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Background: Deaths from liver cirrhosis have increased at least 8 fold since the 1970's in the UK and further increases are anticipated, whereas in the rest of Europe liver deaths are decreasing. In the UK, we urgently need strategies to detect those who misuse alcohol and are at risk of developing alcoholic liver disease before they get to that point. One potential strategy is to screen admissions to hospital with alcohol related conditions for evidence of alcohol misuse.

BACKGROUND:Deaths from liver cirrhosis have increased at least 8 fold since the 1970's in the UK and further increases are anticipated, whereas in the rest of Europe liver deaths are decreasing. In the UK, we urgently need strategies to detect those who misuse alcohol and are at risk of developing alcoholic liver disease before they get to that point. One potential strategy is to screen admissions to hospital with alcohol related conditions for evidence of alcohol misuse.Surprisingly, there has been no research into the important question of where the opportunities are to detect those who misuse alcohol - primary or secondary care. We attempted to answer this firstly by conducting a retrospective analysis of the medical notes of 94 patients diagnosed with alcohol induced liver cirrhosis between 1st January 1995 and 31st December 2000 at Southampton General Hospital with the purpose of identifying admissions to hospital prior to a diagnosis of alcoholic liver disease. In the second part of the study, we interviewed patients with alcoholic liver disease about their contact with health services.RESULTS:Before diagnosis of alcoholic liver disease, 33% (31/94) of the patients had had an admission to hospital for an alcohol related condition. There was a mean of 7 years and 1 month (SD 6 years 3 months) between the first alcohol-related admission and presentation with alcoholic liver disease (in those who had had admissions). The commonest reason for alcohol related admission was falls/fractures/injuries, followed by non-variceal gastro-intestinal bleeds. Patients with alcoholic liver disease who were interviewed had seen their General Practitioner on average at least 2 times per year.CONCLUSION:Most patients who develop alcohol-induced cirrhosis do not have an admission to hospital with an alcohol related condition before developing alcoholic liver disease. Therefore, if we screen patients admitted to hospital with alcohol related conditions for evidence of alcohol misuse, we could potentially detect around a third of those at risk of developing cirrhosis. Although secondary care has an important role to play in detecting those at risk, the main opportunity for detection is in primary care.

Aims: To examine the hypothesis that patients who present in the UK to detoxification services differ from patients who present with severe alcohol-induced liver disease (ALD) with respect to severity of dependence on alcohol and other features of their drinking history. Methods: Levels of alcohol dependence were assessed in 34 patients with severe ALD, all of whom were cirrhotic, and 34 subjects from a residential alcohol detox centre in Southampton using the Severity of Alcohol Dependence Questionnaire (SADQ). During interview, various aspects of participants' alcohol consumption were recorded, including total monthly consumption, whom they usually drank with and where, and, if applicable, what caused them to start drinking heavily. Social circumstances were also noted, including participants' employment and marital status. Results: Among ALD patients, 58% scored none/mild on the SADQ, 32% moderate and 9% severe. In contrast, 76% of the detox group were graded severe and 34% moderate (P < 0.001). ALD patients were also significantly older, had lower scores on the Alcohol Use Disorders Identification Test, tended to drink less alcohol, were more likely to be in a stable relationship, were less likely to be unemployed and gave different reasons for starting to drink heavily. The ALD group were most likely to have started drinking heavily for social reasons, whereas subjects in the detox group were most likely to have started drinking heavily as a result of relationship or money problems. Conclusion: Patients attending a liver unit and patients admitted to a detoxification unit were separate but overlapping populations of alcohol misusers. Perhaps these two populations of alcohol misusers are likely to require different approaches for effective detection, intervention and treatment.

Background: House dust mite allergens are a risk factor for asthma in New Zealand, and levels in domestic dwellings have been found to be high compared with levels in most other countries, Studies in other countries have demonstrated lower levels of Dermatophagoides pteronyssimus allergens in public places compared with levels in domestic dwellings.Objectives: The purpose of this study was to measure reservoir Her p I levels in public places in New Zealand and to examine determinants of these levels.Methods: Reservoir dust was obtained in the two centers (Christchurch and Wellington) from hotels, hospitals, rest homes, churches, primary schools, childcare centers, cinemas, bank head offices, and airplanes; samples were also obtained from ski lodges, Single measurements of temperature and relative humidity were taken with thermohygrometers and an average humidity over 2 weeks was estimated with use of waxed wooden sticks. Information was collected on building construction, type of heating, and frequency of cleaning. Der p 1 levels (micrograms per gram of fine dust) for Boor (n = 202), bed (n = 65), and seat (n = 24) samples in public places were expressed as geometric means (95% confidence intervals).Results: Der p 1 levels in public places were significantly lower than domestic levels in both Wellington and Christchurch. Both Boor and bed levels were higher in hotels than in other public places, After controlling for potential confounders, floor Der p 1 levels were higher with carpeted floors (p < 0.0001) and lower with recent cleaning (p = 0.02) and bed Her p 1 levels were higher with timber wall construction (p = 0.03). Other building, heating, or cleaning characteristics did not show significant associations with allergen levels.Conclusion: Der p 1 levels were much lower in public places than in domestic dwellings with floor levels primarily affected by floor covering.

This paper presents a model for space in which an autonomous agent acquires information about its environment. The agent uses a predefined exploration strategy to build a map allowing it to navigate and deduce relationships between points in space. The shapes of objects in the environment are represented qualitatively. This shape information is deduced from the agent's motion. Normally, in a qualitative model, directional information degrades under transitive deduction. By reasoning about the shape of the environment, the agent can match visual events to points on the objects. This strengthens the model by allowing further relationships to be deduced. In particular, points that are separated by long distances, or complex surfaces, can be related by line-of-sight. These relationships are deduced without incorporating any metric information into the model. Examples are given to demonstrate the use of the model.

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THE effect of gravitational radiation on an elastic body has been previously investigated1. The component varying with time of the Riemann tensor (R iojo) associated with the gravitational field acts as a driving term in the wave equation for the strain or displacement. It was proposed1 that the normal modes of the Earth or a laboratory mass be used as a detector of gravitational radiation. Experiments to measure the interstellar gravitational radiation at kilocycle frequencies are at present in progress at the University of Maryland.

Maine agriculture continues to respond and adapt to new world environments with varying degrees of success. It has historically done so, and continues today. Some of these responses are represented by long historical trends; others may be the start of new trends. This paper explores those trends as part of the context to understanding the current condition of Maine agriculture. It then lists a number of strengths and weaknesses of Maine agriculture, discusses opportunities provided by them, and suggests some "new ways" of thinking that might further the capture of those opportunities. The paper focuses largely on the farming sector, since it holds most of the land base and has been the major constituent of Maine agricultural policy. It focuses less on the processing and the distribution and retailing sectors, although each is a much larger component of the food and agricultural system than farming. It is important to recognize that while the focus of the paper is on the farming sector, food processing and distribution are essential components of the Maine food and agricultural system, and each substantially exceeds farming in economic value added.