bluuebunny/crossref_metadata_2025 huggingface dataset:
Atypical Clinical Features of Pediatric Appendicitis
Authors: Becker Theresa , Kharbanda Anupam , Bachur Richard
Published: December 2006

Background

The diagnosis of appendicitis remains challenging in children. Delays in diagnosis, or misdiagnosis, have important medical and legal implications. The typical, or classic, presentation of pediatric appendicitis has been modeled after adult disease; however, many children present atypically with subtle findings or unusual signs.

Objectives

To determine the frequency of atypical clinical features among pediatric patients with appendicitis and to investigate which atypical features are the strongest negative predictors for appendicitis among patients being evaluated for appendicitis.

Methods

Children and adolescents with suspected appendicitis were enrolled over 20 consecutive months. Pediatric emergency physicians completed standardized data collection forms on eligible patients. Final diagnosis was determined by pathology or follow‐up telephone call. Typical and atypical findings were defined strictly a priori.

Results

Seven hundred fifty‐five patients were enrolled. The median age was 11.9 years (interquartile range [IQR]: 8.5, 14.9 yr); 36% of patients were diagnosed with appendicitis. Among patients with appendicitis, the most common atypical features included absence of pyrexia (83%), absence of Rovsing's sign (68%), normal or increased bowel sounds (64%), absence of rebound pain (52%), lack of migration of pain (50%), lack of guarding (47%), abrupt onset of pain (45%), lack of anorexia (40%), absence of maximal pain in the right lower quadrant (32%), and absence of percussive tenderness (31%). Forty‐four percent of patients with proven appendicitis had six or more atypical characteristics. The median number of atypical features for patients with proven appendicitis was five (IQR: 4.0, 7.0). The greatest negative predictors, on the basis of likelihood ratios, were as follows: white blood cell count (WBC) of <10,000 per cubic millimeter (likelihood ratios [LR], 0.18), absolute neutrophil count (ANC) of <7,500 per cubic millimeter (LR, 0.35), lack of percussive tenderness (LR, 0.50), lack of guarding (LR, 0.63), and no nausea or emesis (LR, 0.65).

Conclusions

Appendicitis in pediatric patients is difficult to diagnose because children present with a wide variety of atypical clinical features. Forty‐four percent of patients with appendicitis presented with six or more atypical features. Two atypical features are the strongest negative predictors of appendicitis in children: WBC of <10,000 per cubic millimeter and an ANC of <7,500 per cubic millimeter.
Multicenter Phase II Trial of Chemoradiation With Oxaliplatin for Rectal Cancer
Authors: Rödel Claus , Liersch Torsten , Hermann Robert Michael , Arnold Dirk , Reese Thomas , Hipp Matthias , Fürst Alois , Schwella Nimrod , Bieker Michael , Hellmich Gunter , Ewald Hermann , Haier Jörg , Lordick Florian , Flentje Michael , Sülberg Heiko , Hohenberger Werner , Sauer Rolf
Published: December 2006

Purpose

To evaluate the activity and safety of preoperative radiotherapy (RT) and concurrent capecitabine and oxaliplatin (XELOX-RT) plus four cycles of adjuvant XELOX in patients with rectal cancer.

Patients and Methods

One hundred ten patients with T3/T4 or N+ rectal cancer were entered onto the trial in 11 investigator sites and received preoperative RT (50.4 Gy in 28 fractions). Capecitabine was administered concurrently at 1,650 mg/m2 on days 1 to 14 and 22 to 35, and oxaliplatin was administered at 50 mg/m2 on days 1, 8, 22, and 29. Surgery was scheduled 4 to 6 weeks after completion of XELOX-RT. Four cycles of adjuvant XELOX (capecitabine 1,000 mg/m2 bid on days 1 to 14; oxaliplatin 130 mg/m2 on day 1) were administered. The main end points were activity as assessed by the pathologic complete response (pCR) rate and the feasibility of postoperative XELOX chemotherapy.

Results

After XELOX-RT, 103 of 104 eligible patients underwent surgery; pCR was achieved in 17 patients (16%), one patient had ypT0N1 disease, and 53 patients showed tumor regression of more than 50% of the tumor mass. R0 resections were achieved in 95% of patients, and sphincter preservation was accomplished in 77%. Full-dose preoperative XELOX-RT was administered in 96%. Grade 3 or 4 diarrhea occurred in 12% of patients. Postoperative complication occurred in 43% of patients. Sixty percent of patients received all four cycles of adjuvant XELOX, with sensory neuropathy (18%) and diarrhea (12%) being the main grade 3 or 4 toxicities.

Conclusion

Preoperative XELOX-RT plus four cycles of adjuvant XELOX is an active and feasible treatment. This regimen is proposed for phase III evaluation comparing standard fluorouracil-based treatment with XELOX- based multimodality treatment.
Outcome After Radiotherapy Alone for Metastatic Spinal Cord Compression in Patients With Oligometastases
Authors: Rades Dirk , Veninga Theo , Stalpers Lukas J.A. , Basic Hiba , Rudat Volker , Karstens Johann H. , Dunst Juergen , Schild Steven E.
Published: December 2006

Purpose

To investigate outcome and prognosis of metastatic spinal cord compression (MSCC) patients with oligometastatic disease treated with radiotherapy alone.

Patients and Methods

Oligometastatic disease was defined as involvement of three or fewer vertebrae and lack of other bone or visceral metastases. Five hundred twenty-one patients with oligometastatic disease and MSCC were evaluated for functional outcome, ambulatory status, local control of MSCC, and survival. Furthermore, seven potential prognostic factors were investigated.

Results

Motor function improved in 40% (n = 207), remained stable in 54% (n = 279), and deteriorated in 7% (n = 35) of patients. Fifty-eight (54%) of 107 nonambulatory patients became ambulatory, and 388 (94%) of 414 ambulatory patients remained ambulatory. Improved functional outcome was significantly associated with tumor type and slower development of motor deficits (> 14 days). Local control at 1, 2, and 3 years was 92%, 88%, and 78%, respectively. Improved local control was significantly associated with long-course radiotherapy. Survival at 1, 2, and 3 years was 71%, 58%, and 50%, respectively. Better survival was significantly associated with tumor type, ambulatory status, slower development of motor deficits, and long-course radiotherapy. Patients who developed motor deficits slowly (onset > 14 days before initiating treatment) were further analyzed. In this subgroup, the best results were observed for myeloma/lymphoma and breast cancer patients. No patient had progression of motor deficits. One hundred percent (myeloma/lymphoma) and 99% (breast cancer) of patients were ambulatory after radiotherapy. One-year local control was 100% and 98%, 1-year survival was 94% and 89%.

Conclusion

Given the limitations of a retrospective review, improved outcome of patients with oligometastatic MSCC was associated with myeloma/lymphoma and breast cancer, slower development of motor deficits, and a more prolonged course of radiation.
Relaxin Antagonizes Hypertrophy and Apoptosis in Neonatal Rat Cardiomyocytes
Authors: Moore Xiao-lei , Tan Su-ling , Lo Chen-yi , Fang Lu , Su Yi-Dan , Gao Xiao-Ming , Woodcock Elizabeth A. , Summers Roger J. , Tregear Geoffrey W. , Bathgate Ross A. D. , Du Xiao-Jun
Published: January 2007

The pregnancy hormone relaxin has recently been shown to be cardio-protective. Despite its well-established antifibrotic actions in the heart, the effects of relaxin on cardiomyocytes (CM) remain to be determined. We investigated effects of isoform 2 of the human relaxin (H2-relaxin) on CM hypertrophy and apoptosis. In cultured neonatal rat CM, phenylephrine (50 μm) and cardiac fibroblast-conditioned medium were used respectively to induce CM hypertrophy. The degree of hypertrophy was indicated by increased cell size, protein synthesis and gene expression of atrial natriuretic peptide. Although H2-relaxin (16.7 nm) alone failed to suppress hypertrophy induced by phenylephrine, it repressed the cardiac fibroblast-conditioned medium-induced increase in protein synthesis by 24% (P < 0.05) and reversed the increase in cell size (P < 0.001) and atrial natriuretic peptide expression (P<0.01). We further studied the effect of H2-relaxin on CM apoptosis induced by H2O2 (200 μm). Studies of DNA laddering and nuclear staining demonstrated that H2-relaxin treatment reduced H2O2-induced DNA fragmentation. Real-time PCR and Western blot analysis revealed a significant increase in the Bcl2/Bax ratio in H2-relaxin-treated CM. Further analysis showed that activation of Akt (1.8-fold, P< 0.001) and ERK (2.0-fold, P<0.01) were involved in the antiapoptotic action of H2-relaxin in CM, and that Gi/o coupling of relaxin receptors was associated with the H2-relaxin-induced Akt activation in CM. In conclusion, these results extend our current knowledge of the cardiac actions of relaxin by demonstrating that H2-relaxin indirectly inhibits CM hypertrophy and directly protects CM from apoptosis.
Immigration medical screening and HIV infection in Canada
Authors: Zencovich M , Kennedy K , MacPherson D W , Gushulak B D
Published: December 2006

HIV infection, particularly associated with AIDS, is often used by migrant screening nations to exclude entry into the country. The unique feature of the Canadian immigration HIV screening programme is that it was not primarily for determining inadmissibility of HIV-positive applicants, but for health promotion and disease prevention purposes. All applicants over 15 years of age for permanent residency or temporary residency from designated countries are HIV antibody tested. This includes persons seeking asylum from within Canada. The highest rates of HIV infection were found in migrant applicants from high prevalence areas of the world and reflected the demographic profile of the source region (predominately women). The majorities of HIV-positive persons are exempt from exclusion from Canada due to class of application (refugee, family) or are already in Canada (refugee claimant). Significant issues in notification, reporting and programme management have been identified as a consequence of this programme.
Betadine for herpes simplex infection
Authors: Waters L J , Barton S E , Boag F C
Published: December 2006

The clinical value of aciclovir, oral or topical, in the episodic treatment of recurrent herpes virus infection is limited. Betadine (povidone-iodine) could provide a cheap, effective alternative for managing symptomatic recurrences. We describe a case where povidone-iodine was used successfully to treat a recurrence of genital herpes simplex and review the literature supporting povidone-iodine in the treatment of genital tract infections.
High HIV prevalence among patients choosing anonymous and free testing in Belgium, 1990–2002
Authors: Sasse A , Vincent A , Galand M , Ryckmans P , Liesnard C
Published: December 2006

From 1990 through 2002, 25,250 anonymous and free HIV tests were performed at a testing site, which carried out the majority (85%) of anonymous testing in Belgium. During the same period, approximately 7.3 million confidential tests were registered nationwide.

The rate of new HIV infections diagnosed at the anonymous testing site was 11.1/1000 tests; it was significantly higher than the rate observed among confidential tests (relative risk = 7.41; P < 0.0001). New HIV cases diagnosed through anonymous testing include a higher proportion of young adults (42.0% versus 32.5% in confidential testing; P < 0.001) and a higher proportion of men who have sex with men (32.7% vs. 25.9% in confidential testing; P < 0.02). Anonymous and free HIV testing was particularly sought by persons with higher infection risk, and efficiently contributed to HIV diagnosis in this population. Anonymous and free testing should be and remain an accessible alternative integrated in HIV testing policies.
Audit of the management of genital herpes simplex infection
Authors: Matin R N , Brady M , Poulton M
Published: December 2006

We evaluated the management of genital herpes simplex virus (HSV) infection at our clinic. Over six months, 135 patients with primary HSV and 97 patients with recurrent HSV attended. Sixty percent of patients presenting within five days of primary infection were treated with oral acyclovir. Only 53% of patients with primary HSV were given written/verbal information. Follow-up appointments were attended by 78%. Seventy-seven percent of patients with recurrent HSV had at least one viral isolate typed and 72% of patients experiencing episodes exceeding, annually, six were offered suppressive therapy. Our results demonstrate successful management of patients with HSV infections but recommendations are made to reach the standards set by BASSH. Furthermore, we illustrate that improved documentation would go a long way in validating the result.
Mentoring in genitourinary medicine
Authors: Coyne K M , Maw R , Rooney G , Cohen C
Published: December 2006

Mentoring is a process whereby one doctor (the mentor) facilitates and encourages another doctor (the mentee) to develop their career, in light of their own priorities. Mentees benefit from time dedicated to addressing their needs, challenging the status quo, and exploring ways to change. Mentoring schemes depend on the availability and enthusiasm of suitably trained mentors, as well as the voluntary participation of mentees. The specialty of genitourinary (GU) medicine is setting up such a scheme, which will initially be offered to new consultants. Workshops to train mentors are starting that are specifically tailored to our specialty. We discuss the principles and benefits of mentoring, different models that can be used, and potential difficulties. We also present the results of a survey that demonstrated widespread interest in mentoring within GU medicine.
Presentation and reasons for HIV-1 testing in Saudi Arabia
Authors: Alrajhi A A , Halim M A , Al-Abdely H M
Published: December 2006

Clinical presentation, CD4+ T lymphocyte count at diagnosis, and reasons for HIV-1 testing reflect the attitudes towards HIV testing and also the ability of the health-care system to diagnose HIV early. In a cross-sectional study from the HIV database in a large HIV-referral centre in Saudi Arabia, all 410 HIV-infected patients were included, 276 men and 134 women. Women were younger at diagnosis (mean age 25.5 compared with 29 years for men, P < 0.04) and had higher CD4+ T lymphocytes (mean 461 for women and 223 for men, P < 0.001). Out of 276 men, 90 (33%) were identified as HIV infected when they presented with AIDS. Fifty-five percent of the infected women were tested for HIV-1 because of contact with an infected person compared with 8% of the infected men, odds ratio (OR) 13.8 (95% confidence interval [CI]: 7.7–24.9). AIDS remains the main presentation for HIV-infected men. Women are diagnosed earlier and younger than men.
Lessons learned from a population-based chlamydia screening pilot
Authors: Götz Hannelore M , van Bergen Jan E A M , Veldhuijzen Irene K , Hoebe Christian J P A , Broer Jan , Coenen A J J , de Groot F , Verhooren M J C , van Schaik D T , Richardus Jan H
Published: December 2006

We evaluated process organization and response optimization in a home-based Chlamydia trachomatis (Ct) screening project in the Netherlands among 15- to 29-year-old women and men. The method used was computer-supported data flow, from population sampling to informing participants of the result. A new test kit or a letter reminded non-respondents after six weeks. Fifteen-year olds required parental consent. Urine arrived at the laboratory within 29 days from invitation, and four (1–11) days after collection, indicating good specimen quality. Test kits had a higher response than letters (15 versus 10%). Response in 15-year olds was 33%; with 2% Ct infected sexually active 15 year olds. In Conclusion, purpose made computer software is essential for an efficient screening programme. Sending urine by mail does not impair diagnostics. Reminders are necessary and effective after four weeks. Necessary parental consent for under 16-year olds should not be a deterrent to offer Ct screening to this age group.
Reduced fertility among HIV-infected women associated with viral load in Rakai district, Uganda
Authors: Nguyen Ruby H N , Gange Stephen J , Wabwire-Mangen Fred , Sewankambo Nelson K , Serwadda David , Wawer Maria J , Quinn Thomas C , Gray Ronald H
Published: December 2006

We assessed whether HIV-1 viral load affects the likelihood of live birth among HIV-positive women in a nested case–control study of HIV-positive women from a community cohort in Rakai District, Uganda. Cases were women who had a live birth ( n = 270), and controls were sexually active women who did not use contraception and did not become pregnant during follow-up ( n = 263). In women with a live birth and non-pregnant controls, median HIV viral loads were 4.12 log10 copies/mL and 4.41 log10 copies/mL, respectively ( P = 0.001). A non-linear association was observed, and a segmented linear regression with spline knot at 4.5 log10 copies/mL was fit. We observed a decline in the log (adjusted odds ratio [adj. OR])= −0.08 (95% confidence interval [CI]: −0.36, 0.20) between 3.0 and 4.49 log10 viral load and −0.92 (95% CI: −1.21, −0.63) between 4.5 and 6.5 log10 viral load. The two reductions differed significantly from one another ( P < 0.001). Each increase in log10 viral load after 4.5 log10 resulted in an adj. OR of live birth which was 12% of the previous viral load category. Our data suggest that there may be considerable differences in the ability to produce a live birth among HIV-positive women with high viral loads.
Increasing resistance to ciprofloxacin and other antibiotics in Neisseria gonorrhoeae from East Java and Papua, Indonesia, in 2004 – implications for treatment
Authors: Sutrisna A , Soebjakto O , Wignall FS , Kaul S , Limnios EA , Ray S , Nguyen N-L , Tapsall J W
Published: December 2006

We examined gonococci isolated in 2004, in East Java and Papua, Indonesia, to review the suitability of ciprofloxacin-based and other treatment regimens. Gonococci from the two provinces were tested in Sydney for susceptibility to penicillin, tetracycline, spectinomycin, ceftriaxone, ciprofloxacin, gentamicin, azithromycin and rifampicin. Of 163 gonococcal isolates from East Java (91) and Papua (72), 120 (74%) of gonococci, 62 (68%) and 58 (80%) from East Java and Papua, respectively, were penicillinase-producing gonococci and 162 displayed high-level tetracycline resistance. Eighty-seven isolates (53%) were ciprofloxacin resistant, 44 (48%) from East Java and 43 (60%) from Papua. All isolates were sensitive to cefixime/ceftriaxone, spectinomycin and azithromycin. Minimum inhibitory concentrations of gentamicin were in the range 0.05–8 mg/L. Sixty-nine gonococci (42%) showed combined resistance, to penicillin, tetracycline and quinolones. Quinolone resistance has now reached unacceptable levels, and their use for the treatment of gonorrhoea in Indonesia should be reconsidered.
Survey of HIV and hepatitis B or C co-infection management in the UK 2004
Authors: de Silva S , Brook M G , Curtis H , Johnson M ,   The British HIV Association Audit Committee
Published: December 2006

The objective of this study is to evaluate the current management practices of patients with HIV and hepatitis B or C co-infection. A postal survey was made of 186 clinics in the UK between October 2003 and January 2004. In total, 100/186 (54%) clinics responded: 16% estimated their hepatitis B prevalence to be above 10%, 27% estimated their hepatitis C to be above 10%. Problems were identified in a minority of clinics including: not routinely screening HIV-positive patients for hepatitis C (6%), restrictions on diagnostic tests required for the management of hepatitis infection and offering inappropriate treatment for hepatitis B infection. The use of diagnostic liver biopsies varied and clinics reported restrictions on access to hepatitis C therapy, with a consequent impact on waiting times. In conclusion, we identified several areas of concern in the diagnosis and management of HIV/hepatitis co-infection in several UK HIV treatment centres.
Grassroots activities, national initiatives and HIV prevention: clues to explain Australia's dramatic early success in controlling the HIV epidemic
Authors: Plummer D , Irwin L
Published: December 2006

During the mid-1980s Australia experienced a remarkable decline in HIV incidence that can rightly be considered a public health milestone of global importance. The effects of this decline lasted for about 20 years and greatly benefited all Australians. In contrast, as we enter the mid-2000s, we see the global epidemic continues to intensify, HIV vaccines remain a distant possibility, and Australia is experiencing rising HIV incidence again. Clearly, better understanding of HIV prevention has important implications both for Australia and the world. Therefore, we believe, it is timely to revisit Australian experiences of the mid-1980s in order to understand those early events better.

To gauge the influence (if any) of government strategies, funding levels and other events during a period of dramatic decline in HIV transmission, incidence figures are mapped against Federal HIV/AIDS funding patterns and the occurrence of key national interventions and events. The analysis reveals that the greatest decline in HIV preceded almost all substantive initiatives undertaken at the national level, which are often held responsible for Australia's successful early containment of HIV. In particular, dramatic declines were already well advanced and/or preceded (i) substantive growth in national HIV/AIDS prevention education funding, (ii) publication of the first National AIDS Strategy, (iii) establishment of key national HIV/AIDS bodies and (iv) promulgation of the 'Ottawa Charter'. Explanations for, and lessons learned from Australia's dramatic early declines in HIV incidence are discussed.
Factors influencing women's views on the acceptability and experience of being opportunistically screened for Chlamydia trachomatis in hospital settings
Authors: McMillan L E J , Norman J E , Murray K , Reid M E
Published: December 2006

A subsample of 681 women participating in a two-centred, three-setting larger (2817) prevalence study were approached and, with consent, administered a questionnaire by post or in person. The questionnaire asked about their views of opportunistic screening for Chlamydia trachomatis (CT).

The study response rate was 71%. In all, 94% women reported screening should be offered and most, on a regular basis. About 91% thought men should be screened but only 47% thought they would attend. Most (89%) knew the term 'chlamydia' but fewer, (63%) knew they could catch CT more than once.

This is one of the very few UK studies which has explored women's views towards the acceptability of CT screening. Results suggest the majority of women report that screening for the condition is acceptable but not all have in-depth knowledge of CT. If a screening programme is to be established more education regarding the condition is required.
Perceived risks and benefits of HIV testing, and predictors of acceptance of HIV counselling and testing among pregnant women in Zimbabwe
Authors: Martin-Herz Susanne P , Shetty Avinash K , Bassett Mary T , Ley Catherine , Mhazo Miriam , Moyo Sostain , Herz Arnd M , Katzenstein David
Published: December 2006

This project evaluated perceived risks and benefits and determined predictors of acceptance of voluntary HIV counselling and testing (VCT) among pregnant women in Zimbabwe. One hundred and seventy pregnant women attending an urban antenatal clinic were surveyed. Implications of a negative or positive HIV test result and of telling a partner or community members that one is HIV positive were queried. Forty women (23.5%) consented to VCT, and 16 (40%) were HIV positive. Women who saw VCT as lower risk (odds ratio [OR] = 2.3, 95% confidence interval [CI] [1.1–5.0]) and women who had had a stillbirth or child die (OR = 0.4, 95% CI [0.16–0.97]) were more likely to consent. Prenatal HIV VCT offers the best opportunity for prevention of mother-to-child transmission of HIV; however, less than 25% of women consented. If such interventions are to be successful, attention must be directed towards developing culturally appropriate strategies to address women's concerns and improve future acceptance of VCT in Zimbabwe.
Prevalence and risk factors of squamous intraepithelial lesions of the cervix among HIV-infected women – a long-term follow-up study in a low-prevalence population
Authors: Lehtovirta Päivi , Finne Patrik , Nieminen Pekka , Skogberg Kirsi , Savonius Hannele , Paavonen Jorma , Heikinheimo Oskari
Published: December 2006

HIV-infected women have high risk for precancerous lesions of the uterine cervix. We studied the prevalence and risk factors of squamous intraepithelial lesions (SIL) among systematically followed HIV-infected women enrolled from a population with low HIV prevalence. The study population consisted of 108 HIV-infected women enrolled between 1989 and 2003 with a mean follow-up 4.4 years. Risk factors of SIL were assessed based on samples collected during 2000–02. The overall rates of atypical glandular cells of uncertain significance (AGUS), atypical squamous cells of uncertain significance (ASCUS), low-grade SIL (LSIL) and high-grade SIL (HSIL) were 4, 24, 15 and 5%, respectively. Reduced CD4-lymphocyte count was associated with an increased prevalence of SIL, whereas duration of HIV infection (< or ≥5 years), use of antiretroviral medication, or HIV viral load (<50 or ≥50 copies/mL) was not. The cumulative risk of developing SIL after 1 and 5 years was 17% (95% confidence interval [CI] 7–27%) and 48% (95% CI 33–63%), respectively. The cumulative risk of SIL was increased among women younger than 31 years ( P = 0.04) as well as in women displaying high initial HIV viral load ( P = 0.01). Our results from a low HIV-incidence population re-emphasize the importance of guidelines for cytologic screening of HIV-seropositive women.
Comparison of outcomes of management of gonorrhoea by clinic-based test of cure with those by telephone follow-up
Authors: Malu M K , Haque M S , Radcliffe K W
Published: December 2006

We compared the outcomes in 278 patients managed with clinic-based test of cure (phase 1) for gonorrhoea with 271 patients managed with the new policy of telephone follow-up (phase 2). Almost 98% of the patients in both phases were treated within 28 days of diagnosis. Follow-up of the patients was significantly better with telephone follow-up (phase 2), with an increase in proportion of patients reviewed (76.1% compared with 59.7% in phase 1, P < 0.001). Yield of partner notification was 0.22 and 0.31 contacts per case of gonorrhoea within four weeks of treatment of the index case in phases 1 and 2, respectively.
Experimental Study of a Vertical-Axis Sailwing Water-Pumping System
Authors: Dei Tsutomu , Nemoto Yasuyuki , Ushiyama Izumi
Published: December 2006

A vertical-axis ‘sailwing’ windmill is developed for autonomous wind-powered water-pumping. To determine the optimum design configuration of the rotor, various model test were carried out in a wind tunnel. The variable parameters were the shape and number of sails. The results favoured a rectangular shape with four sails, as fabricated for tests. Experimental studies determined the starting characteristics and water discharge capability of the integrated V-axis sailwing water-pumping system. The result shows that the system has self-starting characteristics and could pump 25 l/min. of water at 6 m/s wind speed.
A Turbulence-Based Model for Resolving Velocity and Temperature Profiles in the Atmospheric Surface Layer
Authors: Sumner Jonathon , Masson Christian
Published: December 2006

The goal of this paper is to demonstrate the advantages of coupling the integrated Monin-Obukhov similarity functions with an algebraic turbulence equation to resolve the profiles of temperature and velocity in the atmospheric surface layer. The latter equation is derived using the definition of turbulent viscosity from the k-ε turbulence model. The proposed surface-layer model is validated with eddy covariance and profile measurements from the CASES99 experiment and the results are compared with classic flux-profile techniques. In doing so, the relative benefits of the presented formulation become apparent. Firstly, the addition of a turbulence model improves convergence in the moderate to very stable regime. Secondly, the addition of an extra equation allows the four atmospheric parameters of interest ( u*, θ*, L and z0) to be resolved simultaneously. Furthermore, the definition of turbulent viscosity can be used to reformulate the Monin-Obukhov equations for the very stable limit.
Turbulent Flow Simulation of the NREL S809 Airfoil
Authors: Guerri Ouahiba , Bouhadef Khadidja , Harhad Ameziane
Published: December 2006

Numerical computations are carried out for the NREL S809 airfoil. The flow is modelled using an unsteady incompressible Reynolds Averaged Navier-Stokes solver. Two turbulence models (SST k/ω of Menter and RNG k/ε) are applied to close the RANS equations. All computations are performed assuming fully turbulent flow. The flow field is analyzed at various angles of attack from 0 to 20 degrees. Lift and drag forces are obtained from the computations by integrating the pressure and shear stress over the blade surface. The performance of the two turbulence models is compared and the influence of the free stream turbulence intensity is checked. The results confirm the satisfactory performance of the SST k/ω model of Menter for modelling turbulent flow around airfoils.
The emergency general surgeon: a new career pathway?
Authors: Dunkley AS , Eyers PS , Vickery CJ , Welbourn CRB , Chester JF
Published: December 2006

Emergency services have an increasingly high profile: they are the acute contact zone between the NHS and the population it serves. Furthermore, emergencies represent an increasingly high percentage of all surgical admissions and account for almost half of all abdominal operations. Despite these well-recognised statistics, no actual policy directive other than the Department of Health (DoH) and The Royal College of Surgeons of England guidelines has been issued to deal with the problems inherent in the delivery of emergency general surgical services.
The Iraq war: experience of a trainee surgeon away from the EWTD
Authors: Robinson SJ
Published: December 2006

Senior colleagues often tell the modern trainee surgeon that apparently arduous, long hours can provide some of the best and most rewarding training of a surgical career. In 2003 I was an SHO in general surgery in the West Midlands serving as a part-time territorial officer with 202 Field Hospital (Volunteer). Under the Reserve Forces Act (1996) I was called up for active service in the second Gulf war.
The EWTD 'triple whammy': hitting surgical trainees where it hurts
Authors: Heath RM , Gate TCS , Halloran CM , Callaghan M , Paraoan MT , Blair SD
Published: December 2006

Surgical training in the UK has undergone a revolution following Calmanisation and the implementation of the European Working Time Directive (EWTD). The former envisaged that reduced training time would be compensated for by a more structured, competency-based training system centred upon surgical consultant supervision and regular assessment. The EWTD on the other hand aims to improve the working lives of hospital doctors and to improve patients' safety, as well as to comply with EU law by reducing working hours to 56 by August 2004 and further to 48 hours by 2009. No trainee surgeon can now work longer than 13 hours without rest.
The Future Delivery of Surgical Services: a meeting for managers and surgeons
Authors: Armitage James , Russell Neil
Published: December 2006

The structure of the NHS is currently undergoing radical reforms that will inevitably impact on the future delivery of surgical care in England. In light of these changes, The Royal College of Surgeons of England has set out to establish a greater understanding between surgeons and hospital managers. In October 2006, a meeting was held in the Lake District at Rheged, Europe's largest grass-covered building. It was attended by almost a hundred people and included both managers of NHS hospitals and those from the independent sector, chief executives, and consultant and trainee surgeons representing all of the surgical specialties. The meeting was hosted by the president of the College, Mr Bernard Ribeiro, and was facilitated by Professor Tony Mundy, medical director of University College Hospital and director of the Institute of Urology. The meeting took an interactive format and generated some lively debate.
Surgical training in the UK
Authors: Williams L
Published: December 2006

The surgical training system in the UK has long been considered to be of a very high standard. However, it is currently under threat from many changes. To assure the quality of the future surgical consultant workforce we have moved away from apprentice-type training towards more ordered education. Although the reduction in hours and years will mean less overall experience there is a genuine belief that improved education and assessment can compensate. It says much for our island mentality that although we belong to the EU we consider European surgical training to be distinct from our own.
Improving Working Lives: how flexible are surgeons?
Authors: Walls Janet
Published: December 2006

In 2001 the Improving Working Lives (IWL) document for doctors was produced by the Department of Health. Since 2002 the intercollegiate IWL committee has met regularly to discuss ways in which relevant matters can be addressed during training and beyond. Eric Waters, the previous IWL champion for doctors, was spot on when he deduced 'the NHS Improving Working Lives initiative seems largely to have passed doctors by' and I think no more so than in surgery. During a survey undertaken in 2004 designed to identify factors that would most improve working lives for doctors, consultant surgeons commented that they were dissatisfied with support offered by the royal colleges.
Mapping Canada: The UK's first Diploma in clinical dental technology
Authors: Hunter Sally
Published: December 2006

The dental profession in the UK has seen several significant changes during 2006. Among these has been the extension of statutory registration with the General Dental Council (GDC) to dental care professionals (DCPs). From 31 July, dental nurses and dental technicians, as well as orthodontic therapists and clinical dental technicians – two newly created roles within the dental team – have been able to register with the GDC; all must have done so by 31 July 2008.
Lessons from High-Risk Industries for the Safety of Patients
Authors: Barbour Alex , Goldman Allan , Giddings Tony
Published: December 2006

It may seem strange for surgeons to be asking astronauts, psychologists and oilmen how to improve performance in the operating theatre but this conference was really about life skills. Similar problems arise in many high-risk workplaces where human fallibility interacts with complex technology. Recently these problems have been studied in industries such as nuclear power, shipping and the aviation industry, often after dramatic accidents. General lessons have been learned but they have not always been applied to the health service. The relatively clear objectives of commercial companies contrast starkly with the mixed motives and political manipulation of the NHS.
College launches National Anatomy Project
Authors: Rainsbury Dick , Barbour Alex , Mahadevan Vishy
Published: December 2006

The detailed study of topographical human anatomy based on cadaver dissections has for centuries been an essential, integral and traditional part of the undergraduate medical curriculum in the UK. However, in 1993, following a comprehensive review of the existing curriculum, increased emphasis was placed on issues such as communication skills, self-directed learning, etc. This has unfortunately resulted in a corresponding reduction in the amount of time allocated to the study of basic medical sciences, including human anatomy. Several medical schools have since abandoned dissection-based anatomy teaching altogether. As a consequence, there has been a noticeable and serious decline in the general level of applied anatomical knowledge displayed by senior medical students and surgical trainees.
Regulation of the dental profession
Authors: Avery Brian
Published: December 2006

Recent reports will significantly alter the way in which the dental profession is regulated in future. These include the chief medical officer's report Good doctors, safer patients, the report entitled The regulation of the non-medical healthcare professions (Foster Report) and a consultation document from the General Dental Council (GDC) called Fitness to Practise Guidance for the Professional Performance Committee, Health Committee and on Preliminary Meetings (http://www.gdc-uk.org/). The first two of these are available on http://www.dh.gov.uk/publications/.
Modernising your surgical career: how to compete for MMC training posts
Authors: Thorpe J , Lace S , Williams L , McCarthy K
Published: December 2006

The advent of Modernising Medical Careers is the biggest change since the Calman reforms. New trainees have the prospect of run-through training, but does this leave SHOs with the prospect of unemployment? There remains uncertainty about whether the old and new systems will dovetail or collide. What follows is some advice for those between systems from an SpR, an SHO and an ST2.
Laparoscopic live donor nephrectomy: a visit to the Mayo Clinic
Authors: Shrestha BM
Published: December 2006

Despite being a career renal transplant surgeon, I enjoy laparoscopic surgery and perform laparoscopic cholecystectomy regularly, which has helped preserve the skills necessary to undertake laparoscopic live donor nephrectomy (LLDN). Ratner et al introduced LLDN and demonstrated its advantages over open donor nephrectomy in terms of post-operative pain, hospital stay and time to return to work.
Happy New Year
Authors: Ribeiro Bernard
Published: December 2006

I hope 2007 will prove a happy year for countless SHOs seeking to achieve a national training number (NTN) through the transitional selection process, which begins on 22 January. I have previously stated that this is the best year for the current SHOs to achieve an NTN: I remain confident that this will prove to be the case. I am less confident that all of the funding required to support such appointments will be there after reports of Strategic Health Authorities (SHAs) raiding the Medical and Dental Education Levy (MADEL) budget for training in order to address NHS deficits.
Provision of paediatric surgery under threat
Authors: Towell Elaine
Published: December 2006

The British Association of Paediatric Surgeons (BAPS) exists to ensure that young patients receive the best surgical care possible by setting and maintaining a 'gold standard' for paediatric surgery. Currently the association is concerned that the safety of young patients is at risk due to an increasing lack of general paediatric surgery provision in the district general hospital (DGH) setting.
Comparing the squared multiple correlation coefficients of non‐nested models: An examination of confidence intervals and hypothesis testing
Authors: Azen Razia , Sass Daniel A.
Published: December 2006

The performance of the asymptotic method for comparing the squared multiple correlations of non‐nested models was investigated. Specifically, the increase in a given regression model's R2 when one predictor is added was compared to the increase in the same model's R2 when another predictor is added. This comparison can be used to determine predictor importance and is the basis for procedures such as Dominance Analysis. Results indicate that the asymptotic procedure provides the expected coverage rates for sample sizes of 200 or more, but in many cases much higher sample sizes are required to achieve adequate power. Guidelines and computations are provided for the determination of adequate sample sizes for hypothesis testing.
Telemental Health Technology in Deaf and General Mental-Health Services: Access and Use
Authors: Austen Sally , McGrath Melissa
Published: January 2007

Long-distance travel to provide mental health services for deaf people has implications for efficiency, safety, and equality of service. However, uptake of Telemental Health (TMH) has been slow in both deaf and general mental health services. A quantitative study was used to investigate access to TMH and whether staff confidence, experience, or demographics affect TMH use. It was concluded that staff in neither deaf mental health services nor general mental health services had adequate knowledge of or access to TMH. Staff expressed concerns over TMH's appropriateness in their work. Previous use of videoconferencing was associated significantly with confidence, but previous use of videophones was not. Neither staff in deaf services nor deaf staff were more experienced with or more confident about videoconferencing, whereas, within deaf services, deaf staff were significantly more confident about videophone use. Training implications are discussed.
The Analyst's Fears
Authors: Poland Warren S
Published: January 2007

The analyst's fears, usually addressed only in terms of their eccentric or neurotic roots, are recognized as inescapable and multiply determined. The analytic process itself implies such fears, both because of the state of uncertainty in which valid exploration unfolds and because of the inevitable loss confronting the analyst's emotional attachment that results from the patient's growing autonomy. Factors related to the analyst's character and current developmental stage further color unavoidable fears. Clinical vignettes are used illustratively. The occupation hazards of a life immersed in other people's analyses are considered, as is the analyst's defensive misuse of theory to ward off experience of some of these emotional dangers.
Psychic Reality: Belief or Illusion? Psychoanalytic Tradition as Belief in Psychic Reality
Authors: Widlöcher Daniel
Published: January 2007

This paper presents the view that psychoanalytic tradition involves a belief in the existence of psychic reality and the transmission of a method what allows access to it, rather than a belief in the contents of that reality. Through an analysis of several texts by Freud, the paper maintains that psychic reality should be defined in terms of the compulsive power of unconscious drives and the hallucinatory activity issuing from the id. It points to a tension between this view and that expressed in Freud's writings on historical truth, which explain the compulsive character of psychic reality as a result of its historical source. Further light is shed on the concept of psychic reality by understanding the role of action in Freud's thinking about the processes of representation involved in the dream. Based on this understanding, it emerges that the unconscious should be seen less as an oracular message to be decoded than as a continuous creation of scenes and stories that puts in question all historical truth. The implications of this position for psychoanalytic tradition and method are noted.
On the SL (2) period integral
Authors: Anandavardhanan U. K. , Prasad Dipendra
Published: January 2007

Let E/F be a quadratic extension of number fields. For a cuspidal representation π of SL 2 (A E ), we study in this paper the integral of functions in π on SL 2 ( F )\SL 2 (A F ). We characterize the nonvanishing of these integrals, called period integrals, in terms of π having a Whittaker model with respect to characters of E \A E which are trivial on A F . We show that the period integral in general is not a product of local invariant functionals, and find a necessary and sufficient condition when it is. We exhibit cuspidal representations of SL 2 (A E ) whose period integral vanishes identically while each local constituent admits an SL2-invariant linear functional. Finally, we construct an automorphic representation π on SL 2 (A E ) which is abstractly SL 2 (A F ) distinguished but for which none of the elements in the global L -packet determined by it is distinguished by SL 2 (A F ).
Erratum to "Representation-theoretic support spaces for finite group schemes"
Authors: Friedlander Eric M. , Pevtsova Julia
Published: January 2007

As pointed out to us by Rolf Farnsteiner, the results presented in our paper [AJM 127, pp. 379-420] require a modified definition of "abelian p -point." With this modified definition (functionally equivalent to one which we implicitly use), all of the results of our paper become valid. We make explicit this modified definition as well as those arguments which require this new definition and the modification of one proof (of Theorem 4.8) which is required.
F -regularity of large Schubert varieties
Authors: Brion Michel , Thomsen Jesper Funch
Published: January 2007

Let G denote a connected reductive algebraic group over an algebraically closed field k and let X denote a projective G × G -equivariant embedding of G . The large Schubert varieties in X are the closures of the double cosets BgB , where B denotes a Borel subgroup of G , and g ε G . We prove that these varieties are globally F -regular in positive characteristic, resp. of globally F -regular type in characteristic 0. As a consequence, the large Schubert varieties are normal and Cohen-Macaulay.
Addendum to "On a general Thue's equation"
Authors: Corvaja Pietro , Zannier Umberto
Published: January 2007

The present note is an addendum to our previous article "On a general Thue's equation." Corollary 2 in that paper provides a lower bound for the values of a polynomial with algebraic coefficients at integral points. Our purpose here is to prove a stronger version of it; also, we slightly simplify its proof, avoiding the use of Theorem 3 in the original paper.
Nontempered A-packets of G 2 : Liftings from [inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="01i"/]
Authors: Gan Wee Teck , Gurevich Nadya
Published: January 2007

We give a construction of a family of nontempered (local and global) Arthur packets of the exceptional group G 2 . One particular local packet contains a reducible representation. Using a Rankin-Selberg integral, we show that the subspace of the discrete spectrum associated to each packet is a full near equivalence class and this implies the Arthur multiplicity formula for these packets.
Formulas for multiplier ideals on singular varieties
Authors: Takagi Shunsuke
Published: January 2007

We prove a generalization of Demailly-Ein-Lazarsfeld's subadditivity formula and Mustaţǎ's summation formula for multiplier ideals to the case of singular varieties, using characteristic p methods. As an application of our formula, we improve Hochster-Huneke's result on the growth of symbolic powers of ideals in singular affine algebras.
Vergil's Italian Diomedes
Authors: Fletcher K. F. B
Published: January 2007

This paper builds on existing scholarship concerning Vergil's Diomedes and his relationship to Aeneas in two ways: first, by stressing that the character of Diomedes presented a problem for Vergil, not just because he wounded Aeneas, Aphrodite, and Ares in Iliad 5, but also because he came to be an important figure in Italian myth; second, by focusing on numerous passages previously ignored in this context, including ones in which Diomedes significantly does not appear. In these ways, I hope to show just how elaborate, and important, a process Vergil's rewriting of Diomedes is.
On Being Vatic: Pindar, Pragmatism, and Historicism
Authors: Payne Mark
Published: January 2007

In this paper I argue that the large truth claims made in Pindar's gnomic language have a correspondingly large cultural function since they instantiate the capacity for unprecedented conceptual invention within a culture that lacks any master discourse in which its own self-understanding is embedded. I discuss the famous Nomos basileus fragment and its handling by Callicles in Plato's Gorgias, and by H�lderlin in his Pindar Fragments. I argue that, by using Pindar's claim as a starting point for reflections of their own, these thinkers recognize its contingency, and future orientation, as vatic speech.