Summary. In this study, we retrospectively analysed the clinical features, risk factors and outcome of 22 patients with thrombotic thrombocytopenic purpura (TTP) occurring after allogeneic stem cell transplantation. All but two of these patients received stem cells from unrelated donors (UDs), two-thirds were female, three-quarters were adults and leukaemia was the major reason for transplant. The incidence of TTP was 20 out of 332 patients (6%) with UD transplants and two out of 104 recipients (2%) of matched sibling allografts (P 0´16). In order to ascertain basic demographic risk factors for the development of TTP, we compared the 22 patients with 434 patients who did not develop TTP. Compared with patients who did not develop TTP, patients with TTP were nearly three times older (P , 0´001) and were more than twice as likely to be female (P 0´001). Because . 90% of patients were recipients of UD marrow, we then compared the 20 UDbone marrow transplantation (BMT) patients with 60 randomly selected UD-BMT patients who did not develop TTP. On univariate analysis, age and female gender were again significant risk factors, as was grade II±IV acute graft-versus-host disease (GvHD) (P 0´002), and there was a trend towards an association with chronic GvHD (P 0´083). However, after logistic regression analysis, only age and sex remained significant (P , 0´001 and 0´009 respectively). We report an 86% mortality with only three survivors out of 22 patients, and one of these remains thrombocytopenic and red cell transfusion dependent, possibly in part because of graft hypoplasia. Six out of 17 patients responded to plasmapheresis, but the majority of them ultimately succumbed because of TTP, often in association with GvHD or fungal infection.

The authors recommend including inquiry about abuse in standardized admission procedures and providing inpatient staff with training in how and when to ask patients about abuse and how to effectively follow up affirmative responses.

Introduction 463 Materials 464 Basic Structure and Terminology 466 Mandibular base 466 Mandibular surfaces 466 Outer surface 467 Distal margin 473 Summary and abbreviations 473 Comparative Study 474 Parasitic Anthophorids 476 Hyelaeinae and Xeromelissinae 477 Xylocopinae and Lithurginae 477 Megachilinae 478 Meliponinae and Apinae 479 Bombinae 479 Discussion and Conclusions 480 Acknowledgements 482 Literature Cited 482ABSTRACT Mandibular structures, particularly the ridges and grooves of the outer and inner surfaces, were investigated and illustrated for all major groups of Apoidea. A nomenclature is provided for these structures, and homologies among apoid groups are indicated. A basic mandibular type is found among sphecoid wasps, all short tongued families of bees, and also the Anthophoridae and Fideliidae. Various modifications are found within some of these groups, such as the parasitic anthophorids, the Hylaeinae and Xeromelissinae, and the Xylocopinae. Markedly modified mandibles characterize the Megachilidae and the Apidae.

Are people with learning disabilities able to contribute to focus groups on health promotion? Aim. This paper shows the differences between the success of three focus groups in promoting group discussion on health promotion and also the detailed effects of individual members with speech and language difficulties in participating. Background. Conducting focus groups with people with learning disabilities can promote their social inclusion. Conclusions. We conclude that focus groups are an effective method of conducting exploratory research with adults with learning disabilities in the community, however, ability to participate with other members may be a limiting factor. Furthermore, special arrangements may need to be made for groups to be successful, including the use of an interpreter. The preparation of the moderator is also an important factor in group success.

It was hypothesised that the low staff response rate is not unique to the particular unit evaluated here. Recommendations are offered regarding the need for unit policies ensuring routine abuse inquiry and for staff training about how to respond to abuse disclosures.

Summary Participatory research is becoming a very popular way of helping to empower people with learning disabilities. All stages of this kind of research are conducted in partnership with non‐disabled researchers. Furthermore, the research agenda in learning disability is moving towards increasing participation in all forms of research. As a group undertaking participatory research, the present authors wish to share their experience of setting up a project over a period of 9 months to examine ‘keeping fit’. The authors include adults with learning disabilities, clinicians and a researcher from a primary care NHS trust, and support workers who work directly with the adults with learning disabilities in various community settings. An understanding of what is involved in participatory research is important as a first stage, and so the present authors invited speakers undertaking a similar project investigating direct payments to a one‐day conference that was set up locally. At the end of the conference, the present authors requested volunteers for the local project to investigate health. This approach enabled well‐informed agreement to participate. The present paper discusses the initial 9 months of the project, including a description of the volunteers and the major issues which all the participants learned during these early stages.

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Objective To explore lung cancer patient’s experiences of telehealth during COVID-19 restrictions. Methods Thirty patients with lung cancer were recruited. Data was collected using a qualitative exploratory design with semi-structured interviews. Transcripts were thematically coded using NVivo software. Results Five key themes were identified: maintaining resilience, participants acknowledged that they were self-reliant prior to their diagnosis and that the sense of their own internal capabilities was a source of comfort for them; importance of pre-established relationships with healthcare professionals, the sense of connection established prior to the telehealth consultation supported participants to engage with healthcare professionals where the need for connectedness was amplified by a sense of isolation; seeking help, participants sought help from services that they perceived as being “expert”; convenience, factors such as costs and saving time were highlighted; and preferences for consultation type, majority of participants identified physical and emotional comfort being in their own space. For a small number of patients, continuing a face-to-face assessment was important due to expectation based on previous experience. Conclusion The use of telehealth was supported during the management of COVID-19. Connectedness and convenience were key to the level of comfort and confidence for patients with lung cancer using telehealth during “lockdown.”