bluuebunny/crossref_metadata_2025 huggingface dataset:
A Multiple-Model Convection-Permitting Ensemble Examination of the Probabilistic Prediction of Tropical Cyclones: Hurricanes Sandy (2012) and Edouard (2014)
Authors: Melhauser Christopher , Zhang Fuqing , Weng Yonghui , Jin Yi , Jin Hao , Zhao Qingyun
Published: January 2017

This study examines a multimodel comparison of regional-scale convection-permitting ensembles including both physics and initial condition uncertainties for the probabilistic prediction of Hurricanes Sandy (2012) and Edouard (2014). The model cores examined include COAMPS-TC, HWRF, and WRF-ARW. Two stochastic physics schemes were also applied using the WRF-ARW model. Each ensemble was initialized with the same initial condition uncertainties represented by the analysis perturbations from a WRF-ARW-based real-time cycling ensemble Kalman filter. It is found that single-core ensembles were capable of producing similar ensemble statistics for track and intensity for the first 36–48 h of model integration, with biases in the ensemble mean evident at longer forecast lead times along with increased variability in spread. The ensemble spread of a multicore ensemble with members sampled from single-core ensembles was generally as large or larger than any constituent model, especially at longer lead times. Systematically varying the physic parameterizations in the WRF-ARW ensemble can alter both the forecast ensemble mean and spread to resemble the ensemble performance using a different forecast model. Compared to the control WRF-ARW experiment, the application of the stochastic kinetic energy backscattering scheme had minimal impact on the ensemble spread of track and intensity for both cases, while the use of stochastic perturbed physics tendencies increased the ensemble spread in track for Sandy and in intensity for both cases. This case study suggests that it is important to include model physics uncertainties for probabilistic TC prediction. A single-core multiphysics ensemble can capture the ensemble mean and spread forecasted by a multicore ensemble for the presented case studies.
Impact of Statin Therapy on Plasma MMP-3, MMP-9, and TIMP-1 Concentrations: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials
Authors: Ferretti Gianna , Bacchetti Tiziana , Banach Maciej , Simental-Mendía Luis E. , Sahebkar Amirhossein
Published: January 2017

Tissue inhibitors of metalloproteinases (TIMPs) and matrix metalloproteinases (MMPs) are associated with the development of atherosclerosis and cardiovascular disease. Statin therapy has been shown to modulate MMPs and TIMP-1 levels, but clinical findings have not been conclusive. This study aimed to systematically review the clinical findings on the impact of statin therapy on plasma MMP-9, MMP-3, and TIMP-1 levels and calculate an effect size for the mentioned effect through a meta-analysis of available data. A total of 10 eligible studies with 11 treatment arms were included in the meta-analysis. Statin therapy had no significant effect on plasma MMP-9 (standardized mean difference [SMD]: −0.23, 95% confidence interval [CI]: −0.69 to 0.24, P = .345) nor MMP-3 concentrations (SMD: −0.004, 95% CI: −0.60 to 0.59, P = .990). However, meta-analysis demonstrated that statin therapy significantly decreases plasma TIMP-1 levels (SMD: −0.30, 95% CI: −0.56 to −0.03, P = .029). Random-effects meta-regression indicated that neither treatment duration nor changes in low-density lipoprotein cholesterol levels are associated with changes in plasma MMP-9 levels following statin therapy. The results of the present meta-analysis suggested a significant reduction in plasma concentrations of TIMP-1, but not MMP-9 and MMP-3, following statin therapy.
The Prevalence of Lipoprotein(a) Measurement and Degree of Elevation Among 2710 Patients With Calcific Aortic Valve Stenosis in an Academic Echocardiography Laboratory Setting
Authors: Wilkinson Michael J. , Ma Gary S. , Yeang Calvin , Ang Lawrence , Strachan Monet , DeMaria Anthony N. , Tsimikas Sotirios , Cotter Bruno
Published: January 2017

Lipoprotein(a; Lp[a]) and its associated oxidized phospholipids are causal, genetic risk factors for calcific aortic valve stenosis (CAVS). We determined the prevalence of Lp(a) measurement among 2710 patients with CAVS and 1369 control patients (∼50% of study group) without CAVS with an echocardiogram between January 2010 and February 2016 in an academic echocardiography laboratory. Lipoprotein(a) measurements were performed at a referral laboratory using an isoform-independent assay. The prevalence of any Lp(a) measurement was 4.6% (124 of the 2710) in patients with CAVS and 3.1% (42 of the 1369) in the control group ( P = .021). In patients with CAVS, mean (standard deviation) Lp(a) levels were 38 (54) mg/dL and median (interquartile range) Lp(a) levels were 14 (6-48) mg/dL. Of the 124 patients with CAVS having Lp(a) measurements, 83 (66.9%) had Lp(a) <30 mg/dL and 41 (33.1%) had Lp(a) ≥30 mg/dL. This study reflects low physician testing of Lp(a) levels in CAVS. Given the role of Lp(a) as a causal risk factor for CAVS, and the ongoing development of therapies to normalize Lp(a) levels, our results suggest that Lp(a) measurements in CAVS should be more widely obtained in clinical practice.
Measuring cortisol in serum, urine and saliva – are our assays good enough?
Authors: El-Farhan Nadia , Rees D Aled , Evans Carol
Published: January 2017

Cortisol is a steroid hormone produced in response to stress. It is essential for maintaining health and wellbeing and leads to significant morbidity when deficient or present in excess. It is lipophilic and is transported bound to cortisol-binding globulin (CBG) and albumin; a small fraction (∼10%) of total serum cortisol is unbound and biologically active. Serum cortisol assays measure total cortisol and their results can be misleading in patients with altered serum protein concentrations. Automated immunoassays are used to measure cortisol but lack specificity and show significant inter-assay differences. Liquid chromatography – tandem mass spectrometry (LC-MS/MS) offers improved specificity and sensitivity; however, cortisol cut-offs used in the short Synacthen and Dexamethasone suppression tests are yet to be validated for these assays. Urine free cortisol is used to screen for Cushing’s syndrome. Unbound cortisol is excreted unchanged in the urine and 24-h urine free cortisol correlates well with mean serum-free cortisol in conditions of cortisol excess. Urine free cortisol is measured predominantly by immunoassay or LC-MS/MS. Salivary cortisol also reflects changes in unbound serum cortisol and offers a reliable alternative to measuring free cortisol in serum. LC-MS/MS is the method of choice for measuring salivary cortisol; however, its use is limited by the lack of a single, validated reference range and poorly standardized assays. This review examines the methods available for measuring cortisol in serum, urine and saliva, explores cortisol in disease and considers the difficulties of measuring cortisol in acutely unwell patients and in neonates.
Artefactual 25-OH vitamin D concentration in multiple myeloma
Authors: Ong Michal WS , Salota Rashim , Reeman Tracy , Lapsley Marta , Jones Lydia
Published: January 2017

The most commonly used techniques to measure vitamin D are automated immunoassays which are known to be affected by interferences, especially from immunoglobulins present in the patient’s serum. We present a case of a patient with myeloma in whom interference with the vitamin D assay was identified. An 83-year-old female, known to have IgG myeloma, was found to have a high concentration of 25-OH vitamin D on a routine test without any signs of vitamin D toxicity. She was not taking vitamin D supplements or any other multivitamin preparation and had minimal sun exposure. The initial and subsequent samples run by the ARCHITECT 25-OH vitamin D assay (chemiluminescent microparticle immunoassay technology, Abbott Laboratories, Abbott Park, IL) showed a high concentration of 25-OH vitamin D of 281 nmol/L and 327 nmol/L, respectively. Further fresh samples taken for 25-OH vitamin D and analysed by liquid chromatography-mass spectrometry (LC-MS/MS) and ARCHITECT analysis showed results of 49 nmol/L and 289 nmol/L, respectively. Our patient had high concentrations of circulating IgG paraproteins and had a long history of rheumatoid arthritis; paraproteins and rheumatoid factor may interfere in the assay. In conclusion, we report a case of a patient with IgG myeloma and rheumatoid arthritis with high concentrations of 25-OH vitamin D detected by the Abbott ARCHITECT, but not by a reference method (LC-MS/MS). The most likely cause of the discordant results is interference in the immunoassay by the paraprotein but interference from rheumatoid factor remains a possibility.
The Cornish experience of the ASSIST-CKD project
Authors: Barton Anna L , Mallard Angela S , Patterson Anthea , Thomas Nicola , Dickinson Stephen , Gallagher Hugh
Published: January 2017

Introduction

The ASSIST-CKD project is a national quality improvement programme, aiming to decrease the number of patients presenting late to renal services by enabling laboratories to review up to five years of estimated glomerular filtration rate results graphically and report deteriorating patients to their general practitioner.

Aim

To assess the impact of the project on the laboratory, and of patient reporting on general practitioner management and the local renal service.

Method

Each week two searches were performed (Search A: maximum age 65 years, maximum eGFR 50 ml/min/1.73 m2 and Search B: Age 66–120 years, maximum eGFR 40 ml/min/1.73 m2) on patients with an estimated glomerular filtration rate requested by their general practitioner within the previous seven days. Patients showing deterioration in estimated glomerular filtration rate had a printed graph sent to their general practitioner. Feedback on the graphs and their impact on patient management were obtained from the general practitioners via a questionnaire.

Results

A median of 37 patients/week were listed for review for Search A, with 32% reported; and Search B a median of 227 patients/week listed, 32% reported. General practitioner surgery questionnaires (29) showed the reports were well received. Of general practitioners responding to the questionnaire, 67% had reviewed a patient earlier than intended, 54% had reviewed local guidance, 48% had emailed the renal team and 48% had referred a patient on receipt of a graph; 34% had shown a graph to their patients, of whom 70% found that useful.

Conclusion

There is some evidence that ASSIST-CKD reporting has enhanced patient care; however, further long-term assessment is still required.
The Problem of Multidimensionality in Course Scores and Course Choices in the Production of a Single Year 12 Tertiary Entrance Score
Authors: Cooksey Ray W.
Published: January 2017

The present study considers the problem of multidimensionality in Tertiary Entrance (TE) scores where a single TE score is the desired goal. Using data from the 1988 cohort of the ACT college system, course scores as assessed by teachers were shown to distinguish performance in a four-dimensional space. TE scores, computed using both a modified multiple regression strategy and the Daley's (1989) Other Course Score scaling method, were shown to be related to, at best, two of the four dimensions. A second phase of the study revealed the presence of multidimensionality in the choices of courses that students made when assembling their college curricula. These dimensions of course choice were subsequently related back to the demographic characteristics of the students and to the two types of TE scores. Conclusions were drawn regarding the dubious validity of assuming that a single TE score carries all the information needed to summarise the performance of secondary school students.
Being Productive, Being Clever: The Enchanted Forest of Intellectual Property
Authors: Stockley David
Published: January 2017

Government rhetoric and policies exhort Australian universities to be ‘productive’ and to build a ‘clever country’. Academic award restructuring is an important element in this re-shaping of Australian higher education, although the increasingly fashionable term ‘intellectual property’ enters higher education discourse and re-defines academic labour and the ways in which academics perceive themselves and their roles. It is argued that the term intellectual property carries within it a range of meanings extending beyond the legal world of patent and copyright and that this privatising and capitalising discourse has the capacity to transform universities. The individualising and formalising of academic labour goes against the tradition of university collegiality and, crucially, contradicts the processes by which ideas and skills are constituted within a university. Inappropriate intellectual property discourse has the potential to devalue university work by positing a model drawn from the world of the managerialists within the bureaucracy and private sector.
Patricia Arredondo
Authors: Delgado-Romero Edward A. , Romero-Shih Angela I.
Published: January 2017

Patricia Arredondo has influenced the development and refinement of cultural competency in psychology. She is thrice a fellow of the American Psychological Association (APA), has been named a Living Legend by the American Counseling Association (ACA), and has provided transformative leadership to many organizations including the Society of Counseling Psychology of APA, the Society for the Psychological Study of Culture, Ethnicity and Race of APA, the ACA, and the National Latina/o Psychological Association. Her work on cultural competency and empowerment has helped usher in an era where social justice is a main focus of counseling and counseling psychology. During this charla (interview) Patricia shares how she created her own career path.
The Relative Effects of Multiple Factors on Target Acquisition
Authors: GROSSMAN JEFFREY D. , WHITEHURST HUGH O.
Published: January 2017

Two laboratory experiments were conducted to assess the usefulness of visual acuity as a personnel selection criterion. In the first experiment a screening technique (fractional factorial) was employed to determine the relative effects of eleven factors on target acquisition performance. The factors and first-order interactions were ranked by the percent of the variance in the data for which each accounted. Slant range, far visual acuity, masking, and target type were among the highest ranked factors. Search times and detection probabilities were measured in the second experiment as far visual acuity, slant range to the target, masking, and observer experience were varied in a full factorial design. Masking accounted for most of the variation in the data followed by slant range and visual acuity.
Is There Ageism in Oncology?
Authors: Austin D. , Russell E. M.
Published: January 2017

Objective: To use routine data to explore age-related decision making in the hospital management of colorectal cancer. Design: Retrospective analysis of linked Scottish cancer registry and hospital discharge data for colorectal cancer. Setting: All Scottish general hospitals. Participants: All patients on the Scottish colorectal cancer registry 1992–6 (n=15.299). Main Results: Histological verification was used to indicate the “gold standard” of investigation. Definitive surgery and chemotherapy were used as indicators of treatment received. After adjusting for demographic factors, tumour sub-site, co-morbidity and route of first admission, increasing age was associated with markedly decreased rates of histological verification, surgery and chemotherapy. It is still not possible to be sure whether there is ageism in the management of older patients with colorectal cancer. However, the rate of histological verification fell markedly with increasing age, making it questionable whether decisions to treat were based on best clinical practice at the time. Differences observed between this study and clinical trial data may represent the margin of ageism between everyday clinical practice and controlled conditions. Conclusions: The value of this analysis lies in the fact that the data come from routine clinical practice rather than special studies. The improved content of Scottish cancer register and the ability to link it to hospital care provides a useful baseline for monitoring adherence to clinical guidelines.
A Case Report of Acute Gastric Volvulus with Avulsion of the Splenic Vessels
Authors: Cairns D A , Hulme-Moir M
Published: January 2017

Gastric volvulus is a rare condition which usually presents with intermittent abdominal pain. It is typically associated with a paraoesophageal hiatus hernia and may present with acute strangulation or perforation. The mortality associated with an acutely obstructed volvulus may be up to 50%. Correspondingly, this condition is regarded as a surgical emergency. We present the history of a patient with an acute gastric volvulus and unexplained hypotension.
Timing of Aspirin and Secondary Preventative Therapies in Acute Stroke: Support for Use of Stroke Units
Authors: Reid J , MacLeod M-J , Williams D
Published: January 2017

Background: We aimed to study the timing of aspirin prescription in ischaemic stroke comparing patients admitted to an acute stroke unit (ASU) directly or via a general medical ward. We also analysed prescription of secondary preventive therapies in stroke patients in an ASU. Methods: Retrospective analysis was made of medical notes and prescription records of 69 patients admitted to an ASU over a three month period to establish timing of aspirin prescription with respect to onset of stroke symptoms, CT brain scan and route of admission to the ASU. Results: CT brain scans were obtained at a median of 2.1 days post stroke (IQ range 1.3–4.3). Patients directly admitted to the ASU received aspirin earlier post admission compared to those admitted via a medical ward (0.7 vs 2.2 days, p<0.01) and were also more likely to receive aspirin prior to CT scan being performed (57% vs 19%, p=0.02). 86% of stroke patients were discharged on an antiplatelet therapy, 79% on a statin, 37% on a thiazide diuretic and 32% on an ACE inhibitor or angiotensin II antagonist. Conclusion: Aspirin was given more promptly in acute stroke and more commonly prior to CT scanning in an ASU compared to a medical ward. Statin therapy is used extensively in stroke but there is a much lower rate of initiation of other secondary preventive therapies (e.g. anti-hypertensive therapy) in hospital. These findings demonstrate a hesitancy in early use of aspirin amongst general physicians and lends support for the use of stroke units.
Switch—Hospital Case History on Computer
Authors: Kennedy F.
Published: January 2017

A computer system to handle full hospital case records has been in operation in the Department of Surgery for 3 years. This aids clinical research and costs less than £20 per new patient per year.
Malaria in Edinburgh
Authors: Carswell J. , Stevenson D. J. D.
Published: January 2017

Fifty cases of malaria were treated at the Tropical Diseases Unit, Edinburgh City Hospital, in the 5 years 1965–69. These were approximately half of the cases notified in Scotland. Presentations were varied and in several cases far from the commonly accepted clinical picture of malaria. There were no deaths. One case of falciparum malaria had continued proguanil prophylaxis for 24 days in this country but nevertheless presented with this serious illness. Under 50 per cent (9 out of 21) of the cases coming from Africa were of falciparum malaria.
The Incidence of Farmer's Lung in Caithness
Authors: Boyd D. H. A.
Published: January 2017

In a 5-year period, 11 cases of farmer's lung were seen in Caithness giving a prevalence in the total population of 7.8 per 100,000 per year and in the farming population, 110 per 100,000 per year. A serological survey of 50 healthy farmers revealed 4 with anti-complementary reactions in the complement fixation test for M.faeni and none with positive gel diffusion tests for F.L.H. precipitins. The prevalence of this disease may have a correlation with rainfall.
Female Sterilisation
Authors: Davidson A. C. , Donald I.
Published: January 2017

There has been a rapid increase in the number of female sterilisations performed over the last 6 years. The reasons for this together with the indications for sterilisation are discussed. The different forms of sterilisation operation currently performed are discussed and an attempt made to evaluate the relative merits of each.

A series of 810 laparoscopic sterilisations performed in the Western Infirmary, Glasgow, is presented and the results discussed. The view is expressed that this form of sterilisation may well become the method of choice in most gynaecological units within the next 5 years.
Airways Obstruction in the Carcinoid Syndrome a Study of the Effect of Drugs and other Factors
Authors: Turck W. P. G. , Grant I. W. B. , Zeitlin I. J. , Smith A. N.
Published: January 2017

A patient with the carcinoid syndrome had reversible airways obstruction as his predominant complaint. Standard provocation by intravenous adrenaline in conjunction with serial recordings of FEV1 provided a simple and reproducible method for testing the patient's response to a variety of pharmacological agents and food factors. The degree of the airways obstruction was increased by food with a high protein content, and lessened by alcohol. No protection against adrenaline-induced airways obstruction was afforded by a specific 5-HT antagonist (methysergide), a kallikrein inhibitor (aprotinin), adrenergic blocking agents or corticosteroids. Other pharmacological studies suggested that the airways obstruction was mediated by the secretion of histamine by the carcinoid tumour. Despite the deleterious effect of intravenous catecholamines, the patient derived considerable benefit from adrenaline or isoprenaline given by inhalation. The timing of administration in relationship to meals was important for maximal effect.
Oral Infections with Candida Albicans
Authors: Jenkins W. M. M. , Thomas H. C. , Mason D. K.
Published: January 2017

The majority of oral infections with Candida albicans have a local cause. However some Candida infections, such as chronic muco-cutaneous candidosis, which may be widespread over skin and mucous membranes are associated with systemic disorders. Indeed, antibiotic or corticosteroid therapy and severe debilitating disease are proven causes of Candida infection while the association of various endocrinopathies with candidosis has now become well established. More recently, other systemic factors such as impaired cellular immunity and nutritional deficiency have been recognised as influencing Candida infections, and this knowledge is now being successfully applied to the treatment of the disease.
How Do Viruses Multiply?
Authors: Cooper R. J. , Keir H. M.
Published: January 2017

This review article describes the mechanism of multiplication of viruses. Virus infection of mammalian cells proceeds in 4 main stages, adsorption of the virus to the host cell followed by penetration, pre-emption of the synthetic machinery of the cell by the virus, synthesis of viral macromolecular components under the direction of the viral genome, and assembly of viral components to produce mature virus progeny.
Cyclophosphamide in Disseminated Bronchial Carcinoma
Authors: Cameron S. J. , Grant I. W. B. , Crompton G. K.
Published: January 2017

Twenty-four patients with advanced, disseminated bronchial carcinoma were treated with monthly intravenous infusions of cyclophosphamide in doses of 2g. or 3g. (1–1.5g./m2). Useful clinical, chest radiographic and subjective improvement occurred in those patients with anaplastic carcinoma and was especially marked in patients with oat-cell carcinoma. Some patients with squamous carcinoma obtained benefit but no improvement occurred in cases of adenocarcinoma. Toxic effects were not marked. Intermittent infusion of cyclophosphamide should be considered for palliation of symptoms in advanced anaplastic bronchial carcin-noma unsuitable for more radical treatment.
The International System of Units (S.I.) and its Application to Clinical Chemistry
Authors: Whitby L. G.
Published: January 2017

As part of the national programme of metrication, clinical chemistry laboratories in the U.K. are in process of changing their methods of reporting results so as to express them in SI units.

This article gives examples of the effects of adopting SI units on the numerical expression of chemical results, and discusses practical aspects which may facilitate their introduction and acceptance in medical practice. For many chemical measurements, the change to SI units will cause substantial alterations in the numerical data with which clinicians will have to deal, and awareness of this fact will be necessary if serious mistakes in the management of patients' illnesses are to be avoided. The tasks of laboratory staff in planning and carrying out the necessary educational programmes are considered.
Acute Spinal Epidural Abscess—A Cause of Meningism
Authors: Stewart I. C. , Ford M. J. , Heading R. C. , Mendelow A. D. , Harris P.
Published: January 2017

Spinal epidural abscess is a rare condition requiring prompt diagnosis and neurosurgical intervention if permanent neurological sequelae are be avoided. A patient is described who presented with meningism due to an acute spinal epidural abscess extending from the cervical to the lumbar region and which was managed non-operatively.
The Silicon Content of Body Fluids
Authors: Dobbie J. W. , Smith Mary J. B.
Published: January 2017

Samples of bile, pancreatic juice, cerebrospinal, pleural, peritoneal, synovial and amniotic fluid obtained from patients during routine clinical procedures were analysed for their silicon (Si) content by atomic absorption spectroscopy (AAS). Similar Si concentrations were found in each fluid, while these in turn were shown to be similar to the concentration of Si in the serum of 50 healthy subjects (mean serum Si 21.5 μmol/l, SD±4.5). The concentration of Si in 24-hour collections of urine from 50 healthy subjects was also determined (mean urinary Si 194 μmol/l, SD±94). A comparative study was made of serum Si levels in nine different species of domesticated animal.
Cirrhosis and Primary Liver Cell Carcinoma in Tayside
Authors: Hislop W. S. , Masterton Norma , Bouchier Ian A. D. , Hopwood D.
Published: January 2017

Despite Scotland's well-recognised alcohol problem, there is scant information on the aetiology of cirrhosis in this country. This study of 222 patients, reviewed 197 cases presenting as cirrhosis and 25 cases presenting as primary liver cell carcinoma (PLCC) in the East Tayside area of Scotland between 1975 and 1979.

The survey was based on an analysis of all histologically proven cases of cirrhosis and PLCC encountered during a five-year period. There was a constant rate of presentation of cirrhosis of about 40 new patients per year, with a stable pattern of aetiology. About 55 per cent were due to alcohol, and there was no significant change in this proportion over the study. No evidence was found for an increasing female susceptibility or earlier female morbidity in alcoholic cirrhosis. Cryptogenic cirrhosis, cardiac cirrhosis and secondary biliary cirrhosis were more often diagnosed at post mortem. Ninety one per cent of patients with primary biliary cirrhosis were females, but the expected male preponderance in haemochromatosis was not present.

In addition to the 25 patients presenting with PLCC, three of the cirrhotic patients developed the tumour by the end of 1979. Seventy one per cent of PLCC cases arose in already cirrhotic livers, none were HBsAg positive.

Bronchopneumonia, hepatic failure, gastrointestinal bleeding and cardiac failure were the most frequent causes of death.
Cystic Fibrosis Presenting with Chronic Electrolyte Depletion, Metabolic Alkalosis and Hyperaldosteronism
Authors: Forsyth J. S. , Gillies D. R. N. , Wilson S. G. F.
Published: January 2017

A five month old infant who presented with failure to thrive and was found to have severe electrolyte depletion, metabolic alkalosis and hyperaldosteronism is described. The diagnosis of cystic fibrosis was made by demonstrating abnormal sweat electrolytes and pancreatic insufficiency. It is important to exclude cystic fibrosis in any infant presenting with this biochemical abnormality.
Subacute Pulmonary Hypertension and Systemic Tumour Embolism from Cervical Cancer
Authors: Varma J. S.
Published: January 2017

Venous tumour embolization is not unusual in malignant disease (1–3) usually in the form of individual cells or small clumps. Malignant cells in the pulmonary vasculature are therefore not an uncommon finding, especially in patients with abdominal neoplasms (4–7). Arterial emboli from a malignant tumour are, however, rare (8,9), particularly peripheral ones (9,10) and those sufficiently large to cause organ infarction.

An unusual case of pulmonary and widespread systemic tumour embolization from carcinoma of the cervix is described in which systemic dissemination of tumour emboli had apparently resulted from transpulmonary passage, without the development of pulmonary metastases.
Rheumatic Heart Disease and Thyroid Status
Authors: Haslett C. , Douglas J. G. , Munro J. F.
Published: January 2017

A retrospective analysis of 76 patients with rheumatic heart disease revealed nine with thyrotoxicosis, three with hypothyroidism and seven with normal thyroid function and circulating thyroid antibodies. This suggests that there may be an association between rheumatic heart disease and thyroid dysfunction. The findings emphasize the need to formally exclude hyperthyroidism in patients with atrial fibrillation whatever the apparent cause. They also imply a possible autoimmune factor in the pathogenesis of rheumatic heart disease and suggest that patients with rheumatic heart disease may develope clinical or sub-clinical thyroid disease.
Neurosyphilis Revisited
Authors: Allan S. G. , Smith C. C. , Downie Aileen G.
Published: January 2017

Neurosyphilis has become an uncommon clinical problem, for primary and secondary infections are usually recognised and treated early and successfully. However, patients occasionally receive no treatment for their acute infections—usually because they fail to seek advice—or may receive inadequate therapy when prescribed oral penicillin for other infections. The natural course of the disease is thus influenced, but the syphilis is not cured. Variegated clinical presentations of late disease arise and may make objective diagnosis difficult, especially when this occurs in a clinical setting where neurosyphilis may not be entertained in the initial diagnostic deliberations.

Details of three such patients, seen during the last five years in the Aberdeen hospitals, are described—and highlight the range and diversity of clinical presentations which may occur, and typify the problem of making a firm diagnosis while the condition is still potentially curable.
Masquerading Mesothelioma: A Diagnostic Problem
Authors: Campbell J. M.
Published: January 2017

A case of malignant peritoneal mesothelioma is presented which exemplifies the difficulty in making the diagnosis. A short review is given of diagnostic methods and treatment of peritoneal mesothelioma.
Colonic Rupture after Blunt Trauma
Authors: Hansell D. T. , Maguire J. , Smith I. S.
Published: January 2017

A case report of an unusual colonic injury from closed abdominal trauma is described. Diagnosis was made late by an air enema but prompt staged surgical intervention resulted in successful recovery.
Was Mary, Queen of Scots, Anorexic?
Authors: McSherry J. A.
Published: January 2017

Medical historians have traditionally believed that Mary, Queen of Scots, suffered from gastric ulceration which began when she was aged thirteen years. More recent evidence indicates that she may have suffered from porphyria with her first severe attack occurring when she was aged twenty four years.

The medical history of Queen Mary's teenage years is reviewed and thought to be compatible with a diagnosis of anorexia nervosa. A brief outline of the historical awareness, diagnostic criteria and epidemiological aspects of anorexia nervosa supports this view.
Mixed Follicular-Parafollicular Carcinoma of the Thyroid
Authors: Burt A.D. , MacGuire J. , Lindop G.B. , Browne M.K.
Published: January 2017

We present a case of mixed follicular-parafollicular carcinoma of the thyroid. Immunohistochemical studies demonstrated the presence of both thyroglobulin and calcitonin within tumour cells. The recognition of thyroid tumours showing this mixed differentiation may have implications for existing concepts of C-cell and follicular cell development in the human thyroid.
Mark Jameson's Physic Plants, a Sixteenth Century Garden for Gynaecology in Glasgow?
Authors: Dickson J.H. , Gauld W. W.
Published: January 2017

Deputy rector of the University of Glasgow and a vicar choral of Glasgow Cathedral, the physician Mark Jameson made many annotations in his copy of the 1549 edition of Fuchs' herbal. On the back flyleaf are the names of 26 plants, 22 of which were “To be sett & sawin in ye garding”. Many of the 26 plants have gynaecological properties; some are even abortifacient, especially the highly dangerous savin, Juniperus sabina.
General Practice Geriatric Surveillance Scheme
Authors: McIntosh I.B. , Young M. , Stewart T.
Published: January 2017

This project converted an on-demand, crisis intervention service into a doctor-initiated, anticipatory, preventive programme to improve management, based on home visiting and ‘activities of daily living’ screening by state enrolled nurse, with serial medical assessment and regular surveillance by the general practitioner. Opportunistic and domiciliary organised, standardised, serial, numerically scored, medical, social and functional assessment of list patients over 75 years, allowed comparison over time and identification of high need/risk patients — Focus for anticipatory service and aids provision. 24% healthy, 41% moderately impaired and 35% high risk patients were contacted or visited annually, six-monthly and quarterly respectively. Patient-initated calls decreased by 41% but additional surveillance input increased work load by 9% per annum. Improved standards of care helped patients live longer at home however. The nurse proved effective and economical in this role.
Infective Endocarditis as a Complication of a Permanent Indwelling Right Atrial Catheter in a Patient with Severe Aplastic Anaemia
Authors: Morrison A.E. , Burnett A.K. , Simpson I.
Published: January 2017

Endocarditis is a recognised complication of both temporary and permanent indwelling right atrial catheters. Endocardial damage by the catheter may result in non-bacterial thrombotic endocarditis. Sterile vegetations composed of platelets and fibrin may become infected, either by direct spread of bacteria along the catheter, or following an episode of bacteraemia. Bacteria in infected vegetations may be protected from phagocytosis by a ‘roof’ of fibrin.

Echocardiography is a valuable non-invasive method of diagnosis and may be used to monitor the resolution of vegetations and valve function. The right atrial catheter produces reflections which must be distinguished from cardiac abnormalities.

We report a case of infective endocarditis in a patient with severe aplastic anaemia and a permanent indwelling right atrial catheter which was managed conservatively.
Association of Non-Hodgkin's Lymphoma of Stomach, and Colonic Carcinoma; Practical Implications for Management
Authors: Neilly I.J. , Dawson A.A. , Bennett B.
Published: January 2017

The incidence of adenocarcinoma of the colon in patients with gastric non-Hodgkin's lymphoma (NHL) was much higher than that in patients with other forms of NHL. Abdominal symptoms in patients with previously treated gastric NHL should be investigated and treated carefully with this association in mind.
Benign Intracranial Hypertension Associated with Danazol
Authors: Pears J. , Sandercock P. A.
Published: January 2017

We describe a case of benign intracranial hypertension (BIH) whose onset coincided with treatment of danazol for menorrhagia. No other causative factors were identified. Headache and visual symptoms occurring in patients treated with danazol therefore require careful assessment, so that visual failure from advanced BIH can be avoided by appropriate treatment.
Disc Battery Swallowers — Two Contrasting Cases
Authors: Lawson G.M. , Scobie W.G.
Published: January 2017

Increased use and availability of disc batteries has been reflected in the number of children presenting following ingestion of such batteries.1 An expectant, non operative policy is advocated.2,3 Battery manufacturers, however, recommend immediate removal of the battery.4 Two cases presented here illustrate contrasting modes of management, and highlight the unpredictability of disc battery degradation.
Patterns of Unhealthy Eating Behaviours in a Middle Aged Scottish Population
Authors: Abel T. , McQueen D.V. , Backen K , Currie C.
Published: January 2017

This paper examines unhealthy eating in a middle aged Scottish population. Data from a 1989 survey of 5 00 Scottish men and women aged 45 to 59 years are used to explore inter-relations among five items of unhealthy eating, smoking and alcohol consumption. The results show that unhealthy eating behaviours are highly correlated, indicating strong links among certain nutrition habits. The findings also reveal that such patterns of unhealthy eating vary considerably between males and females. Finally, unhealthy eating behaviours were also found to be significantly associated with smoking and alcohol consumption. Implications of these findings for future research in epidemiology and health promotion are considered.
Hypopituitarism following Coronary Artery Bypass Surgery
Authors: Cummings J.F.R. , Davies R. , Newton R. W. , Thompson C.J.
Published: January 2017

Coronary artery bypass surgery (CABS) is a common operation,1 which is often complicated by neurological sequelae.2 Disturbances of cerebral blood flow have been reported up to eight days after surgery and pituitary apoplexy has previously been reported.3–5 We report a case of hypopituitarism without pituitary apoplexy, which developed after a period of sustained arterial hypotension, during coronary artery bypass surgery.
Edward Jenner and the Eradication of Smallpox
Authors: Willis N J
Published: January 2017

Edward Jenner's careful investigations into the usefulness of cowpox vaccination for the prevention of smallpox during the late 1790s, and his enthusiastic and continued advocation of vaccination despite the skepticism of critics, laid the foundations for the growth of understanding about the nature of infectious disease and the development of immunity during the 19th century. He began the long process which resulted in the successful eradication of the smallpox virus in 1980. His life story remains an inspiration to physicians facing an uncertain future as viruses and bacteria not yet eradicated adapt to the antibiotic age
State Regulation of Canadian Pharmacies: A Prescription to Violate the Supremacy Clause
Authors: Kleiman Mary Ellen Fleck
Published: January 2017

“This Constitution, and the Laws of the United States … shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the Contrary notwithstanding.”

Under the Supremacy Clause of the United States Constitution, federal law, such as the Federal Food Drug and Cosmetic Act (“FDCA”), is supposed to be the “supreme Law of the Land.” The FDCA establishes a national closed domestic distribution system for approved prescription drugs in an effort to ensure drug integrity and safety. In doing so, it purportedly sets the “gold standard” for prescription drugs regulation around the world. Lately, though, this “gold standard” has been tarnished by personal importation, the practice of buying prescription drugs directly from foreign pharmacies—primarily Canadian—in conflict with the FDCA's restrictions on unapproved drugs and importation.
Urethral Overdilatation in Females with Lower Urinary Tract Symptoms
Authors: Eastwood D M , Goldman M , Farrar D J
Published: January 2017

The long-term results of using the Otis urethrotome as a dilator only in females with lower urinary tract symptoms are reported. Out of 103 patients, 80% were symptomatically improved or cured at initial follow up and this was maintained at 18 months in 62% of cases. Optimal, long-term results (78% improvement or cure) were obtained in the subgroup of patients who had recurrent urinary tract infections. The results compare favourably with those reported following urethrotomy. The advantages of urethral overdilatation are discussed.
Captopril for Refractory Hypertension in Patients with Impaired Renal Function
Authors: Laher M S , O'Donohoe J F , O'Regan P , Counihan T B
Published: January 2017

The use of captopril in 19 patients with renal parenchymal disease and refractory hypertension was studied for a mean period of 12 months. There was a significant reduction in the systolic and diastolic blood pressures, with a reduction in the mean arterial pressure of 29 mmHg. The mean maintenance dose of captopril was 142 mg daily in three divided doses. All but one of the patients required a diuretic for satisfactory blood pressure control and 3 patients were also given a beta-blocker. In all patients a simplification of the previous therapeutic regimen was achieved. A significant rise in serum creatinine was noted in 2 patients, one of whom had to be withdrawn from the study. Despite the presence of renal functional impairment, proteinuria did not occur de novo nor did established proteinuria increase. Leukopenia was not noted in any of the patients in this group.
Cornerstones of Toxicology
Authors: Hayes A. Wallace , Dixon Darlene
Published: January 2017

The 35th Annual Society of Toxicologic Pathology Symposium, held in June 2016 in San Diego, California, focused on “The Basis and Relevance of Variation in Toxicologic Responses.” In order to review the basic tenants of toxicology, a “broad brush” interactive talk that gave an overview of the Cornerstones of Toxicology was presented. The presentation focused on the historical milestones and perspectives of toxicology and through many scientific graphs, data, and real-life examples covered the three basic principles of toxicology that can be summarized, as dose matters (as does timing), people differ, and things change (related to metabolism and biotransformation).
Caste and Gender in Relation to Health Inequality
Authors: Scaria Suma
Published: January 2017

This article is based on a micro-level village study in Kerala, the southernmost Indian state with its long-standing impressive basic indicators in health, economic growth and social development. Using the theoretical perspective of ‘cultural inflation of morbidity’ for a hypothesis of continuing inequities in health outcomes, it examines how far such impressive basic indicators have actually translated into equity in health outcomes, defined in terms of incidence of morbidity and morbidity pattern. Confirming the hypothesis, the findings discuss to what extent both caste and gender, separately and together, may be continuing today to mediate health outcomes in a changing socio-economic environment.
Evaluating the services and facilities of European cities using crowdsourced place data
Authors: Spyratos Spyridon , Stathakis Demetris
Published: January 2017

Statistics about citizen satisfaction regarding urban facilities and services are required for governing urban areas. Such statistics are often unavailable or outdated. At times, existing statistics are irrelevant to the major problems of most citizens. In this article, we propose a cost-effective method for estimating citizen satisfaction regarding urban facilities and services using crowdsourced place data. Two indicators are proposed based on place data derived from the Foursquare social media application. Both indicators are based on the hypothesis that the higher the number of places is that belong to a facility or service type on social media, then the higher the satisfaction of citizens regarding this facility or service type will be. This hypothesis was tested by using the Eurobarometer survey data as reference. The accuracy assessment revealed strong and statistically significant linear relationships ([Formula: see text]) between the reference percentage of very satisfied citizens and some categories (i.e. “ Sport facilities”, “ Cultural Categories,” and “S treets & buildings”). Other categories showed moderate and statistically significant linear relationships (i.e. “ Public spaces” and “ Green spaces”). Therefore, the proposed indicators provide estimates about citizen satisfaction with regard to these five categories. The new indicators can be used to better design public opinion surveys by making them more relevant to the public in terms of topics, space, and time.
A Randomised Controlled Trial of the Effect of Esmarch Tourniquet Use on Blood Loss, Bruising and Quality of Life in Elective Varicose Vein Surgery
Authors: Fowler A. , Stechman M. , Mitchell D.
Published: January 2017

Objective:

To assess the effect of tourniquet use on bleeding, bruising and quality of life in varicose vein surgery.

Method:

A prospective randomised trial of 49 patients undergoing varicose vein surgery was carried out. All patients were having single leg surgery as a day case. Blood loss was assessed by weighing swabs. Bruising was measured at 10 days, and quality of life assessed with SF36 questionaires.

Synthesis:

In the tourniquet group blood loss was significantly reduced but not the area of bruising. The SF36 scores showed deterioration in the non-tourniquet group at 10 days but this was not present at 6 weeks. We saw no complications of tourniquet use but the study was limited by disappointing recruitment reducing the power.

Conclusion:

Tourniquet use may be of clinical value. A larger study is required to assess the significance.
Thromboprophylaxis and Total Hip Replacement: A Cost-Efficacy Study Comparing Duplex Screening of Asymptomatic Venous Thrombosis versus Prolonged Prophylaxis with Low-Molecular-Weight Heparins
Authors: Barrellier M. T.
Published: January 2017

Background:

Despite use of the anti-thrombotic prophylaxis, clinical thrombo-embolic events and fatal pulmonary embolism are still observed after total hip replacement. To reduce these complications, two strategies have been adopted: to prolong the use of low-molecular-weight heparins (LMWH) to 35 days or to screen patients systematically before discharge, using duplex ultrasonography, following the short-course prophylactic treatment.

Objective:

To assess, based on published literature, the relative costs and benefits of these two strategies for prophylaxis following total hip arthroplasty.

Method:

The author identified relevant papers in this field from his own resources and from medical literature databases.

Synthesis:

Prolonging LMWH treatment to a total of 35 days represents a direct cost in France of approximately £340 per patient, or for 100000 total hip replacements per year, an annual budget of £34 000000. If this strategy attained maximum efficacy, it would avoid 150 fatal pulmonary embolisms. The direct cost would therefore be at least £227000 per life saved. A systematic single duplex ultrasound examination before discharge from hospital would cost £76 per patient, or for 100 000 arthroplasties a total annual budget in France of £7 600000. If this approach achieved maximum efficacy, preventing the 150 fatal pulmonary embolisms corresponding to 100000 total hip replacements, the minimum direct cost would be £50 300 per life saved.

Conclusion:

Duplex screening may be more effective and lest costly than prolongation of prophylactic treatment using LMWH. This deduction needs to be confirmed by complex cost-benefit studies using clinical end-points.