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Epilepsy and catalepsy in Anglo-American literature between romanticism and realism: Tennyson, Poe, Eliot and Collins.

Epilepsy and catalepsy were not clearly separated in the minds of people in the early 19th century, and catalepsy may have been used as a diagnostic euphemism for epilepsy. Tennyson, in "The Princess" describes, under the diagnosis of catalepsy, probable temporal lobe epileptic dreamy states with derealization which serve as a metaphor of sexual and moral ambivalence, the poem's central theme. It seems that Tennyson knew such seizures from his own father who had been given a diagnosis of catalepsy. Poe gave his Berenice in the novella of the same title a diagnosis of epilepsy as a reason for a premature burial. However, there was a good deal of unlikelyhood in this, and when he came to this theme in "The Fall of the House of Usher" and in "The Premature Burial" he chose instead a diagnosis of catalepsy which fitted better with the plot. The fits of the title character in George Eliot's Silas Marner, diagnosed as catalepsy, would today rather be seen as epileptic twilight states. It would seem that this author drew from contemporary dictionary descriptions which described conditions similar to Marner's fits under the heading of catalepsy. In Eliot's "legend with a realistic treatment", the twilight states are a central factor in the plot and explain Marner's reclusion and passivity. In Poor Miss Finch by English realist Wilkie Collins, the post-traumatic seizures of Oscar, one of the main characters, their cause, their treatment with silver nitrate, and the subsequent discoloration of his skin are central supporting elements of a perfectly constructed plot. Collins gives an exact description of a right versive seizure with secondary generalisation, and how to deal with it. In none of these works seizures are seen in a negative light. They rather evoke reactions of sympathy and support.

Catalepsy↗

Iatrogenic symptoms associated with a therapy cult: examination of an extinct "new psychotherapy" with respect to psychiatric deterioration and "brainwashing".

In 1982, the first and only discussion of psychotherapy cults appeared in the literature. Temerlin and Temerlin (1982) studied five "bizarre" groups which were formed when five practitioners of psychotherapy simultaneously served as friends, lovers, relatives, employers, colleagues, and teachers, all to patients who were themselves mental health professionals. In choosing the term "psychotherapy cult," the authors have noted similarities of the groups they reviewed to some religious cults, citing the three definitions of the "cult" in Webster's 1966 Third New International Dictionary: (1) a system for the cure of disease based on the dogma, tenets or principles set forth by its promulgator to the exclusion of scientific experience or demonstration, (2) great or excessive dedication to some person, idea or organization, (3) a religion or mystic regarded as mysterious or unorthodox. The psychotherapy cults studied by Temerlin and Temerlin varied from 15 to 75 mental health professionals held together by their idealization of a shared therapist and the activities which they conducted jointly: workshops, seminars, courses, businesses, professional ventures, and social life. As patients became more involved in the social and personal life of their therapists, they gradually withdrew from all friends and family, becoming increasingly dependent on the therapist and their new "siblings." Upon joining the group, many patients felt a sense of being loved and belongingness. The authors described the "cognitive pathology" of idiosyncratic group jargon which served to maintain an illusion of knowledge, sophistication, and personal growth, while removing all ambivalence and uncertainty. The authors concluded that psychotherapy cult membership is an iatrogenically determined negative effect of psychotherapy. Of the former cult members they interviewed, most had perceived themselves as deteriorating or at an impasse, or had experienced disillusionment with their therapists; however, they were unable to terminate unilaterally because of a pathological symbiosis with the group. This paper focuses on a now defunct school of psychotherapy which had both much in common with these psychotherapy cults and several contrasting qualities. First, the school was officially led by a junta of psychotherapists, in a deliberate attempt to avoid any taint of a personality cult. Second, the group of patients and therapists was far larger than any referred to in the original study. Third, most patients were not mental health professionals. Fourth, liberal usage was made of many novel techniques identified with the California psychotherapy scene.

Adult↗

Gender: history, theory and usage of the term in sexology and its relationship to nature/nurture.

A person's sexual status is conventionally defined on the criterion of the external sex organs, and this criterion is presumed to be concordant with the other criteria of sex. When the sex organs are deformed, as in hermaphroditism, or mutilated, their sex role is to some extent affected, whereas all the other manifestations of the person's masculinity or femininity may be intact. Gender, not sex, is the umbrella term which refers to the totality of masculinity/femininity, genital sex included. Gender role and gender identity are two sides of the same coin, gender-identity/role (G-I/R). G-I/R may differentiate to be discordant with one or more of the basic sex variables which are now listed in the definition of sex in Dorland's Medical Dictionary. G-I/R is the product not of either nature or nurture acting alone, but of both in interaction at crucial periods of developmental differentiation. The new paradigm is nature/crucial-period/nurture, not nature/nurture. Social scientists and sexologists are among those who, for the most part, have not made the paradigm shift.

Animals↗

Curriculum or syllabus: which are we reforming?

Although the concept of 'curriculum' is complex, a common understanding of the term by those involved in medical education is essential, given the current climate of medical curriculum development and reform. It has not previously been established that such a common frame of reference exists. We polled a sample of medical educators with a range of teaching experience and responsibility in an attempt to discover what they understood by 'curriculum' (and whether or not the concept could be articulated). A sample of medical students was similarly polled. In total, 85% of staff and 34.9% of the students responded. The responses obtained were subjected to a content analysis. The answers received were polythematic in 87.5% of cases, dominant themes including 'curriculum as a syllabus', 'curriculum as a meta-syllabus', and 'curriculum as a means to an end'. Our data show that the nature of curriculum is complex and does not lend itself to dictionary-style definitions. Moreover, the majority of those polled view 'curriculum' in two-dimensional terms, tending to equate it to 'syllabus'. This may have significant implications for curriculum reform.

Journal Article↗

History, present status and future of sentinel node biopsy in breast cancer. The Mary Béves Lecture.

The word Sentinel' is defined in The Oxford English Dictionary as 'a guard, one who keeps watch or a sentry'. When translated to the concept of a tumour and its lymph node drainage, the sentinel node could be interpreted to mean the lymph node that guards or keeps watch over a tumour. The sentinel lymph node can thus be defined as the first lymph node that drains a primary tumour within the regional lymphatic basin of that tumour. We know that tumour progression in breast cancer often occurs in an orderly, progressive fashion. So in theory, if the sentinel node is tumour free then the rest of the nodes in the lymphatic basin should also be uninvolved by the tumour.

Biopsy↗

Dactylitis, a term for different digit diseases.

Dorland's Illustrated Medical Dictionary gives the following definition of dactylitis (deltaalphachitauupsilonlambdaomicronsigma = digit): 'inflammation of a finger or toe'. Although any inflammatory process involving the fingers or toes may be called dactylitis, the term has entered in current use only in some well-defined entities. These differ in the involved tissue of the digit and in the type of involvement. Tuberculous dactylitis is the variant of tuberculous osteomyelitis affecting the short tubular bone of the hands and feet. Radiographs typically show a central, lytic, cystic, and expansive lesion known as spina ventosa. Syphilitic dactylitis is a manifestation of congenital syphilis. Radiological findings mimic those of tuberculous dactylitis but the involvement is bilateral and symmetric. Sarcoid dactylitis is due to typical non-caseating granulomas invading the phalanges and the adjacent soft tissue. Blistering distal dactylitis is an infection of the anterior fat pad on the volar surface of the distal portion of a single finger or more rarely a toe, mostly caused by group A beta-haemolytic streptococci. Sickle cell dactylitis, also known as 'hand-foot syndrome', is due to localized bone marrow infarction of the carpal and tarsal bones and phalanges. Spondyloarthritis dactylitis, also called 'sausage-like' digit, is a diffuse painful swelling of the fingers and toes. Recent ultrasonography (US) and magnetic resonance imaging (MRI) studies on both finger and toe dactylitis have established that dactylitis is due to flexor tenosynovitis and that the enlargement of the joint capsule is not an indispensable condition for the 'sausage-like' feature. There is no evidence of enthesitis of flexor digitorum tendons and joint capsule.

Fingers↗

Classification of dermal patterns on the proximal sole.

A classification formula which includes all true patterns on the proximal sole and is based on topological principles is presented. The frequencies of all respective pattern elements were obtained from a sample of 219 healthy individuals of Croatian origin (116 males and 103 females) and all the formulae (total patterns) encountered in this sample are listed in a dictionary form. Examples of the whole configurations are also given and the applications of the topological formula, combining all patterns on the plantar surface, in studies of normal or abnormal variation of a system of parallel ridges, are indicated.

Child↗

Beliefs, practices, and experiences of Korean women in relation to childbirth.

Korean women's health beliefs and childbirth experiences in the United States were examined. A convenience sampling procedure was used, and face-to-face interviews were conducted in Korean. Interviews were audiotaped, typed, and translated from Korean to English. These women had a holistic concept of health. Some practices were influence by ancient Chinese medicine. Childbirth experiences indicated that language is a barrier requiring specific interventions. Recommendations include (a) development of an assessment tool with which health-care professionals can identify individual health beliefs early in pregnancy; (b) development of a bilingual pamphlet about medical terms and the U.S. health-care system; (c) development of a short bilingual dictionary of common foods for use in menu selection during hospitalization; and (d) provision of English practice periods based on anticipatory guidance principles to prepare women to ask for specific assistance.

Adult↗

Altruistic cell suicide in relation to radiation hormesis.

The high radiosensitivity to killing of undifferentiated primordial cells (Bergonié and Tribondeau 1906) can be described as a manifestation of the suicide of injured cells for the benefit of an organism as a whole if their suicide stimulates proliferation of healthy cells to replace them, resulting in complete elimination of injury. This process is called cell-replacement repair, to distinguish it from DNA repair which is rarely complete. 'Cell suicide', 'programmed death' and 'apoptosis' are terms used for the same type of active cell death. Cell suicide is not always altruistic. Altruistic suicide in Drosophila, mice, humans, plants, and E. coli is reviewed in this paper to illustrate its widely different facets. The hypothesis that in animals, radiation hormesis results from altruistic cell suicide is proposed. This hypothesis can explain the hormetic effect of low doses of radiation on the immune system in mice. In contrast, in plants, radiation hormesis seems to be mainly due to non-altruistic cell death. HORMESIS--'the stimulating effect of small doses of substances which in larger doses are inhibitory' (British Medical Dictionary, Caxton Publ. Co., 1961).

Animals↗

A new bioactive flavone glycoside from the seeds of Melilotus indica All.

Melilotus indica All. [Chopra, R.N., Nayar, S.L. and Chopra, I.C. (1956) Glossary Indian Med. Plants, 164 C.S.I.R. Publication New-Delhi; Kirtikar, K.R. and Basu, B.D. (1935) Indian Medicinal Plants, 2nd Ed., Vol. I, pp. 703-704 Lalit Mohan Basuan Co. Allahabad. The Wealth of India (1962) A Dictionary of Raw Materials and Industrial Products, Vol. VI, pp. 329-331 (C.S.I.R. Publication: New-Delhi)] belongs to family Leguminosae, which is commonly known as 'Banmethi' in Hindi. It is found in North India, extending into S. Persia, S. Europe and the Tropical zone of India. The seeds are used as an anthelmintic, an antipyretic, for curing heart diseases, bronchitis, leprosy, bowel complaints and infantile diarrhea. The plant has also been used as a discutient, emollient, and as a fomentation. It is also useful in a plaster for swelling. It is considered astringent and narcotic. Earlier workers have reported the presence of C-glycosides [Sayed, E.L., Ishak, M.S. and Mabry, T.J. (1997) Asian J. Chem., 9, 551], methylene-dioxypterocarpan (MIS6) [Saxena, V.K. and Nigam, S. (1997) Fitoterapia, 68, 343-345], pterocarpane (MIS2) [Saxena, V.K. and Nigam, S. (1996) J. Institution Chem. 68, 122-125] and prenylated pterocarpan [Saxena, V.K. and Nigam, S. (1997) Fitoterapia, 68, 403-407] from this plant. Here, we report the isolation of the new flavone glycoside 5,7,4'-trihydroxy-6,3'-dimethoxyflavone-7-O-alpha-L-arabinopyranosyl(1-->6)-O-beta-D-galactopyranoside (1) from the seeds of this plant.

Flavones↗

The development of a prototype database for the voluntary reporting of occupational exposure data on chemicals.

A prototype occupational exposure database was developed as part of a study to retrospectively collect chemical exposure data from U.K. industry. The data dictionary for the database was constructed using existing recommendations on core data elements developed by working groups from the ACGIH and the European Union. The study also made use of existing job and workplace coding schemes. The practicalities of gathering the data by voluntary donation, its storage in a database, and the transfer of suitably anonymised data to the U.K. Health and Safety Executive's National Exposure Database system were investigated and assessed. Prior to the development, several existing exposure database systems were evaluated for their suitability to store the data from the study. Though of high quality, these were found to be insufficiently flexible for the diversity of datasets encountered and so the prototype exposure database was constructed using a leading database development package. The database was successfully used to gather data and forward it in a suitable format to the U.K. Health and Safety Executive. The published recommendations on occupational exposure databases and the associated coding schemes provided a very useful foundation for designing and implementing the prototype database. However, as data collection proceeded it became clear that the existing recommendations often were poorly understood and misinterpreted, or at least interpreted differently, by different database designers, data collectors, and other users of occupational exposure data. It is suggested that several items in the ACGIH and European Union core recommendations are ambiguous and need to be clarified. Once agreed, the improved database design criteria need to be widely promoted to foster a common understanding and to encourage their use by all those involved in collecting occupational exposure data. Beyond this, recommendations for exposure databases should be augmented to facilitate easy exchange of data between organizations.

Databases, Factual↗

Reproducibility of survey results from a study of occupation-related respiratory health in the aluminum industry.

Confidence in dose-response relationships arising from occupational studies is dependent upon the reliability and validity of relevant exposure and morbidity estimates. Often self-reported occupational histories are a surrogate for direct exposure measures, and self-report of symptoms serves a similar purpose in place of more objective measures of morbidity. Unfortunately, there are few methods for validating either of these sources of information. This study attempts to evaluate the reproducibility of a survey instrument, and resulting cumulative exposure estimates, utilized in a study of work-related respiratory morbidity in the aluminum industry. The survey instrument comprised measures of pulmonary function, atopic status, smoking, occupational history, and respiratory symptoms. A Task Exposure Matrix was used to estimate exposure categories and cumulative exposure scores. Two groups of employees were administered the survey instrument on two separate occasions. Group A (n = 74) completed their two surveys more than ten weeks apart and Group B (n = 43) completed their surveys less than two weeks apart. Reproducibility was assessed using Cohen's Kappa for categorically measured outcome measures and intraclass correlation coefficients for continuously measured outcomes. Agreement across most variables, for both groups, was generally high. Repeatability of self-reported respiratory symptoms ranged from 70 to 98 percent (Group A) and 88 to 100 percent (Group B). Cumulative exposure scores were highly reproducible, despite some discrepancies in the self-reported occupational histories across interviews, with most of the calculated intraclass r scores exceeding 0.8. These results give strength to studies reporting dose-response relationships derived from similarly collected data. Reproducibility of the survey data was enhanced by use of standardized questionnaire material, consistent interview structure, and calibrated equipment for objective observation. In particular the authors recommend use of a company job dictionary to optimize reproducibility of self-reported occupational information.

Adult↗

Advancing disaster epidemiology and response: developing a national disaster-victim database.

BACKGROUND: The need to further disaster preparedness has resulted in a call for more comprehensive disaster research. Past disaster research has, for the most part, been limited by the inability to obtain complete medical data from victims of disasters. A national disaster-victim database (NDVD) can be developed that will facilitate collection and aggregation of disaster-victim medical data from health care facilities. Three aspects of the NDVD are discussed: DATA REQUIREMENTS: Medical records of disaster victims must be standardized before being uploaded from various databases into the NDVD. Existing data dictionaries provide formats in which data elements can become standardized. Once standardized, data sets from different facilities can be pooled and subjected to analyses. Database System. The three tiers of the NDVD system are: 1) medical data are collected at the point of care, 2) medical data are entered into databases and converted into a specific format, and 3) formatted data sets are uploaded to the NDVD. In order for this system to be viable, it must not add burden to health care workers; rather, it must benefit them and their facilities. REAL-TIME COLLECTION OF MEDICAL DATA: Capturing data on victims of a disaster, during a disaster, is ideal. This would allow for more victim data to be studied as well as for more accurate data to be collected. Technologic advancement has encouraged a real-time data-collection model in St. Louis that can act as a model for NDVD implementation.

Databases as Topic↗

Evaluating state capacity to collect and analyze emergency medical services data.

BACKGROUND: Centralized emergency medical services (EMS) data collection is critical to evaluating EMS system effectiveness, yet a general lack of EMS data persists at local, state, and national levels. OBJECTIVE: To assess state capacity to collect, analyze, and utilize EMS data. METHODS: Information was gathered through state site visits and surveys from 54 states and U.S. territories in spring 2003 regarding EMS data-collection systems. Survey results were used to create 11 broad indicators that assess state data system infrastructure, collection methods, compliance with data standards, and data uses. RESULTS: States and territories on average met 59% of the EMS data system indicators, with four states meeting all 11 indicators and two states meeting none. Seventy-six percent of the states reported having state-level EMS data-collection systems, and 78% reported having authority to collect EMS data. However, most state EMS data sets were not capturing information on all EMS incidents, and only 46% of the states had data dictionaries containing at least three-fourths of nationally recommended EMS data elements. In addition, only 33% of the states had linked EMS data with other health data sets to analyze EMS system operations and patient outcomes. CONCLUSION: While EMS data systems exist in the majority of states, continued attention and resources are needed for state-level EMS data system development to improve capacity for evaluation of emergency medical services.

Data Collection↗

Data base management system for tracking occupational health.

An Occupational Health Information System (OHIS), a data base management system for tracking occupational health, has been developed. A primary feature is its ability to correlate employee workplace environment with health. Hardware implementation of OHIS is on a minicomputer with application programs written in ANSI standard MUMPS language. OHIS integrates personnel, medical and industrial hygiene/toxicology information into one data base. The personnel module is comprised of demographic information collected and updated by the personnel department. The medical module utilizes an interactive video display terminal (VDT)-driven questionnaire and multiphasic testing subsystems which are accessed selectively by authorized users. The backbone of OHIS is a parameter dictionary of all possible data elements. A final medical report includes a medical history summary, physical findings and X-ray interpretation, highlighted and normal test findings, computer interpretations, and a final one-page summary of problem and health-risk information. Information characterizing the workplace environment is captured and reported by the questionnaire subsystem. This questionnaire is designed to define: 1) monitoring conditions, 2) sample analysis, 3) measurement results, and 4) personal protective equipment used. These data provide a means of assigning environmental exposure measurements to appropriate employees.

Adult↗

Classification and naming of dyes, stains and fluorochromes.

A classification of dyes and other colorants is proposed, based on the chemical features responsible for their visibility and generally consonant with the writings of modern color chemists. The scheme differs in several respects from that of the Colour Index (CI), but it retains some traditional small groups of dyes that include biological stains. Natural dyes, recognized as a group in the CI, are placed with or near synthetic dyes with identical or similar chromophores. The new scheme also provides categories for dyes and fluorochromes that do not have places in the CI classification. Some CI categories, including lactones, aminoketones and hydroxyketones, are not recognized in this new scheme, which is adopted in the forthcoming 10th edition of Conn's Biological Stains: a Handbook of Dyes and Fluorochromes for Use in Biology and Medicine. Some rules are also set out for the spelling of trivial names, which has long been inconsistent in scientific literature. The ending '-ine' is used for compounds derived from organic bases (e.g., fuchsine and thionine, not fuchsin or thionin), and names ending in '-in' are for compounds that are not bases or their derivatives (e.g., eosin and phloxin, not eosine or phloxine). Initial capital letters are used only for words that are names of people or places (e.g., Nile blue or Congo red) and for the 'generic' components of CI application names (as in Acid yellow 36). Other words, including trade names that have fallen into common usage are not capitalized (e.g., alcian blue, biebrich scarlet, coomassie blue). The recommended spellings of some dyes differ from those commonly seen in vendors' catalogs and in biological publications, but they are generally consistent with English and American dictionaries, with recent writings in English by color chemists, and with the trivial names of other organic compounds.

Coloring Agents↗

Alcohol and drug abusers' perceived reasons for self-change in Canada and Switzerland: computer-assisted content analysis.

Although many people recover from substance-use associated problems on their own, little is known about this phenomenon. The paper had two objectives: to use a new research method, computer-assisted content analysis, to understand alcohol and drug abusers' perceived reasons for self-change and to undertake a comparative evaluation across substances and cultures to validate previous findings about subjective appraisal processes. Three studies of natural recoveries of alcohol and drug abusers in two countries conducted tape-recorded interviews with 216 respondents. The taped responses were coded based on a content analytic dictionary approach using a computerized content analysis program. All three studies found several processes mediating the decision to change substance use. The computer content analysis confirmed a cognitive appraisal process regardless of the cultural setting or substance. The findings suggest that several procedures might have benefit in clinical interventions.

Behavior, Addictive↗

Performance analysis of manual and automated systemized nomenclature of medicine (SNOMED) coding.

Many pathology departments rely on the accuracy of computer-generated diagnostic coding for surgical specimens. At present, there are no published guidelines to assure the quality of coding devices. To assess the performance of systemized nomenclature of medicine (SNOMED) coding software, manual coding was compared with automated coding in 9353 consecutive surgical pathology reports at the Baltimore Veterans Affairs Medical Center. Manual SNOMED coding produced 13,454 morphologic codes comprising 519 distinct codes; 209 were unique codes (assigned to only one report apiece). Automated coding obtained 23,744 morphologic codes comprising 498 distinct codes, of which 129 were unique codes. Only 44 (.5%) instances were found in which automated coding missed key diagnoses on surgical case reports. Thus, automated coding compared favorably with manual coding. To achieve the maximum performance, departments should monitor the output from automatic coders. Modifications in reporting style, code dictionaries, and coding algorithms can lead to improved coding performance.

Classification↗