Objective: To determine the efficacy of a computerised decision aid in patients with atrial fibrillation making decisions on whether to take warfarin or aspirin therapy. Design: Two-armed open exploratory randomised controlled trial. Setting: Two research clinics deriving participants from general practices in Northeast England. Participants: 109 patients with atrial fibrillation aged over 60. Interventions: Computerised decision aid applied in shared decision-making clinic compared to evidencebased paper guidelines applied as direct advice. Main outcome measures: Primary outcome measure was the decision conflict scale. Secondary outcome measures included anxiety, knowledge, decision-making preference, treatment decision, use of primary and secondary care services and health outcomes. Results: Decision conflict was lower in the computerised decision aid group immediately after the clinic; mean difference 20.18 (95% CI 20.34 to 20.01). Participants in this group not already on warfarin were much less likely to start warfarin than those in the guidelines arm (4/16, 25% compared to the guidelines group 15/16, 93.8%, RR 0.27, 95% CI 0.11 to 0.63). Conclusions: Decision conflict was lower immediately following the use of a computerised decision aid in a shared decision-making consultation than immediately following direct doctor-led advice based on paper guidelines. Furthermore, participants in the computerised decision aid group were significantly much less likely to start warfarin than those in the guidelines arm. The results show that such an approach has a positive impact on decision conflict comparable to other studies of decision aids, but also reduces the uptake of a clinically effective treatment that may have important implications for health outcomes.

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After aerosolization of a bovine strain of parainfluenza type 3 virus, the pathogenesis of the virus was followed from the trachea to the bronchioalveolar compartments of the lung of colostrum-free calves and of conventionally reared calves during a 5to 12-day postexposure interval. By tissue titration, plaque assay, and electron microscopy, it was found that virus infection could be established in colostrum-free calves as well as in conventionally reared calves, even though sequential changes of virus replication were observed mainly in the infected colostrum-free calves during the 5to 6-day postexposure periods. Electron microscopy demonstrations of (i) aggregates of viral nucleocapsids in the cytoplasm, (ii) alterations of cilia and basal bodies, (iii) dissolution of cytoplasmic membranes, and (iv) the shedding of virus into luminal spaces confirmed that epithelial cells of the respiratory tract were the primary target cells for the virus replication leading to cell destruction. These observations revealed further that productive infection was more efficient in the bronchioalveolar regions than in the tracheal regions, although large aggregates of viral nucleocapsids and destructive changes were more pronounced in the tracheal epithelium. The finding that parainfluenza type 3 virus replicates in the alveolar type II cells suggests that changes in surfactant production may occur during the peak of infection of these cells. The demonstration of virus budding through the basement membrane of small bronchioles and the presence of virus particles in the interstitial regions imply that one of the host defense lines, the basement membrane, may be impaired by virus invasion.