bluuebunny/crossref_metadata_2025 huggingface dataset:
Paediatric selective bronchial blocker
Authors: LIN YUAN‐CHI , HACKEL ALVIN
Published: February 2007

Optimal conditions for pulmonary lobectomy requires the use of a ventilation system which allows the collapse of the ipsilateral lung. In infants and small children, a double lumen tracheal tube cannot be used because an appropriately sized tube is not widely available. We report the successful use of a tracheal tube, along which a Fogarty arterial catheter was passed and inflated in a mainstem bronchus, thus providing adequate ventilation and oxygenation as well as optimal surgical conditions for a left lower lobe lobectomy.
Accidents following extradural analgesia in children. The results of a retrospective study
Authors: FLANDIN‐BLÉTY C. , BARRIER G.
Published: February 2007

A retrospective multicentre study of the complications observed after regional anaesthesia in children was undertaken in 1991 at the request of the association of Anesthésistes‐Réanimateurs Pédiatriques d'Expression Française (ADARPEF). The incidence of accidents seen in the study was comparable to that found in the literature. Five cases which were exceptional due to the severity of the sequelae have been analysed separately. Different pathophysiological mechanisms are proposed.
Cardiorespiratory changes during laparoscopic fundoplication in children
Authors: SFEZ M. , GUÉRARD A. , DESRUELLE P.
Published: February 2007

The results of a prospective assessment of cardiorespiratory changes related to anaesthesia and laparoscopic Nissen fundoplication are described in 25 children aged 1.2 to 14.3 years, weighing 9.0 to 64.0 kg. Respiratory disease or oesophagitis were present in 68% cases. During balanced inhalational anaesthesia, hypotension or bradycardia occurred prior to peritoneal insufflation in three cases of reverse Trendelenburg position. During surgery, intra‐abdominal pressure was in the 6–10 mmHg range. Transiently, two patients were hypotensive while ten were hypertensive. PETCO2 gradually increased but only two patients required increased minute ventilation. One bronchial intubation episode developed. Airway complications were related to isoflurane administration. Postoperatively, transient hypoxia (25% cases) was observed during the first 3 h. Analgesia duration was in the 40–1440 min range. Hospital stay was 5.6 ± 1.5 days (mean ± SD). Laparoscopic paediatric fundoplication is safe when hypovolaemia and postoperative hypoxia are prevented.
Nicardipine: perioperative applications in children
Authors: TOBIAS JOSEPH D. , LOWE SANDRA , DESHPANDE JAYANT K.
Published: February 2007

Nicardipine is the first intravenously administered dihydropyridine calcium channel blocker. Its primary physiological actions include vasodilatation with limited effects on the inotropic and dromotropic function of the myocardium. Several reports have documented its use in adult patients for pharmacological control of blood pressure. We present our experience with the perioperative use of nicardipine in children to treat intraoperative hypertension, as an agent for controlled hypotension during spinal fusion and LeFort I maxillary osteotomies and to treat postoperative hypertension. Dosing regimens and possible applications in paediatric anaesthesia are discussed.
Independent right lung high frequency and left lung conventional ventilation in the management of severe air leak during ARDS
Authors: WIPPERMANN C.‐F. , SCHRANZ D. , BAUM V. , HUTH R.
Published: February 2007

Pulmonary air leaks are one of the most common problems in patients with the adult respiratory distress syndrome, ARDS. We report what we believe to be the first case in which unilateral high‐frequency ventilation combined with contralateral conventional positive pressure ventilation has been used successfully to manage severe air leak in an infant with ARDS.
The laryngeal mask airway for fibreoptic bronchoscopy in children
Authors: BARAKA ANIS , CHOUEIRY PATRICK , MEDAWWAR ANTOINE
Published: February 2007

A size 2 laryngeal mask airway (ID 7 mm) was used for general anaesthesia during fibreoptic bronchoscopy in a six‐year‐old child. The mask permitted the use of an adult bronchoscope with an external diameter of 5 mm. Throughout bronchoscopy, adequate controlled ventilation could be achieved easily without excessive air leak or airway resistance; the Spo2 was always > 97%, and the endtidal Pco2 ranged between 3·9–4·5 kPa (30–35 mmHg).
Sinus node recovery function is relatively well preserved under halothane anaesthesia in children
Authors: M. IWAI MD  , R. IWAI MD  , H. HORIGOME MD  , M. YAMASHITA MD
Published: February 2007

The purpose of this study was to evaluate the effect of halothane on sinus node recovery time (SNRT). Nine children with congenital heart disease scheduled for cardiac catheterization were studied. After the routine procedure, the sinus node was paced at rates of 120, 150 and 180 beats per minute. SNRTs were measured with control conditions and under 1 MAC halothane anaesthesia. The absolute SNRT was standardized and expressed as ‘%SNRT’ and ‘Corrected SNRT (CSNRT)’. CSNRT was slightly prolonged by halothane (P= 0.042), while the %SNRT was not significantly prolonged. We conclude that the recovery function of the sinus node is relatively well preserved under 1 MAC halothane in children.
Anaesthesia for a child with centronuclear myopathy
Authors: PRICE S.R. , CURRIE J.
Published: February 2007

Centronuclear myopathy (CNM) is an inherited condition involving most muscle fibres in all the body mass, first described in 1966, which has a varying spectrum of presentations. Until recently it had not been associated with an increased risk of malignant hyperpyrexia. A seven‐year‐old male with CNM was admitted to our hospital for elective surgery. High dose propofol anaesthesia was used, supplemented with N2O/O2 from a new anaesthesia machine. The operation was successful with uncomplicated anaesthesia and recovery.
Rapid control of severe hypercapnia with high frequency oscillatory ventilation
Authors: TATMAN ANDREW , MOK QUEN , JAMES IAN , TASKER ROBERT C.
Published: February 2007

We present a case report of a neonate with severe meconium aspiration syndrome, complicated by severe refractory hypercapnia, who was successfully rescued with high frequency oscillatory ventilation, when maximal conventional ventilation had failed.
The safety of continuous pleural lignocaine after thoracotomy in children and adolescents
Authors: STAYER STEPHEN A. , PASQUARIELLO CAROL A. , SCHWARTZ ROY E. , BALSARA ROHINTON K. , LEAR BARBARA R.
Published: February 2007

Several studies have proven pleural bupivacaine effectively provides postthoracotomy analgesia for both children and adults. When 0.25% bupivacaine is administered as a continuous infusion or repeated bolus, serum bupivacaine levels frequently approach the toxic range. The hazards of bupivacaine toxicity are more difficult to monitor, especially in children who may not report symptoms of local anaesthetic toxicity. Because of this concern, we initiated the use of pleural lignocaine to provide postthoracotomy analgesia for paediatric patients. The records of all patients receiving pleural lignocaine from January 1991 to December 1992 were reviewed. A total of 98 pleural catheters were inserted in 96 patients ranging in age from five months to 20 years. Seven patients had lignocaine levels that exceeded 5 μg·ml‐1 and no patient manifested symptoms of systemic toxicity. This study shows that the administration of pleural lignocaine is a safe method of providing postthoracotomy analgesia. Lignocaine infusions in the dosage range of 20 to 40 μg·kg‐1·min‐1 rarely produce toxic levels, and monitoring of lignocaine levels every 12 h is an effective method of screening for toxicity.
Haemodynamic changes in children with portal hypertension during the postoperative period
Authors: ISMAIL‐ZADE I.A. , TRIFONOVA N.A. , RAZUMOVSKI A.Y. , STEPANENKO S.M.
Published: February 2007

The cardiovascular changes following portosystemic shunt surgery (PSSS) in 33 children with extrahepatic portal hypertension (EPH) were studied to determine if portosystemic shunt surgery had any influence on the cardiovascular state. Haemodynamic data were obtained using two‐dimensional and M‐mode echocardiography, pulsed‐wave Doppler and direct invasive techniques. Postoperatively all patients developed a hyperdynamic state, associated with an increase in cardiac index (CI), heart rate (HR) and a decrease in systemic vascular resistance index (SVRI). In 16 patients (group I), who preoperatively exhibited a hyperdynamic state accompanied by pulmonary hypertension, postoperative studies found an increase in acceleration time to ejection time ratio (AT/ET) in the pulmonary artery from 0.32 ± 0.05 (mean ± SEM) to 0.43±0.01; P < 0.01. Nine patients (group II) who were normodynamic preoperatively developed pulmonary hypertension and right ventricular (RV) dysfunction postoperatively: decrease in AT/ET from 0.42 ± 0.02 (mean ± SEM) to 0.32 ± 0.01; P < 0.01 and an increase in maximal peak pulmonary artery velocity to acceleration time ratio (Vmax/AT) from 702.56 ± 69.10 (mean ± SEM) to 1127 ± 105.30 cm·sec‐2; P < 0.01. In eight patients (group III) who were normodynamic preoperatively and were treated with dobutamine infusions at a rate of 5 μg·kg‐1·min‐1 postoperatively, the CI was found to increase from 5.28 ± 1.1 (mean ± SEM) to 7.97 ± 1.64 L·min‐1·m‐2; P < 0.01, left ventricular ejection fraction (LVEF) from 69.0 ± 4.1 (mean ± SEM) to 81.0 ± 2.9%; P < 0.01 and AT/ET from 0.37 ± 0.04 (mean ± SEM) to 0.44 ± 0.03; P < 0.01. Hence, dobutamine infusion at a dose of 5 μg·kg‐1·min‐1 can markedly increase cardiac performance and prevent pulmonary hypertension and RV dysfunction in children with EPH during the postoperative period.
Patient controlled analgesia (PCA) in paediatric surgery: a prospective study following laparoscopic and open appendicectomy
Authors: TILL H. , LOCHBÜHLER H. , LOCHBÜHLER Ha. , KELLNAR St. , BÖHM R. , JOPPICH I.
Published: February 2007

Patient controlled analgesia (PCA) has not yet gained universal acceptance for the management of postoperative pain in paediatric surgery. In a prospective study we evaluated feasibility and complications of PCA following 90 cases of laparoscopic or open appendicectomy. PCA proved to be a safe and feasible method with few complications (2% of medical complications, no abort of application, 17 technical checks in a total running time of 4125 h). Acceptance by patients was high and children of all age groups worked the system properly. Assessment of application protocols showed, that the consumption of analgesics was significantly reduced following laparoscopic appendicectomy (P < 0.05). PCA is a safe and feasible method for the management of postoperative pain in children and PCA recording provides an excellent insight into the consumptional behaviour of patients, enabling staff to evaluate postoperative pain for various procedures.
Nicardipine to control mean arterial pressure during extracorporeal membrane oxygenation
Authors: TOBIAS JOSEPH D. , PIETSCH JOHN B. , LYNCH AMY
Published: February 2007

The authors present the use of nicardipine to control mean arterial pressure (MAP) in a 19–month‐old boy who required venoarterial extracorporeal membrane oxygenation for 11 days for treatment of hydrocarbon aspiration. Nicardipine is an intravenously administered dihydropyridine calcium channel antagonist whose primary physiological action includes vasodilatation. Unlike other calcium channel blockers, it has limited effects on the inotropic and dromotropic function of the myocardium. Nicardipine was started at 5 μg·kg−1·min−1 and within five min lowered the MAP from a maximum value of 108 mmHg back to the baseline range of 60 to 80 mmHg. Once the MAP had returned to baseline values, infusion requirements varied from 1 to 3 μg·kg−1·min−1 to maintain the MAP at 60 to 80 mmHg during the 11 days of ECMO. No increase in dose requirements were noted during the 11 days.
Anaesthetic management of a neonate with nesidioblastosis
Authors: BELLWOAR COLETTE , SCHWARTZ ROY , STAYER STEPHEN
Published: February 2007

Nesidioblastosis is a disorder which is characterized by autonomous insulin secretion that is not affected by decreases in blood glucose. Patients usually present during the neonatal or infantile period with hypoglycaemia associated with hyperinsulinaemia. Most cases of nesidioblastosis are sporadic; however, familial forms appear to be inherited in an autosomal recessive manner. We discuss the anaesthetic management of a patient with nesidioblastosis who presented for near total pancreatectomy and review the literature pertinent to the anaesthesiologist.
Parents in the anaesthetic room: a questionnaire survey of departments of anaesthesia
Authors: McCORMICK A.S.M. , SPARGO P.M.
Published: February 2007

Thirty departments of paediatric anaesthesia in the United Kingdom were sent a questionnaire about their policies and practices regarding parental presence in the anaesthetic room. Of 22 respondents, 100% left the decision about whether a parent should be present for induction of anaesthesia to the individual anaesthetist and only 14% had written policy guidelines. All departments permitted parental presence at induction for elective surgery, compared with 77% for emergency surgery and 55% for a rapid sequence induction. The minimum age of child below which parents were not allowed at induction varied between no age limit and one year.
Rocuronium in infants, children and adults during balanced anaesthesia
Authors: TAIVAINEN TOMI , MERETOJA OLLI A. , ERKOLA OLLI , RAUTOMA PEKKA , JUVAKOSKI MARKKU
Published: February 2007

We studied 20 infants, 20 children and 20 adults during balanced anaesthesia to compare the neuromuscular blocking effects of rocuronium in these age groups. Neuromuscular function was recorded by adductor pollicis emg and a cumulative log‐probit dose‐response curve of rocuronium was established. Thereafter, full spontaneous recovery of the neuromuscular function was recorded. Onset time of the first dose of rocuronium was shorter in children than in infants or adults. The potency of rocuronium was greatest in infants and least in children; the ED50 doses (mean ± SD) being 149 ± 36 μg˙kg−1 in infants, 205 ± 52 μg˙kg−1 in children and 169 ± 47 μg˙kg−1 in adults (P<0.05 between infants and children) and the ED95 doses being 251 ± 73 μg˙kg−1, 409 ± 71 μg˙kg−1 and 350 ± 77 μg˙kg−1, respectively (P<0.05 between all groups). The emg recovery following an average 94.5 ± 4.8% neuromuscular blockade established by rocuronium was roughly similar in all study groups. Thus, one ED95 dose of rocuronium, unlike vecuronium, acts as an intermediate‐acting agent in all age groups.
Recovery of psychomotor function following general anaesthesia in children: a comparison of propofol and thiopentone/halothane
Authors: SCHRÖTER J. , MOTSCH J. , HUFNAGEL A. R. , BACH A. , MARTIN E.
Published: February 2007

The present study was undertaken to compare immediate recovery and recovery of complex psychomotor function in 20 children (aged 6–12 years) following general anaesthesia with either thiopentone/halothane or propofol. Early recovery of psychomotor skills was significantly faster in the propofol group than in the thiopentone/halothane group. Compared to preanaesthesia baseline the sedation and cooperation scores, the reaction time to visual and auditory stimuli as well as the postbox test and the flicker fusion frequency were less impaired after propofol than after thiopentone/halothane anaesthesia up to 120 min postoperatively. In the propofol group most tests reached preanaesthesia levels after 120 min, while in the thiopentone/halothane group these levels were not reattained throughout the entire study period. The results indicate that the recovery of psychomotor function in paediatric patients following general anaesthesia with propofol is significantly faster than with thiopentone/halothane. This has important implications for parental satisfaction, the time over which patients need to be monitored in the recovery room and for the discharge criteria after daycase surgery.
Regurgitation and aspiration of gastric contents in a child during general anaesthesia using the laryngeal mask airway
Authors: ISMAIL‐ZADE I.A. , VANNER R.G.
Published: February 2007

We present a case report of a child who underwent general anaesthesia for elective surgery in whom regurgitation and aspiration of gastric contents were associated with the use of the laryngeal mask airway (LMA). Bronchospasm developed but mechanical ventilation was not required. The possible mechanisms causing regurgitation are discussed.
Ethnic differences in the timely diagnosis of children with Type 1 diabetes mellitus in the Netherlands: clinical presentation at onset
Authors: Van Laar J. J. N. , Grishchenko M. , Van Wouwe J. P. , Stronks K.
Published: February 2007

Aims  Little is known about ethnic differences in the timely diagnosis of Type 1 diabetes mellitus (Type 1 DM). This study aimed to assess ethnic inequalities in the timely diagnosis of Type 1 DM, as indicated by a more adverse clinical condition at onset. In addition, we assessed whether these differences could be explained by differences in socio‐economic status.

Methods  From a national register, we selected 3128 children aged < 15 years with newly diagnosed Type 1 DM. Ethnic differences in serum glucose, blood pH, bicarbonate, presence of ketonuria, level of consciousness, hydration status, and diabetic ketoacidosis were assessed by logistic regression. A measure of socio‐economic status based on postal codes was used as an explanatory variable.

Results  The risk of adverse clinical presentation was 1.5–2 times higher in non‐Western immigrants than Dutch children, while Western immigrant children did not differ from Dutch children. Blood pH, bicarbonate level, and level of consciousness were lower in Turkish and Antillean children in particular. The adverse socio‐economic position of immigrant children contributed very little to these differences in clinical presentation.

Conclusions  Non‐Western children were likely to be sicker at first presentation of Type 1 DM, and thus diagnosis may have been delayed. These disparities were not accounted for by differences in socio‐economic status. Possible explanations may be difficulties in recognition of symptoms, failure of GPs to take symptom reporting seriously and lack of awareness of the fact that Type 1 DM occurs more often in certain ethnic groups.
CGE EVALUATION OF A UNIVERSITY'S EFFECTS ON A REGIONAL ECONOMY: AN INTEGRATED ASSESSMENT OF EXPENDITURE AND KNOWLEDGE IMPACTS
Authors: Giesecke James A. , Madden John R.
Published: February 2007

In recent years many universities have commissioned studies of the effects of their institutions on their local economies. Typically, these impact studies have concentrated on the demand‐side stimuli to the regional economy that the university generates. Normally, the studies are undertaken with comparative‐static input‐output models. The present study employs a dynamic multiregional computable general equilibrium model to investigate supply‐side as well as demand‐side effects. There are a range of supply‐side effects that have been investigated in the spatial econometrics literature. The supply‐side impacts of the university that we examine in particular are a rise in the average skill level of the local workforce, and successful R&D outcomes. CGE modelling allows simulation of the associated productivity effects, while the dynamic features of the model allow for consequent effects on a region's population and capital stock growth rates to be taken into account.
The Idea of Welfare
Authors: Mishra Ramesh
Published: February 2007

The Idea of Welfare by Robert Pinker.
From Charles Booth to Peter Townsend: Poverty Research in the U. K.
Authors: Golding Peter
Published: February 2007

Poverty in the United Kingdom: A Survey of Household Resources and Standards of Living by PETER TOWNSEND.
A Response to Social Problems in Developing Countries
Authors: Kaseke Edwin
Published: February 2007

This paper considers social development as a relatively new concept, and new practice model. Its definition still lacks concreteness. Here it is viewed as a process of planned institutional change to bring about a better fit between human needs and social policies and programmes (Sanders, 1982); it is not satisfactory to measure development in purely economic terms, for this has resulted in the marginalization of the majority of the population in developing countries. The curative and remedial functions adopted by the social work profession in accordance with the dictates of the modernization approach, have rendered social work unable to address itself meaningfully to the problem of marginalization or mass poverty. Social development rests upon social policies that are promotive of human needs and this is only possible in circumstances where such policies are a product of the people's participation.
Anti‐Poverty Action and Research in the U.K.
Authors: Craig Gary
Published: February 2007

This paper briefly reviews the deteriorating position of the poor in the UK in recent years; summarizes the range of action and research initiatives that has developed to address the problem of poverty; and suggests an agenda of principles to inform further action and research.
The Reform of the Local Social Services In Israel: 1984 Compared to 1977
Authors: Cnaan Ram A. , Korazim Josef , Meller Yassef , Rosenfeld Jona M.
Published: February 2007

In 1977, there was a nationwide reform of the Local Departments of Social Services (LDSS) in Israel. This article reports on the findings of two independent and complementary studies which sought to evaluate the consequences of this comprehensive planned change. To determine what changes if any, occurred from 1977 to 1984, the first seven years following the reform, the article presents seven major foci of change. Each reflects an objective set forth by those who planned the change at the Ministry of Labour and Social Affairs. Preceding the report of these changes are a review of the historical background of the reform and a summary of the components of this planned change. This article focuses on the changes identified in these studies and concludes with a discussion of policy and organizational implications.
Devolution and Centralism in the National Health Service
Authors: Paton Calum
Published: February 2007

The reforms to the NHS following the White Paper, Working for Patients, were presented by the Conservative government as promoting devolution, defined as “decisions … taken at the lowest possible level” by Douglas Hurd (1991) — reflecting a senior Minister's interpretation of the overall policy agenda, including health. It was further claimed that such policies (“reforms in hospitals, in schools and in housing”) were a way to “empower citizens”. This approach was naturally an attempt to present the Conservatives' policy as pro‐community and ‘practical’ rather than ‘ideological’ or free‐market obsessed.

It is worth renewing the debate about whether power and/or responsibility were devolved in the NHS — or, indeed, to the NHS from the Department of Health. Rudolf Klein, in the first edition of his The Politics of the National Health Service (1983), had no sooner pointed to the ‘devolution’ inherent in the 1982 reorganization of the NHS (based on the document Patients First (HMSO, 1981) when the Griffiths Inquiry recommendations were accepted. As a result, he was soon to observe that the pendulum — at that time — had quickly swung back to centralism, an observation reiterated after a few years when The Politics of the National Health Service came out in its second edition (Klein, 1989).

In other words, there may be a cycle from centralism to devolution and back, or at least an interpretation of events as such in health policy, which makes a current reassessment timely. Which direction did the NHS Act of 1990 and related initiatives embody?
By What Authority? Ethics and Policy Analysis*
Authors: Donnison David
Published: February 2007

By what authority do social policy analysts evaluate institutions and propose reforms? They have often relied on past traditions of political and moral philosophy, briefly reviewed here, to answer that question. These sources of authority are now failing, and many analysts are moving reluctantly towards a relativist or historicist standpoint which they nevertheless find unattractive. However, by studying institutions, practices and the traditions developed within them, it is possible to formulate and defend a socially embedded morality which will be helpful to policy analysts. Principles derived from it are contestable and liable to change as social circumstances change. But this is a strength, not a weakness, of the approach. Aesthetic reasoning offers helpful paradigms for policy analysis. Social policies and programmes may be derived from moral and political values, but they also help to change them. Indeed, that may be their most important achievement. The paper concludes with questions which teachers and researchers may wish to explore with the help of the concepts set forth here.
Secrecy and Openness in Adoption: An Historical Perspective
Authors: Ryburn Murray
Published: February 2007

The issue of whether there should be continuing contact between those who are adopted and their birth relatives is one of the most contentious issues in current adoption practice (see for example DoH, 1993; McWhinnie and Smith 1994). The view traditionally taken is that adoption in England and Wales has been secret since its legal origins in 1926 and any moves to more fully disclosed information and indeed contact between the parties in adoption is a recent development (see for example DoH 1992). This article considers the history of birth family contact and access to records in adoption from 1926 to the 1958 Adoption Act and examines the factors that favoured the development of closed models of practice where there was no contact between the parties and records became secret. In doing so it challenges the accepted view that adoption has always provided for secrecy in England and Wales and establishes that both the thinking of policy makers and the legislation itself until 1949 provided for more open forms of adoption than we enjoy today. Secrecy, it is claimed, developed as a consequence of a collusion between professionals and the judiciary which disregarded the legal rights of birth parents and failed to respect their entitlement to a proper say in the decisions about the future of their children.
Social Justice and the Reform of Social Security
Authors: Wilson Dorothy J. , Wilson Thomas
Published: February 2007

There have been massive increases over the years in expenditure on the public services loosely grouped together as the “welfare state”, but widespread dissatisfaction persists. This article is a critique of the proposals for reform presented in the Report of the Commission on Social Justice, set up by the late John Smith. The report contains a sweeping condemnation of existing arrangements and puts forward a series of recommendations ranging from the health service to decentralization in government and from employment policy to benefits for the elderly. As was perhaps inevitable, some are more precisely presented than others.

An important example of the more fully specified proposals is one to establish what would, in effect, be a means‐tested “pension guarantee”but with “means”so defined as to exclude capital and with much improved “disregards”. Another is the endorsement of the proposals to extend social insurance to part‐time workers—a proposal which raises some controversial issues.

There is much in this report that deserves close attention, and it is, therefore, all the more unfortunate that its proposals are not presented in the form of a quantified plan for social policy. Even for the first five years or so of the fifteen the Commission has in mind, there is no attempt at quantification. The importance of economic growth is rightly stressed, but “faster growth”can become a panacea that obscures the need for choice, not only between private and public expenditure but also between the various components of public policy itself.
The Purchaser/Provider Split in Social Care: Is It Working?
Authors: Lewis Jane , Bernstock Penny , Bovell Virginia , Wookey Fiona
Published: February 2007

This paper reviews the ideas of public choice theory that provided the rationale for introducing the purchaser/provider split and suggests that the notion of provider self‐interest is as undifferentiated a concept as its rival: public ethos or duty. Using data from eighteen months' observation and interviewing in five local authorities, it then goes on to address the huge amount of work involved in separating purchasing from providing. We trace the changing understanding of the purpose of the split, problems of defining who is a purchaser and who a providers, problems of working the new relationship between purchasers and providers, and difficulties in developing the purchasing function.

We then seek to examine what are believed to be the main benefits of the purchaser/provider split, asking whether there is evidence that purchasers are doing a better job of identifying needs than providers, and whether there is evidence of competition involving multiple providers and multiple suppliers. Finally, we investigate whether there has been an increase in responsiveness, taking home care as an example. The paper concludes that while increased competition among suppliers has been one important factor in two authorities in securing a more responsive service, the evidence is equivocal as to whether the purchaser/provider split has been the key to securing competition.
The Burden of Headache in a Patient Population from a Specialized Headache Centre
Authors: Vinding GR , Zeeberg P , Lyngberg A , Nielsen RT , Jensen R
Published: February 2007

The aim was to characterize the individual and socio-economic impact of headache in a patient population from The Danish Headache Centre. This was a cross-sectional study using a structured interview, prospective headache diaries and standardized self-administered questionnaires using the ICHD-II criteria. Fifty-five subjects (12 male and 43 female) with a median age of 41 years and a median headache frequency of 15 days/month participated. Very high utilization of the healthcare system and a high absence rate due to headache of 12 days/ year were reported. Eighty-one percent experienced a marked decrease in work effectiveness. Overall, 91% felt hampered by their headache on a daily basis and 98% had had expenses for headache medication. Frequent headache disorders are highly costly, especially due to indirect costs. Prevention, early intervention or effective treatment strategies for headache disorders may therefore be highly cost effective, not only for the individual but also for society.
EGO STRENGTH AND RESPONSE STEREOTYPY
Authors: Roessler Robert , Greenfield N.S. , Alexander A. A.
Published: February 2007

The incidence of specificity and stereotypy was examined among 36 Ss'responses to six intensities of a 1000‐cps tone. It was found that stereotypy occurred in 26 of the 36 Ss and was significantly less frequent among subjects in an intermediate range of ego strength. When a significant hierarchical patterning of ranks was found (stereotypy), there was marked individual variation in the order of ranks among physiological variables and the order was not related to ego strength. Specificity of response was less frequent, occurring in 16 of the 36 Ss. There was significantly more specificity in a high ego strength group as compared to middle and low Ea groups. Specificity occurred most frequently on heart rate but not significantly more frequently.
AN IMPROVED SIAVLOMETER
Authors: Feather Ben W.
Published: February 2007

A high resolution, liquid‐displacement apparatus for monitoring salivary flow is described, and details of its construction from standard laboratory items are provided. The results of a quantitative evaluation indicate: (1) sensitivity to variations in intraglandular pressure of less than 1 mm Hg; (2) instrument time lag of less than 500 msec; and (3) resolution of 0.003 ml. A comparison with previously described liquid‐displacement sialometers indicates an increase in resolution by a factor of 3.
AN AUTOMATIC ANALYZER OF STATES OF VIGILANCE
Authors: Berger Ralph. J. , Meier Gilbert W.
Published: February 2007

An assemblage of relay‐operated, commercially available programming modules is described. It is capable of discriminating among the states of vigilance wakefulness (W): high‐voltage, slow‐wave sleep (HVS); and low‐voltage, fast‐wave sleep (LVF) and it requires information from only the nuchal electromyogram (EMG) and the electrooculogram (EOG).
THE INTERACTION OF RESPONSES IN THE BRAIN TO SEMANTIC STIMULI
Authors: Cohen Jerome , Walter W. Grey
Published: February 2007

Long time‐constant EEG recording during paired stimuli has led to the discovery of the contingent negative variation or expectancy wave (Walter, 1964). This effect is produced when a conditional stimulus signals that an imperative stimulus demanding action, decision, or attention will follow at a short, constant time interval.

Symbolic and meaningful stimuli were presented to subjects tachistoscopically, and the evoked responses in the brain were electronically averaged. The cerebral evoked responses to such psychological stimuli are more complex than to flashes. A slow negative DC potential shift (CNV) was seen during the interval between an auditory ready signal and the visual exposure if recognition of the stimulus was required, or if it was interesting. Following the visual exposure, a slow positive DC shift occurred. The method has been developed to study the brain responses to psychological stimuli. The amplitude of the responses relates to the information content and subjective factors rather than to the physical strength of the stimulus.
EFFECTS OF SOME DRUGS ON ELECTROENCEPHALOGRAPHIC FAST ACTIVITY AND DREAM TIME
Authors: Lester B. K. , Guerrero‐Figueroa R.
Published: February 2007

The purpose of this study was to test the hypothesis that latency of REM onset is a negative function of drug‐induced precentral fast (18 to 26 cps) activity in the EEG. Chlorpromazine increased this activity during sleep and wakefulness and decreased latency of REM sleep, whereas α‐chloralose, pentothal, and phenobarbital were associated with a decrease of this activity during sleep, increased slow wave sleep, and increased latency of REM sleep. Phenobarbital and pentothal increased this fast activity during wakefulness and drowsiness, respectively. However, 18 to 26 cps precentral activity was reduced during sleep with α‐chloralose and pentothal. A supporting study in cats demonstrates apparent synchrony of fast activity in the limbic system and cortex during wakefulness, and chlorpromazine increases fast activity in the limbic system. It is speculated that chlorpromazine enhances the effect of the limbic system on cortical (primarily precentral) activity. The sedatives are thought to potentiate the spontaneous slow wave sleep pattern.
EEG AMPLITUDE CHANGES DURING DIFFERENT COGNITIVE PROCESSES INVOLVING SIMILAR STIMULI AND RESPONSES
Authors: MacNeilage Peter F.
Published: February 2007

In order to investigate the effects on electroencephalographic (EEG) amplitude of cognitive processes, as distinct from direct effects of sensory stimulation and motor response, subjects were given three different tasks in which the stimuli were always similar sets of spoken numbers and the responses were always written numbers. In response to 61 regularly occurring, randomly ordered, single‐digit numbers, seven Ss wrote, on successive trials, (1) the sum of every 4 consecutive numbers, (2) every fourth number, and (3) every “7” and “9” heard. Since the physical stimuli were the same and the movements of response were similar for the three tasks, intertask pattern differences in EEG alpha and beta amplitude would presumably be due to differences in the cognitive processes required in the tasks. No differences due to cognitive factors were found. All short‐term variations in both alpha and beta appeared related to widespread effects of response and preparation for response. Preresponse effects seemed related to motor set which was distinguished from attentional factors. The results suggest the necessity for a greater emphasis on motor effects in EEG studies.
A NOVEL PEAK DETECTOR
Authors: Swinnen Maurice E. T. , Plumlee Lawrence A. , Brown Clinton C.
Published: February 2007

A photoelectric triggering device has been developed with the aim of providing a minimum or maximum trigger on a blood pressure wave. The output from a strain gauge which measures blood pressure is displayed on an oscilloscope, and triggering is done by means of a miniature photocell mounted on a micrometric advance. A transistor circuit transforms the photocell pulse into a relay contact.
OPERANT ELECTRODERMAL CONDITIONING UNDER MULTIPLE SCHEDULES OE REINEORCEMENT
Authors: Shapiro David , Crider Andrew
Published: February 2007

An operant discrimination procedure was used to determine whether human subjects show shifts in palmar skin potential response rate under varying schedules of reinforcement. In Experiment I, a monetary reinforcer was either given or subtracted on a short fixed ratio schedule during alternating 5‐min periods. In Experiment II, the schedules alternated between 10‐min periods in which either a variable ninnber of responses or long interresponse times were reinforced. Each experiment consisted of seven subjects tested over several sessions. The results indicated differences in response rates consonant with changes in the scheduling of reinforcement. Concurrent recordings of respiration, heart rate, and skin potential level showed that the reinforcement effects were generally specific to the skin potential response variable.
EFFECTS OF SPINAL‐CORD TRANSECTIONS ON ELECTRODERMAL ACTIVITY IN MAN
Authors: Euhrer Marcus J. , Kilbey Marlyne
Published: February 2007

Skin conductance levels (SCLs) and skin resistance responses (SRRs) were recorded bilaterally from the plantar aspect of the halluces in 10 patients with functionally complete transections of the cervical or thoracic spinal cord. Compared to a group of neurologically intact individuals, SCLs were significantly lower in patients. Fewer nonspecific SRRs were observed in patients than normals, and responses between the halluces were asynchronous in patients. It was demonstrated that SRRs could be reliably elicited by electrocutaneous stimulation to a foot in some of the patients. Responses were more frequently elicited in the foot which was stimulated than in the contralateral foot.
ABILITY OF ACTORS TO CONTROL THEIR GSRS AND EXPRESS EMOTIONS
Authors: Stern Robert M. , Lewis Nancy L.
Published: February 2007

Ability to control GSRs through the use of ideational stimulation was studied in 26 professional actors. During one 10‐min period, “Respond,”Ss had to make as many GSRs as possible; during the other period, “Rest,”Ss were instructed to inhibit their GSRs. All Ss received continuous visual feedback of their responses during both periods. No relationship was found between ability to control GSRs and emotional expression as measured by the ratings of directors. However, as predicted, method actors performed at a significantly higher level than non‐method actors. An additional finding was that those actors who normally experience sweating as their primary response to stress performed at a higher level than non‐sweaters.
RATE OF HABITUATION AND THE LAW OF INITIAL VALUES
Authors: Germana Joseph
Published: February 2007

The galvanic skin response (GSR) data of two experiments were analyzed in an attempt to determine the effects of tonic shifts in baseline conductance on apparent rate of habituation. The results of the first experiment indicated that rate of habituation is exaggerated when response measures which are not base‐independent are employed. The positive correlation found between habituation slope and an index of base‐level change in conductance was significantly reduced when autonomic lability scores (ALSs) were used. Thus, base‐corrected responses produced less steep habituation functions. The second experiment demonstrated that a tonic increase in conductance occurs to an intense auditory stimulus and that rate of habituation is consequently over‐estimated in comparison to that associated with repeated presentation of a mild stimulus.
PATTERNS OF GALVANIC SKIN RESPONSES TO SIGNAL AND NON SIGNAL STIMULI
Authors: Germana Joseph , Chernault George
Published: February 2007

Two studies investigating the specific features of galvanic skin responses (GSRs) to signal and non‐signal stimuli are reported. The results of Exp. I indicate that stimuli which have instructed behavioral associates (signal significance) produce GSRs which are both multiphasic and relatively persistent in nature. Multiple GSRs are produced by the initial presentation of a signal stimulus and the persistence of the overall response appears to have at least a short‐term effect on baseline. Exp. II was designed to investigate the possible independence of these two characteristics through the manipulation of response certainty. The results suggest that multiplicity and persistence may be separable features of the response to signal stimuli in which the latter may be a correlate of response novelty.
EXTEROCEPTIVE STIMULATION AS A CONTINGENT FACTOR IN THE INDUCTION AND ELICITATION OF DELAYED TYPE HYPERSENSITIVITY REACTIONS TO 1 CHLORO‐, 2‐4, DINITROBENZENE IN GUINEA PIGS
Authors: Mettrop Peter J. G. , Visser Piet
Published: February 2007

This study attempted to determine whether a prior period of “stress” would elicit the sensitization reaction of the skin to topically applied chemical agents. A subthreshold concentration of 1‐chloro‐, 2‐4, dinitrobenzene (DNCB) was applied to the skin of 40 guinea‐pigs, 20 of which had been subjected to repetitive electrical shocks throughout the previous 15 minutes. They were examined 24 hours later, and were retested with DNCB at another site after 9 days for signs of delayed sensitization. The stressed animals exhibited a more severe contact‐reaction (p <. 01) after the induction test and also after the delayed test.
SENSITIVITY OF FOUR FINGFR SWEAT PRINT DURATIONS TO AN ANTICHOLINERGIC AGENT
Authors: Droppleman Leo F. , M.cNair Douglas
Published: February 2007

Four durations of finger sweat prints (FSPs) were compared for their relative sensitivity to atropine sulfate in a double‐blind study with 24 normal volunteers. The statistically significant results indicate: 1) FSPs within a wide range of duration are sensitive indicators of treatment effects; 2) however, shorter durations are clearly superior to longer ones in sensitivity; and 3) there can be greater flexibility in the use of this technique since length of the measurement period can now be more appropriately determined by experimental requirements rather than by an a priori standard.
THE RELATIONSHIP BETWEEN STIMULUS INFORMATION, REACTION TIME, AND CORTICAL HABITUATION
Authors: Orr William C. , Stern John A.
Published: February 2007

This investigation was an attempt to study systematically the effects of uncertainty, or stimulus information, on habituation rate. Subjects were randomly assigned to one of three conditions varying in uncertainty. EEG alpha desynchrony duration, electrodermal conductance change, and reaction time were the dependent measures. The results showed uncertainty to have no significant effect on any of the neurophysiological measures. There was a significant effect on the reaction time measure. There was no significant correlation between the EEG and electrodermal response measures, nor was there any correlation between either of these measures and reaction time. Results indicated that habituation could occur in the presence of cortical and behavioral arousal. It was concluded that information may be most meaningfully measured behaviorally and that habituation parameters are dependent upon the physiological system being measured.
QUANTIFICATION OF THE REM SLEEP CYCLE AS A RHYTHM
Authors: Globus Gordon G.
Published: February 2007

The goal of this study was to develop an objective quantitative method for representing the temporal organization of sleep in terms of the period and rhythmicity of REM sleep occurrences. Data on normative human sleep, already scored for stage REM and not stage REM, were subjected to a “binary autocorrelation.” The mean period over 92 nights of sleep for 10 Ss was 101.5 min and quite stable. Data is also presented on variability of the rhythm in terms of an “index of rhythmicity.” Measures of temporal organization may prove to be as significant for sleep research as amount of the various sleep stages.
EFFICIENCY OF GSR DETECTION OF INFORMATION AS A FUNCTION OF STIMULUS SET SIZE
Authors: Lieblich Israel , Kugelmass Sol , Ben‐Shakhar Gershox
Published: February 2007

The reported studies attempted to evaluate the influence of stimulus set size on the efficiency of detection of information through the analysis of GSR responses. Three stimulus set size variations of a standard card detection test were employed. No significant reduction in absolute detection scores was found as the number of cards was increased, and an analysis based on the Theory of Signal Detection also suggested better autonomic discrimination as the stimulus set size increased.

The results suggest that the subject responds to the stimuli by dividing them into a single relevant stimulus and a reject category containing all others.
SELECTIVE HABITUATION OF GALVANIC SKIN RESPONSE COMPONENT OF THE ORIENTATION REACTION TO AN AUDITORY STIMULUS
Authors: O'Gorman J. G. , Mangan G. L. , Gowen Joan A.
Published: February 2007

The prediction from Sokolov's (1960) theory that, following OR habituation, size of OR return is proportional to the amount of difference between the new stimulus and the habituating stimulus was tested using an auditory stimulus varying in frequency and intensity. Five Ss were allocated to each of 16 conditions, three conditions involving changes in frequency, three involving changes in intensity, nine involving changes in both frequency and intensity, with one control condition involving a repetition of the habituating stimulus. Following habituation of the GSR component of the OR to a criterion of response failure for three successive trials, magnitude of GSR under the 16 conditions was measured.

Contrary to Sokolov's theory, only increase in intensity had a significantly different effect on OR return. More importantly, it was found that Ss habituating rapidly to the initial stimulus were less likely to show OR return to stimulus change. It was concluded that individual differences in habituation rate may be more important than stimulus difference effects in selective habituation.
EXPERIMENTER EFFECTS ON THE PHYSIOLOGICAL EXPERIMENT
Authors: Hicks Ronald G.
Published: February 2007

Human subjects establish expectancies that often reflect the investigator's orientation before and during an experiment. The purpose of this experiment is to determine the effects of subject expectancies as inadvertently influenced by the investigator in a perceptual‐physiological experiment, even to the point where the principal investigator's choice of an “experimentally naive” assistant still reflects his expectancies. Eighteen adult male subjects were randomly assigned to one of three different naive experimenters: (1) an automated procedure, (2) a reserved female, and (3) a sociable female. All the subjects were tachistoscopically presented with 76 four‐letter words which included both socially acceptable and taboo words. The subjects' physiological responses were monitored during the entire experiment. The words were grouped according to their social desirability and were analyzed by a trend analysis of variance. The results demonstrate that both the subject's physiological responsivity and his reporting of socially acceptable and taboo words are dependent upon the experimenter.