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Notes: This article examines how physicians and patients interactionally accomplish the transition from the activity of history taking to that of physical examination. Prior research focuses on participants' reliance on overt verbal resources (e.g., physicians' requests for permission to examine patients or explanations that foreshadow examination). Using the methodology of conversation analysis, this article draws on a corpus of 40 primary-care encounters to demonstrate that: (a) In addition to verbal behavior, nonverbal behavior is integral to the accomplishment of transitions; and (b) patients' understandings of physicians' verbal and nonverbal behavior as communicating transitions are achieved through situating those behaviors in other contexts of embodied action, talk, activity, and social structure (i.e., the phase structure of encounters). Findings have implications for: (a) the theoretic relationship between verbal and nonverbal behavior in terms of social meaning, (b) what it means to explain transitions and reduce patients' uncertainty, (c) the organization of physician-patient interaction, and (d) the relationship and interface between macro- and microconceptualization of context.

Notes: The real geometry of holomorphic four-metrics is investigated. The almost product and complex structures, associated with the real eight-metrics corresponding to the real and imaginary parts of the holomorphic metrics, are studied. It is shown that half-flat holomorphic metrics, and the corresponding real eight-metrics, are associated with integrable almost product, complex and hyper-Kähler structures. Real and complex local coordinate descriptions are presented. © 2002 American Institute of Physics.

Notes: Infection of several commercially important potato cultivars with Tobacco rattle virus (TRV) can result in systemic infection with M-type virus, which persists through generations of vegetative propagation, although spraing symptoms in the tubers rarely develop. In field trials of nine such cultivars it was shown that TRV infection can delay plant emergence and retard subsequent growth, reduce tuber yield and mean tuber weight, increase tuber numbers and the proportion of small tubers, increase the incidence of growth cracks and misshapen tubers, diminish dry matter content, and exacerbate after-cooking blackening. Each cultivar was affected differently, showing different combinations and degrees of these effects. Virus concentration in leaf extracts from individual plants was also highly variable. These, and other potato cultivars similarly susceptible to TRV, are grown on large areas of UK and European potato land. The implications of growing such cultivars for the seed, ware and processing sectors of the potato industry are discussed.

Notes: Introduction  Remifentanil is a potent synthetic opioid that does not accumulate after infusion or repeated bolus doses. It may be rapidly titrated to the requirements of individual patients. Remifentanil has potential advantages for paediatric cardiac surgery in being able to provide potent analgesia required to blunt the stress response in theatre and a lack of prolonged sedative affects that may delay progress in intensive care.Methods  After approval by the local ethics committee, 18 patients were randomised to receive a titrated infusion of remifentanil (0–1 mcg.kg.min−1) or a standard dose of fentanyl (30 mcg.kg−1) pre-bypass with morphine (1 mg.kg−1) on rewarming. The anaesthetic technique aside from analgesia was that normally used by the consultant anaesthetist responsible for the case. Blood samples for glucose and cortisol were taken at regular intervals from induction through bypass and into the first 24 hours of postoperative intensive care. Urine samples taken over the same period were analysed for 3 methythistidine:creatinine ratios. In addition to biochemical indicators of the stress response we recorded baseline haemodynamic parameters and any acute physiological events.Results  Statistical analysis is not yet complete – initial analysis shows that both techniques obtunded the stress response to a very similar extent.Ten patients were randomised to receive morphine and eight to receive remifentanil (there were late cancellations in the remifentanil group). One patient was withdrawn from the remifentanil group for a protocol violation.There were two incidences of inadequate analgesia in the remifentanil group one related to rapid haemodilution going onto cardiopulmonary bypass and a second as a consequence of an infusion line kinking.Discussion and conclusions  Although it was our original intention to continue remifentanil up to 24 hours postoperatively, this was only achieved in four out of the seven remifentanil patients due either to discharge to the ward or to difficulty in titration of an appropriate dose for spontaneously breathing patients in intensive care. In our unit it became appropriate to start a morphine infusion to replace remifentanil within the first few hours of PICU admission.The episode of inadequate analgesia going on to bypass occurred when remifentanil was infusing at 1 mcg.kg.min−1 which illustrates high inter-individual variation. The other episode when a peripheral line kinked emphasises the importance of line patency and we would recommend that infusions are given centrally to help ensure adequate delivery.

Notes: Background:  We have previously described both modification of allergen immunotherapy using peptide fragments, and reduced regulation of allergen stimulated T cells by CD4+ CD25+ T cells from allergic donors when compared with nonallergic controls. It has been suggested that allergen immunotherapy induces regulatory T cell activity: we hypothesized that allergen peptide immunotherapy might increase suppressive activity of CD4+ CD25+ T cells.Objective:  To examine cat allergen-stimulated CD4 T cell responses and their suppression by CD4+ CD25+ T cells before and after cat allergen peptide immunotherapy in a double-blind placebo-controlled study.Methods:  Peripheral blood was obtained and stored before and after peptide immunotherapy or placebo treatment. CD4+ and CD4+ CD25+ were then isolated by immunomagnetic beads and cultured with allergen in vitro.Results:  Comparing cells from blood taken before with that after peptide immunotherapy there was a significant reduction in both proliferation and IL-13 production by allergen-stimulated CD4+ T cells, whereas no change was seen after placebo. CD4+ CD25+ T cells suppressed both proliferation and IL-13 production by CD4+ CD25− T cells before and after therapy but peptide therapy was not associated with any change in suppressive activity of these cells.Conclusion:  Allergen peptide immunotherapy alters T cell response to allergen through mechanisms other than changes in CD4+ CD25+ T cell suppression.

Notes: Background : Remifentanil is a short acting, potent synthetic opioid that does not accumulate after infusion or repeated bolus doses. It may be rapidly titrated to the requirements of individual patients. Titrated infusion of remifentanil may be able to provide potent analgesia required for pediatric cardiac surgery and obtund the stress response in theater whilst not having the persistent respiratory depression and sedation seen with longer acting opioids.Methods : Twenty patients were randomized to receive a titrated infusion of remifentanil (0–1 μg·kg−1·min−1) or a standard dose of fentanyl (30 μg·kg−1) prebypass plus morphine (1 mg·kg−1) on rewarming. Blood samples for glucose and cortisol were taken at regular intervals from induction through bypass and into the first 24 h of postoperative intensive care. In addition to biochemical indicators of the stress response we recorded baseline hemodynamic parameters and any acute physiological events.Results : Ten patients received morphine, seven received remifentanil. There were no statistically significant differences between the two treatment groups in cortisol measurements, mean arterial pressure or heart rate recordings. In the last time period the remifentanil group had a larger rise in blood glucose concentration (baseline 3.9, rise 3 mmol·l−1) than the fentanyl/morphine group (baseline 4.2 rise 1.9 mmol·l−1), CI −4.3 to −0.2.Conclusions : The only significant difference was in glucose in the postbypass time periods. Although statistically significant, this difference is insufficient evidence of increased stress in the remifentanil group. The results show that in the patients studied there was no clinically important difference between the two techniques.