Lewes Victoria Hospital

Abstract In devising methods for determining the velocity of any chemical reaction there are two experimental problems which invariably arise : (1) To arrange that the chemical system under investigation be made initially unstable in a period of time that is negligibly short in comparison with that taken by the chemical reaction. (2) To record from time to time the stages reached by the system (during its passage from the initial unstable state to the final stable condition wherein the several reacting substances are in chemical equilibrium) by means of methods which take a negligibly short time in comparison with that taken by the chemical reaction. A perusal of the literature shows that previous investigators have, in the main, restricted themselves to the study of slow reactions, such as may require many minutes or even hours to reach completion. In such cases, both requirements which we have mentioned can be easily met. For the production of the initially unstable condition can be achieved without difficulty by merely mixing the several reacting substances together in proportions far removed from those which prevail when equilibrium has been attained. The time required by the mixing operation can be reduced to a few seconds, and can therefore be neglected when dealing with a process which may last many minutes or even hours. The slow reactions possess a further attraction, in that the procedure for estimating the concentrations of the several reactants at different stages during the progress of the reaction need not be a hurried one. This permits the use of a wide variety of methods, e. g., polarimetry as in the study of the inversion of sucrose, ordinary titration as in the saponification of esters, and separation of one of the constituents as a gas phase as in the decomposition of diazo-acetic ester by water, i. e., N2. CHCOOC2H5+H2O→OHCH2. COOC2H5+N2 (gas phase).

BACKGROUND: The few studies that have assessed oral health in professional/elite football suggest poor oral health with minimal data on impact on performance. The aim of this research was to determine oral health in a representative sample of professional footballers in the UK and investigate possible determinants of oral health and self-reported impact on well-being, training and performance. METHODS: Clinical oral health examination of senior squad players using standard methods and outcomes carried out at club training facilities. Questionnaire data were also collected. 8 teams were included, 5 Premier League, 2 Championship and 1 League One. RESULTS: 6 dentists examined 187 players who represented >90% of each senior squad. Oral health was poor: 37% players had active dental caries, 53% dental erosion and 5% moderate-severe irreversible periodontal disease. 45% were bothered by their oral health, 20% reported an impact on their quality of life and 7% on training or performance. Despite attendance for dental check-ups, oral health deteriorated with age. CONCLUSIONS: This is the first large, representative sample study in professional football. Oral health of professional footballers is poor, and this impacts on well-being and performance. Successful strategies to promote oral health within professional football are urgently needed, and research should investigate models based on best evidence for behaviour change and implementation science. Furthermore, this study provides strong evidence to support oral health screening within professional football.

Abstract The velocity with which oxygen combines with, and is dissociated from, hæmoglobin is a matter of considerable interest both to the physiologist and the physical chemist; to the former because of the all-important part performed by this compound in respiration, and to the latter because hæmoglobin is an almost unique example of a large complex protein molecule which combines with gases, apparently not by adsorption, but in a simple chemical manner defined by the laws of mass action. There were several preliminary problems which it was necessary for us to solve, before our main experimental investigation could be commenced. Our first major problem was to find some very sudden method of upsetting the chemical equilibrium subsisting between oxygen, hæmoglobin and oxyhæmoglobin in solution. The time taken to upset the equilibrium must be very much shorter than the time taken by the system to regain chemical equilibrium. This problem in the case of the reaction CO+O2Hb⇄O,+COHb was solved by exposing the solution to a powerful beam of light; the latter caused a new position of equilibrium to be taken up, and this could be instantaneously upset by a sudden interruption of the beam of light. The system thereupon returned to its position of dark equilibrium. In order that all parts of the solution shall be passing through the same stages of the resulting reaction it is necessary that the time taken for the equilibrium to be disturbed be of negligible duration compared with that taken for equilibrium to be regained. Unfortunately, a similar method was not open to us in the present case, for the reaction O2 + Hb ⇄ O2Hb is not appreciably, if at all, affected by a powerful beam of light. The factors upon which the equilibrium of this system depends have been very thoroughly studied by Barcroft and his co-workers in recent years (18) ; the principal ones are the temperature, the hydrogen ion concentration and salt content of the solution. Calculations showed that even if we had some very sudden method of changing one or more of these factors, the amount by which the system would be displaced would be too small compared with the experimental error of the quantitative methods available. The plan which we have therefore adopted was to prepare a hæmoglobin solution I and another solution II such that if I and II are very rapidly, but completely, mixed, the solution immediately after mixing is not in chemical equilibrium, but reaches equilibrium after an interval of time which is long in comparison with the time taken up by the process of mixing. Thus as an example we may mention that, in studying the rate of oxidation of hæmoglobin, solution I consisted of dilute reduced hæmoglobin, whilst solution II consisted of water containing sufficient dissolved O2 to combine with the hæmoglobin of I. At the instant after the very rapid mixing of I and II the hæmoglobin is still partially reduced, and by methods to be described later the rate at which it subsequently becomes fully oxidised is measured. For this plan to be successful it was necessary to devise a special type of mixing apparatus, the description and testing of which have already been described in one of our previous papers (2).

Abstract The object of the work described in this paper was to determine the velocity of the reaction CO + O2Hb ⇌ O2 + COHb, in the hope thereby of throwing further light upon the physico-chemical behaviour of hæmoglobin. There are two reasons which make it specially difficult to devise a successful method of making this measurement. (a) The reaction was found by preliminary experiments to be a swift one, lasting not more than a few seconds ; this made it necessary to estimate the respective concentrations of the different reacting substances instantaneously. This puts out of court the usual methods by gas analysis because of the considerable time taken by such methods.

The control of the inflammatory response induced by the implantation of foreign biomaterials is fundamental in determining tissue healing. It has been shown that the activation of specific macrophage pathways upon contact with a biomaterial can lead either to a chronic inflammation preventing a physiological tissue repair or to an improved tissue healing. In the case of bone repair, calcium phosphate cements with good osteoconductivity properties have been successfully applied in bone defect filling and repair, but poor handling properties, insufficient viscous flow and unmatched degradation rate are still problems that remain unsolved. In this study, a strontium-doped hydroxyapatite (HA) gel was modified by integrating branched poly(epsilon-lysine) dendrons with third-generation branches exposing phosphoserine (SrHA/G3-K PS). The interaction of this material with macrophages was investigated in vitro, focusing on the secretion and gene expression of specific pro-inflammatory cytokines. Our results showed that the addition of strontium and G3-K PS to HA sol-gel could down-regulate the gene expression of inflammatory factors such as IL-1β, TNF-α and MCP-1, while increasing the gene expression of IL-6, a cytokine known for its osteogenic effect. These results were further confirmed by ELISA test of the respective protein concentrations. When exposed to supernatants of macrophage culture in the presence of strontium and G3-K PS, osteoblast viability was promoted with elevated osteogenic gene markers, in terms of OPG, ALP, OCN and COL-I. In vivo implantation experiments using an osteoporotic rat model with bone defect further confirmed that the addition of G3-K PS to HA could dramatically promote new bone regeneration. Although the introduction of strontium improved the degradation properties of the injectable materials, no positive effect on promoting in vivo bone regeneration was observed.

Abstract Many experimenters have endeavoured to isolate diphtheria antitoxin from fludis containing it. In 1893 Brieger and Ehrlich (1) investigated the properties of milk obtained from animals which had been immunised against diphtheria toxin. This milk contained an appreciable amount of antitoxin which could be precipitated between 27- and 38-per-cent. ammonium sulphate. By this method they were able to increase the antitoxic value of their fluid about five hundred times. But in milk only two proteins are present which differ widely in their physical properties—caseinogen and lact albumin—and their results could not be extended to horse serum, which is the main source of diphtheria antitoxin. Their experiments did not show that antitoxin is not a protein.

Abstract [This paper is published in Series A, No. 726, October, 1923.]

Abstract These structures were first described by Langerhans in 1869. They have since been found by many observers in the pancreas of every species of mammal, bird, reptile, and amphibian in which they have been looked for. Kühne and Lea first recognised the peculiarly rich plexus of wide blood-capillaries in the islets. As regards their function, they have been regarded as connected with the nervous system, as lymphatic structures, as embryonic remnants, as patches of exhausted or degenerate pancreatic tissue, as furnishing a particular constituent of the pancreatic juice, and as internally secreting ductless glandular tissue, furnishing a substance necessary for normal carbohydrate metabolism, and quite unconnected with the externally secreting function of the pancreas. This last view has received support from many observations of the degeneration or absence of the islets in diabetes, and from the statement of several observers that, after occlusion of the pancreatic duct, the islets remain intact when the ordinary secretory tissue has disappeared.

Although the issues surrounding the introduction of wind energy into electricity networks tend to be controversial, an increasing number of analytical studies suggest that the issues can be addressed at modest cost. This paper first discusses the key characteristics of electricity networks in order to establish the technical framework within which wind operates. Drawing on actual data from western Denmark, it is shown that the additional fluctuations encountered by system operators are measurable – and manageable. The importance of aggregation is emphasised and recent data from the British system operator are used as a basis for an estimate of additional balancing costs with wind energy penetration levels up to 40%. Above a penetration level of about 5%, additional costs are incurred as the ‘capacity credit’ of wind falls, which reduces the load factor of thermal plant. Combining this ‘backup’ cost with the costs of extra balancing, it is suggested that the extra cost to the consumer of wind variability at the 40% level is likely to be around £6/MWh – about 5% of the typical domestic electricity price. Factors that may reduce this extra cost, such as demand-side management and better wind forecasting, are also discussed.

Abstract Although hitherto most physiologists have considered that the pulmonary vessels probably possessed a system of vaso-motor nerves, yet no direct experimental proof of the existence of such a system has been obtained. Still less has any evidence been adduced to demonstrate the actual anatomical paths by which such nerves, if they exist, reach the lungs. Hence it seemed that the whole question was one deserving a further attempt for its solution. When this research was commenced, there were practically only two facts which could be appealed to in support of the existence of these nerves.

Abstract In nineteenth-century London, theater-going was a genuinely mass activity. Within a rapidly expanding entertainment industry, working-class playgoers abounded. Opened to the public in 1818, the Coburg Theatre, later renamed the Victoria and known as the Vic, developed an especially strong association with popular drama. Although much has been written on the kind of work that places like the Vic presented, much less has been said about their operation as plebeian public spheres, or what I term here “radical half-spaces.” Active in the campaign for political reform in the early 1830s, and the site of numerous socially critical melodramas, under the joint managerial team of David Osbaldiston and Eliza Vincent, the Coburg/Victoria would later align itself to Chartism. All the while, the theater continued to function as a profitable commercial enterprise. By showing how audiences at the Vic sought (and found) knowledge and cultural capital, as much as entertainment and spectacle, the article suggests that when considering the period's alternative radical spaces, account should be made of such avowedly populist establishments as London's minor theaters, and the complex assemblages of time, place, and people they represented.

In this descriptive study, the use of a professional e-communication tool, Congredi, is evaluated. Ninety-six Congredi records of patients with dementia could be divided into the subgroups low-complex care (n = 43) and high-complex care (n = 53). If Congredi is an adequate communication tool for professionals, the changing involvement of caregivers must also be reflected within the two subgroups. We hypothesized that use would be more intensive in the high-complex group in comparison with the low-complex group. Data were gathered during 42 weeks. Results showed that the mean number of care activities in the high-complex group was significantly higher than in the low-complex group (10.43 vs 5.61, P = .001). The number of professionals involved with the high-complex care group (3.58) was higher compared to the low-complex care group (2.51) (P = .000). The most frequent use was by case managers and nurses (43.4%) in the high-complex group and by several case managers (41.9%) in the low-complex group. It was concluded that professionals used Congredi adequately in the multidisciplinary care of patients with dementia because the changing involvement of caregivers and the level of care activities were reflected in the use of Congredi.

Abstract The following work was undertaken in order to map out the origin, course, and nature of the renal nerves more accurately than had hitherto been attempted. It was considered (more especially in the light of Gaskell’s well-known work on the sympathetic) important to decide whether the renal and other abdominal vascular nerves were of two kinds, i. e., vaso-constrictor and vaso-dilator, or whether the latter nerves could not be demonstrated to exist. This research was carried out exclusively on the dog, inasmuch as this was the animal used by Gaskell in his work.

BACKGROUND: The World Health Organization declared the outbreak of SARS-CoV-2 a pandemic on February 11, 2020. This organism causes COVID-19 disease and the rapid rise in cases and geographic spread strained healthcare systems. Clinical research trials were hindered by infection control measures discouraging physical contact and diversion of resources to meet emergent requirements. The need for effective treatment and prevention of COVID-19 prompted an untested investigational response. Trial groups adapted approaches using remote enrolment and consenting, newly developed diagnostic tests, delivery of study medications and devices to participants' homes, and remote monitoring to ensure investigator/enrollee safety while preserving ethical integrity, confidentiality, and data accuracy. METHODS: Clinical researchers at our community health system in the USA undertook an outpatient randomized open-label study of hydroxychloroquine (HCQ) prophylaxis versus observation of SARS-CoV-2 infection in household COVID-19 contacts. Designed in March 2020, challenges included COVID-19 infection in the research group, HCQ shortage, and lack of well-established home SARS-CoV-2 tests and remote ECG monitoring protocols in populations naive to these procedures. The study was written, funded, and received ethical committee approval in 4 months and was completed by September 2020 during a period of fluctuating infection rates and conflicting political opinions on HCQ use; results have been published. Singular methodology included the use of a new RNA PCR saliva SARS-CoV-2 home diagnostic test and a remote smartphone-based 6-lead ECG recording system. RESULTS: Of 483 households contacted regarding trial participation, 209 (43.3%) did not respond to telephone calls/e-mails and 90 (18.6%) declined; others were not eligible by inclusion or exclusion criteria. Ultimately, 54 individuals were enrolled and 42 completed the study. Numbers were too small to determine the efficacy of HCQ prophylaxis. No serious treatment-related adverse events were encountered. CONCLUSIONS: Flexibility in design, a multidisciplinary research team, prompt cooperation among research, funding, ethics review groups, and finding innovative study approaches enabled this work. Concerns were balancing study recruitment against unduly influencing individuals anxious for protection from the pandemic and exclusion of groups based on lack of Internet access and technology. An issue to address going forward is establishing research cooperation across community health systems before emergencies develop. TRIAL REGISTRATION: ClinicalTrials.gov NCT04652648 . Registered on December 3, 2020.

SummaryThe results of a multi-centre general practitioner trial of isoxsuprine in cerebrovascular disease suggest that long-term continuous treatment of such disease with isoxsuprine may improve the mental function of patients, as measured by serial Crichton Scale Scoring.One hundred and seventy patients completed the 4-month trial, and the improvement in their mental function was such that many were able to be transferred from the group requiring day hospital care to that in which normal home life could be resumed.

The object of the paper is to urge the establishment throughout the country of institutions for the treatment of nervous cases and of early uncertifiable insanity. The fact of certification leads to an erroneous view of insanity, for it does not make a person insane, nor does the absence of it prove sanity. The boundary line of certification is a purely arbitrary one, and, from the nature of the illness and our present ignorance of it, this is bound to be so. Certification does not necessarily mean that at such a moment a person became mentally upset, but rather that at such a time, after observation showing them not to be responsible for their actions, it became advisable, in the interests of themselves or others, to control them, if required, by force.

Abstract The “fibrin ferment” which makes its appearance in shed blood is generally, I believe, supposed to arise from the cellular elements of blood, either from ordinary white corpuscles or from some special kind of corpuscles, the cells so concerned discharging the ferment into the blood or setting it free by their actual disintegration. Without wishing to deny that this may be one source of fibrin ferment, I am able, I think, to bring forward evidence that ferment may make its appearance in blood-plasma perfectly free from cellular, and indeed from all formed elements, in which case it must arise from some constituents of the plasma itself, and not from cells of any kind. It will be most convenient, perhaps, if I state the facts which I have to bring forward in connexion with two series of experiments.

It’s always unfortunate when any research project fails to deliver the promise in its proposal, but it seems odd for Filippon to rail against the custodian of the nation’s medical histories, the Health and Social Care Information Centre (HSCIC).1 Filippon’s institution could not give the required assurance that it could protect data to the standard the public expects. The …

Purpose The article sheds light on the phenomenon of bullying in the workplace and the need to create truly assertive and inclusive organizations in which business leaders and employees embrace diversity in all they do. Design/methodology/approach The paper presents a framework of assertiveness and diversity, of openness, trust and respect, which can benefit everyone in the workplace. Findings The reveals that a lack of awareness of self and others, and a fear of difference, is the underlying cause of bullying. Practical implications The paper shows that that, by integrating diversity awareness into everything that people do, and valuing people for their “gifts different,” bullying can be tackled. Originality/value The author argues that people change their behavior when given support and encouragement to understand the impact of their behavior on others, and that they can be helped to appreciate their differences and thus build bigger relationships in which more and greater business opportunities are realized.

This paper is an answer to a challenge thrown down by Dr. Urquhart on the occasion of the Annual Meeting of this Association in 1905, when I had the honour of reading a short description of the small hospital we were then opening in Brighton and its raison d'être.