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INTRODUCTION The fast-track assessment clinic (FTAC) is a process to select patients who are very likely to require primary total hip replacement. Selected patients can then be seen in a one-off clinic reducing the number of hospital visits, cost to primary care trusts and delay between referral and treatment.PATIENTS AND METHODS Fifty patients on the waiting list for hip replacement were analysed to see if there were common parameters that led to their inclusion. From these data, fast-track selection criteria (FTSCs) were generated. These FTSCs were used to make a dual comparison of outcomes between 52 patients seen in a traditional clinic. Finally, a pilot study was conducted in which patients fulfilling FTSCs were seen in a designated clinic.RESULTS An Oxford hip score (OHS) of 34 and above combined with severe loss of joint space, severe marginal osteophytes, or both was common to most patients on the waiting list (84%). FTSCs correctly predicted the outcome of the orthopaedic clinic in 38 patients out of a total of 52. During the pilot stage, positive FTSCs were shown to have a positive predictive value of 92% for joint replacement being carried out and a negative predictive value of 46%. CONCLUSIONS An OHS of 34 or above combined with complete loss of joint space and/or severe marginal osteophyte formation can be used to select patients who are very likely to need total hip replacement. These patients can be seen in a clinic that combines assessment of surgical indication with medical fitness for surgery.

Both natural infection with SARS-CoV-2 and immunization with a number of vaccines induce protective immunity. However, the ability of such immune responses to recognize and therefore protect against emerging variants is a matter of increasing importance. Such variants of concern (VOC) include isolates of lineage B1.1.7, first identified in the UK, and B1.351, first identified in South Africa. Our data confirm that VOC, particularly those with substitutions at residues 484 and 417 escape neutralization by antibodies directed to the ACE2-binding Class 1 and the adjacent Class 2 epitopes but are susceptible to neutralization by the generally less potent antibodies directed to Class 3 and 4 epitopes on the flanks RBD. To address this potential threat, we sampled a SARS-CoV-2 uninfected UK cohort recently vaccinated with BNT162b2 (Pfizer-BioNTech, two doses delivered 18-28 days apart), alongside a cohort naturally infected in the first wave of the epidemic in Spring 2020. We tested antibody and T cell responses against a reference isolate (VIC001) representing the original circulating lineage B and the impact of sequence variation in these two VOCs. We identified a reduction in antibody neutralization against the VOCs which was most evident in the B1.351 variant. However, the majority of the T cell response was directed against epitopes conserved across all three strains. The reduction in antibody neutralization was less marked in post-boost vaccine-induced than in naturally-induced immune responses and could be largely explained by the potency of the homotypic antibody response. However, after a single vaccination, which induced only modestly neutralizing homotypic antibody titres, neutralization against the VOCs was completely abrogated in the majority of vaccinees. These data indicate that VOCs may evade protective neutralising responses induced by prior infection, and to a lesser extent by immunization, particularly after a single vaccine, but the impact of the VOCs on T cell responses appears less marked. The results emphasize the need to generate high potency immune responses through vaccination in order to provide protection against these and other emergent variants. We observed that two doses of vaccine also induced a significant increase in binding antibodies to spike of both SARS-CoV-1 & MERS, in addition to the four common coronaviruses currently circulating in the UK. The impact of antigenic imprinting on the potency of humoral and cellular heterotypic protection generated by the next generation of variant-directed vaccines remains to be determined.

1. Lohmann Brown pullets, in one trial, and Hyline Brown pullets in another, were reared from day 2 on short daylengths, and from week 8 in trial 1 (week 16 in trial 2) on food restriction. These restrictions were lifted at various times during the rearing period as a means of determining the relative importance of the day length and food restriction stimuli on the attainment of sexual maturity and subsequent laying performance. 2. A total of 2304 pullets were used in each trial. The birds were reared in light proof rooms, and subjected to 8L:16D until they were moved to a laying facility where a light stimulus of 16L:8D was applied. In trial 1 the six ages at which light stimulation was applied were 115, 122, 129, 136, 143 and 171 d. Within each light treatment, food restriction of pullets, which consisted of feeding 72 g of food/bird d, was lifted at six different ages, namely, 115, 129, 143, 157, 171 and 185 d. In trial 2 both the light stimulation and the lifting of food restriction occured at 111, 125, 139, 153, 167 and 181 d of age, producing 6x6=36 treatments in both trials. 3. The first trial was terminated when the pullets were 28 weeks old, soon after all the birds had commenced laying, because of an outbreak of Egg Drop Syndrome. However, because age at maturity was the variable of major interest, data from this experiment could be used in the analysis. The second trial ended when the birds reached 40 weeks of age. Variables measured were age at maturity, food intake and body weight gain subsequent to the lifting of restrictions and, in the second experiment, rate of lay, peak rate of lay and egg weight at various ages. 4. The mean age at sexual maturity was influenced by the date of release from light restriction (P<0.001) and from food restriction (P<0.001) in both trials. In addition, the interaction between the age at release from light and from food restriction was significant. Regression equations were produced for each trial to describe the relationships between the age at sexual maturity and the age at release from light restriction and food restriction. 5. There was an effect of both light restriction (P<0.001) and of food restriction (P<0.001) on the increase in food intake (g/bird d) in the week following release from food restriction in both experiments. These effects were not independent: the effect of the interaction of light and food restriction on this increase in food intake was also highly significant. The longer the birds were subjected to light restriction, the less dramatic the increase in food intake when food restriction was lifted. The more sustained the period of food restriction, the higher the increase in food intake in the week following release from the restriction. 6. Mean egg weight was 4 g heavier at 22 weeks of age in birds released from food restriction at 16 and 18 weeks, than from those released at 24 and 26 weeks of age. However, by 30 weeks of age, birds restricted for longer produced heavier eggs than their earlier-maturing counterparts. This effect continued to t...

SummaryA group of patients with clinical hemorrhagic disease who exhibited a prolonged bleeding time and a short prothrombin consumption time classified as Thrombocytopathy A were studied utilizing procedures involving isolated platelets and purified prothrombin. These frozen and thawed platelet extracts had poor platelet factor 3 activity which was normal after the extracts had been treated with ultrasonic oscillations. The electron microscope studies of the morphology of these platelets were abnormal. It is concluded that these platelets contain adequate amounts of platelet factor 3 but are resistant to disintegration and the activity is only liberated with difficulty.The authors wish to thank Miss Jeanne M. Riddle, M.S. medical technologist in Hematology at Henry Ford Hospital for technical assistance in providing the platelet counts for this investigation.

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