Implementation of ironXS: a study of the acceptability and feasibility of genetic screening for hereditary hemochromatosis in high schools.

Hereditary hemochromatosis (HH), most often due to HFE C282Y homozygosity, is an iron overload disorder that can result in severe morbidity including hepatic cirrhosis. Predisposition to HH is easily diagnosed and morbidity is preventable by maintaining normal body iron and thus calls have been made to introduce community screening. The current study has been designed to assess the acceptability and feasibility of HH screening in high schools. Students (mostly 15-16 years of age) watched a purpose-designed DVD for education about HH. Those with parental consent were then offered cheek-brush screening for C282Y. Students completed a questionnaire prior to screening. The program was offered to 9187 students at 32 schools and 3489 (38%) had screening. Nineteen C282Y homozygotes (1 in 183) and 376 heterozygotes (1 in 9.3) were identified. More than 90% of students answered each of five knowledge questions correctly. Eight homozygotes (42%) had elevated transferrin saturation, but only two (10.5%) had marginally elevated serum ferritin (SF). We have shown that genetic screening for HH can successfully be offered in the high school setting. Ongoing research in this study will answer questions about the impact of high school students learning that they are at risk of HH.

Carcass disposal: lessons from Great Britain following the foot and mouth disease outbreaks of 2001.

The foot and mouth disease (FMD) outbreak that occurred in the United Kingdom in 2001 was of an unprecedented scale and severity and presented a massive logistical challenge to Government. Over 6.5 million animals were slaughtered and disposed of, over 4 million as a direct result of disease and a further 2.5 million on welfare grounds. On-farm burial and on-farm burning were the principal routes for disposal at the commencement of the outbreak. On-farm burial was limited by legislation to protect groundwater supplies and pyre burning came increasingly under attack from local communities concerned about health risks from smoke and emissions. Burning also painted a vivid but distressing picture of the war against disease. Increasingly, rendering capacity made an important contribution to disposal. The peak of the outbreak could only be managed by the development of a new disposal route--mass burial in engineered sites and by using licensed landfill where available. During the course of the outbreak, a disposal hierarchy was developed to reflect environmental and public health concerns, namely: rendering and incineration ranked first, licensed landfill next, followed by burning with mass burial or on-farm burial as the least preferred options. However, the campaign against the disease could not have been won without the tactical use of mass burial in addition to all the other available disposal routes. The authors describe the development and deployment of the disposal routes used in the 2001 outbreak.

An audit of drug usage for in-hospital cardiopulmonary resuscitation.

The objective of this study was to assess the changes in outcome of cardiac arrest due to ventricular fibrillation, asystole and electromechanical dissociation in relation to the changing guidelines for drug therapy set by the U.K. Resuscitation Council. It was a retrospective study of 667 resuscitation records for the years 1982, 1986, 1988, 1989, 1990 and 1991. It took place in a large district general hospital with a regional cardio-thoracic centre. We have audited the asystolic cardiac arrests (N = 271) which occurred outside the cardiac care unit (CCU). Adrenaline (intravenous 1 mg) is now the first line drug followed by atropine at an increased dose (2 mg intravenously); calcium is no longer recommended and sodium bicarbonate should be reserved for cases in which an acidosis has been documented. Atropine use has increased over the 9-year period. Bicarbonate use did not change from 1982 to 1986 but fell progressively to no use at all in 1991. Calcium use has declined since 1982. Adrenaline use has remained unchanged. Survival from asystolic arrests (hospital discharge) has remained unchanged at 0-5.5%. Asystole as a primary event in the CCU was uncommon (N = 17) and no patient was discharged. Over the same period, 60% of patients (N = 92) with a cardiac arrest on CCU due to ventricular fibrillation (VF) were discharged and 55% were alive after 6 months. For VF on the wards (N = 192), only 20% of patients were discharged from hospital. A similar proportion was successful for each year.(ABSTRACT TRUNCATED AT 250 WORDS)

Benign paroxysmal positional vertigo resulting from surgical trauma.

A patient developed benign paroxysmal positional vertigo following partial excision of the upper jaw for squamous carcinoma. It is probable that the trauma sustained by the labyrinth during surgery led to the development of vertigo. Benign paroxysmal positional vertigo may be a preventable post-operative complication.

Intra-aortic balloon counterpulsation. Clinical experience.

From March 1975 until September 1978, seventy patients were referred for intra-aortic balloon counterpulsation for cardiogenic shock complicating acute myocardial infarction or for the treatment of low cardiac output states following cardiopulmonary bypass. Sixty of these received adequate intra-aortic balloon pump assistance; fifty-two ped successfully off the balloon pump. Twenty-three patients survived to leave hospital.

A theory of fluid flow in compliant tubes.

Starting with the Navier-Stokes equations, a system of equations is obtained to describe quasi-one-dimensional behavior of fluid in a compliant tube. The nonlinear terms which cannot be shown to be small in the original equations are retained, and the resulting equations are nonlinear. A functional pressure-area relationship is postulated and the final set of equations are quasi-linear and hyperbolic, with two independent and two dependent variables. A method of numerical solution of the set of equations is indicated, and the application to cases of interest is discussed.

Numerical hydrodynamic calculations of catheter characteristics.

The theory of fluid flow in compliant tubes developed in a previous paper is applied to a catheter, and the results of various calculations are compared with experiment. When a parabola is used for the unknown velocity profile, the calculated gains are too high. Agreement is slightly improved by using more reasonable profiles. It is shown that there exists a functional relationship between the parameter gamma and the nondimensional parameter alpha(10) which gives reasonable agreements with all the experimental data considered. The theory of Womersley is applied to the catheter, and the calculated gains are larger than those observed experimentally. A form for the frictional force suggested by Lambossy is used in some further calculations.

Peaking of the pressure pulse in fluid-filled tubes of spatially varying compliance.

Calculations are made for a fluid-filled tube with characteristics approximately those found physiologically. The pressure variation, diameter, and compliance at the input end are as measured by Lawton for the abdominal aorta of a dog. After a 30 cm-long input section of constant k (=dp/dA), the tube is taken to stiffen by approximately the amount measured by Patel et al., i.e., k increases by a factor of 5 over the next 40 cm. The cross-section remains constant. Pressure and velocity wave forms are calculated at 8 stations spaced at 10-cm intervals down the tube. The pressure pulse leading edge is found to become steeper in the stiffening section. The peak height of the pressure pulse is found to increase by about 50% and the velocity pulse to decrease by about 30% as the disturbance propagates over a distance of 70 cm. These values agree qualitatively with the experimental physiological values given by McDonald. Most of the pressure peaking takes place upstream of the stiffening section.