Cholecystography as an aid in the diagnosis of gall-bladder disease: with special reference to the administration of sodium tetraiodophenolphthalein by the oral method

During the last four years a great deal of work has been done on Cholecystography, and it has now come to be recognised as one of the great recent advances in the diagnosis of Gall- bladder disease. it must be emphasised, however, that a diagnosis should never be made on radiographic evidence alone, without taking into consideration the history and clinical findings.in this `thesis an attempt is made to show that, if the technique is carried out properly, the oral administration of Sodium Tetraiodophenolphthalein gives fairly accurate results. No attempt is made to compare the oral and the intravenous methods.The investigations have all been carried out at the North Middlesex Hospital, London N.18, during the past 18 months. The writer has studied all the cases mentioned and has supervised the administration of the dye.A series of seventy cases was investigated and X-rayed after the oral administration of Sodium Tetraiodophenolphthalein; Fifty cases of this series were operated upon and as this forms an important group, the main facts in the histories and findings are recorded.As economy had to be considered, only three X-ray photographs were taken of each patient. The material which follows is arranged under the following main headings: -1. Historical Survey. 2. The Physiology of the Gall-Bladder. 3. The oral administration of Sodium Tetraiodophenolphthalein. 4. Writer's case records - 50 cases operated upon. 5. Summary and Conclusions. 6. X -ray photographic prints. 7. Bibliography

Question design in nurse-led and GP-led telephone triage for same-day appointment requests: a comparative investigation

Objective: To compare doctors’ and nurses’ communication with patients in primary care telephone triage consultations. Design: Qualitative comparative study of content and form of questions in 51 telephone triage encounters between practitioners (general practitioners (GPs)=29; nurses=22) and patients requesting a same-day appointment in primary care. Audio-recordings of nurse-led calls were synchronised with video recordings of nurse's use of computer decision support software (CDSS) during triage. Setting: 2 GP practices in Devon and Warwickshire, UK. Participants: 4 GPs and 29 patients; and 4 nurses and 22 patients requesting a same-day face-to-face appointment with a GP. Main outcome measure: Form and content of practitioner-initiated questions and patient responses during clinical assessment. Results: A total of 484 question–response sequences were coded (160 GP; 324 N). Despite average call lengths being similar (GP=4 min, 37 s, (SD=1 min, 26 s); N=4 min, 39 s, (SD=2 min, 22 s)), GPs and nurses differed in the average number (GP=5.51, (SD=4.66); N=14.72, (SD=6.42)), content and form of questions asked. A higher frequency of questioning in nurse-led triage was found to be due to nurses’ use of CDSS to guide telephone triage. 89% of nurse questions were oriented to asking patients about their reported symptoms or to wider-information gathering, compared to 54% of GP questions. 43% of GP questions involved eliciting patient concerns or expectations, and obtaining details of medical history, compared to 11% of nurse questions. Nurses using CDSS frequently delivered questions designed as declarative statements requesting confirmation and which typically preferred a ‘no problem’ response. In contrast, GPs asked a higher proportion of interrogative questions designed to request information. Conclusions: Nurses and GPs emphasise different aspects of the clinical assessment process during telephone triage. These different styles of triage have implications for the type of information available following nurse-led or doctor-led triage, and for how patients experience triage

How can marketing theory be applied to policy design to deliver on sustainable agriculture in England?

Marketing theory was applied to develop a qualitative tool to predict levels of compliance based on involvement with the issue (policy objective) and involvement with the intervention (regulation). Based on an understanding farmer decision-making, the I3 Response Framework can help identify strategies that can strongly influence compliance, providing more efficient targeting of resources for policy. We report on further testing by application to the issue of water quality and the regulations around slurry storage as part of the Nitrate Pollution Prevention Regulations 2008 as applicable to dairy farmers in the Derwent catchment of North Yorkshire, EnglandPolicy, I3 Response Framework, involvement, water quality, slurry storage, Nitrogen Vulnerable Zone, regulation, Nitrate Pollution Prevention Regulations 2008, NPPR2008, Agricultural and Food Policy,

Hubble's law and faster than light expansion speeds

Naively applying Hubble's law to a sufficiently distant object gives a receding velocity larger than the speed of light. By discussing a very similar situation in special relativity, we argue that Hubble's law is meaningful only for nearby objects with non-relativistic receding speeds. To support this claim, we note that in a curved spacetime manifold it is not possible to directly compare tangent vectors at different points, and thus there is no natural definition of relative velocity between two spatially separated objects in cosmology. We clarify the geometrical meaning of the Hubble's receding speed v by showing that in a Friedmann-Robertson-Walker spacetime if the four-velocity vector of a comoving object is parallel-transported along the straight line in flat comoving coordinates to the position of a second comoving object, then v/c actually becomes the rapidity of the local Lorentz transformation, which maps the fixed four-velocity vector to the transported one.Comment: 5 pages, 2 figures, to appear in Am. J. Phy

Applications of control theory

Applications of control theory are considered in the areas of decoupling and wake steering control of submersibles, a method of electrohydraulic conversion with no moving parts, and socio-economic system modelling

Nonlinear optics of fibre event horizons

The nonlinear interaction of light in an optical fibre can mimic the physics at an event horizon. This analogue arises when a weak probe wave is unable to pass through an intense soliton, despite propagating at a different velocity. To date, these dynamics have been described in the time domain in terms of a soliton-induced refractive index barrier that modifies the velocity of the probe. Here, we complete the physical description of fibre-optic event horizons by presenting a full frequency-domain description in terms of cascaded four-wave mixing between discrete single-frequency fields, and experimentally demonstrate signature frequency shifts using continuous wave lasers. Our description is confirmed by the remarkable agreement with experiments performed in the continuum limit, reached using ultrafast lasers. We anticipate that clarifying the description of fibre event horizons will significantly impact on the description of horizon dynamics and soliton interactions in photonics and other systems.Comment: 7 pages, 5 figure

"An apple pie a day does not keep the doctor away": Fictional depictions of gout in contemporary film and television.

BACKGROUND: Fictional portrayals of illness and medical management in film and television can reflect and perpetuate cultural stereotypes about illness. The aim of this study was to analyse fictional depictions of gout in contemporary film and television. METHODS: We conducted a search for English language depictions of gout in film and television since 1990 using the Internet Movie Database (IMDb), other internet media databases, and member suggestions from the Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN). Film and television episodes with gout content were analysed for depictions of characters with gout, causal factors, and management strategies (n=44). RESULTS: Gout was used to denote royalty or nobility in historical settings, and as a plot device to explain the absence of characters from key events. The most commonly depicted causes of gout were overindulgence of food and alcohol (61%), and portrayals of biological causes were infrequent (12%). Common management strategies were change in diet (36%) and short-term pain relief (32%), with only one mention of urate-lowering therapy (5%). The majority of films and television episodes depicted gout as humorous (59%) and embarrassing (50%). CONCLUSIONS: In contemporary film and television, gout is portrayed as a humorous and embarrassing condition, caused by dietary indulgence. These depictions may reinforce inaccurate beliefs about the causes of gout and its management

Experimental Predictions of The Functional Response of A Freshwater Fish

The functional response is the relationship between the feeding rate of an animal and its food density. It is reliant on two basic parameters; the volume searched for prey per unit time (searching rate) and the time taken to consume each prey item (handling time). As fish functional responses can be difficult to determine directly, it may be more feasible to measure their underlying behavioural parameters in controlled conditions and use these to predict the functional response. Here, we tested how accurately a Type II functional response model predicted the observed functional response of roach Rutilus rutilus, a visually foraging fish, and compared it with Type I functional response. Foraging experiments were performed by exposing fish in tank aquaria to a range of food densities, with their response captured using a two-camera videography system. This system was validated and was able to accurately measure fish behaviour in the aquaria, and enabled estimates of fish reaction distance, swimming speed (from which searching rate was calculated) and handling time to be measured. The parameterised Type II functional response model accurately predicted the observed functional response and was superior to the Type I model. These outputs suggest it will be possible to accurately measure behavioural parameters in other animal species and use these to predict the functional response in situations where it cannot be observed directly