bluuebunny/crossref_metadata_2025 huggingface dataset:
“Photography is the Destruction of History”: Flusser and the Victory of Memory over History in the Age of Technical Images
Authors: Seligmann Marcio
Published: November 2017

Abstract: For Vilém Flusser the technical images should be seen as “vacuum cleaners” that suck all history: they accelerate time and metamorphose everything into frozen images. For him we should see those images as the concretization of the Judaic-Christian redemption concept. Technical images allow the overcoming of what he saw as the imprisoning inside the historical world, characterized by textolatry. They allow to logically rebuild the universe departing from its imagistic decomposition, as if images (built by “calculi”, pixels) were lego bricks. The work presents Flusser‟s Jewish mystical eschatology about magical redemptive images taking also in account his credo (which he judged also to be Jewish), that said that instead of consider the immortality of the soul, we should bet that “we shall survive within the memory of others”. What kind of memory would it be and what would it mean to survive in a post-historical world are some of the questions this text poses. Comparing with some of Walter Benjamin‟s ideas and concepts, it shows how Flusser proposed to answer to the demand of Benjamin, who wrote that the new techniques imposed the necessity to rethink today the meaning of death and love.
Der Zerfall des Schriftdeutschen im Estado Novo?
Authors: Woytowicz Lisa
Published: November 2017

Der folgende Beitrag beschäftigt sich mit Sprechern des Hunsrückischen in Brasilien und deren Gebrauch des Schriftdeutschen im 20. Jahrhundert. Basis der Analyse ist ein Korpus von Privatbriefen, die während der ersten Diktatur geschrieben wurden. Der Fokus der Analyse ist die Frage nach einer uniformen Schriftnorm für diese Sprechergruppe, deren Muttersprache fast ausschließlich mündlich verwendet wurde. Es wird argumentiert, dass der Estado Novo nicht die einzige Ursache für den Dachsprachenwechsel vom Deutschen zum Portugiesischen war, jedoch entscheidend dazu beigetragen hat, dass die Etablierung einer brasilianischen Schriftnorm des Deutschen endgültig verhindert wurde.
Values, heuristics and the politics of knowledge
Authors: Longino Helen
Published: November 2017

Há um conjunto de valores, comumente denominados cognitivos, epistêmicos ou científi cos, que com frequência são considerados informativos do bom juízo científi co, quando a evidência se esgota. Contrastando esses valores com um conjunto alternativo, delineado no trabalho de cientistas, historiadoras e fi lósofas feministas, é possível mostrar como a dependência desses valores chamados científi cos tem consequências sociais problemáticas. O artigo examina a valencia social diferencial dos dois conjuntos de valores, argumenta que nenhum dos dois deve ser considerado como dando as condições de produ- ção da verdade e propõe que ambos pertencem a um coleção (provavelmente maior) de heurísticas cuja conveniência depende das características da investigação particular na qual são empregadas
NEU: recurso de aproximação do estudante de medicina com a comunidade
Authors: Scarponi Ana Clara Drummond , Brum Natália Fernanda Ferreira , Fiamoncini   Gabriella Maciel , Teixeira Angélica Fernandes , Valente Bruna Pimenta , Kopper Karina Cristina , Pimentel Karina Vieira Resende Ignacchiti , Sampaio Roberta Duarte , Braga Sandra Carvalho de Almeida , Sicupira Deborah Luíza , Guimarães Fabiano Gonçalves
Published: November 2017

Fazem parte da formação do profissional médico o fortalecimento da cidadania e a capacitação para atuar na promoção e prevenção da saúde em diferentes realidades socioculturais. Assim, o Núcleo de Extensão Universitária (NEU) do curso de medicina – UNIFENAS - BH foi planejado como um recurso que proporcionará o intercâmbio de saberes entre acadêmicos de medicina, docentes e a comunidade. Objetivo: o NEU propõe uma maior vinculação entre universitários e membros da comunidade, a fim de aproximá-los da realidade brasileira, bem como atuar em localidades carentes por meio de projetos variados, ressaltando a importância da medicina humanizada. Método: Em julho de 2016, o NEU, durante sete dias, realizou sua primeira expedição em Urucânia – MG. Foram desenvolvidas oficinas de música, higienização e abordados temas, como violência e educação sexual para crianças e adolescentes. Com a população adulta foi debatido sobre violência contra a mulher, vínculo afetivo, saúde do homem e amamentação. Por demanda da cidade, foi incluído um projeto para o centro de reabilitação de usuários de drogas. Para o público idoso a abordagem incluiu oficinas de hipertensão e diabetes, grupo de caminhada e visitas ao asilo. Além do público-alvo já mencionado, as atividades abrangeram educadores, agentes municipais de saúde e lideranças comunitárias. Resultados: As ações promovidas pelo NEU foram positivas para a população de Urucânia, bem como para os membros do grupo, possibilitando reflexões que engrandeceram a formação acadêmica e pessoal dos integrantes. Em relação às dificuldades, o grupo enfrentou, em alguns momentos, falta de estrutura, desinteresse de algumas instituições e a imprevisibilidade do público. Conclusão: Nessa expedição, a verdadeira essência do ser médico se mostrou efetiva, contribuindo para o desenvolvimento do município e para o fortalecimento do conceito de corresponsabilidade social entre acadêmico e comunidade.
Aspectos fisiopatológicos do reflexo da tosse: uma revisão de literatura
Authors: Rodrigues Mateus de Sousa , Galvão Ivan Martins
Published: November 2017

A tosse é um reflexo de defesa da via aérea em condições fisiológicas. Entretanto, ela compõe o quadro clínico de diversas doenças pulmonares, cardíacas e gastrintestinais. A persistência desse sintoma afeta a qualidade de vida do paciente e acomete 3 a 40% da população geral. Embora possua uma prevalência alta, a fisiopatologia desse sintoma ainda não é bem esclarecida. Nesse sentido, anualmente, são publicados novos achados sobre a fisiopatologia desse sintoma. Assim, o objetivo desse trabalho é realizar uma revisão de literatura sobre a fisiopatologia da tosse. Essa revisão utilizou quarenta publicações presentes nas seguintes bases de dados: Scholar Google, SciELO, Pubmed Central® (PMC), National Center for Biotechnology Information (NCBI) e Medline. A fisiopatologia da tosse está intimamente ligada à estimulação química das fibras-C e à ativação por estímulos mecânicos dos receptores de adaptação rápida (RARs) e dos receptores de estiramento de adaptação lenta (SARs). O conhecimento desses mecanismos fisiopatológicos é importante para o manejo clínico de pacientes com esse sintoma e contribui para o entendimento do mecanismo de ação de antitussígenos que agem sobre esses receptores.
Bottle rack: a ausência da Coca-Cola nas obras de Marcel Duchamp
Authors: Silva Miriam Cristina Carlos , Silva Paulo Celso da
Published: November 2017

Este artigo resulta de pesquisa iniciada em 2015, a qual tem como objeto as reapropriações artísticas e midiáticas da marca Coca-Cola, bem como a expansão de suas cargas simbólicas. Neste caso, discutimos o Bottle rack de Marcel Duchamp. Para as análises, dialogamos com Paz, Cabanne, Fabbrini, Cage, entre outros, e realizamos um experimento denominado Coca-Cola’s bottle rack. Conclui-se que Coca-Cola’s bottle rack nos fez refletir acerca da linha narrativa que se cria com essa composição. A ideia é a de um objeto de arte e sua própria negação em diálogo com o espectador, que “complementa” a obra com sua percepção e seu repertório, seja este oriundo ou não da sociedade de massas, da indústria cultural ou da sociedade do espetáculo.
Anotações sobre a modernidade líquida em Once Upon a Time
Authors: Brandão Marcos Aleksander , Canepa Laura
Published: November 2017

Este trabalho discute o seriado televisivo Once Upon a Time, da rede de televisão estadunidense ABC, que realiza uma releitura contemporânea dos contos de fadas. Sugere-se que aspectos da modernidade líquida descritos pelo sociólogo Zygmunt Bauman – como fluidez, fragmentação, incerteza e volatilidade – afetam e ajudam a moldar peças audiovisuais de sucesso, como a série em questão. Consideramos que, em Once Upon a Time, esses aspectos se expressam por meio de duas estratégias principais: a divisão do mundo diegético em mundos paralelos e a reinvenção de personagens de narrativas tradicionais. A partir dessas estratégias, a série traça o caminho da sua protagonista, Emma Swan, que busca dar sentido à existência num mundo atravessado por imaginários construídos pelos produtos midiáticos e também por noções instáveis de identidade, história e passado.
Serialização da cultura e promoção de imaginários ambivalentes: construindo o “comum-excepcional” em A feiticeira
Authors: Rocha Rose de Melo , Cunha Paulo Roberto Ferreira da
Published: November 2017

Este artigo problematiza algumas significações imagéticas e imaginárias articuladas no consumo de narrativas serializadas. Para empreender esta análise, partimos de uma contextualização teórica sobre serialização da cultura e descentralização da cultura de massas, analisando a imagética do consumo articulada na serialização. Voltamo-nos, a seguir, em uma perspectiva histórica, a imagens modelares de estilo de vida, através da disseminação da comunicação de forma massiva em um seriado estadunidense produzido para a TV na década de 1960, A feiticeira. Em paralelo à ação normativa da difusão do referido modelo, contradições e fatores contextuais tensionavam o padrão, evidenciando ações intencionais e involuntárias que dialogavam com parcelas distintas da população não coniventes ou contempladas pelo status quo. Assim, entendemos que há a disseminação de imaginários ambivalentes pela série e no processo de seu consumo.
Tomando decisões criativas nos estúdios da Hollywood contemporânea
Authors: Ross Alexander G.
Published: November 2017

Este artigo busca contribuir para o atual debate sobre os processos de tomada de decisões nos estúdios de Hollywood e do microgerenciamento do processo criativo com o objetivo de produzir filmes consistentemente lucrativos. O autor delineia o processo pelo qual os roteiros são submetidos aos estúdios para determinar a viabilidade deles para produção e como isso impacta na qualidade dos roteiros. Há questões persuasivas sobre se o atual modelo de negócios impossibilita narrativas culturais relevantes e definitivas, e como isso afeta a qualidade e a lucratividade dos filmes contemporâneos. Além de considerar a literatura existente sobre esse tópico, o artigo traz o saber de quinze anos de experiência do autor em Hollywood como roteirista, agente e produtor.
Imaginários em movimento na cultura e na vida social
Authors: Soares Rosana , Limberto Andrea
Published: November 2017

Apresentação da proposta desta nova edição da revista.
Narratives of the Prophet’s Early Life in Ṣaḥīḥ Al-Buḫārī: An Analytical Study of Qurʾānic References in Sīra Nabawiyya
Authors: Azmi Ahmad Sanusi
Published: November 2017

Research into early Muslim sources has demonstrated that some verses of the Qurʾān have been seen by Muslim scholars as containing direct references to the events of the Prophet’s early life. Modern scholars, however, have questioned the appropriateness and authority of these Qurʾānic references as being accurate sources of information for the Prophet’s biography. Since the ḥadīṯ are regarded as an authoritative exegetical tool for understanding the meaning of Qurʾānic verses, the ḥadīṯ and scholars’ views on the scripture and its relationship to the narratives of sīra nabawiyya must be undertaken. The objectives of this present study are to explore the narratives of the Prophet’s early life as found in Ṣaḥīḥ al-Buḫārī and analyse al-Buḫārī’s perspective on the role of ḥadīṯ as an exegetical tool for Qurʿānic references in sīra nabawiyya. The study is qualitative in nature, as it utilises both critical and analytical approaches for its methodology. The study suggests that al-Buḫārī employed innovative and novel approaches when presenting narratives of the Prophet’s early life. At certain places in his al-Ṣaḥīḥ, by adducing certain ḥadīṯ in detail, al-Buḫārī endeavours to convey one distinctive and irrevocable message to the reader.
A Comparative Study on Interpretation of Planet from Al-Quran and Astronomy Views
Authors: Wahid Khairussaadah , Nawawi Mohd Saiful Anwar Mohd , Man Saadan
Published: November 2017

The interpretation submitted by the translator of mashaf Quran against the pronouncement of al-kawkab and al-kawakib means ‘star’. Based on the studies from the modern astronomy, both words refer to a planet. The study of the meaning of al-kawkab and al-kawakib is about explaining more appropriate meanings based on the context of Islamic astronomy. The main objective of this study is to identify the meaning of al-kawkab and al-kawakib terms in al-Quran and to analyze the correlation between Quranic commentaries with modern discoveries of planets in the solar system. Methods of comparison between the views of Quranic commentaries and modern astronomy are highlighted with reference based on classical and contemporary tafseers, and modern astronomy literature. The study found that there are four passages that discuss physical characteristics of planets. In addition, the reason that may be adduced to explain appropriate translations for the words al-kawkab and al-kawakib as ‘planet’ is based on the majority of Quranic commentaries and research on the difference in physical nature of planets and stars. In conclusion, the is no difference between Quranic commentaries and modern astronomy related to planets and their features. Thus the pronouncement of al-kawkab and al-kawakib in the Quran refers to a planet, not a star.
Idealism of Jihad and War from the Qurʾanic Perspective
Authors: Mohd Khambali@Hambali Khadijah , Abdullah Mustaffa , Ali Abdul Karim
Published: November 2017

There are various verses in the Qurʾan which apparently lead to the meaning of war. With regard to its intepretation of its related verses, there are mainly two different views. The first view argues that war in Islam will not happen but in a defensive manner. In other words, a war among Muslims would not happen unless they have been attacked and their reaction is in the form of counter attack in order to protect their dignity and life. The second view sees war in offensive manner. It is considered as a holy war (jihād) which is under the category of striving in the cause of Allah, and recommended to gain the status of martyrdom (syahīd).

These different views create variant intepretations of the word jihād and war. The existance of certain groups related to terrorism such as Islamic State of Iraq and al-Syam (isis), al-Qaeda, Abu Sayyaf, Jemaah Islamiyyah and others, abusing the name of Islam and using hostile approaches in order to achieve their aims, have clearly a negative impact on Islam.

This article reviews the meaning of jihād and war in accordance to the Qurʾanic perspective in order to address this issue fairly. Relevant data have been taken from selected authoritative Qurʾanic exegesis pertaining to verses of jihād and war. It uses content analysis to analyse those related data.The article concludes that jihad in Islam is subject to sincere intention and a clear objective: it does not simply mean fighting. A war should be viewed from different aspects whether defensive or offensive because different backgounds will lead to the both. Both jihad and war are clearly different from terrorism, and both of them are associated with the meaning of fī sabīllah as commonly understood.
Who’s Shaping Whom? Digital Disruption in the Spiritual Lives of Post-familial Emerging Adults
Authors: Baker Samuel
Published: November 2017

Technology has always interrupted and reshaped culture. Digital technology is no different, of course, and—predictably—it continues to reshape a variety of frameworks: individual, social, and ecclesiastical. This paper investigates how late adolescent, emerging adults engage with new media, paying special attention to how digital technology influences their neurological, personal, and spiritual vitalities. Youth ministry practitioners, it will be argued, must be far more attentive to the conforming and transforming properties of digital engagement, which more profoundly impact the spiritual lives of late adolescents. A viable theology of technology is promoted, and suggestions for discipleship and stewardship praxis are encouraged.
Contextualizing the 2016 State Duma Election
Authors: Hutcheson Derek S.
Published: November 2017

An overview is given of the 2016 Russian State Duma election, and its significance for the current Russian regime. As the first in a series of five articles in this edition of Russian Politics, it sets the 2016 State Duma election into context. It begins by discussing the role of the Duma in Russian politics, and reviews political developments between the protests that followed the 2011 parliamentary election, and the successful conclusion of the 2016 one. It then examines how institutional and political changes came together in the 2016 campaign. The resultant supermajority for the pro-Kremlin United Russia party is analyzed, before the remaining articles in this issue – which examine the issues of turnout, voting behavior, electoral manipulation and the future of the regime – are introduced.
Prodromus of a fern flora for Bolivia. XII. Lygodiaceae
Authors: KESSLER MICHAEL , SMITH ALAN R.
Published: November 2017

We provide a synopsis to the leptosporangiate fern family Lygodiaceae in Bolivia, comprising two species in the genus Lygodium, both of which are widely distributed in the Neotropics.
A new species of Palaeugoa Durante, 2012 from Sierra Leone (Lepidoptera, Erebidae, Arctiinae)
Authors: VOLYNKIN ANTON V.
Published: November 2017

The Asura / Miltochrista generic complex (family Erebidae, subfamily Arctiinae, tribe Lithosiini) is one of the largest and taxonomically most difficult Lithosiini groups widely distributed in Afrotropical, Palaearctic, Oriental, and Indo-Australian regions. In Africa, the generic complex is represented by the genera Tumicla Wallengren, 1863 (= Asuroides Durante, 2008, syn. rev.), Afrasura Durante, 2009, Parafrasura Durante, 2012 and Palaeugoa Durante, 2012. The genus Palaeugoa was erected as monobasic for Xanthetis spurrelli Hampson, 1914 described from Ghana (Durante 2012). During the studies of West African Lithosiini materials deposited in the collection of the African Natural History Research Trust, I found a second, yet undescribed species of Palaeugoa collected in Sierra Leone. The description of the new species is given below.
New substitute name for Sobara Oman, 1949 and recognization on Chinese Orientus species (Hemiptera: Cicadellidae: Deltocephalinae)
Authors: XING JI-CHUN
Published: November 2017

Oman (1949) established the leafhopper genus Sobara with Eutettix palliolata Ball, 1902 as its type species. This genus belongs to the tribe Athysanini Van Duzee, 1892 of subfamily Deltocephalinae (Hemiptera: Cicadellidae). Until now, there have been no further reports on this genus, and only one species is recorded from southwest USA.
Deep-water scleractinian corals (Cnidaria: Anthozoa) from 2010-2011 INDEMARES expeditions to the Galicia Bank (Spain, northeast Atlantic)
Authors: ALTUNA ALVARO
Published: November 2017

During surveys in the Galicia Bank (northeastern Atlantic) in the years 2010–2011 (INDEMARES project), 25 species of scleractinian corals corals were collected in a depth interval of 744–1764 m. Most interesting species are described and depicted. Additionally, species list and remarks are given for the 23 species dredged in the bank during the 1987 SEAMOUNT 1 expedition at 675–1125 m depth.From a literature review and new records from Galicia Bank given herein, 31 species of scleractinian corals are known from this seamount in a depth interval of 614–1764 m depth. Six are colonial and 25 solitary, with 17 occurring on hard bottoms and 14 on soft bottoms. Desmophyllum dianthus, Lophelia pertusa and Madrepora oculata are the most widely distributed species in both number of stations and depth range of specimens collected alive. Some species were recorded outside their previously known bathymetric ranges in the northeastern Atlantic. Javania pseudoalabastra is first documented for the Iberian Peninsula and Spanish faunas. Thrypticotrochus sp. is first collected from the Atlantic Ocean.
Migration, migrants, and human security
Authors: Purkayastha Bandana
Published: November 2017

This introductory article outlines a framework to bridge some of the current fragmentation and knowledge hierarchies in the sociological field of migration. The article builds on the insights – and epistemological roots – used in different parts of the world to reflect on 21st-century realities of migration and human security. It considers international migrants, internally displaced persons, refugees and trafficked persons as part of a continuum of migrants who exhibit seasonal, temporary and long-term migration patterns. The framework draws upon the scholarship of the Global South and North on political-economic processes that have historically influenced migration and migrants’ lives and continue to do so today. It considers the dominant approach used in studies of international migration and shows why it is necessary to go beyond the focus on nation-states and an emphasis on a particular group of migrants. The framework weaves the insights of scholars who work on international, internal migration and forced migration, as well as the critical literatures on intersectionality and human rights to build an approach that centers questions of migrants’ human security. The framework emphasizes the glocal – i.e. intersecting global-national-local – terrains of migration and discusses human security within glocal terrains.
Co-constituting migrant strangers and foreigners: The case of Japan
Authors: Iwata Miho , Nemoto Kumiko
Published: November 2017

This study examines the experiences of diverse groups of migrants in a highly developed non-Western society: Japan. Using critical analysis of literature and semi-structural interview data with 50 Japanese nationals and 109 foreign migrants, it explores how Japan, which sees itself as a relatively racially homogeneous society, operates in response to increasing demands for migrants, and how the structures of the state and interactions of dominant and migrant groups affect migrants’ security. It shows the salience of glocal racial ideologies creating an uneven terrain of migration for migrants from different parts of the world. Specifically, the Japanese state grants work visas for highly-skilled and specialized labor migrants as it maintains that it only accepts highly-skilled labor migrants, while opening a side-door to recruit Japanese descendants and trainees from the Global South as low-skilled laborers. This bifurcated visa structure reinforces racial hierarchies, where those who are perceived to be from Western societies are deemed as superior foreigners, while those who are from non-Western societies are seen as strangers who are a potential threat to the country’s moral standards. This hierarchy shapes their level of human security.
“Bringing the State Back In”: Explaining Women’s Economic Empowerment in an Era of Globalization
Authors: Wang Zhiyuan
Published: November 2017

The extant literature views the decision to protect women’s economic rights as made by firms and neglects the role of the state. This study argues that states are pressured to improve the protection of these rights by enacting gender parity–promoting policies in response to similar policy choices by their economic competitors, resulting in a specific type of policy interdependence—the upward policy convergence. Additionally, this convergence should be stronger in laws than in practices because some states continue to benefit from women-suppressing policies, and because improving laws is less costly than improving policy implementation. Using newly coded global data from 1999 to 2009 on women’s economic rights that distinguish between laws and practices, spatial econometrical analyses support these conjectures. Essentially, this study shows that the race to the bottom is not the sole consequence of globalization, a climb to the top is possible as well when we look closer and more carefully. In other words, trade and capital dependence can generate positive policy gains too.
Hope Abjuring Hope: On the Place of Utopia in Realist Political Theory
Authors: Thaler Mathias
Published: November 2017

This essay reconstructs the place of utopia in realist political theory, by examining the ways in which the literary genre of critical utopias can productively unsettle ongoing discussions about “how to do political theory.” I start by analyzing two prominent accounts of the relationship between realism and utopia: “real utopia” (Erik Olin Wright et al.) and “dystopic liberalism” (Judith Shklar et al.). Elaborating on Raymond Geuss’s recent reflections, the essay then claims that an engagement with literature can shift the focus of these accounts. Utopian fiction, I maintain, is useful for comprehending what is (thus enhancing our understanding of the world) and for contemplating what might be (thus nurturing the hope for a better future). Ursula K. Le Guin’s novel The Dispossessed deploys this double function in an exemplary fashion: through her dynamic and open-ended portrayal of an Anarchist community, Le Guin succeeds in imagining a utopia that negates the status quo, without striving to construct a perfect society. The book’s radical, yet ambiguous, narrative hence reveals a strategy for locating utopia within realist political theory that moves beyond the positions dominating the current debate. Reading The Dispossessed ultimately demonstrates that realism without utopia is status quo–affirming, while utopia without realism is wishful thinking.
An Audit of Audits: Are we Completing the Cycle?
Authors: Gnanalingham Janaki , Gnanalingham Muhuntha G , Gnanalingham Kanna K
Published: November 2017

Clinical audit plays an important part in the drive to improve quality of patient care and thus forms a cornerstone of clinical governance. We evaluated the standard of clinical audits conducted by all departments in a teaching hospital between 1996 and 1997.

Of a total of 213 audits carried out, 102 (48%) were ‘partial’ and only 29 (14%) were ‘full’. Recommendations for improvement emerged from 134 (63%) of the audits performed. In only 51 audits (24%) was the cycle completed by re-auditing, during the subsequent 3 years.

Most departments undertake clinical audits but failure to close the loop undermines their effectiveness and wastes resources.
Students Sitting Medical Finals–-Ready to be House Officers?
Authors: Goodfellow P B , Claydon P
Published: November 2017

An initial survey of students approaching qualification and the preregistration house officer year revealed anxiety about competence in several important clinical skills. A questionnaire study was then undertaken to assess, first, the extent to which students had attained the skills required for the preregistration year and, second, the amount of training in these skills provided during the preregistration year. 122 medical students taking their final examinations were asked about training and practice in eight core clinical skills, and 84 graduates from the same school, approaching the end of their preregistration year, were asked about postgraduate training in these skills.

The response rate of each group was 100%. Of the eight skills studied, most had been performed few times by the students at qualification. Less than half the current preregistration house officers could recall training being given in any of the skills studied. There were no significant differences in house-officer training between teaching hospitals and district general hospitals. Regarding needlestick injuries, nearly two-thirds of preregistration house officers were unable to recall any training at either undergraduate or postgraduate level.

These results suggest that training in clinical skills can be improved. Training is already changing with use of clinical skills laboratories and logbooks. We also recommend mandatory needlestick training both in undergraduate programmes and in induction courses for preregistration house officers.
Is the National Health Service at the Edge of Chaos?
Authors: Papadopoulos Marios C , Hadjitheodossiou Michalis , Chrysostomou Costas , Hardwidge Carl , Bell B Anthony
Published: November 2017

We used chaos and complexity theory to analyse waiting-list data (1998–2001) pertaining to over 20000 National Health Service (NHS) patients from general surgical, orthopaedic and neurosurgical units across England. Plots of frequency versus quarter-to-quarter change in waiting times revealed a power relation which seems independent of surgical specialty and hospital location. One interpretation of these findings is that, for the period in question, the NHS was a system at the edge of chaos. This hypothesis might explain why waiting times have resisted attempts at shortening.
Injuries among Female Army Recruits: A Conflict of Legislation
Authors: Gemmell Lan M M
Published: November 2017

In the final decade of the 20th century, the British Armed Forces came under intense pressure to open up traditionally male roles to female recruits. For training, women were initially given lower entry and exit standards, but it became apparent that many did not possess the strength necessary for their work. This ‘gender fair’ policy was therefore changed to a ‘gender free’ policy, whereby identical physical fitness tests were used for selection of male and female recruits and the training programme made no allowances for gender differences. To determine the effects of this policy change, data from medical discharges were examined for the periods before and after implementation, with reference to musculoskeletal injuries of the lower limbs. In the first cohort there were 5697 men and 791 women, in the second 6228 men and 592 women.

The cross-gender (F/M) odds ratio for discharges because of overuse injury rose from 4.0 (95% CI 2.8 to 5.7) under the gender-fair system to 7.5 (5.8 to 9.7) under the gender-free system (P—0.001). Despite reducing the number of women selected, the gender-free policy led to higher losses from overuse injuries.

This study confirms and quantifies the excess risk for women when they undertake the same arduous training as male recruits, and highlights the conflict between health and safety legislation and equal opportunities legislation.
Emergency Ambulance Dispatch: Is there a Case for Triage?
Authors: Thakore S , Mcgugan E A , Morrison W
Published: November 2017

Emergency telephone calls for an ambulance (999 calls) are usually dealt with first-come first-served. We have devised and assessed criteria that ambulance dispatch might use to prioritize responses. Data were collected retrospectively on consecutive patients presenting to an accident and emergency (A&E) department after a 999 call. An unblinded researcher abstracted data including age, date, time, caller, location, reason for call and A&E diagnosis and each case was examined for ten predetermined criteria necessitating an immediate ambulance response—namely, cardiac arrest; chest pain; shortness of breath; altered mental status/seizure; abdominal/loin pain >65 years old; fresh haematemesis; fall > 2 m; stabbing; major burns.

471 patients were recruited, 55% male, median age 50 years. 406 calls came from bystanders or the patients themselves, 36 from general practitioners, 8 from other hospitals and 21 from the police. 52% of patients were admitted. 44% met at least one of the above criteria.

Most patients did not meet the criteria for an immediate ambulance response but might nonetheless be suitable for an urgent response. The criteria used in this study have the advantage of being based on the history provided by the caller. The introduction of a priority-based dispatch system could reduce response times to those who are seriously ill, and also improve road safety.
Venous Thromboembolic Prophylaxis for Transurethral Prostatectomy: Practice among British Urologists
Authors: Golash A , Collins P W , Kynaston H G , Jenkins B J
Published: November 2017

Venous thromboembolism (VTE) is an occasional cause of death after transurethral prostatectomy but there are no established guidelines for its prevention in relation to this operation. We assessed practice in the UK by mailing a questionnaire to 460 consultant members of the British Association of Urological Surgeons.

362 (79%) completed questionnaires were received. 280 of 362 (77%) respondents routinely used VTE prophylaxis with transurethral prostatectomy; 82 (23%) did not. 230 of the 280 urologists who took precautions used mechanical methods; 50 used low dose heparin, either with stockings or alone.

This survey indicates that, despite a lack of clear evidence, most British urologists favour some form of precaution against VTE in patients undergoing transurethral prostatectomy.
A Simple Index for Detection of Gestational Diabetes Mellitus
Authors: Perea-Carrasco Rafael , Pérez-Coronel Rocio , Albusac-Aguilar Rogelio , Lombardo-Grifol Manuel , De León Elena Bassas-Baena , Romero-Diaz Carlos
Published: November 2017

The conventional screening test for gestational diabetes mellitus is measurement of plasma glucose 1 hour after 50 g glucose by mouth. The sensitivity and specificity of this test are lower than desirable; we therefore developed an index including other plasma constituents. In a preliminary study, 138 pregnant women had the standard oral glucose load screening test, and plasma fructosamine and total proteins were measured, in addition to glucose, in the 1-hour samples. An index value (I) was calculated as [fructosamine (μmol/L)÷total proteins (g/L)]×[glucose (mmol/L)÷100]. Cut-off values for I were then assessed in a second prospective study, of 642 pregnant women. Definitive diagnosis of gestational diabetes was by oral glucose tolerance test (OGTT). The index was also assessed in terms of fetal macrosomia (birthweight ≥ 4000 g).

With a cut-off value of I=27.2, sensitivity was 98%, specificity 89%, diagnostic efficiency 90%, positive likelihood ratio 8.76. Application of the index would have avoided 42% of the OGTTs demanded by the standard screening test, reducing false positives from about 24% to 10%. Predictive efficacy for macrosomia was 10.3% versus 7.9%.

Our index offers an efficient screening test for gestational diabetes, and with more stringent cut-off points may be applicable as a single-step diagnostic procedure.
A Comparison of Patients with Chronic Fatigue Syndrome Attending Separate Fatigue Clinics Based in Immunology and Psychiatry
Authors: White P D , Pinching A J , Rakib A , Castle M , Hedge B , Priebe S
Published: November 2017

Hospital clinics for patients with chronic unexplained fatigue are held in departments of various disciplines. This causes difficulties for referrers in choosing the appropriate clinic and for researchers in generalizing findings from one type of clinic to others. We randomly selected 37 outpatients attending an immunology fatigue clinic and 36 outpatients attending a psychiatry fatigue clinic, all of whom had chronic fatigue syndrome. We compared demographic factors, symptoms, disability, quality of life, psychological distress and illness attributions.

The patients from the two clinics were closely similar in their specific symptoms, disability, quality of life, psychological distress and previous attendance to mental health professionals. Psychological distress was high and equal in the two samples. The proportion of men was greater among patients attending the immunology clinic. In a post-hoc analysis, 64% of immunology attenders attributed their fatigue to physical factors, compared with 31% of psychiatry clinic attenders (χ2=6.35, 1 d.f., P=0.01).

These findings suggest that research data from one type of chronic fatigue clinic can be generalized to others. Clinically similar patients are referred to different clinics, and the choice of clinic may be influenced by the patients’ illness beliefs. The high levels of emotional distress suggest that psychosocial management is as important as physical management in hospital outpatients with chronic fatigue syndrome, irrespective of its aetiology.
Influence of a Nurse Practitioner on Non-Attendance Rate for Barium Enema
Authors: Scott Michael , Allen Sian , Bamford Alasdair , Walshe Maria , Clark Celia Ingham
Published: November 2017

Non-attendance for barium enema investigation wastes resources, prolongs waiting times and delays diagnosis of colorectal carcinoma. In an inner-city hospital with a previous non-attendance rate of over 20% for barium enema we investigated the value of systematic personal contact with a nurse practitioner at the time of booking. We compared two groups of patients, all of whom received an explanation of the procedure from the referring clinician. Patients referred from the colorectal clinic were accompanied by the colorectal nurse practitioner to the radiology department for booking, an appointment being sent later by mail. The nurse practitioner reiterated the details of the procedure, provided supplementary information, confirmed the patient's contact details and provided a telephone number in case further information or assistance was needed. Patients referred from the gastroenterology clinic were managed as previously, making their own way to the radiology department and receiving supplementary information only on request.

The patients referred from the two clinics were closely similar; however, the non-attendance rate for the intervention (colorectal) clinic was 4/157 (2.5%) compared with 17/110 (15.5%) for the comparison clinic (P < 0.001). A year previously the non-attendance rates in these clinics had been 23% and 20%, respectively.

These results indicate that personal contact, with supplementary information, can substantially reduce the non-attendance rate for barium enema.
Pupil Perimetry in the Diagnosis of Functional Visual Field Loss
Authors: Rajan M S , Bremner F D , Riordan-Eva P
Published: November 2017

The diagnosis of functional visual loss—reduced visual performance in the absence of an organic cause—is usually made by exclusion. We conducted a pilot study to evaluate pupil perimetry in three patients (aged 14, 43 and 50) with visual field loss presumed to be functional on clinical grounds and having no cause identified by visual electro-physiology or magnetic resonance imaging. A modified automated perimeter was used to examine visual and pupil responses to a light stimulus (size 1.7°) presented at five locations in the visual field (fixation and in each of the four quadrants).

In each patient, the pupil responses were normal in those test quadrants which showed apparent visual field loss.

Pupil perimetry provides objective evidence for a diagnosis of functional visual field loss in selected patients and may circumvent the need for other investigations.
Illegible Handwriting in Medical Records
Authors: Rodríguez-Vera F Javier , Marín Y , Sánchez A , Borrachero C , Pujol E
Published: November 2017

In clinical records many items are handwritten and difficult to read. We examined clinical histories in a representative sample of case notes from a Spanish general hospital. Two independent observers assigned legibility scores, and a third adjudicated in case of disagreement. Defects of legibility such that the whole was unclear were present in 18 (15%) of 117 reports, and were particularly frequent in records from surgical departments.

Through poor handwriting, much information in medical records is inaccessible to auditors, to researchers, and to other clinicians involved in the patient's care. If clinicians cannot be persuaded to write legibly, the solution must be an accelerated switch to computer-based systems.
Pathologists’ Views on Consent for Autopsy
Authors: Williams A T , Morris D , Patel N K
Published: November 2017

Consent to autopsy is usually obtained by a doctor other than the one who will perform the procedure. There is an argument that, for proper informed consent, a pathologist should participate. We ascertained the views of consultant pathologists in south-east England.

53 (87%) of 61 consultants responded, of whom 50 currently do autopsies. Only 2 at present participate directly in obtaining consent, and 10 of the remaining 48 expressed willingness to do so. The general view was that consent is best obtained by a senior clinician from the team that has looked after the patient.

Pathologists see their primary role as to provide guidance to clinicians. Few see it as their function to obtain consent for autopsy.
Outpatient Clinic: Where is the Delay?
Authors: Patel H R H , Luxman C N , Bailey T S , Brunning J D M , Zemmel D , Morrell L K , Nathan M S , Miller R A
Published: November 2017

In outpatient clinics, consultation times are often eroded by extraneous activities. We measured the components of each outpatient episode in 167 patients attending a general urology follow-up clinic. 41% of time in the clinic was spent away from the patient—administration 17%, disturbances 15%, finding results 9%. The inefficiencies had changed little since a study in the same setting thirteen years earlier. Since then, parallel nurse-practitioner-run clinics have been introduced in the hope of giving consultants longer with the patient; however, time with each patient is now 4.8 min compared with a previous 7.6 min. The most easily addressed inefficiencies are those relating to missing information, such as radiology reports.
Patients’ Understanding of Anticoagulant Therapy in a Multiethnic Population
Authors: Nadar Sunil , Begum Nazneen , Kaur Bhupinder , Sandhu Sukhpreet , Lip Gregory Y H
Published: November 2017

To investigate whether knowledge and perceptions of antithrombotic therapy differ between ethnic groups in the UK, we conducted a cross-sectional questionnaire survey of patients attending anticoagulation clinics in three Birmingham teaching hospitals. 180 consecutive patients were recruited—135 white European, 29 Indo-Asian, 16 Afro-Caribbean.

The average knowledge score was 5.5 out of 9, with no significant differences between the groups. Indo-Asians were significantly less likely than the other groups to know the name of the anticoagulant they were taking (warfarin) and Afro-Caribbeans to know the condition for which they were being anticoagulated. Few patients of any group were able to specify more than one side-effect of warfarin or the dose they were on. In logistic regression analysis the factors associated with a low score were age >gT 61 years, having been born outside the UK, and the perception of difficulty in comprehension. Nearly half the Indo-Asians felt unable to understand what was said to them in the clinic, and 62% expressed a preference for a doctor of the same ethnic group.

Although there were no significant between-group differences, this study points to gaps in the knowledge of patients from ethnic minorities and to deficiencies in the provision of information. In patient education, these groups should receive special attention.
Hypothermia and Acute Pancreatitis: Myth or Reality?
Authors: Stiff Rh E , Morris-Stiff Gj , Torkington J
Published: November 2017

Among the rarer causes of acute pancreatitis listed in surgical texts is hypothermia. To assess the evidence for cause and effect, we questioned selected consultants about their experience and examined the case-notes of patients admitted with hypothermia.

The 31 consultants who returned our questionnaire (69% response rate; 317 consultant-years’ experience) could recall only 5 cases of pancreatitis associated with hypothermia, in 2 of which other aetiological factors were judged primary. In case-notes for 100 months of emergency admissions at a single hospital we identified 310 patients with hypothermia and 1153 with acute pancreatitis; none had the dual diagnosis. Of the hypothermic patients, none had abdominal pain typical of acute pancreatitis. In 43 serum amylase was measured because the patient was unable to give a full history and in 2 of these the enzyme was slightly raised; both had experienced a cerebrovascular accident, which is a known cause of hyperamylasaemia.

Considered alongside the weak evidence from previous studies, these findings offer negligible support for the idea that hypothermia is a clinically relevant risk factor for acute pancreatitis.
An Audit of Medicolegal Conferencing
Authors: Pringle R G
Published: November 2017

In the English civil justice system, experts involved in a case are now commonly required to confer before the hearing and identify the areas of agreement and disagreement. A prospective study of 50 consecutive medicolegal conferences of experts was undertaken, with a view to defining their benefits, weaknesses and the optimum conference format. A record was kept of the dates of first instruction, court deadlines, and date, time and duration of conferences, together with related calls and correspondence. The manner of preparation of the statement was noted, the level of agreement/disagreement, any compromise, any later modifications of the draft, and the author's fees. Subsequently the instructing solicitors were asked to comment on the suitability of the joint statement and its contribution to settlement.

Medicolegal conferencing is time-consuming and expensive. It may be of limited value where there is little or no difference of opinion, either between experts in a single field or between experts in different fields. The instructing solicitors must ensure that the participants receive, in advance of the conference, copies of all relevant documents including medical reports and medical records. An agenda is helpful in ensuring that matters of importance are not overlooked. Conferences are more effective when held in person than when conducted by telephone. The joint statement is best dictated in the presence of all participants during or after the conference.

To ensure the most efficient and economical use of consultant time a formal combined audit of conferencing should be undertaken by the medical and legal professions.
Swallowed Partial Dentures
Authors: Hashmi Syed , Walter John , Smith Wendy , Latis Sergios
Published: November 2017

Swallowed or inhaled partial dentures can present a diagnostic challenge. Three new cases are described, one of them near-fatal because of vascular erosion and haemorrhage. The published work points to the importance of good design and proper maintenance. The key to early recognition is awareness of the hazard by denture-wearers, carers and clinicians.
Generic Waiting Lists for Routine Spinal Surgery
Authors: Leach P , Rutherford SA , King AT , Leggate JRS
Published: November 2017

National Health Service Hospitals are under pressure to reduce waiting lists within the constraints of a limited infrastructure. We implemented two systems to reduce waiting times for elective non-complex spinal surgery. The first of these was the introduction of managed generic waiting lists for both initial outpatient appointments and subsequent surgery. Thereafter, the MRI booking system was integrated with outpatient review appointments. Times from referral to first outpatient appointment and from scan to outpatient review and time on waiting list for surgery were analysed before and after implementation of these changes.

Despite constant unit capacity there was a global decrease in waiting times. Before introduction of the generic waiting list, 37% of listed patients waited for more than 9 months; this figure fell to zero. Time from scan to outpatient review was 185 days before integration, 30 days after.

Changes of this sort demand a quorum of consultants who will accept each others’ recommendations. The generic waiting list will have impact only when there are large disparities in waiting times for different consultants. Targets are met at the expense of continuity of care.