Background: Neurofibromatosis type 1 (NF1) is a common single-gene disorder. A multidisciplinary approach to the management of NF1 patients is necessitated by the heterogeneity of clinical manifestations. Although multidisciplinary paediatric clinics have been well established, there is a dearth of such resources for adults with NF1. Herein we report our one-year institutional experience with a multidisciplinary adult NF1 clinic. Methods: A multidisciplinary team was assembled, and an NF Patient Registry Initiative questionnaire was adapted to collect patient-reported data during clinics. Multiple databases were searched to identify publications pertaining to the experience of other multidisciplinary NF1 clinics focusing on adult patients. Data on patient epidemiology and clinical staff were compared to our data. Results: A total of 77 patients were scheduled, and 68 attended the clinic, of whom 66 completed the intake questionnaire. The demographic and clinical data from this Canadian population are mostly consistent with previous reports, with some exceptions. Clinical data related to immune system involvement such as asthma, airway/breathing-related difficulties or allergies were striking in our NF1 population. Six relevant published reports of other NF1 clinics were identified. Reports from these studies pertained to periods ranging from 10 to 38 months, and the number of adults assessed ranged from 19 to 177 patients. Conclusions: The structure of our clinic and the patient volume are comparable to those of other established centres found in the literature. Our data offer valuable cross-sectional prevalence statistics in the Canadian population. The patient-reported data concerning involvement of the immune system contribute to an emerging recognized medical concern within the NF1 population and warrant further clinical and basic investigation.

Extensive supplemental training exists for many subspecialty disciplines within fellowship training for paediatric cardiology in the United States of America. These disciplines, or domains, such as echocardiography, cardiac intensive care, interventional cardiology, and electrophysiology, allow for initial exposure and training during the basic 3 years of fellowship, plus mandate a 4th year of advanced training; however, ambulatory cardiology has no in-depth or additional training beyond the basic clinical exposure during fellowship training. Ambulatory cardiology is not included in the recommended scheduling of the various domains of cardiology training. This document reviews the reasons to consider augmenting the depth and breadth of training in ambulatory paediatric cardiology.

Law school clinics focused on international humanitarian law (IHL) enable students to participate directly in the development and application of IHL through concrete “real world” work – from training to research and fact-finding, litigation to high-level advocacy, and many spaces in between. These opportunities do far more than just contribute to these students' development as effective, reflective lawyers, certainly a key goal of any clinical environment. Clinical IHL work also matches clinical pedagogy with cutting-edge issues in armed conflict to deepen students' law school experiences and enables them to engage in the IHL goals of promotion, implementation and enforcement.

Background: Drive-through mass vaccination clinics are an increasingly popular component of public health emergency response plans. One potential disadvantage, however, is the exposure of clinicians, volunteers, public health responders, and the public to carbon monoxide (CO) from vehicle exhaust emissions when clinics are held within garages or other enclosed structures.

Methods: CO levels were monitored during indoor drive-through clinics held on the same day at 2 separate locations in a rural upstate New York county. Each clinic was operated for 2 hours during which seasonal influenza vaccines were administered to county residents as they remained within their vehicles. At each location, vehicle engines remained operating indoors within multiple lanes of traffic. No mechanical ventilation was used, but wind speeds through the buildings were relatively strong and consistent. CO was measured at breathing-zone height throughout the clinic sessions using direct-reading instruments.

Results: CO levels remained below detection for the majority of the clinic sessions. Short-term, high CO exposures, however, were found to be associated with a small number of individual vehicles that were in apparent disrepair.

Conclusions: The findings from this study indicate that CO exposures may be minimized by identifying and separately processing problematic vehicles before they enter the clinic. Direct reading CO monitors can help to identify these vehicles. (Disaster Med Public Health Preparedness. 2009;3:158–162)

Manuls or Pallas' cats (Felis manul, syn. Otocolobus manul) are endangered wild cats from Central Asia kept and bred in many zoos. Despite good breeding success young cats frequently die from acute toxoplasmosis. From 1998 to 2002, a breeding pair in the Schönbrunn Zoo in Vienna, Austria, gave birth to 24 kittens; 58% of kittens died between the 2nd and the 14th week of life, mostly due to acute toxoplasmosis. The epidemiology of toxoplasmosis in Pallas' cats was examined and a control strategy to protect the kittens from fatal toxoplasmosis was developed. One 12-week-old kitten from a litter of 6 born in 2001 died of generalized toxoplasmosis. This kitten had shed T. gondii oocysts that were bioassayed in mice. Toxoplasma gondii was isolated in tissue culture inoculated with tissues of these mice. The surviving animals were immediately treated with clindamycin for 16 weeks; they acquired a natural infection and seroconverted by the end of this time without clinical signs.

A one-year prospective audit (1989) of patient non-attendance for elective surgery in our department showed that of those summoned, five per cent defaulted on the day of admission without contacting the hospital (Hampal and Flood, 1992). Contributing factors such as lengthy waiting lists and inefficient communication with the patients were amenable to correction by the hospital. However, the current admission policy made inevitable a significant waste of theatre time.

The pre-admission clinic (PAC), an outpatient attendance shortly before planned surgery, was recommended in ENT practice by Robin (1991) and introduced into our department that year. Failure to attend the PAC allowed adequate time' for replacement on the theatre list and was recommended as a solution to the problem of unfilled theatre sessions (Dingle et al., 1993).

A subsequent four-year experience of conducting PACs has confirmed several expected advantages. However, some of the hopes for development expressed in our earlier work (Dingle et al., 1993) have failed to materialize. This study aims to review retrospectively our experience and compare it with the admission practice and desires of ENT departments in the United Kingdom as revealed by a postal survey. The findings are of relevance to all surgical specialties and to anaesthetic departments wishing, to adopt this system of admission.