bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Priority Assignment of Attentional Resources, Order of Testing, and Response Sequence on Tunnel Vision
Authors: Chan H. S. , Courtney Alan J.
Published: May 2017

The effects of relative priority of attentional resources allocated to simultaneous peripheral and foveal tasks, response sequence to the tasks, and order of testing with two levels of foveal cognitive loading on tunnel vision were studied with 32 Chinese undergraduates. Two levels of foveal condition were used for the foveal task while the peripheral task required a single-target detection. Performance decrement value and a significant interaction of levels x eccentricities indicated that tunnel vision was most prominent when the foveal task was primary. Greater magnitude of tunnel vision was obtained when the more difficult foveal task was tested prior to the no-foveal-load condition. Responding sequence to the tasks was nonsignificant.
Effect of a Low Dose of Alcohol on Dynamic Visual Acuity
Authors: Miyao Masaru , Ishikawa Hirohiko , Ito Mitsuaki , Teo Pern Chian , Furuta Masashi , Ishigaki Hisao
Published: May 2017

An experiment was carried out to investigate the relationship between dynamic visual acuity and a low dose of alcohol. For the study, 18 subjects ranging from 18 to 25 years of age were chosen. The subjects' dynamic visual acuities were compared before and after drinking 16.5 ml of alcohol, the amount in one standard can of beer. It was found that the acuity improved 30 min. after consuming this low volume of alcohol.
Perceptual Fluency and Recognition Judgments in Haptic Information Processing
Authors: Wippich Werner , Mecklenbräuker Silvia
Published: May 2017

To 32 subjects objects that are relatively easy to explore haptically were more likely to be judged repeated in recognition even when they had not been presented previously. Similar correlations between perceptual fluency and memory judgments are known from other sense modalities.
Humanistic Grading Criteria for Essay Examinations
Authors: Ebersole Peter
Published: May 2017

The author asserts that using for an essay examination the grading criteria of accuracy, clarity of organization, complexity of expression, and creativity helps humanistically oriented professors both to fulfill university regulations and to remain true to their humanistic orientation.
A Test of the Cope Model on Motor Performance and Affect
Authors: Anshel Mark H.
Published: May 2017

The effect of a model called COPE which suggests the use of cognitive-behavioral strategies in response to acute stress in sport was tested. Both rotary pursuit performance and changes in affect were similar for 33 subjects in groups who used the COPE model or used only a segment (one strategy) of the model. Both experimental groups performed better and experienced less negative affect after treatment than the control group.
Rapid-Fire Pistol Shooting as a Dynamic Problem
Authors: Walmsley A. , Williams L. R. T.
Published: May 2017

The kinetic aspects of the aiming phase of a pistol-shooting task were examined in the light of the previous finding of relative timing invariance in the shooting phase of the same task. A single highly skilled marksman executed a total of 45 trials over three timing conditions in a normal competition setting. Data from a tri-axial accelerometer fixed to the pistol were used to produce phase plane trajectories of the movement in each of the three timing conditions. These trajectories showed marked consistency across timing conditions which indicated that the marksman applied a single kinetic solution to his motor problem.
Exercises for Training Vision and Dynamic Visual Acuity among College Students
Authors: Long Gerald M.
Published: May 2017

For 40 college students a commercially available vision training program (Eyerobics) produced no effect on a standard measure of dynamic visual acuity across four separate target velocities.
A word from Pamela R. Durso: Baptists and clergy sexual misconduct
Authors: Durso Pamela R.
Published: May 2017

The prevalence of clergy sexual misconduct and the damage it causes to individuals, congregations, and communities makes congregational and ministerial education on the subject critical. Education is especially needed by Baptists, who have no official code of conduct or mandated policies for clergy members and who have no hierarchical structures or systems that provide education for clergy members or churches. Baptists also lack a denomination-wide way of investigating violations or monitoring violators. Included in this article is a select list of helpful resources that address clergy sexual misconduct.
A withered hand, hardened hearts, and a distressed Jesus: Getting a feel for the Sabbath scene in Mark 3:1–6
Authors: Spencer F. Scott
Published: May 2017

In dealing with a man who had a disabled hand and a group of Pharisees who complicate healing work on the Sabbath (Mark 3:1–6), Jesus responds not only with restorative power and effective argument, but also with intense emotions of anger and grief. His thoughts, words, actions—and feelings—swirl together to reveal what Jesus is most passionate about, namely: the health, wholeness, and well-being of all people made in God’s image. Far from clashing with Sabbath aims, such fervent commitment to healthcare reflects the very core of Sabbath “rest.” It both boils Jesus’ blood and breaks his heart that all the learning and dedication of the religious teachers function in Mark’s scene to perpetuate strife, not rest—death, not life.
The hope of a biblical imagination: A sermonic reflection on Genesis 1:1–3, 26–31 and Colossians 1:15–20, 25–27
Authors: Ellis Robert R.
Published: May 2017

Imagination is a powerful shaper of our values and of the way we interact within our contexts. We instinctively form an imagination about the nature of the world, of God, of other people, and of our own selves. A variety of influences offer to shape the foundational imagination out of which we engage the world. In Scripture, we find generative images for creating a worldview that bends Godward. This sermonic reflection explores three overarching images for shaping a biblical imagination: Generous Creation, Redemptive Incarnation, and Compassionate Reconciliation.
“All generations shall call me blessed”: A Baptist recovery of Mary
Authors: Newman Elizabeth
Published: May 2017

In Baptist life, Mary typically appears only at Christmas. Accordingly, there is minimal theological reflection on Mary as a resource for ecclesial self-understanding. This article argues for embracing Mary as a figure of the church. Rightly understood, a richer Scriptural reading of Mary can both enhance Baptist (and more broadly Protestant) ecclesiology as well as contribute to the unity of the church.
A word about … Reframing soul competency in terms of the “capable self” in Nussbaum, Sen, and Ricoeur
Authors: Stiver Dan R.
Published: May 2017

Baptists are commonly considered to have a distinctive emphasis on the priesthood of all believers, which came to be translated early in the twentieth century by the premier Baptist theologian E. Y. Mullins as “soul competency” ( Axioms of Religion, chap. 3). Mullins’s version has fallen on hard times as he has been criticized in Baptist life from both the right and the “moderate” sides as too individualistic and captive to American culture. This article revisits soul competency in light of the more recent emphases on the “capable self” in the philosophers Martha Nussbaum, Amartya Sen, and Paul Ricoeur. Nussbaum’s approach concerns human capabilities in terms of global political distribution of goods ( Creating Capabilities) as well as does Sen ( The Idea of Justice); Ricoeur considers the capable self in ethical, political, and religious terms (“ Asserting Personal Capacities and Pleading for Mutual Recognition” and “ Religious Belief” in A Passion for the Possible). In contrast to Mullins’s more modernistic optimism about the self, Nussbaum, Sen, and Ricoeur consider the suffering self along with their emphasis on the powers of the self; as such, in the light of their thought, soul competency or capability could be seen to presuppose not the autonomous Enlightenment self but a thoroughly situated self immersed in social bonds with other people.

Such a dialogue, I propose, can inject fresh twenty-first century meaning into Mullins’s ideas of a century ago. Although the ideas of the priesthood of all believers and soul competency have been distinctively Baptist emphases, they are certainly not uniquely Baptist nor even of Baptist origin; their understanding has ramifications far beyond Baptists. In that sense, their revivification can have reverberations beyond Baptist life. In addition, such a dialogue injects a religious dimension into the wider global and philosophical discussions of Nussbaum, Sen, and Ricoeur.
The value of the relationship: An intertextual reading of Song of Songs and Lamentations
Authors: Strollo Megan Fullerton
Published: May 2017

For the most part, scholars interested in biblical “intertextuality” have divided themselves into two categories: those interested in a reader-oriented approach and those utilizing an author-oriented approach. The reader-oriented approach is a synchronic reading focused primarily on the reader’s perception of the text. By contrast, the author-oriented approach is a diachronic reading concerned with discerning the authorial intent of an intertextual connection. Proponents of an author-oriented approach accuse reader-oriented scholars with eisegesis, whereas those interested in reader-oriented studies claim that the other side runs the risk of speculation by focusing on something as elusive as authorial intent. An appropriate method or approach for studying intertextuality depends on the two (or more) texts in question. This article will examine the benefits of utilizing the best method for the right texts. In some cases, a reader-oriented approach brings to light a connection that might not be found if an author-oriented approach took precedence. In order to substantiate this proposal this article will explore the intertextual connections between Lam 4:1–10 and Song 5:10–16. The lexical parallels within these two passages are distinct and dense. Their unique use of color imagery and their utilization of rare Hebrew words create a purposeful point of connection. Whereas an author-oriented approach is nearly impossible in this case (owing to the difficulty of dating), a reader-oriented approach reveals a deep and profound new meaning for each text.
Mining affective words to capture customer’s affective response to apparel products
Authors: Zhao Y , Song J , Montazeri Alireza , Gupta MM , Lin Y , Wang C , Zhang WJ
Published: May 2017

Contemporary apparel design practice is such that the functional and ergonomic aspects can be readily rationalized and thus computerized, but this is not true for the aspects of affect or emotion. Design for emotion or affect remains an ad hoc exercise. In the apparel industry, affects or emotions of both wearers and audiences are very important. This paper presents a work with an overall objective to rationalize the affective property of apparel. To achieve this overall objective, the first step is to have a language (a set of words in this case) to describe the customer’s need in the affective attribute or property of apparel into a technical specification. In the work reported in this paper, this language (simply, a set of words) has been developed by the application of a proposed data mining procedure with a proprietary tool. A preliminary experiment was performed to validate this language – how to accurately capture the voice of customer in the aspect of affects in this case. There are two contributions out of this work: (1) finding a set of words that describe the affective property of apparel to capture the voice of customer in the aspect of affect, which is a foundation for the computer-based affective design of apparel; and (2) formulation of a new data mining process for searching affective words from the internet, which has a generalized implication to affective design in other domains of products, such as furniture.
Introducing complementary medicine into the medical curriculum
Authors: Rampes Hagen , Sharples Fiona , Maragh Sarah , Fisher Peter
Published: May 2017

We surveyed the deans of British medical schools to determine the provision of complementary medicine in the undergraduate curriculum. We also sampled medical students at one British medical school to determine their knowledge of, and views on instruction in, complementary medicine. There is little education in complementary medicine at British medical schools, but it is an area of active curriculum development. Students' levels of knowledge vary widely between different therapies. Most medical students would like to learn about acupuncture, hypnosis, homoeopathy and osteopathy. We conclude that complementary medicine should be included in the medical undergraduate curriculum. This could be done without a great increase in teaching of facts, and could serve as a vehicle to introduce broader issues, as recommended by the General Medical Council.
Surgical Treatment of Acute Manifestations of Crohn's Disease during Pregnancy
Authors: Hill Chm J , Clark A , Scott Na
Published: May 2017

When requiring surgery, acute exacerbations of Crohn's disease in pregnancy have been reported to carry high maternal and fetal mortality. We report six cases.

The women presented at 30, 28, 12, 11, 31 and 25 weeks' gestation and all proved to have intraperitoneal sepsis. In three, the acute symptoms were the first indication of Crohn's disease. All the women recovered and five had healthy babies; the other had a miscarriage when a colonic anastomosis dehisced.

In pregnant women with Crohn's disease, the indications for surgery are the same as in non-pregnant patients. For acute manifestations we recommend removal of the source of the sepsis and exteriorization of the bowel ends.
Four Years' Experience of an Undergraduate Medical Nutrition Course
Authors: Powell-Tuck J , Summerbell Carolyn , Holsgrove G , Garrow J S
Published: May 2017

In 1992 the medical colleges of The Royal London and St Bartholomew's hospitals launched a new curriculum in which basic medical sciences were to be integrated with early exposure to clinical medicine in the first phase. The curriculum was to be modular and integrative, combining clinical and medical-science-based teaching of body systems, rather than the traditional teaching by departmental discipline.

We describe the inception, content and evaluation of a 7-day course on nutrition which was developed as part of this curriculum. It was rated highly by the students, whose feedback led to important modifications. The programme works well in practice, and could provide a useful guide for other schools about to set up nutrition courses for medical students.
A Survey of Croquet Injuries
Authors: Appleton D R
Published: May 2017

Of 214 croquet players who responded to a questionnaire, 76 reported at least one injury to hand, wrist or forearm caused by striking the ball. There was no obvious relation to which of the three main grips the player applied to the mallet. Injuries were somewhat more frequent when the mallet shaft consisted of fibreglass than when it was wood, metal or carbon fibre, but a causal relation has not been established. Back injuries seem less troublesome in croquet than in golf.
Chronic Fatigue Syndrome: Sufferers' Evaluation of Medical Support
Authors: Ax Susanne , Gregg Vernon H , Jones David
Published: May 2017

In response to reports of negative cooperation between sufferers of chronic fatigue syndrome (CFS) and their doctors, semi-structured interviews were conducted with sufferers from two different patient samples.

Satisfaction with support received and with medical professionals in general was low. Sufferers complained about insufficient informational as well as emotional support from their doctors, and as a consequence most opted for alternative or complementary forms of treatment. In addition, disagreements over illness aetiology and treatment precluded effective cooperation.

If satisfaction and compliance are to improve, sufferers will need more information about CFS and more support.
Development of an Essential Drugs List for Bosnia and Herzegovina
Authors: Carballo M , Serdarevic D , Zulic I
Published: May 2017

Part of the impact of the war in ex-Yugoslavia and especially Bosnia and Herzegovina was to limit the supply of therapeutic drugs they had used before the war. The difficulties encountered made the health care system temporarily dependent on humanitarian assistance agencies which applied the concept of essential drugs; and, after initial difficulties, national health staff adapted to the need to prescribe from a very limited range of drugs. Meanwhile, national drug policy and procurement and prescribing practices were reviewed by working groups and a national List of Essential Drugs was drawn up by national experts with international support. This list has now been passed into legislation.
Effect of Anorectal Eversion on Long-Term Clinical outcome of Restorative Proctocolectomy
Authors: Defriend D J , Mughal M , Grace R H , Schofield P F
Published: May 2017

Eversion of the rectum during restorative proctocolectomy with stapled ileal pouch-anal anastomosis (IPAA) remains a controversial surgical manoeuvre because of concern that it may impair anal sphincter function and adversely affect outcome. We have reviewed the long-term results in 41 patients whose operation included formation of a 20 cm J-pouch with stapled IPAA by the technique of rectal eversion.

At median follow-up of 4 years (range 1–6 years), 4 pouches (10%) had been removed (2 for pelvic sepsis, 1 for rectovaginal fistula and 1 for Crohn's disease). In 34 patients with functioning pouches in situ, median stool frequency was 5 per 24 h (range 2–10). 11 patients (33%) regularly had to evacuate their pouch at night and 4 (12%) used antidiarrhoeal medication. No patients reported major incontinence; 2 (6%) had minor leakage, and in another 2 minor leakage had now ceased. 4 patients had had episodes of pouchitis.

These favourable results offer no support for the contention that rectal eversion substantially worsens the long-term results of restorative proctocolectomy.
Neuropathy in Non-Freezing Cold Injury (Trench Foot)
Authors: Irwin Michael S , Sanders Roy , Green Colin J , Terenghi Giorgio
Published: May 2017

Non-freezing cold injury (trench foot) is characterized, in severe cases, by peripheral nerve damage and tissue necrosis. Controversy exists regarding the susceptibility of nerve fibre populations to injury as well as the mechanism of injury. Clinical and histological studies (n=2) were conducted in a 40-year-old man with severe non-freezing cold injury in both feet.

Clinical sensory tests, including two-point discrimination and pressure, vibration and thermal thresholds, indicated damage to large and small diameter nerves. On immunohistochemical assessment, terminal cutaneous nerve fibres within the plantar skin stained much less than in a normal control whereas staining to von Willebrand factor pointed to increased vascularity in all areas.

The results indicate that all nerve populations (myelinated and unmyelinated) were damaged, possibly in a cycle of ischaemia and reperfusion.
Nine Cases of Merkel Cell Tumour
Authors: Bose Aniruddha
Published: May 2017

Merkel cell tumour is an aggressive neuroendocrine neoplasm arising in the dermis. Although only a few hundred cases have been reported worldwide, nine were seen in Nottingham between 1985 and early 1994. The patients were five women and four men age 63–88. One was the first Afro-Caribbean reported to have such a tumour. In no case was the diagnosis made clinically; histological and histochemical examination was necessary. Three of the patients died quickly with metastatic disease. The primary treatment is surgical excision. For advanced disease, radiotherapy is commonly beneficial
Teenagers' use of Emergency Contraception in a General Practice
Authors: Seamark C J , Gray D J Pereira
Published: May 2017

British teenagers who become pregnant commonly express ignorance about emergency contraception. A case-note survey was conducted in a general practice serving about 14 200 people in a Devon market town. Of the 373 registered girls aged 15–19 years, 59 (16%) had consulted for emergency contraception, 19 of them more than once. The oral method (Yuzpe regimen) was prescribed eighty times and 2 girls became pregnant. 4 of the 59 girls who used emergency contraception had subsequent unwanted pregnancies. A consultation for emergency contraception presents an opportunity to discuss more reliable and acceptable methods of contraception.
Trends in Self-Poisoning: Admissions to a Central London Hospital, 1991–1994
Authors: Mcevedy Christopher J B
Published: May 2017

Self-poisoning is a common reason for admission to hospital; and, although most patients admitted do not have a psychiatric disorder, as a group they are at greatly increased risk of completed suicide. Admissions to a hospital in Central London over a four-year period were examined with special attention to patients admitted more than once.

From 1991 to 1994 admissions for self-poisoning rose by 108%, with larger increases in the younger age groups of both sexes. 9% of patients were admitted more than once, the mean interval to repetition being three months. A third of the repeaters were readmitted within one month.

The increase in admissions for self-poisoning, which has been noted elsewhere in the UK, is unlikely to be due wholly to changes in clinical practice. In view of the relation between parasuicide and suicide, further research and analysis is urgently needed.
Extreme Attitudes to Body Shape, Social and Psychological Factors and a Reluctance to Breast Feed
Authors: Barnes J , Stein A , Smith T , Pollock J I , Study Alspac
Published: May 2017

Despite widespread advocacy of breast feeding, many babies are breast fed only briefly, if at all. Mothers' decisions on how to feed are often made before the birth; so we have sought demographic, social and psychological factors that might be amenable to intervention during pregnancy.

In the Avon Longitudinal Study of Pregnancy and Childhood about 12000 women completed questionnaires in pregnancy. Univariate analyses were carried out to establish which factors were related to breast feeding intentions. All significant factors in univariate analyses were entered into logistic regression analyses.

Demographic characteristics independently related to intentions to breast feed included older maternal age, more maternal education, primiparity and not smoking; in previous work all these had been associated with actual feeding behaviour. Social relationship variables had a small influence. Of the psychological variables, a notable finding was that women who were preoccupied with their body shape and those who expressed controlling, less child-centred, responses to managing an infant in the postnatal months were less likely to express intentions to breast feed. Depression did not predict breast feeding intentions once the other factors had been taken into account.

Health care professionals may be able to intervene to increase breast feeding by making routine enquiries during antenatal care and targeting appropriate subgroups.
Home Artificial Nutrition in Advanced Cancer
Authors: Pironi Loris , Ruggeri Enrico , Tanneberger Stephan , Giordani Stefano , Pannuti Franco , Miglioli Mario
Published: May 2017

Attitudes to home artificial nutrition (HAN) in cancer vary greatly from country to country. A 6-year prospective survey of the practice of HAN in advanced cancer patients applied by a hospital-at-home programme in an Italian health district was performed to estimate the utilization rate, to evaluate efficacy in preventing death from cachexia, maintaining patients at home without burdens and distress and improving patients' performance status, and to obtain information about costs. Patients were eligible for HAN when all the following were present: hypophagia; life expectancy 6 weeks or more, suitable patient and family circumstances; and verbal informed consent.

From July 1990 to June 1996, 587 patients were evaluated; 164 were selected for HAN (135 enteral and 29 parenteral) and were followed until 31 December 1996. The incidence of HAN per million inhabitants was 18.4 in the first year of activity and 33.2–36.9 in subsequent years, being 4–10 times greater than rates reported by the Italian HAN registers. On 31 December 1996, 158 patients had died because of the disease and 6 were on treatment. Mean survival was 17.2 weeks for those on enteral nutrition and 12.2 weeks for those on parenteral nutrition. Prediction of survival was 72% accurate. 95 patients had undergone 155 readmissions to hospital, where they spent 15–23% of their survival time. Burdens due to HAN were well accepted by 124 patients, an annoyance or scarcely tolerable in the remainder. The frequency of major complications of parenteral nutrition was 0.67 per year for catheter sepsis and 0.16 per year for deep vein thrombosis. Karnofsky performance score increased in only 13 patients and body weight increased in 43. The fixed direct costs per patient-day (in European Currency Units) were 14.2 for the nutrition team, 18.2 for enteral nutrition and 61 for parenteral nutrition.

The results indicate that definite entry criteria and local surveys are required for the correct use of HAN in advanced cancer patients, that HAN can be applied without causing additional burdens and distress, and that its costs are not higher than hospital costs.
Psychiatric Disorders after Transurethral Resection of the Prostate
Authors: Lethem Rosemary , Rands Gianetta
Published: May 2017

Three men in their 70s had long-term changes in mood and personality dating from immediately after transurethral prostatectomy. Focal abnormalities in the brain were not detected. The possibility of psychiatric as well as cardiovascular sequelae from this operation deserves investigation.
Common Mental Disorders, Explanatory Models and Consultation Behaviour among Indian Women Living in the UK
Authors: Jacob K S , Bhugra D , Lloyd K R , Mann A H
Published: May 2017

Women of Indian origin are said to have a lower rate of recognized common mental disorders and a higher frequency of consultation in primary care than white British. The aim of this study was to evaluate factors, including explanatory models (patient perspectives) of illness, associated with common mental disorders and with frequency of consultation among women of Indian origin in primary care.

The investigation was conducted in a general practice in West London with a large Indian population. Consecutive woman attenders of Indian descent were screened with the General Health Questionnaire-12 to identify probable cases of psychiatric morbidity. 100 patients were interviewed with the Revised Clinical Interview Schedule (CIS-R), a specific tool for the diagnosis of common mental disorders, and the Short Explanatory Model Interview, which elicits the individual's conceptualization of his or her illness. Those patients who satisfied CIS-R criteria were classified as ‘cases’, the others as ‘controls’.

Common mental disorders were documented in 30% of patients. The general practitioner's diagnosis of common mental disorders had a sensitivity of 17% and a specificity of 91%. Individuals with common mental disorders had a higher frequency of consultation (P=0.017), were less likely to see depression as an indication for medical intervention and were more likely to withhold some of their concerns from the general practitioner. Incorrect diagnosis by the GP was most likely to occur when patients did not disclose all their complaints. These associations were all statistically significant after adjustment for possible confounders by multiple linear and logistic regression.

Women of Indian origin in this sample had rates of common mental disorders similar to those in other UK populations. Differing conceptualizations of common mental disorders may contribute to their underrecognition in women of Indian origin.
Does ‘healing’ benefit patients with chronic symptoms? A quasi-randomized trial in general practice
Authors: Dixon Michael
Published: May 2017

This study was designed to examine the effects of a healer seeing chronically ill patients in a large semirural practice. The 57 patients were allocated alternately either to receive ten weekly healing sessions or to become waiting-list controls.

Two weeks after completion of ‘healing’ 22 (81%) of the 27 study patients thought their symptoms had improved and 15 of these thought they had improved substantially. Study patients scored better than controls on both measures of symptoms (P < 0.05, P < 0.01), on anxiety and depression ratings (P < 0.01, P < 0.05) and on general function measured by the Nottingham Health Profile (P < 0.01). Treatment differences were still evident three months later for one of the measures of symptom change (P <0.05) and for both anxiety and depression ratings (P < 0.01, P < 0.05). The percentages of natural killer cells (CD16, CD56) did not change greatly in either group.

These results suggest that healing may be an effective adjunct for the treatment of chronically ill patients presenting in general practice. They do not distinguish between any specific effects of spiritual healing and non-specific effects such as relaxation; for further investigation, randomized controlled trials will be needed.
Ambulatory blood pressure monitoring for hypertension in general practice
Authors: Taylor R S , Stockman J , Kernick D , Reinhold D , Shore A C , Tooke J E
Published: May 2017

Ambulatory blood pressure monitoring (ABPM) is being increasingly used in general practice. There is at present little published evidence regarding the clinical utility of ABPM in the care of patients with established hypertension in this setting. We examined this issue by undertaking ABPM in a group of patients with established hypertension.

40 patients (aged 33–60 years) currently being treated for hypertension were randomly selected from a general practice list and underwent a single 24-hour ABPM study. ABPM values were compared with clinic blood pressure (CBP) values obtained on the day of monitoring together with previous readings taken by the general practitioner (GP).

In the case of mean arterial pressure, 24-hour, awake and asleep ABPM values were found to underestimate CBP values by 14 mmHg (95% confidence interval 11–16 mmHg), 9 mmHg (95% Cl 6–12 mmHg) and 24 mmHg (95% Cl 21–27 mmHg), respectively. When used to classify blood pressure control, ABPM values produced equivalent results to CBP except by the criterion of BP load, for which 24-hour ABPM showed a higher rate of unsatisfactory control. 5 patients classified by CBP to have satisfactory BP control according to current international guidelines were found to have unsatisfactory BP control by ABPM.

This study demonstrates the potential value of ABPM in patients with essential hypertension in a general practice setting. ABPM provided information over and above that obtained by CBP in a substantial proportion of patients.
Screening instruments for psychiatric morbidity in chronic fatigue syndrome
Authors: Morriss Richard K , Wearden Alison J
Published: May 2017

Physicians require a screening instrument to detect psychiatric disorders in patients with chronic fatigue syndrome (CFS). Different threshold scores on the Hospital Anxiety and Depression scale (HAD) and the mental health scale of the Medical Outcome Survey (MOS) were compared with two gold standards for the presence or absence of psychiatric disorder, standard diagnostic criteria (DSM-III-R) and a threshold score for the number of psychiatric symptoms at a standardized psychiatric interview (Revised Clinical Interview Schedule total cut-off score of 11/12). They were compared by use of validating coefficients and receiver operating characteristics in 136 consecutive CFS medical outpatients.

The HAD scale at cut-off of 9/10 was a valid and efficient screening instrument for anxiety and depression by comparison with both gold standards. The MOS mental health scale at its recommended cut-off score of 67/68 yielded too many false-positives to be recommended as a psychiatric screening instrument in CFS patients.
Relation between depression and circulating immune products in patients with advanced colorectal cancer
Authors: Allen-Mersh T G , Glover Clare , Fordy Carol , Henderson D C , Davies M
Published: May 2017

We have previously suggested that colorectal liver metastases might produce ‘toxins' that reduce both quality of life (QoL) and survival. In this study we assessed whether QoL in patients with such metastases was related to immune activation, as determined by increased serum levels of interleukin 6 (IL6), soluble tumour necrosis factor receptor 1 (sTNFr1), soluble interleukin 2 receptor alpha (sIL2rα) or the interferon-γ marker neopterin.

Serum IL6, sTNFr1, sIL2rα, neopterin, alkaline phosphatase and carcinoembryonic antigen levels, liver metastasis volume, and QoL (Hospital Anxiety and Depression [HAD] scale, Rotterdam Symptom Checklist [RSC], and Sickness Impact Profile [SIP]) were measured in 43 patients. There were significant positive correlations between serum sIL2rα and HAD depression score (r=0.66, P=0.0001), RSC physical symptom score (r=0.46, P<0.01), and SIP score (r=0.47, P=0.009). Multiple regression analysis suggested that serum sIL2rα level was a significant independent predictor of HAD depression score. Although survival was shorter (logrank test P<0.05) where sIL2rα, sTNFr1 and IL6 levels were higher, the ability of sIL2rα to predict HAD depression score was independent of survival.
Primary repair of dog bites to the face: 40 cases
Authors: Javaid M , Feldberg L , Gipson M
Published: May 2017

Dog bites to the face can be life-threatening if major infection occurs, and traditional management consists of wound toilet and debridement, with repair only when the possibility of infection has been eliminated. Surgical opinion is now swinging towards earlier repair. We have analysed retrospectively the outcome of 40 cases that, irrespective of time delay between injury and presentation, underwent primary repair or reconstruction after wound toilet, debridement and administration of prophylactic antibiotics.

The victims were 17 males and 23 females with ages ranging from 2 to 76 years (mean 25). Median delay between the injury and presentation in the emergency department was 60 minutes (range 7 minutes to 5 days). All patients received surgical treatment within 24 hours of admission, 18 being operated on within 6 hours. 31 had primary repairs and 9 patients had reconstructive procedures with local skin flaps or skin grafts. Primary healing was achieved in all but 2 patients, of whom one developed minor wound infection and one had necrosis of a composite graft.

These results support the view that, for dog bites to the face, primary repair is the method of choice.
Consent obtained by the junior house officer—is it informed?
Authors: Huntley J S , Shields D A , Stallworthy N K
Published: May 2017

Of 30 junior house officers questioned, 21 had obtained patients' consent for colonoscopy. Of these 21, about one-third did not routinely discuss with patients the risks of perforation and haemorrhage.

Ideally, consent should be obtained by a person capable of performing the procedure. If it is to be obtained by junior house officers, they need to know exactly what must be disclosed about each procedure. This could easily be done as part of the induction package.
Should doctors practise resuscitation skills on newly deceased patients? A survey of public opinion
Authors: Tachakra Sapal , Ho Selwyn , Lynch Maria , Newson Roger
Published: May 2017

Trainee doctors must acquire skills in resuscitation, but opportunities for learning on real patients are limited. One option is to practise these skills in newly deceased patients. We sought opinions from 400 multiethnic guests at an open-access dinner dance for members of a local community. The questionnaire could elicit the responses strongly agree, agree, unsure, disagree or strongly disagree.

332 (83%) guests responded. For non-invasive techniques, 32% of responders supported practice without consent, 74% with consent. Support diminished with increasing invasiveness of procedure. 91 % of the sample were uncomfortable about the procedures, the commonest reason being ‘respect for the body’ (264/302). 86% of responders felt that practice should last for no more than 5 minutes. The most popular solutions were for people to carry a personal card giving consent (89%) and establishment of a central register of individuals consenting to be practised upon after death (79%).
Randomized double-blind placebo-controlled trial of homoeopathic ‘proving' for Belladonna C30
Authors: Goodyear Kathryn , Lewith George , Low J Lorraine
Published: May 2017

Homoeopathic drug pictures are developed by recording the symptomatic effects of homoeopathic remedies given to healthy volunteers (a ‘proving’). In a double-blind randomized controlled trial we tested the hypothesis that individuals using an infinitesimal dilution of Belladonna (thirtieth potency, C30) would record more true symptoms, on a questionnaire that contained both true and false Belladonna proving symptoms, than those receiving placebo.

60 volunteers entered the study and 47 completed data collection. We were unable to distinguish between Belladonna C30 and placebo using our primary outcome measure. For the secondary outcome measure we analysed the number of individuals who proved to the remedy according to our predefined criteria: 4 out of 19 proved in the Belladonna C30 group and 1 out of 27 in the placebo group (difference not statistically significant).

This pilot study does not demonstrate a clear proving reaction for Belladonna C30 versus placebo, but indicates how the question might be further investigated.
Primary inguinal hernia repair: how audit changed a surgeon's practice
Authors: Drew P J , Hartley J E , Qureshi A , Lee P W R
Published: May 2017

Over 10 years one senior consultant surgeon performed 114 standard plication darn herniorraphies on 92 patients with primary inguinal hernias. These patients were contacted and were reviewed if there was any suspicion of recurrence. Four recurrences were detected, giving an overall recurrence rate of about 3.5%. According to actuarial life-table analysis the risks of recurrence at 1 year, 5 years and 10 years were 0.94%, 3.02% and 9%. This level of recurrence is unacceptable in modern practice and, as a result of the audit, the surgeon changed his technique of primary inguinal hernia repair.
Diabetes epidemic in newly westernized populations: is it due to thrifty genes or to genetically unknown foods?
Authors: Baschetti Riccardo
Published: May 2017

Until a few decades ago, certain ‘new-world' populations that kept to traditional dietary habits were virtually free from diabetes; then, after they began eating some foods that are common in Europe, the disease reached epidemic proportions. Europeans, by contrast, have a low rate of diabetes. To account for this paradox, it has been suggested that those new-world populations have a thrifty genotype, which would have conferred a selective advantage during the frequent famines of the past, while today it would be detrimental because the recently adopted foods are constantly available. Here it is proposed that thrifty genes are unlikely to exist Both the diabetes epidemics that occur in newly westernized populations and the low rate of diabetes in Europeans can be explained by the hypothesis that Europeans, through millenary natural selection, have become adapted, albeit incompletely, to some diabetogenic foods for which humankind is genetically unequipped.
Effect of beer consumption on plasma magnesium: randomized comparison with mineral water
Authors: Gorinstein S , Zemser M , Libman I , Trakhtenberg S , Caspi A
Published: May 2017

Moderate consumption of ethanol lowers mortality from coronary artery disease, and one of the possible mechanisms is an antiarrhythmic action. We therefore investigated the effect of a small daily dose of beer on plasma electrolytes. 52 men who seldom drank alcohol, clinically stable more than one year after coronary bypass surgery, were randomized to drink either 330 mL beer (containing about 20g ethanol) or mineral water with similar potassium, magnesium, calcium and sodium content daily for 30 days. Plasma electrolytes and liver function indices, and also heart rate, blood pressure and weight, were measured before and after the trial period.

The only significant before-and-after difference was in the group consuming beer, whose plasma magnesium rose from 0.89 (SD 0.01) to 0.98 (SD 0.02) mmol/L (P<0.0025).

This level of beer consumption did no obvious harm to liver function and its possibly beneficial effect on plasma magnesium deserves further investigation.
Hospital practice
Authors: Mansfield Averil O
Published: May 2017

Averil Mansfield is Vice-President of the Royal College of Surgeons of England and is the immediate Past President of the Section of Surgery of The Royal Society of Medicine. She is a Vascular Surgeon and the Professor of Surgery at Imperial College School of Medicine at St Mary's Hospital, London.

She has been President of the Association of Surgeons of Great Britain & Ireland, The Vascular Surgical Society of Great Britain & Ireland and was founding Chairman of ‘Women in Surgical Training’ of the Royal College of Surgeons.

She has chaired the Intercollegiate Board in General Surgery, The Federation of Surgical Specialty Associations and the Intercollegiate Committee of Continuing Medical Education for the Senate of Surgeons.

Her medical training and initial consultant appointments were in Liverpool.
Reducing non-attendance at outpatient clinics
Authors: Stone Christopher A , Palmer John H , Saxby Peter J , Devaraj Vikram S
Published: May 2017

Outpatient non-attendance is a common source of inefficiency in a health service, wasting time and resources and potentially lengthening waiting lists.

A prospective audit of plastic surgery outpatient clinics was conducted during the six months from January to June 1997, to determine the clinical and demographic profile of non-attenders. Of 6095 appointments 16% were not kept. Using the demographic information, we changed our follow-up guidelines to reflect risk factors for multiple non-attendances, and a self-referral clinic was introduced to replace routine follow-up for high risk non-attenders. After these changes, a second audit in the same six months of 1998 revealed a non-attendance rate of 11%—i.e. 30% lower than before.

Many follow-up appointments are sent inappropriately to patients who do not want further attention. This study, indicating how risk factor analysis can identify a group of patients who are unlikely to attend again after one missed appointment, may be a useful model for the reduction of outpatient non-attendance in other specialties.
Issues of consent in colonoscopy: if a patient says ‘stop’ should we continue?
Authors: Ward B , Shah S , Kirwan P , Mayberry J F
Published: May 2017

Colonoscopy is generally performed under intravenous sedation, which may alter a patient's responses and perception. What should be done if, during the procedure, a patient withdraws the consent previously given? The views of gastroenterologists and patients were ascertained by mailing questionnaires to 100 members of the British Society of Gastroenterology and to 100 patients who had undergone colonoscopy with intravenous sedation.

Only 1 of 59 eligible consultants who replied said they would stop the procedure after a single request, but a further 51 would stop if repeatedly asked to do so. Of the remaining 7 who would complete the procedure, 1 nevertheless believed that a sedated patient is capable of making a rational decision. Of the 51 patients who returned a usable questionnaire, 25 thought that the procedure should be stopped immediately following a request, while 26 felt that the doctor should continue.

The divergent and sometimes inconsistent views found in this study highlighted the need for further clarification of the issue of informed consent for procedures conducted with the patient under sedation.
Trends in Teenage Pregnancy in England and Wales: How can we Explain Them?
Authors: Wellings Kaye , Kane Roslyn
Published: May 2017

Teenage pregnancy is associated with adverse social and physical outcomes for both mother and child. We drew on various sources—birth and abortion statistics from the Office for National Statistics, data from the National Survey of Sexual Attitudes and Lifestyles, and routinely collected data from family planning clinics—to identify trends in England and Wales and their possible determinants.

The rate of teenage sexual activity has increased steadily and consistently over the past four decades, whilst the rate of teenage fertility has shown greater variation. When the teenage fertility rate is calculated against the denominator of sexually active women, rather than the total sample of teenage women, the underlying trend in teenage fertility over the past four decades has been downwards, though not consistently so. Fluctuations in the teenage fertility rate seem to track intervention-related factors such as access to, and use of, contraceptive services and the general climate surrounding the sexual health of young people.
Transport and Temperature Effects on Measurement of Serum and Plasma Potassium
Authors: Seamark David , Backhouse Susan , Barber Paul , Hichens John , Salzmann Maurice , Powell Roy
Published: May 2017

Transport of blood samples from general practice to a central laboratory can result in spuriously high or low potassium concentrations. The importance of this phenomenon was studied in a general practice serving a population of 15000 patients, 27 km from the pathology laboratory that routinely measured serum potassium. The design involved comparison of potassium levels between control serum (plain gel-separation serum tubes centrifuged in the surgery), routine serum (plain gel-separation tubes centrifuged in the laboratory) and routine plasma samples (lithium-heparin tubes centrifuged in the laboratory).

Complete triple sets of data were obtained for 371 samples. Altman and Bland plots for the control serum vs routine serum samples showed a mean difference of +0.1 mmol/L with limits of agreement (± 2SD) +0.6 mmol/L, -0.4 mmol/L and for control serum vs routine plasma a mean difference of +0.2 mmol/L with limits of agreement +0.8 mmol/L, -0.4 mmol/L. There was a negative association between mean weekly routine plasma potassium levels with mean weekly temperatures achieved. Regression analysis indicated that both maximum temperature achieved and time to centrifugation significantly contributed to differences observed in the routine plasma samples, but not with the routine serum samples. For plasma samples exposed to high temperatures a clinically significant lowering of potassium concentrations can arise.

These results confirm that spurious lowering of potassium concentrations occurs in plasma samples collected in a primary care setting. The preferred method is to centrifuge samples soon after venepuncture. Where this is not possible, collection into plain gel-separation tubes (serum) ensures less variation due to temperature and time to centrifugation than does collection into lithium-heparin tubes (plasma).