Effect of Preheating on the Permeability of Neonatal Rat Stratum Corneum to Alkanols

We heated flat sheets of neonatal rat stratum corneum for various times at temperatures between 40 and 90°C before determining the permeability coefficient (Kp) of propanol and/or hexanol from water. Below 70°C, Kp remained constant; at 75°C, Kp increased linearly with exposure time; at 80°C and above, there was a large increase in under 2 h, with no further increase on longer heating. There was a 15-fold increase in 6-h Kp between 70°C and 80°C, values being constant above 80°C but at a figure less than for lipid-extracted stratum corneum. Thermal analysis showed that the increase in Kp corresponds to changes in the 80°C lipid endotherm, suggesting that the increased Kp is due to a disordering of the lipid structures. The effect of treating preheated stratum corneum with dimethylsulfoxide (DMSO) vapor for 16h was also studied. Below 70°C, Kp was increased five-fold, but between 70 and 80°C this difference was eliminated, so that above 80°C the Kp was the same as with heat treatment alone. We concluded that both heat and DMSO affect the lipid structures of stratum corneum. DMSO produced a small, reversible structural change, while the effect of heat is irreversible and produces a greater degree of disorder in the lipid structures, but the lipid still contributed to the barrier effect of stratum corneum

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

White House publicity operations during the Korean War, June 1950 – June 1951

Truman was the first modern president to face the challenge of selling a limited war. Based on a wide range of primary sources, this article explores the impact that the Korean War had on Truman’s publicity operations. Whereas all wars place important new demands on presidents to speak out more frequently and forcefully, limited wars place significant constraints on what presidents can say and do. During the Korean War, Truman refused to go public at key moments, often employed rhetoric that was more restrained than at earlier moments of the Cold War, and shied away from creating new structures to coordinate the official message. Such actions also had important consequences. In 1950-51, they hampered the task of effective presidential communication, and contributed to the war’s growing unpopularity. For the longer term, they demonstrated the difficulties of selling a limited war, and hence place into sharper context the problems that beset Truman’s successors during the subsequent conflict in Vietnam