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The aim of this study is to evaluate the reliability and validity of the Byron Physical Assessment Framework (BPAF). The BPAF is a systems based checklist of physiological measurements, signs, and symptoms designed to structure and document the assessment of a patients physical condition by nursing staff. Initially the BPAF was refined using extensive literature review and expert opinion to improve the comprehensiveness and clarity for its intended purpose. As a result the content validity of the BPAF was supported. Inter-rater reliability between both expert-expert and novice-expert pairings was assessed. A total of 68 assessments were conducted by pairs of qualified nurses with patients on general medical and surgical wards and a nursing-led unit in one London Hospital. Reliability of the dichotomous data items of the BPAF was found to be generally good (kappa > 0.6) with only one item showing a poor reliability (kappa < 0.20). Reliability for continuous items such as pulse and respiratory rate was surprisingly low with evidence of large variation between raters in addition to systematic bias. With relatively little teaching, novice assessors were able to use the BPAF and achieve good inter-rater reliability with expert assessors although this was lower than the reliability of the expert diads. The utilisation of the BPAF to fulfil intended purpose was assessed by examining completed assessments and the outcome in terms of nurses' actions in light of new abnormal findings. Both were found to be fair, showing that the BPAF does affect the actions of nurses although it could be utilised more.

Chitosan microspheres cross-linked with genipin were prepared by a spray-drying method and were characterized in terms of morphology, loading efficiency, zeta potential and X-ray diffraction. The model drug used in this study was tramadol hydrochloride. In vitro drug release was also evaluated and microspheres showed controlled release kinetics.

The most costly American earthquake since 1906 struck Los Angeles on 17 January 1994. The magnitude 6.7 Northridge earthquake resulted from more than 3 meters of reverse slip on a 15-kilometer-long south-dipping thrust fault that raised the Santa Susana mountains by as much as 70 centimeters. The fault appears to be truncated by the fault that broke in the 1971 San Fernando earthquake at a depth of 8 kilometers. Of these two events, the Northridge earthquake caused many times more damage, primarily because its causative fault is directly under the city. Many types of structures were damaged, but the fracture of welds in steel-frame buildings was the greatest surprise. The Northridge earthquake emphasizes the hazard posed to Los Angeles by concealed thrust faults and the potential for strong ground shaking in moderate earthquakes.

Summary The literature concerning dementia and disintegrative psychosis in childhood is reviewed. Two cases with different neurodegenerative disorders presenting with late juvenile onset psychiatric symptoms arc described. There appears little point in retaining the eponymous syndromes of de Sanctis and Heller. The diagnostic category of Progressive Disintegrative Psychosis is appropriate to describe the clinical psychiatric picture in these children. Because of the rarity of such conditions further collaboration between child psychiatrists, paediatiric neurologists and neuropathologists is needed to delineate further the psychiatric syndromes associated with the neurodegenerative disorders.

SUMMARY A negative replication of Nuffield's (1961a, b) neuropsychiatric correlation study is presented. Of 946 patients seen over a twelve-year period in the EEG Department of The Maudsley Hospital, 350 had spike abnormalities in their EEGs; however, only 22 patients had “pure” EEG patterns (unilateral temporal lobe spike; generalized 3 c/sec spike and wave; generalized, irregular spike and wave). Of these, 11 had only had a single EEG and a further 2 patients had normal follow-up recordings. The authors conclude that previously reported neuropsychiatric correlations based upon “pure” EEGs may be the result of chance finding only.

Emerging nations stand in greater need of valuable human resources than of measures aimed at the reduction of problems. Developing countries depend upon indigenous talent for lasting measures which ensure growth and independent functioning. The gifted, who provide a source for future growth and strength, for leadership, and for role models, are frequently neglected, providing a self-perpetuated cycle of dependency upon outside talent. A low cultural self-image, pervasive in sub-dominant societies, which contributes to the reluctance to support education for the gifted, can be effectively tempered by practical demonstrations of workable programs. Such programs as those demonstrated in Micronesia, avail themselves of existing resources and provide examples of effective implementation with concrete, visible results. The working programs could be replicated and expanded into a network and provide an arena for sustained effort, offering a viable solution for the problems of development of indigenous talent.

To investigate the possibility that Hodgkin's disease (H.D.) may be transmitted from person to person, a case-control study was conducted among 87 of the 97 H.D. patients diagnosed under the age of 40 years in the period 1962-71, resident at the time of diagnosis in a defined area around Oxford. For each of the 87 H.D. patients a matched control patient was selected with a diagnosis other than that of a chronic or malignant disease. H.D. patients and controls were interviewed to determine their places of schooling and work and attempts were made to link pairs of patients who had attended the same school or work place at the same time. The findings do not support the hypothesis that H.D. patients may pass on the disease to others. Among the H.D. patients, links between 40 pairs were established, compared with 40·75 links expected, based upon the experience of all 174 persons studied. The only finding which was statistically significant (P≃0·04) arose when H.D. patients were considered to be "susceptible" from 10 to 5 years before diagnosis and "infective" from diagnosis to 2 years after diagnosis: 7 pairs of links were found against 2·75 expected. However, since 7 postulated periods of susceptibility and 9 postulated periods of infectivity were examined, this one "statistically significant" finding might easily have arisen by chance.

Since the summer of 1975 the Gifted Department of the Rockford Public Schools has provided a pre-school program for pre-kindergarteners who are potentially able learners (P.A.L.s). The program has been for identified gifted children and their parents attending co-joint sessions with preschoolers in a classroom environment directed by a teacher and parents in a discussion/work group with a psychologist. Identification techniques have ranged from nomination of children by the district's elementary school staffs after pre-kindergarten screening in the Spring to individual testing with the Slosson Intelligence Test. Children have participated in a center-based classroom with some academic emphases. Parents met to discuss topics which included understanding the gifted child, parenting, further enrichment techniques, developing at-home learning experiences, and expressing feelings about topics of personal relevance.

The EEGs of twenty-three patients and five asymptomatic siblings with Wilson's disease were correlated with their clinical states and biochemical studies related to liver function and copper metabolism. In uncomplicated cases of the disease the EEG may be normal or abnormal. When the EEG is abnormal there does not appear to be a clear correlation with a clinical or biochemical state. Severely abnormal EEGs are seen with severe complications of the disease and are appropriate to the complication. These EEGs show improvement parallel with clinical improvement. Asymptomatic siblings with the characteristic biochemical defect of copper metabolism may also show normal or abnormal EEGs, a feature which seems to have a familial tendency. The abnormal EEGs of asymptomatic siblings show improvement with treatment, supporting the argument for prophylaxis in such cases.

Seven patients are described in whom dementia developed during treatment with methotrexate for meningeal leukaemia. The patients presented with confusion, tremor, ataxia, irritability, and somnolence. There were major epileptic fits in two cases and in one case there was progression to coma and death. Necropsy findings in the latter showed infarcted areas in the temporal and parietal lobes, with no evidence of active leukaemic disease or of viral encephalitis. The condition has not responded to radiotherapy and no positive evidence of viral encephalitis has been obtained. On the other hand, when treated with folinic and folic acid the deterioration has been arrested and there has been some improvement; thus the condition appears to be due to methotrexate. The occurrence of so many cases within the past year of a condition not previously described is probably attributable to the introduction of intensive cytotoxic therapy directed against meningeal leukaemia.

The effects of a low cobalamin (Cbl) diet, together with chronic cyanide or thiocyanate administration in some animals have been investigated in baboons over a period of 42 months. All animals remained healthy throughout the study and gained weight at a similar rate. None became anaemic or showed major haematological changes and there were no major neurological changes. Plasma total Cbl in the animals on the low Cbl diet fell withing 9 months to values below the lower limit in man and were lowest at 24 months in baboons not receiving cyanide or thiocyanate. A striking feature in all animals, however, was an apparently seasonal increase in the plasma total Cbl each autumn with a corresponding decrease the following spring. This fluctuation was detected by radioisotopic assay but not by Euglena Methylmalonic (MMA) excretion after oral valine ranged from 0.1–8.4 mg/24 h and was greatest in animals on the low Cbl diet and not receiving cyanide or thiocyanate. The results suggested an inverse relationship between MMA excretion and plasma total Cbl. Plasma thiocyanate was consistently higher in animals receiving cyanide or thiocyanate and at the end of the study plasma cyanide was highest in animals on the low Cbl diet receiviong cyanide. The results support the suggestions that cyanide affects bodily handling of Cbl and that hdyroxocobalamin plays a part in detoxication of cyanide.

In a case control study of the prevalence of palmar keratoses in 69 bladder cancer patients, 66 lung cancer patients, and 218 hospital controls palmar keratoses were more common in the cases, especially among those with cancer of the bladder. Above the age of 50 years, 87% of bladder cancer patients and 71% of lung cancer patients but only 36% of the controls had one or more keratoses. The prevalence increased with age and keratoses were more common in males. No features could be found which distinguished the keratoses in cases from those in controls.

A 10-year-old girl, one of three affected sisters, with non-ketotic hyperglycinaemia is described. In contrast to other reported cases, the course of the disorder was comparatively mild in this family. The only clinical signs were mental retardation and abnormalities in the EEG; blood glycine levels were 2-3 times normal. In the propositus, the formation of 14CO2 from glycine-1-14C and of FH414CH2OH from glycine-2-14C were impaired, shown by the decreased 14CO2 content of expired air and diminished labelling of carbon 3 of serine. However, the biochemical defect was no less than that seen in patients with much more severe clinical effects.

SynopsisThis article discusses the trial of a woman accused of murder in 1890 whose defence rested on the claim that she acted unconsciously under the hypnotic influence of her older lover. This relatively banal case brought together two rival schools of French psychiatry – that of J.-M. Charcot in Paris and that of Hippolyte Bernheim in Nancy – and provided a wide-ranging examination of views on the nature of unconscious mental activity as well as the social, political and professional implications that their theories on hypnotism and hysteria contained. Discussions on women's sexuality, family relations, crowd behaviour and political radicalism all played a part in the debate and are examined through the case study that the trial of Gabrielle Bompard permits. Moreover, the trial shed incidental light on the campaign by physicians against amateur healers and hypnotists whom they blamed for unleashing a wave of mass hysteria through their theatrical representations. The episode was one important element in the struggle for the passage of the law of 30 November 1892, which outlawed amateur practitioners and established the medical monopoly over healing in France.

One hundred and twenty-four EEGs were obtained from thirty-nine juvenile baboons during anaesthesia with phencyclidine hydrochloride (Sernyl) and pentobarbitone (Nembutal). Changing EEG patterns were found which could be related to the time interval from the onset of anaesthesia. It was found, with some variations in individual animals, that a relatively stable EEG was seen from 15 to 45 min after starting anaesthesia. It is suggested that evaluation of these variations are important in experiments where the EEG is being used to monitor changes in cerebral function.