bluuebunny/crossref_metadata_2025 huggingface dataset:
Cantilevering the Malaise: Confusopoly in the 21st Century Employment Relationship
Authors: Desjardins Guillaume
Published: July 2022

Critiques of the way workforces were managed in capitalist market economies throughout the 20th century exist but are not necessarily relevant to emergent industries. In the digital age, new economic sectors have proliferated. These are often associated with distinctive labor management practices. A case in point is the telecommunications retail sector—shopping mall outlets where salespeople sell smartphones and associated contracts. In such outlets, it is difficult for consumers to accurately assess their needs and make informed choices, a phenomenon sometime described as confusopoly. This study provides evidence that confusopoly not only characterizes the relationship between customers and firms in the retail telecommunications industry but is also a construct that aptly applies to the employment relationship existing between vendors and their employer. Five themes supporting this conclusion are presented which draw on the results obtained from two focus-groups conducted with Canadian telco vendors in the summer of 2020.
The Fragmentation of Human Rights. Case Studies from a Post-Arab Spring Context
Authors: Annicchino Pasquale
Published: July 2022

The Middle East and North Africa region is diverse and large, and it is therefore difficult to make broad arguments and generalizations on the impact of the Arab Spring on human rights protection. In this context, Egypt and Tunisia are important case studies for the assessment of constitutional transitions and human rights protection in a post-Arab Spring context. After the 2011 uprisings and the fall of the ruling authoritarian regimes, activists, scholars, and civil society organizations raised hopes about improvements in the protection of human rights. However, many forces (security services, the military, religious actors) worked against the hopes of the Revolution. The counter-reaction did not happen only because of national political struggles. Institutional factors also played against structural improvements in human rights promotion and protection. Changes in human rights practices need stable institutional frameworks which facilitate the improvement of human rights practices and constitutional transitions. Tommaso Virgili, with his contribution, focuses on the protection of sexual minorities and freethinkers.
A new look at an old Australian raptor places “Taphaetus” lacertosus de Vis 1905 in the Old World vultures (Accipitridae: Aegypiinae)
Authors: MATHER ELLEN K. , LEE MICHAEL S. Y. , WORTHY TREVOR H.
Published: July 2022

The Australian Pleistocene fossil record of the Accipitridae (hawks, eagles and Old World vultures) is sparse and poorly known. Only two extinct confirmed accipitrid species have been described for this time period; both have received little investigation since their description. One is “Taphaetus” lacertosus de Vis, 1905, described from a distal humerus and a quadrate from north-eastern South Australia. While this species was verified as an accipitrid in subsequent studies, its more precise taxonomic affinities have remained conjectural. In this study, a new analysis incorporating newly referred material and phylogenetic analyses using a wide range of accipitriforms reveals that the lectotype humerus of “T.” lacertosus is an Old World vulture in the subfamily Aegypiinae. The associated quadrate, one of two original syntypes from which de Vis named this species, is of an indeterminate species of ardeid. We erect the novel genus Cryptogyps, to accommodate the species ‘lacertosus’, as it cannot be placed in Taphaetus de Vis, 1891, because the type species of this genus, Uroaetus brachialis de Vis, 1889, was transferred back to the genus Uroaetus, a synonym of Aquila Brisson, by de Vis in 1905. Further, U. brachialis is now considered a synonym of Aquila audax (Latham, 1801). Moreover, Taphaetus de Vis, 1891 is a senior homonym of Taphaetus de Vis, 1905, type species Taphaetus lacertosus de Vis, 1905, making the 1905 version of the genus unavailable. Newly referred fossils from Wellington Caves (NSW) and the Nullarbor Plains (WA) reveal this taxon had a wide geographical range across Pleistocene Australia. The referred tarsometatarsus lacks hyper-developed trochleae, indicating that Cryptogyps lacertosus (de Vis, 1905) comb. nov., was probably a scavenger like other aegypiines. Identification of Cryptogyps lacertosus as an aegypiine significantly expands the palaeogeographical range of the Old World vultures, hitherto unknown in Australia. The avian guild of large, obligate scavenging birds of prey, is currently absent in the modern Australian biota, but its former presence is not surprising given the megafauna-rich communities of the Pleistocene.
New records of oribatid mites from Mexico with description of a new species
Authors: REVELO-TOBAR HAROL , ESTRADA-VENEGAS EDITH G. , MARTINEZ ARMANDO EQUIHUA
Published: July 2022

The present taxonomic study was carried out with material collected in the Michoacán state, Mexico, during one year of sampling. Ten new records of oribatid mites are reported for Mexico. Also, a new species, Gustavia mexicana sp. nov., is described, which differs from Gustavia fusifer (Koch, 1841), G. transylvanica Mahunka, 2006, G. latolamellata Hammer, 1977 and G. magnifica Golosova et Karppinen, 1984 by the absence of setal alveolus c, shape of sensillum, size and shape of rostrum, shape of lamella and presence of sejugal suture, respectively. A detailed description, schemes and photographs of the new species and an identification key for the species of the genus are provided.
A swan-sized fossil anatid (Aves: Anatidae) from the early Miocene St Bathans Fauna of New Zealand
Authors: WORTHY TREVOR H. , SCOFIELD R. PAUL , HAND SUZANNE J. , DE PIETRI VANESA L. , ARCHER MICHAEL
Published: July 2022

A large fossil anserine-like anatid (Aves, Anatidae, Notochen bannockburnensis gen. et sp. nov.) is described based on a distal humerus from the lower Bannockburn Formation, early Miocene (19–16 Ma), St Bathans Fauna from New Zealand. Its morphology and size suggest that this taxon represents an early swan rather than a goose. Extant anserines are split into Northern and Southern Hemisphere clades. The St Bathans Fauna is known to have the oldest anserines in the Southern Hemisphere, unnamed cereopsines perhaps ancestral to species of Cnemiornis (New Zealand geese). The elongate and flat morphology of the tuberculum supracondylare ventrale of the new species, however, preclude affinities with cereopsines. It is a rare taxon and the eighth anatid represented in the fauna and is the largest known anseriform from the Oligo-Miocene of Australasia. We also reassess other large anatid specimens from the St Bathans Fauna and identify Miotadorna catrionae Tennyson, Greer, Lubbe, Marx, Richards, Giovanardi & Rawlence, 2022 as a junior synonym of Miotadorna sanctibathansi Worthy, Tennyson, Jones, McNamara & Douglas, 2007.
Three new species of the genus Sulcolotis Miyatake (Coleoptera, Coccinellidae, Sticholotidini) from the Philippines
Authors: LIU LIYUAN , WANG YAN , GUO QIUHONG , CHEN XIAOSHENG , WANG XINGMIN
Published: July 2022

The genus Sulcolotis Miyatake, 1994 is reviewed. Three new species (S. threadis sp. n., S. ovalis sp. n., and S. xanthomarginalis sp. n.) from the Philippines are described and illustrated in the present paper. A key to species of the genus Sulcolotis is also provided.
Investigation of Titanium Mesh and Nano-Hydroxyapatite/Polyamide 66 Bone Graft in Cervical Reconstruction of Spondylosis After Sub-Total Vertebral Body Resection
Authors: Zong Chenyu , Du Jiashang , Lu Shenji , Zhou Rui , Zhang Miaomiao , Zhu Jianwei , Xu Jiacheng
Published: July 2022

The nano-hydroxyapatite/polyamide 66 (n-HA/PA66) bionic bone column, as a high-performance tissue repair and replacement material, introduced as a high osteo-induction ability agent. Nanomaterial has significantly taken a place in orthopedic surgery, however, the efficacy of using n-HA/PA66
is yet to be established. In this regard, this study evaluated various sagittal parameters (such as imaging measurement) and clinical efficacy in postoperative patients, whom underwent cervical reconstruction surgery due to cervical spondylosis myelopathy (CSM). In this study, total 62 CSM
cases were enrolled between October 2016 to March 2020, and were hospitalized for cervical reconstruction surgery. 31 cases were grafted with titanium mesh and 31 cases were grafted with n-HA/P66. The sagittal parameters such as cervical spine lateral radiographs (C0–2Coob,
C2–7Coob, T1S, CSVA, and TIA) were taken before operation, after operation (within 1 week), 3, 6, and 9 months after operation. In order to evaluate the clinical efficacy, we used JOA scores before, after, 3 months, 6 months and 9 months after operation. Results showed that
JOA scores after the re-examination in the two groups (titanium and n-HA/P66) were significantly higher than before the operation, suggesting a well postoperative functional recovery after surgery in both groups; however, there was no significant difference in JOA score and JOA improvement
index between the two groups. In regard of angles measurement (C0–2Cobb, C2–7Cobb, T1S, CSVA, and TIA), we observed no significant difference between these two groups before and after the operation. In addition, we showed that C0–2Cobb and
C2–7Cobb angle had a significant positive correlation; and C0–2Cobb angle is positively correlated with T1S, and negatively correlated with CSVA. Both titanium mesh and n-HA/PA66 can be well improved and maintained within 9 months after surgery with clinical
efficacy, however, using n-HA/PA66 might have more benefits.
Symmetric and Antisymmetric Components of Polar-Amplified Warming
Authors: Hill Spencer A. , Burls Natalie J. , Fedorov Alexey , Merlis Timothy M.
Published: July 2022

CO2-forced surface warming in general circulation models (GCMs) is initially polar amplified in the Arctic but not in the Antarctic—a largely hemispherically antisymmetric signal. Nevertheless, we show in CESM1 and 11 LongRunMIP GCMs that the hemispherically symmetric component of global-mean-normalized, zonal-mean warming () under 4 × CO2 changes weakly or becomes modestly more polar amplified from the first decade to near-equilibrium. Conversely, the antisymmetric warming component () weakens with time in all models, modestly in some including FAMOUS, but effectively vanishing in others including CESM1. We explore mechanisms underlying the robust behavior with a diffusive moist energy balance model (MEBM), which given radiative feedback parameter (λ) and ocean heat uptake () fields diagnosed from CESM1 adequately reproduces the CESM1 and fields. In further MEBM simulations perturbing λ and , is sensitive to their symmetric components only, and more to that of λ. A three-box, two-time-scale model fitted to FAMOUS and CESM1 reveals a curiously short Antarctic fast-response time scale in FAMOUS. In additional CESM1 simulations spanning a broader range of forcings, changes modestly across 2–16 × CO2, and in a Pliocene-like simulation is more polar amplified but likewise approximately time invariant. Determining the real-world relevance of these behaviors—which imply that a surprising amount of information about near-equilibrium polar amplification emerges within decades—merits further study.
Prevalence of Primary Liver Cancer is Affected by Place of Birth in Hispanic People Residing in the United States: All of Us Research Program Report
Authors: Yu Jingjing , Sullivan Brittany G. , Senthil Girish N. , Gonda Amber , Dehkordi-Vakil Farideh , Campos Belinda , Dayyani Farshid , Senthil Maheswari
Published: July 2022

Background

Hispanic individuals have a disproportionately higher incidence and mortality for stomach, cervix, and liver cancers compared to Non-Hispanic White people. Since disparities in cancer incidence are influenced by multiple factors including immigration, elucidating the effect of birthplace and exposure to risk factors on the prevalence of these cancers is crucial for identifying high-risk populations and target risk reduction interventions.

Methods

The National Institutes of Health All of Us Research Program is a prospective, multidimensional biomedical data resource of underrepresented, minoritized people. The Registered Tier Dataset v5 was utilized to evaluate the prevalence and risk of stomach, cervix, and liver cancers among United States (US) born and non-US born Hispanic participants.

Results

Of over 434 000 current participants, 60 540 are Hispanic; 30 803 (50.9%) reported being US born and 29 294 (48.4%) non-US born. Non-US born Hispanic participants had significantly higher prevalence (.39% vs .21%, P < .001) and associated risk (OR 1.84, 95% CI 1.29-2.64, P < .001) of liver cancer, and trend towards higher prevalence of stomach (.14% vs .09%, P = .076) and cervix cancers (.27% vs .20%, P = .083) compared to US born counterparts. US born Hispanic patients with these 3 cancers were significantly younger than non-US born cohort (mean age 56.8 vs 61.7 years, P < .001).

Discussion

This is the first report using All of Us data to show that non-US born Hispanic participants have a higher risk of liver cancer compared to US born participants. Further analyses, including genomic studies, are necessary to understand these differences and identify targets for risk reduction interventions.
Abdomino-Pelvic Ultrasound Evaluation in Monosymptomatic Primary Nocturnal Enuresis
Authors: Ghobrial Emad E. , Fawzi Nevin M. , Shiba Maha F. , Tawfik Mary A.
Published: July 2022

Background:

Enuresis is one of the most common childhood problems. Our study aimed to evaluate children with enuresis by renal bladder ultrasound (RBUS) to detect urological abnormalities and to compare the sonographic findings with control group.

Methods:

Our study included 30 children with primary monosymptomatic nocturnal enuresis (PMNE). Another 30 matched children with normal continence to urine were assigned as controls. The 2 groups were subjected to urine analysis, serum creatinine, and RBUS.

Results:

Ultrasound showed abnormality in 10% of case group, which was not significantly different from controls ( p = 1.000).

Conclusion:

Abnormalities discovered by ultrasonography in PMNE are more than in control group but without statistical significance and do not require invasive diagnostic tests. Children with sonographic abnormalities appear to be more resistant to treatment. We concluded that ultrasound is not necessary in MPNE and should be done in patients resistant to treatment.
Treating ADHD and Comorbid Anxiety in Children: A Guide for Clinical Practice
Authors: León-Barriera Roberto , Ortegon Richard S. , Chaplin Margaret M. , Modesto-Lowe Vania
Published: July 2022

Attention-deficit hyperactivity disorder (ADHD) is frequently comorbid with anxiety disorders with rates as high as 25% to 50% in children and adolescents. Despite various treatment options for ADHD symptoms, limited research addresses treatment in the context of comorbidity. This article seeks to provide a review of the evidence regarding treatment of this comorbid population. Distinct emotional, cognitive, and behavioral symptoms have been observed in this population, suggesting a need for tailored treatment. Despite common concerns about anxiety exacerbation, stimulant medications demonstrate good tolerability and good response in addressing symptoms. Atomoxetine has also demonstrated some benefit and good tolerability for treating this comorbid population. Selective serotonin reuptake inhibitors can be used as adjunctive treatment for anxiety but require careful monitoring of side effects. Cognitive behavioral therapy (CBT) is an important treatment to improve anxiety symptoms in the absence of significant ADHD symptoms. Psychosocial interventions are also essential to improve outcomes.
Influence of in-Vehicle Audio Warning on Drivers’ Eye-Movement and Behavior at Flashing Light-Controlled Grade Crossings
Authors: Ma Siwei , Yan Xuedong , Yang Jingsi , Liu Ran
Published: July 2022

Objective

This study aims to evaluate the effect of in-vehicle audio warning at flashing-light-controlled grade crossings based on driving simulation and eye-tracking systems.

Background

Collisions at flashing-light-controlled grade crossings have severe consequences. In-vehicle audio warning has the potential to regulate driver behavior. However, whether this improvement occurs through priming drivers’ visual search patterns is not yet clear.

Method

Drivers’ visual activity and behaviors were recorded. The effect of a warning was tested with a series of flashing light trigger times (FLTTs) ranging from 2s to 6s with a 1s increment. Different driving conditions (i.e., clear and fog) and driver experience were considered in the experiment design.

Results

Warnings could guide the allocation of both overt and covert attention, as well as raise drivers’ situation awareness, manifesting as the enhanced perception of signs and better understanding of the flashing red light. Significant improvement in the stop-compliance rate was found in warning scenarios, particularly with a late FLTT. The decreased saccade duration and increased fixation duration on the signal implied a dilemma-zone effect when the FLTT was lower than 4s. Furthermore, reduced fixation duration on signs and signals was found in foggy conditions. Non-professional drivers had a wider search range than their counterparts.

Conclusion

In-vehicle audio warning is an effective countermeasure for improving crossing safety by optimizing visual search strategy.

Application

In-vehicle audio warnings warrant promotion at grade crossings based on the driver assistance system.
Titans that Clash and a State that Buffers
Authors: Doğan Serhat , Karagözoğlu Emin , Keskin Kerim , Sağlam Hüseyin Çağrı
Published: July 2022

We present a game-theoretic approach to the analysis of the emergence or survival of buffer states. We analyze a two-stage game with three players orderly located on a linear territory, where the player in the middle is passive, and the players on the two ends are aggressive with options to declare war against the others. We conduct an equilibrium analysis and characterize the conditions under which the passive player acts as a buffer state between the aggressive players. We find various equilibrium outcomes, which can be grouped into the following categories: ( i) peace with buffer, ( ii) peace without buffer, and ( iii) the last man standing. Our comparative static analyses reveal valuable insights regarding the factors affecting the existence of buffer states.
Gender and Social Isolation across the Life Course
Authors: Umberson Debra , Lin Zhiyong , Cha Hyungmin
Published: July 2022

Social isolation has robust adverse effects on health, well-being, dementia risk, and longevity. Although most studies suggest similar effects of isolation on the health of men and women, there has been much less attention to gendered patterns of social isolation over the life course—despite decades of research suggesting gender differences in social ties. We build on theoretical frames of constrained choice and gender-as-relational to argue that gender differences in isolation are apparent but depend on timing in the life course and marital/partnership history. Results indicate that boys/men are more isolated than girls/women through most of the life course, and this gender difference is much greater for the never married and those with disrupted relationship histories. Strikingly, levels of social isolation steadily increase from adolescence through later life for both men and women.
Effects of Transitional Elements on Listeners’ Aesthetic Responses to a Choral Performance
Authors: Adams Kari , Springer D. Gregory , Geringer John M. , Nápoles Jessica , Davis M. Nicole
Published: July 2022

The purpose of this study was to investigate the effect of transitional elements on listeners’ aesthetic responses. Participants ( N = 81) viewed an excerpt of a choral performance while manipulating a Continuous Response Digital Interface to record their aesthetic responses. Participants in one group viewed the original choral performance, which included two purposeful transitions and no applause between pieces. In the other group, participants viewed the same choral performance but with applause over a black screen added between pieces. Participants then answered two open-ended questions to indicate the features of the performance most salient to their aesthetic responses. Mean aesthetic responses during each transition were higher for the continuous transition group compared to the applause group; however, differences between groups were statistically significant only during the attacca transition between the second and third piece. In response to “What factors contributed the most to your aesthetic response?” participants most commonly cited ensemble musicianship, followed by compositional elements such as harmonic, melodic, or rhythmic material; performer engagement; and song choices. When describing what kept them most engaged, participants mentioned programming most frequently, with the majority of comments referencing variety. We discuss implications for music teaching and learning.
Effect of fiber twisting on the Z-directional properties of composites
Authors: Guo Zitong , Shan Zhongde , Huang Ji H , Wang Dong , Huang Hao , Chen Zhe
Published: July 2022

To further improve the Z-direction tensile properties of flexible oriented 3D braided composites, we proposed a new process for twisting Z-fibers. We found a pattern of increasing and then decreasing tensile strength after twisting fibers with different K-numbers, and the four bundles of 3K fiber with 20 twists/m had the strongest tensile performance, which increased by 29.06% compared with the untwisted. Scanning electron microscopy was used to observe the twisting morphology and hairiness statistics of fiber bundles to analyze the reasons for this phenomenon. In order to increase the theoretical research on twisted fiber bundles, the relationships between the twist of fiber bundles and the tensile strength of fiber bundles, the length of fiber bundles, and the elongation of fiber bundles were established by using the idea of the least square method, and the prediction of fiber bundle strength was realized by twisting, length, and elongation purpose. The geometric model of the twisted fiber bundle was established, and the relationships between axial strain and radial strain of fiber bundles, axial strain and Poisson's ratio were realized. Combined with finite element simulation, the stress distribution position of the twisted fiber bundle was predicted. Finally, combined with the flexible-oriented three-dimensional weaving method, we selected the fiber with a twist of 20 twists/m as the Z-direction fiber, and completed the Z-direction performance enhancement of the composite material and, compared with the untwisted fiber, the tensile strength was increased by 60.9%.
Motivational Interviewing and Self-Determination Theory in Suicide Assessment: A Practical Application to Aid Residents’ Management of Suicide
Authors: Hyer Steven M. , Dixon Mark A.
Published: July 2022

Suicide is a problem on the rise in the United States. One significant avenue to help reverse the trend is through family medicine and interventions within primary care clinics. This can be a significant stressor for many family medicine physicians to manage patients experiencing suicidal ideation within their busy schedule. Motivational Interviewing is an evidence-based method of interacting with patients in a healthy and collaborative manner. The literature is growing on how to use Motivational Interviewing in assessments of suicidal ideation. Additionally, Self-Determination Theory proposes that individuals have three basic needs: a sense of connection, a level of autonomy, and a degree of competence. These needs and the associated principles of intrinsic and extrinsic motivation help to explain why Motivational Interviewing can be so helpful in the change process. By examining the principles of Motivational Interviewing and Self-Determination Theory residents will be able to better create an environment conducive to collaborative sharing, honest discussion, and meaningful assessment to ensure safety for patients in primary care.
Towards No Incisional Hernias: Lateral Paramedian versus Midline Incisions
Authors: Cox P J , Ausobsky J R , Ellis H , Pollock A V
Published: July 2022

A prospective randomized controlled clinical trial is reported which compares midline with lateral paramedian incisions in relation to the development of incisional hernias at one year. Of 431 patients randomized, 329 were available for assessment one year later. Two patients suffered burst abdomen, both being in the lateral paramedian group. Twenty-two incisional hernias occurred, 2 in the lateral paramedian group and 20 in the midline group ( P < 0.001). Of the two types of incision, the lateral paramedian incision takes longer to perform, requires a longer incision, rarely results in dehiscence, and does confer protection against incisional hernia.
Accuracy of Reagent Strip Testing for Urinary Tract Infection in the Elderly
Authors: Evans P J , Leaker B R , McNabb W R , Lewis R R
Published: July 2022

The accuracy of reagent strip testing for urinary tract infection (UTI) was assessed in 100 elderly patients (50 acute patients admitted to hospital and 50 attending the day hospital). Reagent strip sensitivities were: Acute patients – urinary nitrite 83%, blood 67%, protein 72% and leucocytes 72%, and day hospital patients — urinary nitrite 90%, blood 65%, protein 30% and leucocytes 60%. Urinary nitrite specificities were 100% for both groups of patients. Only 28% of patients with a UTI had specific symptoms of the infection; pyrexia and a raised WBC also proved poor indicators. Urinary nitrite was thus the most accurate immediate indicator of UTI.
Low Dose Botulinum Toxin in Spasmodic Torticollis
Authors: D'Costa D F , Abbott R J
Published: July 2022

Botulinum toxin has been successfully used to treat spasmodic torticollis. The optimum dosage is not clear and the recommended doses in the United Kingdom are 20–25 ng. We have used much lower doses (average 13 ng) without loss of efficacy and accompanied by a reduction in side effects. We treated 12 patients (eight women and four men) with a mean duration of torticollis of 4 years. Eleven of the 12 patients (91%) showed an improvement in total scores for pain and degree of head movement. The benefits appeared a week after treatment and lasted for 3 months. Side effects were minimal and transient. Our experience suggests low doses of the toxin may be equally efficacious.
Rape and Sexually Transmitted Diseases: Patterns of Referral and Incidence in a Department of Genitourinary Medicine
Authors: Ross J D C , Scott G R , Busuttil A
Published: July 2022

A retrospective study was carried out of all women attending a Department of Genitourinary Medicine over a 3-year period. Note was taken of referring source, presenting symptoms, infection detected at STD screening and follow-up attendance. Comparison was also made between the number of women referred by the police surgeon and the number who actually attended.

We observed an overall incidence of STD of 35% and noted that many infections had a similar prevalence to that of our normal clinic population over the same time period. Only 13% of the women referred by the police attended although after the initial visit attendance was similar regardless of referral source. A number of asymptomatic women were noted to have infection with Neisseria gonorrhoeae and Chlamydia trachomatis.

Although the risk of significant STD following sexual assault is low greater efforts should be made to encourage women to attend for screening whether or not they are symptomatic.
Management of Generalized Faecal Peritonitis-Can We Do Better?
Authors: Scholefield J H , Wyman A , Rogers K
Published: July 2022

Generalized faecal peritonitis is associated with a mortality of over 50% in most series of cases. Despite great improvements in the standards of intensive care the morbidity and mortality associated with this condition have not improved, in part due to recurrent intra-abdominal sepsis. This preliminary study investigated the role of laparotomy, repeated abdominal lavage and debridement to determine whether such a policy might lead to an improvement in outcome. Of six cases studied three had perforated diverticular disease, two had Crohn's disease. Twenty lavages were performed on these six patients who had a mean ICU stay of 8 days. Five out of the six patients left hospital and remain well, one patient died of septicaemia and pre-existing renal failure. This study found that laparotomy, repeated abdominal lavage and debridement may be effective in reducing the morbidity and mortality of generalized faecal peritonitis and further study of this technique is appropriate.
Al Jubail — An Aeromedical Staging Facility during the Gulf Conflict: Discussion Paper
Authors: Martin T E
Published: July 2022

During the latter half of 1990 the Royal Air Force established a medical evacuation chain in support of the British First Armoured Division during Operation Granby (known as Operation Desert Storm in the USA). Medical contingency plans, formulated prior to embarkation from the UK, foresaw the need for five aeromedical staging facilities sub-deployed throughout the east of the Arabian Peninsula. The early days of the deployment found personnel busy with the construction of tented and hardened facilities and with the establishment of local operating procedures. Many problems were initially encountered, especially with supply, communications and in co-ordinating with collaborating coalition and host nation units. Nevertheless, progress was rapid and non-combatant operations were started within days of arrival. As the ground offensive became more imminent, training took on a sense of urgency. Advanced first aid techniques were taught to all non-medical staff, whereas doctors, nurses and paramedical personnel were taught ACLS and ATLS skills. All studied field hygiene, the hazards of nuclear, chemical and biological warfare, casualty handling, battle psychology and the intricacies of loading and unloading various types of aircraft. By the start of the ground phase of the war the British evacuation chain was fully operational and capable of treating and transferring hundreds of casualties per day. In the event, only about 850 patients were transported down the evacuation chain during the conflict, and less than 10% of these were battle casualties. This paper presents an overview of the British aeromedical evacuation system and discusses, in more detail, the establishment and operation of the busiest aeromedical staging facility at Al Jubail in the Eastern Province of Saudi Arabia.
Diurnal Changes in Perceptions of Energy and Mood
Authors: Wood C , Magnello M E
Published: July 2022

Data from five separate groups of volunteers show that diurnal variation in perceptions of physical and mental energy (‘vigour’) can be simply measured by the use of visual analogue scales. In all five groups, perceptions of vigour were significantly higher in the morning than at other times of day. In three groups where energy levels were measured six times daily the values achieved between 10.00 h and 12.00 h were significantly higher (P< 0.05) than those recorded on rising or retiring.

Some evidence was also found for the existence of high energy levels in the evening (particularly among the undergraduates) and for an ‘afternoon dip’ in energy in about 20% of subjects. Higher levels of positive affect were also found in the morning and levels recorded between 10.00 h and 12.00 h were significantly greater than those on rising or retiring, (P< 0.01). However, no similar diurnal variation was observed for negative affect. The difference may be due to the fact that positive affect has a distinct ‘biological’ component contributing to perceptions of energy, whilst negative affbct depends more on features in the individual's environment, which show no consistent diurnal pattern.
Dementia and Driving
Authors: O'Neill D , Neubauer K , Boyle M , Gerrard J , Surmon D , Wilcock G K
Published: July 2022

Many European countries test cars, but not their drivers, as they age. There is evidence to suggest that human factors are more important than vehicular factors as causes of motor crashes. The elderly also are involved in more accidents per distance travelled than middle-aged drivers. As the UK relies on selfcertification of health by drivers over the age of 70 years, we examined the driving practices of patients with dementia attending a Memory Clinic. Nearly one-fifth of 329 patients with documented dementia continued to drive after the onset of dementia, and impaired driving ability was noted in two-thirds of these. Their families experienced great difficulty in persuading patients to stop driving, and had to invoke outside help in many cases. Neuropsychological tests did not help to identify those who drove badly while activity of daily living scores were related to driving ability. These findings suggest that many patients with dementia drive in an unsafe fashion after the onset of the illness. The present system of selfcertification of health by the elderly for driverlicencing purposes needs to be reassessed.
Laxative Induced Diarrhoea-A Neglected Diagnosis
Authors: Duncan A , Morris A J , Cameron A , Stewart M J , Brydon W G , Russell R I
Published: July 2022

A laxative screening service was established and offered to gastroenterologists in hospitals covering the West and Central belt of Scotland. The prevalence of laxative induced diarrhoea was assessed in two populations and was found to be 4% in new patients presenting to a gastroenterology clinic with diarrhoea and 20% in patients already under investigation of chronic idiopathic diarrhoea. A high rate of missed diagnosis of laxative induced diarrhoea (71%) and a low request rate (eight per annum) confirm the low clinical awareness of this diagnosis. We found potential savings of 80% of the cost of investigations subsequently ordered which could have been avoided by performing laxative screens on all patients presenting with diarrhoea. The introduction of such a screening policy is recommended as a cost-effective measure.
Abnormalities of Cerebral Structure in Schizophrenia on Magnetic Resonance Imaging: Interpretation in Relation to the Neurodevelopmental Hypothesis
Authors: O'Callaghan E , Buckley P , Redmond O , Stack J , Ennis J T , Larkin C , Waddington J L
Published: July 2022

The nature of abnormalities of cerebral structure evident in schizophrenia on magnetic resonance imaging is considered in relation to the neurodevelopmental hypothesis of the disorder. While schizophrenic patients showed increased ventricular volume, the extent of increase with age was comparable with that evident in controls and was unrelated to duration of illness. Conversely, cortical atrophy was evident only in patients, and this increased markedly with age and duration of illness. Such findings could be suggestive of two distinct pathophysiological processes in schizophrenia, but a schema for their reconciliation with the neurodevelopmental hypothesis is elaborated.
The Use of Thromboprophylaxis in Total Hip Replacement Surgery: Are the Attitudes of Orthopaedic Surgeons Changing?
Authors: Owen T D , Coorsh J
Published: July 2022

We conducted a survey of all 926 active members of the British Orthopaedic Association using a postal questionnaire to find out their current attitude to thromboprophylaxis in total hip replacement surgery. Previous surveys have been performed, and with all the recent literature on the subject we wanted to see if the attitude of British orthopaedic surgeons has changed. There were 676 replies, a response rate of 73%. Fifty-five replies were excluded, those from surgeons who had retired from practice or whose practice did not include total hip replacement surgery. Of the remaining 621 surgeons, 466 (75%) use some method of thromboprophylaxis, with 367 (59%) routinely using prophylactic pharmacological agents and 99 (16%) using mechanical methods of thromboprophylaxis. Twenty-five per cent (155) of surgeons used no routine method of thromboprophylaxis. Eighty-six per cent (534) of surgeons used a pharmacological method of prophylaxis in those patients thought to have a high risk of developing a deep vein thrombosis (DVT) (eg previous DVT, cardiovascular disease, obesity). Thirty-two different methods of thromboprophylaxis were used. Low molecular weight heparin is now being used by 19% of surgeons routinely and by 25% of surgeons in high risk cases, whereas 3 years ago it was not used at all. Our survey shows that although there is still a great reluctance for British orthopaedic surgeons to use pharmacological agents routinely in thromboprophylaxis. Amongst those that do, low molecular weight heparin is being increasingly used. More surgeons may want to use low molecular weight heparin routinely, but in some hospitals it is not currently available.
What's So Special about Being 65? The Challenge Facing Eldercare Departments
Authors: MacMahon Douglas G
Published: July 2022

There is no abrupt change in physiology, pathology or pharmacology occurring at or around the age of 65 years. There is some evidence of a change in the effect of illness, and of the prevalence of disability with advancing age. However, these changes are individual and gradual, and more associated with passing 75–80 years rather than 65. The main change occurring in the seventh decade arises from retirement from paid employment, and is therefore financial. Hence, in contrast to personal financial support, Health and Social Services departments would be ill advised to use the age of 65 as a threshold. Age-related admission policies may perpetuate ageism, and needs-related policies may therefore be preferable. The challenge facing departments of geriatric medicine and psychiatry is to present their services attractively to patients, carers and purchasers, who need to recognize the rationale for the purchase of these forms of care, with reference not only to benefit to patients, but also to their informal carers.
Resource Implications of Head Injuries on an Acute Surgical Unit
Authors: Williams R J Li , Hittinger R , Glazer G
Published: July 2022

Head injuries are expensive and demanding in terms of resources. In the UK, most are cared for outside neurosurgical centres. In the absence of specialist rehabilitation services, patients with on-going disability add to those admitted for observation and treatment on acute surgical wards. We audited the workload pattern and financial implications related to head injuries on a general surgical unit in a central London teaching hospital. Data collected prospectively at the time of admission and derived from departmental computerized information systems included clinical outcome, hospital stay and its relationship to severity of injury and other factors. Ward, departmental (accident and emergency (A & E), intensive therapy unit (ITU), radiology, and theatre) and neurosurgical referral costs were derived. Long-term social and rehabilitation costs were not calculated.

Over a 6 month period 899 patients with head injuries were treated in the A & E department, of whom 156 were admitted. Of the admitted patients 68% were classified as minor; 22% as moderate; and 10% as severe head injuries. Fifty-one per cent of adult admissions were intoxicated by alcohol. Prolonged hospital stay was related to age, severity of head injury, mechanism of injury, associated injuries and preexisting neuropsychiatric conditions (including alcoholism). Six patients died. The direct cost of these head injuries patients was estimated at £173 500, during which time they occupied 7.6% of our unit's adult inpatient capacity. Twenty-four hour observation of 76 patients with minor head injuries contributed £9700 (5.6%) to this figure. Associated extracranial injuries cost a further £46 500.

Head injuries are an important component of an acute unit's costs, particularly when the unit serves an inner city population where alcohol-related and neuropsychiatric problems are prevalent. In view of the financial implications involved, all hospitals whether directly managed or trusts will have to analyse their position in relation to local needs and available facilities.
Management of Tetanus: A Review of 18 Cases
Authors: Sun K O , Chan Y W , Cheung R T F , So P C , Yu Y L , Li P C K
Published: July 2022

Eighteen patients with generalized tetanus seen during an 8-year period in three regional hospitals in Hong Kong are reviewed. Eighty-nine per cent of the patients were intravenous heroin addicts who developed a severe type of generalized tetanus with autonomic dysfunction. Pain or stiffness of the neck or back was the commonest presenting symptom, followed by trismus and dysphagia. Most of the patients developed muscle spasms within 24 h of the onset of presenting symptoms. Early ventilatory support and tracheostomy, together with intensive nursing care, were the mainstay of the treatment. Pulmonary and gastrointestinal complications were common during the course of illness and treatment of autonomic dysfunction was often unsatisfactory. The case fatality rate was 25% among the heroin addicts, but full recovery was the usual outcome for those who survived. The simultaneous administration of intrathecal tetanus immunoglobulin tends to reduce mortality.
Routine X-Rays in Nasal Trauma: The Influence of Audit on Clinical Practice
Authors: Sharp J F , Denholm S
Published: July 2022

The introduction of treatment protocols require audited prospective data. The use of X-rays in patients with simple nasal trauma is common but of limited value. A prospective audit of this practice and the implications of introducing a ‘no X-ray’ policy for these patients into the local casualty department are presented. Patients are spared radiation exposure and there are savings in patient throughput time and departmental costs. Casualty departments which have not already adopted such a policy are urged to do so. Where such a protocol is in use, audit to ensure adherence is encouraged.
Applied Comparative Anatomy of the Avian Middle Ear
Authors: Mills Robert
Published: July 2022

The anatomy of the middle ear has been studied in nine species of birds, with particular reference to the structure of the ossicle and its relationship to the tympanic membrane. The morphology of the avian middle ear has been compared to that of the reconstructed human middle ear. Drum to stapes foot plate assemblies created during ossiculoplasty operations differ from the pattern found in the avian middle ear in a number of important respects and this may help to explain why they are often unsuccessful. It is not technically feasible to reproduce the avian middle ear pattern exactly in the human middle ear and developments in reconstructive technique should therefore be directed towards reproducing the three ossicle pattern of the mammalian ear.
Confrontation in the Climacteric
Authors: Wilbush Joel
Published: July 2022

Why is an increasing number of women dissatisfied with their doctors' help in their climacteric? Why do so many object to hormone replacement therapy (HRT)? Why do they generally feel it is not ‘natural’?

Though many object to getting old, want to continue flaunting their ‘eternal youth’, many more, women and men, embrace retirement, wish to rest and slow down. There is no mistaking these extremes, for while the first grasp at every possible treatment, the last are but seldom medically seen. It is the middle majority, their demands, censure, disapproval, even open confrontation with those who try to help them which is difficult to understand.

This paper briefly reviews the manner in which Western climacteric women have, during two hundred, but mainly last fifty, years confronted their world: their protests at societal attitudes, their private marital conflicts, their demands of doctors and, finally, their present criticism of them. It also pays detailed attention to the key concept of ‘natural’ treatment. Finally it suggests that much of present climacteric confrontation is a displacement activity, born of concurrent conflicting desires for both youth and retirement, rather than aimed specifically at doctors.
Why Use a Pain Clinic? Management of Neurogenic Pain before and after Referral
Authors: Davies Huw T O , Crombie Iain K , Macrae William A
Published: July 2022

Pain arising from damage or malfunction of the nervous system (for example postherpetic neuralgia, peripheral nerve injuries and the neuropathies) is often severe and resistant to standard analgesics. These patients are commonly seen in pain clinics where they receive a variety of treatments including psychotropic drugs (such as antidepressants and anticonvulsants), nerve blocks and stimulation. There is concern that the management of these difficult patients may be less than optimal where they are not seen by pain specialists.

We examined a cohort of 703 patients with long-established nerve-damage pain seen in ten outpatient pain clinics. We compared their use of treatments prior to referral with the management given in the pain clinic. The majority of patients (79%) had had their pain for over 1 year before being seen in the pain clinic, yet many had not tried simple and effective treatments prior to referral. Less than a quarter had received an adequate trial of antidepressants; only one in seven had been appropriately treated with anticonvulsants; and only one in 10 had tried a nerve stimulator. All these treatments were frequently provided in the pain clinic.

Referral of patients with nerve-damage pain to a pain clinic may greatly increase their access to therapies of proven value.
The D2 Dopamine Receptor Gene and Alcoholism: A Genetic Effect in the Liability for Alcoholism
Authors: Cook C C H , Gurling H M D
Published: July 2022

Three of five recent association studies have demonstrated an increased frequency of the A1 allele of the TaqI Restriction Fragment Length Polymorphism (RFLP) of the DRD2 locus in alcoholics compared to controls. One of three family studies has shown preliminary results in favour of linkage of this locus with alcoholism and heavy drinking. The possible mechanism of a genetic effect of the DRD2 locus in alcoholism remains open to speculation, but may involve personality characteristics such as impulsiveness or spontaneity. The applications of the findings of research in this field offer much potential for the prevention and treatment of alcoholism, but also raise certain ethical issues when applied to screening programmes. Future research will be assisted by the development of new, and more informative, genetic markers which are now available at this locus.
The Motivation and Shared Experience of Mouth and Foot Painting Artists
Authors: Critchley E M R
Published: July 2022

The purpose of this article is to examine the success and motivation of a small but remarkable group of severely handicapped individuals.