bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Global t-SNE to Preserve Intercluster Data Structure
Authors: Zhou Yuansheng , Sharpee Tatyana O.
Published: July 2022

The t-distributed stochastic neighbor embedding (t-SNE) method is one of the leading techniques for data visualization and clustering. This method finds lower-dimensional embedding of data points while minimizing distortions in distances between neighboring data points. By construction, t-SNE discards information about large-scale structure of the data. We show that adding a global cost function to the t-SNE cost function makes it possible to cluster the data while preserving global intercluster data structure. We test the new global t-SNE (g-SNE) method on one synthetic and two real data sets on flower shapes and human brain cells. We find that significant and meaningful global structure exists in both the plant and human brain data sets. In all cases, g-SNE outperforms t-SNE and UMAP in preserving the global structure. Topological analysis of the clustering result makes it possible to find an appropriate trade-off of data distribution across scales. We find differences in how data are distributed across scales between the two subjects that were part of the human brain data set. Thus, by striving to produce both accurate clustering and positioning between clusters, the g-SNE method can identify new aspects of data organization across scales.
Recurrent Connections in the Primate Ventral Visual Stream Mediate a Trade-Off Between Task Performance and Network Size During Core Object Recognition
Authors: Nayebi Aran , Sagastuy-Brena Javier , Bear Daniel M. , Kar Kohitij , Kubilius Jonas , Ganguli Surya , Sussillo David , DiCarlo James J. , Yamins Daniel L. K.
Published: July 2022

The computational role of the abundant feedback connections in the ventral visual stream is unclear, enabling humans and nonhuman primates to effortlessly recognize objects across a multitude of viewing conditions. Prior studies have augmented feedforward convolutional neural networks (CNNs) with recurrent connections to study their role in visual processing; however, often these recurrent networks are optimized directly on neural data or the comparative metrics used are undefined for standard feedforward networks that lack these connections. In this work, we develop task-optimized convolutional recurrent (ConvRNN) network models that more correctly mimic the timing and gross neuroanatomy of the ventral pathway. Properly chosen intermediate-depth ConvRNN circuit architectures, which incorporate mechanisms of feedforward bypassing and recurrent gating, can achieve high performance on a core recognition task, comparable to that of much deeper feedforward networks. We then develop methods that allow us to compare both CNNs and ConvRNNs to finely grained measurements of primate categorization behavior and neural response trajectories across thousands of stimuli. We find that high-performing ConvRNNs provide a better match to these data than feedforward networks of any depth, predicting the precise timings at which each stimulus is behaviorally decoded from neural activation patterns. Moreover, these ConvRNN circuits consistently produce quantitatively accurate predictions of neural dynamics from V4 and IT across the entire stimulus presentation. In fact, we find that the highest-performing ConvRNNs, which best match neural and behavioral data, also achieve a strong Pareto trade-off between task performance and overall network size. Taken together, our results suggest the functional purpose of recurrence in the ventral pathway is to fit a high-performing network in cortex, attaining computational power through temporal rather than spatial complexity.
The Love Child and the State: Transnational Family Formation in Guangzhou
Authors: Haugen Heidi Østbø
Published: July 2022

Transnational families are becoming more common in China. They emerge within a social system that is designed for sedentary rather than mobile lives and favours two-parent households over other family forms. Chinese citizens who have children with foreigners must navigate national and local bureaucratic institutions while building and maintaining social relations in transnational fields. The bureaucratic challenges associated with transnational family formation can cause emotional and financial friction within intimate relationships, while gender norms shape how various family members manage these frictions. Gender and race intersect through the ways ethnic boundary crossings are judged differently for men and women, while immigration status affects prospects for meeting gender-specific expectations in romantic relationships. Drawing upon data from ethnographic fieldwork among Chinese−African families in a multi-ethnic neighbourhood in Guangzhou, the article explores tensions that arise as families pursue cosmopolitan aspirations at the same time as they struggle to access basic welfare services and legal and social recognition of their family relationships.
“Robbed of my life”: The Felt Loss of Familiar and Engaged Presence in Depersonalization/Derealization Disorder
Authors: Pienkos Elizabeth , Sass Louis
Published: July 2022

Depersonalization/derealization disorder (DPDR) is classified as a dissociative disorder in the DSM5. It is noteworthy that the symptoms of depersonalization and derealization are commonly found in many other psychological disorders, including schizophrenia spectrum disorders, while phenomenological features of schizophrenia are commonly found in DPDR. The current study attempts to clarify these apparent similarities via highly detailed phenomenological interviews with four persons diagnosed with DPDR. The data revealed four interrelated facets: 1, Loss of resonance, 2, Detachment from experience, 3, Loss of self, and 4, Commitment to reality. These facets point to a felt loss of immediate and familiar engagement in experience as a basic organizing Gestalt which permeates the various symptoms and signs of our participants with DPDR. Close consideration of this disruption allows their experiences to be more easily distinguished from those of schizophrenia-spectrum disorders.
Oviposition preference of pink bollworm, Pectinophora gossypiella on cotton
Authors: Shah Vivek , Pande Rachna , Verma Pooja , Gokte-Narkhedkar Nandini , Prasad Y.G.
Published: July 2022

The effect of four cultivated species of cotton on the oviposition behaviour and/or preference of pink bollworm, Pectinophora gossypiella was studied under laboratory conditions. Blends of volatile organic compounds from squares of all four species of cotton (Gossypium arboreum, G. herbaceum, G. hirsutum, G. barbadense) were identified using gas chromatography-mass spectroscopy (GC-MS). Differences were observed across the species with respect to the relative proportion of identified compounds, viz., pinene, carene, caryophyllene, humulene and γ terpinene. In order to evaluate the ovipositional preference of pink bollworm, a series of no-choice and choice experiments were conducted using square extract, artificial blend-treated muslin cloth and cotton twig as substrate for oviposition. All four species of cotton had differences in the volatile blend composition that were reflected in the mean number of eggs laid under no-choice and choice experiments. A substantially higher number of eggs was laid on cotton twig under both no-choice and choice experiments than on square extract and artificial blend treatments. In both no-choice and choice experiments G. herbaceum was found to be the least preferred for egg laying compared to the other three species.
Sensitive, Indifferent or Labile: Psychopathy and Emotions in Finnish Forensic Psychiatry, 1900s–1960s
Authors: Parhi Katariina
Published: July 2022

Psychopathy was one of the most common diagnoses in Finnish forensic psychiatric examinations between the 1910s and 1960s. Abnormal categories of emotions such as sensitivity, indifference and the tendency to shift among different emotions or lability, were among the principal symptoms of psychopathy. This paper describes and analyses the ways in which Finnish forensic psychiatrists between the 1900s and 1930s perceived and portrayed the emotions of individuals they considered to be psychopaths, and how abnormal categories of emotions persisted until the end of the 1960s. Psychopathic categories of emotions were defined along a spectrum ranging between the extremes of sensitivity and of coldness and included volatility, which entailed rapid mood swings. Displaying either or both extremes of emotion defined psychopathy. The unifying category of abnormal emotions disappeared when the diagnosis of psychopathy ceased to exist in 1969, when it was replaced by the diagnostic category of personality disorders.
Coolie Legend on the Deli Plantation
Authors: Stenberg Josh , Minasny Budiman
Published: July 2022

This article traces one narrative of anti-colonial violence on the Sumatra plantation through various Sinophone iterations and establishes the historical events on which it was based. The European anxiety about the defiance of the condemned Chinese men shows how this particular event turned into oral legend, religious observance, touring socialist theatre, leftist fiction, and a PRC Third World internationalist travelogue. In one moment of bravura, Chinese plantation workers rejected their status as colonial subjects. That gesture made them an emblem of the proletarian bona fides of the ethnic Chinese in Indonesia, and of the traumatic origins of Medan and other North Sumatra Chinese communities in plantation labour. By connecting the foreboding in the colonial archive with the eulogy in the Sinophone literary record, we can triangulate a fuller vision of resistance on the Deli plantations than is available from either one.
Use of wood by indigenous peoples of the Eastern Amazon, Brazil
Authors: de Jesus dos Santos Laise , Souza Lohana Vieira , de Andrade Gabriele Melo , Matos Thayrine Silva , Braga Júnior Marcelo Mendes , Manaças Mirtes Emilia Almeida , Gontijo Alexandre Bahia , de Melo Júnior João Carlos Ferreira , Motta Javan Pereira , de Lima Melo Luiz Eduardo
Published: July 2022

The Brazilian Amazon has the world’s largest concentration of indigenous American peoples, but many environmental threats have affected the preservation of this enormous human ethnocultural heritage. This study identified the species and studied the different uses of wood by two indigenous ethnic groups in Southeastern Pará, Brazil, namely the “Gavião” and “Suruí”. Ten taxa were identified, distributed in eight botanical families, with five being identified to genus and five to species levels. The wood of Bertholletia excelsa, an endangered forest species in Brazil, is important in the material culture of the Suruí indigenous people. The indigenous ethnic groups studied preferentially use medium density wood for building and high-density wood for hunting and warfare artefacts. The technological properties of wood justify its use by the indigenous peoples studied. We caution that the increasing environmental threats in Indigenous Lands within the Brazilian Amazon harm the preservation of the ethnocultural heritage of indigenous peoples.
Southeast Asian “Island Barbarians” as Perceived by a Fujian Official He Qiaoyuan 何喬遠 (1558–1632) in the Late Ming Dynasty
Authors: Kolnin Ilia S.
Published: July 2022

Min shu 閩書 (The Book of Min; finished in 1620) written by He Qiaoyuan 何喬遠 (1558–1632), a native of Quanzhou, is a relatively well-known source among researchers studying the local history of Fujian province. However, apart from the information on the administrative division of the province, its customs and various aspects of local history it does also contain a section entirely dedicated to the description of the foreign island nations entitled Daoyi zhi 島夷志 (“A Description of Island Barbarians”). The present article analyzes the structure and the contents of this section, provides translations of several passages from it connected with the polities of Southeast Asia. Apart from that, a comparison of borrowings from the first edition of a Yuan dynasty treatise Daoyi zhilüe 島夷誌略 (A Brief Description of the Island Barbarians; 1349/1350) which was at the disposal of He Qiaoyuan and by which the name of the section was probably inspired has been carried out. Most importantly, drawing on the data from the text this paper shows how the outside maritime world to the east and south of China was perceived from the perspective of a South China resident who dealt with and gathered information about the foreign both as an official and as a common person. All in all, the present study is meant to build a basis for the future studies of Min shu and its contents in relation to the foreign countries and people as well as other understudied late Ming – early Qing geographical works.
Fritillaria kordestanica (Liliaceae), a new species from western Iran
Authors: ADVAY MAHFOUZ , RIX MARTYN , TEKŞEN MEHTAP
Published: July 2022

Fritillaria Linnaeus (1753: 303; Liliaceae) comprises about 170 species of geophytic perennials (Rix 2019) occurring in most temperate regions of the Northern Hemisphere (Tomović et al. 2007, Hill 2014, Day et al. 2014). The largest number of taxa has been found in Turkey (46 species) and Greece (31 taxa, 26 species and five subspecies).
Essential Dynamics of the Vertical Wind Shear Affecting the Secondary Eyewall Formation in Tropical Cyclones
Authors: Wang Yi-Fan , Tan Zhe-Min
Published: July 2022

This study investigated the effects of vertical wind shear (VWS) with varying magnitudes on secondary eyewall formation (SEF). It turns out that weak-to-moderate VWS advances the timing of SEF. Strong VWS, however, is unfavorable for SEF in our idealized simulations. VWS affecting SEF mainly lies on its influence on the outer rainbands (ORBs). Under weak-to-moderate VWS, ORBs develop more quickly in the downshear side and have distinct stratiform features in the upshear-left quadrant. The asymmetric inflow associated with the stratiform cooling descends into the boundary layer, reinforcing radial convergence at the radially inward side of ORBs. The radial convergence enhances the low-level convection, resulting in strengthened boundary layer inflow and accelerated low-level tangential wind jet. A budget analysis reveals that tangential advection extends a tangential wind jet farther downwind, forming supergradient winds above the boundary layer in the upshear-right quadrant. As the ORBs propagate into the upshear-right quadrant, the pre-existing supergradient winds enhances the low-level convection, facilitating the closing of the secondary convective ring. The evolution in the upshear side exhibit quadrant-dependent interactions between ORBs and boundary layer. Following that, azimuthal-mean tangential wind acceleration becomes visible, forming the secondary tangential wind maximum. Under strong VWS, the storm is weakened and the boundary layer in the upshear-left quadrant is invaded by low-entropy air, resulting in decreased conditional instability and low-level thermal buoyancy. The decreased stratiform precipitation due to weakened convective activity in the upshear-left quadrant prevents the upshear propagation of ORBs and thus is unfavorable for SEF.
Low-Frequency Dynamic Ocean Response to Barometric-Pressure Loading
Authors: Piecuch Christopher G. , Fukumori Ichiro , Ponte Rui M. , Schindelegger Michael , Wang Ou , Zhao Mengnan
Published: July 2022

Changes in dynamic manometric sea level ζm represent mass-related sea level changes associated with ocean circulation and climate. We use twin model experiments to quantify magnitudes and spatiotemporal scales of ζm variability caused by barometric pressure pa loading at long periods ( month) and large scales () relevant to Gravity Recovery and Climate Experiment (GRACE) ocean data. Loading by pa drives basin-scale monthly ζm variability with magnitudes as large as a few centimeters. Largest ζm signals occur over abyssal plains, on the shelf, and in marginal seas. Correlation patterns of modeled ζm are determined by continental coasts and H/f contours (H is ocean depth and f is Coriolis parameter). On average, ζm signals forced by pa represent departures of and from the inverted-barometer effect ζib on monthly and annual periods, respectively. Basic magnitudes, spatial patterns, and spectral behaviors of ζm from the model are consistent with scaling arguments from barotropic potential vorticity conservation. We also compare ζm from the model driven by pa to ζm from GRACE observations. Modeled and observed ζm are significantly correlated across parts of the tropical and extratropical oceans, on shelf and slope regions, and in marginal seas. Ratios of modeled to observed ζm magnitudes are as large as ∼0.2 (largest in the Arctic Ocean) and qualitatively agree with analytical theory for the gain of the transfer function between ζm forced by pa and wind stress. Results demonstrate that pa loading is a secondary but nevertheless important contributor to monthly mass variability from GRACE over the ocean.
Did State Pre-Kindergarten Programs Affect the Head Start Enrollment of Children with Disabilities? A Quasi-Experimental Analysis
Authors: Zhang Qing , Jenkins Jade Marcus
Published: July 2022

Little is known about how the expansion of state pre-kindergarten (pre-k) programs affects low-income children with disabilities in Head Start. Using almost 30 years of administrative data of all Head Start programs and a differences-in-differences design, this study tests the possibility that, as state pre-k differentially draws relatively more advantaged children from the pool of eligible 4-year-olds, Head Start taps into their relative programmatic strengths and serves more children with disabilities. We found that, overall, the introduction of state pre-k was associated with a 1 percentage point (7%) decrease in Head Start enrollment of children with disabilities. However, Head Start programs located in school systems did experience an increase in their enrollment of children with disabilities identified before Head Start enrollment. We also found that the decrease was primarily driven by children with speech impairment, suggesting that state pre-k might affect the Head Start enrollment of children with disabilities through “cream-skimming” because services for these children are relatively more common and less expensive. Implications for future research and practice are discussed.
The impact of employment programs on common mental disorders: A systematic review
Authors: Evans Libby , Lund Crick , Massazza Alessandro , Weir Hannah , Fuhr Daniela C
Published: July 2022

Background:

While employment programs were not created with the intent to improve common mental disorders (CMDs), they may have a positive impact on the prevalence, incidence, and severity of CMD by reducing poverty and increasing access to economic mobility.

Aim:

To examine and synthesize the available quantitative evidence of the impact of employment programs on outcomes of CMD.

Methods:

Embase, Econlit, Global Health, MEDLINE, APA PsychINFO, and Social Policy and Practice were searched for experimental and quasi-experimental studies which investigated the impact of employment programs on primary and secondary outcomes of a CMD. A narrative synthesis according to Popay was conducted. The methodological quality of studies was assessed with the Cochrane Risk of Bias tool and the Newcastle-Ottawa Assessment Scale.

Results:

Of the 1,327 studies retrieved, two randomized controlled trials, one retrospective cohort, one pilot study with a non-randomized experimental design, and one randomized field experiment were included in the final review. Employment programs generally included multiple components such as skills-based training, and hands-on placements. Depression and anxiety were the CMDs measured as primary or secondary outcomes within included studies. Findings regarding the impact of employment programs on CMD were mixed with two studies reporting significantly positive effects, two reporting no effects, and one reporting mixed effects. The quality among included studies was good overall with some concerns regarding internal validity.

Conclusion:

Employment programs may support a decrease in the prevalence, incidence, and severity of CMDs. However, there is high heterogeneity among study effects, designs, and contexts. More research is needed to gain further insight into the nature of this association and the mechanisms of impact. This review highlights the potential for employment programs and other poverty-reduction interventions to be utilized and integrated into the wider care, prevention, and treatment of common-mental disorders.
Fibre bridging: Continuum modelling of extrinsic toughening in double cantilever beam tests
Authors: Huxford Bobby , Ronan William , Russell Benjamin P
Published: July 2022

Extrinsic toughening, such as fibre bridging, acts behind the crack tip to increase toughness in composite laminates. Computational studies have captured this phenomenon; however, the uniqueness of fit between computational results (which vary based on the interface traction-separation relationship) and experimental results has not been explored in detail. Here, detailed exploration of the parameter space for various traction-separation laws (TSL) using finite elements is presented to investigate the role of fibre bridging. In the absence of extrinsic toughening, a linear softening TSL is sufficient to capture the key R-curve features, the total input fracture energy is of primary importance. Where extrinsic toughening is present, the ratio between intrinsic and extrinsic energy dictates the shape of the crack growth resistance curve (where fracture toughness (energy) increases with increasing crack growth). The influence of fibre bridging length on the crack growth required to reach a plateau in toughness is examined. A strategy for determining key cohesive properties from a double cantilever beam test is presented and applied to experimental results.
Views on Modifying the Traditional School Calendar for a Post-COVID World: Could a Balanced Calendar Model Mitigate COVID-19 Slide?
Authors: Jones Daniel A.
Published: July 2022

The COVID-19 pandemic has provided a period for reexamination of how the world schools its children. Policy makers are considering how to address myriad challenges during this tenuous post-COVID era in primary and secondary education. This paper discusses potential school calendar change in the aftermath of the COVID-19 pandemic. Modifying the traditional school calendar to a balanced approach has been attempted and scrutinized for decades providing varying results on academic achievement. The question is whether a year-round or extended school calendar could counteract COVID-19 learning loss, in addition to addressing achievement gaps, reducing viral transmission, and supporting vulnerable student populations.
Electronic textiles for electrocardiogram monitoring: A review on the structure–property and performance evaluation from fiber to fabric
Authors: Le Katherine , Narayana Harishkumar , Servati Amir , Bahi Addie , Soltanian Saeid , Servati Peyman , Ko Frank
Published: July 2022

The development of electronic textiles used for wearable devices and systems for healthcare monitoring applications has experienced rapid growth in the last decade. Knowledge and understanding of the textile structural hierarchy, as well as the ability to define properties from the fiber and yarn to the fabric level are crucial to the selection of materials and design and performance of wearable systems. However, few studies have approached the selection of optimal e-textile structures with respect to material, electrical, and signal performance properties of sensors used for long-term biological signal monitoring. In this work, a review of e-textile structural properties (fiber, yarn, and fabric) for electrocardiogram (ECG) electrodes is presented, along with their relationship to performance properties including electrical, material, ECG signal quality, fabric hand (sensory perception and quality), and physiological comfort. Considerations and insights into the textile fiber and yarn morphology, electrode structure, design, and construction are outlined. In addition, relevant and upcoming standards for e-textile testing and performance evaluation are summarized. This work serves to organize requirements for ECG textile electrodes into a general reference framework from a bottom-up approach, which can better guide the material selection and design of ECG textile electrodes for wearable applications.
Interrupting the neoliberal masculine state machinery? Strategic selectivities and municipalist practice in Barcelona and Zagreb
Authors: Sarnow Martin , Tiedemann Norma
Published: July 2022

All municipalist initiatives are confronted with what Marx called the ‘state machinery’: an ensemble of apparatuses protecting the status quo of capitalist accumulation. It is difficult for municipalist movements to sustain their momentum of storming the city halls in the face of this reality. Looking at Barcelona En Comú (Barcelona in Common) and Zagreb Je NAŠ! (Zagreb Is Ours!), the article discusses what experiences municipalist actors gain when inspecting the state machinery close up. We identify the traces they leave on the materiality of the (local) state: organising participation as conflict, scandalising the serving of particularistic interests, and confronting sexist behaviour within the masculine apparatuses. Nevertheless, the examples illustrate the systemic inertia of the hegemonically programmed state apparatuses and the difficulties of breaking with neoliberal and masculinist policies.
Recognition and Management of Patients Who Repeatedly Swallow Foreign Bodies
Authors: James A H , Allen-Mersh T G
Published: July 2022

Repeated swallowing of foreign bodies, in adults, is part of a syndrome comprising personality disorder, drug overdose, and other self-inflicted injuries. The management should be conservative, as in many cases the foreign body will pass naturally or can be left in the bowel, if necessary for several years. Surgical intervention should be reserved for the complications of perforation, severe haemorrhage and persistent complete bowel obstruction, or for the removal of a toxic substance from the bowel. Five cases are reported which illustrate the natural history and management of the problem.
Pancreatic Abscess
Authors: Gartell P C
Published: July 2022

Three cases of pancreatic abscess are described to show the difficulties in diagnosis and that inadequate treatment is invariably fatal. Early recognition and prompt surgical drainage, together with biliary decompression if indicated, are advised.
Madreporique Stemmed Total Hip Replacement: Five Years' Clinical Experience
Authors: Lord Gerald A
Published: July 2022

Between February 1975 and December 1980, 1214 total hip arthroplasties were performed with a new type of rough surface implant. The results, pitfalls and complications are presented with special reference to the first 173 cases which have had a complete clinical and radiological follow up for at least five years. The indications for operations in both primary and revision arthroplasties are defined.
Umbilical Vein Graft for Lower Limb Ischaemia
Authors: Thomas Martin , Chilvers A S , Hall P T
Published: July 2022

Over a two-year period 30 patients in a British district general hospital had human umbilical vein grafts (Meadox Medical) inserted for severe lower limb ischaemia. There were no perioperative deaths but 6 patients subsequently died from their atherosclerosis. The cumulative patency rate at one year was 70%. Five patients suffered immediate graft failure and all required amputation. Failures were due to inappropriate case selection and early technical inexperience with handling the graft.
Ultrastructural Localization of IgA Deposits in Adult Linear IgA Disease
Authors: Leonard J N , Ring Nicola , Haffenden G P , Fry Lionel
Published: July 2022

Two cases of adult linear IgA disease are reported. They demonstrate the two sites of deposition of IgA at an ultrastructural level: sub-basal lamina and lamina lucida. This finding supports the view that there are subgroups of this disease. Clinical presentation and histological appearance of lesional skin are misleading, and the immunofluorescent appearance is unhelpful in predicting the ultrastructural localization of the IgA deposit.
Effects of Acupuncture in Bronchial Asthma: Preliminary Communication
Authors: Dias P L R , Subramaniam S , Lionel N D W
Published: July 2022

Twenty patients randomly assigned to an experimental and a control group participated in a double blind study to assess the effectiveness of acupuncture in bronchial asthma, using the peak expiratory flow rate (PEFR) as an index of bronchial patency. All patients in the control group showed a significant improvement in their PEFR while only 3 patients in the treated group showed an improvement. A subjective improvement and a reduction in drug dosages were observed in both groups. It is concluded that acupuncture has a placebo effect in bronchial asthma.
Identification and Characterization of Early and Late Prescribes in General Practice
Authors: Strickland-Hodge B , Jepson M H
Published: July 2022

National Health Service prescriptions written by general medical practitioners in one urban Area were analysed over a fifteen-month period to classify doctors into those who prescribed a named drug early or relatively later in its market life. A questionnaire, designed to answer a number of hypotheses intended to characterize these groups of practitioners, was mailed to the 100 doctors in each group. Statistical analysis of the results suggests that there are several identifiable characteristic differences between ‘early’ and ‘late’ prescribers. Early prescribers have larger list sizes than late prescribers and rely more on industrial sources for information about drugs.
Management of Perianal Crohn's Disease
Authors: Hobbiss J H , Schofield Philip F
Published: July 2022

Symptomatic anal disease (excluding skin tags) was observed in 49 out of 151 successive patients treated for Crohn's disease. Two main types of anal disease were encountered: anal ulceration (23 patients) and anal abscesses and fistulae (26 patients). The ulcer group rarely required local surgical treatment. In the fistula group, a low tract was demonstrated and laid open in 20 patients. The healing times after operation in these patients were compared with those of 18 patients with non-Crohn's fistula-in-ano treated by the same method. No significant difference between the two groups could be demonstrated. Surgical treatment of low fistula-in-ano may be undertaken in patients with Crohn's disease, provided the bowel disease is under adequate control.
Chronic Upper Airway Obstruction: Value of the Flow Volume Loop Examination in Assessment and Management
Authors: Brookes G B , Fairfax A J
Published: July 2022

Chronic obstructive lesions of the upper airways such as post-traumatic strictures, bilateral vocal cord paralysis and chronic inflammatory foci are uncommon. The functional assessment of the severity and character of an obstruction is important both for diagnosis and management, and may also allow evaluation of the efficacy of medical and surgical treatment. There are limitations of simple spirometric pulmonary function tests, which are evident when assessing upper airways obstruction. The flow volume loop is a graphic recording of airflow during maximal respiration and expiration at different lung volumes, and may be affected in a characteristic way by alterations in the airway resistance. Three unusual cases of chronic upper airway obstruction are presented which illustrate the value of the flow volume loop examination in their management.
Umbilical Hernia in Xhosa Infants and Children
Authors: James Theodore
Published: July 2022

During the period 12 March 1980 to 10 March 1981 a consecutive series of 1200 Xhosa (Black) infants and young children, ranging in age from the newborn to the prepubertal, who attended the general outpatients department for a variety of medical complaints were examined for umbilical herniation. None had undergone any surgical operation, and patients with conditions possibly associated with umbilical herniation were excluded. Evidence of umbilical protrusion was found in 742 (61.8%), with a similar incidence in males and females. The overall incidence was reflected in each age group by a preponderance of children with umbilical hernia. This study confirms the validity of a generally-held impression that in Black children there is a strong tendency towards the persistence of umbilical hernia when it appears after separation of the cord.
Airways Responses to Oral Ethanol in Normal Subjects and in Patients with Asthma
Authors: Ayres Jon , Ancic Patricia , Clark T J H
Published: July 2022

The effect of oral ethanol on airflow was studied in 5 normal subjects and 5 patients with asthma. On 4 different study days, each subject was asked to drink 40 ml of either water or 20%, 40% or 60% ethanol, and measurements were made of specific airways conductance (sGaw), blood ethanol levels, pulse rate and blood pressure. In some subjects in both groups there was a significant immediate fall in sGaw after drinking ethanol (below 5% confidence limits). Once absorbed, ethanol had a slight bronchodilator effect in 2 normal subjects and in 3 patients with asthma (5% level). Sixty per cent ethanol, when drunk slowly, showed significant bronchodilatation in 4 out of 5 patients with asthma and in one normal subject (5% level) with no acute fall in sGaw. Pulse rate and blood pressure did not change after water, 20% and 40% ethanol in either group, but immediately after 60% ethanol normal subjects showed a significant rise in pulse rate ( P < 0.01) which was not seen in patients with asthma. The immediate changes in sGaw and pulse rate may be due to stimulation of irritant receptors in the upper airways. Ethanol may act directly on bronchial smooth muscle to produce bronchodilatation and may be useful as a bronchodilator when given intravenously.
Some Patients Don't Need Analgesics after Surgery
Authors: McQuay H J , Moore R A , Lloyd J W , Bullingham R E S , Evans P J D
Published: July 2022

Postoperative analgesic requirements of 410 patients undergoing elective orthopaedic limb surgery were studied. Premedication and anaesthetic were standardized with no narcotic. Twenty-three patients required no analgesic at all during their hospital stay. The importance of acknowledging the existence of this group of patients is discussed. The distribution of time to first analgesic requirement for the other patients was obtained. The importance of knowing the distribution for particular operative procedures and the effect of analgesic interventions such as premedication is discussed.
Faecal Urobilinogen Levels and pH of Stools in Population Groups with Different Incidence of Cancer of the Colon, and Their Possible Role in its Aetiology
Authors: Malhotra S L
Published: July 2022

Mean faecal urobilinogen levels and the pH of stools were both found to be higher in subjects from a population group at high risk of developing cancer of the colon than in subjects matched for age, sex and socioeconomic status from a low-risk population group. An alkaline reaction of the colon contents seems to have a tumorigenic effect by a direct action on the mucus of the mucous cells. An acidic reaction, on the other hand, appears to be protective. These differences are dependent on the patterns of diet and manner of eating. Proper mastication of food, roughage, cellulose and vegetable fibre, and short-chain fatty acids of milk and fermented milk products in the diet appear to be protective.
Studying General Practice in the Inner City — A Model for Linking Available Sources of Data: Preliminary Communication
Authors: Fitton Peter , Freeling Paul
Published: July 2022

The effect of implementing proposals intended to improve general practice primary care in inner London is not known. To test it requires a model of how general practice works and methods of measuring appropriate variables. The methods must be sufficiently simple to allow measurement prior to, as well as during, change. This paper presents such a model, describes methods used to measure some of those variables, and illustrates the results.
Spectrum of Breast Disease in Outpatient Surgical Practice
Authors: Cox P J , Li M K W , Ellis H
Published: July 2022

Seven hundred and fifty-three new referrals with problems relating to the breast were seen as outpatients in a general surgical clinic during 1980 and 1981. The age distribution and final diagnoses are reported with a breakdown into the varying pathological groups. The relationship of diagnosis to previous benign breast disease, parity and breastfeeding is discussed.
Chemotherapy of Endodermal Sinus Tumour (Yolk Sac Tumour) of the Ovary: Preliminary Communication
Authors: Wiltshaw E , Stuart-Harris R , Barker G H , Gowing N F C , Raju S
Published: July 2022

Eight patients presenting with endodermal sinus tumour of the ovary have been treated with combination chemotherapy using cisplatin, bleomycin and vinblastine (PVB). Complete remission occurred in 7 out of 8 cases, all of whom are alive and well 3 to 33 months later. These preliminary results are compared with our own past experience and recent reports in the literature. It is concluded that the PVB regimen is probably as effective in female germ cell tumours as it is in testicular teratoma.
Measurement of Anxiety in Psychotherapy Process Research
Authors: Feinmann Charlotte , Goldberg David
Published: July 2022

A new technique designed to measure a patient's anxiety during a psychotherapeutic interview is described. Videotaped recordings were made of interviews between 2 psychotherapists and 6 patients. The anxiety levels experienced by the patients during the interview were measured in three ways. One therapist signalled his recognition of a patient's changing anxiety levels and his interventions to manipulate the patient's anxiety during the interview. Subsequently, the 2 therapists and 6 patients made independent retrospective ratings while viewing a recording of the interview. Significant agreement was found between three sets of ratings and the results suggest that the technique may be of value in psychotherapy process research.
Antenatal Care in High-Risk Pregnancies
Authors: Al-Nahi Q M , Dale J W , Brown E R , Anderson J A D
Published: July 2022

A retrospective analysis pf the antenatal records of women who gave birth to live babies was conducted in the three Districts of the East Sussex Health Area in 1977. A high-risk group was identified and the antenatal care for them was compared with that given to mothers in general. Comparison was also made between Districts.

Women in the high-risk group were similar to those in the general group with respect to the number of antenatal visits. Overall this was also found with respect to when the last visit was made, but there were differences among those with short or long gestations. Pregnant women at high risk were more likely to be supervised by the hospital team exclusively during the antenatal period than those in the general group. Maternal characteristics which might have been used to identify high-risk pregnancies were often not recorded. High-risk mothers more frequently had infants with Apgar scores of less than 5 at one minute and birth weights of 2500 g or less than did women in the general group.

However, it would appear that District policy on health care varied significantly since various aspects of care were found to be more dependent on the District concerned than on the risk group involved.
Comparison of Results of Treatment of Fistula-in-Ano
Authors: Khubchandani Moti
Published: July 2022

The results of treatment of 137 consecutive patients with fistula-in-ano are presented. Sixty-eight were treated by the ‘lay-open’ technique and 69 by the Parks technique, the two groups being comparable. The results slightly favour the Parks technique.
The Forgotten People: Survey of the Chronic Younger Sick in Welsh Hospitals
Authors: Swithinbank J M , Beswick N , Mayberry J F
Published: July 2022

In a survey of Welsh hospitals, 96 patients were identified who had been continuously resident for between 4 months and 20 years; they were aged between 15 and 65 years on admission. The commonest causes for such admissions were cerebrovascular accidents, trauma and diabetes. Suitable facilities for the long-term care and rehabilitation of such severely disabled young people are very limited in Wales, and in an era when rehabilitation should be possible they have been forgotten.
Controlled Comparison of Three Interventions for Mother and Toddler Problems: Preliminary Communication
Authors: Nicol A R , Stretch D D , Davison I , Fundudis T
Published: July 2022

This paper summarizes the preliminary thinking, the hypotheses and design and some preliminary results of a large community-based intervention project which is currently underway in the North East of England.
Effect of Different Drinks on Fluid and Electrolyte Losses from a Jejunostomy
Authors: Newton C R , McIntyre P B , Lennard-Jones J E , Gonvers J J , Preston D M
Published: July 2022

The effectiveness of 5 different solutions on the absorption of fluid and electrolytes was tested in 7 patients with a proximal intestinal stoma and large fluid losses, all of whom previously needed intravenous infusions to maintain balance. In 4 patients it proved possible to replace the intravenous infusions with an enteral supplement. The WHO glucose/electrolyte solution without added potassium (NaCl 3.5 g, NaHCO3 2.5 g, glucose 20 g/l) gave satisfactory results, though was slightly less effective than a solution containing more sodium in which maltose was substituted for glucose. Neither sucrose nor an oligosaccharide*** (Caloreen) gave an advantage over glucose in the formulations used. In 3 patients losses were so great, and absorption of sodium from oral solutions so small, that intravenous supplements had to be continued. These 3 patients could be distinguished from the other 4 by the fact that more than 250 ml emerged from the stoma during the 3 hours after a drink of 500 ml of glucose/electrolyte solution. In all patients a drink of water or tea led to a loss of sodium from the stoma; water should be restricted in such patients and replaced by a glucose/electrolyte solution.
The Value of Screening for Diabetes in Patients with Skin Sepsis
Authors: Baynes C , Caplan S , Hames P , Swift R , Poole S , Wadsworth J , Touquet R , Elkeles R S
Published: July 2022

Four hundred and eighty-two patients with spontaneous skin and superficial sepsis and 291 controls of similar age and sex underwent random capillary blood glucose measurements in order to assess whether screening for diabetes in patients presenting with skin sepsis to an Accident & Emergency Department detects a greater number of cases than that present in the background population. All subjects with a concentration >7.8 mmol/l were subsequently followed up with a 75 g oral glucose tolerance test. Forty-two (8.7%) of the 482 skin sepsis patients had a capillary blood glucose >7.8 mmol/l compared to eight (2.7%) of the 291 without sepsis (χ2=9.71, P<0.002). Of these, 26 of the skin sepsis group and 7 of the control group attended for follow up. Of those who attended, 13 of the skin sepsis group had an abnormal glucose tolerance test (seven diabetes, six impaired glucose tolerance — IGT) compared to two (one diabetes, one IGT) of the control group (χ2=2.87, P<0.1). The difference in cases of frank diabetes between the two groups was not statistically significant. Of the total eight diabetic cases identified, five (on direct questioning) had symptoms of hyperglycaemia (thirst, polyuria and/or weight loss) and two of the others were obese, one of whom had documented ischaemic heart disease. Thus, while most cases of diabetes in patients with skin sepsis could be detected by specifically asking about hyperglycaemic symptoms and performing a blood glucose estimation when these are present, we suggest that the screening of patients with skin sepsis over 40 years of age provides an opportunistic method of screening. This strategy should yield clinically significant numbers of abnormal cases.
The Diagnosis and Management of Arteritis
Authors: Karanjia N D , Cawthorn S J , Giddings A E B
Published: July 2022

Inflammatory arterial disease is often insidious and associated with a substantial morbidity and mortality. Early recognition is vital. Patients with arteritis ( n=106) were studied and divided into five groups. Two of these were subgroups of giant cell arteritis classified by site into either cranial —arteritis (66), or upper limb arteritis (7). Three other groups were identified; chronic periaortitis (with or without inflammatory aortic aneurysm) (7), polyarteritis nodosa (14), and small vessel arteritis (12). Clinicians are not sufficiently aware of arteritis and its many atypical presentations. Delay in management is associated with a significant morbidity and mortality. In this district serving 200 000 people at least one patient per month is seriously at risk from the disease. Improved outlook depends on early recognition of the clinical syndromes and rapid appropriate treatment.
NHS Provision for the Treatment of Ankle Fractures: A Patient Satisfaction Study
Authors: Meredith Philip , Gillham N R
Published: July 2022

From a clinical audit of the treatment given to 1005 patients suffering from ankle fractures, 507 patients of 626 taken randomly from 15 hospitals were contacted and asked to complete a questionnaire describing and evaluating their experiences. The design of the study aimed in a number of ways to reduce respondents' tendency towards a positive response in completing satisfaction scales. The very high response rate, commentaries and variations in opinions about specific service criteria indicate that the results have a high degree of validity. The generally high rates of satisfaction reported here reflect very well on existing NHS provision for a specific procedure, with the exception of certain hospitals' arrangements for waiting, and the provision of certain types of information. Against general indicators of satisfaction with the management of pain relief in hospitals, that in ankle fracture treatments appears to be exceptionally high. However, it would be valuable to discover why younger patients appear to be strikingly more critical than older patients across the entire range of issues. The inquiry aims to compare findings with studies of other orthopaedic services using a similar elementary methodology as a routine component of clinical audit.
Detection of Laryngeal Cancer-The Case for Early Specialist Assessment
Authors: Hoare Timothy J , Thomson Hamish G , Proops David W
Published: July 2022

The first 300 patients referred from 11 participating general practices (GPs) to the Hoarse Voice Clinic, Queen Elizabeth Hospital, Birmingham, were studied prospectively to estimate the accuracy of GPs' diagnosis of laryngeal symptoms and to assess whether the provision of a direct referral immediate access service for the assessment of persistent laryngeal symptoms is an effective way of ensuring early referral and detection of laryngeal cancer.

The GPs' assessment of laryngeal symptoms was inaccurate. Diagnosis after the initial clinic visit was accurate, predicting all histological cases of cancer. Laryngoscopy was possible in all patients at the first clinic visit. Disease requiring admission for direct laryngoscopy and biopsy was found in 39 patients (14%). Ten (3.3%) were found to have laryngeal cancer, of which eight were early lesions. When seen in the clinic 102 (34%) had normal voices and larynxes.

A hoarse voice is a symptom requiring specialist assessment. By using the flexible fibreoptic nasendoscope all patients larynxes can be seen in clinic, an accurate diagnosis quickly made and the appropriate management instigated. It is feasible to offer this service without appointments to patients with persistent hoarseness.