Investigation of molecular markers in the diagnosis of refractory coeliac disease in a large patient cohort

Some patients with coeliac disease, despite strict adherence to a gluten-free diet, continue to have significant symptoms and/or a severe small intestinal histological lesion. The term "refractory coeliac disease" (rCD) is used to describe this condition. The purpose of this study was to investigate the value of tissue molecular markers reported to help in the diagnosis of rCD.

Patient removals from general practitioner lists in Northern Ireland:1987-1996

Being struck off a general practitioner's list is a major event for patients and a subject for much media attention. However, it has not hitherto received much research attention.

Patient satisfaction with realtime teledermatology in Northern Ireland

Teledermatology consultations were organized between two health centers and two hospitals in Northern Ireland using low-cost videoconferencing equipment. A prospective study of patient satisfaction was carried out. Following each teleconsultation, patients were asked to complete a questionnaire assessing their satisfaction with the service. Over 22 months, 334 patients were seen by a dermatologist over the video-link, and 292 patients (87%) completed the 16-item questionnaire. Patients reported universal satisfaction with the technical aspects of teledermatology. The quality of both the audio and the display was highly acceptable to patients. Personal experiences of the teledermatology consultation were also favourable: 85% felt comfortable using the video-link. The benefits of teledermatology were generally recognized: 88% of patients thought that a teleconsultation could save time. Patients found the teledermatology consultation to be as acceptable as the conventional dermatology consultation. These findings suggest overall patient satisfaction with realtime teledermatology.

A Review on Improving the Autonomy of Unmanned Surface Vehicles through Intelligent Collision Avoidance Manoeuvres

In recent years unmanned vehicles have grown in popularity, with an ever increasing number of applications in industry, the military and research within air, ground and marine domains. In particular, the challenges posed by unmanned marine vehicles in order to increase the level of autonomy include automatic obstacle avoidance and conformance with the Rules of the Road when navigating in the presence of other maritime traffic. The USV Master Plan which has been established for the US Navy outlines a list of objectives for improving autonomy in order to increase mission diversity and reduce the amount of supervisory intervention. This paper addresses the specific development needs based on notable research carried out to date, primarily with regard to navigation, guidance, control and motion planning. The integration of the International Regulations for Avoiding Collisions at Sea within the obstacle avoidance protocols seeks to prevent maritime accidents attributed to human error. The addition of these critical safety measures may be key to a future growth in demand for USVs, as they serve to pave the way for establishing legal policies for unmanned vessels.

Retransplantation in a patient with cystic fibrosis

A patient with cystic fibrosis is described who requested a third lung transplant. The medical and ethical issues involved are discussed.

Obesity associated severe asthma represents a distinct clinical phenotype - Analysis of the British Thoracic Society Difficult Asthma Registry patient cohort according to body mass index

BACKGROUND: Obesity has emerged as a risk factor for the development of asthma and it may also influence asthma control and airways inflammation. However, the role of obesity in severe asthma remains unclear. OBJECTIVE: To explore the association between obesity (defined by BMI) and severe asthma. METHODS: Data from the National Registry for dedicated UK Difficult Asthma Services were used to compare patient demographics, disease characteristics and healthcare utilisation between three body mass index (BMI) categories (normal weight: 18.5 -24.99, overweight: 25 -29.99, obese: =30) in a well characterised group of severe asthmatic adults. RESULTS: The study population consisted of 666 severe asthmatics with a median BMI of 29.8 (interquartile range 22.5 -34.0). The obese group exhibited greater asthma medication requirements in terms of maintenance corticosteroid therapy (48.9% versus 40.4% and 34.5% in the overweight and normal weight groups, respectively), steroid burst therapy and short-acting ß2-agonist (SABA) use per day. Significant differences were seen with gastro-oesophageal reflux disease (GORD) (53.9% versus 48.1% and 39.7% in the overweight and normal weight groups, respectively) and proton pump inhibitor (PPI) use. Bone density scores were higher in the obese group, whilst pulmonary function testing revealed a reduced FVC and raised Kco. Serum IgE levels decreased with increasing BMI and the obese group were more likely to report eczema, but less likely to have a history of nasal polyps. CONCLUSIONS: Severe asthmatics display particular characteristics according to BMI that support the view that obesity associated severe asthma may represent a distinct clinical phenotype.1Royal Brompton Hospital, London, UK;2Department of Computing, Imperial College, UK3Airways Disease, National Heart & Lung Institute, Imperial College, UK;4Centre for infection and immunity, Queen's University of Belfast, UK;5University of Leicester, UK;6The University of Manchester and University Hospital of South Manchester, UK;7Birmingham Heartlands Hospital, University of Birmingham, UK;8Gartnavel General Hospital, University of Glasgow, UK;9Glasgow Royal Infirmary, Glasgow, UKCorrespondence: Dr Andrew N. Menzies-Gow, Royal Brompton Hospital, Fulham Road, London SW3 6HP.

Mycobacterium triplex pulmonary infection in an immunocompetent patient

We present the case of a 47-year-old immunocompetent patient with clinical evidence of pulmonary mycobacterial disease which was found to be due to Mycobacterium triplex. This novel organism is an uncommon, emerging, pathogen for which few reports of clinical infection exist in the medical literature. © 2002 The British Infection Society.

Autonomy and Control of State Agencies:Comparing States and Agencies

Do public organizations with similar tasks or structures differ across states with respect to their autonomy and control? If so, why? By comparing the autonomy, control and internal management of state agencies, this book shows how New Public Management doctrines actually work in three small European states with different politico-administrative regimes. Using a unique set of similar survey data on 226 state agencies in Norway, Ireland and Flanders, this study explains differences in agency autonomy, control and management by referring to international isomorphic pressures, state-specific politico-administrative regimes and characteristics of agencies. Therefore, organization theory and neo-institutional schools are used to formulate four competing theoretical perspectives and hypotheses are tested through simple and advanced statistical techniques. By comparing practices between states and between types of agencies, this study substantially enhances scientific knowledge about why public organizations are granted autonomy, why they are controlled in specific ways, and how autonomy affects internal management.

Autonomy and regulation of state agencies:Reinforcement, indifference or compensation?

This paper analyses the relationships between the autonomy and regulation of state agencies in Norway, Ireland and Flanders (Belgium). The empirical basis is provided by broad surveys of public sector organizations carried out in 2002-2004. Three hypotheses on these relationships are formulated and examined, indicating different patterns. The reinforcement hypothesis, stating a negative relationship does not get any support. On the other hand, the compensation hypothesis, stating a positive relationship gets some support. In general, however, the indifference hypothesis, stating low or no correlations seems to be the most adequate. The hypotheses are also linked to prevalent administrative doctrines, and the empirical findings indicate how relevant they are. © Springer Science+Business Media, LLC 2008.

Learning curves, taking instructions, and patient safety:using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors

ABSTRACT: