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

Constipation in elderly patients attending a polyclinic

Objective. Tb determine the prevalence of and risk factors for constipation in the elderly. Differences between the white and black elderly populations in this regard were examined.Design. Cross-section hospital-based study.Setting. The family medicine cliriics at National and Pelonomi hospitals in greater Bloemfontein.Participants. 179 white and 188 black patients, born before 1930, visiting the clinics during December and January 1994/95 and seen by one doctor. Mizin outcome measures. Constipation.Results. In both the black and white population groups 29% of the participants were constipated according to the definition used in this study. Depression was a risk factor for constipation in both population groups. Age over 80 years was a risk factor in the black participants. The fibre and fluid contents of participants' diets were not found to be associated with constipation. Pain during defaecation was positively associated with constipation. Forty-three per cent of the white and 76.6% of the black participants used laxatives. Of the white and black laxative users 14.3% and 21.5%, respectively, used more than one laxative at a time.Conclusion. The prevalence of constipation was high in both groups. Laxative use and abuse are very common in the black elderly population

Metal abundances at z<1.5: new measurements in sub-Damped Lyman-alpha Absorbers

Damped Lyman-alpha systems (DLAs) and sub-DLAs seen toward background quasars provide the most detailed probes of elemental abundances. Somewhat paradoxically these measurements are more difficult at lower redshifts due to the atmospheric cut-off, and so a few years ago our group began a programme to study abundances at z < 1.5 in quasar absorbers. In this paper, we present new UVES observations of six additional quasar absorption line systems at z < 1.5, five of which are sub-DLAs. We find solar or above solar metallicity, as measured by the abundance of zinc, assumed not to be affected by dust, in two sub-DLAs: one, towards Q0138-0005 with [Zn/H]=+0.28 +/- 0.16; the other towards Q2335+1501 with [Zn/H]=+0.07 +/- 0.34. Relatively high metallicity was observed in another system: Q0123-0058 with [Zn/H]=-0.45 +/- 0.20. Only for the one DLA in our sample, in Q0449-1645, do we find a low metallicity, [Zn/H]=-0.96 +/- 0.08. We also note that in some of these systems large relative abundance variations from component to component are observed in Si, Mn, Cr and Zn.Comment: 7 figures and 10 tables. Accepted for publication in MNRA

Acute Hepatic Necrosis Caused by Salmonella enterica Serotype I 4,5,12:-:1,2 in a Dog.

Acute hepatic necrosis was diagnosed in a dog. Gram staining and fluorescence in situ hybridization identified Salmonella enterica in the liver, subsequently confirmed as S. enterica serotype I 4,5,12:-:1,2. This is the first report of acute hepatic necrosis with liver failure caused by Salmonella in a dog.This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1128/JCM.01256-1

Deriving Laws for Developing Concurrent Programs in a Rely-Guarantee Style

In this paper we present a theory for the refinement of shared-memory concurrent algorithms from specifications. Our approach avoids restrictive atomicity contraints. It provides a range of constructs for specifying concurrent programs and laws for refining these to code. We augment pre and post condition specifications with Jones' rely and guarantee conditions, which we encode as commands within a wide-spectrum language. Program components are specified using either partial and total correctness versions of end-to-end specifications. Operations on shared data structures and atomic machine operations (e.g. compare-and-swap) are specified using an atomic specification command. All the above constructs are defined in terms of a simple core language, based on four primitive commands and a handful of operators, and for which we have developed an extensive algebraic theory in Isabelle/HOL. For shared memory programs, expression evaluation is subject to fine-grained interference and we have avoided atomicity restrictions other than for read and write of primitive types (words). Expression evaluation and assignment commands are also defined in terms of our core language primitives, allowing laws for reasoning about them to be proven in the theory. Control structures such as conditionals, recursion and loops are all defined in terms of the core language. In developing the laws for refining to such structures from specifications we have taken care to develop laws that are as general as possible; our laws are typically more general than those found in the literature. In developing our concurrent refinement theory we have taken care to focus on the algebraic properties of our commands and operators, which has allowed us to reuse algebraic theories, including well-known theories, such as lattices and boolean algebra, as well as programming-specific algebras, such as our synchronous algebra

The evaluation of a frame-of-reference training programme for intern psychometrists

Orientation: The use of assessment centres (ACs) has drastically increased over the past decade. However, ACs are constantly confronted with the lack of construct validity. One aspect of ACs that could improve the construct validity significantly is that of assessor training. Unfortunately untrained or poorly trained assessors are often used in AC processes. Research purpose: The purpose of this research was to evaluate a frame-of-reference (FOR) programme to train intern psychometrists as assessors at an assessment centre. Motivation of study: The role of an assessor is important in an AC; therefore it is vital for an assessor to be able to evaluate and observe candidates’ behaviour adequately. Commencing with this training in a graduate psychometrist programme gives the added benefit of sending skilled psychometrists to the workplace. Research design, approach and method: A quantitative research approach was implemented, utilising a randomised pre-test-post-test comparison group design. Industrial Psychology postgraduate students (N = 22) at a South African university were used and divided into an experimental group (n = 11) and control group (n = 11). Three typical AC simulations were utilised as pre- and post-tests, and the ratings obtained from both groups were statistically analysed to determine the effect of the FOR training programme. Main findings: The data indicated that there was a significant increase in the familiarity of the participants with the one-on-one simulation and the group discussion simulation. Practical/managerial implications: Training intern psychometrists in a FOR programme could assist organisations in the appointment of more competent assessors. Contribution/value-add: To design an assessor training programme using FOR training for intern psychometrists in the South African context, specifically by incorporating this programme into the training programme for Honours students at universities

�n Huldigingsartikel: Johan Heyns - Man van die kerk

Johan Heyns - Man of the church Johan Heyns� ministry in the Dutch Reformed Church spans a period of forty years. During these years he left an indelible mark on the life and the work of the Church, in the congregations he served, at universities where he taught, as well as in synodical and ecumenical meetings

Complete homochirality induced by the nonlinear autocatalysis and recycling

A nonlinear autocatalysis of a chiral substance is shown to achieve homochirality in a closed system, if the back-reaction is included. Asymmetry in the concentration of two enantiomers or the enantiometric excess increases due to the nonlinear autocatalysis. Furthermore, when the back-reaction is taken into account, the reactant supplied by the decomposition of the enantiomers is recycled to produce more and more the dominant one, and eventually the homochirality is established.Comment: 4 pages, 2 figure

Evidence for Cold Accretion: Primitive Gas Flowing onto a Galaxy at z~0.274

We present UV and optical observations from the Cosmic Origins Spectrograph on the Hubble Space Telescope and Keck of a z= 0.27395 Lyman limit system (LLS) seen in absorption against the QSO PG1630+377. We detect H I absorption with log N(HI)=17.06\pm0.05 as well as Mg II, C III, Si III, and O VI in this system. The column densities are readily explained if this is a multi-phase system, with the intermediate and low ions arising in a very low metallicity ([Mg/ H] =-1.71 \pm 0.06) photoionized gas. We identify via Keck spectroscopy and Large Binocular Telescope imaging a 0.3 L_* star-forming galaxy projected 37 kpc from the QSO at nearly identical redshift (z=0.27406, \Delta v = -26 \kms) with near solar metallicity ([O/ H]=-0.20 \pm 0.15). The presence of very low metallicity gas in the proximity of a near-solar metallicity, sub-L_* galaxy strongly suggests that the LLS probes gas infalling onto the galaxy. A search of the literature reveals that such low metallicity LLSs are not uncommon. We found that 50% (4/8) of the well-studied z < 1 LLSs have metallicities similar to the present system and show sub-L_* galaxies with rho < 100 kpc in those fields where redshifts have been surveyed. We argue that the properties of these primitive LLSs and their host galaxies are consistent with those of cold mode accretion streams seen in galaxy simulations.Comment: Accepted for publication in the Astrophysical Journa