Balfour Hospital

A motor programme is described for defensive kicking in the locust which is also probably the programme for jumping. The method of analysis has been to make intracellular recordings from the somata of identified motornuerones which control the metathoracic tibiae while defensive kicks are made in response to tactile stimuli. Three stages are recognized in the programme. (1) Initial flexion of the tibiae results from the low spike threshold of tibial flexor motorneurones to tactile stimulation of the body. (2) Co-contraction of flexor and extensor muscles followa in which flexor and extensor excitor motoneurones spike at high frequency for 300-600 ms. the tibia flexed while the extensor muscle develops tension isometrically to the level required for a kick or jump. (3) Trigger activity terminates the co-contraction by inhibiting the flexor excitor motorneurones and simultaneously exciting the flexor inhibitors. This causes relaxation of the flexor muscle and allows the tibiae to extend. If the trigger activity does not occur, the jump or kick is aborted, and the tibiae remain flexed.

In remote communities, where frequent face-to-face contact with health professionals may be difficult, the ongoing review and management of symptoms--a fundamental part of good palliative care--can be difficult to achieve. Telecare and other developments in information technology are increasingly being sought as a means of addressing shifting population demographics and rising demands on stretched health services, and may help in providing a system which allows patients to report their symptoms as they are happening. This may be one way of enhancing symptom management and improving quality of care at the end of life. A study testing the feasibility of using mobile phone-based technology (Advanced Symptom Management System in Palliative Care (ASyMSp)) to monitor and manage symptoms reported by patients being cared for at home in the advanced stages of their illness was carried out in two rural communities in the north of Scotland. The results of this study show that the system was usable and acceptable to patients and the health professionals who cared for them.

Previous studies have shown that allergy to storage mites is a significant contributor to allergic disease among an isolated farming community in the Orkneys. The present study was undertaken to determine the prevalence of disease due to storage mites among farmers on the mainland of Scotland. Of the 290 subjects employed on 102 randomly selected farms studied, eighty-seven (30%) reported allergic symptoms on entering barns or byres, and prick tests to storage mites were positive in 62 (21%). Rhinitis and conjunctivitis together were the more frequently reported symptoms, with less than half the subjects recording respitatory symptoms. Specific IgE antibody to storage mites was detected in 43% of subjects reporting allergic symptoms associated with hay dust. Specific IgE to storage mites was strongly associated with atopy in those subjects who reported allergic symptoms.

Summary. The female reproductive organs and secondary sexual characters of Homarus vulgaris are described, in particular the pleopods, which possess seven groups of long non‐plumose setæ. The developing eggs are attached, either directly or by way of other eggs, exclusively to these setæ. Attachment is by means of strands of transparent “cement” (the funiculus), which also forms the outer membrane of the egg, surrounding an inner membrane which adheres closely to the egg mass. Chemical and physical tests reveal that the outer membrane has properties identical with those of the superficial cuticle of the integument. The inner membrane is chitinous. Experiments on the penetration of a variety of substances into the developing egg indicate that the outer membrane has the limited permeability of cuticle, the inner membrane being freely permeable. The inner membrane is secreted by the oviducal epithelium, the histological character of which varies in relation to egg‐laying. Secretion of chitin indicates that the oviduct may be ectodermal. The outer membrane is formed by cement glands present in great numbers within the pleopods of the female, and these resemble in all respects the tegumental glands which secrete the cuticle. Secretion by the cement glands is associated with egg‐laying, not with ecdysis. The ducts from the glands pass into the interior of the specialized non‐plumose setæ, circumstantial evidence indicating that the secretion is discharged through the sides of these. This would explain the attachment of eggs exclusively to these setæ. In Decapod Crustacea there is an intimate association between ecdysis and reproduction, the sequence of events being outlined. Available evidence points to fertilization occurring externally in the Astacura, and the complicated structure of the spermatozoa may be correlated with the need for the penetration of the inner chitinous membrane. Egg‐attachment involves low surface tension in the cement, a property already postulated for the cuticle. The limited permeability of the outer membrane formed by this means renders osmotic hatching possible. Attachment of eggs in Homarus and allied Decapoda represents the exploitation of a substance which forms the outer covering of the integument and the properties of which—probably low surface tension, slow solidification in water, final hardness, and limited permeability—combine to make it ideal for both purposes. The sequence of events involved in egg‐laying and attachment indicates the probability of control by hormones. With the exception of the Peneidæ there appears no reason for assuming that the method of egg‐attachment differs in any essential particular throughout the Decapod Crustacea.

BACKGROUND: Interprofessional collaborative practice (ICP) is currently recommended for the delivery of high-quality integrated care for older people. Frailty prevention and management are key elements to be tackled on a multi-professional level. AIM: This study aims to develop a consensus-based European multi-professional capability framework for frailty prevention and management. METHODS: Using a modified Delphi technique, a consensus-based framework of knowledge, skills and attitudes for all professions involved in the care pathway of older people was developed within two consultation rounds. The template for the process was derived from competency frameworks collected in a comprehensive approach from EU-funded projects of the European Commission (EC) supported best practice models for health workforce development. RESULTS: The agreed framework consists of 25 items structured in 4 domains of capabilities. Content covers the understanding about frailty, skills for screening and assessment as well as management procedures for every profession involved. The majority of items focused on interprofessional collaboration, communication and person-centred care planning. DISCUSSION: This framework facilitates clarification of professionals' roles and standardizes procedures for cross-sectional care processes. Despite a lack of evidence for educational interventions, health workforce development remains an important aspect of quality assurance in health care systems. CONCLUSIONS: The multi-professional capability framework for frailty prevention and management incorporated interprofessional collaborative practice, consistent with current recommendations by the World Health Organization, Science Advice for Policy by European Academies and the European Commission.

Abstract Cardio-oncology is a rapidly growing field of cardiovascular (CV) medicine that has resulted from the continuously increasing clinical demand for specialized CV evaluation, prevention and management of patients suffering or surviving from malignant diseases. Dealing with CV disease in patients with cancer requires special knowledge beyond that included in the general core curriculum for cardiology. Therefore, the European Society of Cardiology (ESC) has developed a special core curriculum for cardio-oncology, a consensus document that defines the level of experience and knowledge required for cardiologists in this particular field. It is structured into 8 chapters, including (i) principles of cancer biology and therapy; (ii) forms and definitions of cancer therapy-related cardiovascular toxicity (CTR-CVT); (iii) risk stratification, prevention and monitoring protocols for CTR-CVT; (iv) diagnosis and management of CV disease in patients with cancer; (v) long-term survivorship programmes and cardio-oncology rehabilitation; (vi) multidisciplinary team management of special populations; (vii) organization of cardio-oncology services; (viii) research in cardio-oncology. The core curriculum aims at promoting standardization and harmonization of training and evaluation in cardio-oncology, while it further provides the ground for an ESC certification programme designed to recognize the competencies of certified specialists.

BACKGROUND AND PURPOSE: To explore the prevalence, risk factors, time correlation, characteristics and clinical outcome of dural arteriovenous fistulas (dAVFs) in a cerebral venous thrombosis (CVT) population. METHODS: We included patients from the International CVT Consortium registries. Diagnosis of dAVF was confirmed centrally. We assessed the prevalence and risk factors for dAVF among consecutive CVT patients and investigated its impact on clinical outcome using logistic regression analysis. We defined poor outcome as modified Rankin Scale score 3-6 at last follow-up. RESULTS: dAVF was confirmed in 29/1218 (2.4%) consecutive CVT patients. The median (interquartile range [IQR]) follow-up time was 8 (5-23) months. Patients with dAVF were older (median [IQR] 53 [44-61] vs. 41 [29-53] years; p < 0.001), more frequently male (69% vs. 33%; p < 0.001), more often had chronic clinical CVT onset (>30 days: 39% vs. 7%; p < 0.001) and sigmoid sinus thrombosis (86% vs. 51%; p < 0.001), and less frequently had parenchymal lesions (31% vs. 55%; p = 0.013) at baseline imaging. Clinical outcome at last follow-up did not differ between patients with and without dAVF. Additionally, five patients were confirmed with dAVF from non-consecutive CVT cohorts. Among all patients with CVT and dAVF, 17/34 (50%) had multiple fistulas and 23/34 (68%) had cortical venous drainage. Of 34 patients with dAVF with 36 separate CVT events, 3/36 fistulas (8%) were diagnosed prior to, 20/36 (56%) simultaneously and 13/36 after (36%, median 115 [IQR 38-337] days) diagnosis of CVT. CONCLUSIONS: Dural arteriovenous fistulas occur in at least 2% of CVT patients and are associated with chronic CVT onset, older age and male sex. Most CVT-related dAVFs are detected simultaneously or subsequently to diagnosis of CVT.

Abstract The name chlorocruorin was given by Ray Lankester (1867) to a pigment dissolved in the blood plasma of Sabellid, Serpulid and Chlorhæmid polychæte worms. Lankester showed that chlorocruorin is related to hæmoglobin, since he obtained a hæmochromogen from it. The pigment is burgundy-red when in concentrated solution, green when dilute. It will be shown below that while chlorocruorin is constructed on the same plan as hæmoglobin, the differences between the two are very much greater than the differences between specific hæmoglobins. Chlorocruorin exists in an oxidised and a reduced state which are of almost the same colour. The reduced form in dilute solution is a slightly yellower green than the oxidised. The oxidised differs, however, spectroscopically from the reduced form in the same manner as oxyhæmoglobin differs from hæmoglobin. Oxychlorocruorin has two bands in the red-green part of the visible spectrum and reduced chlorocruorin one broader one. These bands are situated to the red of the corresponding hæmoglobin bands. Chlorocruorin like hæmoglobin, can act as a peroxidase (Lankester, 1870).

The mechanism of action of the beta-adrenergic blocking agents in the management of hypertension has not been fully elucidated. Of a group of 20 patients with varying grades of hypertension treated with prindolol, 18 appeared to respond well, and two not at all. Fourteen of the original group of 20 were submitted to a double-blind trial. Results were significant in favour of the active agent, and indicate that prindolol is a useful agent in the management of mild to complicated hypertension when used alone.

Objectives: Launched in 1989, the Scottish Motor Neuron Disease Register (SMNDR) has provided a resource for prospective clinical data collection. However, in 2015 we aimed to evolve a system to allow: i) A patient-centered approach to care based on recognized standards, ii) Harmonized data sharing between Scottish health professionals in “real-time”, iii) Regular audit of care to facilitate timely improvements in service delivery, and iv) Patient participation in a diverse range of observational and interventional research studies including clinical trials. Methods: We developed a standardized national electronic data platform—Clinical Audit Research and Evaluation of MND (CARE-MND) which integrates clinical audit and research data fields. Data completion pre- and post-CARE-MND were compared, guided by recently published National Institute for Clinical Excellence (NICE) recommendations. Statistical difference in data capture between time periods was assessed using Z-test of proportions. Results: Data field completion for the historical 2011–2014 period ranged from 4 to 95%; median 50%. CARE-MND capture ranged from 32 to 98%; median 87%. 15/17 fields were significantly more complete post-CARE-MND (p < 0.001). All MND nurse/allied health specialists in Scotland use the CARE-MND platform. Management of MND in Scotland is now coordinated through a standardized template. Conclusions: Through CARE-MND, national audits of MND care and interventions have been possible, leading to protocols for harmonized service provision. Stratification of the MND population is facilitating participation in observational and interventional studies. CARE-MND can act as a template for other neurological disorders.

Summary Asthma and allergic rhinitis in farmers has been shown to be associated with the large numbers of ‘storage mites’ present in stored hay (Cuthbert et al. , 1979). During the year July 1977 to June 1978, studies were undertaken to compare the IgE levels to specific storage mites in the sera of five farming and one control subject, with the numbers of mites present in their hay. Samples of hay were collected at monthly intervals and the total number of mites per gram of hay in each sample recorded. Species were identified and approximate estimates of the number of two of these, Tyrophagus longior and Acarus farris , were made for two of the farms Crook and Queenalia, respectively. Blood samples were also taken at monthly intervals from all the subjects and assayed by radioallergosorbet test for specific IgE to five storage mite species and to the house‐dust mite ( Dermatophagoides pteronyssinus ). Mite numbers, both in respect of total counts and specific estimates, showed a rapid increase to a peak during the month of October with a subsequent fall in November and a partial recovery in December, after which numbers tended to even out. Only two of the farmers showed consistently raised levels of specific IgE to any of the storage mite species and these tended to follow the fluctuations of the mite numbers during the months to January 1978, after which one farmer (J.M. from Crook) showed a fall in his positive IgE titre to T. longior , whilst the other (W.W. of Queenalia) who was positive to A. farris showed a sudden rise in titre to this species. High titres to the house‐dust mite ( D. pteronyssinus ) were recorded in the sera of three of the farmers. One farmer (J.M.) whilst giving a persistently high titre of IgE to T. longior , gave only a low one of less than twice normal to Tyrophagus putrescentiae , demonstrating a specificity of sensitization to the more commonly occuring of two of the species of a single genus.

Indicative prescribing amounts, and the equivalent prescribing element of funds in the case of fund-holding practices, are now an established part of UK general practice. This paper examines the implications of variations in GP prescribing behaviour for the determination of prescribing budgets. Using regression analysis, the extent to which variations in total practice prescribing costs can be explained by factors suggested for inclusion in a weighted capitation formula is established. The results indicate that 97% of the variation in practice prescribing costs can be explained by differences in practice list size, the proportion of patients aged 65 years and over, the proportion of patients living in 'deprived areas' and whether or not the practice qualifies for 'inducement payments'. The implications of the results for budget setting are discussed. A resource allocation formula based on regression analysis of expenditures can be used to promote horizontal equity in terms of equal budgets for equal need. However, its implications for vertical equity and efficiency are more ambiguous.

To determine the most effective way of monitoring glucose levels as an indicator of glycaemic control in people with type 2 diabetes in the community, we conducted a criteria-based review of randomized controlled trials and systematic reviews of randomized controlled trials that studied the efficacy of various glucose monitoring strategies. We searched the Cochrane Library, Medline, Embase, CINAHL and BNIPlus databases for relevant studies. The journals 'Diabetes', 'Diabetic Medicine', 'Diabetologica', 'Evidence-Based Medicine' and 'Evidence-Based Nursing' were hand searched. The outcome of interest was glycaemic control, as measured by glycated haemoglobin (HbA(1c)). A total of 642 titles were identified from the search; three studies answered the question criteria and only one study met all the quality criteria. The study that met the criteria was a systematic review of four trials measuring the efficacy of self-monitoring of glucose levels. The reduction in HbA(1c) in those who monitored glucose levels was estimated to be -0.25% (95% Cl -0.61 - +0.10). This result shows a small improvement, but it is not statistically significant. A meta-analysis was also performed on three studies (n=278) comparing HbA(1c) in subjects who performed blood glucose monitoring with those who performed urine monitoring. The reduction in HbA(1c) when monitoring blood glucose rather than urine glucose was -0.03% (95% Cl -0.52 - +0.47). This result is not statistically significant. The efficacy of blood and urine glucose monitoring testing, for people with type 2 diabetes, in improving glycaemic control as measured by HbA(1c) levels is still questionable. A rigorous randomized controlled trial is needed to establish these answers although there is no evidence of harm. Clinical protocols that make recommendations for glucose monitoring strategies for people with type 2 diabetes should acknowledge that the evidence is weak. There is no basis to recommend one method above another.

The management of dental patients taking either antiplatelet medication, anticoagulant medication or both has been well established in the previous literature. Recently, new generations of drugs have emerged which are becoming increasingly common, including direct thrombin inhibitors, factor X inhibitors and a new class of oral thienopyridines. The implications of these drugs for the dental surgeon are not yet fully known. Awareness remains low and there is very little information available within the literature on safe use during surgery. This review paper aims to provide some guidance for dental practitioners performing invasive procedures. CPD/CLINICAL RELEVANCE: A new generation of anticoagulant and antiplatelet drugs have serious implications for patients undergoing surgery and their use is increasing.

Scapa Flow in Orkney is one of the major world centres for wreck diving. Because of the geography of Orkney and the nature of the diving, it is possible to make relatively accurate estimates of the number of dives taking place. The denominator of dive activity allows the unusual opportunity of precise calculation of accident rates. In 1999, one in every 178 sports divers visiting Orkney was involved in a significant accident, in 2000 the figure was one in 102. Some of these accidents appear to have been predictable and could be avoided by better education and preparation of visiting divers.

No undergraduate or postgraduate programmes currently exist for the professional education of informal educators. The authors outline the development of previous programmes and consider the emergence of informal education as a discrete concept. The article then highlights some key failings in the professional education of informal educators and outlines some changes in the orientation and content of programmes.

Summary Fifty farming families on the mainland (the largest island) of Orkney were surveyed to assess the amount of allergic respiratory disease and the principal causative factor. This account deals with only type I allergy and demonstrates a prevalence of asthma and rhinitis of 17.3% and of extrinsic asthma and rhinitis, in which definite allergic causes can be identified, of 12.7%. In addition it is shown that over one‐fifth of the farming community are ‘atopic’ in that they demonstrate positive prick tests to one or more allergens. Less than 50% of those with allergic respiratory disease have attended the doctor with their complaint, a fact which calls in question the validity of epidemiological studies of allergic disease based on hospital and clinic attendances. Sex distribution confirms the finding that males suffer from asthma more frequently than females, however more females than males give positive skin tests without exhibiting symptoms of allergy. Pollens, animal danders and fungi all have a part to play in the aetiology of asthma and rhinitis among Orkney farmers, although the incidence of grass pollenosis is well below average. The two commonest allergens are hay dust and Dermatophagoides pteronyssinus which are found frequently to affect the same subject.

The sediment microbiome is a demographically diverse and functionally active biosphere. Ensuring that data acquired from sediment is truly representative of the microbiome is critical to achieving robust analyses. Sample storage and the processing and timing of nucleic acid purification after environmental sample extraction may fundamentally affect the detectable microbial community and thereby significantly alter resultant data. Direct sequencing of environmental samples is increasingly commonplace due to the advent of the portable Oxford Nanopore MinION sequencing device. Here we demonstrate that storing sediment subsamples at - 20 °C or storing the cores at 4 °C for 10 weeks prior to analysis, has a significant effect on the sediment microbiome analysed using sedimentary DNA (sedDNA), especially for Alpha-, Beta- and Deltaproteobacteria species. Furthermore, these significant differences are observed regardless of sediment type. We show that the taxa which are predominantly affected by storage are Proteobacteria, and therefore recommend on-site purifications are performed to ensure an accurate representation of these taxa are observed in the microbiome. Comparisons of sedimentary RNA (sedRNA) analyses, revealed substantial differences between samples purified and sequenced immediately on-site, samples that were frozen before transportation, and cores that were stored at 4 °C prior to analysis. Our data therefore suggest that a more accurate representation of the sediment microbiome demography and functionality may be achieved by environmental sequencing as rapidly as possible to minimise confounding effects of storage.

INTRODUCTION: Olfactory dysfunction (OD) is a common symptom of COVID-19. In some patients, OD persists for many months, fluctuates during recovery or parosmia may occur. Knowledge about the prognosis of these patients is insufficient. METHODS: Data on chemosensory function and possible prognostic factors were collected through a baseline questionnaire and six follow-up questionnaires answered at 2-3-month intervals. RESULTS: One year after onset of OD, 42.0% of the respondents reported sustained complete recovery, 41.7% reported partial recovery and 2.4% reported no improvement of olfaction. Follow-up was unavailable for 13.9%. Parosmia, high severity of OD and female sex were associated with lower rates of recovery. Subjects who reported that OD had a high impact on their quality of life were less likely to recover within one month. Smoking, alcohol habits, BMI and physical activity were not associated with persistence of OD. CONCLUSIONS: High recovery rates were reported within the first months. Recovery of sensory function after more than six months with no prior improvement was reported. After one year, 97.1% of participants with at least one year of follow-up had reported at least some recovery. Recurring OD after initial complete recovery was reported by 24.5% of participants. Parosmia and severity of OD were associated with prolonged recovery rates. FUNDING: AF received research funding from Velux Fonden. The sponsors had no say nor any responsibilities in relation to the study. TRIAL REGISTRATION: not relevant.

RÉSUMÉ La législation, dans de nombreuses juridictions, nécessite les établissements des soins de longue durée (SLD) d'avoir une infirmière en service 24 heures par jour, 7 jours par semaine. Bien que la recherche considérable existe sur l'intensité SLD de la dotation en personnel infirmier, il n'existe pas de la recherche empirique relative à cette exigence. Notre étude rétrospectif d'observation a comparé des installations en Saskatchewan avec 24/7 RN couverture aux établissements offrant moins de couverture, complétées par divers modèles de dotation des postes de nuit. Les ratios de risque associés à moins de 24/7 couverture RN complété de la dotation infirmière autorisé de nuit, ajusté pour l'intensité de dotation en personnel infirmier et d'autres facteurs de confusion potentiels, étaient de 1,17, IC 95% [0,91, 1,50] et 1.00, IC à 95% [0,72, 1,39], et avec moins de couverture 24/7 RN complété avec soin par aides personnels de nuit, les ratios de risque étaient de 1,46, IC 95% [1,11, 1,91] et 1,11, IC 95% [0,78, 1,58], pour les patients hospitalisés et de visites aux services d'urgence, respectivement. Ces résultats suggèrent que l'utilisation des soins de courte durée peut être influencée négativement par l'absence de la couverture 24/7 RN.