bluuebunny/crossref_metadata_2025 huggingface dataset:
Diet and injection, our recommendation to characterizeClavibacter michiganensis- tomato interactions
Authors: Brochu Anne-Sophie , Durrivage Jeanne , Torres Dagoberto , Pérez-López Edel
Published: April 2023

Tomato (Solanum lycopersicumL.) is one of the most important vegetables in the world. Its extensive cultivation has made this plant the target of many viral, fungal, and bacterial diseases. Among them, the bacterial canker of tomato caused byClavibacter michiganensis(Cm) has been named one of the most devastating diseases affecting the tomato industry worldwide. It can significantly reduce the yields and profitability of this crop. One of the big challenges we found when working withCmand trying to characterize the virulence of different isolates was the lack of a consensus methodology to inoculate tomato plants, how to fertilize them and characterizeCmvirulence. This research aimed to identify an artificial inoculation method to induce bacterial canker on tomato plants in greenhouse conditions to homogenize the results of different studies withCm. We compared two inoculation methods, including the scalpel and syringe method with two levels of fertilization, low and high fertilization. After evaluating several variables like the percentage of necrotic leaves and the height of the plants, the results showed that the syringe inoculation with low fertilization was the most effective inoculation method allowing the development of a multilevel scale that can be used to study the interaction between tomato plants andCmisolates.
A transposase-derived gene required for human brain development
Authors: Zapater Luz Jubierre , Lewis Sara A. , Gutierrez Rodrigo Lopez , Yamada Makiko , Rodriguez-Fos Elias , Planas-Felix Merce , Cameron Daniel , Demarest Phillip , Nabila Anika , Mueller Helen , Zhao Junfei , Bergin Paul , Reed Casie , Chwat-Edelstein Tzippora , Pagnozzi Alex , Nava Caroline , Bourel-Ponchel Emilie , Cornejo Patricia , Dursun Ali , Özgül R. Köksal , Akar Halil Tuna , Maroofian Reza , Houlden Henry , Cheema Huma Arshad , Anjum Muhammad Nadeem , Zifarelli Giovanni , Essid Miriam , Hafsa Meriem Ben , Benrhouma Hanene , Montoya Carolina Isabel Galaz , Proekt Alex , Zhao Xiaolan , Socci Nicholas D. , Hayes Matthew , Bigot Yves , Rabadan Raul , Torrents David , Kleinmann Claudia L , Kruer Michael C. , Toth Miklos , Kentsis Alex
Published: April 2023

DNA transposable elements and transposase-derived genes are present in most living organisms, including vertebrates, but their function is largely unknown. PiggyBac Transposable Element Derived 5 (PGBD5) is an evolutionarily conserved vertebrate DNA transposase-derived gene with retained nuclease activity in human cells. Vertebrate brain development is known to be associated with prominent neuronal cell death and DNA breaks, but their causes and functions are not well understood. Here, we show that PGBD5 contributes to normal brain development in mice and humans, where its deficiency causes disorder of intellectual disability, movement, and seizures. In mice, Pgbd5 is required for the developmental induction of post-mitotic DNA breaks and recurrent somatic genome rearrangements. In the brain cortex, loss of Pgbd5 leads to aberrant differentiation and gene expression of distinct neuronal populations, including specific types of glutamatergic neurons, which explains the features of PGBD5 deficiency in humans. Thus, PGBD5 might be a transposase-derived enzyme required for brain development in mammals.

One-Sentence Summary

PiggyBac Transposable Element Derived 5 (PGBD5) is required for brain development in humans and mice through genetic and epigenetic mechanisms.
EBF1 limits the numbers of cochlear hair and supporting cells and forms the scala tympani and spiral limbus during inner ear development
Authors: Kagoshima Hiroki , Ohnishi Hiroe , Yamamoto Ryosuke , Yasumoto Akiyoshi , Tona Yosuke , Nakagawa Takayuki , Omori Koichi , Yamamoto Norio
Published: April 2023

Early B-cell factor 1 (EBF1) is a basic helix-loop-helix transcription factor essential for the differentiation of various tissues. Our single-cell RNA sequencing data suggest thatEbf1is expressed in the sensory epithelium of the inner ear. Here, we found that theEbf1gene and its protein are expressed in the prosensory domain of the inner ear, medial region of the cochlear floor, inner ear mesenchyme, and cochleo-vestibular ganglion.Ebf1deletion results in incomplete formation of the spiral limbus and scala tympani, increased number of cells in the organ of Corti and Kölliker’s organ, and aberrant course of the spiral ganglion axons. The inner ear-specific deletion ofEbf1revealed that scala tympani formation depended onEbf1expressed in the otic mesenchyme.Ebf1deletion in the cochlear epithelia caused the proliferation of SOX2-positive cochlear cells at E13.5, indicating that EBF1 suppresses the proliferation of the prosensory domain and cells of Kölliker’s organ to facilitate the development of appropriate numbers of hair and supporting cells. Furthermore, mice with deletion of cochlear epithelium-specificEbf1showed poor postnatal hearing function. Our results suggest thatEbf1is essential for normal auditory function in mammals.
Neural dynamics of predictive timing and motor engagement in music listening
Authors: Zalta Arnaud , Large Edward W. , Schön Daniele , Morillon Benjamin
Published: April 2023

Why do humans spontaneously dance to music? To test the hypothesis that motor dynamics reflect predictive timing during music listening, we built melodies with varying degrees of rhythmic predictability. Magnetoencephalography data showed that while auditory regions track the rhythm of melodies, intrinsic neural dynamics at delta (1.4 Hz) and beta (20-30 Hz) rates in the dorsal auditory pathway embody the experience of groove. Critically, neural dynamics are organized along this pathway in a spectral gradient, with the left sensorimotor cortex acting as a hub coordinating groove-related delta and beta activity. Combined with predictions of a neurodynamic model, this indicate that spontaneous motor engagement during music listening is a manifestation of predictive timing effected by interaction of neural dynamics along the dorsal auditory pathway.

One-Sentence Summary

Interacting neural dynamics along the dorsal auditory pathway effect the experience of groove during music listening.
Effect of substitution of wheat flour with chickpea flour on their physico-chemical characteristics
Authors: Sidhu Jiwan S. , Zafar Tasleem , Almusallam Abdulwahab , Ali Muslim , Al-Othman Amani
Published: April 2023

Purpose

The major objective of this research work was to evaluate various physico-chemical characteristics, such as, chemical composition, antioxidant capacity, objective color and texture profile analysis (TPA) of the wheat flour/chickpea flour (CF) blends, so that nutritious baked products could be consumed by the type-2 diabetic persons.

Design/methodology/approach

Wholegrain wheat flour (WGF) and white wheat flour (WWF) were substituted with CF at 0 to 40% levels. These wheat flour/CF blends were analyzed for proximate composition, the prepared dough and baked breads were tested for objective color, antioxidant capacity as trolox equivalent antioxidant capacity (TEAC), malondialdehyde (MDA) and total phenolic content (TPC) and TPA.

Findings

WGF had the highest TEAC (117.42 mM/100g) value, followed by WWF (73.98 mM/100g) and CF (60.67 mM/100g). TEAC, MDA and TPC values varied significantly among all the three flour samples.

Research limitations/implications

Inclusion of whole chickpea (without dehulling) flour in such type of blends would be another interesting investigation during the future research studies.

Practical implications

These research findings have a great potential for the production of these baked products for human consumption on an industrial scale.

Social implications

Production of breads using wheat flour and CF blends would benefits the consumers.

Originality/value

Production of Arabic and pan breads using wheat flour and CF blends would, therefore, combine the benefits of both the needed proteins of plant origin and the health-promoting bioactive compounds, in a most sustainable way for the consumers.
Emotions, perceived knowledge and food behaviors during stressful periods
Authors: Xie Hu , Veeck Ann , Yu Hongyan , Zhu Hong
Published: April 2023

Purpose

This paper aims to examine how emotions affect consumers' food choices and food preparation activities during stressful periods, using the context of the coronavirus disease 2019 (COVID-19) outbreak in China.

Design/methodology/approach

This study used an online survey, with a sample of 1,050 individuals from 32 regions in China. Multi-regression and mediation models were used to test the relationships among perceived knowledge, emotions and food behaviors.

Findings

The results show that positive emotions positively affect healthy food consumption and engagement in food preparations. In contrast, negative emotions contribute to an increase in indulgent food consumption and quick-and-easy meal preparations. Increased knowledge of the current situation can enhance positive emotions and thus promote healthy food behaviors. Lacking knowledge may result in unhealthy food behaviors through negative emotions.

Originality/value

This study contributes to the understanding of emotions and food behaviors by examining the effects of both negative and positive emotions in the general population, exploring a wider constellation of food behaviors and identifying perceived knowledge as an important antecedent to emotions' effects on food behaviors. Implications for consumers and public policy are offered.
Industrialized house building productivity growth
Authors: Stehn Lars , Jimenez Alexander
Published: May 2023

Purpose

The purpose of this paper is to understand if and how industrialized house building (IHB) could support productivity developments for housebuilding on project and industry levels. The take is that fragmentation of construction is one explanation for the lack of productivity growth, and that IHB could be an integrating method of overcoming horizontal and vertical fragmentation.

Design/methodology/approach

Singe-factor productivity measures are calculated based on data reported by IHB companies and compared to official produced and published research data. The survey covers the years 2013–2020 for IHB companies building multi-storey houses in timber. Generalization is sought through descriptive statistics by contrasting the data samples to the used means to control vertical and horizontal fragmentation formulated as three theoretical propositions.

Findings

According to the results, IHB in timber is on average more productive than conventional housebuilding at the company level, project level, in absolute and in growth terms over the eight-year period. On the company level, the labour productivity was on average 10% higher for IHB compared to general construction and positioned between general construction and general manufacturing. On the project level, IHB displayed an average cost productivity growth of 19% for an employed prefabrication degree of about 45%.

Originality/value

Empirical evidence is presented quantifying so far perceived advantages of IHB. By providing analysis of actual cost and project data derived from IHB companies, the article quantifies previous research that IHB is not only about prefabrication. The observed positive productivity growth in relation to the employed prefabrication degree indicates that off-site production is not a sufficient mean for reaching high productivity and productivity growth. Instead, the capabilities to integrate the operative logic of conventional housebuilding together with logic of IHB platform development and use is a probable explanation of the observed positive productivity growth.
Micro-credentials and reflections on higher education
Authors: Orman Rukiye , Şi̇mşek Elif , Kozak Çakır Meryem Ayşegül
Published: April 2023

Purpose

Micro-credentials, which have been widely used in re-skilling and skills development, provide advantages for improvement in the professional career. As a complementary approach to career and professional development in formal education, it can be said that micro-credentials are preferred for supporting professional development and/or to acquiring new skills to find a job in a new field (Fisher and Leder, 2022). This study aims to provide a detailed perspective on conceptual framework and the use of micro-credentials in higher education.

Design/methodology/approach

Many questions have arisen regarding micro-credentials, applicability, quality assurance, inclusion in formal educational settings and how to include them in traditional education systems, especially in higher education institutions. Oliver (2019) emphasizes that there is little research on micro-credentials or their derivatives in the literature. There is still uncertainty on micro-credential on behalf of students, employers or employees. In addition, although there are studies on micro-credentials in the USA, Europe and Australia, there is very little research around countries such as Turkey (Yilik, 2021). This study discusses the use of micro-credentials in the world and their reflections on higher education.

Findings

As it is shown in this article, micro-credentials have the potential to challenge or complement traditional ways of how learning is taking place, understood, recognized and certified. Research on micro-credentials is still in its infancy and could benefit a lot from more research. Especially research on employers' recognition and appreciation of digital credentials needs to be studied. Also, empirically confirming propositions of literature on micro-credentials could be beneficial.

Originality/value

This study is original in terms of discussing the use of micro-credential in the world and their reflections on higher education and presenting suggestions on this subject.
Evaluation of an artificial intelligence project in the software industry based on fuzzy analytic hierarchy process and complex adaptive systems
Authors: Chang Tsung-Sheng
Published: April 2023

Purpose

Artificial intelligence (AI) is the most progressive commodity among current information system applications. In-house development and sales of beneficial products are difficult for many software development and service companies (SDSCs). SDSCs have some implicit concerns about implementing AI software development due to the complexity of AI technology; they require an evaluation framework to avoid development failure. To fill the void, this study identified the factors influencing SDSCs when developing AI software development.

Design/methodology/approach

Based on complex adaptive systems theory, three aspects were developed as the main factors of hierarchy, namely, employees' capabilities, environmental resources and team capabilities. Fuzzy analytic hierarchy process (FAHP) was used to assess the SDSCs' attitude. Based on SDSCs, attitudes toward implementing AI software projects were collected to calculate the hierarchy of factors.

Findings

The outcome of FAHP is used as understanding the key factors of SDSCs for selecting an AI software project, toward the improvement of overall project planning. Employees' stress resistance was considered as a priority for the project, although professional AI skills and resources were also important.

Originality/value

This study suggested three variables developed using complex adaptive systems. This study contributes to a better understanding of the critical aspects of developing AI software projects in SDSCs. The study's findings have practical and academic implications for SDSCs and subsequent academic development, broadening the scope of AI software development research.
Reliability evaluation on SRG with full-bridge power converter considering thermal stress
Authors: Yang Fan , Chen Hao , Xu Shuai
Published: May 2023

Purpose

Quantitative reliability analysis can effectively identify the time the driving system needs to be maintained. Then, the potential safety problems can be found, and some catastrophic failures can be effectively prevented. Therefore, this paper aims to evaluate the reliability of the switched reluctance generator (SRG) driving system.

Design/methodology/approach

In this paper, a method considering different thermal stresses and fault tolerance capacity is proposed to analyze the reliability of an SRG. A full-bridge power converter (FBPC) instead of the asymmetric half-bridge power converter (AHBPC) is adopted to drive the SRG system. First, the primary fault modes of the SRG system are introduced, and a fault criterion is proposed to determine whether the system fails. Second, the thermal circuit model of the converter is established to quickly and accurately obtain the junction temperature of the devices. At last, the Markov models of different levels are established to evaluate the reliability of the system.

Findings

The results show that the two-level Markov model is the most suitable when compared to the static model and the one-level Markov model.

Originality/value

The driving system of SRG will be more reliable after the reliability of the system is evaluated by the Markov model. At the same time, an FBPC is adopted to drive the SRG. The FBPCs have the advantages of fewer switching devices, higher integration and lower cost. The proposed driving strategy of the FBPC avoids the current reversal and the generation of dead zone time, which has the advantage of reliable operation. In addition, a precise thermal circuit model of the FBPC is proposed, and the junction temperature of each device can be obtained, respectively.
The Decent Work Questionnaire: adaptation and validation of the Spanish version
Authors: Ferraro Tânia , Pais Leonor , Dos Santos Nuno Rebelo , Martinez-Tur Vicente
Published: May 2023

Purpose

The growing attention to business ethics, integrity and respect for human rights at work has become increasingly relevant. Decent work is an important concept representing the promotion of human rights at work and business, the fulfilling and productive work maintained with social dialogue. This study aims to present the adaptation and validation of the Spanish version of the Decent Work Questionnaire (DWQ), allowing the decent work assessment in Spanish. Initially developed and validated for Portuguese-speaking countries, the DWQ’s Italian version was also recently adapted and validated.

Design/methodology/approach

The 31-item scale was applied to a sample of 1,528 Spanish high-skilled workers. Confirmatory factor analysis (CFA) was performed. Convergent and discriminant validity was tested, examining the links of the DWQ to Work Engagement and Burnout measures.

Findings

CFA confirmed the original higher-order model with seven factors, a very good model fit and good internal consistency reliability (α = 0.94). Statistical analyzes also supported its convergent and discriminant validity.

Originality/value

The results confirmed the DWQ’s Spanish version as a reliable and valid multidimensional measurement tool and strengthened it as a good cross-cultural measure of decent work.
Labour market impacts of the equalisation of basic public health and medical services on internal migrants in China
Authors: Lu Chong , Wu Ailin
Published: April 2023

Using China Migrants Dynamic Survey Project data from 2011 to 2017, this study investigates the labour market impacts of equalisation of basic public health and medical services on internal migrants by the difference‐in‐differences approach in China. The results reveal that equalisation of basic public health and medical services increases the probability of labour participation and the income of internal migrants. Male migrants, married migrants and migrants who cover long migration distances have a much stronger positive response to the equalisation of basic public health and medical services in terms of likelihood of labour participation and level of income. Mechanism checks indicate that the increases in labour participation and income of internal migrants are enhanced by the improvement of medical service utilisation, human capital and social integration after the implementation of the equalisation of basic public health and medical services.
Leveraging projection models to evaluate long‐term dynamics of scrub mint translocations
Authors: López‐Borghesi Federico , Koontz Stephanie M. , Smith Stacy A. , Haller Crate Sarah J. , Quintana‐Ascencio Pedro F. , Menges Eric S.
Published: April 2023

Translocated populations often show vigorous initial dynamics but eventually collapse. Modeling tools that incorporate basic ecological knowledge and allow for propagation of uncertainty can help identify potential risks. Here, we use Bayesian Integral Projection Models to estimate population growth rates (λs), associated elasticities, and extinction risks for the endangered Dicerandra christmanii. Our study compared natural populations in gaps (open areas) within the shrub matrix and roadsides, unoccupied gaps augmented with transplants, and introduced populations. These populations experienced different management, including prescribed fires, and had different initial conditions. Augmented gaps showed lower means but similar variation in λs as natural gaps. Yet, simulations indicate that augmentations can delay quasi‐extinction (40% of simulations) by 4 years at the population level. Introduced populations showed higher means and variation in λs as wild gaps. While vital rate estimates suggested initial translocation success, time to quasi‐extinction was projected to be 7 years shorter for introductions in gaps than for natural gap populations. These contradictory results are partially explained by the lack of established seed banks in introduced populations, which affected the response of early life stage transitions to a prescribed fire. This study highlights the need to account for site‐specific information in models of population dynamics, including initial conditions and management history, and especially cryptic life stages such as dormant seeds.
The Role of Response Style Adjustments in Cross‐Country Comparisons—A Case Study Using Data from the PISA 2015 Questionnaire
Authors: Ulitzsch Esther , Lüdtke Oliver , Robitzsch Alexander
Published: May 2023

Country differences in response styles (RS) may jeopardize cross‐country comparability of Likert‐type scales. When adjusting for rather than investigating RS is the primary goal, it seems advantageous to impose minimal assumptions on RS structures and leverage information from multiple scales for RS measurement. Using PISA 2015 background questionnaire data, we investigate such an adjustment procedure and explore its impact on cross‐country comparisons in contrast to customary analyses and RS adjustments that (a) leave RS unconsidered, (b) incorporate stronger assumptions on RS structure, and/or (c) only use some selected scales for RS measurement. Our findings suggest that not only the decision as to whether to adjust for RS but also how to adjust may heavily impact cross‐country comparisons. This concerns both the assumptions on RS structures and the scales employed for RS measurement. Implications for RS adjustments in cross‐country comparisons are derived, strongly advocating for taking model uncertainty into account.
PrismPatNet: Novel prism pattern network for accurate fault classification using engine sound signals
Authors: Sahin Sakir Engin , Gulhan Gokhan , Barua Prabal Datta , Tuncer Turker , Dogan Sengul , Faust Oliver , Acharya U. Rajendra
Published: May 2023

Engines are prone to various types of faults, and it is crucial to detect and indeed classify them accurately. However, manual fault type detection is time‐consuming and error‐prone. Automated fault type detection promises to reduce inter‐ and intra‐observer variability while ensuring time invariant attention during the observation duration. We have proposed an automated fault‐type detection model based on sound signals to realize these advantageous properties. We have named the detection model prism pattern network (PrismPatNet) to reflect the fact that our design incorporates a novel feature extraction algorithm that was inspired by a 3D prism shape. Our prism pattern model achieves high accuracy with low‐computational complexity. It consists of three main phases: (i) prism pattern inspired multilevel feature generation and maximum pooling operator, (ii) feature ranking and feature selection using neighbourhood component analysis (NCA), and (iii) support vector machine (SVM) based classification. The maximum pooling operator decomposes the sound signal into six levels. The proposed prism pattern algorithm extracts parameter values from both the signal itself and its decompositions. The generated parameter values are merged and fed to the NCA algorithm, which extracts 512 features from that input. The resulting feature vectors are passed on to the SVM classifier, which labels the input as belonging to 1 of 27 classes. We have validated our model with a newly collected dataset containing the sound of (1) a normal engine and (2) 26 different types of engine faults. Our model reached an accuracy of 99.19% and 98.75% using 80:20 hold‐out validation and 10‐fold cross‐validation, respectively. Compared with previous studies, our model achieved the highest overall classification accuracy even though our model was tasked with identifying significantly more fault classes. This performance indicates that our PrismPatNet model is ready to be installed in real‐world applications.
Alternative raw material research for decarbonization of UK glass manufacture
Authors: Deng Wei , Backhouse Daniel J. , Kabir Kazi Feroz , Janani Ronak , Holcroft Chris , Magallanes Marlin , Marshall Martyn , Jackson Caroline M. , Bingham Paul A.
Published: April 2023

Based on the current UK decarbonization policy, a general outlook on potential routes for the glass industry to achieve net‐zero is discussed and the differentiation during decarbonization is specified. Biomass ash is considered a potential alternative raw material for low‐carbon glass manufacture as it is rich in certain advantageous components, chiefly network modifiers. Simple sieving processes were shown to effectively separate impurities such as S, Cl, and C from some biomass ashes according to particle size distribution. The concentration of undesirable impurities decreased with increasing particle size. Morphologies and X‐ray diffraction patterns of larger washed biomass ash particles indicated liquid/amorphous phase formation during biomass combustion. The washing of ashes was also shown to be a potential route to purification. A washed bracken ash relevant to both modern and ancient glass production was characterized for comparison. Ultraviolet‐visible near‐infrared (UV‐Vis‐near IR) absorption spectra of representative green container glasses produced using biomass ash confirmed that ∼5 wt.% ash in representative glass batches has little impact on the color and redox state of glasses; the redox status of glass produced using >2 mm biomass ash after washing was less reduced than that of glass produced using high levels (>∼9 wt.%) of >2 mm biomass ash after sieving alone, observed via the redox couple Cr3+/Cr6+ by UV‐Vis‐near IR absorption spectroscopy.
MEASUREMENT AND INTERPRETATION OF ARTERIAL BLOOD GASES
Authors: Syabbalo N
Published: April 2023

Arterial blood gases and pH are routinely being measured in clinical practice, both to provide diagnosis and to guide therapy in critically ill patients. Oximetry is clinically useful in establishing the presence of hypoxaemia in patients with respiratory diseases. Oximetry is also a simple and reliable method for monitoring patients undergoing anaesthesia, sleep studies and cardiopulmonary exercise testing. The search continues for new innovative techniques for continuous transcutaneous and intra‐arterial blood gas monitoring. This is essential in the management of critically ill patients because blood analysers provide only intermittent monitoring of arterial blood gases.
BILE DUCT HAMARTOMA OCCURRING IN ASSOCIATION WITH LONG‐TERM TREATMENT WITH DANAZOL
Authors: Elmadbouh HM , Douglas‐Jones M
Published: April 2023

We report a case of bile duct hamartoma which developed in a patient who had been on long‐term danazol treatment. Such patients should be under close follow‐up, preferably with periodic ultrasound examination of the liver. If the patient develops a liver mass, because of non‐specific clinical features and imaging appearances, biopsy may be the only way to achieve a definitive diagnosis.
SUPERIOR MESENTERIC VEIN OCCLUSION PRESENTING WITH A MASSIVE VASCULAR MALFORMATION OF THE COLON
Authors: Clements WDB , Cunnick G , Hull D
Published: April 2023

Superior mesenteric vein occlusion is a rare condition which has protean clinical manifestations. It frequently occurs secondary to an underlying coagulation defect. We present the case of a young female who presented uniquely with a massive colonic vascular malformation and who had various predisposing factors, the most serious being a protein C deficiency.
USE OF SYMPATHOMIMETIC NASAL SPRAY IN ASSOCIATION WITH CARDIAC FIBROMA: AN UNUSUAL CAUSE OF VENTRICULAR TACHYCARDIA
Authors: Khan A , Dewhurst N
Published: April 2023

A patient prescribed oxymetazoline hydrochloride nasal drops presented with recurrent ventricular tachycardia of fascicular origin. Cardiac ultrasound showed a calcified lesion, presumably a fibroma arising from the interventricular septum. Fascicular tachycardia related to the lesion and provoked by the use of a sympathomimetic agent is postulated.
ACUTE ADMISSIONS WITH HEART FAILURE TO A DISTRICT GENERAL HOSPITAL SERVING A MULTIRACIAL POPULATION
Authors: Lip GYH , Zarifis J , Beevers DG
Published: April 2023

To assess the incidence, clinical characteristics and current strategies in the management of patients with acute heart failure, we conducted a prospective survey of all acute medical admissions with heart failure to a district hospital serving a city centre population of 300,000 people in a multiracial community. Of 7451 such admissions, 348 (4.7%) were diagnosed as having acute heart failure: 265 Caucasian (76.1%), 27 black/Afro Caribbean (7.7%), 56 Indo‐Asian (16.1%). Complete clinical data were available from 260 patients. The main presenting symptom was dyspnoea in 233 patients (89.6%) and chest pain in 60 patients (23.1%); 139 patients (53.5%) had a history of ischaemic heart disease, 87 (33.5%) hypertension and 49 (18.8%) had diabetes; 103 patients (39.6%) had a previous history of heart failure; 75 patients (28.8%) were in atrial fibrillation. An echocardiogram was performed in 89 patients (34.2%). On admission, ACE inhibition was prescribed to only 78 patients (30.0). The diagnosis of heart failure was stated on the hospital inpatient data sheet (KMR‐1) in only 170 patients (65.4%). Following admission, 50 patients (19.2%) died while in the wards. Heart failure is a common problem among acute medical admissions and has a poor prognosis. The KMR‐1 diagnosis may underestimate the prevalence of heart failure.
ON THE CAUSES OF COLLAPSE AND SUDDEN DEATH BY AVICENNA
Authors: Nathan B , Wray R
Published: April 2023

Avicenna's views on the causes of collapse and sudden death are presented from a literal translation of the mediaeval Arabic text. Medical knowledge based on observation mixed with pure abstract reasoning forms the essence of Avicenna's medical writings.
SHOULD WOMEN WITH DIABETES MELLITUS RECEIVE HORMONE REPLACEMENT THERAPY?
Authors: Dunne FP
Published: April 2023

The benefits of hormone replacement therapy (HRT) in non‐diabetic postmenopausal women are now well established. HRT improves climacteric symptoms and has beneficial effects on the cardiovascular system and the skeleton. In addition, recent studies suggest a reduced risk of Alzheimer's disease and colorectal cancer. Despite these beneficial effects, concerns continue regarding the increased risk of malignancy, thromboembolism and the possible deterioration in blood pressure. There are no long‐term studies in women with diabetes who also receive HRT, so we cannot be certain of the benefits and risks in this population. We can postulate, however, and draw some conclusions from current data, which suggest that the risk/benefit ratio is similar to that for the non‐diabetic population. Based on present information, postmenopausal diabetic women should be actively considered for HRT provided the physician is aware of the possible problems and the patient is sufficiently counselled to make an informed decision.
THE NASAL DELIVERY OF SYSTEMIC DRUGS
Authors: Jones NS , Quraishi S , Mason JDT
Published: April 2023

Systemic drugs are increasingly being administered intranasally. We highlight the potential problems and the effect of nasal pathology on absorption and bioavailability. There is insufficient information to evaluate the effect of these factors on therapeutic effectiveness. However, there is evidence that nasal pathology can influence mucociliary clearance and absorption, so the prescriber should recognise and consider the effect of any intranasal pathology. We suggest that, until the effects of these factors are quantified, patients who are about to embark on long‐term intranasal medication should have a rhinological assessment, particularly if they have any nasal symptoms. By doing this, factors that may cause reduced bioavailability can be identified. It would also prevent pre‐existing mucosal changes being wrongly attributed to nasal drugs.
A DOUBLE‐BLIND, COMPARATIVE STUDY OF DOTHIEPIN AND CLOMIPRAMINE IN THE TREATMENT OF MAJOR DEPRESSIVE ILLNESS
Authors: Welch CP , Tweed JA , Smithers A , Gostick NK , Raniwalla J
Published: April 2023

Dothiepin, a well‐established antidepressant, has been compared with clomipramine in a single‐blind study which demonstrated that dothiepin was better tolerated but there was no difference in efficacy. The present study was performed to recent European guidelines on good clinical practice using a randomised, double‐blind, parallel‐group methodology. One hundred and one patients suffering from major depressive disorder as defined by DSM‐III‐R were randomised to receive either clomipramine (25‐150 mg daily) or dothiepin (75‐150 mg daily) for up to six weeks. The clomipramine group comprised 51 patients, the dothiepin group 50 patients. At baseline, both groups had a mean age of 41‐43 years and gave similar mean scores on the Hamilton Depression Rating Scale (23.5 for clomipramine, 23.6 for dothiepin). At endpoint it was reduced in both groups but there were no significant differences between the groups (mean change from baseline for the clomipramine and dothiepin groups was ‐14.6 and ‐14.1 respectively). Thirty‐one clomipramine patients and 41 dothiepin patients completed six weeks' treatment. Withdrawal from treatment (20 patients for clomipramine, nine for dothiepin) was significantly different (p=0.0105). When reasons for withdrawal were analysed, 13 clomipramine patients and two dothiepin patients withdrew because of adverse events, this difference being significant (p=0.002). Thus both treatments were effective in treating patients suffering from major depressive disorder, but patients receiving dothiepin suffered fewer adverse events and were more likely to complete their treatment.
CYCLICAL ETIDRONATE INCREASES LUMBAR SPINE BONE DENSITY IN PATIENTS ON LONG‐TERM GLUCOCORTICOSTEROID THERAPY
Authors: Skingle SJ , Moore DJ , Crisp AJ
Published: April 2023

To determine whether cyclical etidronate modifies bone density in patients on chronic glucocorticosteroid therapy, annual bone density measurements were performed on 55 patients receiving glucocorticosteroids who were randomised to either continuous calcium supplementation or cyclical etidronate plus calcium supplementation in this secondary prevention study. Median L1‐L4 lumbar spine bone density decreased by 0.7% in the calcium treated group after one year but increased by 3.1% in the group treated by calcium and etidronate (p=0.00116). Median L1‐L4 bone density decreased by 2.8% from baseline after two years in the calcium treated group but increased by 4.7% from baseline In the group treated by calcium and etidronate (p=0.04). There were no significant effects of treatment on femoral neck density. Cyclical etidronate and calcium increased lumbar spine bone density in patients established on prednisolone treatment over a two‐year period but had no effect on femoral density.
LATE TENSION PNEUMOCEPHALUS FOLLOWING FRONTAL CRANIOTOMY
Authors: Yu L , Farnsworth TA
Published: April 2023

Tension pneumocephalus is an uncommon but life‐threatening complication of craniotomy which requires urgent diagnosis and treatment. It most often occurs perioperatively following subsequent anaesthesia using nitrous oxide. All previously reported postoperative cases followed posterior fossa or upper spinal cord surgery. Only two cases associated with frontal craniotomy have been reported since 1972, both occurring intraoperatively.
INHALER USE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Authors: Oliver S , Rees PJ
Published: April 2023

Inhaler technique is a common problem, particularly in the elderly. We have assessed the ability to use seven common inhaler devices in 20 patients with chronic obstructive pulmonary disease (COPD). Techniques were taught in a standard fashion in random order and assessed immediately and one hour later by two observers. Fourteen patients had a fault that would result in no drug delivery at some time during the study, and such a fault occurred at some point for each inhaler device. These faults were most common with the diskhaler. Accuhaler, autohaler and turbohaler scored highest and diskhaler lowest. Overall scores declined by one hour after instruction. Patients ranked the metered dose inhaler and accuhaler highest for ease of use and preference. These results show that it is useful to have a small range of devices for patients with COPD and that it is important to review inhaler technique regularly.
SPONTANEOUS CERVICAL EPIDURAL HAEMATOMA
Authors: Aitken EM , Lock BA , Sharr MM
Published: April 2023

Spontaneous spinal epidural haematoma can occur in the elderly and is a reversible cause of neurological deficit if treated promptly. The diagnosis can be made from a careful history and a simple neurological examination, but it can be confused with myocardial infarct, musculoskeletal pain, vasculitis and acute dissection of an aortic aneurysm. For a favourable outcome, early decompressive laminectomy and evacuation of the haematoma are necessary. We report an unusual case of acute quadriplegia in which prompt diagnosis and early intervention led to almost complete functional recovery with minimal disability.
LITHIUM FOLLOW‐UP IN GENERAL PRACTICE
Authors: Moscovich DG
Published: April 2023

Lithium salts have been used in medicine for over a century and are a widely accepted treatment. Clinical practice in the London borough of Barnet led us to suspect that agreed guidelines were not being followed. We checked them against published guidelines and followed up their implementation. A list of patients on lithium was obtained from the local biochemistry laboratory and a representative sample extracted. We looked at the frequency of laboratory testing and compared it with the guidelines. We found that the standards for lithium therapy follow‐up were not being met and that while we awaited the outcome of our consultant psychiatrists' committee deliberations, the recommendations were not being implemented. A lithium register or clinic needs to be established in the area, and there is also a need for more reliable and effective implementation of clinical audit recommendations.
THE MANAGEMENT OF THYROGLOSSAL DUCT CYSTS
Authors: Ghaneim A , Atkins P
Published: April 2023

Thirty patients undergoing surgery for a preoperative diagnosis of thyroglossal duct cyst have been reviewed. All patients were seen in a hospital service for patients of 16 years and over. Sistrunk's procedure is the operation of choice but when histological examination of a thyroglossal duct cyst reveals a papillary carcinoma, total thyroidectomy should be considered.
THE USE OF MOBILE TELEPHONES IN A DISTRICT GENERAL HOSPITAL
Authors: Wong LS , Mahendrakumar R , Tan D , Bullen BR
Published: April 2023

Advances in technology have led to the increased availability of mobile telephones, but their use in an NHS hospital has not previously been reported. Junior doctors require easy access to a telephone, but ward telephones are frequently busy and not readily accessible when urgently needed. A one‐year retrospective study was carried out on the use of mobile telephones in a small district general hospital.
DIPHALLUS WITH URETHRAL DUPLICATION: A RARE CASE
Authors: Mutlu N , Baykal M , Merder E , Çulha M , Canbazoglu N
Published: April 2023

We report on a case of glandular diphallus with incomplete urethral duplication associated with rotation anomaly in the right kidney, and a bifid pelvis and an ectopic ureteral orifice in the left kidney. The bladder was single with good sphincter control. At operation, the hipoplasic glans was resected and the urethra which opened into this glans anastomosed alongside the other urethra. Diphallus and incomplete urethral duplication are discussed.
CLINICAL APPLICATIONS OF PHOTODYNAMIC THERAPY
Authors: Carruth JAS
Published: April 2023

Photodynamic therapy is a modality for the treatment of malignant disease in which a photosensitive drug is selectively absorbed or retained by malignant tissues, after intravenous injection and is then photoactivated by light of an appropriate wavelength, often produced by a laser. Over the past two decades, the combination of haematoporphyrin derivative (HPD) and then its active component dihaematoprophyrin ether (DHE), now marketed as Photofrin, plus red light at 630 nm have been used in clinical practice for the treatment of a range of tumours; some very promising results have been obtained. Several countries have approved this drug/light combination for clinical use for a number of tumours. Some second generation photosensitising agents with appropriate light sources, and with perceived advantages over Photofrin, are under investigation, and it is to be hoped that major improvements in drug/light combinations will enable photodynamic therapy to achieve its full potential in the not‐too‐distant future.
‘CARDIAC CLAUDICATION’: ISCHAEMIC HEART DISEASE PRESENTING AS INTERMITTENT CLAUDICATION
Authors: Sandison AJP , Jackson G , Taylor PR
Published: April 2023

CLINICAL MESSAGE Coronary artery disease causing impaired left ventricular function may present as intermittent claudication in the absence of significant occlusive lower limb arterial disease.
CONTROLLED TRIAL OF THE SUBJECTIVE PATIENT BENEFITS OF ACCOMPANIED WALKING TO THE OPERATING THEATRE
Authors: Turnbull LA , Wood N , Rester G
Published: April 2023

A trial was carried out to determine if walking unpremedicated patients to the operating theatre would prove acceptable to the patients. One hundred surgical patients from a short‐stay ward were randomised into experimental (walked to theatre by ward nurse) and control (taken to theatre on a hospital trolley) groups. Seventy‐eight patients responded to a questionnaire; a large majority indicated they would like to be given the choice of mode of conveyance and perceived this as an improvement in patient care. The results showed that a more favourable impression of walking to the theatre was given by patients who had actually experienced it, and of those given the opportunity to walk, almost all reported that it made them feel more relaxed. The findings are discussed in relation to patient choice, efficiency gains and a reduction in manual handling.
COMPARISON OF EFFICACY AND EASE OF HANDLING OF SALMETEROL AND TERBUTALINE POWDER INHALERS
Authors: Burdon J , Droszcz W , Jones R , Johnston PR , Trowell SJ
Published: April 2023

A multicentre, randomised, open, parallel‐group study was performed to compare the efficacy, tolerability and ease of handling of salmeterol xinafoate 50 μg twice daily via the DiskusTM inhaler with terbutaline sulphate 500 μg four times daily via the TurbuhalerTM inhaler. Two hundred and sixty‐three patients (aged 18‐79 years, baseline FEV, 50‐90% predicted, mean PEFR 85% of response to salbutamol) were randomised to treatment with salmeterol (n=136) or terbutaline (n=127). A statistically significant difference in favour of salmeterol was seen between treatment groups for the primary efficacy variable, mean morning PEFR (difference in adjusted means 25.4 l/min, p<0.001). Within the groups randomised to each device, ease of handling assessments favoured the Diskus inhaler over the Turbuhaler inhaler. More patients liked the Diskus inhaler than the Turbuhaler inhaler (98% vs 72%, p<0.001). The Diskus inhaler received better scores than the‐Turbuhaler inhaler for all features assessed in the device questionnaire.
THE ECONOMIC IMPLICATIONS OF IMPLEMENTING EVIDENCE‐BASED DIABETIC TREATMENT STRATEGIES
Authors: Phillips CJ
Published: April 2023

In Type I diabetes, conclusive evidence exists that intensive insulin strategies can achieve normal or near normal blood glucose levels and, as a result, reduce the risk of major complications and produce major benefits in years of life, years of sight, and years free from end‐stage renal disease and amputation. The evidence in Type II diabetes is less clear but claims are made that insulin‐based strategies should be started earlier, even at initial diagnosis. Intensive strategies have also been shown to improve survival in diabetic patients with acute myocardial infarction. The economic implications of introducing intensive insulin‐based strategies have assumed different rates of obesity and patients currently receiving insulin. Since the costs of an intensive insulin‐based strategy are approximately 50% more than conventional strategies, the average cost per diabetic patient will increase by half the percentage increase in patients receiving intensive therapy. It is argued that the extra costs incurred by the switch in therapy are likely to be offset by savings made as a result of reductions in expensive episodes of care, such as hospitalisation. In addition, evidence exists to show that such a switch is cost effective in generating additional life years and quality adjusted life years for diabetics.
THE EFFECT OF DIETARY INTERVENTION ON CHANGES IN TOTAL CHOLESTEROL, BLOOD PRESSURE AND WEIGHT IN A CAMBRIDGE STUDY
Authors: Yasmin  , Mascie‐Taylor CGN , Brown MJ , Hughes M
Published: April 2023

The study examined the impact of dietary advice on cholesterol reduction, to see whether diet was more effective when preceded by a cholesterol estimation. A total of 635 healthy individuals aged between 40 and 60 years attended a general practice cardiovascular risk screening in 1990. All subjects had their blood pressure, body mass index and smoking history recorded, and 50% were randomised to cholesterol measurement. Two years later, all individuals were invited to participate in a follow‐up screening and 356 individuals took part (158 men, 198 women). All the above estimations were undertaken in 100% of attendees. The mean total cholesterol levels and weight declined in the subjects who were given dietary advice and had their cholesterol measured, while the mean cholesterol level increased slightly in subjects who did not receive dietary advice but had their cholesterol measured. There was a significant increase in diastolic blood pressure in all patients. The figures for reported smokers decreased from 22.4% to 19.4% in men and 19.4% to 8.4% in women. The results suggest that dietary advice can achieve a sustained reduction in cholesterol levels, but may require the stimulus of a prior cholesterol estimation.
ACUTE ON‐CHRONIC MIDDLE EAR DISEASE
Authors: Ghufoor K , Diver J , O'Flynn P
Published: April 2023

The discharging ear is a common presenting symptom to GPs and otologists. The commonest causes are otitis externa and otitis media. Less common is cholesteatoma, which presents with a chronic offensive mucopurulent discharge and deafness. Acute mastoiditis as a presenting symptom of cholesteatoma is rare and, with the introduction of antibiotics, the incidence has declined even further. We present three cases of cholesteatoma presenting as mastoiditis.