bluuebunny/crossref_metadata_2025 huggingface dataset:
The Child-Psychoanalytic Play Interview: A Technique for Studying Thematic Content
Authors: Marans Steven , Mayes Linda , Cicchetti Domenic , Dahl Kirsten , Marans Wendy , Cohen Donald J.
Published: January 2017

Child psychoanalysts have long viewed play as a reflection of children's inner lives and have used the themes children represent in play for diagnostic and therapeutic work. Given the central role children's play has for clinical work, few studies have addressed play empirically. This paper presents a technique for studying the thematic content of children's play as it emerges during a play session with a child analyst. We report the steps involved in developing this investigative technique and describe the interobserver agreement among four raters using the technique with videotaped play sessions. Implications for future research using such an approach are discussed.
Some Thoughts on the Psychoanalytic Situation
Authors: Chasseguet-Smirgel Janine
Published: January 2017

This article develops ideas set out in a previous study on the “archaic matrix of the Oedipus complex” versus the fully developed Oedipus complex (their similarities and their differences), applying these to a study of the psychoanalytic situation. The central hypothesis is that there is a correspondence between the psychoanalytic situation and the structure of the mental apparatus.

The author supposes that our perception of the world is intimately linked to the primary maternal relationship, to our wish to fuse with the mother once more, and to the accompanying fear such a wish inspires. To deal with this we create enclaves where the regressive wish can be satisfied without fear of ego dissolution. The author suggests that the psychoanalytic situation is one such enclave. She examines its specific features in the light of the structure of the mental apparatus as she defines it.
Psychoanalysis and its Neighboring Sciences: Paradigms and Opportunities
Authors: Holzman Philip S. , Aronson Gerald
Published: January 2017

Breuer and Freud's prepsychoanalytic cathartic treatment proved to be generally ineffective. Consequently, both the treatment and the theory adduced to support it were revised to accommodate the issue of wishes and their expression. But the new treatment, too, had only limited success, which resulted in a further revision of the supporting theory to emphasize the “resistances,” or the control and modulation of drives. There is an irony in these progressive shifts: as the therapy's limitations became more apparent, the theory became more expansive, and extended itself beyond its beginnings in neurotic symptoms, and into slips, dreams, character formation, and sociology. In short, it encompassed more of normal behavior as its expectations for the therapy of pathological behavior were increasingly called into question. The paper explores some implications of this historical turn for a scientific data base with opportunities to test and revise the various psychoanalytic hypotheses. One view would have it that psychoanalysis has been lamed by the physicalistic language of its metapsychology, by its isolation from the neurosciences and the cognitive sciences, and by a compartmentalization of practice and knowledge that has kept its practitioners focused on the worried well and unimpressed by the knowledge at its borders. Another view would propose that the restiveness of some current and past theorists to claim the mantle of “science” continues to lead to premature and awkward attempts to couple psychoanalysis with putative neighbors rather than stick to its last of shaping its own findings into a language reflecting a coherent theory capable of validation.
Model Scenes: Implications for Psychoanalytic Treatment
Authors: Lachmann Frank M. , Lichtenberg Joseph
Published: January 2017

Model scenes are constructed by analyst and patient to organize puzzling information, integrate previous understanding, and initiate further exploration of experience. They are derived from a variety of sources: literature (oedipal myth); transference; ordinary or traumatic childhood events that occupy a pivotal position. Model scenes may conceptualize experiences of any age and motivational system, and are contrasted with screen memories and “telescoping” of events.

Two clinical examples are used to illustrate the relation between the model scene and the transference. Model scenes provide a valuable clinical tool for moving from general to specific experience. They afford empathic entry into the transference experience and the opportunity through which the experience of motivations representative of past and present can be conceptualized and integrated into a cohesive self organization.
Use of Ultrasonic Shears in the Harvest of the Free Osteocutaneous Fibula Flap
Authors: Burton Jon N. , El-Deiry Mark W.
Published: January 2017

Objective:

Traditionally, the fibula free flap has been raised by electrocautery and sharp dissection with clipping and tying of vessels. Use of the ultrasonic scalpel has been proposed to be a faster, more hemostatic, and less traumatic method of harvest.

Methods:

We performed a retrospective chart review of 58 patients who underwent fibula free flap reconstruction between 2007 and 2010. The main outcome measures were blood loss, operative time, and flap harvest time.

Results:

Use of the ultrasonic shears was not associated with a statistically significant reduction in intraoperative blood loss, operative time, or flap harvest time. However, the flap harvest time did trend toward statistical significance (p = 0.073). Use of distribution-based effect sizes demonstrated a moderate clinically important difference in favor of the ultrasonic shears for both operative time and flap harvest time.

Conclusions:

The use of ultrasonic shears is comparable to traditional methods of fibula free flap harvest and can be considered an alternative method of harvest.
Nasal Resonance in Middle-Aged Women: A Multiparameter Approach
Authors: D'haeseleer Evelien , Depypere Herman , Claeys Sofie , Lierde Kristiane M. Van
Published: January 2017

Objectives:

Aging influences several speech characteristics in middle-aged women. However, the effect of aging on nasal resonance has not been widely investigated, and findings are contradictory. The purpose of this study was to investigate the effect of aging on nasal resonance by comparing young women (between 20 and 28 years of age) with middle-aged women (between 45 and 55 years of age).

Methods:

Thirty-one middle-aged women with a mean age of 48 years participated in the subject group. The control group consisted of 22 young women with a mean age of 23 years. To investigate nasal resonance, we used a multiparameter approach by means of the Nasal Severity Index (NSI). Objective acoustic (nasal resonance scores of sounds and connected speech measured with the Nasometer) and aerodynamic measurements (maximum duration time of /s/, vital capacity, and mirror fogging test), as well as perceptual evaluations (Gutzmann /a/-/i/ test), were performed.

Results:

The results of this study showed no differences in aerodynamic measurements and nasal resonance scores of connected speech and the sounds /i/, /u/, and /m/. Only the mean nasal resonance score of /a/ and the Gutzmann /a/ test were significantly different between the young and middle-aged women. The mean (±SD) NSI scores of the young women (12.93 ± 17.9) and the middle-aged women (-1.49 ± 14.4) both corresponded to normal nasal resonance.

Conclusions:

The results of this study indicate that both young and middle-aged women show a normal nasal resonance. Differences in objective and subjective measurements of nasal resonance were only found in isolated vowels, and not in connected speech.
Subglottic Laryngeal Closure: A Unique Modified Method of Laryngotracheal Separation to Prevent Aspiration
Authors: Miyake Naritomo , Kawamoto Katsuyuki , Fujiwara Kazunori , Hasegawa Yuji , Kitano Hiroya
Published: January 2017

Objectives:

Laryngotracheal separation (LTS) is an ideal surgical method for intractable aspiration; however, the oral side of the tracheal stump can easily disintegrate. Therefore, we developed a modified LTS method. We performed subglottic laryngeal closure (SGLC) as a new surgical method and evaluated the outcomes.

Methods:

We retrospectively analyzed the medical records of 36 patients (28 male and 8 female; 15 to 91 years of age) who underwent SGLC between 2007 and 2011 at Tottori University Hospital, Japan. Operative data (operative time, intraoperative bleeding, and time to drain removal), outcomes (aspiration and changes in nutritional status), and complications with regard to the surgical method were examined. The occurrence of a subcutaneous proximal laryngeal stump fistula was evaluated by videofluoroscopy.

Results:

The SGLC was performed safely in all patients. Fistulization was observed in only 1 of the patients (2.8%), and major bleeding after surgery was observed in 1 patient (2.8%). The procedure relieved aspiration pneumonia in all patients.

Conclusions:

We conclude that SGLC is effective for treating and preventing pulmonary aspiration. The incidence of postoperative complications, particularly that of subcutaneous fistulas, was very low. Therefore, this method may be useful for patients in poor condition.
Damage of the Auditory System Associated with Acute Blast Trauma
Authors: Roberto Michele , Hamernik Roger P. , Turrentine George A.
Published: January 2017

This paper reviews the results of several studies on the effects of blast wave exposure on the auditory system of the chinchilla, the pig, and the sheep. The chinchillas were exposed at peak sound pressure levels of approximately 160 dB under well-controlled laboratory conditions. A modified shock tube was used to generate the blast waves. The pigs and sheep were exposed under field conditions in an instrumented hard-walled enclosure. Blast trauma was induced by the impact of a single explosive projectile. The peak sound pressure levels varied between 178 and 209 dB. All animals were killed immediately following exposure, and their temporal bones were removed for fixation and histologic analysis using light microscopy and scanning electron microscopy. Middle ears were examined visually for damage to the conductive system. There were well-defined differences in susceptibility to acoustic trauma among species. However, common findings in each species were the acute mechanical fracture and separation of the organ of Corti from the basilar membrane, and tympanic membrane and ossicular failure.
Response to Robert K. C. Forman
Authors: Janz Bruce
Published: January 2017

The hermeneutical and the epistemological paradigms for understanding mystical experience are not easily translated into each other. The hermeneutical model has the advantage in that it shifts the emphasis from explanation to understanding. Mystical experience, namely, the falling away of the factical conditions of human existence and the meeting with Infinite Being, cannot be reduced to epistemology, nor does it adhere to the categories of knowledge. Mystical experience is not about content at all; the mystic understands Being without concepts.
Death and rhetoric in the Hebrews "hymn to faith"
Authors: Bulley Alan D.
Published: January 2017

Michael R. Cosby's The Rhetorical Composition and Function of Hebrews 11 provides the most extensive rhetorical analysis of the passage in question. In spite of the title of his book, however, Cosby's discussion of "function" has more to do with the rhetorical function of individual elements of style in Hebrews 11 than it has to do with the workings of the chapter as a persuasive unit. This article attends to the role of chapter 11 in the argumentation of Hebrews by building on Cosby's work through analysis of the techniques of epideictic rhetoric in connection with orations celebrating the dead, and of the inter-relation of the themes of pistis, suffering and death.
Face-to-face: Ethical asymmetry or the symmetry of mutuality?
Authors: Olthuis James H.
Published: January 2017

Emmanuel Levinas's insistence on the ethical priority of the other is vulnerable to being misread as a plea for selflessness and self-sacrifice. The author suggests an alternative ethics of non-hierarchical mutuality in which "substitution" and self-sacrifice are seen not as the heart of ethics, but as an emergency compromise ethic because of the breakdown of mutuality.
Jérusalem : ville de l'ascension du Prophète Muhammad
Authors: Steigerwald Diane
Published: January 2017

Cet article analyse les significations symboliques de Jérusalem pour les musulmans. Il explique pourquoi, au début de la prédication du Prophète, les musulmans priaient en direction de Jérusalem avant de se tourner vers La Mecque. Pourquoi Jérusalem a-t-elle perdu sa préséance en devenant la troisième ville sainte après La Mecque et Médine? Cet article décrit l'ascension spirituelle (mi'rāj) du Prophète Muhammad et comment cette expérience mystique apporte une signification spirituelle à Jérusalem. Les sufīs donnent différentes interprétations de l'ascension spirituelle dont quelques-unes seront examinées. Chez les sufīs, Jérusalem garde une position privilégiée. Elle est la première et dernière qibla (pôle de la prière), la «Cité de la suprême Hégire».
La déconstruction et le jeu de l'athéologie (Nietzsche, Bataille, Derrida)
Authors: Nault François
Published: January 2017

L'auteur tente de saisir la spécificité du jeu de Jacques Derrida, en le situant notamment par rapport à celui de Friedrich Nietzsche et de Georges Bataille. Cette comparaison conduit à mettre en lumière la double économie sous-jacente à la déconstruction (économie de la violence et économie de la dissémination), et à dégager les liens étroits unissant les problématiques du jeu, de l' écriture et du rire. En conclusion, l'auteur rattache les analyses du jeu derridien à la question théologique et introduit la notion d' athéologie.
Christ in Kierkegaard's later writings
Authors: Mckinnon Alastair
Published: January 2017

This study reports the relative frequency of the words representing the 35 main roles or themes in Kierkegaard's conception of Christ in order finally to settle the question of the relative importance of "the crucified Christ" within this conception. The result provides the reader with an overall view of the account of Christ in 14 of Kierkegaard's last books and of his changing emphasis on these themes over the period covered by these works.
The Scope and Control of Chemical Disarmament Treaties Particularly with Regard to Binary Chemical Weapons
Authors: Lundin Johan
Published: January 2017

In principle, this paper gives an account of the meaning of the term ‘binary chemical weapons’, and of the effects their existence has on the scope of and controls covered by conventions concerning prohibition of the development, production and stockpiling of chemical weapons, as well as prescriptions for their destruction. The conclusions drawn are particularly relevant to those responsible for the defence of a country against attack by chemical weapons.
A Comparison of Performance on Visual and Auditory Monitoring Tasks
Authors: Kennedy Robert S.
Published: January 2017

Four forms of a vigilance task were administered over four sessions in counter-balanced order to 16 subjects. Three of the forms required auditory monitoring (one, two, or three tones) and one required visual (three lights) monitoring. Visual performance was superior to auditory performance; the auditory performance was a function of the number of channels monitored. Performance did not change over the four sessions. Among the different scoring methods used, “percent correct” had the most common variance. Decrements in performance appeared within ten minutes in the one- and two-channel auditory tasks. An overall downward trend appeared in the three-channel visual task but was less regular. No systematic change in performance was apparent in the three-channel auditory task. Intratask correlations over subjects were high (r >. 75), while intertask correlations showed only 20% common variance.
Perceptual Narrowing during Simulated Pressure-Chamber Exposure
Authors: Weltman Gershon , Smith Janice E. , Egstrom Glen H.
Published: January 2017

In this study, 15 male subjects performed a central visual acuity task (Landolt ring detections) and a peripheral light detection task during what they thought to be a 60-ft. dive in a pressure chamber. There was no actual pressure change. A 15-man control group performed the same tasks at an outside location. Experimental measures included a posttest anxiety checklist and continuous heart rate recording. The chamber group showed significantly higher anxiety scores and also a significantly higher heart rate throughout the experiment. There was no difference between the groups with regard to correct Landolt detections, although the chamber group responded somewhat slower. Peripheral detection, however, was severely and significantly degraded in the chamber group. It was concluded that perceptual narrowing had been demonstrated as a result of psychological stress associated with exposure to the “dangerous” pressure-chamber.
In-Flight Target Reporting—How Many is “A Bunch”?
Authors: Rigby Lynn V. , Swain Alan D.
Published: January 2017

This study defines the quantitative meaning of some common but ambiguous modifiers used in noun phrases. The modifiers were “couple,” “few,” “some,” “several,” “(object)s,” “number,” “bunch,” “lot,” and “many,” A total of 117 subjects were asked to make quantitative estimates of each of 45 sighting reports, such as “a bunch of trucks.” It was found that the mean numerical estimates associated with the above modifiers differed significantly across the modifiers and types of target used in the noun phrases but did not depend on the type of pilot background and aircraft flown.
Alphabetic Data Entry via the Touch-Tone Pad: A Comment
Authors: Smith Sidney L. , Goodwin Nancy C.
Published: January 2017

Computer analysis indicates the feasibility of single-stroke keying for data entry of alphabetic names using the standard touch-tone telephone pad. In many practical job situations little ambiguity will result from the single-keying technique, and this ambiguity can be resolved under computer control.
A Psychophysical Evaluation of the Accuracy of Shape Discrimination as an Aircraft Landing Aid
Authors: Kelly Michael J. , Bliss William D.
Published: January 2017

Pilots flying into unfamiliar airports may find it difficult to judge correctly the proper glide angle when landing. Several types of landing aids are now in use to eliminate this problem; however, they are typically expensive to install and maintain. A possible solution to this problem is the replacement of runway centerline striping with painted diamonds. Changes in the projected shape of the diamonds could provide glide angle information. It was the purpose of this study to evaluate the accuracy possible in detecting glide angle using this method. The just-noticeable difference between a square and a diamond shape was determined. This ratio was found to be 1.049/1.00 for the upper just noticeable difference and .945/1.00 for the lower just noticeable difference. This finding indicates that, if discrimination in the real world approaches this accuracy, deviations of approximately .17° above or below glide slope are detectable.
Cognitive Efficiency of Divers Working in Cold Water
Authors: Baddeley Alan D. , Cuccaro William J. , Egstrom Glen H. , Weltman Gershon , Willis Michael A.
Published: January 2017

The cognitive efficiency of 14 divers was studied during 1-hour exposure to water of 40°F (4.4°C) and 78°F (25.6°C). Reasoning ability was tested using a sentence comprehension task presented at the beginning and end of each test session. Vigilance was tested by requiring subjects to detect the onset of a faint peripheral light during the performance of a two-man pipe assembly task. Memory was tested by requiring subjects to learn a number of “facts” during the dive, with retention tested by recall and recognition on land, after a 40-min delay. Despite a mean drop in rectal temperature of 1.3°F (0.72°C), neither reasoning nor vigilance was impaired. Memory performance did deteriorate, though it is suggested that this may reflect a peripheral context-dependent memory effect. It is concluded that a well-motivated subject may be cognitively unimpaired despite a marked drop in deep body temperature.
Estimates of the Length of Highway Guidelines and Spaces
Authors: Harte David B.
Published: January 2017

Driving skills depend greatly upon efficient estimates of length and distance. The present study found that male and female subjects between the ages of 16–79 grossly underestimated the length of both the guidelines and the spaces between guidelines used on Massachusetts state highways when tested by memory and under actual driving conditions. It is proposed that this major illusion should be dealt with through driver education or through improvement of highway design.
Information Seeking with Limitations on Available Information and Resources
Authors: Levine Jerrold M. , Samet Michael G. , Brahlek Rae E.
Published: January 2017

Nineteen subjects were given a multinomial Bayesian task in which they had to determine which of four populations was being sampled. Each sequentially drawn data item was described on one of three dimensions of differing diagnosticity; knowledge of the given dimension was presented and the subject could choose to purchase or pass it up. Sixty computer-generated problems were administered in a 2 times 3 within-subject factorial design. A problem contained either 16 or 24 total items of information, and subjects were given sufficient resources to purchase either 50%, 75%, or 100% of the available information. A second study incorporating the same task, involving 20 subjects, and employing a one-factor design was carried out to compare available information limits that were specified either exactly (12 and 24 items) or within a range (12 to 24 items). Results indicated that: (1) significantly more information was sought as both amount of available information and resources increased; (2) as response uncertainty was reduced by the acquisition of additional information, accuracy generally increased; (3) when more information was available, subjects were more efficient in selecting data items; and (4) there was no significant difference in information seeking or accuracy between the average of the two exact-limit conditions and the range-limit condition of amount of available information.
Russian Forensic Psychiatry
Authors: Lowe-Ponsford Francesca
Published: January 2017

Two forensic psychiatric clinics visited on an exchange trip to Russia are described. The legal system for mentally disordered offenders in these institutions is also summarized, as is the training of psychiatrists in Russia.
1. Maternal Mortality following the Use of Misoprostol
Authors: Daisley Hubert
Published: January 2017

Three cases of maternal death following the use of misoprostol are presented. In two of the cases the drug was used to procure illegal abortion, and in the third case maternal death occurred following uterine rupture, after misoprostol was used clinically for induction of labour. A brief review of the usage of misoprostol is presented, including recommendations for its safe use.
II. Kerosene Poisoning
Authors: George B.
Published: January 2017

The treatment of choice in a case of ingested Kerosene is rapid, efficient evacuation of the stomach by the use of a stomach tube. The individual components of Kerosene would make it extremely dangerous to allow either gastric, or intestinal absorption to occur.

The following gives information regarding the constituents of Kerosene and the toxicology of these individual materials.
Sudden Death Resulting from Inhalation of Fire Extinguishers Containing Bromochlorodifluoromethane
Authors: Smeeton W. M. I. , Clark M. S.
Published: January 2017

Solvent abuse or glue-sniffing has become an increasing problem in the young and a wide variety of substances have been involved. Bromochlorodifluoromethane (BCF) is a vapourizing liquid fire-extinguishing agent, particularly effective against burning liquids or electrical fires. We report five sudden deaths resulting from the deliberate inhalation for euphoric effect of the contents of BCF-type fire extinguishers.
Crowds, Mobs and Riots
Authors: Weller Malcolm P. I.
Published: January 2017

Football hooliganism and a spate of riots in Brixton, Toxteth, Moss Side, Southall, Wandsworth and very recently Handsworth and the unrest on union picket lines has reawakened interest in crowd behaviour. The chaos of mob violence and the sway of orators over crowds, when individual judgement is momentarily submerged in shared powerful emotions, have affected most ages. Savonorola in Florence, Robspierre in Paris and Hitler in Nazi Germany exemplify the inordinate influence of a charismatic figure; in the last two instances during times of immense social upheaval. Common factors can be discerned in these situations.

This paper was submitted in May 1985 and drafts circulated. Subsequent events and legislation focused on football matches has incorporated some of the suggestions contained herein.
Predictive Value of Human Footprints in a Forensic Context
Authors: Barker S L , Scheuer J L
Published: January 2017

Previous work from the United States has shown close correlation between an individual's size and weight and predetermined measurements taken from his or her footprints. This study investigated the situation in a group of United Kingdom subjects, for which there is at present little data. Walking and standing footprints, fleshed foot measurements and stature were obtained from 105 adult volunteers from the staff and students of the United Medical and Dental Schools of Guy's and St Thomas' Hospitals, London. The footprints were measured using predetermined landmarks and the results analysed to investigate the significance of the parameters in a forensic context. Inter-observer and intra-observer errors were within acceptable limits.

Regression equations were calculated for foot length from various parameters measured on a footprint. Topinard's finding that foot length represents between 14.9%–18.1% of stature in a given individual was confirmed. Footprint length showed a normal distribution in both sexes but male footprint length was greater than female footprint length for any given height.

This study provides a quantitative method that could be used both with partial footprints and in the absence of dermatoglyphics to assist in the identification of an individual in a forensic context.
The Treatment of Overdose–Time for a Change?
Authors: McGuffie A.C. , Wilkie S.C. , Kerr G.W.
Published: January 2017

To determine emergency management of overdose relating to gastrointestinal decontamination procedures in Scottish Accident & Emergency (A & E) Departments. A postal questionnaire was sent to the 28 main A & E Departments in Scotland. There was a 75% response rate. Nineteen departments (90%) continue to perform gastric lavage, with the majority carrying out this procedure more than one hour post-ingestion of commonly presenting overdoses. Sixteen departments (76%) regularly administer activated charcoal and four (19%) use syrup of ipecacuanha. Twenty departments (95%) had access to Toxbase. The majority of respondents (86%) feel there is a need for standardisation of treatment in acute overdose. Despite the availability of guidelines provided by the UK National Poisons Information Service and the Position Statements, there is no consensus in the actual management of acute overdose among Scottish A&E departments.
Physician Opinions on the Implementation of the Sign Guideline for Heart Failure
Authors: McKee S P , Leslie S J , LeMaitre J P , Webb D J , Denvir M A
Published: January 2017

Background and Aims: To assess physician opinion of, and attitudes to, the Scottish Intercollegiate Guideline Network (SIGN) guideline for chronic heart failure (CHF) due to left ventricular systolic dysfunction. Methods and Results: A questionnaire examining physicians' attitudes and their use of the SIGN guideline for CHF was distributed to 158 physicians in two teaching hospitals within one NHS trust. 65% of recipients responded. More cardiologists had read the guideline compared to non-cardiologists (91 vs 56%, p < 0.05). The majority of cardiologists and non-cardiologists agreed that it was applicable to their patients (92 vs 79%, p > 0.1) and that implementation may reduce hospital admissions (65 vs 59%, p > 0.5). In general, compliance was thought to be a problem in only a minority of patients in both groups for angiotensin converting enzyme inhibitors (8 vs 19%), diuretics (12 vs 29%) and digoxin (17 vs 19%, all p > 0.1). Beta-blocker compliance was identified as a problem by both groups (50 vs 53%, p > 0.5) while fewer cardiologists reported compliance as a problem with spironolactone (4 vs 25%, p < 0.05). More cardiologists felt that there was a need for a community based CHF nurse specialist (100 vs 57%, p < 0.001), and that this strategy would reduce hospital admissions (92 vs 57%, p < 0.01). Conclusions: Differences exist between cardiologist and non-cardiologist physicians' awareness of the SIGN guideline for CHF. Furthermore, we have shown differences in reported implementation of the guideline and perceived difficulties with specific drug therapies. This is in spite of high levels of agreement in both groups with the treatment suggested by the guideline and the anticipated benefits resulting from its implementation.
Carotenaemia in Children is Common and Benign: Most Can Stay at Home
Authors: McGowan R , Beattie J , Galloway P
Published: January 2017

We identified children with elevated plasma carotene levels who attended the Royal Hospital for Sick Children, Glasgow, between July 1998 and April 2001 and carried out a retrospective case record review. Thirty-one children were identified (17 boys; 14 girls) with a median age at presentation of 13 months (range 7m- 11yrs). Twenty-seven (87%) children had simple diet-related carotenaemia and were well. In four cases the hypercarotenaemia reflected nutritional problems with associated failure to thrive. In only one case did the family doctor recognise the condition before referral. Many who attended hospital had laboratory confirmation of the benign diagnosis despite a clear dietary origin. Some had repeat laboratory tests to confirm resolution. Diet-related carotenaemia appears common in our community. The condition appears poorly recognised within primary care and hospital investigations may be over-enthusiastic.
The Impact of Specialist Management of Jaundiced Alcoholic Liver Disease Patients
Authors: Forrest E H
Published: January 2017

Background: Patients with alcoholic liver disease (ALD) presenting with jaundice have advanced chronic ALD and/or acute alcoholic hepatitis. Their prognosis is poor. These patients may be managed by General Medical physicians (GM) or by Gastroenterologists (GE). Aim: This study aimed to retrospectively assess the differences in management and outcome of jaundiced ALD between GM and GE. Patients and Methods: Patients with a serum bilirubin greater than 80 mmol/l on admission and a history of alcohol excess until within three weeks of admission were identified retrospectively. In particular the use of corticosteroids (CS), nutritional support (N) and the use of broad-spectrum antibiotics (A/b) were noted. Results: 97 patients were identified, 62 managed by GE. Differences were apparent between GE and GM managed patients with respect to CS (p = 0.017), N (p < 0.001) and A/b (p < 0.001). The overall mortality was 27.8%, 34.0%, and 37.1% at 28, 56, and 84 days respectively. Mortality for patients with a Discriminant Function ≈ 32 was greater in GM managed patients compared with GE at 28 (p=0.006), 56 (p = 0.013), and 84 days (p = 0.036). Conclusion: Differences exist between the management of jaundiced ALD between GM and GE. Such differences may translate into improved outcomes.
Constipation and Soiling—Outcome of Treatment at One Year
Authors: McDonald L A B , Rennie A C , Tappin D M
Published: January 2017

Aim To assess the outcome at one year of a cohort of patients referred to outpatient clinics with soiling. Method Retrospective case note audit of 34 children referred to hospital outpatients over a four month period with soiling stated as the main problem in the referral letter. Results After one year, 29% of the 34 children studied were discharged to patient satisfaction, 38% defaulted from follow up, 24% were still attending outpatient clinics and 9% had been referred back to source. Coexisting pathologies, in particular enuresis and family stress, were found in several of the children. At the time of referral, 44% of new patients and 89% of re-referrals had symptoms present for longer than 12 months. Only 18% of the children were receiving treatment at the time referral was made. Conclusion: Constipation is often undiagnosed until the problem is well established with soiling present, which makes treatment a long and often difficult process. It is necessary to consider the wider social and family issues when managing a child with constipation and soiling. Hospital based general medical and surgical outpatient clinics may not be the ideal setting in which to deal with these problems.
Epidemiology of Multiple Sclerosis in Glasgow
Authors: Murray S , Bashir K , Penrice G , Womersley SJ
Published: January 2017

Abstract Study objective: The objectives of the study were to establish the prevalence and incidence of multiple sclerosis in Glasgow and to assess the epidemiological importance of deprivation and ethnicity. Design: The study was a descriptive cross-sectional study. Multiple sources of ascertainment were used to identify cases. Setting and patients: The study was carried out in the population of three Local Health Care Cooperatives (LHCCs) in the area of Greater Glasgow NHS Board. The total population was approximately 169,000. Main results: In total, 245 patients with multiple sclerosis were identified. The mean age of patients was 49.8 years, the female to male ratio was 3.2:1, and the mean duration of disease was 16 years. The overall prevalence was 14.5 per 10,000, and the overall incidence 5.7 per 100,000 per year. Both the prevalence and incidence of multiple sclerosis were higher in the more affluent population. The crude prevalence in the Asian population was 6.3 per 10,000. Conclusions: The epidemiology of multiple sclerosis in Glasgow was similar, in most respects, to the epidemiology described in other parts of the U.K. There was evidence for the importance of deprivation as a determinant of both incidence and prevalence of disease. The reasons for the higher incidence and prevalence of multiple sclerosis in less deprived populations are not clear.
Do Creatine Kinase (CK) Levels Influence the Diagnosis or Outcome in Patients with Compartment Syndrome?
Authors: Ihedioha U , Sinha S , Campbell A C
Published: January 2017

We report a retrospective study in patients with compartment syndrome with the aim to analyse: 1) whether the level of rise in CK levels is a useful marker to the presence of compartment syndrome and; 2) whether an early fasciotomy assists in lowering of the elevated CK levels. The results of our study suggest that although raised CK levels are not diagnostic, they are a useful adjunct in making a diagnosis, and hence CK estimation should be done in all patients with suspected compartment syndrome. Moreover, an early fasciotomy (<12 hours) has a statistically significant influence in lowering elevated CK levels, confirming the view that the earlier the decompression, the lesser the muscle damage.
Severe Osteomalacia in a Patient with Idiopathic Chronic Pancreatitis
Authors: Kurtulmus N , Yarman S , Tanakol R , Alagol F
Published: January 2017

We report a 30-year-old woman who was confined to a wheelchair because of severe myopathy. She was first seen by a neurologist because of a convulsive syndrome of unknown etiology when she was nine. She was started on anticonvulsive drugs but the drug was stopped when her serum calcium level was found to be very low. She had a history from childhood of steatorrhea and abdominal pain after a fatty meal and became vegetarian at age five years. She worked in a hospital as a nurse and at home her living room received no direct sunlight. As a result of these conditions osteomalacia progressed. We believe an awareness of chronic pancreatitis (CP) during childhood could have prevented the consequences of the disease in this case.
A Look at Cryosurgery
Authors: Gill W. , Fraser James
Published: January 2017

Cryosurgery provides a means of tissue destruction which is easily and accurately controllable and which can be applied to remote areas of the body. The mechanism and properties of freezing are discussed with particular mention of the maximum freezing effect and its clinical application. The application of cryosurgery to various clinical problems is discussed.
Inhibition of Lactation with Quinestrol
Authors: Barbour E. M. , Baruah N. K.
Published: January 2017

A new synthetic oestrogen is shown to have a highly significant advantage over standard therapy in the inhibition of lactation.
Treatment of Thyrotoxic Patients with Atrial Fibrillation
Authors: McLarty D. G. , Harden R. McG. , Alexander W. D.
Published: January 2017

In 50 of 96 patients, atrial fibrillation spontaneously reverted to sinus rhythm following treatment for thyrotoxicosis with radioiodine. Reversion to sinus rhythm did not occur, however, until the patient was euthyroid. Forty-seven per cent of the patients required more than one dose of 131I, 10 per cent receiving 4 doses, and 23 per cent took longer than one year before they were rendered permanently euthyroid. The incidence of hypothyroidism was 43 per cent. Thus radioiodine is not ideal treatment in patients with atrial fibrillation and thyrotoxicosis. We suggest that patients with thyrotoxicosis and atrial fibrillation be treated with antithyroid drugs in the first instance as these result in rapid control of the thyrotoxicosiss.
Resuscitation Room Survey
Authors: Jenkins A. McL. , McQuillan W. M. , McNair T. J.
Published: January 2017

A survey of 100 seriously ill patients admitted to a Resuscitation Room is described.

The survey was conducted over a comparatively short space of time, but it has nonetheless illustrated several facts.

The remarkable frequency of violence and poisoning among patients requiring resuscitation is demonstrated. This combined group constitutes over 80 per cent of all the patients. Also notable is the frequency of head injury, and in particular the high percentage (75%) of patients who received their head injuries in road traffic accidents.

The Neurosurgical Unit is shown to receive far more patients from the resuscitation room than any other unit, and this fact might be usefully employed in planning the proximity of such units to casualty departments of the future.

The use of a specially equipped resuscitation room is described. It is clearly desirable to have such an area, but with the relatively small number of resuscitation patients it is not economical to restrict the very expensive X-ray facilities to these patients alone.
Thrombotic Microangiopathy in Rheumatoid Arthritis
Authors: Thomson D. , Gardner D. L.
Published: January 2017

The syndrome of thrombotic microangiopathy is described in an elderly woman with active rheumatoid arthritis and thyroiditis. Phenylbutazone and imipramine were used in treatment immediately before thrombocytopenia was recognised and the possible role of these drugs in precipitating microvascular thrombi in rheumatoid arthritis is discussed.
Neurological Assessment of Gestational Age in Low Birth Weight Infants
Authors: Coutts N. A.
Published: January 2017

One hundred newborn infants of low birth weight were examined neurologically in the neonatal period to determine their gestational age. Comparison of this assessed gestational age with the maternal menstrual history, in the 80 cases in which this was known accurately, showed a good correlation, particularly if neurological assessment was deferred until the infant was 5 days old. It is suggested that neurological examination is a useful method of assessing gestational age when the mother's menstrual dates are in doubt.
Delirium Tremens: A Comparison of Intravenous Treatment with Diazepam and Chlordiazepoxide
Authors: Brown J. H. , Moggey D. E. , Shane F. H.
Published: January 2017

In a clinical trial comparing diazepam and chlordiazepoxide in the treatment of delirium tremens, the outstanding difference noted was that diazepam appeared to have a more rapid onset of action, enabling dosage to be adjusted more accurately. It is suggested that this difference, in conjunction with its greater anticonvulsant activity, renders diazepam preferable to chlordiazepoxide in the treatment of delirium tremens. Certain ethical and methodological problems peculiar to this type of study are noted.
Gout in Scotland
Authors: Durward W. F.
Published: January 2017

The discharge statistics of 1012 in-patients with gout in Scotland during a 10-year period were analysed. Almost one fifth were female and had a significantly higher mean age than the males. There was a curiously high incidence of emergency admission in those with gout as the sole or main diagnosis. Social classes I and II did contain a small but significant preponderance of gouty individuals; however more than 60 per cent of patients belonged to social classes III to V. The known high incidence of cardiac and renal disease in these patients was confirmed. One per cent of patients were hypothyroid.
Recent Advances in the Drug Treatment of the Functional Psychoses
Authors: Bennie F. H.
Published: January 2017

Little is known about the primary cause of mental illness but in a major area of psychiatry effective secondary prevention has been developed. Potent psychopharmacological agents have become available to the clinical psychiatrist and it has been shown that the prognosis in the psychoses can be significantly improved when continuous drug treatment is prescribed. As treatment has to be given for years the psychiatric clinic has become committed to a potentially large group of patients whose mental wellbeing is dependent upon regular psychotropic medication.
Urinary Oestrogen and Plasma Human Placental Lactogen as Initial Screening Tests for a Placental Sulphatase Deficiency
Authors: Beastall G. H. , Kelly Anne M. , England P. , Rao L. G. S. , Macgregor Margaret W. , Paterson M. L.
Published: January 2017

As a result of routine screening of ante-natal patients by urinary total oestrogens and plasma human placental lactogen (HPL) from 35 weeks, a rare placental sulphatase deficiency was indicated which was later confirmed by in vitro studies of placental enzyme activities.
Ambulance Transport of Obstetric Emergencies
Authors: Carty M. J. , Waddell G.
Published: January 2017

Ninety-eight patient records from obstetric flying squad calls were reviewed. The reasons for call-out and the effect of transport on maternal and foetal cardiovascular parameters were analysed. The main reason for calling the flying squad is now antepartum haemorrhage. Transporting the patient to hospital has little effect on the cardiovascular state.
Group B Streptococcal Endocarditis
Authors: Reid T. M. S.
Published: January 2017

A retrospective study of group B streptococcal endocarditis during 1965–74 in Aberdeen General Hospitals revealed that group B streptococci now principally affect patients in the older age groups with or without a history of antecedent heart disease. Despite recent reports of increased group B infections in obstetric and perinatal practice there were no cases of post-puerperal endocarditis. Although aortic valve involvement would appear to be increasing, group B streptococci still show a marked predilection for the mitral valve.
Persistence of a Specific Pseudomonas Infection in a Large General Hospital
Authors: Tinne J. E.
Published: January 2017

Of at least 37 strains of Pseudomonas aeruginosa distinguishable by their pyocine production, Type 10 is noteworthy for its relative rarity and its virulence to man. Opportunistic infections by this organism occurring in a single hospital over 8 years are described, and its ecology discussed with reference to its possible control.
Cephalothin Induced Neutropenia during the Treatment of Bacterial Endocarditis
Authors: Holt S. , Khan M. M. , Orlans D. A. , Epstein E. J.
Published: January 2017

The occurrence of cephalothin induced neutropenia in 3 patients with infective endocarditis is described. In each patient, withdrawal of cephalothin was followed by rapid haematological recovery. It is apparent that granulocytopenia may frequently occur in patients receiving prolonged, high dose, intravenous cephalothin for the treatment of bacterial endocarditis.
Fundamental Aspects of Oestrogens: Intracellular Receptors and Gene Activation
Authors: Keir H. M.
Published: January 2017

The steroid hormones exert their biological responses through a multi-step process involving regulation of gene expression. The hormone passes across the target-cell membrane from the circulation and enters the cytoplasm where it binds to a specific protein designated the receptor. A conformational change in the receptor ensues and the receptor-hormone complex is translocated to the chromatin in the cell nucleus. Interaction of the receptor-hormone complex with specific regions of the DNA and with specific non-histone chromatin proteins leads to initiation of transcription of new molecules of RNA. The primary RNA transcripts are processed to give mature molecules of messenger-RNA which are transported to the cytoplasm where they combine with ribosomes to form polysomes. The messenger-RNA is translated, by the cytoplasmic machinery of protein synthesis, into various new proteins. These proteins then promote the well-established biological responses associated with each particular steroid. Impairment of any of these steps (for example, lack of production of steroid, absence of receptor, a defect in structure of the receptor) results in a disturbance in or loss of the normal biological response.
Current Trends in the Management of Carcinoma of the Prostate
Authors: Steyn J. H.
Published: January 2017

Prostatic carcinoma is a fairly common tumour and its diagnosis should always have a histological basis. Staging of the tumour by the TNM system permits a more rational approach to the choice of therapy-radical prostatectomy, radiotherapy and/or hormonal manipulation. To date there is no hormonal therapy convincingly superior to the use of oestrogen or the undertaking of bilateral orchidectomy. Chemotherapy has so far been disappointing.
The Assessment of Continuing Medical Education
Authors: Davies I. J. T.
Published: January 2017

There is a close link between audit of clinical competence and audit of continuing medical education. Some of the earlier assumptions about the organisation of continuing medical education need to be reviewed. The increasing provision of resources for continuing medical education by the NHS means that added safeguards are necessary to ensure that professional standards are not subordinated to service exigencies. The introduction of higher educational methodology into continuing medical education should be critically examined with an awareness of the limitations and controversies concerning many methods of teaching and assessing educational outcome. The methodology of higher education may need to be substantially modified to suit the uniqueness of the clinical process and the problems of altering the behaviour of experienced and practising doctors. Criticism of behaviourist educational methods should be based on an understanding and knowledge of these methods. A new functional clinical educational domain is proposed which links educational methods with the clinical application of new learning.