bluuebunny/crossref_metadata_2025 huggingface dataset:
Ossification in Abdominal Scars1
Authors: Eke Ndu , Warrington Alexander J
Published: February 2018

Three cases of heterotopic ossification in abdominal scars are presented. The aetiology and pathogenesis of this condition are discussed with reference to the literature. Awareness of its occurrence will prevent anxiety and unnecessary investigations. When symptomatic, the treatment is local excision with or without local irradiation.
Composite Hyoid-Sternohyoid Graft in the Correction of Established Subglottic Stenosis
Authors: Freeland A P
Published: February 2018

A new technique for the treatment of subglottic stenosis is reported. A composite hyoid bone with sternohyoid muscle graft is used to replace the anterior arch of the cricoid, combined with a vertical split of the posterior lamina of the cricoid. Internal splinting is maintained with a Silastic mould. Ten patients with established subglottic stenosis, 7 from traumatic and 3 from non-traumatic causes, have been treated. All patients needed a tracheostomy for maintenance of an airway prior to operation. Nine patients were successfully decannulated two weeks after removal of the internal Silastic splint. Five of the 10 patients were children under the age of 13 years.
Experience with Extracapsular Extraction and Binkhorst 2-loop Intraocular Lenses: Preliminary Communication
Authors: Marsh R J , Andrew N C
Published: February 2018

Extracapsular cataract extraction and implantation of a Binkhorst 2-loop intraocular lens were performed on 50 patients. The majority of the patients achieved a corrected postoperative acuity of 6/9. Operative, immediate postoperative and late postoperative complications are discussed. The commonest postoperative complication was the formation of a dense capsular membrane which required capsulotomy in 9 patients. Suggestions are put forward for improving the result of this rewarding operation.
Sleep and the Enuresis Alarm Device
Authors: Sireling L I , Crisp A H
Published: February 2018

The effect on sleep of the wire-mesh element within the ‘buzzer and pad’ enuresis alarm device was studied using healthy adult volunteers in a single or double crossover design. Polygraphic recording revealed a reduction in the number of shifts between sleep stages, and in the time spent in wakefulness, movement and stage 1, on the nights when the mesh was in the bed. This effect may be responsible for preventing some of the enuretic episodes which would otherwise have occurred at such times.
Forefoot Rotation - a Hindfoot Problem?: Preliminary Communication
Authors: Duckworth T
Published: February 2018

A type of valgus deformity of the foot which differs from those commonly recognized is described. In this foot, correction of the hindfoot valgus results in the talus assuming an abnormally horizontal position, so that the forefoot is markedly rotated relative to the hindfoot. The condition is usually present at birth and may occur in paralytic and non-paralytic forms. Its recognition is important as the deformity may lead to difficulties later in life.
Scanning Electron Microscopy of the Human Organ of Corti
Authors: Wright A
Published: February 2018

The human cochlea has been preserved from post-mortem autolysis by perfusion with a fixative shortly after death. Subsequent staining with osmium permits dissection of this structure from the temporal bone. (Temporal bones were obtained from eight patients). When prepared for examination in the scanning electron microscope, the auditory sensory cells are found to be located in the band-like organ of Corti which extends the length of the cochlea. The sensory cells have a cluster of stereocilia projecting from their free upper surface and because of this are called hair cells. The hair cells are divided into two separate groups: a single row of inner hair cells, which show little variation in their surface appearance along the length of the cochlea, and three or four rows of outer hair cells whose cilia change in conformation and increase in length along the cochlea.
Bowel Disease after Radiotherapy
Authors: Schofield Philip F , Holden D , Carr N D
Published: February 2018

The clinical presentation, operative findings and outcome in 40 patients who required surgery for bowel disease after radiotherapy are presented. The type of presentation varied according to the time after radiotherapy. In the first month, many patients had a proctitis but none required surgery. Five patients were operated on within one month, 2 for radiation-induced acute ileitis and 3 for exacerbations of pre-existing disease (diverticular disease 2, ulcerative colitis 1). The commonest time of presentation was between 3 and 18 months after radiotherapy, when 20 patients needed surgery for bowel disease caused by radiation-induced local ischaemia. Twelve of these patients had chronic perforation, 6 had severe rectal bleeding and 2 had painful anorectal ulceration. Fifteen patients presented between 2 and 24 years after radiotherapy, usually with incomplete intestinal obstruction due to a fibrous stricture, but 2 patients had rectal carcinoma.

Wide resection of the involved bowel was the principal method of treatment but any anastomosis was protected by a proximal defunctioning stoma. There was no operative mortality but 10 patients have died subsequently. The danger of dismissing these patients as having incurable malignancy is stressed because, although the condition is infrequent, it is usually amenable to adequate surgery.
Communicating Hydrocephalus in the Intellectual Deterioration of Diabetes Mellitus
Authors: Jones D B , Hosker J P , Asplin C M
Published: February 2018

Atherosclerosis of cerebral vessels (Grunnet 1963) and hypoglycaemia (Bale 1973) are thought to be involved in the premature intellectual deterioration which occurs in some diabetics. Two diabetics are now reported who, in the course of their investigation for intellectual deterioration, were found to have communicating hydrocephalus.
Some Factors Affecting Nerve Regeneration in Relation to Radiotherapy
Authors: Stearns Michael
Published: February 2018

The effect of delay and irradiation, both separately and combined, on regeneration of rat sciatic nerve was evaluated in adult Wistar rats. Those animals which had received irradiation at some stage fared significantly worse than those which had immediate division and reanastomosis of the sciatic nerve without irradiation. The possible relevance of these findings to nerve regeneration in patients treated by surgery and radiotherapy for parotid cancer is discussed.
Role of Franzen Needle Aspiration Biopsy in Carcinoma of the Prostate
Authors: Anandan N , MacKenzie E , Gingell J C , Rowell M J , Johnson D H
Published: February 2018

A retrospective study is reported of all Franzen fine-needle aspiration cytology undertaken at Southmead Hospital between January 1978 and December 1981. A total of 1043 aspirates were examined from 753 patients. The diagnosis of carcinoma of the prostate was missed in 2 patients. Twenty-one patients with cytologicallyproven carcinoma in histologically-benign prostates were detected, and the role of the Franzen needle in the diagnosis of early prostatic cancer is discussed. Of the 218 patients proceeding to prostatectomy, there were 91 patients with carcinoma and in 65 (72%) the cytological and histological grading was identical. A significant disparity occurred in 8 cases and the reasons are discussed.
Retroperitoneal Fibrosis Complicating Intravesical Formalin Therapy
Authors: Ferrie B G , Smith P J B , Kirk D
Published: February 2018

Two cases are reported of ureteric obstruction due to retroperitoneal fibrosis following the use of intravesical formalin. This particular complication of this treatment has not previously been described.
Necessity for Inpatient Services in Neurological Practice1
Authors: Perkin G D
Published: February 2018

An analysis has been performed of the case material referred to a single neurologist in one year, including outpatient referrals, ward referrals and those patients admitted directly from other hospitals or from general practitioners. A summary of diagnoses, reasons for admission and duration of stay is included. It is concluded that some 6 inpatient beds sufficed for their investigation and management.
Are We Using the Correct Dose of Metronidazole in Colorectal Surgery?
Authors: Hobbiss J H , Carr N D , Schofield P F
Published: February 2018

In a series of 20 patients undergoing elective colorectal surgery, 10 received an infusion of metronidazole 500 mg and 10 an infusion of 1500 mg commencing at the induction of anaesthesia. The concentrations of metronidazole in the plasma, rectus muscle and colon of the two groups during the course of the operation were compared. In those patients who received 1500 mg, the plasma and tissue concentrations were all well above the minimum inhibitory concentration (MIC) of metronidazole against Bacteroides fragilis. In those patients who received 500 mg, serum and tissue concentrations were at or only just above the MIC. It may be that 1500 mg would be a more effective dose of metronidazole for prophylactic use in colorectal surgery.
The Role of the Hospital Consultant in General Practitioner Prescribing
Authors: Strickland-Hodge B , Jepson M H
Published: February 2018

A questionnaire was designed and posted to 600 general medical practitioners in the West Midlands. The results indicated that the prescribers were reassured by the hospital consultant although independence was maintained in prescribing decisions. The hospital medical team was recognized for its expertise rather than the consultant alone. A table was constructed from the results to show the therapy areas in which doctors prefer to refer their patients. Consultant's influence in prescribing is most likely where communication between GP and consultant is optimal.

The generalized influence of the consultant as implied by the Greenfield report remains unproven. Any influence is much more specific and may depend upon therapy area, the consultant specialty, and the standing of the hospital medical team. The innovativeness of the prescriber which was also considered may also have an influence as to how the consultant's recommendations will be accepted.
The Diagnosis and Management of Splenic Artery Aneurysms
Authors: Greene D R , Gorey T F , Tanner W A , Lane B E , Collins P G
Published: February 2018

The presentation and course of 7 patients with splenic artery aneurysms is reviewed. Three presented with abdominal pain, 2 with collapse and rupture and in 2 it was an incidental finding. Four patients had elective ligation-excision of the aneurysm with splenectomy as had one patient operated on as an emergency, with no operative mortality. The aneurysm size ranged from 20 to 45 mm (mean 30 mm) and histology confirmed atheroma. One patient was managed as a myocardial infarct for 8 hours after admission and a ruptured splenic aneurysm was diagnosed at autopsy, an overall mortality of 14%. A 66-year-old woman in poor general health was managed expectantly and was asymptomatic when lost to follow-up after 2 years.
Individualized Stress Vulnerabilities in Manic Depressive Patients with Repeated Episodes
Authors: Ambelas A , George M
Published: February 2018

This paper reports on an observation made in the course of the authors’ investigations into the connection between life events and mania. Briefcase summaries are given where repeated relapses in the same patient appeared to focus around a theme or meaning which is specific for each patient, yet quite different across patients. The therapeutic implications of such individualized vulnerabilities are discussed.
Preliminary Data Suggest a Role for Bacterial Superinfection of a Viral Keratitis after Zosteriform Spread of Herpes Simplex virus to the Eye of the Mouse
Authors: Claoué C
Published: February 2018

After inoculation of herpes simplex virus (HSV) on the snout of the mouse, spread to the eye occurs via neural pathways. The keratitis which ensued was clinically atypical for a pure herpetic keratitis, leading to a search for other causative agents. Preliminary data suggests that bacteriological superinfection of the viral keratitis occurs frequently, producing a unique experimental model.
The use of Acrylic Bone Cement for Cervical Fusion in Patients with Rheumatoid Arthritis
Authors: Wilde G P , Hopkins J S
Published: February 2018

We report on 14 patients with instability of the cervical spine secondary to rheumatoid arthritis treated by fusion using a combination of traditional bone grafting techniques and methylmethacrylate bone cement. Successful fusion was achieved in all cases with few complications. The high infection rate reported by other authors was avoided by reducing the bulk of the cement mass and the use of antibiotic impregnated cement.

We recommend this method of fusion to all orthopaedic surgeons involved in the treatment of patients with rheumatoid arthritis.
Severe Herpetic Keratitis. II. The Costs Associated with Penetrating Keratoplasty
Authors: Menage M J , Claoué C M P
Published: February 2018

We report a study on 100 patients with severe herpetic keratitis.

Overall, one in three of the study group required a penetrating keratoplasty (PK). These patients required a mean of 18 days as an inpatient and 15 outpatient visits in the year the PK was performed; these figures fell to 1 inpatient day and 8 outpatient visits in the second year after surgery. The financial cost of such therapy is discussed.
Future Applications of Lasers in Surgery and Medicine: A Review
Authors: Sliney D H , Wolbarsht M L
Published: February 2018

The experimental use of lasers in surgery and medicine began only shortly after the development of the first working laser system. However, the development of practical, effective, and safe surgical lasers has been lengthy with many obstacles and delays. Today the laser is used for a wide variety of surgical operations. The fundamental limits and potential for future applications of lasers in surgery and medicine are discussed.
Recognition and Treatment of Abdominal Wall Pain
Authors: Gallegos N C , Hobsley M
Published: February 2018

In some patients with abdominal pain, the source of the pain may be the abdominal wall. A simple test is described which allows these patients to be identified and treated with injections of local anaesthetic and steroid. Twenty-six patients were studied, 20 of whom were available for follow-up. Sixteen of these 20 were symptom free or improved at a median follow-up period of 29 months. Failure to recognize abdominal wall pain may lead to unnecessary investigation.
How Many GP Referrals to Dermatology Outpatients are Really Necessary?
Authors: Sladden M J , Graham-Brown R A C
Published: February 2018

In a survey of patients referred to the dermatology outpatients department of a British teaching hospital, 26% of referrals were considered unnecessary by a senior house officer with three months practical dermatological experience. We conclude that better undergraduate and postgraduate education in dermatology is essential. A period spent in dermatology should be included in all vocational training schemes for general practice.
Intractable Pain: A Neglected Area of Medical Education in the UK
Authors: Pilowsky I
Published: February 2018

Preference is given to letters commenting on contributions published recently in the JRSM. They should not exceed 400 words and should be. typed double-spaced.
Proctocolectomy and Ileostomy for Ulcerative Colitis: The Longer Term Story
Authors: Phillips R K S , Ritchie J K , Hawley P R
Published: February 2018

Elective surgery for ulcerative colitis usually involves the removal of the entire large bowel with either a conventional ileostomy or the formation of an ileoanal pouch anastomosis. Seventy patients undergoing a one stage elective total proctocolectomy and ileostomy between 1976 (the first year an ileoanal pouch was carried out in this hospital) and 1986 have been studied. We have confirmed that proctocolectomy and ileostomy for ulcerative colitis is not the trouble free operation many presume it to be when considering the alternative of an ileoanal pouch.
Coronary Atherosclerosis and Myocardial Infarction in Autopsied Patients in Gondar, Ethiopia
Authors: Maru M
Published: February 2018

Autopsy study of 124 Ethiopian patients for athero-sclerotic lesions and myocardial infarction revealed aortic lesions in 58 (47%), coronary lesions in 26 (21%) and myocardial infarction in 8 (6.5%) cases. Fatty streaks in the coronary arteries were detected after the age of 19 years. Thereafter the frequency increased gradually with age reaching a peak of 33.3% by the age group of 50–59 years. Fibrous plaque appeared at the age of 40 years and progressed with age reaching a maximum of 44.4% by the age of 60–69 years. Myocardial infarction was the cause of sudden death in two cases. Six of the patients with myocardial infarction had moderate to severe lesions. Calcification with narrowing of the left anterior descending coronary artery was found in a 60–year-old female. The significance of the increasing incidence of CHD in black Africans and particularly in Ethiopians is discussed.
Surgical Palliation for Pancreatic Cancer: Will Biliary Bypass Alone Suffice?
Authors: Holbrook A G , Chester J F , Britton D C
Published: February 2018

Because a number of options are available to relieve the obstructed bile duct, stomach or both in patients with irresectable carcinoma of the pancreatic head, palliative surgery for this condition was reviewed retrospectively between 1971 and 1981 at the Royal United Hospital, Bath. One hundred and sixty-five patients underwent a biliary bypass procedure with (n=37), or without (n=128) gastric drainage. Thirty patients had a prophylactic gastroenterostomy to avoid gastric outlet obstruction: tumour encroachment made gastroenterostomy essential in seven others. After biliary bypass alone, operative mortality was 14%. After a concomitant gastroenterostomy, mortality was 27% (P<0.04). Within a year of biliary bypass alone, there was a 9% incidence of gastric outlet obstruction requiring gastric drainage, with an associated mortality rate of 18%. Survival after biliary bypass or biliary bypass with gastroenterostomy was equal (7-8 months). Except where gastric outlet obstruction is imminent, palliation for irresectable pancreatic head carcinomas should be by biliary bypass alone, because the addition of a gastroenterostomy almost doubles the mortality without any advantage in survival time.
Acute changes in Atherogenic and Thrombogenic Factors with Cessation of Smoking
Authors: Feher M D , Rampling M W , Brown J , Robinson R , Richmond W , Cholerton S , Bain B J , Sever P S
Published: February 2018

Tobacco smoking is associated with alterations in several factors considered to be important in the atherosclerotic process. Thirty chronic smokers were studied 2 weeks before and 2 weeks after complete tobacco withdrawal. Significant reductions in fibrinogen, haematocrit, plasma viscosity and whole blood viscosity as well as a significant increase in HDL-cholesterol were observed. As these factors are important in both atherogenesis and thrombogenesis, these observations may give insight into tobacco-induced atherosclerotic disease and may be responsible for the more rapid reduction in the incidence of cardiovascular disease that is believed to occur after stopped smoking.
Drug-Induced Epistaxis?
Authors: Watson M G , Shenoi P M
Published: February 2018

To assess the aetiological contribution made to spontaneous epistaxis in adults over the age of 50 years by various groups of drugs, a controlled study was designed. Fifty-three consecutive epistaxis patients were compared with 50 controls. Significant differences were found between the groups in their consumption of warfarin, dipyridamole and non-steroidal anti-inflammatory drugs. Hypertension was equally common in the two groups, but tended to be less well controlled in the epistaxis patients compared to the controls.

It is thought that the link between the use of non-steroidal anti-inflammatory drugs and the occurrence of epistaxis may be due to alteration of platelet function.
Psychiatric Referrals within the Hospital – the Communication Process
Authors: Leonard I , Babbs C , Creed F
Published: February 2018

This two part study examined the written communication between psychiatrists and other hospital doctors. In the first part a set of sample letters from a psychiatrist, who had seen a ward referral, was sent to 110 physicians and surgeons. Nearly half expressed a preference for a psychiatrist's letter that was one page long with main points underlined. Clarity of psychiatric diagnosis and opinion and clear treatment/follow-up arrangements were the key items of content. In the second part 100 consecutive referral letters and their replies were assessed; 20% of referral letters did not express the precise reason why psychiatric opinion was sought and many of the psychiatrists’ replies did not describe adequately the follow-up arrangements and prognosis. In general the psychiatrist found the referral letters short and lacking in information whereas referring doctors found the brief replies from the psychiatrists preferable because the brief letters contained the key items mentioned in the first part of the study. In addition to these recommendations regarding written communications, this study emphasizes the need for personal discussion between psychiatrists and other hospital doctors; nearly half the doctors in the first part of the study thought this would be essential for good management of the patient.
Prescription of Benzodiazepines in a London Teaching Hospital
Authors: Shan K , Nolan J A , Turner P , Jackson S H D
Published: February 2018

A study of the extent of hospital inpatient prescribing of benzodiazepines and their continuation at discharge was carried out on all patients admitted to St Bartholomew's Hospital, London, during a 7-day period. A large majority (73.6%) were not prescribed benzodiazepines at any time. No discharge prescriptions for these drugs were initiated in hospital. The data do not suggest that hospital prescribing of benzodiazepines is contributing to community prescribing.
Decision Making in Advanced Cancer of the Head and Neck: Variation in the Views of Medical Specialists
Authors: Maher E J , Jefferis A F
Published: February 2018

Forty specialists were asked about their management of three theoretical patients with advanced cancer of the head and neck. Reasons for variation were explored by considering the influence of perceived aims of treatment (radical or palliative), together with a number of factors relating to the tumour, the lymph nodes, and the patients' personal circumstances. The perceived aim of treatment was the most important determinant as to treatment modality but, when chances of influencing survival were small, there was disagreement as to the appropriate aim and subjective value judgements became influential. More careful analysis of the initial decision-making process is needed if new clinical trials are to significantly affect clinical practices.
Controlled Trial of Automated External Defibrillators in the London Ambulance Service
Authors: Walters Geraldine , D'Auria D , Glucksman E E
Published: February 2018

This controlled trial was performed in London and compared outcomes of patients treated by ambulance staff using either basic life support alone or an automated external defibrillator (AED) as an adjunct to basic life support.

Five of the 212 (2%) patients were successfully resuscitated by crews using basic life support alone, compared with seven of 186 (4%) patients treated by crews equipped with the AED. Neurological outcomes in the AED group were better. However, meaningful statistical comparisons are not possible with so few survivors.

The AED used (Lifepak 200, PhysioControl Corp) was found to be sensitive and specific, and ambulance staff operated the defibrillator correctly.

The use of AEDs is an option to maximize the provision of defibrillators in the community and could readily be incorporated into basic ambulance training.
Medication in Police Custody
Authors: Busuttil A , Wallace N W
Published: February 2018

Police Officers have an obligation to look after the welfare of the persons detained by them. As such persons may require to be given medication on a regular basis during their period of custody which may last a few days, the Police are also responsible for ensuring that this takes place.

To identify the extent of this requirement, a survey was carried out by questionnaire in Edinburgh over a period of one month. Eighty five per cent of the 127 detainees were carrying with them a variety of drugs or required to be given medication on a regular basis. The problems associated with this practice are discussed.
Hormone Replacement Therapy Acceptability to Nottingham Post-Menopausal Women with a Risk Factor for Osteoporosis
Authors: Wallace W A , Price V H , Elliot C A , MacPherson M B A , Scott B W
Published: February 2018

In Nottingham we have assessed the acceptability of oral hormone replacement therapy (HRT) for an at-risk group of post-menopausal women for osteoporosis. One hundred post-menopausal women between the ages of 50 and 70 years who had sustained a distal radial fracture were offered oral HRT. There was a 36% overall uptake of HRT with 9% of patients unable to take HRT because they had medical contraindications. The uptake in the 50–55 year age group was 54%. We conclude that in prospective studies of HRT for osteoporosis up to 50% of patients may not wish to take HRT and therefore study design should allow for this level of uptake.
Making and Taking Health Care Decisions: Discussion Paper
Authors: Aldridge D
Published: February 2018

‘I want to say a sentence to you and then I want to interpret that sentence in about four different ways, all of which are related to what we are talking about. And the sentence is, “Each person is his own central metaphor”.’

Mary Catherine Bateson1
General Practitioner Referrals to an Eye Hospital: A Standard Referral Form
Authors: Jones N P , Lloyd I C , Kwartz J
Published: February 2018

To assess general practitioner (GP) referrals to an eye hospital, 500 consecutive referral letters were analysed for content, diagnosis, ocular examination, and medical and drug history. Inadequate information was provided. Visual acuity was measured by general practitioners in only 3.7% of referrals. The standard of ocular examination compared unfavourably with that of ophthalmic opticians. A standard ophthalmic referral form is proposed, and referral protocols are desirable. Undergraduate education in ophthalmology is inadequate and requires more curricular time.
Transdermal Glyceryl Trinitrate to Allow Peripheral Total Parenteral Nutrition: A Double-Blind Placebo Controlled Feasibility Study
Authors: Khawaja H T , Williams J D , Weaver P C
Published: February 2018

Seventy-two consecutive patients requiring total parenteral nutrition (TPN) were randomized to two groups. Group A received daily a peripheral intravenous regimen which provided 10 g nitrogen and 1400 non-nitrogen kcal (5.9 MJ). Group B received daily a peripheral intravenous regimen which delivered 9.4 g nitrogen and 1900 non-nitrogen kcal (8.0 MJ). Each group was further randomized to receive a self-adhesive patch of transdermal glyceryl trinitrate (GTN) or an identical placebo. Infusion survival was the main end-point. For group A, the median time of infusion survival was 74 h (range: 58–100) in the control group compared with 108 h (range: 68–156) in the group that received transdermal GTN (P < 0.001). For group B, the median infusion survival was 67 h (range: 46–92) in the control group compared with 103 h (range: 66–151) in the treatment group (P < 0.001). TPN is feasible via peripheral veins and the incidence of infusion failure can be effectively reduced by transdermal GTN.
Persistent Ulceration of the Anal Margin in Homosexuals with Hiv Infection
Authors: Miles A J G , Connolly G M , Barton S E , Allen-Mersh T G , Hawkins D A , Gazzard B G , Wastell C
Published: February 2018

A study of the outcome of surgical treatment of ulceration of the anal margin occurring in male homosexuals with HIV infection was undertaken. Ten patients with acquired immunodeficiency syndrome and three patients with symptomatic HIV infection were referred to the Department of Surgery with painful anal ulceration which had not responded to medical treatment. The medical treatments given prior to surgical referral included high dose oral acyclovir, intravenous foscarnet and broad spectrum antibiotics. Excision biopsy was performed in 12 patients and in 11 cases was followed by healing of the ulcers within 10 weeks. One patient died 2 weeks postoperatively from Pneumocystis carinii pneumonia without healing. The response to excision biopsy was unexpected but suggests that surgical excision may be beneficial for lesions which have failed to respond to aggressive medical treatment.
Are Accident Flying Squads also Worthwhile for Medical Emergencies?
Authors: Cope A R , Dove A F , Kulendrarajah T , McLauchlan C A J
Published: February 2018

A retrospective analysis of 208 flying squad attendances was performed to assess the effect of pre-hospital care by the team on outcome in emergency medical conditions, and in the trauma victim.

Sixty-two (26%) of these cases were medical, but only 24 (11.5%) required immediate cardiopulmonary resuscitation. Only one out of the four successful resuscitations finally left hospital alive. In trauma, there was no significant enhancement of survival due to the presence of the team by comparing the expected against observed mortality and the injury severity score for age-matched groups.

The value of flying squads as a training aid, perception of the local community and relationships with other emergency services are discussed.

Alternative solutions to improving pre-hospital care include advanced trained ambulance and bystander resuscitation schemes. Although difficult to quantify the authors feel that flying squads are of benefit.
Evaluation of a Home Visiting and Befriending Scheme for Young Mothers: Newpin
Authors: Cox A D , Pound A , Mills M , Puckering C , Owen A L
Published: February 2018

Befriending schemes to support families with young children are now widespread in the United Kingdom. One such scheme, Newpin, which aims to prevent child abuse is described. Evaluation compared those recruited to befriend as well as those befriended. Assessments at baseline and 6 months' follow-up comprised interviews with mothers, developmental assessments of the children and observation of mother–child interaction using video tapes. All assessments were conducted in the home and similar measures were applied to a control sample in an area where a Newpin scheme was planned. Newpin recruits, whether befrienders or befriended had high rates of adverse early experiences, but depression was more common amongst those referred for befriending. Approximately a third did not sustain involvement in the scheme, but those that did were more likely to have had training as volunteers and mental health problems of more than 2 years' duration.
Vasomotion in Venous Disease
Authors: Cheatle T R , Shami S K , Stibe E , Smith P D Coleridge , Scurr J H
Published: February 2018

Abnormalities of the capillary microcirculation may be important in the pathogenesis of venous ulceration. In this study the characteristics of capillary vasomotion in venous disease have been studied using laser Doppler flowmetry.

The amplitude and frequency of vasomotion in the skin microcirculation as measured by laser Doppler flowmetry was determined in 101 subjects. These comprised 43 subjects with venous disease and lipodermatosclerosis (LDS), 14 subjects with uncomplicated varicose veins (VV), and 44 normal controls. In 43 of these 101 limbs, vasomotion was also measured after heating the skin to 43°C.

The resting laser Doppler flux was significantly higher in the LDS group compared to the other two groups (LDS median=76, VV median=47 (P < 0.04), controls median=49 (P < 0.003)). The amplitude of vasomotive waves was significantly higher in the LDS group compared to controls (LDS median=20, VV median=8.3 (P < 0.007), controls median=14 (P < 0.007)), as was the frequency of vasomotion (LDS median=3.3 waves/min, VV median=2.5 (P=ns), controls median=2.7 (P < 0.007)).

On heating the skin to 43 °C the frequency of the vasomotion increased significantly in the control (P < 0.004) and VV (P < 0.04) groups but not in the LDS group. The amplitude of the vaso-motion also increased significantly in the control (P < 0.01) and VV (P < 0.002) groups but not in the LDS group. Following heating, the frequency of vasomotive waves was significantly lower in the LDS group than in controls (P=0.05).
Treatment of Colonic Anastomotic Strictures with ‘Through the Scope’ Balloon Dilators
Authors: Dinneen M D , Motson R W
Published: February 2018

Stricture occurs in 1.2–4.2% of colonic anastomoses. Symptomatic strictures have previously been treated by resection and re-anastomosis and more recently by radiographically guided dilatation by a modified Seldinger technique. This paper describes the endoscopic balloon dilatation of five symptomatic cases and three asymptomatic cases.

Eight patients underwent balloon dilatation of colonic anastomotic strictures. Four patients had no symptoms post dilatation and the strictures remained patient on follow-up endoscopy. All the remaining patients required re-dilatation at approximately 2 months. One of these patients underwent dilatation but remained symptomatic, the dilatation was repeated and a colonic perforation occurred at this time. Of the other three, two continue to be followed up, and are well and one patient died of disseminated malignancy.

Balloon dilatation with ‘through the scope’ dilators is a simpler technique than radiologically guided dilatation. These early results suggest that endoscopic dilatation may avoid further surgery in some patients with anastomotic stricture.
Spontaneous Adverse Drug Reaction Reporting Vs Event Monitoring: A Comparison
Authors: Fletcher A P
Published: February 2018

Spontaneous adverse drug reaction (ADR) reporting is the mainstay of national and international drug safety evaluation in the post-approval phase. A major criticism of the method has been a high, but essentially unquantifiable, level of under-reporting by doctors. A direct comparison has been made between spontaneous ADR reporting and an observational event monitoring system for a group of more than 44 000 patients receiving one or other of a group of seven new drugs. The data suggests that under-reporting by the spontaneous system may be as high as 98% for several clinical events believed to be associated with drug treatment.
Duodeno-gastric Reflux and Gastric Adenomas: A Scintigraphic Study in Patients with Familial Adenomatous Polyposis
Authors: Spigelman A D , Granowska M , Phillips R K S
Published: February 2018

To test whether the presence of gastric adenomas (dysplasia) was associated with gastric reflux of duodenal contents, six patients with familial adenomatous polyposis (FAP) who had gastric adenomas and nine matched FAP patients without gastric adenomas underwent scintigraphic duodeno-gastric reflux scanning. Reflux was graded 0–6, where 0=no reflux, 1=intermittent reflux into antrum only, 2=prolonged reflux into antrum only, 3=intermittent reflux into body, 4=prolonged reflux into body, 5=intermittent reflux into body and fundus, and 6=prolonged reflux into body and fundus. FAP patients with gastric adenomas had more severe reflux (median 6, range 4–6) than did controls (median 3, range 0–6; P=0.009, Mann-Whitney U test). These results are consistent with a role for bile in the development of gastric adenomatous polyps and suggest that bile is involved in the dysplasia-carcinoma sequence.
Treatment of Basal Cell Carcinoma with Intralesional Interferon Alpha-2b
Authors: Healsmith M F , Berth-Jones J , Fletcher A , Graham-Brown R A C
Published: February 2018

We report a series of 11 basal cell carcinomas of various types treated with nine intra-lesional injections of 1.5 million units of interferon alpha-2b. The diagnosis was confirmed histologically in each case.

After 3 months' follow-up six tumours had resolved both clinically and histologically. In three cases the tumour size was reduced. One tumour grew larger. Side effects were well tolerated except by one subject who was withdrawn. Those cases which responded have now been followed-up for between 12 and 26 months with no clinical or histological evidence of tumour recurrence.

This is the longest period of follow-up so far reported for this novel treatment. The results are encouraging and, if maintained in future series, may indicate a useful role for interferon alpha in the management of this common cutaneous malignancy.
Who Should have a Prostatectomy? a Survey of the Management of Patients Presenting with Bladder Outflow Obstruction
Authors: Lloyd S N , Kirk D
Published: February 2018

A postal questionnaire was sent to 33 urologists and to 15 general surgeons who perform prostatic surgery in Scotland. Forty-six out of 48 surgeons replied. The waiting time for outpatient consultations and waiting list statistics of the respondents were compared. Differences in access to and use of imaging, laboratory and urodynamic facilities are reported. Waiting times were affected by the individual surgeon's policy. In busy units, the desire to achieve acceptable waiting times may lead to rationing of treatment to only the most severe cases. Better provision and use of modern investigational facilities might better select those patients who will benefit most from surgical management, leading to more effective use of resources. Medical audit of surgical patients must start from the time of their referral and not confine itself to patients undergoing treatment.
Instrumented linear cutting device for the analysis of fiber severing process
Authors: Adamovsky Michael FA , Alexander Ryan W , Kaptur Louis , Tutunea-Fatan O Remus , Wood Jeffrey T
Published: February 2018

In recent years, stringent governmental regulations along with falling carbon fiber prices have pushed high-volume composite manufacturing somewhere at the top of the “to do” list for the majority of carmakers. However, a careful survey of the literature reveals that little is available on the topic of high-throughput severing of the carbon fibers, one of the principal constituents of carbon fiber reinforced polymers. To address this relative paucity of valid scientific information, the major goal of this study was to develop a robust and accurate experimental apparatus capable of establishing correlations between the amount of cutting force developed at the blade/fiber tow/deformable backing interface and various process parameters such as fiber material, tow and backing characteristics, blade geometry/material, and so on. The characteristic cutting force–position curves obtained by means of the developed device suggest that (1) the cutting forces require to cut glass fibers are typically larger (up to 27% observed in this study), (2) softer backings tend to have a positive effect on the fiber severing process both in terms of peak cutting force and total work to cut, and (3) dull blades require either larger severing forces (60 µm blade edge radius was associated with a 21% increase in cutting force) or are simply unable to produce severing of the fibers (80 µm blade edge radius). Future extensions of this work will focus on the determination of systematic correlations between the parameters of fiber severing process.
Modeling and prediction of metallic powder behavior in explosive compaction process by using genetic programming method based on dimensionless numbers
Authors: Alitavoli M , Khaleghi E , Babaei H , Mirzababaie Mostofi T , Namazi N
Published: February 2018

Explosive compaction process of metallic powders has been studied using a semi-empirical method. This method utilizes dimensional analysis along with genetic programming approach to obtain an expression relating the final density of compacts to the effective parameters during compaction process such as shock compaction energy, properties of metallic powder, and geometry of the problem and explosive charge. Dimensionless numbers have been constructed based on the effective parameters using a complete set of input–output experimental data. The obtained dimensionless numbers then have been applied as input–output data pairs for genetic programming optimization process considering modeling error as the objective. The obtained results show that the proposed model using dimensional analysis method along with genetic programming can predict the final density of compacts with 99.8% accuracy. Also, the outputs of the proposed model have been compared with those obtained by group method of data handling type neural network in the literature. Consequently, genetic programming method has much less root mean square error than group method of data handling model and can be successfully used for modeling and prediction of the complex process behavior.
Using empirical Bayes predictors from generalized linear mixed models to test and visualize associations among longitudinal outcomes
Authors: Mikulich-Gilbertson Susan K , Wagner Brandie D , Grunwald Gary K , Riggs Paula D , Zerbe Gary O
Published: February 2018

Medical research is often designed to investigate changes in a collection of response variables that are measured repeatedly on the same subjects. The multivariate generalized linear mixed model (MGLMM) can be used to evaluate random coefficient associations (e.g. simple correlations, partial regression coefficients) among outcomes that may be non-normal and differently distributed by specifying a multivariate normal distribution for their random effects and then evaluating the latent relationship between them. Empirical Bayes predictors are readily available for each subject from any mixed model and are observable and hence, plotable. Here, we evaluate whether second-stage association analyses of empirical Bayes predictors from a MGLMM, provide a good approximation and visual representation of these latent association analyses using medical examples and simulations. Additionally, we compare these results with association analyses of empirical Bayes predictors generated from separate mixed models for each outcome, a procedure that could circumvent computational problems that arise when the dimension of the joint covariance matrix of random effects is large and prohibits estimation of latent associations. As has been shown in other analytic contexts, the p-values for all second-stage coefficients that were determined by naively assuming normality of empirical Bayes predictors provide a good approximation to p-values determined via permutation analysis. Analyzing outcomes that are interrelated with separate models in the first stage and then associating the resulting empirical Bayes predictors in a second stage results in different mean and covariance parameter estimates from the maximum likelihood estimates generated by a MGLMM. The potential for erroneous inference from using results from these separate models increases as the magnitude of the association among the outcomes increases. Thus if computable, scatterplots of the conditionally independent empirical Bayes predictors from a MGLMM are always preferable to scatterplots of empirical Bayes predictors generated by separate models, unless the true association between outcomes is zero.
Stereotype Content: Warmth and Competence Endure
Authors: Fiske Susan T.
Published: February 2018

Two dimensions persist in social cognition when people are making sense of individuals or groups. The stereotype content model (SCM) terms these two basic dimensions perceived warmth (trustworthiness, friendliness) and competence (capability, assertiveness). Measured reliably and validly, these Big Two dimensions converge across survey, cultural, laboratory, and biobehavioral approaches. Generality across place, levels, and time further support the framework. Similar dimensions have emerged repeatedly over the history of psychology and in current theories. The SCM proposes and tests a comprehensive causal theory: Perceived social structure (cooperation, status) predicts stereotypes (warmth, competence), which in turn predict emotional prejudices (pride, pity, contempt, envy), and finally, the emotions predict discrimination (active and passive help and harm). The SCM uncovers systematic content and dynamics of stereotypes, which has practical implications.
Experience and Description: Exploring Two Paths to Knowledge
Authors: Hertwig Ralph , Hogarth Robin M. , Lejarraga Tomás
Published: February 2018

Experience and description are powerful ways of learning and adaptation. Recently, evidence has shown that these can imply systematically distinct cognitions and behaviors. However, there has been little integrative conceptual work. Drawing on different lines of research, we characterize experience and description, sketch the factors that influence learning from them, and suggest how to reconcile previously disparate research. We propose that much can be gained by studying the behavioral, cognitive, and hedonic implications of description- and experience-based learning in parallel.
Development, optimization, and control of a novel magnetorheological brake with no zero-field viscous torque for automotive applications
Authors: Shamieh Hadi , Sedaghati Ramin
Published: February 2018

The significant energy loss due to viscous torque generation in the absence of the applied magnetic field is the main obstacle in the practical realization of magnetorheological brake in the automotive applications. In this study, a novel magnetorheological brake design having no viscous torque generation in the absence of applied magnetic field has been proposed. The Herschel–Bulkley constitutive model is employed to develop the mathematical equations governing the system’s braking torque. Magnetic circuit analysis of the proposed magnetorheological brake has been conducted to predict the magnetic field intensity in the magnetorheological fluid gaps. A multidisciplinary optimization problem has been formulated to identify the optimal brake parameters to maximize the braking toque while minimizing response time and weight of the magnetorheological brake under different constraints. Genetic algorithm combined with sequential quadratic programming algorithm has been utilized to find the true global optimal solution. The optimal design of the proposed magnetorheological brake provides a maximum braking torque of 1802 N m, a response time of 150 ms, and an overall weight just under 37 kg. Finally, braking performance of the proposed magnetorheological brake has been investigated in a quarter vehicle model where a proportional–integral–derivative controller has been integrated with the proposed magnetorheological brake to improve vehicle’s slipping on different road conditions.
Time-domain spectral element method for modelling of the electromechanical impedance of disbonded composites
Authors: Fiborek Piotr , Malinowski Paweł H , Kudela Paweł , Wandowski Tomasz , Ostachowicz Wiesław M
Published: February 2018

The research focuses on the electromechanical impedance method. The electromechanical impedance method can be treated as non-destructive testing or structural health monitoring approach. It is important to have a reliable tool that allows verifying the integrity of the investigated objects. The electromechanical impedance method was applied here to assess the carbon fibre–reinforced polymer samples. The single and adhesively bonded samples were investigated. In the reported research, the electromechanical impedance spectra up to 5 MHz were considered. The investigation comprised of modelling using spectral element method and experimental measurements. Numerical and experimental spectra were analysed. Differences in spectra caused by differences in considered samples were observed.