bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation of Nithsdale Goitre
Authors: Gray H. W. , Murphy Anna V. , Logan R. W. , Greig W. R. , McGirr E. M. 
Published: January 2017

As a sequence to a survey which showed that the prevalence of goitre was higher in schoolchildren in Nithsdale (30%) than in Dumfries (16%), a total of 181 adult subjects from these 2 areas were examined and the plasma inorganic iodide concentrations (PII) were determined. The large majority of PII values in subjects from both areas were within the normal range and the overall conclusions are that iodine deficiency severe enough to account for a high prevalence of small goitre or a low prevalence of large goitre does not exist in the South West of Scotland. Since this area is likely to be representative of the U.K. in general, it is also concluded that there is no practical justification for general dietary iodine supplementation meanwhile.
The Effect of Phenformin and Ethyloestrenol on Fibrinolytic Activity in the Vessel Wall
Authors: Isacson S. , Ljungner H. 
Published: January 2017

In a study of 117 patients with recurrent venous thrombosis 65 patients were identified as having deficient fibrinolytic activity in the walls of veins obtained at biosy. Administration of phenformin and ethyloestrenol enhanced natural fibrinolysis.
The Effect of a Self-Referral Scheme on the Pattern of Hospital Admissions for Acute Asthma
Authors: Forwell M. A. , Grant I. W. B. 
Published: January 2017

An analysis of the pattern of admissions for acute asthma to a respiratory unit which operates a self-referral scheme showed that patients included in such a scheme were admitted to hospital more frequently, and much more quickly. The findings suggested that it is possible to recognise ‘high-risk’ asthmatics and that these patients make full and effective use of well organised self-admission facilities. An attempt to discover what provoked acute attacks of asthma yielded little useful information except to identify a small group of young women in whom hysterical hyperventilation may have been a relevant aetiological factor.
A Scottish Hebridean Antithrombin III Deficient Family — Twelve Years on
Authors: Douglas A.S. , Walker I.D. , Bennett N.B. 
Published: January 2017

The members of this family with ATM deficiency have been followed for at least 12 years (1976–1989). All those with previous venous thrombo-embolism have been free from recurrence when on warfarin. During the half century 1931–1981, all 11 full term pregnancies in four affected patients were associated with venous thromboembolism; one patient was enigmatic having one full term pregnancy, without thrombotic event; between 1982 and 1989 three pregnancies have been actively managed with no clinical thrombosis. Management involved use of monitored, self administered, subcutaneous heparin before or very soon after conception and throughout pregnancy (warfarin having been stopped), planned delivery under cover of intravenous antithrombin III, reduction of heparin dosage at delivery and reintroduction of warfarin in the puerperium. The recognised hazards of heparin therapy in pregnancy did not occur. The involvement of the arterial system is reviewed. Clinical evidence provides tentative suggestions on (a) possible additional risk of cigarette smoking (b) avoidance of venography (c) avoidance of varicose vein surgery. A probe is now available for the defective antithrombin III gene in this famiy, but there has been no occasion yet to apply this in antenatal diagnosis.
Unplanned Re-Attendance in the Accident and Emergency Department
Authors: Armstrong A.M. , Pennycook A.G. , Swann I.J. 
Published: January 2017

The notes of patients who re-attended the Accident and Emergency Department with a problem for which they had already been seen and treated were reviewed over a five-week period. Such patients comprised 2.5% of total attendances. The commonest reason for re-attendance was persistent pain following an injury and of such patients, about a half required a significant change in management. It was estimated that two-thirds of re-attendances were unavoidable. Twenty patients were admitted following re-attendance, and of these, two had serious medical conditions which were missed on initial presentation. The role of senior Accident and Emergency doctors is discussed in the light of these findings.
Patterns of Vascular Pathology in Acute, First-Ever Cerebral Infarction
Authors: Naylor A.R. , Sandercock P.A.G. , Sellar R.J. , Warlow C.P. 
Published: January 2017

This was a preliminary study to see whether patterns of vascular pathology correlated with a simple clinical classification of acute cerebral infarction. Thirty-two patients with acute, first-ever hemispheric cerebral infarction were prospectively studied clinically together with an extra- and transcranial Doppler ultrasound. All 14 patients with the triad of ipsilateral motor/sensory deficit, homonymous hemianopia and higher cortical dysfunction (Total Anterior Circulation Infarction,[TACI]) had occlusion of the symptomatic middle cerebral artery and/or internal carotid artery, or a severe middle cerebral artery stenosis. Three patients with lacunar infarction had no evidence of major vessel occlusion. Eleven of thirteen patients with Partial Anterior Circulation, Infarction (PACI) I(i.e. only one or two clinical features of the TACI triad) had patent symptomatic major vessels, with indirect evidence to suggest distal branch occlusion(s) of the middle cerebral artery in six. The remaining two PACI patients had major vessel occlusions. Two patients were not clinically classifiable, but both had significant vascular pathology on ultrasound. The findings of this preliminary study therefore suggest that a simple clinical classification was generally capable of predicting patterns of vascular pathology inpatients with acute cerebral infarction, which could have implications for the selection of patients for clinical trials of thrombolytic therapy.
A Survey of Exercise Testing Practice in Scottish Hospitals
Authors: Muir K.W. , Rodger J.C. , DeBono J.S. , McDonald H. , Irving J.B. 
Published: January 2017

A 1989 survey (unpublished) of exercise testing practice in Scotland suggested that there were important differences in the practice of exercise testing between hospitals. A postal questionnaire was sent to 30 teaching and district general hospitals in 1991 and followed up by telephone questioning of consultants. The numbers of exercise tests performed had increased to 22,072 in 1990, and a greater proportion were performed in district general hospitals. General practitioners had very limited access to the service but hospital doctors of any grade had almost free access. Rationing of early post myocardial infarction testing led to attempts to define “high risk” post infarction patients and this included inappropriate patients in many hospitals. A variety of different protocols was used Eighteen out of 30 hospitals surveyed discontinued beta blockers but only four hospitals took account of antianginal, antihypertensive or other medication, and all but one exercised patients while on digoxin. In the majority of hospitals decisions regarding drug therapy were taken by individual physicians. A variety of personnel reported tests, many without specialist training in cardiology. Even among consultants there was no concensus on the degree of ST depression which was significant. Exercise tests performed in different hospitals in Scotland are not comparable due to the wide variation in patient selection, test conditions, and interpretation of tests. This problem is likely to be exacerbated by the multiple personnel involved in all aspects of testing. It seems probable that there is a problem throughout the United Kingdom, and that there is a need for guidelines.
Cardiorespiratory Disease in Men and Women in Urban Scotland: Baseline Characteristics of the Renfrew/Paisley(Midspan) Study Population
Authors: Hawthorne V.M. , Watt G.C.M. , Hart C.L. , Hole D.J. , Smith G.D. , Gillis C.R. 
Published: January 2017

Study objective: To describe the distribution of risk factors, risk behaviours, symptoms and the prevalence of cardiorespiratory disease in men and women in an urban area with high levels of socioeconomic deprivation. A cross-sectional survey of 15,411 men and women aged 45–64, comprising an 80% response rate from the general population in Paisley and Renfrew, Scotland Main results: The main characteristics of the male Renfrew/Paisley population, compared to previous British studies, were shorter stature, higher blood pressure, a higher proportion of smokers who continue to smoke, lower FEV1 and higher levels of reported angina, breathlessness on effort and chronic bronchitis. In comparison with men, the main characteristics of the female Renfrew/Paisley population were shorter stature, higher plasma cholesterol, lower FEV1′ fewer current and ex-smokers, and a higher prevalence of breathlessness on effort. There were only small differences between men and women in the prevalence of angina, ECG evidence of myocardial ischaemia and chronic bronchitis. Conclusions: Middle-aged men and women in an urban area with high levels of socio-economic deprivation have different cardio- respiratory risk and disease profiles compared to previous population studies in the UK, based on occupational groups and random national samples.
Nitrogen-Phosphorus Synergism in Flame-Retard Ant Cellulose
Authors: Tesoro G. G. , Sello S. B. , Willard J. J. 
Published: January 2017

Recent work on the definition of synergistic effects has provided the basis for designing more efficient new approaches to flame-retardant cellulose. The synergistic role of nitrogen in enhancing flame-retardant characteristics has been confirmed for cotton and rayon fabrics modified with N-hydroxymethyl-3-(dialkylphosphono)propionamide (NMPA) and tris(hydroxymethyl)melamine (TMM). Results are compared with those reported previously for similar cellulose derivatives formed via the Arbuzov exchange of halogen precursors. Data are further compared for native and regenerated cellulose derivatives in which NMPA and TMM were applied from a single bath with acid curing, and for others in which TMM was subsequently polymerized by wet fixation in NMPA-modified cellulose. Satisfactory flame-retardant properties can be obtained in cotton at phosphorus contents as low as 0.8%, and the total amount of reagent required is lower as the NMPA/TMM ratio is decreased. An additional contribution of halogen, obtained by using the haloalkyl analog of NMPA, to the flame-retarding effectiveness of these systems is described.
In Tepid Defense of Population Health: Physicians and Antibiotic Resistance
Authors: Saver Richard S. 
Published: January 2017

AbstractAntibiotic resistance menaces the population as a dire public health threat and costly social problem. Recent proposals to combat antibiotic resistance focus to a large degree on supply side approaches. Suggestions include tinkering with patent rights so that pharmaceutical companies have greater incentives to discover novel antibiotics as well as to resist overselling their newer drugs already on market. This Article argues that a primarily supply side emphasis unfortunately detracts attention from physicians' important demand side influences. Physicians have a vital and unavoidably necessary role to play in ensuring socially optimal access to antibiotics. Dismayingly, physicians' management of the antibiotic supply has been poor and their defense of population health tepid at best. Acting as a prudent steward of the antibiotic supply often seems to be at odds with a physician's commonly understood fiduciary duties, ethical obligations, and professional norms, all of which traditionally emphasize the individual health paradigm as opposed to population health responsibilities. Meanwhile, physicians face limited incentives for antibiotic conservation from other sources, such as malpractice liability, regulatory standards, and reimbursement systems. While multi-faceted efforts are needed to combat antibiotic resistance effectively, physician gatekeeping behavior should become a priority area of focus. This Article considers how health law and policy tools could favorably change the incentives physicians face for antibiotic conservation. A clear lesson from the managed care reform battles of the recent past is that interventions, to have the best chance of success, need to respect physician interest in clinical autonomy and individualized medicine even if, somewhat paradoxically, vigorously promoting population health perspectives. Also, physicians' legal and ethical obligations need to be reconceptualized in the antibiotic context in order to better support gatekeeping in defense of population health. The principal recommendation is for increased use of financial incentives to reward physicians for compliance with recommended guidelines on antibiotic prescribing. Although not a panacea, greater experimentation with financial incentives can provide a much needed jump-start to physician interest in antibiotic conservation and likely best address physicians' legitimate clinical autonomy concerns.
Toward An Architecture of Health Law
Authors: Mariner Wendy K. 
Published: January 2017

In 1894, John Drinkwater, the befuddled, searching architect in John Crowley’s compelling fantasy, Little, Big, built his own home, Edgewood, “as a kind of compound illustration” of Victorian architectural styles.1 Rounding each corner, the visitor sees a different façade and interior – Italianate villa, Tudor manor house, neo-classical, country cottage – complete in itself, its attachment to the others invisible from a single perspective.Reading a small flurry of articles from the past few years attempting to describe the field of health law, one feels like a visitor to Edgewood. The different perspectives are pleasing in themselves, without necessarily revealing the whole. This essay examines what I call the “architecture” of the health law field. By this I mean, without pressing the metaphor too far, the framework of beams and studs in which interior spaces can be designed, furnished and accessorized in different ways.
Can Speech by FDA-Regulated Firms Ever Be Noncommercial?
Authors: Cortez Nathan 
Published: January 2017

For over a century, the Food and Drug Administration (FDA or the Agency) and its precursors have regulated what companies say about their products. The FDA itself notes that the regulatory scheme imposed by the Federal Food, Drug, and Cosmetic Act “depends on the use of words” and that its requirements can “explicitly limit speech.” For seventy years, the FDA had little reason to worry about First Amendment constraints. But since 1976, when the Supreme Court reversed its longstanding position that the First Amendment does not protect commercial speech, the Agency has had to confront–perhaps more than any other federal agency–the free speech rights of regulated firms.But how far do those rights extend, and what room do they leave for regulators like the FDA? The answer largely depends on another question: Is the speech commercial or noncommercial? The distinction is paramount. If speech by a regulated firm is commercial, then the FDA can ensure that it is not false or misleading; the Agency can require or compel certain speech; it can impose prior restraints; and it can even limit truthful speech, all within certain parameters.
Regulatory Approaches to Ending Cigarette-Caused Death and Disease in the United States
Authors: Daynard Richard 
Published: January 2017

Cigarettes result in over 400,000 preventable American deaths each year. In 2011, fewer than twenty percent of adults smoked. Since the publication of the first U.S. Surgeon General's Report on Smoking and Health nearly fifty years ago, when smoking prevalence was around forty percent, policies such as smoke-free laws, large tax increases, and litigation have collectively contributed to cut smoking prevalence in half. Unfortunately, no one expects the mix of policies currently proposed, which includes further tax increases, spatial smoking restrictions, somewhat higher minimum age restrictions, adverse publicity, and quitting assistance, to reduce U.S. smoking prevalence below fifteen percent in the foreseeable future.The rule adopted by the U.S. Food and Drug Administration (FDA) to require hard-hitting graphic warnings on cigarette packages, as is currently done in dozens of other countries, has thus far been rejected by federal judges who have found that warnings designed to arouse negative emotions violate cigarette manufacturers’ First Amendment rights.
Carbohydrate Oxidation Rates in Patients With Anorexia Nervosa
Authors: Goldstein Richard E. 
Published: January 2017

This study was prompted by the authors' observation that some patients with anorexia nervosa (AN) do not gain weight despite appropriate caloric intake and some recent evidence1 that patients with AN respond differently to caloric supplementation depending on what their body habitus was before developing AN. The primary purpose of this study was to study carbohydrate oxidation rates in patients with AN and determine whether differences could be discerned between those patients who gained weight and those who failed to gain weight.The study consisted of 21 female AN patients whose average weight was 30.1% ± 1.5% below their ideal body weight and 10‐age matched healthy women serving as controls (NC). Caloric intake was stabilized over a 10‐day period. At the conclusion of the 10‐day period, those 21 AN patients were divided into two groups (AN‐a consisted of 10 patients who gained less than 2% of their body weight, and AN‐b consisted of 11 patients who gained more than 2% of their body weight during the 10‐day feeding period). The average daily caloric intakes in the AN‐a, AN‐b, and NC groups were 1465 kcal/d (42.2 kcal/kg), 2121 kcal/d (58.6 kcal/kg), and 1755 kcal/d (35.2 kcal/kg), respectively. At the beginning of the 10‐day study period, after an overnight fast, the subjects ingested 50 g of glucose at 8 AM. Venous blood was sampled for glucose and insulin over the next 3 hours and oxygen consumption and carbon dioxide production were measured with a metabolic cart. Urine was collected for measurement of urinary nitrogen content.There was no difference in nonprotein respiratory quotient (NPRQ) between AN‐a and NC groups. However, NPRQ was significantly elevated in the AN‐b group before and after glucose ingestion compared with the NC and AN‐a groups. Before glucose ingestion, carbohydrate oxidation rates were 61 6 13 mg/min in the NC group, 55 6 12 mg/min in the AN‐a group, and 122 6 13 mg/min in the AN‐b group. After glucose ingestion, the rates increased in the NC and AN‐a groups and remained elevated in the AN‐b group. The plasma glucose response was similar in all three groups, whereas the plasma insulin response was decreased in the AN‐b group and tended to be decreased in AN‐a group compared with the NC group.These authors concluded that measurement of the basal NPRQ may be a predictor of weight gain in patients with AN and they go on to suggest that caloric intake may need to be increased in those patients who fall into the AN‐a category. They also suggest that hepatic glucose processing enzymes (eg, glucokinase and phosphofructokinase) are present in larger amounts in the AN‐b vs the AN‐a group; however, the relationship to weight gain is unclear.
Benchmarking Information and Learning Resources
Authors: Ettinger Andrew 
Published: January 2017

Andrew Ettinger joined Ashridge in 1985 and is the Manager of Learning Resources. He is responsible for Ashridge's unique multi-media Learning Resource Centre. He also organises and lectures on courses for several professional bodies in the UK and abroad and is an external lecturer at library schools. He has also completed consultancy projects in India and Poland. After graduating from London University, he completed a post-graduate diploma in Information Studies and then worked at the North East London Polytechnic before moving to the London Business School. He is particularly interested in managers' use of information and how they learn and is currently researching quality information services.
Evaluation of Compression under an Elastic Tubular Bandage Utilised as an Introduction to Compression Therapy in the Treatment of Venous Leg Ulcers
Authors: Melhuish J. M. , Wertheim D. , Llewellyn M. , Williams R. , Harding K. G. 
Published: January 2017

Objective: To investigate the physical parameters of an elasticated tubular bandage (Tubigrip) on the leg and in durability studies. Design and setting: Cohort studies. Participants: Six healthy volunteers and 16 patients. Main outcome measure: Sub-bandage pressure. Results: Median pressures recorded under the Tubigrip bandage system at the lower, middle and upper calf muscle in 6 healthy volunteers, while sitting were 26, 25 and 12.5 mmHg, and for standing were 32, 40 and 16 mmHg. The median pressures recorded at the lower, middle and upper calf muscle in 16 venous leg ulcer patients while sitting were 18, 20 and 14 mmHg, and for standing were 32.5, 29.5 and 18 mmHg. Tubigrip durability studies demonstrated no decrease in sub-bandage compression over 8 days when applied to a model leg and volunteer leg. However, sub-bandage pressure decreased by more than 29% when the bandage was subjected to four wash-dry cycles. Conclusions: The pressures measured under Tubigrip were consistent with the ranges seen in other compression therapies. Laundering reduced the applied sub-bandage pressure.
Deep Vein Thrombosis Prophylaxis: Audit of Practice in General Surgical Patients in a Teaching Hospital
Authors: Agu O. , Handa A. , Hamilton G , Baker D. M. 
Published: January 2017

Objective: To audit the prescription and implementation of deep vein thrombosis (DVT) prophylaxis in general surgical patients in a teaching hospital. Methods: All inpatients on three general surgical wards were audited for adequacy of prescription and implementation prophylaxis (audit A). A repeat audit 3 months later (audit B) closed the loop. The groups were compared using the chi-square test. Results: In audit A 50 patients participated. Prophylaxis was correctly prescribed in 36 (72%) and implemented in 30 (60%) patients. Eighteen patients at moderate or high risk (45%) received inadequate prophylaxis. Emergency admission, pre-operative stay and inadequate risk assignment were associated with poor implementation of protocol. In audit B 51 patients participated. Prescription was appropriate in 45 (88%) and implementation in 40 (78%) patients (p< 0.05). Eleven patients at moderate or high risk received inadequate prophylaxis. Seven of 11 high-risk patients in audit A (64%) received adequate prophylaxis, in contrast to all high-risk patients in audit B. The decision not to administer prophylaxis was deemed appropriate in 5 of 15 (30%) in audit A compared with 6 of 10 (60%) in audit B. Conclusion: Increased awareness, adequate risk assessment, updating of protocols and consistent reminders to staff and patients may improve implementation of DVT prophylaxis.