bluuebunny/crossref_metadata_2025 huggingface dataset:
Morphology and infraciliature of two new earthworm ciliates, Hoplitophrya polymorphus sp. nov. and Anoplophrya simplex sp. nov. (Ciliophora: Oligohymenophorea: Astomatia)
Authors: NANA PAUL ALAIN , FOKAM ZÉPHYRIN , VIGUÈS BERNARD , BRICHEUX GENEVIÈVE , AGHAINDUM GIDÉON AJEAGAH , NGASSAM PIERRE , NOLA MOÏSE , SIME-NGANDO TÉLESPHORE
Published: March 2018

Morphological and infraciliature studies carried out using pyridinated ammoniacal silver carbonate and the 4’,6-diamidino-2-phenylindole (DAPI) staining techniques, led to the identification of two new species of ciliates pertaining to the subclass Astomatia. The first species, Hoplitophrya polymorphus sp. nov., displays two main cellular forms: the elongated form (150–247 μm long and 40–87 μm width) and the stocky form (140–170 μm long and 70–98 μm width). The macronucleus is generally skinny in the elongated forms and ribbon-shaped in the stocky forms. The common feature of the two cellular shapes uniting them in the same species is the identical structure of their skeletal apparatus, a V-shaped element located in an apical depression and bearing skeletal fibres on its ventral face. The second species, Anoplophrya simplex sp. nov., is totally deprived of skeletal apparatus. The cell shape is fusiform and dorsoventrally flattened (105–180 μm long and 65–125 μm width). Six to 12 pulsatile vacuoles form two rows arranged symmetrically on either side of the macronucleus. These two newly identified species highlight the extremely rich diversity of ciliates inhabiting the digestive tract of tropical earthworms.
What is the Key Feature of Convection Leading up to Tropical Cyclone Formation?
Authors: Wang Zhuo
Published: March 2018

Infrared brightness temperature data are used to investigate convective evolution during tropical cyclone (TC) formation in a quasi-Lagrangian framework. More than 150 named Atlantic storms during 1989–2010 were examined. It is found that both convective intensity and convective frequency increase with time in the inner pouch region but change little, or even weaken slightly, in the outer pouch region. Convection thus appears to concentrate toward the circulation center as genesis is approached. However, large variability is found from storm to storm in convective intensity, area, and duration, and the convective evolution of individual storms does not resemble the composite mean. Further analysis suggests that the composite mean or the median represents the probability of occurrence of convection instead of a recurrent pattern. Three distinct spatial patterns of convection are identified using cluster analysis. Substantial differences in convection intensity and area are found among the clusters and can be attributed to the impacts of environmental conditions. These differences suggest that convection intensity or area is not a key feature of convection for tropical cyclogenesis. In particular, a small and weak convective system is not necessarily associated with a weak vortex. A simple proxy of the radial gradient of convection is found to be similar among the clusters. Furthermore, convection is most effective in strengthening the TC protovortex when its maximum occurs near the pouch center. These findings suggest that organized convection near the pouch center is a key feature of convection for tropical cyclogenesis and that emphasizing convective intensity or frequency without considering the spatial pattern may be misleading.
Linear and Nonlinear Dynamics of North Atlantic Oscillations: A New Thinking of Symmetry Breaking
Authors: Luo Dehai , Chen Xiaodan , Feldstein Steven B.
Published: March 2018

Observations reveal that the North Atlantic Oscillation (NAO) exhibits a strong asymmetry: large amplitude, long persistence, and westward movement in its negative phase (NAO−) and conversely in its positive phase (NAO+). Further calculations show that blocking days occur frequently over the North Atlantic (Eurasia) after the NAO− (NAO+) peaks, thus indicating that North Atlantic blocking occurs because of the retrogression of the NAO−, whereas blocking occurs over Eurasia because of enhanced downstream energy dispersion of the NAO+.

Motivated by a unified nonlinear multiscale interaction (UNMI) model, the authors define dispersion, nonlinearity, and movement indices to describe the basic characteristics of the NAO. On this basis, the physical cause of the strong asymmetry or symmetry breaking of the NAO is examined. It is revealed that the strong asymmetry between the NAO+ and NAO− may be associated with the large difference of the North Atlantic jet in intensity and latitude between both phases. When the NAO+ grows, the North Atlantic jet is intensified and shifts northward and corresponds to reduced nonlinearity and enhanced energy dispersion because of an increased difference between its group velocity and phase speed related to enhanced meridional potential vorticity gradient. Thus, the NAO+ has smaller amplitude, eastward movement, and less persistence. Opposite behavior is seen for the NAO− because of the opposite variation of the North Atlantic jet during its life cycle. Thus, the above results suggest that the NAO+ (NAO−) tends to be a linear (nonlinear) process as a natural consequence of the NAO evolution because of different changes in the North Atlantic jet between both phases.
Understanding Bjerknes Compensation in Meridional Heat Transports and the Role of Freshwater in a Warming Climate
Authors: Yang Qianzi , Zhao Yingying , Wen Qin , Yao Jie , Yang Haijun
Published: March 2018

The Bjerknes compensation (BJC) under global warming is studied using a simple box model and a coupled Earth system model. The BJC states the out-of-phase changes in the meridional atmosphere and ocean heat transports. Results suggest that the BJC can occur during the transient period of global warming. During the transient period, the sea ice melting in the high latitudes can cause a significant weakening of the Atlantic meridional overturning circulation (AMOC), resulting in a cooling in the North Atlantic. The meridional contrast of sea surface temperature would be enhanced, and this can eventually enhance the Hadley cell and storm-track activities in the Northern Hemisphere. Accompanied by changes in both ocean and atmosphere circulations, the northward ocean heat transport in the Atlantic is decreased while the northward atmosphere heat transport is increased, and the BJC occurs in the Northern Hemisphere. Once the freshwater influx into the North Atlantic Ocean stops, or the ocean even loses freshwater because of strong heating in the high latitudes, the AMOC would recover. Both the atmosphere and ocean heat transports would be enhanced, and they can eventually recover to the state of the control run, leading to the BJC to become invalid. The above processes are clearly demonstrated in the coupled model CO2 experiment. Since it is difficult to separate the freshwater effect from the heating effect in the coupled model, a simple box model is used to understand the BJC mechanism and freshwater’s role under global warming. In a warming climate, the freshwater flux into the ocean can cool the global surface temperature, mitigating the temperature rise. Box model experiments indicate clearly that it is the freshwater flux into the North Atlantic that causes out-of-phase changes in the atmosphere and ocean heat transports, which eventually plays a stabilizing role in global climate change.
A Unified Moisture Mode Framework for Seasonality of the Madden–Julian Oscillation
Authors: Jiang Xianan , Adames Ángel F. , Zhao Ming , Waliser Duane , Maloney Eric
Published: March 2018

The Madden–Julian oscillation (MJO) exhibits pronounced seasonality. While it is largely characterized by equatorially eastward propagation during the boreal winter, MJO convection undergoes marked poleward movement over the Asian monsoon region during summer, producing a significant modulation of monsoon rainfall. In classical MJO theories that seek to interpret the distinct seasonality in MJO propagation features, the role of equatorial wave dynamics has been emphasized for its eastward propagation, whereas coupling between MJO convection and the mean monsoon flow is considered essential for its northward propagation. In this study, a unified physical framework based on the moisture mode theory, is offered to explain the seasonality in MJO propagation. Moistening and drying caused by horizontal advection of the lower-tropospheric mean moisture by MJO winds, which was recently found to be critical for the eastward propagation of the winter MJO, is also shown to play a dominant role in operating the northward propagation of the summer MJO. The seasonal variations in the mean moisture pattern largely shape the distinct MJO propagation in different seasons. The critical role of the seasonally varying climatological distribution of moisture for the MJO propagation is further supported by the close association between model skill in representing the MJO propagation and skill at producing the lower-tropospheric mean moisture pattern. This study thus pinpoints an important direction for climate model development for improved MJO representation during all seasons.
Wind-Wave Effects on Estuarine Turbulence: A Comparison of Observations and Second-Moment Closure Predictions
Authors: Fisher Alexander W. , Sanford Lawrence P. , Scully Malcolm E.
Published: March 2018

Observations of turbulent kinetic energy, dissipation, and turbulent stress were collected in the middle reaches of Chesapeake Bay and were used to assess second-moment closure predictions of turbulence generated beneath breaking waves. Dissipation scaling indicates that the turbulent flow structure observed during a 10-day wind event was dominated by a three-layer response that consisted of 1) a wave transport layer, 2) a surface log layer, and 3) a tidal, bottom boundary layer limited by stable stratification. Below the wave transport layer, turbulent mixing was limited by stable stratification. Within the wave transport layer, where dissipation was balanced by a divergence in the vertical turbulent kinetic energy flux, the eddy viscosity was significantly underestimated by second-moment turbulence closure models, suggesting that breaking waves homogenized the mixed surface layer to a greater extent than the simple model of TKE diffusing away from a source at the surface. While the turbulent transport of TKE occurred largely downgradient, the intermittent downward sweeps of momentum generated by breaking waves occurred largely independent of the mean shear. The underprediction of stress in the wave transport layer by second-moment closures was likely due to the inability of the eddy viscosity model to capture the nonlocal turbulent transport of the momentum flux beneath breaking waves. Finally, the authors hypothesize that large-scale coherent turbulent eddies played a significant role in transporting momentum generated near the surface to depth.
Prevalence and Incidence of Schizophrenia Spectrum Disorders: Implications for Prevention
Authors: Jablensky Assen
Published: March 2018

Objective

This paper reviews the historical and conceptual background to proposals about prevention of schizophrenia through intervention targeting asymptomatic, high-risk individuals. It also examines the outcomes of a hypothetical model of prevention based on a two-stage risk segmenting approach.

Method

The assumptions and parameters used in the model are derived from actual epidemiological and clinical research. The two risk criteria selected are: (i) genetic risk (having a parent with schizophrenia); and (ii) neurocognitive deficit (abnormal performance on the Continuous Performance Task, CPT). The parameters and risk factors are applied to a hypothetical screening program covering a population of 100 000.

Results

At the end of the second stage of screening the program using the risk criteria to search for preventable cases will have correctly identified only three out of 20 ‘true’ cases and will have incorrectly assigned to treatment two non-cases. The great majority of people at risk who will eventually develop schizophrenia are likely to remain undetected by current screening or preclinical diagnostic programs, while a certain number of people actually not at risk would be falsely identified as high-risk and offered treatment.

Conclusions

Reliably identifying, with intention to treat, asymptomatic people in the community who are presumed to be at high risk of developing schizophrenia is at present epidemiologically non-viable. This caveat should not apply to strategies for early diagnosis and treatment of incipient episodes of schizophrenia where strategies to reduce the duration of untreated psychosis are likely to be both feasible and cost-effective.
Screening for Low Prevalence Disorders
Authors: O'Toole Brian I.
Published: March 2018

Objective

To examine the epidemiologic theory of screening as it applies to low prevalence disorders, such as schizophrenia, in order to identify the tasks required for primary and secondary prevention.

Method

Review of principles of screening, computation of prevented fraction for varying sensitivities, specificities and prevalences of disease, and review of prevalence of schizophrenia in Australian general practice.

Results

There is no currently available efficient method of screening for schizophrenia or for prodromal symptoms. From the genesis of disease to eventual outcome, the milestones that are passed in the case of schizophrenia are uncertain in their nature and the intervening time periods are of uncertain and possibly varying duration. The extent of false positives and negatives in low prevalence disorders is high unless the specificity is very high.

Conclusion

It may be feasible to screen for behaviours that are precursors to schizophrenia; however, screening depends upon the existence of a reliable screening instrument that can be shown to discriminate accurately between diseased and disease-free individuals. Development of a method for screening requires comparison against formal clinical assessment of both screen positives and screen negatives. For low prevalence disorders the predictive values may be low unless specificity is high.
Eye Movement Dysfunction as a Biological Marker of Risk for Schizophrenia
Authors: Lee Kwang-Hyuk , Williams Leanne M.
Published: March 2018

Objective

Our aim was to review smooth pursuit eye movement (SPEM) studies in schizophrenia and groups at high risk for schizophrenia, with a view to evaluating the utility of SPEM dysfunction as a biological marker of risk for schizophrenia.

Method

Smooth pursuit eye movement studies, related saccade function and the unresolved issues in this area of schizophrenia research were addressed. The different perspectives on the trait marker status of SPEM dysfunction, provided by both high-risk studies and related developmental research were considered. Attention was also given to the relationship between eye movement dysfunction and symptom profiles.

Results

Converging evidence points to the robust and specific nature of SPEM dysfunction in schizophrenia, and highlights the role of frontal lobe and a related network dysfunction. The vast majority of ‘high risk’ studies support the view that SPEM dysfunction is also genetically specific to schizophrenia, and is not simply due to the overt expression of this illness. Studies assessing SPEM in relation to symptomatology show an association with the Disorganisation syndrome in particular.

Conclusions

Evidence for the specificity of SPEM dysfunction to diagnosed schizophrenia, as well as to healthy individuals with a genetic vulnerability to schizophrenia, suggests that the SPEM task has efficacy as a test of gene carrier status in schizophrenia, and therefore as a trait marker of risk for schizophrenia. Future studies should seek to explore the relationships between SPEM and other eye movement dysfunctions (antisaccades, express saccades), in view of evidence that some of these dysfunctions also show specificity for schizophrenia.
Evidence for Progression of Brain Structural Abnormalities in Schizophrenia: Beyond the Neurodevelopmental Model
Authors: Velakoulis Dennis , Wood Stephen J. , McGorry Patrick D. , Pantelis Christos
Published: March 2018

Objective

Clinical, neuroimaging, neuropathological and neuropsychological evidence suggests that, in schizophrenia, there is structural and functional disturbance of the hippocampus. The purpose of this paper is to present published findings concerning the nature, timing and course of these putative disturbances of hippocampal function and the pathophysiological mechanisms involved, and to explore whether schizophrenia is a disorder of neurodevelopment, neurodegeneration or a combination of both processes.

Method

The available cross-sectional and longitudinal evidence for hippocampal involvement in schizophrenia is reviewed and a model of hippocampal involvement in this disorder, which derives from our own cross-sectional and longitudinal hippocampal imaging data, is described.

Results

We propose a three-hit model in which an early neurodevelopmental lesion renders the hippocampus vulnerable to further insult later in life during the transition phase to active illness. The available evidence suggests that the left hippocampus is particularly vulnerable during these early stages, while further insult involving the hippocampus bilaterally occurs in those who develop a chronic form of the illness.

Conclusions

Intervention strategies should target the most vulnerable stages of the illness, in particular the transition phase to psychosis, when novel treatments may prevent the illness or ameliorate its effects.
Case Ascertainment: The Composite International Diagnostic Interview
Authors: Andrews Gavin
Published: March 2018

Objective

To outline the utility of the Composite International Diagnostic Interview (CIDI) in the diagnosis of psychosis.

Method

Report current situation.

Results

The CIDI was designed as a fully structured interview to be used by lay interviewers. It generates false positive diagnoses in community surveys and false negative diagnoses in psychiatric settings. A new psychosis module has been developed to reduce these problems.

Conclusions

The diagnosis of psychosis by fully structured diagnostic interviews is difficult.
Presymptomatic Screening for Schizophrenia: A Geneticist's Perspective
Authors: Turner Gillian
Published: March 2018

Objective

To examine whether the experience gained in offering various genetic tests may be of help in the planning for screening in schools for a personality profile that may identify those destined to develop schizophrenia.

Method

To examine the outcomes in offering genetic testing: (i) to individuals at risk of developing Huntington's disease; (ii) to school pupils for carrier status for cystic fibrosis; and (iii) to the intellectually handicapped in schools to identify those with the fragile X syndrome.

Results

All programs however carefully planned, encounter the unexpected and unforeseen.

Conclusions

It is essential to know the specificity and sensitivity of your screening test; to ensure that all have adequate knowledge before consenting to the testing; to ensure the confidentiality of the test results to the individual being tested and their families; and to ensure that funding is adequate and ongoing to provide continuing support and therapy to the families identified when research converts to service.
Mechanical properties of fiber reinforced polymer composites: A comparative study of conventional and additive manufacturing methods
Authors: Agarwal Kuldeep , Kuchipudi Suresh K , Girard Benoit , Houser Matthew
Published: March 2018

Fiber reinforced polymer composites have been around for many decades but recently their use has started to increase in multiple industries such as automotive, aerospace, and construction. The conventional composite manufacturing processes such as wet lay-up, resin transfer molding, automatic lay ups etc. suffer from a lot of practical and material issues which have limited their use. The mechanical properties of the parts produced by such processes also suffer from variation that causes problems downstream. Composites based additive manufacturing processes such as Fused Deposition Modeling and Composite Filament Fabrication are trying to remove some of the barriers to the use of composites. Additive manufacturing processes offer more design and material freedom than conventional composite manufacturing processes. This paper compares conventional composite processes for the manufacturing of Epoxy-Fiberglass fiber reinforced polymers with composite filament fabrication based Nylon-Fiberglass fiber reinforced polymers. Mechanical properties such as tensile strength, elastic modulus, and fatigue life are compared for the different processes. The effect of process parameters on these mechanical properties for the composite filament fabrication based process is also examined in this work. It is found that the composite filament fabrication based process is very versatile and the parts manufactured by this process can be used in various applications.
Metatranscriptome of the Oral Microbiome in Health and Disease
Authors: Solbiati J. , Frias-Lopez J.
Published: March 2018

The last few decades have witnessed an increasing interest in studying the human microbiome and its role in health and disease. The focus of those studies was mainly the characterization of changes in the composition of the microbial communities under different conditions. As a result of those studies, we now know that imbalance in the composition of the microbiome, also referred to as microbial dysbiosis, is directly linked to developing certain conditions. Dysbiosis of the oral microbiome is a prime example of how this imbalance leads to disease in the case of periodontal disease. However, there is considerable overlap in the phylogenetic profiles of microbial communities associated with active and inactive lesions, suggesting that the difference in periodontal status of those sites may not be explained solely by differences in the subgingival microbial composition. These findings suggest that differences in functional activities may be the essential elements that define the dysbiotic process. Researchers have recently begun to study gene expression of the oral microbiome in situ with the goal of identifying changes in functional activities that could explain the transition from health to disease. These initial results suggest that, rather than a specific composition, a better understanding of oral dysbiosis can be obtained from the study of functional activities of the microbial community. In this review, we give a summary of these initial studies, which have opened a new door to our understanding of the dynamics of the oral community during the dysbiotic process in the oral cavity.
Grief, Tragic Death, and Multiple Loss in the Lives of Irish Traveller Community Health Workers
Authors: Tobin Mary , Lambert Sharon , McCarthy John
Published: March 2018

Recent data on the inequities in mortality, health, and access to health services experienced by the Traveller community in Ireland show higher rates of death by suicide and other sudden causes among members of this marginalized minority group than in the general population. Psychological literature on bereavement suggests that traumatic deaths and multiple deaths within a close network may be more likely to lead to complicated grief reactions. The aim of this study is to add to our understanding of the effects of the differential mortality rate by exploring how grief is experienced within the Traveller community in the context of bereavement from multiple deaths or sudden deaths (including suicide). Data from three semistructured focus group interviews with a total of 10 Traveller Community Health Worker participants (nine female and one male) were analyzed using Interpretative Phenomenological Analysis. Two master themes organized the salient phenomenological aspects of the grief experience: Living with Tragic Loss and Communicating Tragic Loss. A picture emerged of individual and community-level loss that is extensive, profound, and enduring. The sequelae of deaths by suicide include difficulties in coping, a search for meaning, and a pervasive sense of fear. Silence, the embodied act of giving voice to tragic loss, and strategies for managing disclosure of tragic deaths with children were all strong themes which emerged from the analysis. This study uses interpretative phenomenological analysis to generate a vivid picture of the lived psychological experience of grief as it is experienced by members of a minority group with above average rates of sudden and early deaths. This contributes to understanding the burden of health inequality in an underresearched population. Findings in relation to challenges in communicating with children about tragic deaths can be integrated into bereavement support resources.
A case of an acute cutaneous drug reaction with hydroxychloroquine
Authors: Randhawa Amritakaur , Wylie Grant
Published: March 2018

Hydroxychloroquine is considered a relatively benign drug and is regularly used by rheumatologists and dermatologists. We highlight the severe adverse drug reaction potential of this commonly prescribed medication. We report the case of a 63-year-old male, who presented with widespread skin eruption following initiation of hydroxychloroquine two weeks earlier for an inflammatory arthritis. He had typical clinical, biochemical and histological features of the now recognised formal ‘diagnosis’ of severe cutaneous adverse drug reaction. The culprit drug was stopped and he responded to oral and topical steroids as well as supportive measures. Severe reactions to hydroxychloroquine are uncommon; however, as in this case, drug hypersensitivity reactions often manifest in skin. In a drug normally considered to be safe, these potential cutaneous side effects should be highlighted in information given to patients prior to commencement.
Bond graph based control of a solar array
Authors: Tapia Sánchez Roberto , Medina Ríos J. Aurelio , Paz Antonio Ramos
Published: March 2018

In this paper, the control of a solar array is proposed. The bond graph methodology is applied in order to get the structure control law for a solar array connected to the electrical network. For this, the different models of the complete system are presented. The solar array is built up by considering the individual solar panels. The inverter bond graph model is used for the development of the proposed control law. This model is inverted graphically to get the control structure. Also, the Park transformation concept is adapted to handle the control structure. This allows us to get a different control structure. Two different controls are considered in the proposed control structure, with their robustness tested for different power factors. The control law is tested using a real-time simulator. For this test, the rapid control prototyping concept is used. The obtained results demonstrate the viability of the proposed control law.
A novel modeling approach to predict the output performance of photovoltaic modules under different environmental conditions
Authors: Kareem Mohamed Saleem Abdul , Saravanan Manimaran
Published: March 2018

In this paper, an improved mathematical model of a single-diode photovoltaic (PV) module has been developed to predict the maximum power of the PV modules produced by different PV technologies, such as mono crystalline, multi crystalline, and thin film, under varying environmental conditions. The current–voltage characteristic equation of the PV module is used to extract the PV module’s unknown parameters, such as light generated current, saturation current, ideality factor, series resistance, and shunt resistance at standard test condition (STC). In the proposed PV model, numerical methods are used to calculate the parameters of the PV module at STC, by introducing new equations to estimate the value of series resistance and shunt resistance. By introducing new equations IMPP and VMPP, the maximum power of different PV modules manufactured by various PV technologies at different environmental conditions is then found. In the proposed PV model, the percentage relative error obtained at maximum power is calculated and the experimental results are compared with the models that exist in the literature for different PV modules. The maximum power obtained by the proposed PV model is much closer to that obtained by the Sandia model and Ishaque two-diode model. Furthermore, the output performance of the developed PV model has close agreement with the experimentally obtained data and it is verified practically.
The Treatment of Perianal and Anal Condylomata Acuminata: A new Operative Technique
Authors: Thomson James P S , Grace Roger H
Published: March 2018

Seventy-five patients have been treated for condylomata acuminata by means of a new operative approach which results in the preservation of the maximum amount of normal tissue. The technique has proved to be simple to perform, it has minimal complications and causes the patient little in the way of discomfort. Three out of 4 patients treated have no significant recurrent wart formation.
Successful Treatment of Tuberculosis in Renal Transplant Recipients1
Authors: Bell T J , Williams Grant B
Published: March 2018

Tuberculosis is a rare and usually fatal complication of renal transplantation. From 82 transplants in seven years, 4 cases of tuberculosis are reported. All have been treated successfully, with no fatalities or deterioration in renal function.
Pathogenesis of Attic Cholesteatomas
Authors: Sadé Jacob
Published: March 2018

An attic cholesteatoma is defined as an epidermoid cyst found in the attic. Stratified squamous epithelium may also be present in the middle ear as other clinical or pathological entities, such as metaplastic islands of the mucosa in chronic ears with central perforations or as a collapse of an atelectatic drum. Histological examination of 22 temporal bones with attic cholesteatomas has shown them to reside mainly medial to the ossicular chain. This explains the difficulty they have in self-cleansing, as well as the ensuing secondary infection. When a similar process occurs lateral to the ossicles, a self-cleansing nature's atticotomy may be formed. The aetiology ofan attic epidermoid cyst, i.e. an attic cholesteatoma, is usually considered to be an invasive retraction from the external ear. However, it is difficult to accept invasion ofexternal canal skin into the upper medial attic (often through the scutum). This is especially so in the face ofsucb biological phenomena as epithelial contact inhibition, or the invariable outward migration of stratified squamous epithelium from the edges of retraction pockets as well as from cholesteatoma perforations. Also, large cholesteatomas usually present themselves from the ‘beginning’ simultaneously with their perforations; no documentation of an evolving process from a pre-existing perforation exists at present. Marginal perforations which have later cvolved into attic cholesteatomas have so far not been documented. Therefore, the possibility that an attic cholesteatoma often arises primarily in the attic and presents itself secondarily in the external canal as a ‘perforated’ epidermoid cyst, is to be considered. The possibility that a congenital rest is responsible for the epidermoid cyst has often been put forward, but evidence that such rests actually exist has not yet been presented. The frequency with which cholesteatoma sacs (including the congenital type) show mucosal cells as part of their lining, suggests a metaplastic phenomenon, This means that the epithelial cells in question may have changed from mucosal into keratinizing cells or vice versa. Metaplastic changes of mucosas into keratinizing epithelium occur very frequently in the bronchi, nose, ears and genitourinary system. Epidermoid cysts may, therefore, be seen as an analogous formation to glandular cysts in the attic - the latter being very frequently found in the attic in chronically infected ears. Such ‘organ’ formations (glands or epidermoid cysts) may arise when their respective cells (forming mucus or keratin) grow in the midst ofconnective tissue rather than on the surface. Budding of cells, giving rise to epidermoid cysts, is occasionally found in chronically-infected ears adjacent to cholesteatomas.
Local Nerve Blocks for Postoperative Analgesia
Authors: Edmonds-Seal J , Paterson G M C , Loach A B
Published: March 2018

The effect of local nerve blockade on the relief of postoperative pain is reported in a series of 167 patients who underwent surgery of the arm, knee or foot. In 80% of cases analgesics were not required within 4 hours postoperatively, and in 39% analgesics were not required within 8 hours. Conventional methods of postoperative pain relief are not always effective. Local nerve blockade can be used to provide complete analgesia after limb surgery and is therefore of great value to postoperative care.
New Techniques in Diagnosis of Eye Muscle Palsies: A Review
Authors: Huber A
Published: March 2018

New techniques of diagnosis of eye muscle palsies are discussed. Electromyography facilitates differentiation between myopathies, myasthenias, neurogenic palsies and supranuclear motility disorders; this differentiation is based on the different aspects of electromyograms according to the different levels of affection. An important aid in diagnosis of eye muscle palsies, especially for the observation of the course of eye muscle palsies is oculography: here the determination of different parameters of eye movements under normal and pathological conditions is of utmost importance. These parameters are saccadic velocity on the one hand and acceleration on the other. Oculographic measurement of the saccadic movements gives a valuable indication of the severity of an eye muscle palsy and, when repeated, provides an important indication of the degree of recovery. A combination of electromyography and oculography permits the innervational pattern or eye muscles to be correlated with certain types of movements under normal and pathological conditions (Figure 9).
Detection of Disease at the Carotid Bifurcation Using Ultrasound – Including an Imaging System1
Authors: Lewis R R , Beasley M G , Gosling R G
Published: March 2018

A two-stage approach is described for the detection of occlusive arterial disease at the carotid bifurcation using continuous wave Doppler-shift ultrasound with spectral analysis of backscattered signals from erythrocytes. The first stage involves analysis of Doppler-shift signals from the supraorbital and common carotid arteries. Abnormal signals from these arteries are frequently caused by the presence of atheroma at the carotid bifurcation and are used to indicate the necessity for imaging the bifurcation. This latter technique produces a physiological image of the arteries, as it depends on detecting erythrocyte velocities beneath a transducer which is guided over the surface of the neck. The investigation has advantages over arteriography in that it is noninvasive, has no attendant risk and may be repeated as often as required.

In order to evaluate the accuracy of these methods the results have been compared with x-ray findings in patients undergoing carotid arteriography. In 20 comparisons there were no false positives and one false negative in which the arteriogram showed a small lesion. These results indicate that the two noninvasive methods may be used in sequence to demonstrate operable disease around the carotid junction.
Provision of Induced Abortion in Wessex Health Region: Unmet Need and Feasibility of Compensatory Day Care
Authors: Ashton John R
Published: March 2018

A study of routinely collected data showed that in 1975 only 42% of Wessex abortion patients obtained a National Health Service operation in their own region. Within this average the range for own district National Health Service operations was from 8.7% (Central Hampshire) to 68% (South West Hampshire) when known paybed operations had been excluded. Most of the remaining patients obtained private operations outside the region and of these about 50% obtained an operation at the British Pregnancy Advisory Service Clinic (BPAS) at Brighton.

A survey of Wessex women obtaining induced abortions at BPAS, Brighton, found that 85% of a sample of patients interviewed would have been willing to have a National Health Service operation locally but it had not been available. Only 24% of these women had been referred by way of a formal and accepted path, and had obtained their operation before ten weeks gestation, a suggested maximum for day-care provision.

If this proportion is representative of Wessex patients obtaining operations outside the region, the numbers of patients involved in 1975 would have been 643 and the feasibility of a day surgical unit specially providing for this number would be questionable.

It is suggested that by reducing delays in the referral process and accepting patients by non-traditional referral paths at least a further 21% of the patients would have qualified for day care. On the basis of this estimate a Regional Day Abortion Unit is probably a practicable proposition.
Adjuvant Chemotherapy and Immunotherapy for Colorectal Cancer: Preliminary Communication
Authors: Bancewicz J , Caiman K C , Macpherson S G , McArdle C S , McVie J G , Soukop M
Published: March 2018

Following surgical resection of Dukes’ B or C colorectal cancers 72 patients have been randomly allocated to receive: 5-fluorouracil; or 5-fluorouracil and levamisole; or no treatment. Adjuvant treatment was continued for one year. 66 patients remain evaluable for up to 24 months. Preliminary results show no significant differences in survival or recurrence rates. Two patients receiving 5-fluorouracil and levamisole developed severe, but reversible, neutropenia. Other side effects were uncommon.
Anaesthesia for Bronchoscopy: Examination of a Standard Technique
Authors: Newell John P , Collis John M
Published: March 2018

An anaesthetic technique for bronchoscopy is described, based on increments of methohexitone given in strict relation to body weight and time, suxamethonium being used to produce relaxation. There was no awareness in the 75 patients studied, while the recovery was rapid and unrelated to the duration of bronchoscopy. The efficacy of small aliquots of lignocaine in reducing injection pain was the same whether given before, or mixed with, the initial methohexitone injection. Other sequelae relating to the anaesthetic technique were minimal.
Cerebrospinal Fluid Rhinorrhoea in Pituitary Tumours
Authors: Cole I E , Keene Malcolm
Published: March 2018

Three cases of CSF rhinorrhoea due to pituitary tumours are reported and the literature reviewed. The treatment of choice appears to be trans-sphenoidal exploration of the pituitary fossa with insertion of a free muscle graft followed by radiotherapy. The probability of the tumour being a prolactin-secreting adenoma is discussed.
Blood Lead Concentrations in Pre-School Children in Birmingham1
Authors: Archer A , Giltrow J P , Waldron H A
Published: March 2018

A survey has been undertaken of the distribution of blood lead concentrations in pre-school children attending nursery schools or day centres in Birmingham. The majority of levels in excess of 1.65 μmol/l were found in children of Asian origin. It is thought likely that the high blood lead concentration seen in these children is related to nutritional rather than environmental factors.
Cryosurgery for the Urethral Syndrome: Preliminary Communication
Authors: Parkes A C , Boreham P
Published: March 2018

A method has been devised for treating the urethral syndrome by cryosurgery using a special applicator. The results in the first 35 cases are presented and compared with a similar group of women treated by urethral dilatation. The cryosurgical method has proved to be successful and free of complications. The study is being continued.
Delivery and Development: To what Extent can One Associate Cause and Effect?
Authors: Ounsted Margaret , Scott Andrew , Moar Valerie
Published: March 2018

Data on 570 mothers and their children whose development was personally assessed from birth to four years were analysed. Strong associations were found between the incidence of fetal distress during labour, birth asphyxia, and delivery by emergency caesarean section. At the age of four years girls and children in the non-manual social classes were more advanced, developmentally, than boys and children in the manual classes. No associations were found between perinatal factors and total developmental scores; but highly significant differences were found between ‘at risk’ pregnancy groups according to their method of developmental scores. In only one of seven handicapped children could the handicap possibly have been attributable to delivery factors. Case histories of two children illustrate the dangers and difficulties of associating cause and effect in individual patients.
On the Pathogenesis of Syringomyelia: A Review
Authors: Williams Bernard
Published: March 2018

Discussion of the pathogenesis of syringomyelia involves considering the origin of the fluid and also the forces which cause that fluid to break down the structure of the cord. When cerebrospinal fluid (CSF) appears to be the destructive element, it commonly enters through a patent central canal running from the fourth ventricle to the inside of the syrinx. In both clinical and experimental situations pressure differences may be measured which suck on the hindbrain, particularly the cerebellar tonsils, producing deformities. These pressure differences may also suck fluid into the syrinx. In other cases, even when a communication does not appear to be patent, the hindbrain abnormalities are usually present and suck effect may usually be demonstrated and its correction be accompanied by clinical improvement. Other sources of fluid within a syrinx include liquefaction of haematomata after traumatic paraplegia and transudation of fluid from intrinsic spinal tumours. Once fluid is present within a cord cavity it may pulsate upwards and downwards in response to fluid movements in the subarachnoid space, the most energetic of which result from venous influences. Such movement, ‘slosh’, may cause the cavities to extend at either end giving rise to upward and downward extension from a post-traumatic cord cyst and sometimes to syringobulbia. Cord ischaemia, venous congestion and transport of fluid along perivascular spaces may all play a part in the maintainance of cord cavities or the progression of the clinical disabilities.
Effectiveness of Amiodarone in Resistant Arrhythmias1
Authors: Hollman Arthur , Holt Phyllis M
Published: March 2018

Amiodarone is used in the treatment of previously drug-resistant supraventricular and ventricular arrhythmias. We report our experience with amiodarone in 8 patients. Five patients had paroxysmal atrial flutter, one had paroxysmal atrial fibrillation, one had supraventricular tachycardia, and one ventricular tachycardia. Considerable improvement, both objectively and subjectively, was observed in all patients. Side effects were as follows: all patients had corneal microdeposits, one developed left bundle branch block which resolved on stopping amiodarone, and one reported constipation and abdominal pains. Six patients have been treated for 10–28 months; 3 developed tolerance at 4–14 months after the introduction of amiodarone therapy, but symptoms improved with increased dosage. It is important to watch for the development of tolerance to this drug.
Swimming and Grommets
Authors: Marks N J , Mills R P
Published: March 2018

The dictum that patients who have plastic ventilation tubes (grommets) inserted in their tympanic membranes should not go swimming is questioned. A theoretical assessment is made of the pressure necessary to push water through a grommet. This value is compared with practical observations. These values are discussed with reference to chemical and bacteriological hazards and it is concluded that water is unlikely to enter the middle ear in surface swimming, and even when diving underwater the chances of setting up an otitis media must be small.
Ultrastructure of the Synovial Membrane in Seronegative Inflammatory Arthropathies
Authors: Morris C J , Farr M , Hoiiywell C A , Hawkins C F , Scott D L , Walton K W
Published: March 2018

The ultrastructure of the synovial membrane has been studied in 6 patients with seronegative inflammatory arthropathies: Reiter's (2), Crohn's (2), Whipple's (1) and Behcet's disease (1). The most striking changes were found in the synovial B cells, many containing abnormally large mitochondria with altered cristae surrounded by fibrillar material. Similar material was present in dilated endoplasmic reticulum which was the probable source of groups of extracellular fibrillar spheroidal bodies. The B cells also contained electron dense granular lysosomes of very variable size which, in common with the abnormal mitochondria, were often associated with bundles of orientated microfilaments and large golgi complexes. Light microscopy of the synovial membrane was consistent with an inflammatory arthritis, as were the high white cell counts in the synovial fluid. Systemic activity in the patients was indicated by raised ESR and C-reactive protein (CRP).
Effect of Pindolol on Stress-Related Disturbances of Musical Performance: Preliminary Communication1
Authors: James I M , Burgoyne W , Savage I Temple
Published: March 2018

The effect of 5 mg pindolol on stress-induced disturbances of performance were assessed in 30 professional musicians. An overall inverse relationship was found between anxiety and musical performance. Reduction in anxiety by administration of pindolol was associated with a subjective improvement in performance. A stress-related tachycardia and increase in systolic blood pressure were attenuated. Pindolol had no effect on peak flow measurements.
Psychiatric disorders among elderly patients admitted to hospital medical wards
Authors: Cooper Brian
Published: March 2018

A psychiatric investigation was carried out on patients aged 65–80 years who were admitted to the medical wards of six general hospitals in an industrial urban area of West Germany. In all, 626 patients were screened for cognitive and affective disorder using a short standardized interview, and at the second stage all those with abnormal responses, as well as a subsample of the apparently normal patients, were examined in greater detail. After correction for inaccuracies of screening, the frequency of psychiatric illness in this patient population was estimated as 30.2%, made up of 9.1% with organic brain syndromes and 21.1% with functional mental disorders. Comparison with field-study data for the same background population showed that the hospital patients were at increased risk for mental disturbance.

At follow up after one year, outcome in terms of mortality, admission to long-term care and dependency on others was worst for patients with organic mental disorder, even after matching for age and initial severity of physical impairment. Functional mental illness was also associated with a relatively poor outcome in terms of dependency. The mental status of elderly medical patients appears to be important for the prognosis.
Building or Extending a Hospital Department: Radiology a Path through the Planning Minefield
Authors: Roebuck E J , Manton D J , Fordham G L
Published: March 2018

This is the first of a series of articles on the planning and building of a new radiology department or the extension of an old one. While the series focuses on a radiology department, it will be of interest to anyone who is planning any part of a hospital, particularly in the detailed information about the planning process and the part to be played by hospital staff during the subsequent building and commissioning.