bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison between Dexmedetomidine and Remifentanil for Controlled Hypotension and Recovery in Endoscopic Sinus Surgery
Authors: Lee Jungah , Kim Yongshin , Park Chansoon , Jeon Yeonsu , Kim Daewoo , Joo Jinduk , Kang Hyerim
Published: January 2017

Objectives:

We compared the efficacy of dexmedetomidine and remifentanil hydrochloride in intraoperative field conditions and recovery during endoscopic sinus surgery.

Methods:

Sixty-six patients (American Society of Anesthesiologists physical status I and II) scheduled for elective endoscopic sinus surgery were enrolled in this prospective, double-blinded, randomized study. The patients were randomly assigned to two groups. Propofol, 2 to 2.5 mg/kg, was administered to both groups to induce anesthesia, which was maintained with desflurane. One group received dexmedetomidine 1 μg/kg over 10 minutes at anesthesia induction, followed by 0.4 to 0.8 μg/kg per hour infusion during maintenance, whereas the other group received remifentanil 1 μg/kg over 1 minute at anesthesia induction, followed by 0.2 to 0.4 μg/kg per minute infusion during maintenance. Surgical conditions, hemodynamic parameters, intraoperative blood loss, time to extubation, sedation, and pain in the postanesthesia care unit (PACU) were recorded.

Results:

There were no significant differences between the two groups with respect to surgical field conditions, blood loss, or extubation time. The sedation score (Modified Observer's Assessment of Alertness/Sedation) in the PACU was significantly lower in the dexmedetomidine group than in the remifentanil group (p < 0.001). No differences were found in total blood loss, surgical field conditions, hemodynamic parameters, time to extubation, or pain in the PACU when the two groups were compared (p > 0.05).

Conclusions:

Although remifentanil and dexmedetomidine both enabled hypotensive anesthesia and good intraoperative fields for endoscopic sinus surgery, recovery was faster with remifentanil than with dexmedetomidine in the immediate postoperative period.
Chronic Otorrhea Caused by Myospherulosis in the Middle Ear after Tympanoplasty
Authors: Honings Jimmie , Dammeijer Patrick F. M.
Published: January 2017

Objectives:

Myospherulosis is a foreign body reaction induced by the application of oil-based ointments. Myospherulosis in the ear is extremely rare. Only 4 cases have been described, all of which occurred after (repeated) mastoid surgery.

Methods:

We present a case of persistent otorrhea and conductive hearing loss caused by myospherulosis in the middle ear following tympanoplasty.

Results:

The patient underwent revision middle ear surgery with removal of abnormally thick, pale tissue in the middle ear. Histology showed a foreign body reaction with signs of myospherulosis.

Conclusions:

Myospherulosis is a very rare complication of the use of oil-based ointments. Surgeons should be aware that these products might cause a foreign body reaction leading to myospherulosis. In patients who have chronic otorrhea after previous mastoid or middle ear surgery, myospherulosis should be considered in the differential diagnosis.
Toward a Measure of Auditory Handicap in the Army
Authors: Price G. Richard , Kalb Joel T. , Garinther Georges R.
Published: January 2017

The effect of a soldier's ability to hear on the capacity to perform a mission was calculated for a variety of militarily relevant tasks through the use of mathematical models. Changes in hearing can result from organic loss, hearing protectors, the masking effect of noises, etc. The effects were calculated for the detection of sounds of enemy personnel (speech, movement noises) or their equipment (rifle bolt, tank, generator). We also calculated the effects on the ability to control/communicate with troops verbally. The normal ear is highly effective in detecting noises of personnel or their equipment or in understanding speech, even in noise. By contrast, even modest hearing losses and/or the wearing of hearing protectors can have profound effects on military performance, for example, reducing the area that can be monitored acoustically by more than 30-fold or cutting warning times for other sounds by a factor of more than 100. Hearing protectors may have the conflicting effects of protecting hearing while producing unacceptable performance because of their attenuation.
Le chamanisme des Amérindiens et des missionnaires de la Nouvelle-France
Authors: Laflèche Guy
Published: January 2017

Comme je me moquais d'eux et que je Ieur disais que les castors ne savaient pas ce que l'on faisait de leurs os, ils me répondirent, tu ne sais pas prendre les castors et tu en veux parler.

Paul Lejeune, Relation de 1634

C'est chose étrange, disaient-ils, que depuis que la prière est entrée dans nos cabanes, nos anciennes coutumes ne nous servent plus de rien, et cependant nous mourons tous à cause que nous les quittons.

Barthélemy Vimont, Relation de 1643
Jewish law in Israel today: A conundrum for Messianic times
Authors: Amon Moshe
Published: January 2017

In times past all Jews saw the world through the mythic prism of the rabbinic Torah. That is, they viewed the world as created by God. They saw themselves as Israel, to whom Torah had been revealed. They looked forward to the coming of the Messiah. 1
Conflits agraires en Amazonie : racines politico-économiques et réponses des communautés de base
Authors: Cousineau Madeleine
Published: January 2017

Des secteurs d'avant-garde de l'Église catholique brésilienne ont aidé des petits cultivateurs de la région amazonienne à résister à l'expulsion de leurs terres. Les deux acteurs sociaux principaux dans l'organisation de cette résistance furent la Commission Pastorale de la Terre et les communautés de base. Cet article montre que les conflits agraires tirent leur origine des politiques spécifiques du régime militaire qui a été au pouvoir jusqu'en 1985, et il décrit comment les groupes organisés par l'Église ont répondu à ces politiques. Il est basé sur des recherches de terrain que nous avons menés au Nord du Brésil.
La nouvelle théologie pratique : un débat
Authors: Nadeau Jean-Guy , Viau Marcel
Published: January 2017

La théologie pratique connait un renouvellement de ses problématiques auquel contribue de façon notable La nouvelle théologie pratique de Marcel Viau, professeur à l'Université Laval. Se réclamant des approches pragmatistes et néo-pragmatistes, Viau s'y interroge sur les conditions de possibilité du discours de théologie pratique et sur le rapport de ce discours à son objet. Sa recherche conduit à une théologie pratique pragmatiste qui assume pleinement son enracinement dans l'interaction lanre. Après avoir présenté l'ouvrage de Viau, son collègue Jean-Guy Nadeau, de l'Université de Montréal, lui pose quelques questions sur l'objet propre de la théologie pratique et sur la spécificité de celle-ci par rapport aux théologies fondamentale et systématique. Suit la réaction de Marcel Viau qui précise quelques éléments de sa recherche.
La croyance comme modalité de la connaissance
Authors: Denèfle Sylvette
Published: January 2017

La pensée empiriste permet de placer la croyance à la source de la connaissance et de ramener le problème de la vérité à une lecture sociologique des modalités du croire. Dans cette perspective, une interprétation de la légitimation de la croyance est tentée à partir d'arguments de personnes sans-religion expliquant leur adhésion ou non à divers phénomènes paranormaux.
La crémation hindoue : perfectionnement rituel et cuisson sacrificielle du cadavre en vue de l'ultime offrande
Authors: Saindon Marcelle
Published: January 2017

La crémation hindoue est bien différente de l'incinération occidentale. En tant que dernier des samskāra ou rites perfectifs, elle confère au défunt, par le feu sacrificiel, l'ultime perfectionnement qui le rend apte à franchir le passage vers l'au-delà. Elle est aussi un sacrifice, au sens védique du terme, dans lequel le défunt est à la fois le sacrifiant et la victime offerte au feu sacrificiel, sa dernière offrande comme sacrifiant. La crémation perpétue la tradition du feu sacrificiel, un feu qui cuit et perfectionne les offrandes. Sur le bûcher, Agni, le dieu Feu, ne détruit le cadavre qu'en apparence afin de l'acheminer comme une offrande vers les divinités et les ancêtres. Agni, le feu sacrificiel, est l'intermédiaire entre le monde d'ici-bas et l'au-delà.
La transcendance immanente chez Nishida Kitarô et Karl Rahner
Authors: Tremblay Jacynthe
Published: January 2017

Karl Rahner (1904-1984) et Nishida Kitarô (1870-1945) ont tous deux élaboré un type de logique qui permet d'articuler conjointement les termes contradictoires. On trouve, dans la philosophie de la religion de Rahner, une «logique de l'asymptote» qui permet de penser comment la transcendance immanente de Dieu et la transcendantalité immanente de l'humain coïncident totalement tout en ne s'identifiant absolument pas. La «logique de l'auto-identité absolument contradictoire» de Nishida permet de mettre en rapport les termes contradictoires que sont l'absolu et le relatif, en préservant leur caractère contradictoire dans leur identité même. La «transcendance immanente» de Rahner et celle de Nishida sont structurellement très semblables. Elles permettent de repenser ce que visaient les concepts privatifs du dogme de Chalcédoine, à savoir que les «natures» humaine et divine de Jésus sont sans confusion, sans séparation, sans division et sans changement.
The pneumatic foundation of political theology in Voegelin
Authors: Simon Derek
Published: January 2017

This article situates the foundation of Voegelin's political theology in the differentiation between noetic and pneumatic modes of human consciousness. The author establishes that Voegelin envisions the reconstructive science of politics as a political theology, amplifies Voegelin's ontology of human consciousness, then further delineates the specific difference Voegelin develops between the noetic and pneumatic differentiations of consciousness. He then identifies how Voegelin construes the critical implications of the pneumatic differentiation of consciousness for political theology in the fourth part. In light of this essential Voegelinian principle, the author concludes by amplifying some ramifications of Voegelin's political theology for the renewal of sustainable political communities.
Treaty of Friendship, Cooperation and Mutual Assistance between the Soviet Union and Finland: Some Aspects of International Politics
Authors: Korhonen Keijo
Published: January 2017

The 25th anniversary of the Finnish-Soviet FCA-Treaty was celebrated with solemn ceremonies in April, 1973. Referring to the fact that this treaty has been misunderstood frequently in international discussions and, more recently, also in Finnish domestic debate, the author makes an effort to analyze the role the treaty plays in international politics. He notes that the first two articles of the treaty, ‘the military articles’, are precise and detailed, while the rest of the operative articles, referring to friendship and cooperation between the parties, are general in nature. This is natural since the treaty was designed specifically to provide military security in the situation of 1948. The author maintains that the military role of the FCA-Treaty has not lost its significance even now but that due to the tremendous changes in the European situation during the last 25 years the latter part of the treaty has assumed increasing importance in practice. Thus, while the text of the treaty remains unchanged and the whole treaty is revered by both parties, the operational center of gravity has moved, compared with the situation of 1948, more and more to the articles on friendship and cooperation.
Foreign Policy Elites, Ideology and Decision-Making: A Case Study of the Finnish Elites' Image of the Third World and Their Participation in Decision-Making
Authors: Kalela Aira
Published: January 2017

The structure and content of the Finnish foreign policy elite's ideology concerning the issue area of relations with the Third World and development cooperation is discussed. The purpose of the analysis is to increase the understanding of the nature of foreign policy formation. Both potential and actual elites are studied. First the criteria by which the potential elite can be defined arc discussed and then, in order to discover the actual elite, various means of influence are analysed. The various elements of the ideology of the elite are studied in detail. The relationship between the content of the ideology and the functional and structural position of the elite as well as its general societal ideology is also analysed in order to discover the factors which influence the content of the ideology.
The Adult Human Hand: Some Anthropometric and Biomechanical Considerations
Authors: Garrett John W.
Published: January 2017

Recent studies of the anthropometry and selected biomechanical characteristics of hands are summarized. These include: (1) conventional anthropometry of male and female hands, (2) the anthropometry of the relaxed hand, (3) comparison of certain engineering anthropometric and performance parameters between bare and pressure-gloved hands, and (4) the ability to retain grips on selected handles under high dynamic loads. The utility of these data for human factors engineering is discussed.
The Relationship between Information Processing and Driving Accident and Violation Record
Authors: Fergenson P. Everett
Published: January 2017

Seventeen subjects matched for driving experience were divided into four groups according to their accident and traffic violation records. They were tested for their ability to process information. Subjects who had a high accident record processed information at a significantly (p < .01) lower rate than nonaccident subjects. Subjects who had many violations, but no accidents, were the best information processors. There was a significant (p <.01) interaction between accident and violation record. These results and their implications are discussed.
The Application of Conductive Cooling to Human Operators
Authors: Shvartz Esar
Published: January 2017

The application of conductive cooling for men working in different systems is discussed with respect to work load, heat stress, and clothing. Two types of conductive cooling are considered: circulating water, and ice. A brief review of the effects of whole and partial body cooling on the responses of man to heat stress serves as a basis for suggestions about desirable types of cooling which would allow the human operator to maintain satisfactory performance for extended periods.
Increasing the Power of Psychiatric Court Diversion: A New Model of Supra-District Diversion Centre
Authors: James David V , Harlow Paul
Published: January 2017

The object was to develop and evaluate a new concentrated model of psychiatric diversion scheme at the magistrates' court, designed to maximize the potential of such interventions. A one-year prospective study was undertaken of a consecutive series of 264 referrals to the new diversion project at an Inner London magistrates' court, with concurrent examination of police station custody records, magistrates' court returns, hospital admission data and remand prison transfer records for an area with a population of 500,000. The results showed that this one scheme originated 12.8% of all the unrestricted hospital orders in England under section 37 of the Mental Health Act 1983, 4.2% of section 35 orders, and 6.4% of section 48 and 48/49 remand prisoner transfers. Of all arrests in the central London area, 0.46% were referred to the scheme, with 0.28% being admitted. The seriousness of the charge did not have a significant effect on whether or not admission was achieved (p=0.5365). The new model is a powerful intervention in the assessment and diversion of mentally disordered offenders. Similar supra-district diversion centres may have a role to play in other areas, complementing other local diversion exercises, some of which might better be relocated to the police station.
Methadone-Related Deaths: Data from 18 Coroners' Jurisdictions in England
Authors: Valmana Anton , Oyefeso Adenekan , Clancy Carmel , Ghodse Hamid
Published: January 2017

This paper examines the methadone-related deaths (MRD) among entire cases of inquest on drug-related cases in 18 coroners' jurisdictions in England which were entered on the National Programme on Substance Abuse Deaths during a six-month period in 1997. In 154 deaths methadone, either prescribed or not prescribed, was reported to be the substance directly implicated in the death of 40 individuals. The MRD between the prescribed and non-prescribed cases were compared in respect to various demographic variables and associated risks. The main findings reported are that the majority of deaths in this sample were in cases where methadone had not been prescribed (72%) and that there was a significant difference in age between the methadone prescribed (median = 22 years) and non-prescribed groups (median = 37 years) (Mann-Whitney U = 57.5, p = 0.01). Also significant differences amongst the two groups in respect of the coroners' verdicts are reported. The authors suggest more stringent controls around the prescription and dispensing of methadone, along with measures to alert the population at risk of the hazards of using methadone in a non-controlled fashion.
Observation on the Recent Examination of Bones from St David's Cathedral
Authors: Nokes LDM , Evans W , Knight BH , Dent C
Published: January 2017

Bones discovered in 1866 walled up in St David's Cathedral, West Wales were thought possibly to be those of St David and his companion St Justinian, both of whom died in the late 6th or early 7th century. Examination and radio carbon dating of the bones suggested that these were not from St David nor St Justinian. Some of the bones could be the remains of St Caradoc, a 12th century hermit. It is likely, however, that the bones are remains of clergy who, for reasons not yet understood, were re-interred into the wall.
Microscopic Diffuse Axonal Injury in Cases of Head Injury
Authors: Adams J. Hume , Doyle D. , Graham D. I. , Lawrence Audrey E. , McLellan D. R.
Published: January 2017

Diffuse axonal injury is one of the most important types of brain damage that can occur in the course of a head injury. Its presence can usually be predicted post-mortem because of the presence of focal macroscopic abnormalities in the corpus callosum and in the brain stem. This report describes nine cases where the diagnosis could only be made on the basis of histological studies.
Patient Assaults on Staff in a Psychiatric Hospital: A Two-Year Retrospective Study
Authors: Hodgkinson P. E. , McIvor L. , Phillips M.
Published: January 2017

A two-year retrospective study of patient assaults on staff in a large British psychiatric hospital was conducted. An upward trend in assaults was noted. Information on high risk locations, and high risk time periods is presented. Characteristics of both the assaultative patients and the victim population are presented and discussed.
A 10-Year Review of Drug Seizures in Singapore
Authors: Lee T K , Chow S T , Ng T L
Published: January 2017

The trend of illicit drug seizures and analysis in Singapore over a 10-year period from 1986 to 1995 was examined and reviewed. The main drugs were heroin, opium, cannabis, and illicit tablets containing benzodiazepines and amphetamines. The emergence of amphetamines in early 1996 was a major departure from the traditional drug abuse pattern in Singapore. Changes in the legal definitions of opium and cannabis were also reviewed.
Practice of Seclusion: A Five-Year Retrospective Review in North Cheshire
Authors: Salib Emad , Ahmed A G , Cope Mike
Published: January 2017

This study examines, retrospectively, the trends and factors associated with the use of seclusion over a five-year period in a regional secure unit located within a large psychiatric hospital that serves the population of North Cheshire.

Ninety-four patients (15.3% of total admissions to the unit) spent some time in seclusion on 186 occasions. The average time spent in seclusion was 85 minutes (minimum 15 minutes and maximum 10 hours). Sixty-seven per cent of patients were secluded once, 20% secluded twice, and 13% more than three times. Patients with a clinical diagnosis of personality disorder (11.4%) accounted for 44.2% of seclusions whereas those with a defined mental disorder (55%) accounted for 35% of all seclusions. The rate of seclusion, characteristics of secluded patients, reasons, and average duration spent in seclusion, did not vary significantly over the study period, despite the significant reduction of the unit's admission rate from 150 to 63 per year.

The consistent and regular occurrence of the practice over a five-year period may suggest that seclusion of some disturbed patients will inevitably continue to be used as an effective intervention and, probably at times, the only acceptable method that may ensure the safety of patients and staff.
Method and Ethics in Advancing Jury Research
Authors: Robertshaw P
Published: January 2017

In this article the contemporary problems of the jury and jury research are considered. This is timely, in view of the current Home Office Consultation Paper on the future of, and alternatives to, the jury in serious fraud trials, to which the author has submitted representations on its jury aspects.

The research position is dominated by the prohibitions in the Contempt of Court Act 1981. The types of indirect research on jury deliberation which have been achieved within this stricture are outlined.

In the USA, direct research of the jury is possible but, for historical reasons, it has been in television documentaries that direct observation of the deliberation process has been achieved. The first issue is discussed and the problems of inauthenticity, ‘the observer effect’, and of existential invalidity in ‘mock’ or ‘shadow’ juries are noted.

Finally, the kinds of issues that could be addressed if licensed jury deliberation research was legalized, are proposed. It is also suggested that there are methods available to transcend the problems associated with American direct research.
A Longitudinal Survey of the Evolution of Some Cardiovascular Risk Factors during the Careers of Male Firefighters Retiring from Strathclyde Fire Brigade from 1985–1994
Authors: Ide C.W.
Published: January 2017

This paper is based on a retrospective survey of the cardiovascular risk factor records of 526 wholetime male firefighters retiring from Strathclyde Fire Brigade during the decade beginning 1 January 1985 who had accumulated 14,022 man-years of service. Changes in body mass index (BMI) and systolic & diastolic blood pressure (S&DBP) were observed from enlistment and through the triennial routine medical examinations (RME) which took place from age 40 to retirement, usually occuring after age 50. Tobacco consumption, electrocardiographic abnormalities, and fasting lipid levels were checked at each RME. The findings were then subdivided into quinquennia. Mean BMI (+/-1 SD) increased from 23.4(2.6) at enlistment to 26.6(3.2) at retirement with the proportion of those obese (BMI>=30) changing from 1.8% to 17.2% respectively. Systolic and diastolic BP also rose throughout the study from 126(7.14) and 77(7.1 1) to 137(16.9) and 87(10,9). No subjects had BP > 160 or > 110 at enlistment but, on retirement, this had been attained by 7.2 and 2.1%. Mean cholesterol and triglyceride levels rose from 5.23(.70) to 6.21(1.09) and 1.65(0.67) to 1.93(1.32). HDL cholesterol fell from 1.71(0.35) to 1.37(0.46). The proportion of non-smokers rose from 35.9 to 48.9%. When the results were analysed by quinquennia, statistically significant differences at retirement were found for BMI, S&DBP, and triglycerides. This would suggest that health education activities have not been effective in this workforce.
Fatal Haemorrhage from Aortic Dissection following Instillation of Intrapleural Streptokinase
Authors: Srivastava P. , Godden D.J. , Kerr K.M. , Legge J.S.
Published: January 2017

A patient is described who suffered fatal haemorrhage following intrapleural streptokinase for treatment of a presumed empyema. Autopsy revealed an unsuspected abdominal aortic dissection with extension of blood clot into the thoracic cavity. The importance of precise diagnosis of empyema and potential risks associated with intrapleural streptokinase are discussed.
Exercise during Haemodialysis: West of Scotland Pilot Study
Authors: Moug S J , Grant S , Creed G , Jones M Boulton
Published: January 2017

Background: Exercise during dialysis (EDD) in End-Stage Renal Disease (ESRD) has been documented as an effective intervention to improving a patient's aerobic capacity. Aims: This pilot study aimed to confirm physiological improvements, to establish its safety and practicality and to form guidelines for a long-term study, leading to the integration of EDD in ESRD therapy. Methods: A total of 17 patients on hospital haemodialysis were recruited: ten exercisers (age 42.4 ± 12.6) and six controls (age 41.0 ± 8.3). Both groups were initially tested for estimated VO2max, heart rate, blood pressure, leg extension peak torque, anxiety and depression levels, as well as biochemical and haematological values. The exercisers then underwent cycling ergometer exercise sessions during dialysis, twice weekly, for a total of 12 sessions. Both groups were re-tested after this period. Results: All test and exercise sessions were completed without complication. Compliance was high with only 1 exerciser failing to complete all 12 sessions. The exercisers showed a statistically significant increase (p < 0.05) in EDD workrates (44.3 to 52.1 watts) during the 12 sessions and a reduction in anxiety (p < 0.05). Statistical analysis showed no other significant changes in either group after the 6-week period. Conclusion: This pilot study has confirmed that aerobic EDD is feasible and well accepted by patients on hospital haemodialysis. EDD reduced anxiety scores and showed a trend for an improved level of aerobic fitness.
Childhood Asthma in the Highlands of Scotland — Morbidity and School Absence
Authors: Austin J B , Selvaraj S , Russell C
Published: January 2017

Background The prevalence of childhood asthma in Scotland is one of the highest in the world. The morbidity secondary to allergic diseases is significant in terms of costs to the nation and effects on the family including the child. Aims The aims of this study were to describe the prevalence of asthma, eczema and hay fever in the Highlands of Scotland and in the Shetland Isles and to examine factors in relation to quality of life and social deprivation. Method A total population survey of 12 year old children using a parent completed questionnaire. Results 86.3% (2658/3080) returned questionnaires. Of the 2549 questionnaires analysed, 476 (18.7%) reported asthma ever, 362 (14.2%) wheeze in last 12 months, 508 (19.9%) reported hay fever ever and 555 (21.8%) reported eczema ever. Of the children reporting asthma or wheeze, 35.4% (229/647) had missed school because of asthma or wheeze, 38.0% (246/647) had missed physical education. 62.5% (354/566) of subjects with wheeze ever reported sleep disturbance. Deprivation measured by DEPCAT scores was associated with maternal smoking and bronchitis in the child but not with allergic diseases. Conclusion Compared with previous studies, the prevalence of asthma was unchanged but eczema has increased in Highland adolescents. Allergic disease has a significant impact on school attendance and physical activity. Deprivation was associated with maternal smoking and bronchitis in the child but not with allergic diseases. The impact of allergic diseases in rural areas may be different from urban areas.
An Audit of Neonatal Respiratory Morbidity following Elective Caesarean Section at Term
Authors: Nicoll A E , Black C , Powls A , Mackenzie F
Published: January 2017

Studies have suggested that a reduction in neonatal respiratory morbidity may be achieved by delaying elective caesarean section until 39 weeks gestation. In 1997 staff at the Glasgow Royal Maternity Hospital were concerned at the level of neonatal respiratory morbidity following elective caesarean section. Aims: To determine the extent of neonatal respiratory morbidity following elective caesarean section at term. Then to present the findings, make recommendations and perform a repeat analysis. Methods: A retrospective analysis of all elective caesarean sections at term between October 1996 and October 1997 was performed. Labour ward, operating theatre and SCBU records were examined, followed by maternal and infant case note review. The gestational age at the time of caesarean section and any neonatal respiratory morbidity was recorded. The results were subsequently presented at a perinatal morbidity meeting and a recommendation made to delay elective sections until 39 weeks gestation. The audit was repeated between June 1999 and June 2000. Results: The first cycle of the audit showed significantly lower rates of neonatal admissions with advancing gestation (p < 0.001). There was also a reduction in the number of infants requiring oxygen (p = 0.001), the number of infants requiring intensive care admission (p = 0.001) and ventilation (p = 0.003) with advancing gestation. In the second cycle of the audit there was a significant decrease in the number of elective caesarean sections performed prior to 39 weeks gestation (51% vs. 26%) (p < 0.0001). There were fewer neonatal admissions with respiratory morbidity between the two phases of the audit (26/292 vs. 18/327) (RR = 0.62, 95% CI 0.34–1.1). There was also a reduction in the number of infants requiring oxygen (RR = 0.5, 95% CI 0.23–1.06) the number of infants requiring intensive care admission (RR = 0.45, 95% CI 0.15–1.29) and the number of infants requiring ventilation (RR = 0.38, 95% CI 0.1–1.47). Conclusion: A reduction in neonatal respiratory morbidity can be achieved by delaying elective caesarean section until 39 weeks gestation.
Outcome of Halo Immobilisation of 104 Cases of Cervical Spine Injury
Authors: Hossain M , McLean A N , Fraser M H
Published: January 2017

Study design: Retrospective review Objectives: To present and discuss the outcome of halo jacket immobilisation of cervical spine injuries. Setting: National Spinal Injuries Unit in a Scottish University teaching Hospital. Methods: Retrospective review of case-notes and radiographs of all patients treated with halo jacket both as primary means of immobilisation or as adjunct to surgical stabilisation between 1992–1999 and followed up at a weekly halo clinic. Results: Out of a total one hundred and four patients with cervical spine injury, eighty-six were treated with Halo jacket as primary means of cervical immobilisation. Halo was used as adjunct to surgical stabilisation for the rest. There were nine cases of true failure. This is a failure rate of 10% for primary halo immobilisation. Of the nine patients who had failure of bony healing, four had fibrous healing, three had surgery to stabilise spine, two were subsequently lost to follow-up. The highest incidence of recurrence of subluxation occurred in patients with fracture/subluxation with a healing rate of 85%. Patients with ankylosing spondylitis did well. Odontoid fractures had 18% failure rate. The commonest complication was loss of reduction, followed by pin-site infection. Conclusion: Halo is an effective non-surgical treatment for the injured cervical spine at both upper and lower levels.
How Should We Train Physicians for Remote and Rural Practice? What the Present Incumbents Say
Authors: Wilson P , McHardy K C
Published: January 2017

Objective: To obtain the views of the current remote and rural consultant physicians with regards to their opinion on components of an ideal training programme for an aspirant remote and rural physician. Design: A questionnaire was designed to elicit information in three main areas: experience and training prior to appointment, current pattern of service provision and opinions on components of an ideal training programme for remote and rural physicians. Setting: Five Scottish rural hospitals in Shetland, Wick, Stornoway, Fort William and Oban. Subjects: Thirteen consultant physicians based in the five rural hospitals chosen. Results: The response rate to the questionnaire was 85%. All had previous experience in acute general medicine, and most in one of a variety of subspecialties. Each physician had developed interests and skills in other branches of medicine following appointment in order to meet local service needs. Most felt that there was a need for expansion of consultant numbers in the future, 45% citing the European Working Time Directive as the major reason. There was an encouraging degree of commonality between the current consultants as to what they felt should be included in a training programme for remote and rural physicians. Conclusion: There are challenges in meeting training needs for consultant physicians intending to work in a remote setting. Development of broader-based training than offered by most current dual training programmes is essential. Only imaginative approaches to training will produce physicians who are fit for purpose.
Are Atrial Fibrillation Guidelines Altering Management? A Community Based Study
Authors: Murdoch DL , O'Neill K , Jackson J , McMahon A , Rumley A , Wallace I , Lowe GDO , Tait RC
Published: January 2017

Background and Aims: We wanted to determine the prevalence of atrial fibrillation (AF) in a community based cross sectional study in greater Glasgow and how current anti thrombotic management compares to published guidelines. Methods: 1466 patients with AF were identified in General Practices in our community and 1008 consented to take part. Their demographic details and medical history were recorded. Results: 1466 patients (mean age 73.4; 55% female) with AF were identified, in our community, giving a prevalence of 1%. 53% of patients were on warfarin therapy. Of those not receiving warfarin, only one third had a putative contra-indication. The proportion of AF patients on warfarin increased with increasing stroke risk, and over the period of the study. Conclusions: Prevalence of AF was in keeping with previous estimates. The proportion of patients with AF receiving warfarin therapy appears to be increasing. In the moderate risk group, there was a tendency to use more warfarin in the younger age groups compared to the elderly. It was in the moderate and low risk groups that there was still evidence of deviation from published guidelines.
Electroconversion of Dysrhythmias
Authors: Buchanan J. , Semple T.
Published: January 2017

A follow-up of our first 100 electroconversion procedures is presented. Our method, results and complications are compared with those reported in other series. The future place of electroconversion in the management of acute and chronic arrhythmias is discussed.
Ascaris Lumbricoides Infestation Associated with Jejunal Mucosal Abnormalities
Authors: Maxwell J. D. , Murray D. , Ferguson Anne , Calder E.
Published: January 2017

A patient with ascaris lumbricoides infestation associated with small bowel mucosal abnormalities is reported. The importance of careful radiological examination of the small intestine and examination of the faeces is stressed. Morphological changes and disturbed function of small bowel are discussed in relation to infestation with certain worms.
Q Fever Endocarditis
Authors: Lamb R. , Boyd J. F. , Grist N. R.
Published: January 2017

Q fever endocarditis is described in a man aged 48 years, known to have had a rheumatic fever-like illness in 1960. He had evidence of aortic valve disease when seen with mumps infection in 1963. He was again seen in 1966 with suspected subacute bacterial endocarditis, but later, Q fever infection was shown to be present by serological tests. He survived for just over one year from the presumed onset of Q fever, in spite of prolonged intensive antibiotic therapy.

Necropsy examination showed chronic congestive cardiac failure with pleural and pericardial effusions, and calcific aortic stenosis with tiny vegetations along the edges of the cusps. Rickettsia burneti was isolated only from the damaged aortic valve, and histology revealed colonies of cocco-bacillary bodies between the collagen bundles. Immuno-fluorescence studies suggested that the rickettsiae were heavily coated with 7S gamma globulin (presumably the patient's own specific antibody).

It is important to consider Q fever endocarditis in all cases presenting as bacterial endocarditis.
The Assessment of Iron Deficiency in Pregnancy
Authors: Bonnar J. , Goldberg A.
Published: January 2017

Serial observations were made on two groups of women from early pregnancy to term to assess the effect of pregnancy on the iron status. The first group had no evidence of iron deficiency in early pregnancy and were not given supplementary iron. The second group of patients were a random selection and each patient was given a regular supply of iron tablets. The cooperation of the patient in taking the iron was verified by stool tests. The measurements of the serum iron, total iron binding capacity (transferrin), and erythrocyte porphyrins in addition to the other haematological investigations indicated that in the patients not given iron and those who did not take the supplementary iron the haemoglobin level gradually decreased, and iron deficiency was present. In the patients regularly taking supplementary iron the haemoglobin level was over 12 g. per 100 ml. at term, and the biochemical findings showed no evidence of iron deficiency. The total iron-binding capacity gradually increased during pregnancy with and without iron deficiency. Red cell morphology and the mean haemoglobin concentration were not sensitive indices of iron deficiency. The results of the study suggest that ‘physiological’ anaemia does not exist in pregnancy and reduced haemoglobin values in late pregnancy are most likely the result of an inadequate iron intake.
Mycoplasma Pneumoniae
Authors: MacLean D. W.
Published: January 2017

During 1967, 37 patients in an urban general practice were diagnosed as having Mycoplasma pneumoniae infections giving a minimum attack rate of 1.1 per cent. Their varied clinical picture is described, along with the radiographic and haematological findings. Data relating to family infection is presented and the importance of the early school age child in relation to the spread of this infection is stressed. It is suggested that this infection is a ‘general practice illness’ with a low hospital component.
Metabolic Studies with Porcine Calcitonin in Osteoporosis
Authors: Brown Patricia , Thin Christian G. , Mahne D. N. S. , Roscoe P. , Strong J. A.
Published: January 2017

This investigation was undertaken to assess the effect of porcine calcitonin on the available indices of bone metabolism in blood and excreta of patients with osteoporosis.

No consistent changes were observed in 4 patients following a single intramuscular injection of calcitonin.

An intravenous infusion of calcitonin in 2 patients resulted in a slight fall in serum calcium concentration and in a marked phosphaturia.

Four patients were studied for periods of 13, 30, 32 and 105 days each during the administration of calcitonin. This was given in 4 individual intramuscular doses totalling from 40 to 160 M.R.C. units daily. Complete balance studies on calcium, phosphorus and nitrogen were undertaken for the early stages of treatment, but no clear evidence of a response was observed.

The results suggest that under these conditions porcine calcitonin may have little value in the management of osteoporosis.
Surgical Repair of Rectal Prolapse
Authors: Gordon I. , Miller D. F.
Published: January 2017

Twenty-seven cases of rectal prolapse have been treated by complete mobilisation of the rectum which, with the sigmoid colon, is then fixed in an elevated position using a modification of the Pemberton-Stalker technique. Although almost half of the patients were over 70 years of age, there was no operative mortality. One of the prolapses recurred; 18 patients were followed for 3 years or more, giving a 3-year recurrence rate of 5.5 per cent. Bowel control was improved or restored to normal in all but one of the patients with faecal incontinence.

The results appear satisfactory when compared with those following more complicated operations, and it is suggested that this relatively simple operation should be used more widely, particularly in the treatment of elderly patients.
Haematology in a District General Hospital
Authors: McAlpine S. G. , Conway H.
Published: January 2017

A survey of all patients with haematological disorders admitted to a district general hospital under the care of 2 general physicians over a 5-year period revealed that specialised haematological help in diagnosis and management was required on few occasions.
Recent Advances in Plastic Surgery
Authors: Jackson Ian T.
Published: January 2017

Three advances which disagree with many classical premises in plastic surgery are discussed. These are delayed exposed skin grafting, segmental vascular flaps, and flaps from the tongue. Application to general or orthopaedic surgery is stressed.
Phagocytosis of Colloidal Carbon by the Fixed Tissue and Peritoneal Macrophages of New Zealand Mice
Authors: Whaley K. , Singh H. , Webb J.
Published: January 2017

The peritoneal cellular response to colloidal carbon has been studied in NZB, NZW, BWF1, BALB/c, CBA and C3Hf mice aged 8 to 10 weeks. The overall patterns of total and differential peritoneal cell counts was similar in all 6 strains of mice. No inter-strain differences were noted in either the removal of carbon from the peritoneal cavity or the distribution of carbon in the fixed tissue macrophages. The results show that phagocytosis of colloidal carbon, an inert particle, is normal in New Zealand mice.

Intravenous carbon clearance studies performed on NZB, BALB/c and CBA mice showed that phagocytosis of carbon was identical in each strain when correction was made for variations in liver and spleen weight.
The Use and Abuse of Analgesics
Authors: Murray Robin M.
Published: January 2017

Of 740 Glasgow citizens studied 13.6 per cent denied ever taking analgesics while 12.3 per cent took them weekly and a further 5.0 per cent daily. Three fifths of those taking daily analgesics did so without reference to a doctor. Aspirin and paracetamol were most popular in social classes I and II while Askit were mainly used by social classes IV and V. Aspirin was the preparation of choice of those who rarely took analgesics but its popularity declined the more frequently analgesics were taken. Askit, however, were twice as popular amongst the daily self-medicators as amongst those who rarely took analgesics. Patients with renal disease, psychiatric patients, and those with psychogenic pain were much more likely to have abused analgesics than the general population. Although the risks of excessive analgesic ingestion are considerable, in Glasgow alone over 8,000 people may be abusing analgesics.
Cytotoxic Effect of Alcohol on Liver Cells and Fibroblasts in Vitro
Authors: Walker F. , Elmslie W. , Fraser R. A. , Snape P. E. , Watt G. C. M.
Published: January 2017

Cultures of liver cells (Chang) and of fibroblasts (3T6) were exposed to media containing a range of concentrations of ethanol. At the end of a standard period of time the number of viable cells was determined. As the concentration of ethanol increased over 0.25 per cent v/v liver cell survival decreased progressively. Fibroblast survival decreased progressively at ethanol concentrations over 0.50 per cent v/v. This indicates that ethanol is more toxic to liver cells than to fibroblasts. Certain alcoholic beverages, particularly brandy, were found to be more toxic than pure ethanol.
Effect of a Coronary Care Unit on Mortality from Acute Myocardial Infarction
Authors: Sawers J. S. A. , Borsey D. Q. , Lawson A. A. H.
Published: January 2017

The mortality from acute myocardial infarction was compared for 2 years before the introduction of a coronary care unit (C.C.U.), and three and a half years after. The difference was not significant statistically ( 18% before, and 15% after). There was no reduction in the incidence of cardiac arrest in the C.C.U. period, but resuscitation from cardiac arrest was more successful. The results are considered in the light of previous studies, and the current status of coronary care in district general hospitals is discussed.
Hazards of Hepatic Artery Infusion of Streptozocin
Authors: Holt S. , Naysmith A. , Reid J. , Buist T. A. S.
Published: January 2017

Three patients with metastatic malignancy received streptozocin by hepatic artery infusion through a percutaneous transfemoral catheter. Two patients developed major arterial thrombosis, from which one died. The other suffered renal damage following displacement of the catheter tip. Possible avoidable risk factors are identified.
Medical Decisions
Authors: Black Douglas
Published: January 2017

In relation to the application of decision theory to medical problems, a description is given of the terms ‘probability’, ‘utility’ and ‘coherence’. The use of utilities is illustrated by comparing the outcomes of various methods of palliating terminal renal failure. The use of Bayes' theorem in incorporating additional information is described. Reference is made to specific clinical applications of mathematical methods. Some general comments are made on the way in which clinical and other medical decisions are reached.
The Loin Pain—Haematuria Syndrome in Males
Authors: Habte B. , Dobbie J. W. , Boulton-Jones M.
Published: January 2017

Three young male patients with severe loin pain and intermittent haematuria are presented as examples of the loin pain—haematuria syndrome which has previously been described only in young women. The incapacitating severity of the loin pain and the lack of specific diagnostic tests are emphasised.
Treatment of Endometriosis with Reduced Dosage Schedules of Danazol
Authors: Chalmers J. A.
Published: January 2017

Experience of the treatment of endometriosis with danazol compares very favourably with the previous use of an oestrogen-progestogen combination in this condition. Symptoms were relieved more rapidly and for longer periods of time.

The response to various dose regimes of danazol reveals that 200mg daily may be adequate for most cases.
The Diagnostic Value of the Repolarization Pattern in the Electrocardiographic Lead V6
Authors: Jones M. E. , Short D. S.
Published: January 2017

T wave inversion confined to the lateral leads presents one of the commonest dilemmas in the field of electrocardiogram (ECG) reporting. The differentiation between lateral ischaemia and left ventricular hypertrophy is generally based on the presence or absence of the accepted voltage criterion of hypertrophy, even though this is admitted to have a relatively low degree of sensitivity.

In this study the repolarisation pattern in V6 has been analysed in a consecutive series of 100 patients showing T inversion of at least 1 mm in this lead, and correlated with the diagnosis. Patients on digoxin or similar drugs were excluded.

Thirty-four patients were diagnosed as having hypertension or aortic valve disease or a combination of the two conditions: 31 as pure ischaemic heart disease; 24 as a combination of ischaemic and hypertensive or aortic valvular disease and 11 as having miscellaneous diseases.

Two abnormalities of the T wave showed a significant association with aortic valve disease and hypertension; namely marked asymmetry and terminal positivity (overshoot). These features were sometimes seen in these diseases when the commonly acceptable voltage criterion of left ventricular hypertrophy was lacking.