Lumbar puncture for the generalist

The safe and successful performance of a lumbar puncture demands a working and yet specific knowledge as well as competency in performance. This review aims to aid understanding of the knowledge framework, the pitfalls and complications of lumbar puncture. It includes special reference to three dimensional relationships, functional anatomy, imaging anatomy, normal variation and living anatomy. A lumbar puncture is a commonly performed procedure for diagnostic and therapeutic purposes. Epidural and spinal anaesthesia, for example, are common in obstetric practice and involve the same technique as a lumbar puncture except for the endpoint of the needle being in the epidural space and subarachnoid space respectively. The procedure is by no means innocuous and some anatomical pitfalls include inability to find the correct entry site for placement of the lumbar puncture needle and lack of awareness of structures in relation to the advancing needle. Headache is the most common complication and it is important to avoid traumatic and dry taps, herniation syndromes and injury to the terminal end of the spinal cord. With a thorough knowledge of the contraindications, the regional anatomy and rationale of the technique and adequate prior skills practice, a lumbar puncture can be performed safely and successfully

Professional bodies and continuing professional education

This chapter focuses on the role of professional bodies in relation to continuing professional development (CPD) in two different professional spheres - further education and legal services. Similarities and differences between these two areas, and in particular the approaches to continuing professional development, are highlighted. The chapter concludes by identifying commonalities and differences in the trajectories, circumstances and regimes of the professions. We consider whether there are key features of CPD that should be common to all professions or whether models of CPD are contingent and dependent on circumstances. We propose a model that covers emerging factors in the conception of CPD. We argue that these findings have applicability to professions and their professional bodies more widely, as well as employers of professionals

Entrepreneurial Inclination Among Business Students: a Malaysian Study

Entrepreneurship has been the fundamental topics of discussion among the politicians, economists, and academics. Business creation is especially critical in developing countries to stimulate economic growth. The present study attempts to examine entrepreneurial inclination among students who are a potential source of entrepreneurs. The fi ndings of the present research study indicate that majority of our business students are not entrepreneurial-inclined. They do not seem to possess strong entrepreneurial characteristics and entrepreneurial skills, and they are not keen in starting a new business. The roles of higher institutes of education and the government in promoting entrepreneurship are discussed

Doing the Work of Medicine? Medical Television Programmes and Patient Behaviour

This article explores the contribution of television programmes to shaping the doctor-patient relationship in Britain in the Sixties and beyond. Our core proposition is that TV programmes on medicine ascribe a specifi c position as patients to viewers. This is what we call the ‘Inscribed Patient’. In this article we discuss a number of BBC programmes centred on medicine, from the 1958 ‘On Call to a Nation’; to the 1985 ‘A Prize Discovery’, to examine how television accompanied the development of desired patient behaviour during the transition to what was dubbed “Modern Medicine” in early 1970s Britain. To support our argument about the “Inscribed Patient”, we draw a comparison with natural history programmes from the early 1960s, which similarly prescribed specifi c agencies to viewers as potential participants in wildlife fi lmmaking. We conclude that a ‘patient position’ is inscribed in biomedical television programmes, which advance propositions to laypeople about how to submit themselves to medical expertise. Inscribed patient; doctor-patient relationship; biomedical television programmes; wildlife television; documentary television; BBC Horizo

Design of an object-oriented framework for modelling the partitioning of captured solar radiation and evapotranspiration in intercropping systems

x-library is a C++ object-oriented framework for modelling the partitioning of captured solar radiation and evapotranspiration in intercropping systems. The design and analysis of the x-library are done to ensure that the soil-plant-atmosphere system is categorised into classes, such as weather, microclimate, intercrop, crop, canopy, leaf, roots, soil, heat, and radiation. Meanwhile, x-library implements two kinds of solar radiation models; namely, one-dimensional (1-D), and two-dimensional (2-D) model, where irradiance varies in one dimension (vertical) and in two dimensions (vertical and horizontal), respectively. Radiation partitioning is based on weighting criteria so that a crop having the larger leaf area index and extinction coefficient would have greater share of captured radiation. Evapotranspiration partitioning is calculated using the Shuttleworth- Wallace equation. Model comparisons with a field experiment showed an overall good agreement between the simulated and measured solar radiation and transpiration values. A graphical user interface front-end for the x-library known as the x-model was also developed, primarily for non-modellers and non-programmers

Inoculum selection influences the biochemical methane potential of agro-industrial substrates

Obtaining a reliable estimation of the methane potential of organic waste streams in anaerobic digestion, for which a biochemical methane potential (BMP) test is often used, is of high importance. Standardization of this BMP test is required to ensure inter-laboratory repeatability and accuracy of the BMP results. Therefore, guidelines were set out; yet, these do not provide sufficient information concerning origin of and the microbial community in the test inoculum. Here, the specific contribution of the methanogenic community on the BMP test results was evaluated. The biomethane potential of four different substrates (molasses, bio-refinery waste, liquid manure and high-rate activated sludge) was determined by means of four different inocula from full-scale anaerobic digestion plants. A significant effect of the selected inoculum on the BMP result was observed for two out of four substrates. This inoculum effect could be attributed to the abundance of methanogens and a potential inhibiting effect in the inoculum itself, demonstrating the importance of inoculum selection for BMP testing. We recommend the application of granular sludge as an inoculum, because of its higher methanogenic abundance and activity, and protection from bulk solutions, compared with other inocula

A new rock slicing method based on linear programming

One of the important pre-processing stages in the analysis of jointed rock masses is the identification of rock blocks from discontinuities in the field. In 3D, the identification of polyhedral blocks usually involve tedious housekeeping algorithms, because one needs to establish their vertices, edges and faces, together with a hierarchical data structure: edges by pairs of vertices, faces by bounding edges, polyhedron by bounding faces. In this paper, we present a novel rock slicing method, based on the subdivision approach and linear programming optimisation, which requires only a single level of data structure rather than the current 2 or 3 levels presented in the literature. This method exploits the novel mathematical framework for contact detection introduced in Boon et al. (2012). In the proposed method, it is not necessary to calculate the intersections between a discontinuity and the block faces, because information on the block vertices and edges is not needed. The use of a simpler data structure presents obvious advantages in terms of code development, robustness and ease of maintenance. Non-persistent joints are also introduced in a novel way within the framework of linear programming. Advantages and disadvantages of the proposed modelling of non-persistent joints are discussed in this paper. Concave blocks are generated using established methods in the sequential subdivision approach, i.e. through fictitious joints

DEM modelling of a jointed rock beam with emphasis on interface properties

This paper compares analyses performed via the distinct element method (DEM), employing rigid blocks and compliant joints, with results using finite-difference software (FLAC) obtained previously by other researchers. The paper then examines the capability of the rigid-block DEM at modelling joints realistically, with emphasis on the moment transfer between blocks. The line of thrust from this analysis was found to fit well with the well-established uniform catenary curve and the parabola, which has been used extensively in the rock engineering literature. This is an important verification exercise that is still lacking in the literature, especially for the rigid-block DEM. Finally, a comparison is made between the DEM and experimental work carried out previously by other researchers. The previously reported laboratory data were reinterpreted to derive more accurate contact laws in both normal and shear directions. A strain hardening or continuously yielding model was adopted in the latter. The calibration approach is demonstrated. The numerical findings suggest that improved predictions of beam deflections can be obtained and the predicted horizontal thrusts are comparable to the results obtained by FLAC