Relationship between aerodynamic measures of glottal efficiency and stroboscopic findings in asymptomatic singing students

Singing requires exquisite coordination between the respiratory and phonatory systems to efficiently control glottal airflow. Asymptomatic singing students underwent pulmonary function testing (PFT), videostrobolaryngoscopic examination, and measures of glottal efficiency (maximum phonation time [MPT], glottal flow rate [GFR], and phonation quotient [PQ]) performed in both a sung and spoken tone. Pulmonary function and glottal efficiency values were within reported normative data for professional singers. However, sung tones were made with significantly higher GFR and PQ and lower PQ than spoken tones. The mean GFR was not related to the degree of glottal closure (by videostrobolaryngoscopy) or underlying pulmonary support.

The continuing risk of domestic hot water scalds to the elderly

Elderly people are particularly at risk of accidents in the home and with an ageing population, they constitute a large proportion of scald victims. We have seen several elderly patients every year in our own unit who had sustained domestic hot water burns. We decided to ascertain the temperature of water in the private homes of elderly people and in residential care homes in our community. Twenty-five private homes and 14 residential care homes were visited and peak water temperatures were measured in the kitchens and bathrooms. Only one private home and one residential home had water below 45 degrees C. It is recommended that water should be delivered at less than 43 degrees C. We conclude that water is dangerously hot. However, if water is stored at a temperature of less than 60 degrees C there is a risk of infection with Legionella pneumophila. Existing regulations governing the use of 'fail safe' thermostatic mixing devices must be enforced and extended to cover domestic hot water systems.

A CAT-derived one to three session intervention for repeated deliberate self-harm: a description of the model and initial experience of trainee psychiatrists in using it

We describe a new Cognitive Analytic Therapy (CAT)-based intervention for those who repeatedly self-harm. It is specifically designed to be deliverable by staff with no training in psychotherapy. The intervention is simply manualized into sequential tasks that are mediated by new CAT-style standardized tools. A particular feature of this intervention is the deliberate use of feelings elicited in the therapist ('counter-transference') as (a) a guide to how professional poise is being threatened or lost and (b) an indicator of the appropriate focus for this very brief therapy. The psychiatrists' reflection on their elicited feelings is mediated by a new CAT tool, the 'Assessor's Response File' developed in this project. Audiotape analysis suggested that following a very brief learning period, trainee psychiatrists were able to adhere to the structure of the model and arrive at an appropriate reformulation in the first session but tended to be collusive in reciprocating the patients' dysfunctional coping styles.

Text entry on handheld computers by older users

Small pocket computers offer great potential in workplaces where mobility is needed to collect data or access reference information while carrying out tasks such as maintenance or customer support. This paper reports on three studies examining the hypothesis that data entry by older workers is easier when the pocket computer has a physical keyboard, albeit a small one, rather than a touch-screen keyboard. Using a counter-balanced, within-subjects design the accuracy and speed with which adults over 55 years of age could make or modify short text entries was measured for both kinds of pocket computer. The keyboard computer was the Hewlett Packard 360LX (HP), but the touch-screen computers varied across studies (experiment 1: Apple Newton and PalmPilot; experiment 2: Philips Nino; experiment 3: Casio E10). All studies showed significant decrements in accuracy and speed when entering text via the touch-screen. Across studies, most participants preferred using the HP's small physical keyboard. Even after additional practice with the touch screen (experiments 2 and 3) many entries still contained errors. Experiment 3 showed that younger people were faster but not more accurate than older people at using the touch-screen keyboard. It is concluded that satisfactory text entry on palm-size computers awaits improvements to the touch-screen keyboard or alternative input methods such as handwriting or voice. Interface developments that assist older people typically benefit younger users too.

Risk factors for syncope in a community-based sample (the Framingham Heart Study)

The epidemiology of syncope has not been well described. Prior studies have examined risk factors for syncope in hospital-based or other acute or long-term care settings. To determine risk factors for syncope in a community-based sample, we performed a nested case-control study. We examined reports of syncope in Framingham Heart Study participants who underwent routine clinic visits from 1971 to 1990. For each syncope case (n = 543) 2 controls were matched for age, sex, and examination period. Mean age of subjects was 67 years (range 25 to 95); 59% were women. History of stroke or transient ischemic attack, history of myocardial infarction, high blood pressure, use of antihypertensive medication, use of other cardiac medication, smoking, alcohol intake, body mass index, systolic blood pressure, diastolic blood pressure, heart rate, atrial fibrillation, PR interval prolongation, interventricular block, and diabetes or elevated glucose level were examined as potential predictors. Using conditional logistic regression analysis, the predictors of syncope included a history of stroke or transient ischemic attack (odds ratio [OR] 2.56, 95% confidence interval [CI] 1.62 to 4.04), use of cardiac medication (OR 1.67, 95% CI 1.21 to 2. 30), and high blood pressure (OR 1.46, 95% CI 1.14 to 1.88). Lower body mass index was marginally associated with syncope (OR per 4 kg/m(2) decrement 1.10, 95% CI 0.99 to 1.22), as were increased alcohol intake (OR per 5 oz/week 1.11, 95% CI 0.99 to 1.26), and diabetes or an elevated glucose level (OR 1.29, 95% CI 0.96 to 1.75). To our knowledge, this study represents the first community-based study of risk factors for syncope.

Views of junior doctors about their work: survey of qualifiers of 1993 and 1996 from United Kingdom medical schools

OBJECTIVE

To investigate the views of junior doctors about their work.

DESIGN

Postal questionnaire surveys.

SETTING

United Kingdom.

SUBJECTS

Doctors who graduated from medical schools in the United Kingdom in 1996, surveyed at the end of their preregistration year (2926 respondents), and graduates of 1993 surveyed 3 years after qualification (2541 respondents).

RESULTS

Almost 70% of the 1996 qualifiers felt that they worked excessive hours and 80% felt that they undertook too many routine non-clinical duties. Only 24% agreed that their postgraduate training was of a high standard and 22% felt they were being asked to perform clinical tasks with inadequate training. A total of 70% were dissatisfied with arrangements for cover for absent doctors. Senior doctors and nurses were regarded as supportive by most respondents, but hospital management was not. Although 65% were satisfied with their future prospects, only 36% had been able to obtain useful careers advice. Job enjoyment was reasonably high, with two-thirds scoring 6 or more on a scale from 1 (not enjoying at all) to 10 (greatly enjoying), but 70% of respondents felt that they had insufficient time for family and social activities. A briefer questionnaire sent to the 1993 qualifiers in 1996 showed similar results.

CONCLUSIONS

More needs to be done to ensure that junior doctors are trained appropriately for the tasks they undertake, to ensure that they regard their training highly, to reduce excessive non-clinical work, and to provide reasonable working hours and cover.

Factors predictive of outcome in severe lupus nephritis. Lupus Nephritis Collaborative Study Group

In 1992, we published the results of a prospective, controlled trial of aggressive therapy (high-dose prednisone plus oral cyclophosphamide alone or with plasmapheresis) in 86 patients with severe lupus nephritis. During this study, remission (serum creatinine < or =1.4 mg/dL [< or =123 micromol/L] and proteinuria < or =330 mg/d of protein) in renal disease occurred in 37 patients (43%). To assess the long-term effect of remission on patient and renal survival, we now report the results of our extended follow-up of these patients. After an average of 10 years of follow-up in the 86 patients, patient survival rates at both 5 and 10 years were 95% in the group that had a remission and 69% at 5 years and 60% at 10 years in the no-remission group (P < 0.001). Renal survival rates were 94% at both 5 and 10 years in the remission group compared with 46% at 5 years and 31% at 10 years in the no-remission group (P < 0. 0001). Features predictive of remission included stable renal function after 4 weeks on therapy, category IV lesion, lower chronicity index, white race, lower urine protein excretion level at baseline, and lower baseline serum creatinine level. The features predictive of end-stage renal disease were higher baseline serum creatinine level, presence of anti-Ro antibodies, and failure to attain a remission. Thus, in patients with the most severe forms of lupus nephritis, a remission of clinical renal abnormalities is associated with dramatic improvement in long-term patient and renal survival.

Views of UK medical graduates about flexible and part-time working in medicine: a qualitative study

OBJECTIVES

To report on the views of doctors about flexible and part-time working in medicine.

DESIGN

As part of ongoing studies of doctors' careers, postal questionnaires were sent in 1995 and 1996 to all doctors who qualified from UK medical schools in 1977, 1988 and 1993. Structured questions about recipients' careers were accompanied by a form which invited free-text comment. Comments about flexible and part-time working were extracted for analysis.

SUBJECTS

All respondents who commented on flexible and part-time working.

RESULTS

Most doctors who commented believed there were insufficient opportunities to meet demand. They also commonly commented that there was not enough information about flexible training opportunities. Some men, as well as women, expressed a wish to work part-time. The most frequently cited reasons for part-time working were to balance career with family responsibilities, and to reduce work-related stress. Cited disadvantages of part-time working were mainly financial and included the problems of paying for childcare and professional subscriptions when on a reduced income. Some respondents perceived negative attitudes towards doctors in part-time jobs.

DISCUSSION

It is well-recognised that more flexible medical career structures are needed so that doctors can vary their time commitment according to their needs at particular stages in their lives. Until recently, needs have not been adequately met. Changes in arrangements for flexible training accompanying the implementation of the specialist registrar grade may have begun to alleviate some of the problems, but others, such as negative attitudes towards part-time work, may take time to change.

Recurrent subcutaneous infection due to Scopulariopsis brevicaulis in a liver transplant recipient

We describe a case of recurrent Scopulariopsis brevicaulis subcutaneous infection, which occurred 6 years after the patient underwent liver transplantation. Combined surgery and long-term oral therapy with terbinafine resulted in a favorable outcome, although this is not the rule in the previously reported S. brevicaulis infections in immunocompromised patients.

Impulsiveness and the prolactin response to d-fenfluramine

RATIONALE

A number of studies have reported abnormalities of serotonin function in aggressive and impulsive behaviours in psychiatric and forensic populations. It is unknown whether this is because serotonin function plays a part in determining the dimension of trait impulsiveness in the general population or whether this is restricted to these behaviourally extreme groups.

METHOD

The prolactin response to d-fenfluramine was measured in subjects scoring high and low on a scale of impulsiveness selected from a panel of healthy volunteers screened for impulsiveness. Measures included the 17 impulsiveness scale, State Trait Anger Expression Inventory (STAngXI) and the Tridimensional Personality Questionnaire (TPQ). Plasma cortisol was also determined along with fenfluramine and its metabolite norfenfluramine.

RESULTS

The high impulsive group had reduced AUC (PRL) compared with the low impulsive group; this remained significant after adjusting for baseline prolactin, cortisol and drug levels. There was no significant association between impulsiveness, the harm avoidance subscale of the TPQ or trait anger (STAngXI) and prolactin rise. Repeated serum prolactin measures were not significantly different between the two groups.

CONCLUSIONS

This study provides some support to the hypothesis that reduced serotonin function contributes to high trait impulsiveness and is not restricted to behaviourally extreme populations.

Aortic laceration secondary to palmaz stent placement for treatment of superior vena cava syndrome

Aortic laceration secondary to Palmaz Stent placement for treatment of superior vena cava syndrome is reported. This potentially life-threatening complication should be considered when rigid balloon expandable stents are used to treat superior vena cava syndrome of benign origin. Cathet. Cardiovasc. Intervent. 49:160-162, 2000.

Kinetics and Mechanism of the Sorption of Some Aromatic Amines onto Amberlite IRA-904 Anion-Exchange Resin

The kinetics of the sorption of aromatic amines such as o-aminophenol (o-AP), o-phenylenediamine (o-PDA), and p-phenylenediamine (p-PDA) onto Amberlite anion-exchange resin in chloride form was investigated in batch experiments spectrophotometrically at different temperatures. The sorption rate is zero order in all amines sorbed, increasing directly in the order: p-PDA<o-PDA<o-AP, which corresponds to the sequence of the electrostatic contributions to the sorption interactions. The attainment of sorption equilibrium of aromatic amines is seen to be similar. The diffusion coefficients (D) have been calculated by using Fick's equation from the second portions of the sorption/desorption curves; D values ranged from 0.7 to 2.8x10(-9) cm(2)/s. These results, reflecting the diffusion mechanism, were ascribed to intraparticle diffusion. Arrhenius parameters for the diffusion process and the thermodynamic quantities for the process of equilibrium sorption have been estimated. The effect of a chemical oxidation reaction on intraparticle diffusion was investigated by measuring the intraparticle diffusion of amines during the redox reaction. Copyright 2000 Academic Press.

Employment, social inclusion and mental health

Whereas unemployment is clearly linked to mental health problems, employment can improve quality of life, mental health, social networks and social inclusion. Yet in the UK only 15% of people with serious mental health problems are employed--despite an overwhelming consensus from surveys, case studies and personal accounts that users want to work. This paper aims to challenge common misconceptions surrounding employment, work and mental health problems. Drawing on a range of research evidence and legislative guidance it discusses significant barriers to work and proposes feasible solutions. The need for mental health staff and services to become involved in the provision of work opportunities is considered, as is the vital role they can play in changing communities. The potency of work as a vehicle for improving the social inclusion and community tenure of people with mental health problems is highlighted.

Soil factors affecting the sustainability and productivity of perennial and annual pastures in the high rainfall zone of south-eastern Australia

A field study was carried out in the high rainfall zone (HRZ, >600 mm p.a.) of southern Australia from March 1994 to August 1997 to test the hypothesis that sown perennial grasses and liming could make the existing pastures more sustainable through better use of water and nitrogen. The site, on an acid duplex soil at Book Book near Wagga Wagga in southern New South Wales, was typical of much of the HRZ grazing country in southern New South Wales and north-east Victoria. The experiment consisted of 4 replicate paddocks (each 0.135 ha) of 4 treatments: annual pasture (mainly ryegrass Lolium rigidum, silver grass Vulpia spp., subterranean clover Trifolium subterraneum and broadleaf weeds) without lime, annual pasture with lime, perennial pasture (phalaris Phalaris aquatica, cocksfoot Dactylis glomerata and subterranean clover T. subterraneum) without lime, and perennial pasture with lime. Soil pH (0–10 cm) in the limed treatments was maintained at 5.5 (0.01 mol/L CaCl2), compared to 4.1 in the unlimed treatments. The pastures were rotationally grazed with Merino ewe or wether hoggets at a stocking rate which varied with the season, but was 10–25% higher on the limed pastures [14.8–17.3 dry sheep equivalent (dse)/ha] than the unlimed pastures. One replicate set of pasture treatments was intensively monitored for surface runoff, subsurface flow (at the top of the B horizon), water potential gradients and ammonium volatilisation. Other measurements of nitrogen inputs, transformations and losses were made on all paddocks. In a normal to wet year, surface runoff, subsurface flow and deep drainage (>180 cm depth) were about 40 mm less from the perennial than the annual pastures. The reduction in deep drainage under the perennials was about one-third to one-half (20–29 mm/year). The smaller loss of solution NO3– from the perennial pastures (up to 12 kg N/ha.year) suggested soil acidification under perennials was reduced by about 1 kmol H+/ha.year. Denitrification and volatilisation losses of N were small (1–12 kg N/ha.year). Nitrogen fixed by subterranean clover (above ground parts) ranged from 2–8 kg N/ha in the drought of 1994–95 to 128 kg N/ha in a normal year (1996). The soil-pasture nitrogen balance was positive for all treatments and averaged 76 kg N/ha.year over 2 years. The abundance of introduced and native earthworms increased from 85 to 250/m2 in the limed pastures between 1994 and 1997. Introduced species, such as Aporrectodea trapezoides, were especially responsive to lime. Animal production per hectare was 10–25% higher on pastures with lime. Critical gross margins per dse were lowest ($16/ha) for a long-lived perennial pasture (>15 years), and highest ($20/ha) for a short-lived perennial (5 years). Overall, there were substantial benefits in animal production, improved soil quality and water use from establishing perennial grass pastures with lime on these strongly acid soils.

Cloning, functional characterisation and population analysis of a variant form of the human glycine type 2 transporter

Two forms of glycine transporter have been described to date, GlyT-1 and GlyT-2. The GlyT-2 form is expressed mainly in the spinal cord, brainstem and cerebellum. Here we describe the identification of a variant form of the human GlyT-2 (SC6), showing three amino acid changes to the previously reported protein. Population analysis identified the allele causing one of the polymorphisms, D463N, at 10% within the population with 3% being homozygous for the change. We also transfected our new variant into mammalian cells and compared it to the published cDNA, showing that the three amino acid changes present have no major effect on the biochemical properties of the transporter.

Synthesis of the nanomolar photoaffinity GABA(B) receptor ligand CGP 71872 reveals diversity in the tissue distribution of GABA(B) receptor forms

A radioiodinated probe, [125I]-CGP 71872, containing an azido group that can be photoactivated, was synthesized and used to characterize GABA(B) receptors. Photoaffinity labeling experiments using crude membranes prepared from rat brain revealed two predominant ligand binding species at approximately 130 and approximately 100 kDa believed to represent the long (GABA(B)R1a) and short (GABA(B)R1b) forms of the receptor. Indeed, these ligand binding proteins were immunoprecipitated using a GABA(B) receptor-specific antibody confirming the receptor specificity of the photoaffinity probe. Most convincingly, [125I]-CGP 71872 binding was competitively inhibited in a dose-dependent manner by cold CGP 71872, GABA, saclofen, (-)-baclofen, (+)-baclofen and (L)-glutamic acid with a rank order and stereospecificity characteristic of the GABA(B) receptor. Photoaffinity labeling experiments revealed that the recombinant GABA(B)R2 receptor does not bind [125I]-CGP 71872, providing surprising and direct evidence that CGP 71872 is a GABA(B)R1 selective antagonist. Photoaffinity labeling experiments using rat tissues showed that both GABA(B)R1a and GABA(B)R1b are co-expressed in the brain, spinal cord, stomach and testis, but only the short GABA(B)R1b receptor form was detected in kidney and liver whereas the long GABA(B)R1a form was selectively expressed in the adrenal gland, pituitary, spleen and prostate. We report herein the synthesis and biochemical characterization of the nanomolar affinity [125I]-CGP 71872 and CGP 71872 GABA(B)R1 ligands, and differential tissue expression of the long GABA(B)R1a and short GABA(B)R1b receptor forms in rat and dog.

Lower abdominal wall reconstruction using the anterior thigh fasciocutaneous flap

Full thickness defects of the lower abdominal wall are uncommon. They can occur in congenital abdominal wall defects, acute trauma and following resection of soft tissue tumours. In reconstruction of defects not amenable to primary closure, three problems need to be addressed: (i) the fascial layer needs to be reconstructed; (ii) stable and sensate skin coverage is needed as the lower abdominal waistline area is subject to pressure; (iii) it is desirable to restore the contour of the abdominal wall. We present a case with a large area of radiation dermatitis and recurrence of a malignant ovarian tumour in the lower abdominal wall. After en bloc resection the 25 x 6 cm lower abdominal defect was reconstructed with a sensate anterior thigh fasciocutaneous flap. The vascular supply was reliable and the outcome was good. The reasons for using this fasciocutaneous flap in preference to the other options are discussed.