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Clinical characteristics can reliably identify patients who are unlikely to have intracranial injuries and who do not require CT imaging.

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Aim:  To analyse the growth of Bacillus anthracis during simulations of the UK anthrax vaccine manufacturing process. Methods and Results:  Simulated vaccine production runs were performed using the toxigenic, acapsulate Sterne 34F2 strain of B. anthracis in semi‐defined medium. After rising during the logarithmic growth phase, the pH of the culture starts to fall at about 18 h from pH 8·7 to reach <7·6 at 26 h, coincident with consumption of glucose and optimal production of protective antigen (PA; 7·89 g ml−1, SD 1·0) and lethal factor (LF; 1·85 g ml−1, SD 0·29). No increased breakdown of toxin antigens was seen over the 26–32 h period. When glucose was exhausted, amino acids (principally serine) were utilized as an alternative carbon source. Sporulation was not observed during the 32 h. Conclusions:  PA and LF, the principal constituents in the UK anthrax vaccine, undergo little degradation during vaccine fermentation. The vaccine manufacturing process is robust and reproducible. Significance and Impact of the Study:  This is the first detailed analysis of the manufacturing process used for the UK acellular anthrax vaccine; insight gained into the process will support continued and safe vaccine manufacture.

Wolff–Parkinson–White (WPW) syndrome with atrial fibrillation (AF) is a potentially life-threatening problem requiring rapid conversion to sinus rhythm. The most recent American Heart Association guidelines for the treatment of patients with WPW, published in conjunction with the 2000 Advanced Cardiac Life Support (ACLS) guidelines, suggests that intravenous amiodarone is a first-line therapy for AF–WPW; however the evidence suggests this is a potentially dangerous myth.

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