bluuebunny/crossref_metadata_2025 huggingface dataset:
Social and Genetic Pathways in Multigenerational Transmission of Educational Attainment
Authors: Liu Hexuan
Published: March 2018

This study investigates the complex roles of the social environment and genes in the multigenerational transmission of educational attainment. Drawing on genome-wide data and educational attainment measures from the Framingham Heart Study (FHS) and the Health and Retirement Study (HRS), I conduct polygenic score analyses to examine genetic confounding in the estimation of parents’ and grandparents’ influences on their children’s and grandchildren’s educational attainment. I also examine social genetic effects (i.e., genetic effects that operate through the social environment) in the transmission of educational attainment across three generations. Two-generation analyses produce three important findings. First, about one-fifth of the parent-child association in education reflects genetic inheritance. Second, up to half of the association between parents’ polygenic scores and children’s education is mediated by parents’ education. Third, about one-third of the association between children’s polygenic scores and their educational attainment is attributable to parents’ genotypes and education. Three-generation analyses suggest that genetic confounding on the estimate of the direct effect of grandparents’ education on grandchildren’s education (net of parents’ education) may be inconsequential, and I find no evidence that grandparents’ genotypes significantly influence grandchildren’s education through non-biological pathways. The three-generation results are suggestive, and the results may change when different samples are used.
Implementation of the Procalcitonin Assay in a Rural Hospital
Authors: Cole Jennifer L.
Published: March 2018

Objective: Most positive studies in procalcitonin (PCT) utilization were done in large, tertiary medical centers. Furthermore, there is a paucity of data describing the implementation process. This article is the first to describe in detail the implementation process and initial outcomes after 6 months of PCT testing in a rural, 65-bed, primary hospital. Methods: Education before and during PCT implementation as well as facility rollout are described. Initial outcomes were assessed using a before and after quasi-experimental study design comparing 2 identical 6-month time periods: May to October 2016 and May to October 2017. Antibiotic consumption is described with days of therapy (DOT) per 1000 patient days (PD). Antimicrobial purchasing costs, admission rates, and length of stay (LOS) are also compared. Results: Antimicrobial consumption was variable with the greatest reduction at 6 months: 856 DOT/1000 PD before versus 576 DOT/1000 PD after ( P < .0001). Admission rates and LOS were unaffected. There was no associated savings in antibiotic purchasing costs: $114 189.79 before and $139 829.26 after (difference +$25 639.47). Conclusion: Although implementation of PCT testing is feasible in a rural health care facility, after 6 months, it was associated with a marginal decrease in antibiotic consumption with no decrease in admission rates, LOS, or antibiotic cost savings.
Realizing Entrepreneurship in K–12 Music Education: Inside or Outside the Box?
Authors: Hanson Josef
Published: March 2018

Although “entrepreneurship” has become a movement in arts career preparation programs, its application for school-based music educators remains unclear. This article suggests that intrapreneuring—entrepreneurial practice within large organizations—better encapsulates the balance of innovation and affiliation that teachers often pursue to enhance their motivation at work. Results from a survey of K–12 music educators suggest that intrapreneurial mindsets and behaviors predict higher fulfillment of teachers’ needs for autonomy, competence, and relatedness—all elements crucial to healthy motivation. For many music educators, intrapreneuring may serve as an ideal pathway to increased motivation, career longevity, and a broader teacher-driven approach to education reform.
Critical Listening in the Ensemble Rehearsal: A Community of Learners
Authors: Bell Cindy L.
Published: March 2018

This article explores a strategy for engaging ensemble members in critical listening analysis of performances and presents opportunities for improving ensemble sound through rigorous dialogue, reflection, and attentive rehearsing. Critical listening asks ensemble members to draw on individual playing experience and knowledge to describe what they hear. Focused discussion revolves around key issues that music directors consider during daily rehearsals: tonal quality, balance, blend, articulation, accuracy of performance, interpretation, musicality, and much more. An important component of critical listening is teacher monitoring of repeated listening exercises: A short listening is immediately followed by discussion and then another short listening. Questions guide the discussion, which becomes richer and more focused as students compare/apply their musical understandings with their aural perceptions and then demonstrate with performance. Though written from the standpoint of a typical public school music ensemble rehearsal, the critical listening concepts can transfer to any musical tradition where listening skills and collective performance are emphasized.
Study on modeling simulation and optimal control method for the transmission risk of the Ebola virus
Authors: Liu Shihao
Published: March 2018

In order to prevent and control the transmission risk of the Ebola virus, an Ebola virus disease SEIQR model was built. The free-Ebola-virus-disease equilibrium state and the Ebola-virus-disease equilibrium state of the SEIQR model are asymptotically stable. On the basis of the SEIQR model, the numerical simulation was formulated. From the simulation curves, it is found that if the production speed of the medicine cannot keep pace with demand, the transmission risk of Ebola will become out of control. Assuming that the medicine demand point and the medicine supply point constitute a logistics system in a certain planar range, the center-of-gravity method was used to obtain the optimal location for medicine delivery. By using this discrete-time virus model’s optimal control rate to control the serious transmission risk of Ebola virus in the crowd, the effective strategy for transmission was added to the model, and then the control sheet was obtained. From the simulation results on the basis of the SEIQR model, it is concluded that the theory of the optimal control rate has a negative effect on the transmission risk of Ebola.
Genital Flora during Pregnancy and Colonization of the Newborn
Authors: Ross Jean M , Needham J R
Published: March 2018

A longitudinal study of the cervical and vaginal microflora of 131 pregnant women showed a similar range of organisms at first visit (up to 16 weeks), at 28 weeks and at 36 weeks of pregnancy. Twenty different groups or genera of microorganisms were recovered, predominantly lactobacilli. There was a fall in the isolation rate of organisms in the mothers 6 to 8 weeks after delivery. Lactobacilli and yeasts including Candida albicans were recovered less frequently whereas the incidence of Escherichia coli and group B streptococci increased.

Infants bom to these mothers were swabbed within 24 hours of delivery and yielded organisms from the umbilicus, ear and mouth in 24%, 33% and 38% of cases respectively. Alpha haemolytic streptococci and Staphylococcus aureus were the predominant organisms. Sixteen different groups or genera were isolated.

The isolation rates in non-pregnant women attending a ‘well-women’ clinic were similar to those in the postnatal mothers; few women of 60 years or more were colonized.
Functional Evaluation of the Rectal Ampulla with Ampullometrogram
Authors: Bubrick Melvin P , Godec Ciril J , Cass Alexander S
Published: March 2018

An ampullometrogram (AMG) was done in 20 patients to evaluate the rectal ampulla as a functional unit. Results were compared to a cystometrogram (CMG). The AMG displayed a normal curve (capacity 230 to 330 ml; pressure 47 to 80 cmH2O) in 14 of 16 patients having a normal CMG. The AMG was hyporeflexic (variable capacity; no increase in pressure at capacity) in 3 of 5 patients having a hyporeflexic CMG and hyperreflexic (capacity less than 175 ml, pressure over 80 cmH2O) in one patient having a hyperreflexic CMG. This technique might represent a useful clinical adjunct in the evaluation of bladder dysfunction, the evaluation of neurogenic type bowel dysfunction, and in the possible use of functional electrical stimulation for treatment of faecal incontinence or constipation.
Prolonged Incubation Period of Imported P. Vivax Malaria in London1
Authors: Warwick Ruth , Swimer G J , Britt R P
Published: March 2018

Between January 1976 and July 1979, 453 cases of malaria were seen at Hillingdon Hospital. The majority of cases were Plasmodium vivax infections in Asians from the Punjab in Northern India–either new immigrants or United Kingdom resident Asians returning from holidays. Twenty-four cases were contracted in Africa or the Middle East. Figures are presented showing a considerable increase in cases during the period of study. In P. vivax infections the time interval between arrival and development of the acute illness was significantly greater for those subjects entering the United Kingdom in autumn or winter.
Clinical Pharmacology and General Patient Care in Two Teaching Hospitals1
Authors: Wood Susan M , Turner Paul , Vere Duncan
Published: March 2018

The clinical responsibilities and activities over 12-month periods of the Departments of Clinical Pharmacology of two London teaching hospitals have been analysed. The results suggest that clinical pharmacology should not be regarded only as an academic specialty but that it has an important role in patient care.
Antibodies against Defined Nerve Cell Components: Gangliosides
Authors: Gregson N A , Hammer C T
Published: March 2018

Antisera have been raised in rabbits against the purified brain gangliosides GM1, GD1a and GT1b. The reactivity of these sera with a range of purified gangliosides has been examined by complement fixation and their specificities partially defined by absorptions with purified gangliosides.
Long-Term Ingestion of Paracetamol and Liver Disease1
Authors: Neuberger James , Davis M , Williams Roger
Published: March 2018

Of 45 patients with chronic active hepatitis, 17 had taken paracetamol before the onset of symptoms. There were no significant differences, however, between the two groups in abnormalities of liver function tests, nor in ease of control after paracetamol withdrawal and institution of immunosuppressive therapy. The patient who had taken more than 5 g/week was studied in greater detail, but after a challenge dose of 1 g paracetamol there was no rise in serum aminotransferases and the pattern of excretion of paracetamol metabolites was normal. A critical review of the previously published reports failed to uncover any convincing evidence that paracetamol is an initiating factor in the development of chronic active hepatitis, although it may, at therapeutic levels, cause a toxic hepatitis in those individuals at risk.
Familial Pseudohypoparathyroidism Presenting in Adult Life1
Authors: Hamilton D V
Published: March 2018

Three members of one family who presented in adult life with pseudohypoparathyroidism are reported. The importance of screening members of the family of patients with pseudohypoparathyroidism is stressed. Higher doses of 1α-hydroxycholecalciferol are required than in idiopathic or surgical hypoparathyroidism or in chronic renal failure.
Use and Misuse of an Accident and Emergency Department in the East End of London
Authors: Davison Anthony G , Hildrey A C C , Floyer M A
Published: March 2018

A study was made of all 587 new patients attending an accident and emergency department in the East End of London during one week. Two hundred and twenty-six (39%) cases were not accidents or emergencies; of these, 67% were self-referrals who had not previously seen their general practitioner (GP) and 21% were self-referrals who had previously seen their GP. The four main reasons that these self-referred patients had for attending were that they thought their condition needed immediate attention; they were insufficiently organized to see their GP; they were not registered with a GP; or they wanted a second opinion. Twenty-eight (12%) of the cases which were not accidents or emergencies were referred by a GP.

Sixty-nine (12%) of all cases were not registered with a GP. The frequency of cases who, were not accidents or emergencies was significantly higher in those not registered than in those registered (0.01 ≥ p ≥ 0.001). Nineteen (3%) patients were living rough or in hostels. Little abuse of the ambulance service was found.
Effect of Experimental Hypothyroidism on Hearing in Adult Guinea Pigs
Authors: Stearns M , Goodwin P
Published: March 2018

A group of guinea pigs was rendered hypothyroid using propylthiouracil solution in their drinking water. The animals were hypothyroid for at least 120 days. During this time no change was noted in their hearing thresholds for high-frequency clicks. The audiometric evaluation was performed using brainstem evoked response audiometry.
Growth impairment in children with atopic eczema
Authors: Kristmundsdottir F , David T J
Published: March 2018

Growth was studied in 89 children with atopic eczema aged 1–16 years. Nine (10%) had a standing height below the 3rd centile. Both boys and girls had significantly reduced sitting height but normal subischial leg length, and both sexes had significantly delayed skeletal maturity scores. Impaired growth was particularly associated with widespread eczema, but also with the presence of asthma and the potency of topical corticosteroid. Six of the 15 patients with a corrected height centile below the 10th centile had been receiving potent (British National Formulary category I or II) topical corticosteroids. This study suggests that impaired linear growth is a feature of atopic eczema. While the causes of the growth impairment are unclear, there is a need for caution in the use of potent topical corticosteroids in children.
Preoperative staging of local invasion in rectal cancer using endoluminal ultrasound
Authors: Beynon J , Roe A M , Foy D M A , Lchanner J , Virjee J , Mortensen N J McC
Published: March 2018

Digital examination is the most commonly used method of assessing local invasion in rectal cancer, but it is highly subjective and accuracy is related to surgical experience. The use of transrectal ultrasound in the preoperative staging of rectal cancer has been assessed in 51 patients with histologically proven rectal cancers. Results showed a high degree of correlation when compared with postoperative histopathology (r = 0.91, P < 0.001). Invasion beyond the muscularis propria was predicted with a sensitivity of 97%. specificity of 92% and predictive value of 97%.
Effects of Carotid Compression, as Assessed by near Infrared Spectroscopy, upon Cerebral Blood Volume and Haemoglobin Oxygen Saturation
Authors: Ferrari M , Zanette E , Sideri G , Giannini I , Fieschi C , Carpi A
Published: March 2018

Near infrared spectroscopy, a recently developed optoelectronic technique, has been studied as a possible method of monitoring the adequacy of cerebral perfusion in 22 patients who were candidates for carotid endarterectomy. Using this technique, changes in haemoglobin volume, haemoglobin oxygen saturation and redox level of cytochrome-coxidase were recorded from the frontoparietal region during routine carotid compression tests performed under continuous electroencephalographic (EEG) monitoring. A highly significant association was found between EEG slowing, indicating impaired cerebral function, and a fall in haemoglobin volume and oxygen saturation, indicating a reduced blood and oxygen supply to the brain (Fisher exact test, P < 10−5). In a few tests haemoglobin volume and oxygen saturation were reduced without changes in the EEG recording.

This study raises new issues concerning the compensatory mechanisms taking place during carotid occlusion and suggests that near infrared spectroscopy might be useful in monitoring the blood and oxygen supply to the brain during carotid endarterectomy.
Small Bowel Obstruction: A Review of 456 Cases in a West of Ireland Region
Authors: Cross K S H , Johnston J G
Published: March 2018

A retrospective study was carried out of 456 patients with small bowel obstruction (SBO). The operative findings of all patients who presented with SBO between 1977 and 1982 were compared and contrasted with those who presented during equivalent periods in the previous three decades. Obstructed hernias still account for the highest percentage of cases. Surprisingly, adhesions as a causative factor are not significantly more common than they were three decades ago, despite the enormous increase in the frequency with which abdominal surgery is now being carried out. The postoperative mortality rate for the period 1977–82 was 14%.
Indices of Disease Activity in Psoriatic Arthritis
Authors: Daunt A O'N , Cox N L , Robertson J C , Cawley M I D
Published: March 2018

Psoriatic arthritis (PA) may respond to disease-modifying antirheumatic therapy. The value of assessing disease activity with indices devised for rheumatoid arthritis (RA) was investigated in 72 patients with seronegative PA. Thirty patients had a peripheral polyarthritis including the distal inter-phalangeal joints (DIPJs) and 15 a symmetrical arthritis sparing DIPJs (RA-like). Significant correlations (Spearman rank test) were seen between the clinical variables (pain score, grip strength, Ritchie articular index and a summated index of disease activity) in these two groups. Ten patients with a markedly asymmetrical arthritis showed a poor correlation between clinical variables. Although the objective indices – erythrocyte sedimentation rate (ESR) and C-reactive protein – correlated together in the first two groups, the ESR correlated solely with clinical indices, and then only in RA-like patients.

These results cast some doubt on the value of assessment methods based on RA when evaluating subgroups of PA other than RA-like disease.
Regulation of Cell Growth
Authors: Barrett A J
Published: March 2018

At this meeting of the RSM's Section of Pathology, the regulation of haemopoietic stem cells and growth factors regulating various cell lines were described, and the role of oncogenes, platelet-derived growth factor and nerve growth factor in growth regulation was discussed.
Effects of Danazol on Mineral Homeostasis in Normal Postmenopausal Women: Preliminary Communication
Authors: Purdie D W , Hay A , Abbas S K
Published: March 2018

The effects of danazol on calcium homeostasis in normal postmenopausal women was examined in a 14-day study utilizing a dosage of 800 mg per day. Danazol caused significant falls in plasma ionized calcium and in the fasting urinary calcium/creatinine ratio, indicating inhibition of bone resorption. Retention of phosphate was also observed as expected with this anabolic agent. The plasma total alkaline phosphatase was also depressed by the drug, which had no effect on hepatocellular function as measured by plasma AST. Certain effects induced by treatment with danazol were still apparent two weeks after cessation of treatment. The drug was well tolerated and androgenic side effects were not seen. It is suggested that the minimal dose regimen of danazol which exerts a calcium-sharing effect should be identified, and that this regimen should be considered for use in a prospective study of the effects of danazol on bone mineral content in the postmenopause.
Chronic Muscle Contraction Headache: The Importance of Depression and Anxiety
Authors: Hackett G I , Boddie H G , Harrison P
Published: March 2018

Seventy consecutive patients presenting with a clinical diagnosis of chronic muscle contraction headache over a two-year period were evaluated for depression and anxiety scores, along with other possible aetiological factors in this form of headache. Fifty-five of these patients (33 from a hospital neurology clinic and 22 from a local general practice) completed a double-blind study to evaluate flupenthixol 0.5 mg twice daily, diazepam 5 mg twice daily and placebo as prophylactic agents.

Patients evaluated in the hospital neurology clinic had more frequent headaches of longer duration, higher analgesic consumption and higher depression, but no higher anxiety scores than those in general practice. Flupenthixol and diazepam were both significantly superior to placebo in reducing headaches and analgesic consumption. The trend was for flupenthixol to be superior to diazepam without reaching statistical significance. Flupenthixol was significantly better than diazepam and placebo in the reduction of Hamilton depression scores. This effect was independent of the effect on headache and analgesic reduction.
Gastrointestinal Disease Amongst Polish Migrants in Nottingham
Authors: Lichtarowicz A M , Mayberry J F
Published: March 2018

The main Polish migrations to Britain were in the 1940s and many families have retained a traditional diet. People of Polish origin living in Nottingham were interviewed and the frequency of gastrointestinal disease assessed. Gallstones were less common in English people and Polish migrants than in Poland. Appendicitis and haemorrhoids were commoner in Polish migrants that amongst people in Poland.
What Time of Day Should a Urethral Catheter be Removed?
Authors: Wyman A
Published: March 2018

Patients who had undergone bladder neck surgery were randomized to having their urethral catheters removed either early in the morning or late at night. There was no difference in the incidence of urinary retention between these two groups of patients. However, patients who presented with acute urinary retention had a higher incidence of postoperative urinary retention. This study suggests that a urethral catheter may be safely removed in the evening without increasing the risk of urinary retention. There also seems to be no greater chance of the patient having to be recatheterized at an unsocial hour.
Cholecystectomy: Safe or Not Safe to Drain?
Authors: Mellor S G , Thomas M H , Donnellan B S
Published: March 2018

The aim of this study was to determine whether drains influenced the size of subhepatic collections following cholecystectomy, and if these had any affect on complications.

Eighty-five patients undergoing cholecystectomy had either no drain, a narrow bore suction drain or an open corrugated drain. Subhepatic fluid collections were measured by real time ultrasound on the first and fifth postoperative days, and thereafter if necessary. The volumes of fluid drained were also measured and clinical complications recorded. The subhepatic collections were, on average, the same whether a drain was used or not. Drains produced volumes considerably in excess of any subhepatic collection measured, but they did not appear to warn of biliary leakage. More complications (28%) were seen in the drained group compared with the undrained group (10.5%), and furthermore, the complications did not seem to occur in relation to the larger collections. One patient who had had a corrugated drain correctly placed developed biliary peritonitis.

We suggest that drainage of simple cholecystectomy is unnecessary and, if an open drain is used, potentially dangerous.
Fireworks and the Eye
Authors: Vernon S A
Published: March 2018

A prospective study involving all casualty departments in Trent Region and 81% of the major eye units in UK was performed to determine ocular morbidity from the use of fireworks during 1986. A serious injury was defined as involving admission to hospital and/or intraocular damage. Of all the injuries from fireworks, 16.7% seen at major eye units were serious and were caused by rockets or exploding fireworks ( P< 0.001). Only 53% of all injuries and 12.5% of serious injuries involved children, and in contrast to the 1950s and early 1960s, young adults appear at greatest risk in the 1980s. Legislation to reduce ocular morbidity should concentrate on restricting the use of rockets and exploding fireworks and encouraging the use of suitable eye protection.
Early Experience with Gamete Intrafallopian Transfer (GIFT) and Direct Intraperitoneal Insemination (DIPI)
Authors: Dooley M , Lim-Howe D , Savvas M , Studd J W W
Published: March 2018

We present our early experience with gamete intrafallopian transfer (GIFT) and direct intraperitoneal insemination (DIPI) combined with intrauterine insemination (IUI), two recently described methods of assisting conception in patients with patent fallopian tubes. Sixty-nine patients (93 cycles) were entered into the study. Thirty-three patients (51 cycles) entered the DIPI/IUI programme and 36 patients (42 cycles) entered the GIFT programme. The mean age, duration and aetiology of infertility were similar in both groups. In the GIFT programme 12 pregnancies occurred, which is a 29% pregnancy rate per cycle and a 33% pregnancy rate per patient. In the DIPI/IUI programme only 3 pregnancies occurred, being a 6% pregnancy rate per cycle and a 9% pregnancy rate per patient. With the live birth rate of in vitro fertilization (TVF) being 12% per embryo transfer, we conclude that GIFT is more successful than either DIPI/IUI or IVF in patients with patent fallopian tubes. Further controlled studies are required to assess the future role of DIPI/IUI in clinical practice.
Light and Length of Stay in Hospital
Authors: Diffey B L , Storey A
Published: March 2018

A study was carried out to examine whether the time spent as an inpatient in hospital showed a seasonal dependence which could be attributed to differences in ambient lighting levels between summer and winter. It was found that the season of admission to hospital did not make any appreciable difference to how long patients took to recover before they were discharged.
Abdominal Lymphoma - the Place for Surgery
Authors: Baildam A D , Williams G T , Schofield P F
Published: March 2018

Gastrointestinal lymphoma (GIL) is rare but may be cured by surgery and chemotherapy. Because symptoms frequently mimic common abdominal conditions, presentation is often to a surgeon. Fiftyfive patients with GIL were treated between 1975 and 1984: all underwent operations before the correct diagnosis was made, 22 (40%) as emergencies. Misdiagnosis in 23 (42%) led to a delay in correct treatment of ≥ 6 months from the start of symptoms: in 17 (31%) the delay was ≥ one year. Endoscopy and radiology were inaccurate and suggested peptic ulceration, Crohn's disease or irritable bowel syndrome. The site of disease was usually stomach and duodenum (26, 47%) or ileum and jejunum (29, 53%). The extent of surgical resection was associated with survival at ≥3 years - in 16 (29%) who underwent ‘complete resection’ 14 survived, but only one of 28 survived when the operation was limited to diagnostic biopsy (P < 0.0001). Most deaths occurred within one year of operation, commonlyfrom perforation or haematemesis from residual mural disease during chemotherapy. In 5 of 11 patients who had biopsy only, CT scans suggested localized disease, and ‘complete resection’ was achieved at a second laparotomy. Complete resection should be attempted wherever possible before chemotherapy. The place for surgeons with experience is clearly central to the management of this disease.
Is a Drain Necessary after Colonic Anastomosis?
Authors: Johnso C D , Lamont P M , Orr N , Lennox M
Published: March 2018

To date, there have been no clinical investigations of the usefulness of drains following colonic anastomosis in elective operations. We report a prospective study in which 49 patients were randomized to have a corrugated silastic drain (Portex) placed next to the colonic anastomosis. These patients were compared with a control group of 57 patients who had no drain. The two groups were similar in age, sex, diagnosis and site of anastomosis. There was no difference in outcome between the two groups. Anastomotic leakage occurred in six patients in each group. Wound infections were noted in 10 patients in each group. Two patients with a drain and one patient without a drain died from leakage at the anastomosis. This study provides no evidence to support the use of a corrugated drain after anastomosis of the colon.
The Family and Disability - Some Reflections on Culture: Discussion Paper
Authors: Frank A O
Published: March 2018

Severe congenital impairments in one child will affect the whole family, possibly for a generation if the child remains at home as an adult. Disability acquired in adult life will affect both partners as roles are gained or relinquished. For children this may result in a loss of parenting. The adjustment process to any psychological or personality changes may be very painful, particularly if children have no one outside the family to provide informed support. Acquired illness or disability in children may have enormous consequences for siblings, the health of the parents and the whole fabric of family life, often resulting in family isolation.

In some Asian families, the feeling that the extended family unit is self sufficient and able to provide care may conflict with the ideal of increasing independence fostered by the professionals, and limit the possibility of support from social workers or psychologists. The extended family may reduce the need for statutory support. The expectation that care will be provided to old people by their daughters or daughters-in-law may be frustrated if the younger generation of women are disabled or otherwise engaged, resulting in possible family strife or rejection.
Pitfalls in the Management of Acute Adrenocortical Insufficiency: Discussion Paper
Authors: Waise A , Young R J
Published: March 2018

In patients with acute adrenocortical insufficiency prompt recognition and treatment may be life-saving. Treatment should be initiated immediately before confirmation of the diagnosis. As shown by these case reports, junior staff on acute medical and surgical services, to whom these patients usually first present, may not appreciate that (a) hyponatraemia and hyperkalaemia, in the absence of renal failure, should immediately suggest the diagnosis of adrenal insufficiency and (b) treatment should precede confirmation of the diagnosis. Attempts to correct hyperkalaemia due to adrenocortical insufficiency with insulin and infusions of dextrose is inappropriate and potentially dangerous but seems to be a not unusual mistake.
Skin Damage in Chronic Venous Insufficiency: Does an Oxygen Diffusion Barrier Really Exist?
Authors: Cheatle T R , McMullin G M , Farrah J , Coleridge Smith P D , Scurr J H
Published: March 2018

Eleven patients with lipodermatosclerosis (LDS) and 14 patients without venous or arterial disease underwent measurement of xenon-133 (133Xe) half-clearance times from the gaiter region of the leg. Xenon has similar diffusion characteristics to oxygen, and the investigation reflects the ability of the isotope to diffuse from the skin surface into capillary blood. Median skin half-clearance time for skin in the LDS group was 2.2 min and in the control group 2.1 min. From the subcutaneous tissues, the respective times were 14.1 and 17.4 minutes. These differences are not statistically significant. The study fails to yield evidence suggesting that an oxygen diffusion barrier exists in lipodermatosclerosis.
Relationship between Longevity and Lifeline: A Manual Study of 100 Patients
Authors: Newrick P G , Affie E , Corrall R J M
Published: March 2018

The relationship between length of lifeline and age at death has been evaluated in 100 consecutive autopsies. A highly significant association between the two was discovered which was strengthened further when hand size was controlled for. We feel that a powerful new prognostic sign may thus be within grasp.
A Fatal Trip with Ecstasy: A Case of 3,4-Methylene-Dioxymethamphetamine/ 3,4-Methylenedioxy-Amphetamine Toxicity
Authors: Coore J R
Published: March 2018

Since the late 1980s there have been a number of reports about the complications associated with using the designer drug 3,4-methylenedioxymeth-amphetamine (MDMA) or ‘ecstasy’1-3. Although this drug has been widely abused in the past, the potentially fatal complications have arisen recently mainly due to the circumstances of its use at all-night dance sessions or ‘raves’. A combination of direct toxicity and strenuous physical exertion can lead to hyperthermia and its attendant complications. The following case illustrates some of the possible consequences following ingestion of ‘ecstasy’, and reiterates the importance of prompt recognition and treatment in preventing the development of irreversible sequelae.
Informed Consent in Indian Patients
Authors: Sanwal A K , Kumar S , Sahni P , Nundy S
Published: March 2018

It is commonly believed that patients in India do not need to be told about their operations as they are unable to understand the complexities and forget the salient facts soon afterwards. Obtaining informed consent is therefore considered to be an unnecessary ritual.

We studied 100 consecutive patients undergoing elective major abdominal operations and asked them 5 days after their operations to recall certain details about the procedure which had been explained to them preoperatively.

Seventy per cent of the patients recalled the relevant data. The ability was the same in males and females (67% and 69%) but the older, less educated and poorer patients performed worse than the others. Ninety-eight per cent of the patients appreciated being given the information as it reduced their anxiety about the operation.

Indian patients are able to comprehend and should be informed about the details of their operation. Particular care should be taken during explanation to the old, poor and illiterate. In these informed consent should be a continuous process rather than a single event and the information should also be given to a younger and more educated relative.
Schizophrenia in Afro-Caribbean Immigrants
Authors: Callan A F
Published: March 2018

Hospital admission rates for schizophrenia are higher in Afro-Caribbean immigrants to Britain than in the white British-born population. However, the reported differences in incidence and prevalence could be due to confounding variables: the diagnosis of schizophrenia might not carry the same prognostic implications in the two groups; and the differences in formal admission rates might not persist when demographic and diagnostic differences are allowed for.

The case-notes of 50 Afro-Caribbean immigrants and 41 British-born white patients with a hospital diagnosis of schizophrenia were examined retrospectively, the average period covered being 12 years. There were no differences in the number of readmissions, but in the Afro-Caribbean group readmissions were shorter. Involuntary admissions were twice as common in Afro-Caribbeans and this excess was not explained by differences in age, sex, or type of illness.

The reported excess of schizophrenia in Afro-Caribbean immigrants to Britain is real, but the illness seems to run a milder course than in the white British-born population.
Shifting Boundaries in Professional Care
Authors: Hopkins Anthony , Solomon Juliet , Abelson Julia
Published: March 2018

The nature of the work undertaken by different health professionals and inter-professional boundaries are constantly shifting. The greater knowledge of users of health care, and the increasing technical and organizational complexity of modern medicine, have partly eroded the control of health professionals over the substance of their work. The definition of a field of work as lying within the province of any one profession is culturally rather than scientifically determined.

It is evident that care of good quality should be delivered at the lowest possible cost. This might include delivery of care by a less trained person than heretofore, or by someone with limited but focused training. Sharing of skills is a more sensible subject for discussion than transfer of tasks. We review a number of studies which show the effectiveness of inter-professional substitution in various care settings, and also the effectiveness of substitution by those other than health professionals. The views of users of health services on inter-professional substitution need to be considered. Health professionals and others need to work together to devise innovative ways of delivering effective health care. The legal issues need clarification.
Resection and Primary Anastomosis in Necrotizing Enterocolitis
Authors: Ade-Ajayi Niyi , Kiely Edward , Drake David , Wheeler Rob , Spitz Lewis
Published: March 2018

Necrotizing enterocolitis (NEC) is the most common surgical emergency in the newborn. Up to half of babies with NEC develop advanced disease requiring surgical intervention. Options include peritoneal drainage under local anaesthetic, enterostomy only, resection and enterostomies, and resection with primary anastomosis. Resection with enterostomies is favoured by many paediatric surgeons but management of neonatal enterostomies can be difficult. The outcome of 26 infants undergoing surgery for advanced NEC over a 2-year period is reviewed.

Resection and primary anastomosis was possible in 18 infants of whom two (11%) died. Recurrent NEC developed in four (22%) and strictures in three (17%) of these infants. An initial enterostomy was fashioned in eight infants, three following resection of necrotic intestine and five as a proximal diverting stoma in infants with pan-intestinal involvement. Five of these eight infants died (63%), giving an overall mortality of 27%.

Primary anastomosis is an effective procedure following resection of grossly involved intestine in infants with NEC. The mortality and morbidity in this series compared well with those reported for staged procedures.
A Sense of Proportion: The Place of Psychiatry in Medicine
Authors: Lloyd G G
Published: March 2018

Psychiatric disorders have a high prevalence in medical and surgical patients and the need for an effective liaison psychiatry service is widely accepted. However, the development of liaison psychiatry may be jeopardised by the trend towards establishing psychiatric facilities in the community rather than in hospitals. Alternative methods of funding may need to be established if the future of liaison psychiatry is to be safeguarded.
More Than Just Play: Unmasking Black Child Labor in the Athletic Industrial Complex
Authors: Runstedtler Theresa
Published: March 2018

African Americans’ hypervisibility in sports remains a frequent point of critique. There has been a tendency to blame Black youths for their supposed “sports fixation.” Complicating this narrative of cultural pathology, I examine the foundational importance of Black boys’ athletic labor to the profitability of the sporting industries. I first trace the structural conditions (imperialism, racism, industrial capitalism) that contributed to the hypervisibility of young Black boxers at the turn of the 20th century. I then explore the contemporary conditions driving Black hypervisibility in basketball. Analyzing Hoop Dreams (1994) alongside the aggressive tactics of corporations such as Nike, the National Collegiate Athletic Association (NCAA), and the National Basketball Association (NBA) to recruit talent at younger and younger ages, I illustrate that Black boys are performing a kind of child labor. Similar to Black boxers from a century before, Black youths’ focus on achieving success in basketball is not just a simple matter individual “choice.” It is also symptomatic of their continued political, social, and economic marginalization in the postindustrial, neoliberal United States, which sports companies capitalize on.
Design and evaluation of the psychometric properties of a self-questionnaire on patient adherence to wearing elastic compression stockings
Authors: Allaert François-André , Rastel Didier , Graissaguel Anne , Sion Delphine , Hamel-Desnos Claudine
Published: March 2018

Background

Patients’ adherence to elastic compression stockings is difficult to evaluate, and therefore we create a short self-questionnaire and validate its psychometric properties.

Methods

We reduce the questions with Varimed rotation analysis, evaluate its internal consistency using Cronbach’s alpha test and its external validity by comparison to electronic thermic captors. Receiver operating characteristic (ROC) analysis was used to determine a threshold and determine its sensitivity and specificity.

Results

The initial questionnaire was reduced from 22 to 5 questions rated from 0 to 4. The internal consistency and its external validity are good, and the ROC analysis shows that values > 3 correspond to poor compliance with a sensitivity of 88.1% and a specificity of 63.1%.

Conclusion

The adherence score is valid for the detection of patients poorly compliant to the wearing of elastic compression. Its small number of questions makes it a suitable for a screening in everyday practice.
Palliative care for people with advanced liver disease: A feasibility trial of a supportive care liver nurse specialist
Authors: Kimbell Barbara , Murray Scott A , Byrne Heidi , Baird Andrea , Hayes Peter C , MacGilchrist Alastair , Finucane Anne , Brookes Young Patricia , O’Carroll Ronan E , Weir Christopher J , Kendall Marilyn , Boyd Kirsty
Published: March 2018

Background:

Liver disease is an increasing cause of death worldwide but palliative care is largely absent for these patients.

Aim:

We conducted a feasibility trial of a complex intervention delivered by a supportive care liver nurse specialist to improve care coordination, anticipatory care planning and quality of life for people with advanced liver disease and their carers.

Design:

Patients received a 6-month intervention (alongside usual care) from a specially trained liver nurse specialist. The nurse supported patients/carers to live as well as possible with the condition and acted as a resource to facilitate care by community professionals. A mixed-method evaluation was conducted. Case note analysis and questionnaires examined resource use, care planning processes and quality-of-life outcomes over time. Interviews with patients, carers and professionals explored acceptability, effectiveness, feasibility and the intervention.

Setting/participants:

Patients with advanced liver disease who had an unplanned hospital admission with decompensated cirrhosis were recruited from an inpatient liver unit. The intervention was delivered to patients once they had returned home.

Results:

We recruited 47 patients, 27 family carers and 13 case-linked professionals. The intervention was acceptable to all participants. They welcomed access to additional expert advice, support and continuity of care. The intervention greatly increased the number of electronic summary care plans shared by primary care and hospitals. The Palliative care Outcome Scale and EuroQol-5D-5L questionnaire were suitable outcome measurement tools.

Conclusion:

This nurse-led intervention proved acceptable and feasible. We have refined the recruitment processes and outcome measures for a future randomised controlled trial.
Sound analysis of a left ventricular assist device: A technical evaluation of iOS devices
Authors: Sundbom Per , Roth Michael , Granfeldt Hans , Karlsson Daniel M , Ahn Henrik , Gustafsson Fredrik , Hubbert Laila
Published: March 2018

Introduction:

The use of left ventricular assist device (LVAD) has grown rapidly. Adverse events do continue to occur. In recent years, analysis of LVAD sound recordings emerged as a means to monitor pump function and detect pump thrombosis. The aim of this study was to characterize the sounds from HeartMate II and to evaluate the use of handheld iOS devices for sound recordings.

Method:

Signal analysis of LVAD sound recordings, with dedicated recording equipment and iOS devices, was performed. Two LVADs running in mock loop circuits were compared to an implanted LVAD. Spectral analysis and parametric signal models were explored to quantify the sound and potentially detect changes in it.

Results:

The sound recordings of two LVADs in individual mock loop circuits and a third one implanted in a patient appeared to be similar. Qualitatively, sound characteristics were preserved following changes in pump speed. Recordings using dedicated equipment showed that HeartMate II sound comprises low-frequency components corresponding to pump impeller rotation, as well as high-frequency components due to a pulse width modulation of the electric power to the pump. These different signal components interact and result in a complicated frequency spectrum. The iPhone and iPod recordings could not reproduce the sounds as well as the dedicated equipment. In particular, lower frequencies were affected by outside disturbances.

Discussion:

This article outlines a systematic approach to LVAD sound analysis using signal processing methods to quantify and potentially detect changes, and describes some of the challenges, for example, with the use of inexpensive recording devices.
Lead induced oxidative DNA damage in battery-recycling child workers from Bangladesh
Authors: Arif Mohammad , Islam MM Towhidul , Shekhar Hossain Uddin
Published: March 2018

Lead exposure can damage cells directly by effecting DNA or indirectly by modifying proteins and enzymes. In Bangladesh, many working children are exposed to a very high level of lead during their early life due to their involvement with lead-oriented professions. This imposes a severe threat to the growth and development of the children. Therefore to study the effect of lead, we enrolled 60 age-matched male children, from an area of old Dhaka city, where battery-recycling shops are located, depending on their blood lead concentration. If the children had a plasma lead concentration above the WHO recommended threshold level of 10 µg/dl, we grouped them as test subjects and others as control subjects to determine the effect of lead on different biochemical parameters of the body. Compared to the controls, acculumlation of the lipid peroxidation product, malondialdehyde, increased significantly in test subjects ( p < 0.01). Lead exposure also increased the protein carbonyl content ( p < 0.05) and significantly decreased the plasma glutathione levels of test subjects compared to the controls ( p < 0.05). While comparing the lead-exposed group against controls, it was found that the percentage of damaged DNA, as measured using the Comet assay, significantly increased in tail ( p < 0.01) and decreased in head regions. All of these results suggest that high-plasma lead content may induce an oxidative stress to the study population, which may lead to DNA damage.