The creation of the Faculty of Community Medicine (now the Faculty of Public Health Medicine) of the Royal Colleges of Physicians of the United Kingdom

The National Health Service Act 1946 transferred responsibility for the non-voluntary hospitals and certain clinical services from the public health departments of counties and county boroughs to new regional hospital boards, thereby substantially reducing the functions of their medical officers of health and creating a separate cadre of doctors concerned with the planning and management of hospital and specialist services. At around the same time there was pressure to develop in each medical school a department of social and preventive medicine with full-time staff involved in research work. Reviewing the situation 20 years later, the Royal Commission on Medical Education recommended that doctors in public health, medical administration or related teaching and research should form a single professional body concerned with the assessment of specialist training for and standards of practice in 'community medicine'. Immediately after the publication of the Commission's Report in 1968, J. N. Morris invited leaders in the three strands of activities to meet and discuss the proposal. A series of informal meetings led to the setting up, in 1969, of a Working Party (chairman, J. N. Morris) which negotiated with the Royal Colleges of Physicians of Edinburgh, Glasgow and London for them to create a faculty of community medicine. In November 1970 the Colleges set up a Provisional Council (chairman, W. G. Harding), later Board, and the Faculty formally came into existence on 15 March 1972. The key decisions and some of the complications and hitches encountered in achieving this radical outcome are described in this paper

Studies of Impaired People in Paddock Wood

This volume contains three reports based on a community survey of impaired persons living in and around Paddock Wood, Kent and who were registered with a general medical practice of three partners working with nurses, health visitors and ancillary workers from a purpose-built health centre. The opportunity of working with a primary medical care team enabled a number of different questions to be examined, and because some of these form discrete areas of interest the results are presented in the following three papers:- Identifying Handicapped People in a General Practice Population. Interview Surveys of Handicapped People. The Accuracy of Statements about the Underlying Medical Conditions Handicapped People in Paddock Woo

A Comparison of Rectal Diazepam Gel and Placebo for Acute Repetitive Seizures

ABSTRACT Background Acute repetitive seizures are readily recognizable episodes involving increased seizure frequency. Urgent treatment is often required. Rectal diazepam gel is a promising therapy. Methods We conducted a randomized, doubleblind, parallel-group, placebo-controlled study of home-based treatment for acute repetitive seizures. Patients were randomly assigned to receive either rectal diazepam gel, at doses ranging from 0.2 to 0.5 mg per kilogram of body weight on the basis of age, or placebo. Children received one dose at the onset of acute repetitive seizures and a second dose four hours later. Adults received three doses — one dose at onset, and two more doses 4 and 12 hours after onset. Treatment was administered by a care giver, such as a parent, who had received special training. The number of seizures after the first dose was counted for 12 hours in children and for 24 hours in adults. Results Of 125 study patients (64 assigned to diazepam and 61 to placebo) with a history of acute repetitive seizures, 91 (47 children and 44 adults) were treated for an exacerbation of seizures during the study period. Diazepam treatment was superior to placebo with regard to the outcome variables related to efficacy: reduced seizure frequency (P\u3c0.001) and improved global assessment of treatment outcome by the care giver (frequency and severity of seizures and drug toxicity) (P\u3c0.001). Post hoc analysis showed diazepam to be superior to placebo in reducing seizure frequency in both children (P\u3c0.001) and adults (P=0.02), but only in children was it superior with regard to improvement in global outcome (P\u3c0.001). The time to the first recurrence of seizures after initial treatment was longer for the patients receiving diazepam (P\u3c0.001). Thirty-five patients reported at least one adverse effect of treatment; somnolence was the most frequent. Respiratory depression was not reported. Conclusions Rectal diazepam gel, administered at home by trained care givers, is an effective and welltolerated treatment for acute repetitive seizures. (N Engl J Med 1998;338:1869-75.

Appetite, energy intake, and PYY3-36 responses to energy-matched continuous exercise and submaximal high-intensity exercise.

High-intensity intermittent exercise induces physiological adaptations similar to energy-matched continuous exercise, but the comparative appetite and energy balance responses are unknown. Twelve healthy males (mean ± SD: age, 22 ± 3 years; body mass index, 23.7 ± 3.0 kg·m(-2); maximum oxygen uptake, 52.4 ± 7.1 mL·kg(-1)·min(-1)) completed three 8 h trials (control, steady-state exercise (SSE), high-intensity intermittent exercise (HIIE)) separated by 1 week. Trials commenced upon completion of a standardized breakfast. Exercise was performed from hour 2 to hour 3. In SSE, 60 min of cycling at 59.5% ± 1.6% of maximum oxygen uptake was performed. In HIIE, ten 4-min cycling intervals were completed at 85.8% ± 4.0% of maximum oxygen uptake, with a 2-min rest between each interval. A standardized lunch and an ad libitum afternoon meal were provided at hours 3.75 and 7, respectively. Appetite ratings and peptide YY3-36 concentrations were measured throughout each trial. Appetite was acutely suppressed during exercise, but more so during HIIE (p < 0.05). Peptide YY3-36 concentrations increased significantly upon cessation of exercise in SSE (p = 0.002), but were highest in the hours after exercise in HIIE (p = 0.05). Exercise energy expenditure was not different between HIIE and SSE (p = 0.649), but perceived exertion was higher in HIIE (p < 0.0005). Ad libitum energy intake did not differ between trials (p = 0.833). Therefore, relative energy intake (energy intake minus the net energy expenditure of exercise) was lower in the SSE and HIIE trials than in the control trial (control, 4759 ± 1268 kJ; SSE, 2362 ± 1224 kJ; HIIE, 2523 ± 1402 kJ; p < 0.0005). An acute bout of energy-matched continuous exercise and HIIE were equally effective at inducing an energy deficit without stimulating compensatory increases in appetite

Deliberate perioperative systems design improves operating room throughput

Background: New operating room (OR) design focuses more on the surgical environment than on the process of care. The authors sought to improve OR throughput and reduce time per case by goal-directed design of a demonstration OR and the perioperative processes occurring within and around it. Methods: The authors constructed a three-room suite including an OR, an induction room, and an early recovery area. Traditionally sequential activities were run in parallel, and nonsurgical activities were moved from the OR to the supporting spaces. The new workflow was supported by additional anesthesia and nursing personnel. The authors used a retrospective, case-and surgeon-matched design to compare the throughput, cost, and revenue performance of the new OR to traditional ORs. Results: For surgeons performing the same case mix in both environments, the new OR processed more cases per day than traditional ORs and used less time per case. Throughput improvement came from superior nonoperative performance. Nonoperative Time was reduced from 67 min (95% confidence interval, 64 -70 min) to 38 min (95% confidence interval, 35-40 min) in the new OR. All components of Nonoperative Time were meaningfully reduced. Operative Time decreased by approximately 5%. Hospital and anesthesia costs per case increased, but the increased throughput offset costs and the global net margin was unchanged. Conclusions: Deliberate OR and perioperative process redesign improved throughput. Performance improvement derived from relocating and reorganizing nonoperative activities. Better OR throughput entailed additional costs but allowed additiona

Complete population transfer in a degenerate 3-level atom

We find conditions required to achieve complete population transfer, via coherent population trapping, from an initial state to a designated final state at a designated time in a degenerate 3-level atom, where transitions are caused by an external interaction. Complete population transfer from an initially occupied state 1 to a designated state 2 occurs under two conditions. First, there is a constraint on the ratios of the transition matrix elements of the external interaction. Second, there is a constraint on the action integral over the interaction, or "area", corresponding to the phase shift induced by the external interaction. Both conditions may be expressed in terms of simple odd integers.Comment: 22 pages, 4 figure

Enhanced stability of layered phases in parallel hard-spherocylinders due to the addition of hard spheres

There is increasing evidence that entropy can induce microphase separation in binary fluid mixtures interacting through hard particle potentials. One such phase consists of alternating two dimensional liquid-like layers of rods and spheres. We study the transition from a uniform miscible state to this ordered state using computer simulations and compare results to experiments and theory. We conclude that (1) there is stable entropy driven microphase separation in mixtures of parallel rods and spheres, (2) adding spheres smaller then the rod length decreases the total volume fraction needed for the formation of a layered phase, therefore small spheres effectively stabilize the layered phase; the opposite is true for large spheres and (3) the degree of this stabilization increases with increasing rod length.Comment: 11 pages, 9 figures. Submitted to Phys. Rev. E. See related website http://www.elsie.brandeis.ed

Eutectic colony formation: A phase field study

Eutectic two-phase cells, also known as eutectic colonies, are commonly observed during the solidification of ternary alloys when the composition is close to a binary eutectic valley. In analogy with the solidification cells formed in dilute binary alloys, colony formation is triggered by a morphological instability of a macroscopically planar eutectic solidification front due to the rejection by both solid phases of a ternary impurity that diffuses in the liquid. Here we develop a phase-field model of a binary eutectic with a dilute ternary impurity and we investigate by dynamical simulations both the initial linear regime of this instability, and the subsequent highly nonlinear evolution of the interface that leads to fully developed two-phase cells with a spacing much larger than the lamellar spacing. We find a good overall agreement with our recent linear stability analysis [M. Plapp and A. Karma, Phys. Rev. E 60, 6865 (1999)], which predicts a destabilization of the front by long-wavelength modes that may be stationary or oscillatory. A fine comparison, however, reveals that the assumption commonly attributed to Cahn that lamella grow perpendicular to the envelope of the solidification front is weakly violated in the phase-field simulations. We show that, even though weak, this violation has an important quantitative effect on the stability properties of the eutectic front. We also investigate the dynamics of fully developed colonies and find that the large-scale envelope of the composite eutectic front does not converge to a steady state, but exhibits cell elimination and tip-splitting events up to the largest times simulated.Comment: 18 pages, 18 EPS figures, RevTeX twocolumn, submitted to Phys. Rev.

SiMenafil I s a Pulmonary Vasodilator in Awake Lambs with Acute Pulmonary Hypertension

Background: Phosphodiesterase type 5 (PDE5) hydrolyzes cyclic guanosine monophosphate in the lung, thereby modulating nitric oxide (NO)/cyclic guanosine monophosphatemediated pulmonary vasodilation. Inhibitors of PDE5 have been proposed for the treatment of pulmonary hypertension. In this study, we examined the pulmonary and systemic vasodilator properties of sildenafil, a novel selective PDE

Signatures of the slow solar wind streams from active regions in the inner corona

Some of local sources of the slow solar wind can be associated with spectroscopically detected plasma outflows at edges of active regions accompanied with specific signatures in the inner corona. The EUV telescopes (e.g. SPIRIT/CORONAS-F, TESIS/CORONAS-Photon and SWAP/PROBA2) sometimes observed extended ray-like structures seen at the limb above active regions in 1MK iron emission lines and described as "coronal rays". To verify the relationship between coronal rays and plasma outflows, we analyze an isolated active region (AR) adjacent to small coronal hole (CH) observed by different EUV instruments in the end of July - beginning of August 2009. On August 1 EIS revealed in the AR two compact outflows with the Doppler velocities V =10-30 km/s accompanied with fan loops diverging from their regions. At the limb the ARCH interface region produced coronal rays observed by EUVI/STEREO-A on July 31 as well as by TESIS on August 7. The rays were co-aligned with open magnetic field lines expanded to the streamer stalks. Using the DEM analysis, it was found that the fan loops diverged from the outflow regions had the dominant temperature of ~1 MK, which is similar to that of the outgoing plasma streams. Parameters of the solar wind measured by STEREO-B, ACE, WIND, STEREO-A were conformed with identification of the ARCH as a source region at the Wang-Sheeley-Arge map of derived coronal holes for CR 2086. The results of the study support the suggestion that coronal rays can represent signatures of outflows from ARs propagating in the inner corona along open field lines into the heliosphere.Comment: Accepted for publication in Solar Physics; 31 Pages; 13 Figure