"A Certain Portion of the Whole." Inspectors, Guardians and Anatomists in East Anglia : 1832-1908

This thesis reassesses the workings of the Anatomy Act (1832) in East Anglia throughout the nineteenth century. Underpinning the practice of medical education was the need to acquire human corpses to permit the essential study of anatomy. Over the course of the century the source of anatomical material moved from bodies taken from their graves by bodysnatchers to unclaimed pauper corpses from workhouses and hospitals to the increasing use of the cadavers of lunatics from the vast Victorian asylums. The accepted view of the Anatomy Act is that it stopped bodysnatching but failed to ensure a plentiful supply of cadavers. Whilst recent research has largely focused on specific changes in Poor Law legislation or the impact of the reorganisation of medical curricula on the supply of corpses, this study widens the debate by identifying seven groups; bodysnatchers, teachers of anatomy, medical students, inspectors of anatomy, paupers, guardians and those who elected them to office and examines their respective parts in attempting to solve the perennial problem of the shortage of corpses for dissection. The shifting locus of power between the groups is examined with reference to external changes which were brought to bear on their relationships. Cambridge Medical School is used as a case study to highlight the difficulties provincial schools experienced in obtaining dissection material and to indicate how, in this particular case, they were solved by the actions of determined individuals resulting in Cambridge becoming one of the most successful medical schools in the country by the end of the nineteenth century. This research contributes to the small, but growing, number of regional studies which are necessary to enable us to gain an overview of the effect of the Anatomy Act on the study of medicine across Britain in the nineteenth century

Draft Genome Sequences of Four NDM-1-Producing Klebsiella pneumoniae Strains from a Health Care Facility in Northern California.

We report the draft genome sequences of Klebsiella pneumoniae strains from four patients at a northern California health care facility. All strains contained the New Delhi metallo-β-lactamase (NDM1) carbapenemase with extended antibiotic resistance, including resistance to expanded-spectrum cephalosporins, imipenem, ertapenem, and meropenem. NDM gene alignments revealed that the resistance was plasmid encoded

Physical restraint and the therapeutic relationship

The role of the forensic mental health nurse has led to many debates due to the conflicts between security and therapeutic aspects of their role. Physical restraint is a security element of the role which may have an impact on their ability to work therapeutically with patients. This study examined the impact of physical restraint on the nursing staff–patient therapeutic relationship. This was investigated in a secure unit in the North of England. Eight semi-structured interviews were conducted with patients across the service, and thematic analysis was undertaken. Five themes were identified from the data which highlighted the impact of the physical restraint as a power imbalance, the experience as traumatic, the importance of justification, the negative attributes and motives of some staff and the impact of coping with powerlessness. Clinical implications and research recommendations are discussed further in this article

Is antenatal screening for syphilis still necessary?

Congenital syphilis continues to present a significant public health problem worldwide. The cornerstone of prevention of congenital syphilis is antenatal screening and treatment of affected mothers with penicillin. If untreated, symptoms develop within weeks or months. Early congenital syphilis occurs in children between 0 and 2 years old, however newborns may be asymptomatic and are only identified on routine screening. If such infants are missed and untreated, they can develop late congenital syphilis after 2 years. Syphilis is known as the “Great Imitator” and congenital syphilis can present as neurosyphilis, juvenile paresis, optic atrophy, blindness, progressive sensorineural deafness, dental and skeletal abnormalities

The quest for genuine care:A qualitative study of the experiences of young people who self-harm in residential care

Levels of self-harm for young people in care are high, and even higher for those in residential care. Recent research highlights the importance of understanding self-harm relationally. Such an approach may be of particular value for understanding the self-harm of young people in care. The aim of this research was to understand the experiences of young people who self-harm whilst living in residential care, with a particular focus on the effect of the care setting on their self-harm. Five young people participated in semi-structured interviews which were analysed using Interpretive Phenomenological Analysis. Four themes emerged: ‘The black hole of self-harm’, ‘Seeking genuine care and containment, ‘The cry to be understood’ and ‘Loss of control to the system.’ Young people recognised their need for support with their self-harm, but organisationally driven approaches to managing risk contributed to a perception that the care offered was not genuine, which led to an unwillingness to accept care. The findings highlight the need for a more compassionate, relational response to young people who self-harm in residential care

Decades of Delay: EPA Leadership Still Lacking in Protecting America's Great River

This report demonstrates the continuing failure of EPA's voluntary approach and the continuing and growing threats of unregulated nitrogen and phosphorus pollution. EPA has the power and the duty to act to require reasonable, common-sense regulations to address the growing scourge of nutrient pollution, and it should do so. Once again, MRC calls upon EPA to remedy this state of affairs, specifically recommending that EPA:Develop numeric phosphorus criteria for each of the eight states that have yet to adopt them, and numeric nitrogen criteria for all 10 states.Require states to assess their waters for nitrogen and phosphorus pollution and to prioritize TMDL development and implementation planning accordingly.Increase oversight of the state NPDES programs to ensure that both narrative and numeric nutrient criteria are implemented through limits in permits, including the use of Water Quality Based Effluent Limits (WQBELs) where appropriate.Disapprove TMDLs that lacking reasonable assurance that nonpoint source reductions are likely to occur and lack monitoring and timelines to ensure that planned reductions actually take place. Further, EPA needs to provide oversight to ensure consistency among EPA Regions in TMDL review and approval (especially in Regions 4 and 6.)Ensure that states' Nutrient Reduction Strategies contain implementation plans detailing point and nonpoint source reductions needed, responsible parties, funding mechanisms, milestones, measurement metrics, and reasonable timelines.Require states under Section 319 of the Clean Water Act to identify programs and practices for controlling nonpoint sources of pollution to the maximum extent possible

Understanding resilience in young people with complex mental health needs:A Delphi study

Background: Resilience is a term used to describe an individual’s adaptive coping following an adverse experience; it is important for gaining insight into the development of mental health difficulties in young people and their ability to manage adversity, informing both preventive and reactive clinical practice. Methods: The Delphi method was used whereby a panel of 15 clinical psychologists rated 67 statements, generated from focus groups with young people and interviews with multi-disciplinary staff, in terms of their importance relating to resilience for young people with complex mental health needs. A consensus level of 85% across the panel was set to include/exclude statements in terms of their importance for resilience. Results: Nineteen statements were included in the final list. These were grouped into the following four themes: (1) understanding the self, (2) agency in recovery, (3) interpersonal relationships and (4) therapeutic setting and relationships. Conclusions: The results highlight specific resilience factors for young people with complex mental health needs, based upon ratings by clinical psychologists. Recommendations are made which focus upon how to promote resilience within this specific population. These include offering secure therapeutic relationships and a safe environment for young people to make decisions, develop a greater understanding of themselves, and build relationships and a sense of connection with others, both within the specialist mental health service and upon discharge

Calcium stone lithoptysis in primary ciliary dyskinesia

An association between lithoptysis and primary ciliary dyskinesia (PCD) has not been previously reported. However, reports of lithoptysis from 2 older patients (>60 yr) prompted a study of this association. We performed a prospective study of all PCD patients presenting to our institution between August 2003 and March 2006, seeking the symptom of lithoptysis or calcium deposition on radiology. A retrospective analysis of all PCD patients presenting prior to August 2003 was also performed. Patients age > or = 40 previously reviewed were recontacted. If a history of lithoptysis or calcium deposition was present, we further reviewed radiographic, microbiologic, and biochemical data, including serum calcium and phosphate. Broncholiths were analyzed by light and electron microscopy- and electron-dispersive X-ray analysis. In total, 142 patients (n=28 age > or = 40) were included, 41 in the prospective and 91 in the retrospective study. Lithoptysis was reported in 5 patients (all age > or = 40). Chest CT scans identified calcification (4/5), involving bronchiectatic airways in 3 patients and focal nodular calcification in 1 patient. Two other patients (age 46, 59) were identified with airway calcification without lithoptysis. Available broncholiths from 2 of these patients were composed of calcite, whereas a broncholith from 1 patient with focal nodular calcification contained calcium phosphate. Sputum was positive for Pseudomonas aeruginosa in all 7 patients, but negative for mycobacterial and fungal cultures. There is an association between lithoptysis and PCD in patients age > or = 40. We hypothesize that calcite stone formation is a biomineralization response to chronic airway inflammation and retention of infected airway secretions in PCD in a subset of PCD patients