Background: Flow cytometry in the cerebrospinal fluid (CSF) is used as an adjunct to cytology to increase the sensitivity of detecting central nervous system (CNS) lymphoma. We aim to evaluate CSF flow cytometry as a diagnostic tool for lymphoma in patients presenting with undifferentiated neurologic symptoms. Methods: We retrospectively reviewed all CSF flow cytometry samples sent in the Calgary region from 2012-2015. Clinical data, laboratory investigations, radiologic imaging studies, and pathological data were analyzed. Clinical review extended to 2 years post CSF flow cytometric testing. Results: The number of samples of CSF flow cytometry that were positive for a hematological malignancy was 43/763 (5.6%). The overall sensitivity of the test was 72.9%. A positive result was more likely to occur in patients with a prior history of a hematological malignancy or abnormal enhancement on MRI (p<0.0001). In fact, CSF flow cytometry was negative in all patients who did not have a previous hematological malignancy or abnormal enhancement on MRI (n = 247). Conclusions: CSF flow cytometry has very limited role in the screening for primary CNS lymphoma, unless a strictly endorsed testing algorithm is applied. It is, however, an invaluable tool in assessing CNS involvement in patients with previous diagnosis of hematolymphoid malignancy.

Auditory processing and spoken word recognition difficulties have been observed in Specific Language Impairment (SLI), raising the possibility that auditory perceptual deficits disrupt word recognition and, in turn, phonological processing and oral language. In this study, fifty-seven kindergarten children with SLI and fifty-three language-typical age-matched controls were assessed with a speech-gating task to measure spoken word recognition, psychophysical tasks to measure auditory Frequency Modulation (FM) detection and Frequency Discrimination (FD), and standardized psychometric tests of phonological processing and oral language. As a group, children with SLI took significantly longer than language-typical controls to recognize words with high neighborhood density, perhaps reflecting subpar phonological representations. FM, but not FD, was significantly worse in SLI. However, while both poorer speech-gating performance and poorer auditory thresholds (FM) were evident in SLI, spoken word recognition did not mediate any relation between auditory perception and either phonological processing or oral language.

Many engineering problems are governed by partial differential equations which can be solved by analytical as well as numerical methods, and examples include the plasticity problem of a geotechnical system, seepage problem and elasticity problem. Although the governing differential equations can be solved by either iterative finite difference method or finite element, there are however limitations to these methods in some special cases which will be discussed in the present paper. The solutions of these governing differential equations can all be viewed as the stationary value of a functional. Using an approximate solution as the initial solution, the stationary value of the functional can be obtained easily by modern global optimization method. Through the comparisons between analytical solutions and fine mesh finite element analysis, the use of global optimization method will be demonstrated to be equivalent to the solutions of the governing partial differential equations. The use of global optimization method can be an alternative to the finite difference/ finite element method in solving an engineering problem, and it is particularly attractive when an approximate solution is available or can be estimated easily.

To investigate the changes in community responsiveness during the pre-community-outbreak phase of the H1N1 epidemic in Hong Kong, a pooled sample of 999 adults was interviewed in three surveys (S1, S2, S3) from 7 May to 6 June 2009. Over time, fewer people felt confident in staying free from H1N1 infection in the following year (S1, 63·3%; S3, 46%; P<0·001). The level of distress due to H1N1 remained modest throughout the study period. People's confidence in the government's ability to control a large-scale H1N1 outbreak declined slightly at the third survey (S1, 80·5%; S3, 73·8%; P=0·025). Across the three surveys, respondents remained vigilant with frequent adoption of preventive measures (e.g. wearing face masks in public areas when suffering from influenza-like symptoms and frequent hand-washing). The public was generally supportive of the Hong Kong government although misconceptions regarding the disease were common. Provision of evidence-based public-health education is still warranted as the disease outbreak unfolds.

Summary

Background and objective: To assess the knowledge, beliefs and attitudes of anaesthesia providers on the patients' possible intraoperative visual experiences during cataract surgery under local anaesthesia. Methods: Anaesthesia providers from the Ophthalmic Anaesthesia Society (USA); British Ophthalmic Anaesthesia Society (UK); Alexandra Hospital, National University Hospital, Tan Tock Seng Hospital, Singapore General Hospital and Changi General Hospital (Singapore) were surveyed using a structured questionnaire. Results: A total of 146 anaesthesiologists (81.6%), 10 ophthalmologists (5.6%) and 23 nurse anaesthetists (12.8%) responded to the survey. Most respondents believed that patients would experience light perception and many also felt that patients might encounter other visual sensations such as movements, flashes, colours, surgical instruments, hands/fingers and the surgeon during the surgery. A significantly higher proportion of anaesthesia providers with previous experience of monitoring patients under topical anaesthesia believed that patients might experience the various visual sensations compared to those who have not previously monitored. For both topical and regional anaesthesia, anaesthesia providers who routinely counsel their patients are (1) more likely to believe that preoperative counselling helps or (2) were previously told by patients that they could see intraoperatively and/or that they were frightened by their visual sensations. These findings were statistically significant. Conclusions: The majority of anaesthesia providers in the USA, UK and Singapore are aware that patients may experience a variety of visual sensations during cataract surgery under regional or topical anaesthesia. Those who have previously managed patients undergoing cataract surgery under topical anaesthesia are more likely to believe this compared to those who have not.

In August 2003, an outbreak of scombroid fish poisoning occurred at a retreat centre in California, USA. In a retrospective cohort study, 42 (75%) of the 56 dinner attendees who ate escolar fish (Lepidocybium flavobrunneum) met the case definition. Individuals who ate at least 2 oz of fish were 1·5 times more likely to develop symptoms than those who ate less (relative risk 1·5, 95% confidence interval 0·9–2·6), and to develop more symptoms (median 7 vs. 3 symptoms, P=0·03). Patients who took medicine had a longer duration of symptoms than those who did not (median 4 vs. 1·5 h, P=0·05), and experienced a greater number of symptoms (median 8 vs. 3 symptoms, P=0·0002). Samples of fish contained markedly elevated histamine levels (from 2000 to 3800 ppm). This is one of the largest reported outbreaks of scombroid fish poisoning in the United States and was associated with a rare vehicle for scombroid fish poisoning, escolar.