bluuebunny/crossref_metadata_2025 huggingface dataset:
A paediatric case of bilateral mandibular condyle fracture presenting with bloody otorrhoea following trauma
Authors: Chan Yat Chun , Au-Yeung Kwan Leong
Published: April 2017

A 7-year-old boy presented to the emergency department with bilateral bloody otorrhoea after falling from his scooter. Skull base fracture was suspected. CT showed no evidence of skull base fracture but bilateral mandibular condyle and external acoustic canals fractures. We report this case to illustrate a rare possibility of bilateral external acoustic canal fracture associated with condylar fracture in trauma patients presented with bloody otorrhoea.
Haemophagocytic lymphohistiocytosis presenting as HELLP syndrome: a diagnostic and therapeutic challenge
Authors: Kerley Robert Noel , Kelly Raymond Michael , Cahill Mary Rose , Kenny Louise Clare
Published: April 2017

Haemophagocytic lymphohistiocytosis (HLH) is a rare, potentially fatal, haematological disorder, which can be clinically challenging to diagnose and manage. We report a case of HLH in a previously healthy 33-year-old primigravida. The patient presented at 22 weeks gestation with dyspnoea, abdominal pain, anaemia, thrombocytopenia and elevated liver enzymes suggestive of HELLP syndrome.HELLP, a syndrome characterised by haemolysis, elevated liver enzymes and low platelets is considered a severe form of pre-eclampsia. Despite delivery of the fetus, her condition deteriorated over 3–4 days with high-grade fever, worsening thrombocytopenia and anaemia requiring transfusion support. A bone marrow biopsy showed haemophagocytosis and a diagnosis of HLH was made. Partial remission was achieved with etoposide-based chemotherapy and complete remission following bone marrow transplantation. Eleven months post-transplant, the disease aggressively recurred, and the patient died within 3 weeks of relapse.
Is lower hip range of motion a risk factor for groin pain in athletes? A systematic review with clinical applications
Authors: Tak Igor , Engelaar Leonie , Gouttebarge Vincent , Barendrecht Maarten , Van den Heuvel Sylvia , Kerkhoffs Gino , Langhout Rob , Stubbe Janine , Weir Adam
Published: April 2017

Background

Whether hip range of motion (ROM) is a risk factor for groin pain in athletes is not known.

Objectives

To systematically review the relationship between hip ROM and groin pain in athletes in cross-sectional/case–control and prospective studies.

Study design

Systematic review, prospectively registered (PROSPERO) according to PRISMA guidelines.

Methods

Pubmed, Embase, CINAHL and SPORTDiscus were systematically searched up to December 2015. Two authors performed study selection, data extraction/analysis, quality assessment (Critical Appraisal Skills Programme) and strength of evidence synthesis.

Results

We identified seven prospective and four case–control studies. The total quality score ranged from 29% to 92%. Heterogeneity in groin pain classification, injury definitions and physical assessment precluded data pooling. There was strong evidence that total rotation of both hips below 85° measured at the pre-season screening was a risk factor for groin pain development. Strong evidence suggested that internal rotation, abduction and extension were not associated with the risk or presence of groin pain.

Conclusion

Total hip ROM is the factor most consistently related to groin pain in athletes. Screening for hip ROM is unlikely to correctly identify an athlete at risk of developing groin pain because of the small ROM differences found and poor ROM measurement properties.
The prevalence of acne in Mainland China: a systematic review and meta-analysis
Authors: Li Danhui , Chen Qiang , Liu Yi , Liu Tingting , Tang Wenhui , Li Shengjie
Published: April 2017

Introduction

Acne, a very common skin disease, can result in psychological distress and sustain impairment in quality of life. Data on the prevalence of acne and the differences in gender, region and age are limited. The aim of this review is to estimate the prevalence of acne in Mainland China comprehensively and to quantify its association with gender, region and age.

Methods

We searched electronic databases with predetermined search terms to identify relevant studies published between 1 January 1996 and 30 September 2016. We pointed out repeated results using Note Express software and evaluated the studies for inclusion. Two independent reviewers extracted the data, followed with statistical analyses using Comprehensive Meta-Analysis software version 2.0. A random effects model was adopted to calculate the overall pooled prevalence and to merge categories, including gender (males and females), region (Northern China and Southern China) and age (primary and secondary students: 7–17 years old; undergraduates: 18–23 years old; overall: no limits of age) for subgroup analyses. Logistic meta-regression analysis was used to clarify the associations between acne and the predictors age, gender and region using OR and their associated 95% CI.

Results

25 relevant studies were included in this meta-analysis. The overall pooled prevalence rates of acne were 39.2% (95% CI 0.310 to 0.479). The prevalence rates in different age groups were 10.2% overall (95% CI 0.059 to 0.171), 50.2% for primary and secondary students (95% CI 0.451 to 0.554), and 44.5% for undergraduates (95% CI 0.358 to 0.534); by gender, the prevalence rates were 35.7% for females (95% CI 0.275 to 0.448) and 39.7% for males (95% CI 0.317 to 0.482); and by region, the prevalence rates were 34.2% for Northern China (95% CI 0.242 to 0.458) and 46.3% for Southern China (95% CI 0.374 to 0.555). The associations between acne and the predictors age, gender and region were statistically significant.

Conclusions

In Mainland China, primary and secondary students exhibited higher prevalence rates than undergraduate students; males had higher prevalence rates of acne than females; and the prevalence rates of acne in Southern China was higher than Northern China.
GPs and paediatric oncology palliative care: a Q methodological study
Authors: Neilson Sue , Gibson Faith , Jeffares Stephen , Greenfield Sheila M
Published: April 2017

Objective

This mixed-methods study set in the West Midlands region of the UK demonstrates the effectiveness of Q methodology in examining general practitioners' (GPs') perception of their role in children's oncology palliative care.

Methods

Using data obtained from the analysis of semistructured interviews with GPs who had cared for a child receiving palliative care at home and bereaved parents, 50 statements were identified as representative of the analysis findings. 32 GPs with a non-palliative child with cancer on their caseload were asked to rank the statements according to their level of agreement/disagreement on a grid. They were then asked to reflect and comment on the statements they most and least agreed with. The data were analysed using a dedicated statistical software package for Q analysis PQMethod V.2.20 (Schmolck 2012). A centroid factor analysis was undertaken initially with 7 factors then repeated for factors 1–6. Varimax and manual flagging was then completed.

Results

4 shared viewpoints were identified denoting different GP roles: the GP, the compassionate practitioner, the team player practitioner and the pragmatic practitioner. In addition consensus (time pressures, knowledge deficits, emotional toll) and disagreement (psychological support, role, experiential learning, prior relationships) between the viewpoints were identified and examined.

Conclusions

Q methodology, used for the first time in this arena, identified 4 novel and distinct viewpoints reflecting a diverse range of GP perspectives. Appropriately timed and targeted GP education, training, support, in conjunction with collaborative multiprofessional working, have the potential to inform their role and practice across specialities.
Randomised positive control trial of NSAID and antimicrobial treatment for calf fever caused by pneumonia
Authors: Mahendran S. A. , Booth R. , Burge M. , Bell N. J.
Published: April 2017

One hundred and fifty‐four preweaning calves were followed between May and October 2015. Calves were fitted with continuous monitoring temperature probes (TempVerified FeverTag), programmed so a flashing light emitting diode (LED) light was triggered following six hours of a sustained ear canal temperature of ≥39.7°C. A total of 83 calves (61.9 per cent) developed undifferentiated fever, with a presumptive diagnosis of pneumonia through exclusion of other calf diseases. Once fever was detected, calves were randomly allocated to treatment groups. Calves in group 1 (NSAID) received 2 mg/kg flunixin meglumine (Allevinix, Merial) for three consecutive days and group 2 (antimicrobial) received 6 mg/kg gamithromycin (Zactran, Merial). If fever persisted for 72 hours after the initial treatment, calves were given further treatment (group 1 received antimicrobial and group 2 received NSAID). Calves in group 1 (NSAID) were five times more likely (P=0.002) to require a second treatment (the antimicrobial) after 72 hours to resolve the fever compared with the need to give group 2 (antimicrobial) calves a second treatment (NSAID). This demonstrates the importance of ongoing monitoring and follow‐up of calves with respiratory disease. However, of calves with fever in group 1 (NSAID), 25.7 per cent showed resolution following NSAID‐only treatment with no detrimental effect on the development of repeated fever or daily live weight gain. This suggests that NSAID alone may be a useful first‐line treatment, provided adequate attention is given to ongoing monitoring to identify those cases that require additional antimicrobial treatment.
Resource competition and apparent competition in declining mule deer (Odocoileus hemionus)
Authors: Wielgus Robert B.
Published: April 2017

Resource competition and apparent competition have both been suggested as the cause of mule deer (Odocoileus hemionus (Rafinesque, 1817)) decline concurrent with white-tailed deer (Odocoileus virginianus (Zimmerman, 1780)) increase. I tested for both hypotheses by conducting a “press” and “release” experiment in a mule deer, white-tailed deer, and cougar (Puma concolor (L., 1771)) community. If resource competition is causal, then predation should decrease, but other sources of mortality should increase following increased mortality of cougars and release of competing white-tailed deer. If apparent competition is causal, then predation should decrease and mule deer should increase following increased mortality of cougars and release of white-tailed deer. I accepted the apparent competition hypothesis because high mortality of female cougars and cougar population decline was associated with both white-tailed deer and mule deer population growth. Very high mortality of female cougars appeared to result in mule deer population recovery. However, high mortality of male cougars (with increased male immigration) preceding high female mortality appeared to result in sexually segregated prey-switching by females with cubs from abundant white-tailed deer to rare mule deer to avoid sexually selected infanticide. High mortality of resident male cougars may have precipitated the mule deer decline in the first place.
Deformation in a North Sea Jurassic trap analysed using a triaxial plane strain experiment
Authors: Rykkelid Erling , Skurtveit Elin
Published: April 2017

A classical Upper Jurassic fault block in the North Sea, the Fulla Structure, has Brent Group sandstones with good reservoir quality and apparently insignificant fault-related reservoir damage. Core data show high-porous sandstones that extend close to the main faults and there is no evidence of catalase, only of soft-sedimentary deformation. Shear bands are relatively thin with high offsets, and have a texture comparable to the wall rock. To investigate the deformation mechanism and products synthetic Brent Group sands are deformed in a triaxial plane strain box with pre-defined effective consolidation in the range of 100–8000 kPa, simulating a burial depth in the range of 10–800 m. This range covers the burial depth at the time of active faulting for most Jurassic traps in the North Sea, including the Fulla Structure. The experiments demonstrate that grain rolling and grain-boundary sliding are the dominant deformation mechanisms at all the simulated burial depths, and this deformation has no impact on the reservoir quality. The experiments concur with observations from the investigated wells and strengthen an interpretation of limited reservoir damage associated with the Late Jurassic fault activity.
Aberrant Pancreatic Tissue in a Mediastinal Enteric Duplication Cyst: A Rarity with Review of Literature
Authors: Mansi Meha , Mahajan Nidhi , Mahana Sonam , Gupta C. R. , Mohta Anup
Published: April 2017

Mediastinal enteric duplication cysts are a rare congenital malformation encountered mainly in neonates and infants. It is a distinct entity within the family of foregut duplication cysts. It can present with respiratory distress due to mass effect and hence surgical excision is the preferred treatment. Histologically, it is characterised by a double layered smooth muscle wall with intestinal lining epithelium. We report a case of mediastinal enteric duplication cyst with aberrant pancreatic tissue in a neonate due to its rarity and early presentation. A neonate presented with respiratory distress and a cystic mass in the right posterior mediastinum. The lesion was excised and on histopathological analysis the diagnosis of mediastinal enteric duplication cyst was made. Also, aberrant pancreatic tissue which has been reported rarely was noted in this case. We discuss this case and review similar cases reported in literature.
Glycogenic Hepatopathy: Resolution with Minimal Glucose Control
Authors: Chandel Abhimanyu , Scarpato Brittany , Camacho Jeanette , McFarland Miles , Mok Shaffer
Published: April 2017

We describe a presentation of glycogenic hepatopathy in a poorly controlled type I diabetic patient. As patients with glycogenic hepatopathy often have nonspecific complaints, diagnosis tends to be delayed and laboratory and imaging data are often indistinguishable from nonalcoholic fatty liver disease. Our patient’s diagnosis of glycogenic hepatopathy required a liver biopsy, which demonstrated the characteristic pathology. Her symptoms resolved with minimal alteration to her insulin regimen and only slightly improved glucose control.
CD73 on T Cells Orchestrates Cardiac Wound Healing After Myocardial Infarction by Purinergic Metabolic Reprogramming
Authors: Borg Nadine , Alter Christina , Görldt Nicole , Jacoby Christoph , Ding Zhaoping , Steckel Bodo , Quast Christine , Bönner Florian , Friebe Daniela , Temme Sebastian , Flögel Ulrich , Schrader Jürgen
Published: April 2017

Background:

T cells are required for proper healing after myocardial infarction. The mechanism of their beneficial action, however, is unknown. The proinflammatory danger signal ATP, released from damaged cells, is degraded by the ectonucleotidases CD39 and CD73 to the anti-inflammatory mediator adenosine. Here, we investigate the contribution of CD73-derived adenosine produced by T cells to cardiac remodeling after ischemia/reperfusion and define its mechanism of action.

Methods:

Myocardial ischemia (50 minutes followed by reperfusion) was induced in global CD73
−/−
and CD4-CD73
−
/−
mice. Tissue injury, T-cell purinergic signaling, cytokines, and cardiac function (magnetic resonance tomography at 9.4 T over 4 weeks) were analyzed.

Results:

Changes in functional parameters of CD4-CD73
−/−
mice were identical to those in global CD73 knockouts (KOs). T cells infiltrating the injured heart significantly upregulated at the gene (quantitative polymerase chain reaction) and protein (enzymatic activity) levels critical transporters and enzymes (connexin43, connexin37, pannexin-1, equilibrative nucleoside transporter 1, CD39, CD73, ecto-nucleotide pyrophosphatase/phosphodiesterases 1 and 3, CD157, CD38) for the accelerated release and hydrolysis of ATP, cAMP, AMP, and NAD to adenosine. It is surprising that a lack of CD39 on T cells (from CD39
−/−
mice) did not alter ATP hydrolysis and very likely involves pyrophosphatases (ecto-nucleotide pyrophosphatase/phosphodiesterases 1 and 3). Circulating T cells predominantly expressed A
2a
receptor (A
2a
R) transcripts. After myocardial infarction, A
2b
receptor (A
2b
R) transcription was induced in both T cells and myeloid cells in the heart. Thus, A
2a
R and A
2b
R signaling may contribute to myocardial responses after myocardial infarction. In the case of T cells, this was associated with an accelerated secretion of proinflammatory and profibrotic cytokines (interleukin-2, interferon-γ, and interleukin-17) when CD73 was lacking. Cytokine production by T cells from peripheral lymph nodes was inhibited by A
2a
R activation (CGS-21680). The A
2b
R agonist BAY 60-6583 showed off-target effects. The adenosine receptor agonist NECA inhibited interferon-γ and stimulated interleukin-6 production, each of which was antagonized by a specific A
2b
R antagonist (PSB-603).

Conclusions:

This work demonstrates that CD73 on T cells plays a crucial role in the cardiac wound healing process after myocardial infarction. The underlying mechanism involves a profound increase in the hydrolysis of ATP/NAD and AMP, resulting primarily from the upregulation of pyrophosphatases and CD73. We also define A
2b
R/A
2a
R–mediated autacoid feedback inhibition of proinflammatory/profibrotic cytokines by T cell–derived CD73.
In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair
Authors: Qin Jinbao , Zhao Zhen , Wang Ruihua , Ye Kaichuang , Li Weimin , Liu Xiaobing , Liu Guang , Cui Chaoyi , Shi Huihua , Peng Zhiyou , Yuan Fukang , Yang Xinrui , Lu Min , Huang Xintian , Jiang Mier , Wang Xin , Yin Minyi , Lu Xinwu
Published: April 2017

Background

Reconstruction of the aortic major branches during thoracic endovascular aortic repair is complicated because of the complex anatomic configuration and variation of the aortic arch. In situ laser fenestration has shown great potential for the revascularization of aortic branches. This study aims to evaluate the feasibility, effectiveness, and safety of in situ laser fenestration on the three branches of the aortic arch during thoracic endovascular aortic repair.

Methods and Results

Before clinical application, the polytetrafluoroethylene and Dacron grafts were fenestrated by an 810‐nm laser system ex vivo, which did not damage the bare metal portion of the endografts and created a clean fenestration while maintaining the integrity of the endografts. In vivo
,
6 anesthetized female swine survived after this operation, including stent‐graft implantation in the aortic arches, laser fenestration, and conduit implantation through the innominate arteries and the left carotid arteries. Based on the animal experiments, in situ laser fenestration during thoracic endovascular aortic repair was successively performed on 24 patients (aged 33–86 years) with aortic artery diseases (dissection type A: n=4, type B: n=7, aneurysm: n=2, mural thrombus: n=7). Fenestration of 3 aortic branches was performed in 2 (8.3%) patients. Both the left carotid artery and the left subclavian artery were fenestrated in 6 (25%) patients. Only left subclavian artery fenestration surgery was done in 16 (66.7%) patients. Among these patients, 1 fenestration was abandoned secondary to an acute takeoff of the innominate artery in a type
III
aortic arch. The average operative time was 137±15 minutes. The technical success rate was 95.8% (n=23). No fenestration‐related complications or neurological morbidity occurred after this operation. During a mean postoperative 10‐month follow‐up (range: 2–17 months), 1 patient died of severe pneumonia, and all the left subclavian artery and carotid artery stents were patent with no fenestration‐related endoleaks upon computed tomography angiography images.

Conclusions

In situ laser fenestration is a feasible, effective, rapid, repeatable, and safe option for the reconstruction of aortic arch during thoracic endovascular aortic repair, which might be available to revascularize the 3 branches. However, follow‐up periods should be extended to evaluate the robustness of this technique.
Generic reclassification of species formerly included in Rhantus Dejean (Coleoptera, Dytiscidae, Colymbetinae)
Authors: BALKE MICHAEL , HÁJEK JIŘÍ , HENDRICH LARS
Published: April 2017

A reclassification of several species traditionally included in Rhantus Dejean, 1833 is given: Nartus Zaitzev, 1907 is re-instated as genus with one species in the Nearctic and one in the Palaearctic region; two new genera are erected: Meri-diorhantus n. gen., with M. antarcticus (Germain, 1854) n. comb., M. calidus (Fabricius, 1792) n. comb., M. limbatus (Aubé, 1838) n. comb., M. orbignyi (Balke, 1992) n. comb., M. validus (Sharp, 1882) n. comb. in the Neotropical region (M. calidus also in the southern USA and along the eastern coast as far north as New York City), and the monotypic Caperhantus n. gen., with C. cicurius (Fabricius, 1787) n. comb. in south Africa. Furthermore, nine Pacific and Australian Rhantus are transferred to the genus Carabdytes Balke, Hendrich & Wewalka, 1992: C. alutaceus (Fauvel, 1883) n. comb., C. guadalcanalensis (Balke, 1998) n. comb., C. monteithi (Balke, Wewalka, Alarie & Ribera, 2007) n. comb., C. novaecaledoniae (J. Balfour-Browne, 1944) n. comb., C. oceanicus (Balke, 1993b) n. comb., C. pacificus (Boisduval, 1835) n. comb., C. plantaris (Sharp, 1882) n. comb., C. poellerbauerae (Balke, Wewalka, Alarie & Ribera, 2007) n. comb. and C. pseudopacificus Balke, 1993b) n. comb. All changes are based on a previous comprehensive molecular phylogenetic analysis of Colymbetinae. Diagnostic characters are given for all genera mentioned above and each of them is illustrated with one or more habitus pictures. An updated key to all genera of Colymbetinae is also given.
An Evaluation of Single-Case Reading Intervention Study Quality for Students With and At Risk for Emotional and Behavioral Disorders
Authors: McKenna John William , Kim Min Kyung , Shin Mikyung , Pfannenstiel Kathleen
Published: April 2017

Researchers have noted the lack of research to guide reading practice for students with and at risk for emotional and behavioral disorders (EBD). Although comprehensive syntheses have identified promising practices and areas for future research, none have evaluated the rigor of studies according to quality indicators. The current study evaluated the extant single-case reading intervention research for this student population according to the What Works Clearinghouse (WWC) standards. Thirty studies met article selection criteria, 20 (66.6%) of which had at least one dependent variable that did not meet design standards. Study findings suggest a need for researchers to employ stronger designs and place a greater emphasis on investigating the effects of reading instructional practices in inclusive settings. Overall, two reading interventions were identified as potentially promising: cognitive mapping and a listening while reading accommodation. Furthermore, findings suggest that it may be advantageous to embed behavioral strategies within reading interventions. Study limitations include the exclusive use of single-case design studies and a reliance on visual analysis to determine intervention effectiveness.
Psychodynamics of Father Daughter Incest
Authors: Cormier Bruno M. , Kennedy Miriam , Sangowicz Jadwiga
Published: April 2017

A study of father-daughter incest confined to men otherwise non-criminal or sexually deviant. Incest is here studied mainly in function of the psychopathology of the father. The father seeks to find in his daughter the young wife of his early years. Unconsciously, however, as a young man he was looking for a mother substitute in the girl he was courting. We face a paradox, that in taking the daughter the incestuous father is trying to return to the mother. Once incest is discovered, there is rarely repetition. Disclosure brings about a breakdown of pre-existing family relations. This is followed either by separation of the participants, or a re-organization where conscious incest barriers now prevail.
Panel II on the Therapies of the Depressive Illnesses Tendon Reflexes as a Guide to the Safe use of Succinylcholine in Medicine
Authors: David J. Impastato
Published: April 2017

Familiarity with certain physiologic and biochemical reactions and factors of succinylcholine (SCh) in man is helpful in safely administering SCh in convulsive therapy and anesthesiology. These reactions and factors are:

1) the natural variations in the titer of butyrylcholinesterase (BChE) in the plasma,

2) the interactions between SCh with BChE,

3) the action of SCh in the congenital absence of BChE,

4) understanding of the mechanism of transmission of the nerve impulse,

5) the action of succinylcholine at the motor end plate.

Discussion of the above reactions and factors are presented. Two physiologic tests are described. These are the 3 mg SCh test dose and the tendon reflex test. The proper application of these two tests make possible the safest use of succinylcholine in convulsive therapy, as well as in other fields of medicine.
Withdrawal Symptoms after Abrupt Termination of Imipramine
Authors: Shatan Chaim
Published: April 2017

The reports and clinical experience cited illustrate the physiological withdrawal reaction which follows abrupt imipramine withdrawal. Many such reactions have probably gone unreported or have been misinterpreted as incipient exacerbations of the process under treatment.

It is suggested that the patient reported here meets the W.H.O. criteria of a true addiction (31).

These findings are discussed in terms of life situation and personality predisposition contributing to development of addiction in this patient at this time. He was in a heightened state of anxious oral dependency and wished to make drug therapy almost a way of life.

The following conclusions are drawn:

1) A drug's specific psychopharmacologic effect cannot be considered without reference to the emotional significance of drugs to the psychiatric patient, i.e. to each patient's characteristic way of responding to the drug experience.

2) Withdrawal phenomena may interfere with the evaluation of change due to treatment, or may seem to produce a clinically worse patient. This possibility should be considered when a trial without drugs produces symptoms like those which led to treatment.

3) Imipramine and most psychotropic drugs should be withdrawn gradually, especially following prolonged treatment, and in addicted patients. If abstinence symptoms develop, the dosage should be increased and then gradually withdrawn again over a longer period.

4) The imipramine withdrawal syndrome appears to be non-specific and morphine-like. This suggests the speculation that imipramine belongs to the group of physiological C.N.S. ‘depressants’.
A Critical Review of Endogenous Psychotoxins as a Cause of Schizophrenia
Authors: Throne M.L. , Gowdey C.W.
Published: April 2017

The concept of a chemical cause of schizophrenia is as old as the Hippocratic School. The idea gained favour after Thudicum postulated that insanity was caused by poisons fermented within the body and that chemical studies could isolate the poisons and discover antidotes. Research with chemical compounds capable of inducing ‘experimental psychoses’ led to a revival of interest in the toxic theory, and the development of new biochemical techniques intensified the search for a biochemical lesion in schizophrenia. Claims that a variety of abnormal metabolites or unusual amounts of normal metabolites are found in mental patients have been made, including: adrenal corticosteroids, imidazoles, adrenal medullary and other catecholamines, adrenochrome and other possible catecholamine metabolites, 5-hydroxy tryptamine, various indoles, copper-containing compounds (ceruloplasmin) and even histamine. It was also claimed that transfusions of normal blood caused transient improvement of schizophrenics and, conversely, that blood from schizophrenic patients contained a toxic substance which could produce abnormal behaviour in human volunteers, trained monkeys and rats. Toxic effects have been reported following administration of fractions from ‘schizophrenic’ blood or other body fluids in a variety of biochemical and physiological procedures and in a variety of organisms; mice, tadpoles, crabs, pigeons, spiders, larvae, seeds, molds and fungi. Most of these claims have been disputed: the abnormal substances are not present, or not present in higher concentrations in schizophrenics, or not capable of inducing measurable behavioural changes.

Appealing as the chemical concept is, no unequivocal, substantiated evidence for it has yet been produced.
Syndrome De Lasthenie De Ferjol: Approche Psychopathologique
Authors: Gosselin J.-Y. , Delage J.-M. , Pomerleau G.
Published: April 2017

The authors' intention is to illustrate the case of two patients treated for anaemia caused by a bleeding cunningly baited and repeated, the origin of which has only been found after several surgical explorations. Even if the splenectomy, the gastrotomy, and in one case, the ablation of the colon has been made, the symptoms have remained unchanged.

In presuming that this syndrome, seldom discussed in the medical literature, is chiefly found amongst the para-medical personnel, they first try to describe the profile of a such typical personality, then they develop a phenomenological and a dynamic approach. They assume that for these patients the anaemia answers to a need to be explored in order to get rid of a bad introjected object.

In the case they have studied the patient presents a pre-psychotic personality with a poor prognosis; this is due to the difficulty of establishing an adequate transference and to a certain ambivalent motivation toward the treatment.

Evolution toward a paranoid syndrome or the event of a suicidal acting out are amongst the most likely complications.
Family Therapy Drop-Outs: Resistance to Change
Authors: Solomon Martin L.
Published: April 2017

This paper presents an analysis of resistance to change in family therapy — a concept central to the understanding of drop-outs. The resistances used were categorized as Resistance to Therapy, Resistance to Interaction and Family Specific Resistances. Family behaviour was conceptualized as governed by homeodynamic patterns, self-reinforcing modes of interaction in which the primary emphasis is on the preservation of stability. Five families who dropped out of therapy after up to 17 sessions were described in detail. They had consulted for psychiatric symptoms presented by one or more children, and were treated by the author in weekly conjoint family sessions. The dynamic interplay of resistance and change was apparent in all five cases where family members resisted working through the marital conflict, and disrupted treatment when imminent change in the husband-wife relationship was perceived as a threat to family stability. The discussion dealt with the crucial role of the parental couple's strengths and weaknesses as a prognostic indicator, the importance of re-assessing treatment goals after the family is fully engaged in therapy, and the role of the therapist in provoking drop-out. In addition, the drop-outs were compared to families who remained in therapy.
Interpersonal Interaction and Personality Change in Group Psychotherapy
Authors: Coons W. H. , Peacock E. P.
Published: April 2017

The study was concerned with comparing the efficacy of three forms of social interaction in modifying the behaviour of mental hospital patients. Eight groups of seven patients each were assigned, in a simple randomized design, to combinations of Formal Group Psychotherapy (conducted by a professionally trained therapist), Organized Ward Interaction (conducted by untrained group leaders), or Random Ward Interaction (no planned therapy). Equal numbers of male and female groups were involved.

The dependent variables were: 1) The Wechsler Adult Intelligence Scale; 2) The Hospital Adjustment Scale; 3) The Rorschach Technique of Personality Diagnosis.

Formal Group Psychotherapy emerged as the only treatment condition which had a significant impact, alone or in combination with other treatment, on all three criterion measures. It was concluded that judgement must be reserved on the contention of several authors that traditional professional training in psychotherapy is unnecessary for the promotion of therapeutic change.
Three Challenges
Authors: Smith Colin Mcpherson
Published: April 2017

“Les hommes qui ont une foi excessive dans leurs théories ou dans leurs idées sont non seulement mal disposés pour faire des découvertes, mail ils font aussi de très mauvaises observations … L'esprit vraiment scientifique devrait donc nous rendre modestes et bienveillants. Nous savons tous bien peu de chose en réalité, et nous sommes tous fallibles en face des difficultés immenses que nous offre l'investigation dans les phénomènes naturels. Nous n'aurions donc rien de mieux à faire que de réunir nos efforts au lieu de les diviser et de les neutraliser par les disputes personnelles.”

Claude Bernard (7)

“Il n'y a point de doctrine plus propre à l'homme que celle là: qui l'instruit de sa double capacité de recevoir et de perdre la grâce, à cause du double péril où il est toujours exposé de désespoir ou d'orgueil.”

B. Pascal (63)
Children of Immigrants: The Adjustment of Ugandan Asian Primary-School Children in Canada
Authors: Minde K. , Minde R.
Published: April 2017

The study examines the psychological and academic adjustment to Canada of 51 Ugandan Asian primary school-aged children and their families. Twenty-six percent of all the children showed significant psychopathology and about 50 percent had difficulties in certain academic subjects. The psychopathology of the children was significantly correlated with the family's drop in income and professional prestige.

The children's parents predominantly worked in unskilled jobs and all family members had made only very few personal contacts with white Canadians. Nevertheless a significant number of families were under great stress as female members rebelled against their traditional roles. These findings are discussed in relation to other studies dealing with recent immigrants.
A Brief Scale for Predicting Rehospitalization of Former Psychiatric Patients
Authors: Willer Barry , Gary H. Miller
Published: April 2017

Community adjustment of former psychiatric patients has been found to relate highly to the likelihood of rehospitalization and community tenure. The present study examined the ability of a community adjustment scale and various other patient characteristics to predict rehospitalization. Multiple regression analysis using rehospitalization as the dependent variable identified thirteen items including twelve from the community adjustment scale, which combined to provide a highly accurate prediction. The brief scale (13 items) which is now being cross-validated is potentially a useful tool for clinical evaluation and planning of follow-up services to former patients.
Charging a Patient with Assault of a Nurse on a Psychiatric Unit*
Authors: Schwarz Conrad J. , Greenfield Gregory P.
Published: April 2017

A patient was successfully charged with assault of a nurse on a Psychiatric Unit and was placed on probation for one year. The judge found her guilty despite the location of the incident and her 20-year history of previous psychiatric treatment, including 14 hospitalizations. Following this confrontation, the patient improved markedly in her behaviour and has continued to lead a more productive life without hysterical outbursts. It is concluded that proceeding with legal charges in such a situation is justifiable and can also be therapeutic.
Memories and Engrams a Clinical Viewpoint
Authors: Kral V.A.
Published: April 2017

Memory research is based on the assumption that a more or less permanent trace of previous experience, an “engram”, is being laid down somewhere in the brain and memory research is still “the search of the engram”. However, the clinician engaged in memory research has to be aware of the fact that he is dealing with memories and behavioural change, but not with engrams. Nevertheless, clinicopathological studies as well as the introduction of animal experiments into memory research using stimulation ablation and chemical methods have led to some progress in the search of the engram.

The parallelism of the clinical observations and the experimental studies seems to indicate that one has to differentiate two kinds of memory trace, a short term trace which under normal conditions becomes consolidated into a permanent trace, while pathologically, the consolidation process does not take place. There are reasons to believe that the short term trace may be initiated or even maintained for a short time electrophysiologically by reverberating circuits in certain cell assemblies. This may set into action changes at the synapses probably by means of cholinergic and/or adrenergic enzyme systems. The mode of action of the electrophysiological and biochemical changes underlying short term retention, however, is only poorly understood and this also applies to the biochemical changes which are assumed to take place during the consolidation process and which eventually form the basis of the permanent engram.

The clinicopathological findings seem to indicate that the short term memory traces of human experiences, which are always multisensorial, are distributed over the various relevant neocortical areas. The specific partial short term memory traces are integrated at first by the factor of temporal contiguity and form the basis of short term personal memories which characterize the memory function in clouded states and in chronic amnestic syndromes. The cortex seems also to be responsible for the consolidation of the “partial memories” while a bilaterally intact limbic system is necessary for the integration of the short term memory traces into consolidated long term engrams of “personal memories”.
Prognosis of Mental Illness in Old Age: A Four Year Follow-up Study
Authors: Duckworth G.S. , Kedward H.B. , Bailey W.F.
Published: April 2017

This paper describes a four year follow-up study of psychogeriatric patients in Toronto, arising from collaboration with the U.S.-U.K. cross-national study of psychogeriatric disorders. The findings of the study are threefold: First, compared to Roth's study two decades ago, the present sample shows a decline in mortality of patients suffering from senile dementia with a corresponding increase in the need for treatment facilities for this group. Paraphrenic patients on the other hand were discharged earlier and in greater numbers, indicating an improvement in the treatment of this condition. There was no change in the discharge rate of patients with mood disorders despite the much touted use of antidepressant medications. The second finding was that patients with functional disorders were more rapidly discharged in Canada and the U.S. compared to the U.K., possibly indicating a greater pressure to discharge patients early in North America compared to Britain. Finally, the diagnostic categories had a very significant validity in predicting outcome, with organically demented patients being dead or in hospital at follow-up. The best prognosis was displayed by patients with affective disorders, two-thirds of whom were discharged to the community by 90 days. An intermediate prognosis was demonstrated by patients suffering from schizophrenia and miscellaneous functional disorders, nearly half of whom were discharged to the community in 90 days. The implications for management are discussed.
The Nature and Consequences of Forensic Psychiatric Decision-Making
Authors: Menzies Robert J. , Jackson Margaret A. , Glasberg Rhoda E.
Published: April 2017

Data collected from the Metropolitan Toronto Forensic Service (METFORS) were examined to determine factors affecting psychiatric assessments completed for the courts. Psychiatric history is found to be a salient factor for fitness to stand trial decisions; prior violence and the type of charge influence dangerousness to others determinations. Variables affecting whether or not a patient is recommended for further assessment include fitness: 78% of those found fit and 100% of those for whom fitness was unclear were recommended for more extensive examination. Patients diagnosed as mentally disordered were recommended for further assessment in 68% of the cases. Patients who were threatening or acting out were not for the most part hospitalized. Relatively high correlations between psychiatric recommendations derived from these assessments and the actual judicial dispositions suggest that knowledge of the extra legal factors and biases which enter into the decisions should be more widely considered in the legal setting.
Reasons for Involuntary Commitment in Manitoba and Ontario
Authors: Richert R. A. , Moyes A. H.
Published: April 2017

This paper concerns itself with the question of involuntary commitment of psychiatric patients in southwestern Manitoba. The purpose was to survey the reasons given for involuntary psychiatric hospitalization by a group of Manitoba physicians in 1979, and to compare these reasons with those given by their Ontario counterparts, as described in the Page and Yates (1) and Page and Firth (2) studies. Particularly, the aim was to compare the relative emphasis given to dangerousness / self-harm reasons, in view of the fact that Manitoba's Mental Health Act makes no explicit reference to the dangerousness criterion, while Ontario's legislation has increasingly specified this factor as a necessary condition for civil commitment.
Massive Eosinophilic Reaction to Desipramine in Conjunction with Pneumonia*
Authors: Kraus R.P. , Clarke R.J. , Remick R.A.
Published: April 2017

The authors report on a female patient with bipolar affective disorder who presented with marked eosinophilia in conjunction with pneumonia five days after a medication change from amitriptyline to desipramine (for intolerable dry mouth). She improved with discontinuance of medications and supportive management, and her eosinophilia normalized. Reinstitution of desipramine was followed by prompt appearance of asymptomatic eosinophilia, which resolved with discontinuation of desipramine. A subsequent depression managed with amitriptyline was followed by no abnormal white blood count findings.

Eosinophilia is occasionally encountered in imipramine or desipramine therapy and, although usually asymptomatic, appears to be manageable by switching to amitriptyline or nortriptyline.
The Course of Elderly Depressed Out-patients
Authors: Cole Martin G.
Published: April 2017

Fifty-five elderly depressed in-patients were followed up for 24 to 63 months, mean 48 months. Thirty-eight cases remained well more than 60% of the follow-up period and seventeen cases remained more or less chronically ill. These results are comparable with follow-up studies of elderly depressed in-patients. It is suggested that treatment compliance, absence of physical disability, long term follow-up and maintenance anti-depressant therapy in many cases are associated with favorable outcome.
Day Treatment for Alcoholism in a General Hospital Psychiatric Service
Authors: Malla Ashok K. , Cooper Gerry
Published: April 2017

In this paper a time limited, cost effective day treatment program for alcoholics, and characteristics of patients entering this treatment program, are described. The advantages of this day treatment program are discussed with special emphasis on its relationship with other community service agencies, with the community at large and, with a General Hospital Mental Health service, of which it is apart. The implications for planning cost effective treatment services for alcoholics are discussed.
On Transference: Developmental and Clinical Considerations
Authors: Lester Eva P.
Published: April 2017

Following a short historical overview of the evolution of the concept of transference, the factors involved in this process are examined. The developmental or dynamic aspects of transference, that is, its illusory character defined by the “potential space” within which transference develops, and the importance of the holding environment at the early stages of therapy for an optimal development of transference are discussed. To understand resistances, Merton Gill's distinction of resistances to the awareness of the transference, and resistances to the resolution of the transference are particularly relevant. Finally, the concept of transference neurosis is focused upon. Detailed clinical vignettes are given to illustrate the points made. Although the clinical material is taken from sessions of patients in analysis the theoretical implications pertaining to the transference are equally applicable to the practice of psychoanalytic psychotherapy. It is in this spirit that throughout the paper the terms “therapeutic” and “analytic” are used interchangeably.
A Model for Predicting Utilization of Psychiatric Facilities
Authors: Miller Gary H. , Dear Michael , Streiner David L.
Published: April 2017

This paper develops a parsimonious model for predicting utilization of a regional system of psychiatric facilities based on census data. The model combines conceptual simplicity with readily-available data sources. In practical terms, the model removes the need to undertake comprehensive and expensive utilization surveys. In theoretical terms, the model indicates that the fundamental relationship between utilization rates and key social indicators is stable through time. Although further testing is necessary, it would seem that these key indicators can provide reasonable estimates of psychiatric morbidity for up to ten years in the future.
Diagnostic Applications of Sleep Deprivation
Authors: Letemendia F.J.J. , Prowse A.W. , Southmayd S.E.
Published: April 2017

Four cases are described in which observation of the response to forty hour sleep deprivation was used in resolving the differential diagnosis between depression and dementia. In each case it was possible to conduct psychometric assessment of cognitive ability during the period of improvement of the clinical state. The utility of this approach and some of the difficulties associated with its use are discussed.
Social Support and Married Agoraphobic Women
Authors: Pyke Jennifer , Roberts Jacqueline
Published: April 2017

This study was conducted to determine if a relationship exists between social support and agoraphobia. Married agoraphobic women from a support group for phobics were compared with married, non-agoraphobic women from Family Practice clinics, and social support factors were examined. The agoraphobic women were found to perceive their husbands as less supportive. As well, there were important reductions in network size and network support in these agoraphobic women.
What Price Insanity?
Authors: Brooks Simon A.
Published: April 2017

The insanity defence in Canada is defined by the use of Section 16 of the Criminal Code. Legal sanity is determined by the application of an outdated set of rules which require only that the accused be able to determine right from wrong in the particular circumstances that appear to have applied at the time of the alleged offence. The actual application of the defence suggests that its interpretation in practice is considerably affected by factors other than the mental state of the accused. The arbitrary and ill-understood nature of these interposed factors removes any certainty that justice, or the well-being of the accused, is to be found by use of the existing law. Psychiatry should not rest content that its understanding of the determinants of human behavior is in any way accurately represented by Canada's Criminal Code.