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BACKGROUND Lack of validated and responsive outcome measures in the management of Frontal Fibrosing Alopecia (FFA) significantly limits our ability to assess disease progression and treatment response over time. OBJECTIVES The aim of this study was to understand how FFA extent and progression is currently assessed in UK specialist centres, validate components of the International FFA Cooperative Group (IFFACG) statement on FFA assessment, and identify pragmatic advice to improve FFA management in clinic. METHODS Consultant Dermatologists with a specialist interest in hair loss (n=17) were invited to take part. Preferred FFA assessment methods were explored using questionnaires and clinical scenarios. Participants were asked to identify and mark the current hairline in 10 frontal and 10 temporal hairline images, with assessment repeated 3 months later (to assess intra-individual variability) and 12 months later (to test whether inter-individual accuracy could be improved with simple instruction). RESULTS All 17 clinicians (100%) completed the questionnaire at each time interval. We identified a wide variation in assessment techniques between our experts. Measurements were perceived as the most accurate method of assessing frontal recession whereas photography was preferred for temporal recession. Inter-rater reliability between clinicians measuring the frontal hairline scenarios indicated a moderate strength of agreement (ICC 0.613; 95% CI: 0.398 to 0.848), yet intra-rater reliability was found to be poor with wide limits of agreement (-8.71mm to 9.92mm) on follow-up. Importantly, when clear guidance was provided on how the hairline should be identified (questionnaire 3), inter-rater reliability improved significantly, with an ICC 0.702 suggesting moderate agreement (95% CI: 0.508 to 0.890; p

The major promise of the 4th industrial revolution is encompassed by the utilization of real-time process data to inform operational decision-making. Research focus relating to the monitoring of batch process end product qualities has typically been dominated by the use of latent variable models. In this work, we combined latent variable modeling with probabilistic machine learning methods to construct novel soft-sensors, which are able to synchronously capture nonlinearities expressed within process data, as well as identify accurate uncertainty estimates for predictions. Specifically, we explored the combination of multiway projection to latent structures (MPLS) with Gaussian processes (GPs), Bayesian neural networks (BNNs) and heteroscedastic noise neural networks (HNNs). We demonstrated performance of the soft-sensors for industrial batch process quality control, which involves estimating the end viscosity of different variants of a non-newtonian liquid product manufactured over different periods. Through experimental validation, it is concluded that the use of the MPLS-HNN soft-sensor provides particular promise for industrial batch process monitoring given its high accuracy and reliability, as well as ease for practical implementation.

Reinforcement Learning (RL) controllers have generated excitement within the control community. The primary advantage of RL controllers relative to existing methods is their ability to optimize uncertain systems independently of explicit assumption of process uncertainty. Recent focus on engineering applications has been directed towards the development of safe RL controllers. Previous works have proposed approaches to account for constraint satisfaction through constraint tightening from the domain of stochastic model predictive control. Here, we extend these approaches to account for plant-model mismatch. Specifically, we propose a data-driven approach that utilizes Gaussian processes for the offline simulation model and use the associated posterior uncertainty prediction to account for joint chance constraints and plant-model mismatch. The method is benchmarked against nonlinear model predictive control via case studies. The results demonstrate the ability of the methodology to account for process uncertainty, enabling satisfaction of joint chance constraints even in the presence of plant-model mismatch.

Summary Background Psoriatic keratinocytes are poorly differentiated and hyperproliferative. Low concentrations of nitric oxide (NO) induce keratinocyte proliferation, while high concentrations induce differentiation. The NO-producing enzyme inducible NO synthase is overexpressed in psoriatic skin, but so is arginase. The overexpressed arginase competes for arginine, the common substrate for both enzymes, and may reduce NO production. Objectives To determine whether arginase activity is elevated in psoriatic skin and whether exogenous NO will improve psoriatic plaques. Methods Tape strips were taken from healthy skin of eight control subjects and nonlesional skin of eight patients with psoriasis and l-arginine, l-citrulline and l-ornithine concentrations measured by high-performance liquid chromatography. In a second study, four psoriatic patients with a pair of similar symmetrical plaques were treated with an NO donor and vehicle control. Plaques were scored for size, erythema, induration and scaling at the start and after 6 weeks of treatment. Results Ornithine, the end-product of arginase, was at higher concentrations in nonlesional psoriatic than in healthy skin (mean ± SEM 2·08 ± 0·98 vs. 1·13 ± 0·44 μg mg−1 protein; P = 0·0002). Arginine, its substrate, was at lower concentrations. Topical application of an NO donor improved psoriatic plaques clinically [mean ± SD reduction in severity from baseline score (100%) to 35% ± 16% in active NO donor and to 93% ± 10% in control]. Conclusions Arginase is overactive in psoriatic skin, leading to a relative increase in the consumption of arginine. We therefore hypothesize a relative decrease in NO synthase-derived NO production. NO donors may be effective topical treatments for psoriasis.

Scottish Melanoma Group (SMG) data on 2790 melanoma (MM) cases in South East Scotland over a 24-year time period were analysed in four periods each of 6 years duration grouped into frequently exposed, intermittently exposed, and always covered sites. Incidence increased significantly over time with females having a higher incidence rate than males. In both sexes, the proportion of cases seen on the posterior trunk and arm increased significantly (P

This paper discusses the protocol used for electing the Doge of Venice between 1268 and the end of the Republic in 1797. We show that it has some useful properties that in addition to being interesting in themselves, also suggest that its fundamental design principle is worth investigating for application to leader election protocols in computer science. For example, it gives some opportunities to minorities while ensuring that more popular candidates are more likely to win, and offers some resistance to corruption of voters. The most obvious feature of this protocol is that it is complicated and would have taken a long time to carry out. We also advance a hypothesis as to why it is so complicated, and describe a simplified protocol with very similar properties.

We present a new trust management scheme for distributed authorization which can be easily implemented using X.509-based certificate chains, but does not require globally unique role names. A principal proves that he has authorization for a particular action by demonstrating the existence of an acyclic chain of bindings from a specified principal to himself where the sequence of labels in the chain matches a template. This template is in an easily-computed subset of regular path expressions. Our restrictions to acyclic paths and to a subset of path expressions enable us to permit controlled delegation, relax the requirement of global agreement on role names, and provide an intuitive abstraction. We show that some useful security properties can be determined in polynomial time. Our scheme has been used in practice to secure a management framework for distributed components: we give an overview of the implementation.

This paper gives a new definition of security, which takes causal information into account. The new definition can be used to determine the security of nondeterministic concurrent systems for which high-level information may be either input into the system during its operation, or inherent in the original state of the system. It is possible to have systems which are secure under this definition which write to audit before performing each transition. The definition satisfies several useful composition properties, including one which gives it some protection from Trojan horse attacks. >

Numerous factors are known to be associated with an increased rate of deep infection in joint arthroplasty. However, most deep infections occurring during total joint arthroplasty result from airborne contaminants shed by the operating personnel. Ultra-clean air sources in orthopaedic theatres and prophylactic antibiotics are thought to reduce the incidence of infection. Other factors such as the use of non-disposable drapes, poor theatre discipline, the method of skin preparation and surgical suction devices are all implicated in the genesis of wound infection. We are not aware of any study that has investigated the impact of training junior orthopaedic surgeons on the incidence of deep wound infection.

Murchie et al 1 compared morbidity and mortality in patients who had initial diagnostic excision biopsy in primary versus secondary care. The Breslow thickness of a melanoma is the main prognostic indicator in the melanoma patients included in this study. The mean thickness in both the primary and secondary care groups was ≤1mm: such patients have a 95% 10-year survival rate, …

On the afternoon of Saturday 4th March 1989 two trains, both bound for London Victoria Station, collided. Part of the rear train rolled down a steep railway embankment and jack-knifed against a tree. The mechanism of the crash and the injuries sustained by the 55 victims who were seen in the A&E Department of the Mayday University Hospital are described. Improvements in signalling technology and design of rolling stock which may reduce both the risk of collision and severity of injury in future accidents are discussed.

Successful ligament prosthetic surgery involves the rational design of a ligament “system”. Such a “system” should have inputs from professionals in the fields of bioengineering, textile technology, and surgery. This paper reexamines the ABC scaffolding ligament design philosophy and surgical technique, from a multidisciplinary standpoint, in light of clinical results obtained from the follow-up of 198 patients over a 5 year period.

The paper reviews articles in the field of research in medical education specifically dealing with the factors involved in the choice of Psychiatry as a medical specialty and describes three studies conducted in Melbourne. These studies focus on the relevance of personality factors in the psychiatrist's choice of a career. While they confirm other work in this field, it is felt that the emphasis should no longer be placed on single factors. Future investigations should be multifactorial in design and analysis to highlight the combination of factors underlying such choices.

A new 5 binary/6 ternary coding scheme is presented with a similar advantageous spectral property to that of MLT3, but which has bounded running digital sum and maximum run length.

The aim of this study was to examine the relationships between side effects occurring in the first two months of treatment with a contraceptive pill and questionnaire-assessed neuroticism. Because the side effects of contraceptive pills are now widely known, doctors' and patients' expectations could be a significant influence in reporting side effects. In order to control for these non-pharmacological variables we therefore designed a double blind trial of a contraceptive and an inert pill involving an intensive study of a small group of patients. It was assumed that neurotic patients were more likely to report side effects, but that if the degree of neuroticism could be controlled, any significant differences in reports of side effects would be due to the active substance.

This enquiry was prompted by a discussion on training in psychotherapy which took place at the Troon Conference on the Teaching of Psychiatry (Ingram, 1963). We felt that more precise information was required about what is meant by the term psychotherapy, which methods are in use and what opinions are held by psychotherapists in training. This information could be of value in assessing the workload of psychiatrists and in deciding what training might be given to psychiatrists and medical students. It was therefore decided to seek the opinions of Scottish psychiatrists on some aspects of their current practice in psychotherapy.

Lippold and Redfearn (1964) described the mental changes induced by the passage of small polarizing currents between two electrodes attached above the eyebrows and a single electrode on the right knee. When the forehead electrodes were positive with a total current flow of the order of 500 microamps, the mental changes consisted of an elevation of mood and an increased involvement in the environment. Forehead negative electrodes produced withdrawal and quietness. These observations were made on a group of hospitalized patients, the majority of whom were, or had been, mildly depressed. The authors state that “all would probably have been considered quite ‘normal’ by non-medical observers”.

The nature of consciousness is a central theoretical problem for psychology, psychiatry and psychosomatic medicine. Attempts to deal with this problem in these fields have led to precarious relationships with philosophy on the one hand and with neurophysiology on the other. The result is both conceptually and semantically unsatisfactory. For example, is “consciousness” to be taken to mean some general state or level of awareness which is capable of being altered or reduced? Or is there no general consciousness but only states of being conscious of specific things? This paper discusses some of the philosophical problems involved in the term “consciousness” and outlines ways in which recent neurophysiological advances have contributed to clinical knowledge about the general or specific nature of consciousness.

In their evidence to the recent Royal Commission on the Law Relating to Mental Illness and Mental Deficiency the R.M.P.A. stated the problem of the psychopath in terms of delinquent or otherwise anti-social behaviour. After eliminating cases where such behaviour resulted from well-recognized forms of mental illness or defect, from psychoneurosis or organic disease or injury, their Memorandum went on to say that there remained a group of patients “whose daily behaviour shows a want of social responsibility and of consideration for others, of prudence and foresight and of ability to act in their own best interests. Their persistent anti-social mode of conduct may include inefficiency and lack of interest in any form of occupation; pathological lying, swindling and slandering; alcoholism and drug addiction, sexual offences, and violent actions with little motivation and an entire absence of self-restraint, which may go as far as homicide. Punishment, or the threat of punishment, influences their behaviour only momentarily and its more lasting effect is to intensify their vindictiveness and anti-social attitude.”

SynopsisA factor analysis was carried out of ratings on the Hamilton Scale on a group of 134 male and 213 female depressed patients. The original data covered a wide range of severity of illness and the distribution of severity scores was not biased from normal. Hamilton's general factor was confirmed but his bipolarity between agitated and retarded depression did not emerge. Sex differences in factor patterns were found and a preliminary experiment showed that factor scores could isolate anxiety features and personality factors.

The Maudsley Personality Inventory was given to an unselected group of psychiatric inpatients. All diagnostic groups were differentiated from normals on the Neuroticism scale but neither this nor the Extraversion scale distinguished between diagnostic groups. Contrary to Eysenck's claim, hysterics and dysthymics were not distinguished on the Extraversion scale. The negative correlation between Extraversion and Neuroticism in neurotic groups and the use of the short form of the scales are discussed. Because Eysenck's original report is not readily available, some general comments are offered about the methods used to devise and standardize the test. The results suggest that the test is unlikely to be of value in the individual case.

Psychiatric problems amongst students are an important field of study. The paper discusses a questionnaire survey of psychiatric symptoms in 2,363 Australian medical students. The findings are discussed and compared with those from other surveys. A positive correlation was found between higher academic performance and questionnaire-assessed “neuroticism”.

Six patients with persistent anxiety symptoms were used in a preliminary assessment of a new anti-anxiety compound-Doxepin (Sinequan) with placebo. The factorial design is discussed as a potentially useful way of conducting a first-stage test of anti-anxiety compounds. Analysis of the results showed that Doxepin at 25 mg t.d.s. and 50 mg t.d.s. was associated with improvement in the patient's self ratings of anxiety symptoms.

In Scotland the central collection of forms bearing details of admissions to all psychiatric hospitals was begun in January, 1962. These forms are intended to provide knowledge about the incidence of psychiatric disorders and the result of treatment. The details of this scheme and the nature of the information required were presented at a meeting of the Scottish Division of the Royal Medico-Psychological Association in 1961, and in the discussion which followed the reliability of data which depended on clinical diagnosis was questioned.

Mean scores for 2,363 medical students in Australia on the Neuroticism and Extraversion scales of the Eysenck Personality Inventory, Form B, are presented by sex and by year of study.

Studies of the factors which influence the selection of a specialty in medicine represent a major theme in research in medical education. The journal literature in this area is reviewed for the last ten year under the headings of: Reasons for choice of specialty Timing and consistency of choice Expectations of financial success Attitudes and choice of specialty Predictive methods Effect of the curriculum Academic performance Psychiatry as a career choice General differences Personality factors It is concluded that there are a number of inadequacies in the investigations reported in this field. The research is not based on any theoretical model, focuses on only one or a few of the many possible factors and uses different study populations. Greater consistency and applicability of the findings could be achieved by a central organisation conducting appropriately designed multivariate studies using defined populations at a large number of centres.

The ABC synthetic anterior cruciate ligament (Surgicraft Ltd, Redditch, UK) is composed of polyester and carbon fibres combined in a partial braid. Following preconditioning this prosthesis exhibits mechanical compatibility with the natural anterior cruciate ligament and is intended for use as a biological scaffold for the ingrowth of autologous fibrous tissue.