Search

While the waves of the global pandemic continue to pound the borders of New Zealand—we are one of the luckiest countries in the world to live a relatively ‘normal life’ with community eradication of the virus leaving this small drop in the Pacific Ocean the envy of many of countries. Our children know of only minimal ‘lockdown’ periods, so it is with the greatest sympathy that I write in this international journal to others that are still severely restricted. New Zealand has been able to come out of the lockdown with an explosion of sports, and we watch and wait for our international friends to have similar freedom and the dream of Olympic games again. The front cover of this BJSM was from the recent Redbull ignite rugby union sevens tournament played in the beachside town on Mount Maunganui. Eighth men and eight women’s teams united together to find hidden sevens talent from New Zealand in a weekend competition which was a feast of athleticism, energy and colour. Spectators strolled freely …

Harman achieved a double first in the Natural Sciences Tripos at Cambridge and went on to train in medicine at the Middlesex Hospital in 1895. He was lecturer and later examiner in anatomy at Caius and King's Colleges, Cambridge. He was made a FRCS in 1898. He was instrumental in bringing about many innovations and changes during his distinguished career in ophthalmology. He is best known for his fixation forceps, that was designed in 1913 and is still in use. Other instruments that he developed included an aqueous needle, a corneal loupe, a diaphragm test, an eyelid retractor, an ophthalmoscope, a strabismus set of instruments (figure 1a–c⇓) and a refractometer, which is illustrated on the front cover of this issue of the BJO. The …

In this first edition of Occupational and Environmental Medicine for 2015 we have introduced a new front cover. We have decided to retire the ‘word cloud’, which has adorned the front cover since May 2012. This word cloud was based on the frequency of words contained in articles published in OEM prior to that date and after more than two and a half years it was becoming increasingly out of date. Our new front cover retains the blue colour scheme and continues the tradition of OEM being known as the ‘blue journal‘ amongst occupational health journals. The central feature of the new cover is a globe which signifies the wide reach of OEM around the world. For this first edition, we have selected a group of pictures which illustrate a range of hazardous working environments, as well as motor vehicle exhausts, an increasingly recognised …

Objective To explore the basis for patient complaints about the oldness of most magazines in practice waiting rooms. Design Cohort study. Setting Waiting room of a general practice in Auckland, New Zealand. Participants 87 magazines stacked into three mixed piles and placed in the waiting room: this included non-gossipy magazines (Time magazine, the Economist, Australian Women’s Weekly, National Geographic, BBC History) and gossipy ones (not identified for fear of litigation). Gossipy was defined as having five or more photographs of celebrities on the front cover and most gossipy as having up to 10 such images. Interventions The magazines were marked with a unique number on the back cover, placed in three piles in the waiting room, and monitored twice weekly. Main outcome measures Disappearance of magazines less than 2 months old versus magazines 3-12 months old, the overall rate of loss of magazines, and the rate of loss of gossipy versus non-gossipy magazines. Results 47 of the 82 magazines with a visible date on the front cover were aged less than 2 months. 28 of these 47 (60%) magazines and 10 of the 35 (29%) older magazines disappeared (P=0.002). After 31 days, 41 of the 87 (47%, 95% confidence interval 37% to 58%) magazines had disappeared. None of the 19 non-gossipy magazines (the Economist and Time magazine) had disappeared compared with 26 of the 27 (96%) gossipy magazines (P

The image on the front cover of this issue of the British Journal of Ophthalmology is from a book entitled ‘A Manual of the Diseases of The Human Eye’, intended for surgeons commencing practice from ‘The Best National and Foreign Work on the Human Eye’. To give it proper perspective and context, it must be appreciated that the book was written 192 years ago in 1821. Credit for the book probably goes to several individuals. It was first published in German by Karl Heinrich Weller in 1819, but by his own admission he had taken much of the content from the published work of Professor Georg Beer. An English edition of this work was published a couple of years later, …

The position of the patient and surgeon relative to each other during eye surgery has seen its own evolution. First both the patient and surgeon sat; then the patient sat while the surgeon stood; then the patient lay down and the surgeon stood. Several contemporary eye surgical procedures involve the use of gadgets and equipment requiring the surgeon to use both hands and both feet. This mandates that the surgeon is seated while the patient lies down. The illustration on the front cover comes from ‘A Treatise on the extraction of the Cataract’ by Frederick Bischoff published in London in 1793. It shows an operating chair designed by the author with various adjustments that could be made to it. The patient at this time in the history of ophthalmic operations was most frequently operated on in a sitting position the head being held firmly against the chest of the assistant. Bischoff preferred to operate with the patient sitting upright on …

The illustration on the front cover is from Sir William Adams’ book, ‘Practical observations on Ectropium or eversion of the eyelids with a description of the new operation for the cure of that disease’ published in 1812. The book also includes a section ‘on the modes of forming an artificial pupil (figure 1) and on cataract omit ’. Figure 1 Image from Sir William Adams’ book—pupilloplasty. The left eye, top and bottom, shows ‘David Crommie's Eye previous to the operation and a fortnight later’. Likewise on the right top and bottom ‘Mr Menoe's Eye previous to the operation and after the disease was cured’. One might be forgiven for suspecting that the artist was persuaded that anything less than a perfect result would not be tolerated. It was in the illustrator's (artist's) gift to deal with any blemishes left by the surgeon. Preoperative and postoperative images constitute useful and important records and have been presented as evidence of the change induced by …

The giraffe ( Giraffa camelopardalis ) pictured on the front cover has more similarities to us than we might think. Their necks, like ours, contain seven vertebra. The classical Darwinian explanation for the remarkable feat of biological engineering that is the elongated giraffe's neck being that it allowed them to reach higher branches. As a consequence, these giraffes were more reproductively successful since they had untouched food sources while giraffes of lesser stature perished due to competition.1 2 Giraffes can feed at a variety of levels but have the ability to reach high during times of tough competition – sound like a few sportsmen you know? The giraffe's cardiovascular adaptations to overcome massive gravitational forces include a bigger heart (a great exercise benefit!) said to be twice as powerful a pump as other animals', while the tight skin and tough fascia of their legs has been mimicked by National Aeronautics and Space Administration scientists in the design of astronauts' gravity suits.3 But perhaps the most interesting feature of the giraffe, as they gracefully stride across the African savannah, is its visibility – the ability to stand …

When I opened this book, the first thing I noticed was the very few similarities between this and the previous edition. The authors are the same (although their order has changed), the evidence “cube” is still on the front cover, and the title is still Clinical epidemiology . However, the subtitle gives the clue to the major change: from A basic science for clinical medicine to How to do clinical practice research . This book couldn’t be any more different from the previous edition; gone are the statistics (as it states, “this book isn’t about biostatistics,” and the authors “apologize” for the oversimplification in terms of the numbers) and gone is the use of clinical research in clinical practice (this “how to use” research is the domain of the several good evidence-based medicine [EBM] books around). So what is this book about? This new edition is now clearly focused in how to do clinical practice. It is aimed at investigators at any stage of their career, “from beginning students to seasoned investigators,” and is a culmination of the authors’ experiences in undertaking …

Science in general and Medicine in particular have many individuals who have been described as the Father of something or the other. Some of their students or disciples, ‘Sons’, have gone on to achieve sufficient greatness to attract the title in their own right. Antonio Scarpa (figure 1) was one such individual, described as the Father of Italian Ophthalmology, though he himself was not an ophthalmologist. Antonio Scarpa was one of the greatest anatomists and surgeons of all time. He studied at Padua under Giovanni Battista Morgagni (1682–1771) the founder of pathological anatomy and was greatly influenced by him. The illustration on the front cover of this issue of the BJO comes from a book which is considered a …

The unique crown of trephines illustrated on the front cover of this edition of the British Journal of Ophthalmology was presented to Sir Benjamin Rycroft by his colleagues at the Queen Victoria Hospital, East Grinstead, on the occasion of his 60th birthday in August 1962 (figure 1). Figure 1 Sir Benjamin William Rycroft, OBE, MD, FRCS (1902–1967). Fourteen different trephines are attached around the circumference of a wooden stand. The ‘jewel’ on top of the crown is an Arthur von Hippel clockwork trephine. Sir Benjamin Rycroft's main contribution to British ophthalmology was his pioneering work on keratoplasty and the part he played in the drafting of the Corneal Grafting Act 1952. Rycroft was not the first to perform successful keratoplasty in the UK. That accolade goes to another Knight, the Welshman, Sir Tudor Thomas, who in 1930 demonstrated clear corneal grafts on …

A clinical image would seem an obvious choice for the BMJ ’s front cover. But each time we decide to use one we have to think an extra thought—will it upset the postal workers or readers’ children? Anything remotely gory tends to cause complaints. In the past we have covered potentially alarming or offensive images with an opaque wrapper. But we felt this was unnecessary for this week’s cover. I’m sure you (and the Royal Mail) will tell us if we were wrong. Either way we hope you’ll appreciate the image and read the two linked articles. They highlight the dangers of what A Fogo and colleagues call “rapidly …

The use of a false colour computed tomography image on the front cover of the BMJ is disappointing. Hepatic steatosis can be demonstrated elegantly with ultrasound, computed …

Cover illustration courtesy of Mr Richard Keeler, curator of the museum of the Royal College of Ophthalmologists, UK. Cover photo: Mark Thomas. Drug delivery to the eye has always been a matter of interest and innovation. One such endeavour is illustrated on the front cover, which shows a set of 24 circular boxes made in bone, with each box containing discs of different drug preparations in compressed form. These 3 and 5 mm discs were sometimes referred to as ‘lamels’. The discs were made in the late 19th century, at the instigation of Dr Casey Wood,i by a company based in Philadelphia, John Wyeth and Brother. The set of discs …

Polar latitudes have among the harshest of climates on earth, and those ill prepared for these extremes sometimes pay with their lives. Witness those who were bent on finding the northwest passage in the early 1800s. Explorers such as Parry and Franklin, among others, lost ships, supplies, men, and in some cases their own lives in their quest for a route to the orient. They simply weren’t well enough prepared. Surprisingly, some vertebrates prepare for such extreme conditions in a manner many would consider wholly inconsistent with life. These creatures allow up to 65% of their body water, including their eyes, to freeze over winter! Rana sylvatica , the North American wood frog, pictured on the front cover, is found across most of the northern tier of North America. While the range of this frog does extend south of Canada into the northeast United States and even further south into northern Georgia, its stronghold is the Canadian shield, extending northwest to include Alaska. It is the only frog found north of the Arctic Circle. This ectothermic anuran survives there—a feat that …

Edited by Ffion Davies. London: Hodder Murray, 2004, £19.99, pp 210. ISBN 0340732040 ![Graphic][1] For many paediatric doctors the emergency department (aka A&E) is only visited when referrals are made, or the crash bleep summons with its screeching siren. These visits are usually straightforward, especially if the APLS creed can be chanted. However, for those of us who missed the emergency department in a rotation, the intricate management of minor cuts and bruises may evade us. Davies’s guide to minor trauma will help to glue the gaps in knowledge. From the initial child’s drawing on the front cover, there are a number of helpful illustrations, photographs, and x … [1]: /embed/graphic-1.gif

EDITOR-In 2002 the BMJ published a trial of a general practice based intervention to prevent repetition of deliberate self harm.1 The article was illustrated by two pictures, one on the front cover of the paper version of the journal, which depicted …

Editor—The front cover of the BMJ of 27 November declared that screening for aortic aneurysm does not reduce overall death rates. This headline misrepresents the conclusions of the study itself,1 let alone evidence from the UK multicentre aneurysm screening study of 68 000 men, which showed that screening halves aneurysm related deaths by reducing risk of rupture.2​2 Figure 1 The Australian trial studied 41 000 men aged 65-83, and the authors admit their target group was not suitable.1 Half the men over 75 invited for screening did not attend and accounted for two thirds of deaths from aneurysm. Among those aged 65-74, not one patient died of aneurysm disease in 8641 men attending screening, compared with 11 deaths in non-attendees and 13 deaths in controls. The authors concluded that the chief reasons for their overall result seemed to have been their failure to identify and exclude men who were unlikely to attend, a substantial proportion being older than 75. In Britain only suitable men aged 65-74 are invited by and scanned in general practitioners' surgeries. The Australians selected from electoral rolls and scanned people in specialised clinics. The Gloucestershire experience showed general practice based screening achieves 85% compliance,3 compared with 63% in the Australian study. The lesson from Australia, acknowledged by the authors but not the headline, is that aneurysm screening programmes must be designed carefully and monitored rigorously to be effective. A recent survey from the Vascular Society shows national screening programmes for aortic aneurysm to be the highest priority for consultant vascular surgeons in the United Kingdom.

Editor—That small reductions in salt intake (2 g/day) have a small but significant effect on blood pressure is hardly surprising.1 Nevertheless, in populations this would have a large effect on reducing strokes, heart attacks, and heart failure. Hooper et al do not ask why reducing salt intake in the long term is so difficult. They claim that the interventions used were intensive, but most studies gave no details about what advice was offered. Furthermore, 75% of salt intake comes from processed food.2 This needs to be avoided or contain less salt. None of the studies provided reduced salt foods. Interpreting the study by Hooper et al is not helped by the editor writing the front cover of the BMJ, who seems to have read a different paper and misinterpreted the important positive findings. The confusion is increased by the authors' press release,3 which rightly blames the difficulty in reducing salt intake squarely on the food industry. This confusion is compounded by errors in the meta-analysis. For example, the 18 month TOPH trial (phase I) was included as an intervention trial over “60 months,” but salt intake was reduced for only 18 months, after which all participants returned to their normal diet. References were misquoted, and the correspondence following these papers was ignored. The totality of evidence for reducing salt is stronger than for any other non-pharmacological treatment. Ninety five per cent of the population are at risk of developing cardiovascular disease,4 and 40% die from it. There are no controlled trials showing a reduction in mortality on stopping smoking, reducing fat intake alone (without fish oil supplements), reducing salt intake, losing weight, increasing fruit and vegetable consumption, or increasing exercise. For most of these factors no attempt has been made to conduct long term trials, owing to the innate difficulty of conducting and funding such trials and, now, the ethics of randomly putting a group of people on a high salt diet for the rest of their lives. The question that Hooper et al need to consider is what strength of evidence is needed to give dietary and lifestyle advice to try to prevent cardiovascular disease. The study indicates the importance of reducing salt intake in the population, even by small amounts, particularly in treating high blood pressure.5 The BMJ should publish a retraction of its misleading front cover and read the authors' press release.

The front cover of this book bears the words: “Companion manual to the National Emergency Airway Management Course”. It is in this role that the book's design and concept was developed. It is not surprising therefore that the book achieves its maximum potential when used in that role. This is particularly evident in those chapters such as “Special devices for the difficult or failed airway” where complex psychomotor skills …

The History of aerosol science is a symposium volume that provides a written record of the First Symposium on the History of Aerosol Science, held from 31 August to 2 September, 1999 in Vienna, Austria. The symposium was held in the sumptuous surroundings of the Theatersaal of the Austrian Academy of Sciences. The high cultural standing of the event can be judged from the front cover of the book, which carries a reproduction of La Grande Famille by Rene Magritte, and the Appendix which contains the musical score of Haze, Fume and Spray by Meinhard Rudenhauer. This was an original work composed for the opening of the symposium. The symposium volume contains a prologue by Othmar Preining of the Clean Air Commission of the Austrian Academy of …

The new children's hospital handbook 1999. Edited by Kilham H, Isaacs D. (Pp 409, paperback; $44.95) Sydney: New Children's Hospital, 1999. ISBN 0 9587 167 1 4 Any publication dropping onto the doormat of a paediatrician in Manchester at present that has a front cover showing a brand new children's hospital under a crystal clear blue sky had better be good if it hopes to receive an even handed review. Having resisted the initial desire to emigrate, I settled down …

This book lacks vigour and colour. The front cover looked promising but unfortunately the book does not live up to this promise. It is an out of date basic book which is disappointing, considering the biography and experience of …

The Fetal and Neonatal Edition looks different this century. The contents will be as strong as ever, ably supervised by Janet Rennie and Peter Hope. Your letters can now be posted on our website—url: www.archdischild.com—to avoid the long delay inherent in bimonthy publication. Any suggestions or offerings for our front cover picture are welcome. # “Baby triggered ventilation” no better than conventional methods {#article-title-2} Always committed to randomised controlled trials, neonatologists have been working hard to provide more evidence base for practice. In this issue there are two large trials of patient triggered ventilation. One is a large collaborative study in which almost 1000 preterm babies were randomly allocated to either patient triggered (PTV) or conventional ventilation for treatment of their respiratory distress syndrome (Pp 5-10). The group are to be congratulated for having persevered and achieved such a large trial size. There …

Last month an American publisher, Rodale Press, launched Men's Health in Britain. Don't be deceived by the magazine's unambiguous title. There is little in here about health. On the front cover is an unlikely cocktail of sex, scuba diving, dieting advice, and fighter jets. Even more baffling is the cover photograph of a wet looking man with his mouth open and a dead wasp on his forehead. Confused, I turned to the contents pages searching for informed articles on heart disease, peptic ulcer, and AIDS. Of the 32 features listed, only eight are loosely connected with health. Most of the rest are about sex. Where to find it, how to do it, getting more of it, and how to avoid those embarrassing pitfalls for the unwary. “Your babysitter may be the embodiment of succulent young womanhood, but to you, she's forever …