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PubMed2002

The wright-giemsa stain. Secrets revealed.

The colorful story of the development of the Wright-Giemsa stain is retold. Dramas are replayed, secrets are exposed, and laurels are properly returned to scientists long forgotten. The delicately balanced chemical composition of the stain, once enigmatic, is defined. Finally, an attempt is made to unshroud some of the mystery surrounding the staining method; tried-and-true procedures and useful snippets of laboratory lore are provided. Scientific explanations and reliable methods aside, however, the stain continues to possess a certain mystique, seemingly consisting of equal parts technical expertise, art, and magic.

Azure Stains↗
PubMed1998

Sexual behaviour and risk assessment of HIV seroconvertors among urban male factory workers in Zimbabwe.

Despite extensive HIV prevention programmes and knowledge of people dying of AIDS, people in Zimbabwe continue to be infected with HIV and other sexually transmitted infections (STIs). This paper presents selected case histories from interviews with 57 men who became HIV positive during follow up of 1678 seronegative male factory workers in Harare, and describes the circumstances in which they were exposed to infection. Youth was a major risk factor, with 47% of those who seroconverted aged between 18 and 24 yr. STIs were reported by 23% of the group in the seroconversion period, a marker of unprotected sex. Individuals did not recognise themselves or their partners as candidates for infection because of categorisation of high risk groups as "promiscuous" or clients of sex workers. Many were optimistic that they had changed sufficiently by using condoms more often or by avoiding sex workers. They made inaccurate assessments of who was safe for unprotected sex, based on judgements about their character, background and age. Over 40% of the seroconvertors had previously been counselled on staying HIV negative. Community approaches which nurture development of supportive group norms, respect for human rights and responsibilities, and safe environments for disclosure of HIV status, are vital for overcoming denial of risk at individual and societal levels. Special efforts targeted at youth are crucial since they have the highest risk of new infections and include use of media, drama, role models, advisory centres, peer education programmes. Health professionals need training and skills to enable people at risk of HIV infection to devise strategies based on more realistic personal risk assessment.

Adolescent↗
PubMed2000

Our sense of Snow: the myth of John Snow in medical geography.

In 1854, Dr. John Snow identified the Broad Street pump as the source of an intense cholera outbreak by plotting the location of cholera deaths on a dot-map. He had the pump handle removed and the outbreak ended...or so one version of the story goes. In medical geography, the story of Snow and the Broad Street cholera outbreak is a common example of the discipline in action. While authors in other health-related disciplines focus on Snow's "shoe-leather epidemiology", his development of a water-borne theory of cholera transmission, and/or his pioneering role in anaesthesia, it is the dot-map that makes him a hero in medical geography. The story forms part of our disciplinary identity. Geographers have helped to shape the Snow narrative: the map has become part of the myth. Many of the published accounts of Snow are accompanied by versions of the map, but which map did Snow use? What happens to the meaning of our story when the determinative use of the map is challenged? In his book On the Mode of Communication of Cholera (2nd ed., John Churchill, London, 1855), Snow did not write that he used a map to identify the source of the outbreak. The map that accompanies his text shows cholera deaths in Golden Square (the subdistrict of London's Soho district where the outbreak occurred) from August 19 to September 30, a period much longer than the intense outbreak. What happens to the meaning of the myth when the causal connection between the pump's disengagement and the end of the outbreak is examined? Snow's data and text do not support this link but show that the number of cholera deaths was abating before the handle was removed. With the drama of the pump handle being questioned and the map, our artifact, occupying a more illustrative than central role, what is our sense of Snow?

Cholera↗
PubMed2001

Increasingly intolerable boundaries: future control of environmental pollution.

In recent years, there have been a number of toxic accidents on the sea and on land which have caused pollution down current, down wind and down stream. Four were dramatic and these four have led to substantial changes in the way we deal with risk to the environment. There have also been increasing concerns about a less spectacular but equally concerning problem, acid rain, though attempts to deal with this problem have been less successful. Perhaps the drama was lacking. In all these cases, unfortunately, the less developed countries can ill afford the costs of prevention and this means they are often the home of environmentally unfriendly development. While the current approaches to such problems will continue, it is likely that the countries on the receiving end of such pollution, especially if they have economic and military power, will seek more forceful solutions. One outcome may be a UN-sponsored environmental police force.

Disaster Planning↗
PubMed2003

Dietary prevention of post-angioplasty restenosis. From illusion and disillusion to pragmatism.

Prevention of restenosis and major cardiac events after percutaneous coronary intervention (PCI) is of enormous public health importance. Despite the considerable decrease in the restenosis rate in relation to the advent of the drug-eluting stents, it is likely that the complication will still occur in some patients and/or after a certain delay. Thus, dietary or systemic drug prevention will probably have a role in the drama in the future, although the way they can be used is not clear at present. This discussion focuses on the dietary approach of post-PCI restenosis because, among the many drugs that have been tested, none has been consistently shown to be helpful--with the exception of the potent antioxidant drug probucol--, whereas the results of several dietary trials have been encouraging. As discussed in the present issue of NMCD, vitamins of the B group were recently shown to decrease the risk of restenosis, supposedly through an effect on homocysteine metabolization. It seems, however, that homocysteine is a minor risk factor of post-PCI restenosis. On the other hand, 5-methyltetrahydrofolate (the active form of folic acid) was shown to improve endothelial function independently from homocysteine. Thus, folic acid could prevent restenosis not only by reducing homocysteine, but also by promoting nitric oxide formation. Because of their potential to prevent post-PCI restenosis and acute cardiac complications, n-3 fatty acids have been the most widely studied post-PCI medical intervention. Taken together, trial data suggest that if n-3 fatty acids can be useful in certain populations to prevent restenosis, their effects are probably weak. However, according to recent studies on endothelial nitric oxide synthase (eNOS) gene polymorphisms, it is likely that only certain patients could benefit from n-3 fatty acid supplementation. The same reasoning can probably apply to the folic acid and eNOS issue. In conclusion, although none has been concluding, the studies about n-3 fatty acids and folic acid after PCI suggest that certain nutrients (or more probably a combination of nutrients) may be useful for the prevention of post-PCI restenosis. Any future trial involving these nutrients should combine them and take into account some major genetic confounders. In the meantime, it is medically and ethically justified to supplement our CHD patients after PCI. They should receive n-3 fatty acids to prevent sudden cardiac death, and B group vitamins (at the dosages tested in the Swiss Heart Study) to decrease the risk of restenosis. This would be, at least, a low cost intervention, and there is no fear of adverse side effects, contrary to those one can expect from drug treatments.

Angioplasty, Balloon, Coronary↗
PubMed2004

The Hours: between safety and servitude.

This paper explores the issue of how character is created and re-created in the context of relationships. This theme, salient in the recent film The Hours, has been particularly problematic for creative women, who are often caught in tensions between self-development and relationship. Two case examples are given, in counterpoint to the film and to illustrations from Woolf's life and work. Through these various lenses, we can consider the complex interplays between our conjectures as to the expected price of relationship, and the actual price exacted as our various dramas unfold.

Character↗
PubMed1993

The vampire as a metaphor for working with childhood abuse.

The characteristics of the vampire legend are compared to those associated with childhood abuse in terms of the role of the abuser and the abused and of the interchange between them. Principles of analytical psychology are used as a template through which the drama of vampire/abuser and victims can be understood, with the vampire representing the negative aspect of the healer archetype.

Adult↗
PubMed2005

Science and technology in Turner's Georgian dentist's rooms.

Turner's painting of a dental surgeon's rooms, discussed in the first of these two papers,(1) is a very satisfying work of art, successful in its relaying of a domestic drama, and also fulfilling Payne Knight's commission to produce a work to equal that of the older masters. It cannot, though, be relied upon to show us what a late Georgian dentist's rooms actually looked like. For this we are very fortunate to have Turner's sketchbook, with its preparatory drawings for the painting.

Dental Equipment↗
PubMed2003

Involving disabled and chronically ill children and young people in health service development.

AIM: To investigate the extent and nature of involvement of physically disabled or chronically ill children and young people in local health service development. METHODS: A postal survey of all health authorities (n = 99) and NHS Trusts (n = 410) in England. RESULTS: Seventy-six per cent of health authorities and 59% of Trusts responded. Twenty-seven initiatives involving chronically ill or disabled children and young people in consultation regarding service development were identified. Over half of these were carried out in partnership between health services and other agencies, usually local authorities and/or voluntary organizations. A variety of methods was used for consultation, including child-friendly methods such as drawing, drama and making a video. Seventeen initiatives reported that children's involvement had resulted in service changes, but only 11 went beyond consultation to involve children and young people in decision making about service development. Only a third of the organizations had someone with designated responsibility for children's involvement. DISCUSSION: The involvement of this group of children and young people in service development in the NHS is at an early stage. The failure of policy documents on user involvement to identify children and young people as a group for whom methods of consultation need to be developed, and the lack of people with designated responsibility for developing children's involvement may be a reason for slow progress in this area. The initiatives identified show that such involvement is possible and can have a positive impact on services.

Adolescent↗
PubMed2001

Drugs in pregnancy. Respiratory disease.

Respiratory illnesses are the commonest cause of patient visits to physicians. Although the common cold, sinusitis and bronchitis may be lacking in drama, they account for a substantial amount of morbidity among women of reproductive age and are frequently encountered by physicians caring for pregnant women. Present knowledge about the management of these common conditions and the safety of the medications often used to treat them are reviewed in this chapter. Asthma and community-acquired pneumonia are more serious respiratory illnesses that are also often encountered in pregnancy. Present evidence suggests that community-acquired pneumonia is best treated empirically, with additional investigation usually necessary only if there is a failure of initial treatment. The recognition of asthma as an inflammatory condition has led to a very specific approach to its management that can readily and safely be applied to the pregnant woman. Treatment of HIV and tuberculosis should not be withheld during pregnancy because of the life-threatening nature of these infections and the importance of preventing vertical transmission.

Acute Disease↗
PubMed2004

[The history of bronchial carcinoma].

Up to the mid 19 (th) century primary bronchial carcinoma was unknown. Primary tumours and metastases of malignant lung tumours were often not distinguished one from the other. Only in 1871, Theodor Langhans from Marburg reported the first certain observation of bronchial carcinoma. Definite information on the increasing frequency of lung and bronchial carcinomas at the beginning of the 20 (th) century was only obtained by autopsy statistics. The Cancer Registry of the Saarland showed that the incidence of lung cancer has not increased since 1970 in men, but has tripled in women. Already in 1923, Theodor Fahr from Hamburg referred to the danger of smoking. In Germany the so-called Schneeberg's lung cancer plays an important role among occupational lung cancer diseases. Only after Germany's reunification the drama of the uranium miners of the former so-called Wismut AG became fully known. Regarding occupational diseases, asbestos-related bronchial carcinomas and mesotheliomas are at the top of the causes of death today.

Asbestos↗
PubMed2006

[The Leipzig Magistrates Court's death sentences in the Woyzeck case].

The trial of Johann Christian Woyzeck for murder is among the most significant for forensic psychiatry in the 19 (th) century. The case gained worldwide fame, not only because of Georg Büchner's eponymous drama. A thorough analysis and reconstruction of the proceedings would allow more light to be shed on one of the major events in the evolution of modern psychiatric positions regarding criminal responsibility. To support this effort, this paper presents two original sources that have just been rediscovered in the archives, and which are of major importance in respect of both the Woyzeck case and the history of forensic psychiatry. Until now only transcripts had been available. The two documents in question relate to the death sentences issued by the Leipzig magistrates court (Schöppenstuhl). They clearly show the ruling feudal and municipal authorities' efforts to exploit both the general rules of procedure as well as the forensic testimony given by Leipzig's medical officer and professor, Johann Christian August Clarus, for their own restorative political interests. This is revealed by the fact, among others, that the legal procedures are interpreted in the narrowest possible way and the crux of the problem, namely the culprit's criminal responsibility, is not really the focus of attention. The defence does not really have a chance, the more so since it makes pleas that are both contradictory and amateurist from a psychiatric point of view. Moreover, its efforts to garner support from reformist forces, above all among scholars, are undermined by the defence team's manipulation of the facts.

Forensic Medicine↗
PubMed2000

Small-bowel perforation in very low birth weight neonates treated with high-dose dexamethasone.

INTRODUCTION: Early postnatal treatment with high doses of corticosteroids may be effective in reducing the duration of mechanical ventilation in very low birth weight infants at risk for bronchopulmonary dysplasia. However, serious side effects may occur. MATERIAL AND METHODS: A retrospective study on 5 very low birth weight neonates, mean (+/- SEM): gestational age range 27.5 +/- 2 weeks, mean birth weight (+/- SEM): 836 g +/- 169 referred between April 1997 and October 1998 from a single academic neonatal intensive care unit to our tertiary pediatric surgical center with the diagnosis of intestinal perforation. During the same period, 60 very low birth weight infants have been treated in that unit following a standardized protocol including surfactant for respiratory distress syndrome and high-dose dexamethasone to prevent bronchopulmonary dysplasia. RESULTS: Pneumoperitoneum was diagnosed between 6 to 9 days after birth. Clinically, all babies remained surprisingly stable. An isolated ileal perforation, without sign of necrotizing enterocolitis, was found at laparotomy in each patient. A limited intestinal resection was performed, with primary end-toend anastomosis (3 cases) or with transient ileostomies (2 cases). Surgical outcome was favorable in all patients. CONCLUSION: isolated intestinal perforation may be a complication of the preventive treatment of chronic lung disease with high-dose corticosteroids in very low birth weight infants. Conversely, corticosteroids may reduce the clinical signs and the multiple organ dysfunction associated with an abdominal drama, explaining the very good surgical prognosis of these newborns. Attention must be paid to an insidious pneumoperitoneum.

Bronchopulmonary Dysplasia↗
PubMed1979

Earth history at the century mark of the U.S. Geological Survey.

Earth history involves all aspects of geological and biological evolution, especially paleontology and stratigraphy. Early paleontological exploration of the western United States by and before the U.S. Geological Survey featured the dramatic discoveries and rivalries of the great vertebrate paleontologists Leidy, Cope, Marsh, and Osborn. Invertebrate paleontology and paleobotany in the U.S. Geological Survey blossomed with emphasis on practical missions. The most illuminating and useful earth history, nevertheless, emerges where there is a high degree of interaction with academic scholars. Despite a good knowledge of its broad features, the drama of earth history remains obscure in detail. Whereas it speaks conclusively for the reality of organic evolution, it is less conclusive about mechanisms and many important transitions. Current investigations, however, especially in pre-Phanerozoic, mammalian, and human paleontology, promise improved insights. New techniques in collecting, sample preparation, and research are revealing previously unknown kinds of fossils and exquisite details of preservation. Plate tectonic theory provides a new framework for historical geography and biogeography. Emerging techniques in geochronology-matching paleopolarity sequences, for example-promise to resolve old problems of the synchroneity or heterochroneity of different biotal provinces. As it splits into subfields, the teaching and practice of paleontology expand to cover all of them. The fossils themselves, however, remain the basic objective evidence. All hypotheses about them must answer to this court of appeal. But nature rarely responds in an either-or way. The most probable hypotheses are those that have repeatedly confronted objective reality and survived all opportunity for disproof.

Journal Article↗
PubMed1997

The placenta and malaria.

Placental malaria is recognized as a common complication of malaria in pregnancy in areas of stable transmission, and is particularly frequent and severe in primigravidae. Many hypotheses, based on a systemic or local failure of the immunological response to malaria, have been proposed to explain the 'preference' of the parasites for replication in the placenta. Some of the hypotheses are briefly reviewed here, with a particular focus on the discovery of an uncommon subpopulation of Plasmodium falciparum which can adhere and massively sequester in the placenta. Histologically, placental malaria is characterized by the presence of parasites and leucocytes within the intervillous spaces, pigment within macrophages, fibrin deposits and trophoblasts, proliferation of cytotrophoblastic cells and thickening of the trophoblastic basement membrane. The exact mechanisms leading to placental changes and determining the observed impairment of materno-foetal exchange are incompletely understood. Parasites are unlikely to be directly responsible for the placental pathology, but leucocytes, through the production of non-chemotactic cytokines, might be associated with the thickening of the trophoblastic basement membrane, and might cause a mechanical blockage of oxygen and nutrient transport across the placenta. There is sound epidemiological evidence that placental malaria determines low birthweight, mainly mediated by intrauterine growth retardation, and increases the risk of death and disease during the first year of life. Antimalarial chemoprophylaxis significantly reduces placental malaria and prevents the development of low birthweight. It is likely that, in areas of high endemicity, the placenta is where the drama of maternal malaria is mostly played. A deeper understanding of the mechanisms involved in this process is of key importance in the design of protective interventions which are effective and acceptable during the gestation period.

Disease Susceptibility↗
PubMed2006

Six players on the inner stage: Using ego state therapy with the medically ill.

The symptoms of medical illness often speak through eloquent, embedded metaphors that express deeper unconscious conflicts and meanings. Therapeutic attunement to the multilayered issues associated with a patient's illness can be instrumental in the uncovering and working through conflicts that may impede both physical and emotional healing. Among hypnotically facilitated psychotherapeutic approaches that can be helpful, ego state techniques offer rapid access to these illness-associated issues. This article discusses six different ego states that are key players in the illness drama for many patients. Five of these are indwelling components of the patient's psyche, whereas the sixth player belongs to the therapist's resonant self. All of them are relevant when the practitioner seeks to facilitate deeper healing in patients with mind/body conditions.

Ego↗
PubMedDate not supplied

Marathon: a life-and-death experience.

Therapists have a great need for techniques capable of provoking change in their clients. Generally, people resist change and need incentives to accomplish it. The tools to effect change are few. Therefore, the value of the theme Marathon experience is that it can be both innovative and piercing. Many clients need to have the drama of their own lives connected to a meaningful plot. The theme Marathon experience can do this. It exerts an influence on the emotional, cognitive and behavioral aspects of the participants and connects their past to the present and future, allowing them to see clearly the futility of a life of chemical dependence.

Death↗
PubMedDate not supplied

Comparison of gender and victim response to violence in popular movies.

The overwhelming statistics of crime against women affect their perceptions and quality of life. The media have a significant effect on both perceptions and behavior. The manner, therefore, in which fictional victims are portrayed could affect perceptions of control in real-life women fearing victimization and in their potential assailants. Popular crime-drama movies and the difference between male and female behaviors were examined in this pilot study. A total of 65 responses were evaluated from a random sample of film videos. Active attempts to gain control were exhibited by 81% of the male responses, whereas only 17% of the women did so, chi 2 (1, N = 65) = 28.99, p less than .001. The relationship of results and myths concerning women as victims is discussed.

Attitude↗