bluuebunny/crossref_metadata_2025 huggingface dataset:
Mary, the Mother of God
Authors: Stewart Melissa C.
Published: January 2017

Will Marian devotion, especially of Guadalupe, lead to conflict between Catholics and Protestants in the United States as more and more Latinos and Latinas immigrate here, many bringing their Guadalupe adoration with them? Or could it possibly lead to a rapprochement between the two branches of Christianity? Some see Guadalupe as a barrier between Catholic and Protestant forms of Christianity; the author sees her as a bridge. In order to answer this larger question, she begins with a smaller question that is actually more important to her: Does Guadalupe have anything to offer a Protestant, ecofeminist theology?
Bone Age Determination in a Paediatric Population as an Indicator of Nutritional Status
Authors: Fleshman Keith
Published: January 2017

The United Mission to Nepal Tansen Project is in the hill country, 300 km West of Kathmandu. This 40-year-old service centre's major emphasis has been on clinical and community medicine and education. Agronomy, forestry, water resources development, adult literacy, etc., have also been part of the project's outreach.

We had long noted that the children of all of the various tribal groups in the area are small for their age as compared with children in developed countries. Fracture care X-rays were examined to reveal delay in ossification and in physeal closure.

Using the standards found in the Radiographic Atlas of Skeletal Development of the Hand and Wrist, we quantified this apparent delay by determining the bone age of all patients presenting at the hospital with upper limb injuries requiring X-ray. The collection of data was limited to 100 days and to those under the age of 21. Two hundred and nineteen patients' data were analysed.

We found that bone maturation delay was very common and often severe. The average bone age among the 219 was 28% below chronological age. That is, 60% of all fell two standard deviations below the norm: i.e. two-thirds of all 9 year olds had the expected skeletal development of 6 year olds in Boston, USA.

Dental age was also analysed using deciduous tooth shedding and tooth eruption patterns. Dental age retardation averaged 21%, but a larger per cent had normal eruption dates. Other physical and sociological data were included in a questionnaire completed for each patient. Among the variables examined, poverty alone appeared to be the major mover. We believe that national small stature is a result of lifelong community dietary inadequacy.
Tuberculous Cervical Lymphadenopathy: Should Antituberculous Therapy Be Preceded by Histological Proof?
Authors: Morad Nader A
Published: January 2017

In this retrospective study, 212 patients with cervical lymphadenopathy (CL) were studied over a 4-year period (1987–1990). Ninety-six (45.3%) were found to be tuberculous, 64 (30.2%) had reactive hyperplasia, 31 (14.6%) had a malignant lymphoma, 12 (5.7%) showed metastatic carcinoma and nine (4.2%) were due to miscellaneous causes. The original provisional diagnosis was incorrect in 20 cases who were later found to have tuberculous lymphadenopathy (TL) and in 12 patients with secondary malignancy who were originally diagnosed as tuberculous. The study shows that treatment should be preceded by histological proof to avoid delay in treatment of serious malignant disorders, to avoid unnecessary antituberculous treatment in patients with benign reactive lymphadenopathy and to prevent delay of antituberculous treatment in tuberculous patients with atypical clinical presentations.
Need for Paediatric Surgery Care in an Urban Area of the Gambia
Authors: Bickler Stephen W , Telfer Michelle L , Sanno-Duanda Boto
Published: January 2017

The report evaluates the need for paediatric surgical care in an urban area of sub-Saharan Africa. Seven hundred and forty-one children were treated for surgical problems from January through December 1997. The most common surgical problems were injuries (67.1%), congenital anomalies (15.0%) and surgical infections (6.7%). Forty-six per cent of children presenting with a surgical problem required a surgical procedure, 68.2% of which were classified as minor. The annual presentation rate for all surgical conditions was 543 per 10 000 children aged 0–14 years. The estimated cumulative risk for all surgical conditions is 85.4% by age 15 years.

Our data suggest surgical diseases commonly affect children living in Banjul. Surgical care should be an essential component of child health programmes in developing countries.
Craniotomy of the Aftercoming Head via the Palate
Authors: Bullough Colin
Published: January 2017

A technique for carrying out craniotomy through the fetal palate in obstruction of the aftercoming head when perforation through the occiput appears to be difficult or impossible.
Prevalence of Wheeze and Self-Reported Asthma and Asthma Care in an Urban and Rural Area of Tanzania and Cameroon
Authors: Mugusi Ferdinand , Edwards Richard , Hayes Louise , Unwin Nigel , Mbanya Jean-Claude , Whiting David , Sobngwi Eugene , Rashid Seif
Published: January 2017

We investigated the prevalence of wheeze, self-reported asthma, and asthma care via four cross-sectional surveys among adults and children (5-15 years) in urban and rural populations from Tanzania and Cameroon. Age-standardized prevalence of current wheeze (in the previous year) was 2.2% to 5.0% in adults and 1.9% to 5.2% in children in Tanzania, and 1.3% to 2.5% (adults) and 0.8% to 5.4% (children) in Cameroon. There were no consistent patterns of urban:rural prevalence. Peak flow rates varied with age, peaking at 25-34 years, and were higher in urban areas (age adjusted difference 22-70 L/min) and in the Tanzania populations. Awareness (83%–86% versus 52%–58%) and treatment (43%–71% versus 30%–44%) of asthma was higher among those with current wheeze in rural areas. Use of inhaled drugs, particularly steroids, was rare. Diagnosis by traditional healers (15%) and use of traditional remedies (62% of those recalling any treatment) were common only among self-reported asthmatic patients in rural Cameroon.

Asthma is an important clinical condition in sub-Saharan Africa. There were major gaps in clinical care, particularly in urban areas. Sustainable methods for delivering accessible and effective asthma care in sub-Saharan Africa are required.
Seasonality and Antimicrobial Resistance Pattern of Vibrio Cholerae in a Tertiary Care Hospital of North India
Authors: Mohanty Srujana , Kapil Arti , Das Bimal K
Published: January 2017

We retrospectively analysed the seasonal distribution of cholera and the antimicrobial resistance pattern of Vibrio cholerae isolates over a 5-year period from January 1998 to December 2002. Of 3213 stool specimens processed from 3213 patients with acute watery diarrhoea during this period, 431 samples (13.4%) were found positive for V. cholerae. There were 423 V. cholerae Ol biotype E1Tor, 2 V. cholerae 0139 and six isolates of non-01 non-0139. The highest number of cholera cases occurred in May-June followed by July-August. Cases started appearing in April for all years except in the year 2002 when three cases occurred in the first week of March. A large number (90.25% strains) were resistant to at least one antibiotic.
Essential Drug List in a Rural Hospital
Authors: Lindtjørn Bernt
Published: January 2017

An essential drug list was introduced to Gidole Hospital (Gamu Gofa Region, southwestern Ethiopia) in 1980. This study considers whether the introduction of the essential drug list improved drug prescription. Drug usage by admitted patients was examined retrospectively by drawing samples from two one-year periods (1979 and 1983/84). This study demonstrates that a change in drug prescription occurred: a significant decrease of non-essential and placebo drugs as well as vitamin injection was achieved. Oral rehydration solution (ORS) became the main treatment for diarrhoeal diseases, while other “diarrhoeal drugs” (8-hydroxyquinolines, bismuth opium and sulphaguanidine) were no longer used. Multidrug use was significantly reduced. It is concluded that the introduction of local drug lists creates an increased awareness of rational drug prescription.
The Patient as a Starting Point for Health Education in Leprosy Control
Authors: Awofeso Niyi
Published: January 2017

The current strategy for leprosy control remains the early diagnosis and effective treatment of leprosy patients with multi-drug therapy (MDT), together with the prevention and/or limitation of disabilities.

This paper proposes patients-centred health education strategies that may help in the goal of eliminating leprosy as a public health problem by the year 2000, in leprosy endemic countries like Nigeria.
The Diurnal Variation of Stroke in Ghana
Authors: Roberts M A , Opare-Sem O K , Acheampong J W
Published: January 2017

In 68 patients presenting with stroke in Ghana a significant ( P <0.001) peak in onsets occurred between 0600 h and 1000 h. There were no significant differences in time of onset between men and women or hypertensive and non-hypertensive patients. Reasons for the peak of onsets are discussed. A similar diurnal pattern of stroke has been described in temperate countries: any benefits such as timing of prophylactic measures that ensue from research on stroke in temperate climates are likely to be of benefit if also applied to those at risk of stroke in a tropical climate.
Detection of Helicobacter Pylori in Endoscopic Biopsies in Sudan
Authors: Mirghani Yousra A Azim , Ahmed Salah , Ahmed Mohamed , Ismail Mustafa O , Fedail Sulieman Salih , Kamel Michael , Saidia Haruo
Published: January 2017

We studied the prevalence of Helicobacter pylori in Sudanese subjects with gastroduodenal inflammation. H. pylori was looked for in biopsy specimens taken from the antrum by two methods: rapid urease test [Campylobacter-like organism (CLO) test] and culture using Skirrow's selective supplement. One hundred subjects were studied. H. pylori was found in 80% of patients with gastritis, 56% of patients with duodenal ulcer, 60% of patients with duodenitis and 16% of normal control subjects. It was neither detected in patients with gastric ulcer, nor in patients with oesophagitis or in those with oesophageal varices due to schistosomiasis, when using culture. However, it was found in 50% of patients with oesophagitis, when using CLO test.
Multidrug Resistant Non-Typhoidal Salmonella Infections
Authors: Udgaonkar Usha S , Kulkarni Raghavendra D , Raghavendra D , Kulkarni Vanita A , Dharmadhikari Chandrakant A , Pawar Sushila G , Paricharak Shama D
Published: January 2017

Over a period of 2 years, 28 patients admitted to Government General Hospital (GGH), Sangli (which is attached to Government Medical College (GMC), Miraj) yielded multi-drug resistant non-typhoidal salmonellae from their clinical material. The pediatric age group predominated in the study, accounting for 93% of cases. Salmonella typhimurium was the main isolate (86%), the other being Salmonella newport (14%). Gastroenteritis was the commonest presentation. Septicaemia was seen with 100% mortality, in infants below 1 month of age. Two cases of meningitis were also seen.
Non-Invasive Diagnosis of Tropical Splenomegaly Syndrome
Authors: El-Shazly Mohamed , Okello D O , Kawooya M G
Published: January 2017

A study of 41 clinically diagnosed cases of possible tropical splenomegaly syndrome (TSS) was undertaken in Mulago Hospital, Kampala, Uganda, to determine the appropriateness of liver ultrasonography in confirming a diagnosis of TSS. Definitive diagnosis of TSS was made on liver biopsy in 35 (85%) cases. Abdominal ultrasound showed that 30 of the confirmed cases of TSS had normal liver echo-texture and portal vein diameter, and five had abnormally increased liver echo-texture. The combination of massive splenomegaly and hepatomegaly, together with normal ultrasound features of the liver was highly suggestive of TSS. The sensitivity of this criterion was 86% and the specificity was 83%. This non-invasive approach to the diagnosis of TSS is associated with less hazards than liver biopsy, and a normal echogram could be used to make the diagnosis in over 80% of cases, in the field where histopathology may be lacking.
The Second Twin: Retained and Unretained
Authors: Adinma J I Brian , Agbai Andy O
Published: January 2017

In this comparative review of retained and unretained second twins, the commonest causes of retention of the second twins were found to be uterine inertia (48.4%) and obstruction from malpresentation and malposition (32.3%).

The pair-presentation most likely to be retained was vertex/transverse.

Apgar scores were lower for retained than unretained second twins. The perinatal mortality rate was significantly higher for the retained second twins (258/1000) compared to the unretained second twins (60.2/1000) ( P < 0.002). Early recognition of twin pregnancies in which the 2nd twin is more likely to be retained, and prompt application of appropriate remedial measures would reduce the incidence of retention of the second twin.
Health Problems of Automobile Mechanics in Nigeria
Authors: Omokhodion Folashade O , Osungbade O O
Published: January 2017

A questionnaire-based survey was conducted among automobile mechanics and allied technicians in a semi-urban city. Three hundred people were interviewed. The questionnaire sought information on health problems associated with work, the presence of chronic illness and where workers seek help when they fall ill. The interview was followed by an examination of the hands for dermatitis. Musculoskeletal disorders were the commonest work-related health problems reported by respondents. Of the 50 respondents who recorded musculoskeletal disorders, 27 (54%) had low back pain. Seventy-five (25%) of the respondents had signs of hand dermatitis: commonest among panel beaters and welders.

Hand dermatitis and musculoskeletal disorders are the predominant health problems among automobile mechanics. Recommendations for improved health and safety include health education programmes aimed at eliminating hazardous work practices such as sucking of petrol and poor lifting techniques. This study has shown that workers in small-scale industries are willing to accept assistance and advice on improving the health and safety of their workforce.
A Community-Based Investigation of Maternal Mortality from Obstetric Haemorrhage in Rural Zimbabwe
Authors: Fawcus S , Mbizvo M , Lindmark G , Nyström L ,   Maternal Mortality Study*
Published: January 2017

In the rural province Masvingo in Zimbabwe, 25% of maternal deaths were caused by obstetric haemorrhage, which had a cause specific maternal mortality rate (MMR) of 40 per 100 000 live births. Forty per cent of cases were due to a ruptured uterus, and 30% to an atonic uterus. Forty-two per cent were more than 35 years old and 44% para 5 or more. In spite of antenatal coverage for 85% of the women, 42% died outside any health facility. Fifty per cent of the women had had no intervention whatsoever before death from haemorrhage. The most important factor for prevention at community level is provision of emergency transport, which would have saved 50% of the women. Other non-health service factors contributing to the adverse outcome were found in actions of the patient herself or a traditional birth attendant. In the health services avoidable factors were identified in 58% of women. More effective antenatal attention to high risk factors, especially high age and parity, appropriate use of maternity waiting shelters, action programmes for management and haemorrhage at all levels, basic resources for resuscitation, improved surgical skills with supervision and available transport for referrals are all necessary parts of a programme to prevent maternal deaths from obstetric haemorrhage.
Enucleation for Ritual Practices
Authors: Mpyet Caleb D
Published: January 2017

Five cases of enucleation performed on seeing eyes are presented, highlighting the dangers this procedure poses to the patient. It also presents the problems this can pose to the development of ophthalmology.
The Presidents' Mental Health
Authors: Raj Kirath
Published: January 2017

Calvin Coolidge had a successful run in politics for over twenty years before ultimately becoming president of the United States in 1923. Throughout Coolidge's first term as president, he worked long, hard hours, was active in Congress, and maintained a strong relationship with the media. This changed, however, during the second term of his presidency. Less than a month after his second-term election, Coolidge's son died of blood poisoning. This traumatic event caused the President to enter into a deep depression. In his autobiography, Coolidge admitted that when his son died, the power and glory of the presidency went with him. His grief, which has since been coined pathological grief, had an effect on the President's mind, body and spirit. President Coolidge lost interest in his job and began sleeping fourteen hours a day, ultimately earning a reputation as one of the most ineffectual presidents ever to hold office. His depression rendered him incapable of making decisions, and as a result most of his duties were delegated to members of his Cabinet. Though the White House knew for four years that Coolidge's depression rendered him incompetent, he remained in office until the end of his second term.
The Regulation of MR Neuroimaging Research: Disentangling the Gordian Knot
Authors: Kulynych Jennifer J.
Published: January 2017

In a typical magnetic resonance imaging (“MRI”) study of the brain, subjects are screened for contraindications before being placed in the bore of a large machine, the MRI scanner, which contains a powerful magnet. The scanner produces cross-sectional images of brain tissue as the subjects undergo a series of brief electromagnetic pulses, perceptible only as noise and vibration. If the protocol involves functional MRI (“fMRI”), a popular research technique for obtaining indirect measurements of brain activity, equipment might be used to present stimuli (sounds or pictures) during the scan, but generally the study involves no invasive procedures, no physical discomfort, and no ionizing radiation. Upon completion of the scan, MRI data is transferred to an investigator's computer for further analysis, often in combination with behavioral test results and clinical information obtained from subjects or their medical records.

This procedure sounds benign, and usually is. But an MRI scanner is a powerful medical device, capable of causing serious injury or death if operated carelessly.
Neuroscience-Based Lie Detection: The Urgent Need for Regulation
Authors: Greely Henry T. , Illes Judy
Published: January 2017

“Illustration” or “map” are among the most frequently used words for translating the Chinese character tu, a graphic representation of any phenomenon that can be pictured in life and society, whether in traditional China or elsewhere. Investigations of the early role of tu in Chinese culture first set out to answer questions about who produced tu, the background of its originator, and the originator's purpose. How were pictures conceptualized? Interpreted? In examining tu, Chinese scholars stressed the relational aspect of tu and shu (writing) to answer both these questions, as well as to the importance of not robbing an image of its overall beauty and life with too much graphic detail. In the West, specific concepts of technical or scientific illustrations did not exist before the Renaissance. With the coming of that age, technical illustration became a specific branch of knowledge and activity, with its own specific goals and ends.
Pain Detection and the Privacy of Subjective Experience
Authors: Kolber Adam J.
Published: January 2017

A neurologist with abdominal pain goes to see a gastroenterologist for treatment. The gastroenterologist asks the neurologist where it hurts. The neurologist replies, “In myhead, of course.” Indeed, while we can feel pain throughout much of our bodies, pain signals undergo most of their processing in the brain. Using neuroimaging techniques like functional magnetic resonance imaging (“fMRI”) and positron emission tomography (“PET”), researchers have more precisely identified brain regions that enable us to experience physical pain. Certain regions of the brain's cortex, for example, increase in activation when subjects are exposed to painful stimuli. Furthermore, the amount of activation increases with the intensity of the painful stimulus. These findings suggest that we may be able to gain insight into the amount of pain a particular person is experiencing by non-invasively imaging his brain.

Such insight could be particularly valuable in the courtroom where we often have no definitive medical evidence to prove or disprove claims about the existence and extent of pain symptoms.
Translating Rights into Access: Language Access and the Affordable Care Act
Authors: Teitelbaum Joel , Cartwright-Smith Lara , Rosenbaum Sara
Published: January 2017

More than twenty-four million people in the United States are considered limited English proficient (LEP), and numerous studies have documented the consequences of communication barriers in healthcare. These consequences include: patients’ inability to become engaged and involved in their care; the absence of crucial information—including cultural information—essential to healthcare quality; risks to patient safety arising from the misunderstanding of physician instructions; and ethical and legal lapses stemming from the absence of informed consent. Addressing healthcare rights necessarily entails coming to grips with how to facilitate communication and the exchange of information between the healthcare system and an increasingly diverse patient population.

The history of language access services in healthcare is grounded in two distinct bodies of law: the law of informed consent and civil rights law. Modern notions of informed consent law—which have their roots in the Nuremberg trials of the late 1940s—would recognize a cause of action in tort where a lack of adequate communication creates a barrier to an LEP patient's ability to consent to care. In modern healthcare law, the ability of patients to affirmatively give informed consent to treatment is considered a fundamental element of healthcare quality.
If We Can Force People to Purchase Health Insurance, Then Let's Force Them to Be Treated Too
Authors: Kapp Marshall B.
Published: January 2017

Proponents of the 2010 Patient Protection and Affordable Care Act (PPACA) justify the Act's mandate that uninsured individuals either purchase a minimally defined health insurance policy (“Maintain Minimum Essential Coverage”) or pay a fine, as a necessary and proper exercise of Congress's express constitutional power to regulate interstate and foreign commerce. The United States Supreme Court will decide the correctness of that highly debatable position during its spring 2012 session.

Assuming, without by any means predicting, that the validity of all parts of the PPACA—including the individual insurance mandate—is upheld, the Court's (likely multiple) opinions will constitute a major development in the evolution of American constitutional jurisprudence, even if Congress subsequently repeals specific sections of the legislation. Several commentators have expressed concern about the ramifications of a judicially validated PPACA for attempts by the government, especially through the mechanism of Comparative Effectiveness Research (CER), to limit or ration particular forms of potentially beneficial medical care for some or all patients.
What is the Meaning of Health? Constitutional Implications of Defining “Medical Necessity” and “Essential Health Benefits” under the Affordable Care Act
Authors: Hill B. Jessie
Published: January 2017

When the government decides to assume a major role in providing and paying for healthcare, the government also has to decide exactly what constitutes appropriate, reasonable, or essential healthcare under its program. Congress, of course, recognized this necessity when it passed the Patient Protection and Affordable Care Act (ACA), and the statute itself provides authority to the Secretary of Health and Human Services (HHS) to determine the “essential health benefits” that must be covered under the ACA beginning in 2014, both by insurers offering plans within governmentally sponsored exchanges and on the individual and smallemployer markets outside the exchanges. In a decision that was hailed as both “politically astute” and problematic for the goals that the ACA itself was supposed to accomplish, HHS shunted off the task of defining the term “essential health benefits” to the individual states.
Is Follow up of Patients after Surgery for Breast Cancer Worthwhile?
Authors: Ormiston M C , Timoney A G , Qureshi A R
Published: January 2017

The effectiveness of routine outpatient follow up in detecting recurrent disease after ‘curative’ surgery for breast cancer has been evaluated in a retrospective study of 148 patients. In all, 32 patients developed recurrent cancer. In 3 cases, asymptomatic disease was discovered by routine X-rays. In 25 cases, the patient noticed local disease or complained of symptoms due to distant spread, and over half of these returned to the clinic before the next routine appointment. In only 4 cases was routine examination by a doctor solely responsible for the discovery of recurrent disease. It is concluded that routine follow up made little contribution to the welfare of these patients.
DSM-III: Problems in Diagnosing Partial Forms of Multiple Personality Disorder: Discussion Paper
Authors: Ross Colin A
Published: January 2017

Of all the defence mechanisms, only one — Dissociation — is treated as a separate diagnostic category in the third edition of the ‘Diagnostic and Statistical Manual of Mental Disorders’ (DSM-III) (American Psychiatric Association 1980). Delusional marital jealousy, for instance, could be classified as one of the projective disorders, but this is not done. A group of disorders based on dissociation should be easily defined and organized, in comparison with the relatively bewildering array of psychotic disturbances. Yet DSM-III does not provide a conceptually coherent set of dissociative diagnoses.

This problem in DSM-III is best illustrated by partial forms of multiple personality disorder (MPD) which at present receive the unsatisfactory diagnosis of atypical dissociative disorder. First, the organization of other sections of DSM-III will be discussed.
Bias and Fraud in Medical Research: A Review
Authors: Pollock A V , Evans Mary
Published: January 2017

‘If a man will begin with certainties, he shall end in doubts; but if he will be content to begin with doubts, he shall end in certainties' (Bacon 1605). Four centuries later, one of the greatest of contemporary philosophers — Sir Karl Popper — has consistently maintained that knowledge advances by refutation of false doctrines and not by verification of true ones (which, indeed, can never be completely verified). ‘Error is unavoidable; it can be rational, and when responsibly made and honestly reported, is not even culpable’ (Laor 1985).

The desire to verify an hypothesis rather than to seek to refute it can be responsible for the suppression of deviant data. There is a fine distinction between bias, which may afflict honest investigators, and fraud, which is always dishonest. Even a true statement can be tainted by bias, and Ronald Fisher concluded that Mendel's published figures on the genetics of peas were so close to the expected ratio of 3:1 that it would have taken ‘an absolute miracle of chance’ to produce them (Hamblin 1981).
Familial Association between Coeliac Disease and Ulcerative Colitis: Preliminary Communication
Authors: Mayberry J F , Smart H L , Toghill P J
Published: January 2017

One hundred and twenty patients who were members of the Nottinghamshire Coeliac Group completed a questionnaire about the occurrence of coeliac disease, ulcerative colitis and Crohn's disease amongst first-degree relatives. Siblings were at a 20-fold risk of developing coeliac disease and a 15-fold risk of developing ulcerative colitis, and significantly increased risks for these two conditions were also seen in other family members. The relatives of patients with coeliac disease are at increased risk not only of developing coeliac disease but also ulcerative colitis. This provides further support for a possible role of a dietary allergen in the development of ulcerative colitis.
Asthma Education: More Reading or More Viewing?
Authors: Partridge M R
Published: January 2017

An audit of a hospital asthma clinic has revealed deficiencies in its educational activities. A significant minority of attending patients failed to understand the rationale behind their therapy and would take potentially inappropriate action when symptoms worsen. Many of those taking oral theophylline therapy were shown to be at risk of self-induced toxicity. Watching a videotape about the disease in the waiting room was found to be more popular than leaflets and books as a source of information.
Employment after Myocardial Infarction Amongst Previously Healthy Men
Authors: Watson P A , Mayberry J F , Calcraft B , Colbourne G
Published: January 2017

A postal questionnaire was sent to 55 men 18 months after their first myocardial infarction; information obtained was supplemented by interview with two of the authors (PW and GC). Fifty-three men had been in full-time employment prior to their illness, 38 of them in manual work. Their return to work and changes in employment were examined and, in addition, enquiries were made about subsequent health, assistance from trade unions and the local Disabled Resettlement Officer (DRO). Details of attitude to subsequent physical exercise and sexual activity were also recorded.

Eighteen months after myocardial infarction, only 35% of these men were employed and 27% asymptomatic. Patients in heavy manual work were largely unable to return to their previous job and little assistance was obtained from trade unions. Even when patients were made aware of the existence of the DRO, few approached him for advice.

A counselling service is needed for patients recovering from an infarct to encourage them to return to an active and profitable life.
Postoperative Gastric Aspirations Reduced by Glycopyrrolate during Upper Abdominal Surgery
Authors: Fry E N S
Published: January 2017

Summary

Glycopyrrolate is shown to reduce the incidence of large volumes (more than 40 ml) of postoperative gastric contents, but not the pH, after major abdominal operations and reduce the consequent risk of regurgitation. It should be preferred to atropine during these procedures.
Conservative Outpatient Management of Ingrowing Toenails
Authors: Senapati Asha
Published: January 2017

Twenty-five patients with ingrowing toenails were treated conservatively by inserting cotton wool under the ingrowing nail edge. Seventy-nine percent were relieved of their symptoms after follow up for a mean of 23.7 weeks. Thirty-six percent had a history of previous surgery to the nail, 75% of whom had a good or excellent result.

Although conservative management was first described in the eighteenth century and has been reported sporadically since, only a few doctors treat their patients in this way. There is, however, a distinct place for this highly effective, low cost method as the initial treatment of these patients without the need for hospital referral.
Teaching Students of Medicine to Listen: The Missed Diagnosis from a Hidden Agenda
Authors: Menahem Samuel
Published: January 2017

This paper describes the ability of 4 senior students to recognize and deal therapeutically with the hidden agenda of patients — the covert concerns or second diagnosis other than the presenting problem. This naturalistic study was hospital-based and used ambulatory patients with common paediatric problems. The patient encounter was videotaped and subsequently analysed to determine the patient's hidden agenda. The findings indicated that the students had some difficulty in correctly diagnosing the patient's presenting problem or primary diagnosis. They also failed to recognize and deal with their patients’/parents' hidden agendas. The relevance of these findings to patients care is discussed.
Adaptive stabilization of high-order time-delay nonlinear systems with unknown state-dependent growth rates
Authors: Gao Fangzheng , Wu Yuqiang
Published: January 2017

This paper investigates the problem of adaptive stabilization by state feedback for a class of high-order nonlinear systems with time-varying delays. Compared with the existing relevant literature, a distinguishing feature of the systems under investigation is that the growth rates are unknown functions of system states. This renders the existing control methods inapplicable to the control problems of the systems. By skillfully using the method of adding a power integrator, an adaptive state-feedback controller independent of the time delay is explicitly constructed with the help of appropriate Lyapunov–Krasovskii functionals. It is proved that the states of the time-delay nonlinear systems can be regulated to the origin, while all the closed loop signals are globally uniformly bounded. Finally, both physical and academic examples are provided to illustrate the effectiveness of the proposed scheme.
Backstepping-based model reference adaptive controller for a multi-axial system in the presence of external disturbance and saturated input
Authors: Duong Van Tu , Nguyen Huy Hung , Jeong Jae Hoon , Kim Hak Kyeong , Kim Sang Bong
Published: January 2017

This paper presents a backstepping-based model reference adaptive controller for a multi-axial system in the presence of external disturbance and saturated input. The proposed controller synthesizes the backstepping technique and the model reference adaptive control method to construct control inputs for recursive structure and uncertain modelling of the multi-axial system. To cope with the limit of saturated input, an auxiliary system is adopted. A dead-zone modification is introduced to avoid the drift phenomenon of adjusted adaptive parameters. The stability of the proposed controller is proven by Lyapunov’s theory while considering the effect of the auxiliary system and the dead-zone modification in the design stage. The effectiveness and performance of the proposed controller are evaluated by experiment on a transformer winding system.
How does school climate impact academic achievement? An examination of social identity processes
Authors: Reynolds Katherine J. , Lee Eunro , Turner Isobel , Bromhead David , Subasic Emina
Published: January 2017

In explaining academic achievement, school climate and social belonging (connectedness, identification) emerge as important variables. However, both constructs are rarely explored in one model. In the current study, a social psychological framework based on the social identity perspective (Turner, Hogg, Oakes, Reicher, & Wetherell, 1987) is introduced that provides a way to integrate these two areas of enquiry. Using this framework, the current study ( N = 340 grade 7 and 9 students) investigates: (a) school climate and social identification as distinct predictors of academic achievement; and (b) social identification as a mediator of the school climate and achievement relationship. Achievement in reading, numeracy and writing was assessed by a national standardized test. The three variables most significantly associated with achievement were parental education, socio-economic status, and school identification. In line with predictions, school identification fully mediated the relationship between school climate and academic achievement in numeracy and writing, but not reading. The research highlights the importance of feeling psychologically connected to the school as a group for academic success.
Progress in Bolivia: Declining the United States Influence and the Victories of Evo Morales
Authors: Pineo Ronn
Published: January 2017

This article provides an assessment of economic and social progress in Bolivia under Evo Morales. An examination of the leading factors that explain Bolivia’s turn to the left is offered, focusing on how the US policies and actions contributed to the collapse of the old regime. The social and economic policy directions since Morales assumed office is presented, followed by a discussion of the process of creating a Bolivian understanding of democracy, one that is deeper and richer than the nation has experienced heretofore.
Debating Alternative Development at the Mining Frontier: Buen Vivir and the Conflict around El Mirador Mine in Ecuador
Authors: van Teijlingen Karolien , Hogenboom Barbara
Published: January 2017

In Ecuador, the recent introduction of mineral mining led to a conflictive debate on mining and development, particularly the concept of Buen Vivir (good living). This article examines the discourses on the mining–development nexus articulated in the conflict around the first large-scale mine of Ecuador, El Mirador. The findings indicate that although the conflict concerns tangible territorial transformations, it is also a struggle over meanings. In this struggle, Buen Vivir has become subject to strategic framing processes and eventually turned into an empty signifier. The case of El Mirador illustrates the challenges of advancing Buen Vivir from concept to practice in the context of a search for a post-neoliberal development framework.
Impacts of Climate Change in the Andean Foothills of Chile: Economic and Cultural Vulnerability of Indigenous Mapuche Livelihoods
Authors: Parraguez-Vergara Elvis , Barton Jonathan R. , Raposo-Quintana Gabriela
Published: January 2017

The Mapuche communities have the highest levels of vulnerability in Chile in terms of income, basic needs, and access to services. Nevertheless, those living in the Andean foothills have historically been exposed to extreme weather. Examining three Andean municipalities of the Araucanía Region from 1990 to 2015, including climate data, interviews with mayors, and adaptation responses of the Chilean state, the article provides evidence of a changing climate and increased vulnerability. The results show trends in scarcity of water, reduction of agricultural production, colonization of plants and population shifts to higher altitudes, increase pressure on Andean ecosystems, and displacement of traditional Mapuche knowledge and practices. Based on these findings, the authors argue it is necessary to change the context in which Mapuche communities develop their livelihoods. This involves strengthening the knowledge of local actors in order to increase their resilience, with adaptation initiatives that emerge from the local context. It also requires enhanced capacity for municipal emergencies and suitable adaptations in road infrastructure, housing, communications, and agricultural planning. At the national level, this also requires recognition of the specific vulnerabilities of indigenous people.
Effect of a National Community Intervention Programme on Healing Rates of Chronic Leg Ulcer: Randomised Controlled Trial
Authors:   Scottish Leg Ulcer Trial Participants
Published: January 2017

Background and Objective:

Chronic leg ulcer is a common cause of serious disability in the elderly. Healing rates of chronic leg ulcers of 50–75% at 3–6 months have been reported from clinical trials in which specialist nurses delivered the care. But most patients in the population are managed by community nurses in the home, where the results are largely unknown. The aims of this trial were to audit healing rates and to evaluate the effect of a national community-based intervention programme of nurse training.

Design:

Fifteen Community Healthcare Trusts and one Healthcare Division in 10 Health Board Areas in Scotland comprising a population of 2.65 million took part in a cluster randomised controlled trial in which geographically and administratively distinct localities averaging 53 000 population were randomised, at the time of dissemination of Scottish Intercollegiate (SIGN) guidelines, to a programme of nurse training (intervention) or no training (control). Data were provided by 649 district nurse Case Load Managers (CLMs) via 10 3-monthly censuses (6 months baseline, 21 months post-randomisation). SIGN guidelines were disseminated nationally and in the intervention areas an intensive training course in leg ulcer care and teaching methods was provided for 51 link nurses who cascaded training to community nurses, supported by regional workshops run by the project team. Training was evaluated at each stage.

Findings:

A total of 4984 ulcerated legs in 3949 patients were registered: 991 (25%) males and 2958 (75%) females, mean age 77 years. Response rates from CLMs were 99.4% at the first census and 100% for all subsequent censuses. Outcome data were obtained for 98.9% of all ulcerated legs entered into the study. Care was provided by 1700 community nurses, each of whom saw an average of 1.5 leg ulcer patients annually. There were 489 deaths and 65 amputations with identical rates between the two groups. The 3-month healing rate was 28% in the intervention and control groups at baseline and did not change in either during the following 2 years. The more chronic the ulcer the lower the healing rate.

Interpretation:

The 3-month healing rate of less than 30% throughout more than 2 years of study, together with the lack of any evidence of improvement following an intensive guideline-based community intervention programme, indicate that a radical reappraisal is required of how care for patients with chronic leg ulcer should be delivered.
A case-control study of risk factors of chronic venous ulceration in patients with varicose veins
Authors: Abelyan Gohar , Abrahamyan Lusine , Yenokyan Gayane
Published: January 2017

Background/objectives

Venous ulcers carry psychological and high financial burden for patients, causing depression, pain, and limitation of mobility. The study aimed to identify factors associated with an increased risk of venous ulceration in patients with varicose veins in Armenia.

Methods

A case-control study design was utilized enrolling 80 patients in each group, who underwent varicose treatment surgery in two specialized surgical centers in Armenia during 2013–2014 years. Cases were patients with varicose veins and venous leg ulcers. Controls included patients with varicose veins but without venous leg ulcers. Data were collected using interviewer-administered telephone interviews and medical record abstraction. Multiple logistic regression analysis was used to identify the risk factors of venous ulceration.

Results

There were more females than males in both groups (72.5% of cases and 85.0 % of controls). Cases were on average older than controls (53.9 vs. 39.2 years old, p ≤ 0.001). After adjusting for potential confounders, the estimated odds of developing venous ulcer was higher in patients with history of post thrombotic syndrome (odds ratio = 14.90; 95% confidence interval: 3.95–56.19; p = 0.001), with higher average sitting time (odds ratio = 1.32 per hour of sitting time; 95% confidence interval: 1.08–1.61; p = 0.006), those with reflux in deep veins (odds ratio = 3.58; 95% confidence interval: 1.23–10.31; p = 0.019) and history of leg injury (odds ratio = 3.12; 95% confidence interval: 1.18–8.23; p = 0.022). Regular exercise in form of walking (≥5 days per week) was found to be a protective factor from venous ulceration (odds ratio = 0.26; 95% confidence interval: 0.08–0.90; p = 0.034).

Conclusion

We found that reflux in deep veins, history of leg injury, history of post thrombotic syndrome, and physical inactivity were significant risk factors for venous ulceration in patients with varicose veins, while regular physical exercise mitigated that risk. Future studies should investigate the relationships between the duration and type of regular exercise and the risk of venous ulceration to make more specific recommendations on preventing ulcer development.
Is it Necessary to Strip the Long Saphenous Vein?
Authors: Woodyer Anthony B. , Dormandy John A.
Published: January 2017

Two hundred patients with primary, untreated varicose veins were randomly allocated to have their long saphenous veins stripped or to undergo high saphenous ligation alone. The patients were regularly reviewed and, at 3 years follow up, there was no significant difference in the results obtained from the two groups of patients.
Further Studies on Microdose Intravenous Heparin in the Prevention of Postoperative Deep Vein Thrombosis
Authors: Negus D. , Friedgood A.
Published: January 2017

Following in-vitro observations of heparin activity, which demonstrated that sodium heparin was stable in 0.9% saline but not in dextrose solutions, a clinical trial was undertaken to assess the effectiveness of i.v. microdose (I u/kg/h) heparin in preventing postoperative deep vein thrombosis and to find out whether subsequent s.c. low-dose (5000 u/12 hourly) offered additional prophylaxis. Eighty-six patients undergoing major surgical operation received i.v. microdose heparin for mean 4.1 days. Patients were then randomly allocated to one of two groups. Forty received s.c. heparin (5000u/12 hourly) when i.v. fluids were discontinued for an additional mean 4.3 days and 46 received no further prophylaxis. Deep vein thrombosis was detected by 125I-fibrinogen uptake in five patients, with no significant difference between the two groups.
Considerations of the Anatomical Variations in the Venous System of the Lower Limbs in Varicose Disease
Authors: Corcos L. , Peruzzi G.P. , Romeo V. , Fiori C.
Published: January 2017

The Authors experience in the surgical treatment of varicose veins of the lower limbs in the last 15 years, performed on 1500 cases, show that varicose recurrence may be nearly always attributed to unrecognised anatomical variations in the venous system. Methods of preoperative and intraoperative diagnosis are described and the most frequent variants observed are presented and their significance are discussed.
Structure and Use of the External Phlebo-Extractor
Authors: Peruzzi G. , Corcos L. , Romeo V.
Published: January 2017

An external phlebo-extractor for removing varicose veins through short incisions is described.
How Important are Incompetent Thigh Perforating Veins? A Review of Three Papers and Comment
Authors: Corbett C. R. R.
Published: January 2017

Everyone has heard about incompetence of thigh perforating veins. General practitioners in referral letters often suggest them to the surgeon. Yet they are difficult to diagnose and treat. Thigh perforator incompetence is seldom the only site of incompetence in the affected limb and the relative importance of each site can only be surmised. Even after treatment the surgeon may be uncertain if this source of incompetence has been successfully ablated and uncertain if the result will be durable.

Three papers on this topic are reviewed which answer some of the important questions about the frequency of the problem and the sites of thigh perforators.
Venous Claudication Evaluated by Ambulatory Plethysmography
Authors: Baumgartner Iris , Franzeck U. K. , Bollinger A.
Published: January 2017

Objective:

To determine whether dynamic plethysmography during treadmill exercise allows objective confirmation of venous claudication.

Design:

Prospective investigation of the use of calf volume changes during treadmill work using dynamic strain-gauge plethysmography.

Setting:

University Hospital, Zürich, Switzerland.

Patients:

Eighteen patients with suspected venous claudication who had occlusions or stenoses in the femoral or iliac veins shown on phlebography and/or Duplex scanning, compared to a group of 20 healthy volunteers.

Interventions:

Venous occlusion strain-gauge plethysmography was carried out, followed by continuous volume recording while on a treadmill set at 10° and velocity of 7 km/hr for 3 minutes or until pain forced the subject to stop.

Main outcome measure:

Calf volume changes during exercise.

Results:

Significant differences were observed in calf volume changes during exercise in the group of patients with venous stenoses or occlusions and symptomatic venous claudication.

Conclusion:

Dynamic plethysmography during treadmill exercise allows objective confirmation of venous claudication.