observed as long as 26 to 27 months. Although earlier splenic-testicular transplants showed benign granulosa cell tumors, some of the long-term follow-ups showed a seminoma-like transformation.

Refillable point source for motion correction during first-pass radionuclide angiography.

First-pass radionuclide angiography, for the evaluation of ventricular function during peak physiological stress, requires the use of a low-energy point source for correction of motion artifacts. A design for the construction of a refillable 125I point source is presented.

Somatosensory central latencies and disc discrimination in multiple sclerosis.

1. Somatosensory evoked potentials are abnormal in a large percentage of patients with severe multiple sclerosis if amplitude, latency and right-left asymmetry are all considered. Mild disease has remained difficult to identify. This screening test employing two stimulus sites in the same arm did not improve the yield. 2. Stimulation of the median nerve at the elbow is not often likely to justify the associated discomfort, except in patients with known disease in the forearm. 3. Measuring the central conduction velocities from easily recorded low cervical potentials up to the parietal scalp deflections eliminates the need to consider the length and health of the peripheral nerve stimulated. 4. Central conduction velocities were not significantly related to age or total body height in this population. Extremely old or tall subjects may still deserve special consideration if the cervical responses are truly nerve propagated waves. 5. One restricted measure of stereogno-sis--disc size discrimination, correlated well with conduction times from the low cervical region to short-latency deflections in the post-central parietal area, but patients with delayed onset of deflections still maintained normal interpeak latencies. 6. more precise correlations between components of stereognosis, and the integrity of mediating neurons, will be possible when the electrical generators of the SER are better delineated.