bluuebunny/crossref_metadata_2025 huggingface dataset:
The Dynamics–Aerosol–Chemistry–Cloud Interactions in West Africa Field Campaign: Overview and Research Highlights
Authors: Flamant C. , Knippertz P. , Fink A. H. , Akpo A. , Brooks B. , Chiu C. J. , Coe H. , Danuor S. , Evans M. , Jegede O. , Kalthoff N. , Konaré A. , Liousse C. , Lohou F. , Mari C. , Schlager H. , Schwarzenboeck A. , Adler B. , Amekudzi L. , Aryee J. , Ayoola M. , Batenburg A. M. , Bessardon G. , Borrmann S. , Brito J. , Bower K. , Burnet F. , Catoire V. , Colomb A. , Denjean C. , Fosu-Amankwah K. , Hill P. G. , Lee J. , Lothon M. , Maranan M. , Marsham J. , Meynadier R. , Ngamini J.-B. , Rosenberg P. , Sauer D. , Smith V. , Stratmann G. , Taylor J. W. , Voigt C. , Yoboué V.
Published: July 2017

The European Union (EU)-funded project Dynamics–Aerosol–Chemistry–Cloud Interactions in West Africa (DACCIWA) investigates the relationship between weather, climate, and air pollution in southern West Africa—an area with rapid population growth, urbanization, and an increase in anthropogenic aerosol emissions. The air over this region contains a unique mixture of natural and anthropogenic gases, liquid droplets, and particles, emitted in an environment in which multilayer clouds frequently form. These exert a large influence on the local weather and climate, mainly owing to their impact on radiation, the surface energy balance, and thus the diurnal cycle of the atmospheric boundary layer.

In June and July 2016, DACCIWA organized a major international field campaign in Ivory Coast, Ghana, Togo, Benin, and Nigeria. Three supersites in Kumasi, Savè, and Ile-Ife conducted permanent measurements and 15 intensive observation periods. Three European aircraft together flew 50 research flights between 27 June and 16 July 2016, for a total of 155 h. DACCIWA scientists launched weather balloons several times a day across the region (772 in total), measured urban emissions, and evaluated health data. The main objective was to build robust statistics of atmospheric composition, dynamics, and low-level cloud properties in various chemical landscapes to investigate their mutual interactions.

This article presents an overview of the DACCIWA field campaign activities as well as some first research highlights. The rich data obtained during the campaign will be made available to the scientific community and help to advance scientific understanding, modeling, and monitoring of the atmosphere over southern West Africa.
Salinity Variability Associated with the Positive Indian Ocean Dipole and Its Impact on the Upper Ocean Temperature
Authors: Kido Shoichiro , Tozuka Tomoki
Published: July 2017

Both surface and subsurface salinity variability associated with positive Indian Ocean dipole (pIOD) events and its impacts on the sea surface temperature (SST) evolution are investigated through analysis of observational/reanalysis data and sensitivity experiments with a one-dimensional mixed layer model. During the pIOD, negative (positive) sea surface salinity (SSS) anomalies appear in the central-eastern equatorial Indian Ocean (southeastern tropical Indian Ocean). In addition to these SSS anomalies, positive (negative) salinity anomalies are found near the pycnocline in the eastern equatorial Indian Ocean (southern tropical Indian Ocean). A salinity balance analysis shows that these subsurface salinity anomalies are mainly generated by zonal and vertical salt advection anomalies induced by anomalous currents associated with the pIOD. These salinity anomalies stabilize (destabilize) the upper ocean stratification in the central-eastern equatorial (southeastern tropical) Indian Ocean. By decomposing observed densities into contribution from temperature and salinity anomalies, it is shown that the contribution from anomalous salinity stratification is comparable to that from anomalous thermal stratification. Furthermore, impacts of these salinity anomalies on the SST evolution are quantified for the first time using a one-dimensional mixed layer model. Since enhanced salinity stratification in the central-eastern equatorial Indian Ocean suppresses vertical mixing, significant warming of about 0.3°–0.5°C occurs. On the other hand, stronger vertical mixing associated with reduced salinity stratification results in significant SST cooling of about 0.2°–0.5°C in the southeastern tropical Indian Ocean. These results suggest that variations in salinity may potentially play a crucial role in the evolution of the pIOD.
Rotatable Response Surface Designs in the Presence of Differential Neighbour Effects from Adjoining Experimental Units
Authors: Varghese Eldho , Jaggi Seema , Sharma V. K.
Published: July 2017

ABSTRACT:

In RSM, it is generally assumed that the observations are independent and there is no overlap effects from the neighbouring units. But in situations where the units are placed linearly side by side, there is a chance to have overlap effects/neighbour effects from the adjoining experiments units. For example, in field experiments if a chemical spray is applied to one plot, it may spread over to the nearby plots due to wind. Hence, the response from a particular plot may be afected by effects from the adjacent plots and this efect has to be included in the model while fitting RSM. In this paper, first and second order response surface models with diferential effects from adjoining left and right neighbouring units has been considered and the conditions for the model with diferential neighbour effects to be rotatable have been obtained. Method of obtaining designs satisfying the derived conditions has been described. An illustration to show the impact of including neighbour effects in the model on the parameter estimates has also been given using a simulated data set. These designs result in more precise estimates of the parameters of the response surface model.
Group Constraint-Induced Movement Therapy: Motor and Functional Outcomes in Individuals with Stroke
Authors: Yoo Eun-Young , Jung Min-Ye , Park Heung-Seok , Kim Jung-Ran , Jeon Hye-Seon
Published: July 2017

Background

Strokes frequently cause limitations of the upper extremity and in performance of activities of daily living (ADL). Constraint-induced movement therapy (CIMT) is designed to enhance the use of the hemiplegic arm.

Purpose

To assess the effects of group CIMT on upper-extremity motor function and performance level of motor and process skills for instrumental activities in daily living (IADL) in community-dwelling individuals whose stroke occurred at least six months earlier.

Methods

Eight adults with stroke participated in this study. Group-based CIMT was administered for two weeks, five times per week, with two-hour intensive daily training.

Findings

The Fugl-Meyer Assessment (FMA) score and the Assessment of Motor and Process Skills (AMPS) scores improved after intervention.

Implications

The results of this study suggest that relatively brief group-based CIMT may be an effective intervention for improving motor function of the affected upper-limb and the level of IADL in individuals who have had stroke.
A Model of Professional Thinking: Integrating Reflective Practice and Evidence Based Practice
Authors: Bannigan Katrina , Moores Alis
Published: July 2017

Background

Internationally, occupational therapists operate in increasing complex health and social care settings. To function in this environment, high-level thinking skills are required. Reflective practice and evidence-based practice are two key skills that shape the way occupational therapists think.

Purpose

To integrate reflective practice and evidence-based practice so that their complementary qualities form part of a model of professional thinking.

Key issues

Reflective practice and evidence-based practice skills both contribute to clinical reasoning. The “model of professional thinking” can enable occupational therapists to integrate these two skills into their professional thinking.

Implications

Rather than teaching reflective practice and evidence-based practice as discrete subjects, “professional thinking” should be taught as an overarching topic within curricula. This may mean changes to the organisation and delivery of curricula, including practice placements. This model of professional thinking will need to be evaluated.
Dynamics of Political Support-Alienation
Authors: Muller Edward N. , Williams Carol J.
Published: July 2017

Three hypotheses about the relationship between political performance (specific support) and attitude about the political system (diffuse support) are investigated. Data are from a two-wave panel study carried out during 1974–1976 in the Federal Republic of Germany. No support is found for an Independence hypothesis, which predicts that because system support is acquired during an early age it will be resistant to change during adulthood. The results indicate that the relationship between performance evaluation and system attitude is complex. Support is found for (1) a Social Learning hypothesis, which predicts that system support will respond to differential satisfaction with the performance of an incumbent administration, and (2) a Structuring hypothesis, which predicts that system attitude will influence one's evaluation of the performance of an incumbent administration. It is therefore not possible to rule out reciprocal causation between performance evaluation and system attitude, suggesting that unidirectional causal models are likely to misspecify the true relationship.
Lexical Decision for Inflected Nouns
Authors: Lukatela G. , Mandić Z. , Gligorijević B. , Kostić A. , Savić M. , Turvey M.T.
Published: July 2017

Lexical decision times were measured for three grammatical cases of inflected Serbo-Croatian nouns. The grammatical cases occur with different frequencies. Decision times were not related by a unique constant multiplier to the logarithms of the respective case frequencies. The result suggests that a principle of organization in addition to frequency of occurrence is involved in the lexical memory of inflected nouns.
Unmarked-Before-Marked as a Freezing Principle
Authors: Sobkowiak Włodzimierz
Published: July 2017

A lexico- and phonostatistic analysis of over 1200 coordinate and non-coordinate English freezes ( sooner or later, dribs and drabs, razzle-dazzle) has shown that UNMARKED-BEFORE-MARKED is a very potent principle determining the order of compounded elements. One objectively measurable correlate of markedness – lexical and phonemic frequency – was analyzed. In coordinate freezes, first conjuncts (1) were significantly more frequent, (2) were segmentally and syllabically shorter, and (3) contained more voiceless obstruents than second conjuncts. In rhyme freezes, in addition to (2), as above, first conjuncts contained fewer sonorants, voiced obstruents, and labials than second conjuncts. In ablaut freezes, first conjuncts contained fewer diphthongs but more fronted vowels (higher F2), compared to second conjuncts. All these findings support the hypothesis that relative markedness probabilistically regulates the ordering of conjuncts in freezes.
A Feature-Based Account of the Relations Signalled by Sentence and Clause Connectives
Authors: Knott Alistair , Mellish Chris
Published: July 2017

This paper describes a three-stage methodology for investigating the semantics and pragmatics of sentence and clause connective phrases. The first step in the methodology is to assemble a large corpus of connectives. The second step is to organize this corpus into a hierarchical taxonomy of synonyms and hyponyms, using a pre-theoretical substitution test. The final step, upon which we concentrate in this paper, is to impose a theoretical interpretation on the taxonomy. The taxonomy lends itself to an analysis of intersentential / interclausal relations in terms of a number of orthogonal multivalued features; connectives are then seen as signaling the values of one or more of these features.
Regulation of Conceptual Tempo in First-Grade Children
Authors: Becker Laurence D.
Published: July 2017

This study examined the relationship between tempo, as measured by the Matching Familiar Figures Test, the ability to regulate tempo, and teachers' ratings of children's performance in first grade. Data suggest that both tempo and the ability to regulate tempo are related to children's performance in first grade, and that dimensions are additive. On all tasks administered, errors accounted for more of the variance in children's performance than did response time. These results are consistent with recent reports critical of the matching task. Sex differences were also noted.
Specific and Varied Practice of Motor Skill
Authors: Kerr Robert , Booth Bernard
Published: July 2017

To assess the potential effect of specific and varied practice on the development of motor schema, 64 children in two age groups (8 yr. and 12 yr.) were tested on a simple throwing task at the beginning and end of a 12-wk. physical education program. For the throwing test the children were assigned to either a specificity or a schema group (varied practice). The task was performed without visual feedback, but knowledge of results was given after each trial. Prior to both tests at the criterion target, the specific group was given practice throws using the criterion target distance, whereas the schema group practiced on two other targets. No differences were found between the two groups at the beginning of the program but on the posttest those children receiving a variety of practice on the throwing task performed significantly better than the specific-practice group. Thus it was suggested that a varied practice schedule may facilitate the initial formation of motor schema, and this process may be enhanced by participation in a physical education program.
Frequency of Continuing Mucosal Inflammation in Clinically Inactive Crohn's Disease
Authors: Arnott I.D.R. , Drummond H.E. , Ghosh S.
Published: July 2017

The treatment goal in Crohn's disease is clinical remission, not complete mucosal healing. The incidence of mucosal inflammation in Crohn's disease patients in clinical remission is not known. Whole gut lavage is an objective method of assessing mucosal inflammation. We aimed to assess levels of mucosal inflammatory activity in a group of patients with clinically inactive Crohn's disease. We prospectively assessed 30 patients with inactive Crohn's disease and 28 controls. Inactive disease was defined as Crohn's disease activity index of less than 150. All underwent whole put lavage, with analysis of whole gut lavage fluid IgG, haemoglobin, interleukin-1β, interleukin-8 and granulocyte elastase. Serum inflammatory parameters were collected for comparison. Of the 30 patients with Crohn's disease, 10 (33%) had an abnormal immunoglobulin G, 21 (70%) had an elevated interleukin-1β 20 (66%) interleukin-8 and 10 (33%) granulocyte elastase in the whole gut lavage fluid. 58% of patients had either 1 or 2 abnormal results. In contrast only 10% had 1 or 2 abnormal serum results. Few abnormalities were present in lavage fluid or serum of the control population. We concluded that ongoing mucosal inflammation is detectable in whole gut lavage fluid of up to 2/3 of Crohn's disease patients in clinical remission.
Superior Mesenteric Artery Syndrome in Children
Authors: Murthi G.V.S. , Raine P.A.M.
Published: July 2017

Superior mesenteric artery syndrome is an uncommon clinical condition characterised by features of acute or chronic upper gastrointestinal tract obstruction. It sometimes has particular clinical associations such as weight loss, spinal surgery cast application or adhesions. Associated multiple clinical problems can complicate the picture and delay diagnosis. Diagnosis is usually by barium meal showing compression of the 3rd part of duodenum. Treatment can be conservative or surgical. Surgical treatment consists of division of the ligament of Treitz and derotation of the gut. We review our experience of four children with this syndrome.
Effect of Histamine H2-Receptor Blockade on Gastric Emptying and Serum Gastrin in Man
Authors: Forrest J. A. H. , Heading R. C. , Park J. , Carter D. C. , Lennon J. , Lidgard G. , Shearman D. J. C.
Published: July 2017

The effect of orally administered metiamide, a Histamine H2-receptor antagonist, on the rate of gastric emptying was assessed in 24 uncomplicated duodenal ulcer patients given a standard meal containing indium 113m D.T.P.A. chelate. Metiamide produced significant slowing of gastric emptying when compared with control studies performed on the same patients following oral administration of a placebo.

In a further study the effect of metiamide on the serum gastrin response to a protein meal was assessed in seven healthy male volunteers. Paired experiments demonstrated that a significantly greater elevation of serum gastrin occurred after metiamide than after placebo.

The delay in gastric emptying produced by metiamide may be mediated by an elevation of the serum gastrin concentration.
Re-telling the tale
Authors: Podmore Colin
Published: July 2017

This article responds to a reply by Bishop Pierre Whalon (in Theology) to an article originally published in the Ecclesiastical Law Journal in 2008. It aims to correct misunderstandings and misrepresentations and to refute criticisms of the original article. In doing so, it draws on recently published contributions to debate about the ‘polity’ of The Episcopal Church. The article also describes the context in which Whalon’s reply has been written and explains why the sentence of ‘deposition from the ordained ministry’ cannot be regarded as the equivalent of the withdrawal of a bishop’s licence.
A theology of abstraction: Wassily Kandinsky’s ‘Concerning the Spiritual in Art’
Authors: Pickstone Charles
Published: July 2017

On the hundredth anniversary of the first abstract painting of modern times, the rationale for abstract art offered by a pioneer of the genre, Wassily Kandinsky (1866–1944), in his book Concerning the Spiritual in Art (1911), is critically examined. The principal influences on his art and thought are discussed; in particular, what Kandinsky intended by the word ‘spiritual’. Theories about Kandinsky’s possible synaesthesia are reviewed and the historical context of his world-view adumbrated. Finally, the article offers a preliminary sketch as to what an ‘abstract’ theology (had theologians of the day followed Kandinsky’s lead) might have looked like.
Increasing trends in seroprevalence of human hydatidosis in North India: A hospital-based study
Authors: Khurana Sumeeta , Das Anindita , Malla Nancy
Published: July 2017

A retrospective analysis of laboratory data of 3290 clinically suspected and/or radiologically confirmed cases of hydatidosis revealed that 495 (15%) were positive for specific antibody response. Casoni's test was positive in 481/1938 (24.82%) patients. A significant increase (P < 0.001) in seropositivity was observed during the last 5 years (23.12%, 1999-2003) as compared with previous years (10.97%, 1984-1998), and a similar increase (P < 0.001) in positive Casoni's test was also observed (33.83%, 1999-2003 versus 21.38%, 1984-1998) during the same time period.
A challenge for monitoring iodine deficiency disorders in rural Nepal
Authors: Jimba Masamine , Aitken Iain W , Joshi Anand B , Ohashi Toshinori , Poudyal Amod K , Wakai Susumu
Published: July 2017

Developing a strategy for monitoring iodine deficiency disorders (IDD) remains a big challenge in rural Nepal where great variations could exist in IDD status. To explore the possibility of variation in urinary iodine excretion (UIE) level in rural settings, we carried out a detailed study of UIE among 586 school children of 20 schools in five villages. Our data revealed statisitically significant differences in UIE values among rural villages and schools in the same villages. The policy-makers should keep such variations in mind for a successful monitoring of IDD in Nepal and other countries where such variations may exist.
Injuries from cow gore in adults among Fulani
Authors: Sabo S Y , Yusufu L M D
Published: July 2017

A retrospective study of 32 patients managed for cow gore injuries. The abdomen was involved in 16 (50%) patients, scrotum in six (18.9%), neck in three (9.3%) and other sites in seven (22.8%). All injuries were penetrating in nature and laparotomy was done on 17 (53%) patients.
Emotions Overriding Forensic Opinions? The Potentially Biasing Effects of Victim Statements
Authors: Lynett Elizabeth , Rogers Richard
Published: July 2017

Forensic experts are frequently advised to gather multiple sources of data, including victim accounts, in criminal cases. This study is the first empirical investigation of whether victim accounts may exert a biasing effect on clinical-forensic opinions. The research employed a completely randomized factorial design to study the effects of aggressive history, diagnosis of antisocial personality disorder (APD), and victim statements on sentencing issues in a Canadian dangerous offender (DO) case. With a sample of 332 Canadian psychiatrists, the study found that victim statements exerted an unexpected effect on DO determinations (Cohen's d=.52) that exceeded the defendant's aggressive history ( d=.19) and APD diagnosis ( d=.34). The study's implications for gathering victims' accounts are discussed within the framework of forensic evaluations.
Board Certification in Forensic Psychiatry and Psychology: Separating the Chaff from the Wheat
Authors: Dattilio Frank M. , Sadoff Robert L. , Gutheil Thomas G.
Published: July 2017

Psychiatrists and psychologists are under increasing pressure to obtain board certification in their areas of specialization. While this has been the norm for psychiatrists, it is less true for psychologists as of this writing. Regardless, both professionals have been permitted to testify in court without board certification, particularly since the Federal Rules of Evidence 702 tend to be somewhat broad-based in their definition of what constitutes an expert. This article reviews the basic need for board certification and reasons why it should become a requirement for those who practice forensic psychiatry and psychology. The article considers some of the reasons why individuals in both professions may have been reluctant to pursue board certification in the past, as well as some of the pitfalls encountered in the process of becoming certified. Further discussion illuminates the need for psychiatrists and psychologists to adhere to rigid requirements for credentialing and to avoid dubious alternatives such as so-called “vanity” boards that offer ongoing grandfathering periods without rigorous credentials reviews and examination. The impact of such questionable credentials on the forensic field is also discussed.
Learning Disability and Professional Licensing Examinations: What Accommodations are Reasonable under the ADA?
Authors: Ballard Robin S. , Elwork Amiram
Published: July 2017

Among the issues that have arisen since the passage of the Americans With Disabilities Act (ADA) in 1990 is whether learning-disabled applicants for professional licensing should receive accommodations such as more time and a separate room in which to take their licensing examinations. This article evaluates the validity of current policies in light of the legally mandated goals of licensing boards, the legislative intent of the ADA, the job requirements of professions such as medicine and law, and what is known about learning disabilities, distractibility and timed tests. One of the conclusions reached is that testing accommodations should help licensing applicants overcome disabilities that are irrelevant to competent professional practice, but that they should not help applicants mask job-related disabilities.
Attorneys' Perceptions of Child Witnesses with Mental Retardation
Authors: Nathanson Rebecca , Platt Michelle D.
Published: July 2017

Children with mental retardation are more likely to be abused than the general population, yet are often denied access to the justice system. Research on children without mental retardation has revealed skepticism as to their reliability as witnesses in the court of law. Even more so, children with mental retardation face the issue of credibility because of their age and disability. This study assesses attorneys' perceptions of child witnesses with mental retardation. Thirty-nine criminal attorneys completed a 33-item questionnaire designed to assess their opinions of the abilities of adults and of children with and without mental retardation to recall and communicate information in the forensic context. Results revealed that attorneys perceived child witnesses as less credible and more suggestible than adult witnesses. Moreover, analyses indicated that child witnesses with mental retardation were also perceived as less credible and more suggestible than child witnesses without mental retardation.
Avoiding Garbage 2: Assessment of Risk for Sexual Violence after Long-Term Treatment
Authors: Declue Gregory
Published: July 2017

The 1990s saw an upsurge in statutes and procedures for civil commitment of sexually violent predators. Some current cases involve consideration of whether a person who has been in long-term sex-offender treatment continues to meet commitment criteria. Psychologists' and psychiatrists' roles in such proceedings involve diagnosis, risk assessment, and risk communication. Particular challenges to evaluators are how to integrate and communicate findings regarding estimated risk from static and dynamic factors. Although both are theoretically important in considering a person's risk for sexual reoffense, there are considerably less empirical data regarding dynamic factors than static factors. Therefore evaluators should use considerable caution in using dynamic factors to adjust risk assessments based on static factors, and we should clearly communicate the lack of empirical base for risk-assessment adjustments based on dynamic factors.
Serious Suicide Attempts in a State Corrrectional System and Strategies to Prevent Suicide
Authors: Daniel Anasseril E. , Fleming Jennifer
Published: July 2017

The characteristics of offenders who attempt suicide in prisons indicate that they are mostly white males, likely to be property offenders, serving less than ten years, suffer from depression and personality disorders, experience significant psychosocial stressors, often have a cellmate and use predominantly cutting and slashing. A significant percentage use lethal methods such as attempted hanging and overdose. Those who use lethal methods tend to be genuine in their intent and have many features common to those who commit suicide.

Comparison of those who used lethal methods with a cohort of inmates who committed suicide indicated no significant differences in gender, race, age, crime type, diagnosis, and prior or current psychiatric care. However, the suicide completers tended to have more psychiatric symptoms such as delusions, hallucinations, impulsivity and guilt feelings, as well as experience of conflicts, ridicule and/or rape immediately preceding the self harm acts. Furthermore, more completers experienced new convictions, medical conditions, psychosocial stressors, and had shown prior suicidal behaviors. They were likely to be held in maximum security prisons and in single cells. While hanging dominated the completed suicides, medication overdose was more common among the lethal attempters.

The authors discuss multiple strategies to deal with the identified group of suicide attempters in order to prevent subsequent serious attempts or suicides. They include comprehensive mental health (MH) services delivery, implementation of a suicide prevention policy, timely inpatient and involuntary treatment, watch take procedure for psychotropic medications, noncompliance management, suicide watch, therapy, use of liquid medications, elimination of Benzodiazepines and timely action by MH, correctional and medical staff.
Practice Standards and Guidelines for the Evaluation, Treatment, and Management of Sexual Abusers: Bamboozle No More
Authors: DeClue Gregory
Published: July 2017

The Association for the Treatment of Sexual Abusers' (ATSA) 2005 Practice Standards and Guidelines (PSG) are reviewed with reference to the American Psychological Association's (2002a) Criteria for Practice Guideline Development and Evaluation. The 2005 ATSA PSG show considerable improvement over the 2001 version, and suggestions are made for further improvements. It is recommended that future iterations of PSG should list standards and guidelines separately, and not include treatment guidelines within the same document. Careful review of empirical research should precede development of treatment guidelines, and it is suggested that there is insufficient empirical basis to warrant the establishment of sex-offender treatment guidelines at this time. Significant public damage sparked by the 2001 PSG has not been repaired by simply replacing the old version with a new model. Repairing the damage to states' laws and rules is a priority for mental-health professionals.
Personal Injury Evaluations in Motor Vehicle Accident Cases
Authors: Witt Philip H. , Weitz Steven E.
Published: July 2017

This article discusses the legal context of psychological evaluations in personal injury cases. The authors then delineate the main principles of performing such evaluations, including methods of determining pre-incident adjustment, evaluating malingering, and considering both pre-existing psychological problems and concurrent stressors. The article uses motor vehicle accident (MVA) cases as a focus of the discussion, pointing out similarities and differences between such physical stressor cases and social stressor cases, such as workplace discrimination or harassment.
Discovery of Consulting Psychiatric and Psychological Experts
Authors: Shuman Daniel W.
Published: July 2017

To enjoy the excitement and financial rewards of participating in complex legal strategies, while avoiding the exposure of their own work to cross-examination, many psychiatrists and psychologists choose to serve as consultants, operating behind the scenes at what seems like a safe distance from the witness stand. In certain situations, however, rules provide for the discovery of consultants for “good cause” and under “exceptional circumstances.” This article analyzes such situations via a review of cases grouped into three categories: (1) discovery of “real” consulting experts; (2) discovery of “sheltered” experts; and (3) discovery in the event of “buyer's remorse.” Judicial reassignment of consulting and testifying roles threatens the adversary system by dissuading participation from experts leery of unplanned role assignments. Counsel is best advised to anticipate such problems and to guide consultants accordingly.
Vascular Cognitive Impairment: Perspective and Review
Authors: Hyer Lee , Damon Jill , Nizam Zeba
Published: July 2017

Mild Cognitive Impairment (MCI) is a construct that has received considerable interest in the last 15 years. One variant of MCI is Vascular Cognitive Impairment (VCI), a relatively new idea with considerable importance. VCI is a reflection of cerebral vascular disease and is a prodrome of Vascular dementia. It is both prevalent and represents a marker that can be addressed and even prevented. Its presence suggests further decline, as well as current problems. In this article we address this heterogeneous condition and present a context. We discuss both Alzheimer's disease and vascular dementia, and consider the many variables related to vascular problems. We then consider MCI itself, with a focus on the relatively unstudied concept of mild vascular cognitive impairment. We address the cognitive features of this disease process and its implications for adjustment and potential problems. To illustrate these concepts, we will present a case, ways to assess it, and implications for treatment. We conclude by considering assessment and the issue of competence specific to VCI.
Improving Clinical Judgment and Decision Making in Forensic Evalution
Authors: Borum Randy , Otto Randy , Golding Stephen
Published: July 2017

Psychologists, psychiatrists and other mental health professionals are frequently involved as expert witnesses in legal proceedings. However, clinical judgment and decision making, which play a role in almost all clinical evaluations, have problems and limitations. Mental health professionals who conduct forensic examinations should be aware of these problems and take steps to address them. This article details the limitations of clinical judgment and decision making, and suggests ways to minimize associated problems, thereby improving the validity and utility of forensic evaluations.
Psychotic Patients' Awareness of Mental Illness: Implications for Legal Defense Proceedings
Authors: Neumann Craig S. , Walker Elaine F. , Weinstein Jay , Cutshaw Chris
Published: July 2017

This study examined the relationship between psychotic patients' insight into their mental illness and current symptoms, competency to stand trial, and willingness to use the insanity defense. Inpatients with psychotic disorders were grouped by whether they exhibited insight into their mental status (n=18) or denied being mentally ill (n=13). The majority of all patients, regardless of insight status, failed at least one item on a 16-item competency exam. However, the majority of insightful subjects (77%) were willing to consider using the insanity defense, while only a minority (31%) of the non-insightful subjects were willing to consider such a defense. Using the Brief Psychiatric Rating Scale (BPRS), univariate analyses indicated that the insightful subjects manifested significantly more Anxiety-Depression and less Thought Disturbance than the non-insightful subjects. Although there was no relationship between insight and performance on the competency exam, there were significant inverse correlations between competency scores and ratings on the BPRS symptom factors.
Book Section: Essay and Review: Patient Violence and the Clinician
Authors: Hillbrand Marc
Published: July 2017

Numerous books have been published in recent years on the popular topic of violence by psychiatric patients. Unlike most of these, rushed to press without adequate editorial scrutiny, Patient Violence and the Clinician was thoughtfully conceived and packaged in a reader-friendly way. Eleven concise chapters examine the major topics that readers should be exposed to in order to master the basics of managing patient violence. Most chapters are well organized, provide empirical data, and present practical suggestions. The editors and the authors of the various chapters are all prominent scholars in the area of patient violence. Burr Eichelman, a professor and chairman of the Department of Psychiatry, Temple University School of Medicine, has written on the pharmacological treatment of patient violence. Anne Hartwig is affiliated with the Institute of Law and Health Sciences, Temple School of Law, and Temple University School of Medicine.
Book Section: Essay and Review: New Research in Psychiatry
Authors: Lande R. Gregory
Published: July 2017

New Research in Psychiatry, edited by H. Häfner and E.M. Wolpert, is a big little book. The imposing title conjures up visions of a massive text, not the slim volume of reality. In a different context, however, the book is big, meaning the lofty goal “to organize a meeting of leading representatives from the most important research areas ….”
Larva therapy in wound management
Authors: Courtenay M , Church J C T , Ryan T J
Published: July 2017

The use of maggots for wound debridement has a long history and has lately gained ground in several countries. We collected prospective data to examine the current use of larva therapy (LT) in the UK. Quantitative information was collected on 70 patients treated in nine hospitals.

LT is used primarily to treat leg ulcers and generally involves three applications of larvae at two to three day intervals. This method is judged effective in wound debridement and promotes the growth of granulation tissue. Wound exudate, odour, infection and pain are all reduced by the treatment. Adverse reactions are infrequent but include pain, bleeding, pyrexia and influenza-like symptoms. Prevention of hospital admission and surgery, reduced need for antibiotics and reduced hospital stay are all identified as outcomes of LT.

The nurse practitioners who used LT believed it to have an important role in wound management. A randomized clinical trial, comparing LT with other debriding agents, is required for evaluation of cost effectiveness.
Randomized controlled trial of nettle sting for treatment of base-of-thumb pain
Authors: Randall Colin , Randall Hester , Dobbs Frank , Hutton Charles , Sanders Hilary
Published: July 2017

There are numerous published references to use of nettle sting for arthritis pain but no randomized controlled trials have been reported. We conducted a randomized controlled double-blind crossover study in 27 patients with osteoarthritic pain at the base of the thumb or index finger. Patients applied stinging nettle leaf (Urtica dioica) daily for one week to the painful area. The effect of this treatment was compared with that of placebo, white deadnettle leaf (Lamium album), for one week after a five-week washout period. Observations of pain and disability were recorded for the twelve weeks of the study. After one week's treatment with nettle sting, score reductions on both visual analogue scale (pain) and health assessment questionnaire (disability) were significantly greater than with placebo (P=0.026 and P=0.0027).
Urgency of caesarean section: A new classification
Authors: Lucas D N , Yentis S M , Kinsella S M , Holdcroft A , May A E , Wee M , Robinson P N
Published: July 2017

A new classification for caesarean section was developed in a two-part study conducted at six hospitals. Initially, 90 anaesthetists and obstetricians graded ten clinical scenarios according to five different classification methods—visual analogue scale; suitable anaesthetic technique; maximum time to delivery; clinical definitions; and a 1-5 rating scale. Clinical definitions was the most consistent and useful, and this method was then applied prospectively to 407 caesarean sections at the same six hospitals. There was close agreement (86%) between anaesthetists and obstetricians for the five-point scale (weighted kappa 0.89), increasing to 90% if two categories were combined (weighted kappa 0.91). We suggest that the resultant four-grade classification system—(i) immediate threat to life of woman or fetus; (ii) maternal or fetal compromise which is not immediately life-threatening; (iii) needing early delivery but no maternal or fetal compromise; (iv) at a time to suit the patient and maternity team—should be adopted by multidisciplinary groups with an interest in maternity data collection.
Cover arrangements for consultants on leave: An analysis of job descriptions
Authors: Pearson Claire , Janssen Camilla M , Lewis M H , Galland R B
Published: July 2017

There is much ambiguity about consultant leave allowances and arrangements for cover in the National Health Service. We analysed job descriptions for 47 consultant posts advertised in mid-2000. 35 defined a duty rota but only 3 mentioned specific available leave (all different). In 32 there was no mention of cover for colleagues on leave.

When a consultant is absent, colleagues tend to provide cover for emergency cases but not for elective admissions, which are managed largely by junior doctors. This arrangement is particularly hazardous in surgical specialties. If elective surgery is to continue when the consultant is absent, arrangements for leave and cover need to be more clearly defined.
Assessment & management of sexual problems in women
Authors: Wylie Kevan
Published: July 2017

This article is the sixth in a series of articles on sexuality and sexual health.
First do no harm: The impact of recent armed conflict on maternal and child health in Sub-Saharan Africa
Authors: O'hare Bernadette A M , Southall David P
Published: July 2017

Objectives

To compare the rates of under-5 mortality, malnutrition, maternal mortality and other factors which influence health in countries with and without recent conflict. To compare central government expenditure on defence, education and health in countries with and without recent conflict. To summarize the amount spent on SALW and the main legal suppliers to countries in Sub-Saharan African countries (SSA), and to summarize licensed production of Small Arms and Light Weapons (SALW) in these countries.

Design

We compared the under-5 mortality rate in 2004 and the adjusted maternal mortality ratio in SSA which have and have not experienced recent armed conflict (post-1990). We also compared the percentage of children who are underweight in both sets of countries, and expenditure on defence, health and education.

Setting

Demographic data and central government expenditure details (1994–2004) were taken from UNICEF's The State of the World's Children 2006 report.

Main outcome measures

Under-5 mortality, adjusted maternal mortality, and government expenditure.

Results

21 countries have and 21 countries have not experienced recent conflict in this dataset of 42 countries in SSA. Median under-5 mortality in countries with recent conflict is 197/1000 live births, versus 137/1000 live births in countries without recent conflict. In countries which have experienced recent conflict, a median of 27% of under-5s were moderately underweight, versus 22% in countries without recent conflict. The median adjusted maternal mortality in countries with recent conflict was 1000/100,000 births versus 690/100,000 births in countries without recent conflict. Median reported maternal mortality ratio is also significantly higher in countries with recent conflict. Expenditure on health and education is significantly lower and expenditure on defence significantly higher if there has been recent conflict.

Conclusions

There appears to be an association between recent conflict and higher rates of under-5 mortality, malnutrition and maternal mortality. Governments spend more on defence and less on health and education if there has been a recent conflict. SALW are the main weapon used and France and the UK appear to be the two main suppliers of SALW to SSA.
Yes Sir, no Sir, not much difference Sir
Authors: Clarke Mike , Clarke Lorcan , Clarke Thomas
Published: July 2017

Objective

To assess whether making the sender's knighthood explicit in a series of letters would have any detectable effect on the response.

Design

A random sequence was generated by flipping a coin to determine whether a letter would have ‘Sir Iain Chalmers’ or ‘Iain Chalmers’ typed under the signature. This sequence was prepared independently of the preparation of an alphabetic list of the intended recipients and was then used to determine which letter would be sent. The allocation could not be influenced by prior knowledge of the recipient. Two batches of letters were sent.

Setting

Medical royal colleges and associated faculties, and postgraduate medical and dental schools in the UK.

Participants

Presidents and deans of medical royal colleges and deans of postgraduate medical and dental schools in the UK.

Main outcome measures

Rates of response and the mean number of days between the posting of the original letter and the date on the response.

Results

No differences between the groups were detected in the response rates: 91% and 90% for ‘Sir Iain Chalmers’ and ‘Iain Chalmers’ (relative rate for response of 1.01, 95%CI 0.83–1.23, P=0.92), or in the mean number of days to response (‘Sir’: 32 days; ‘no Sir’: 33 days).

Conclusions

This finding is consistent with a systematic review of responses to postal surveys, in which the effect of the status of the signatory was investigated. Combining our result with the two trials that are most comparable to our study, in which letters from professors were compared with letters from students, gives a relative response rate of 1.00 (95% CI 0.91–1.10, P=0.99). There is, therefore, no evidence from the existing randomized experiments that the status of the signatory has any impact on the likelihood or promptness of response—even if the status was conferred by the British monarch.
Brain ‘imaging’ in the Renaissance
Authors: Paluzzi Alessandro , Belli Antonio , Bain Peter , Viva Laura
Published: July 2017

During the Renaissance, a period of ‘rebirth’ for humanities and science, new knowledge and speculation began to emerge about the function of the human body, replacing ancient religious and philosophical dogma. The brain must have been a fascinating mystery to a Renaissance artist, but some speculation existed at that time on the function of its parts. Here we show how revived interest in anatomy and life sciences may have influenced the figurative work of Italian and Flemish masters, such as Rafael, Michelangelo and David. We present a historical perspective on the artists and the period in which they lived, their fascination for human anatomy and its symbolic use in their art.

Prior to the 16th century, knowledge of the brain was limited and influenced in a dogmatic way by the teachings of Galen 1 who, as we now know, conducted his anatomical studies not on humans but on animals. 2 Nemesus, Bishop of Emesa, in around the year 400 was one of the first to attribute mental faculties to the brain, specifically to the ventricles. He identified two anterior (lateral) ventricles, to which he assigned perception, a middle ventricle responsible for cognition and a posterior ventricle for memory. 2 , 3 After a long period of stasis in the Middle Ages, Renaissance scholars realized the importance of making direct observations on dissected cadavers. Between 1504 and 1507, Leonardo da Vinci conducted experiments to reveal the anatomy of the ventricular system in the brain. He injected hot wax through a tube thrust into the ventricular cavities of an ox and then scraped the overlying brain off, thus obtaining, in a simple but ingenious way, an accurate cast of the ventricles. 2 , 4 Leonardo shared the belief promoted by scholarly Christians that the ventricles were the abode of rational soul.

We have several examples of hidden symbolism in Renaissance paintings, but the influence of phrenology and this rudimentary knowledge of neuroanatomy on artists of that period is under-recognized. In the absence of documentary or scientific evidence as to the real intentions of these painters, the notion of such commixture of sacred and profane remains speculative and probably controversial, but at the same time fascinating and provocative. Here we present three examples of Renaissance masterpieces where such symbolism may have been used, although probably many more exist. Conducting an artistic, philosophical and anatomical analysis of the paintings can be an intriguing exercise, but the interpretation will inevitably be conjectural.
Hypnotherapy in Palliative Care
Authors: Finlay I G , Jones O L
Published: July 2017

Complementary therapies have found increasing vogue in the management of patients with cancer, although little formal evaluation has been undertaken. We report on our experience of offering hynotherapy to palliative care outpatients in a hospice day care setting.

During 2½ years, 256 patients had hypnotherapy, all singly; two-thirds (n=104) were women. Only 13% (n=21) had four or more treatment sessions. At the time of survey, the 52 patients still alive were mailed an evaluation sheet, of whom 41 responded. 61 % reported improved coping with their illness. 7% (n=3) reported harmful or negative effects from hypnotherapy. Amongst those whose coping was unchanged, many found the therapy a pleasant experience. 35 respondents (85%) appended positive comments to their questionnaire returns.

Despite the limitations of a retrospective questionnaire, our findings suggest that hypnotherapy, used within strict guidelines in patients with advanced cancer, is a safe complementary therapy to enhance coping.