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Background: Cognitive decline is common in Parkinson's disease (PD) but may not be adequately identified by the mini-mental state examination (MMSE), which is better suited to Alzheimer's disease. The mini-mental Parkinson (MMP) examination is a cognitive screening tool designed in French specifically for PD. We aimed to establish the validity and reliability of the English language version of the MMP compared with the MMSE. ; Methods: People with various stages of PD underwent testing with the MMP and MMSE, which was then compared with a reference standard battery of neuropsychological tests to identify those with significant cognitive impairment. ; Results: Forty-nine patients were recruited. Both the MMP and MMSE were significantly correlated with scores on all the neuropsychological tests in the validation battery. The median MMP score was proportionally lower (80% of maximum) than the MMSE (90% of maximum) in PD patients with cognitive impairment and those with prior neuropsychiatric complications but there was no difference between the MMP and MMSE in areas under the curves (0.84) for detecting cognitive impairment. Test-retest reliability of the MMP was good (intra-class correlation coefficient 0.793). An MMP of 28 or lower out of 32 detected cognitive impairment with 87% sensitivity and 76% specificity. ; Discussion: The English language version of the MMP has now been validated. It detects more cognitive deficits in PD patients than the MMSE and identifies significant cognitive impairment in those with PD at least as well as the MMSE.

Results of small trials suggest that early interventions for social communication are effective for the treatment of autism in children. We therefore investigated the efficacy of such an intervention in a larger trial.

The article describes the types of design of a high school library. It states that the important aspects of a library are to attract students and to store materials. The elements of design in new library spaces and their practical applications are discussed. These design elements include the need of the library to support multiple ways of teaching and learning and the influence of collection development policy on library space needs.

(Anaesthesia. 2019;74:904–914)Drug administration errors during neuraxial anesthesia can result in dire outcomes. These authors had previously reported on neuraxial drug administration errors, but have since learned of several incidents of accidental intrathecal administration of tranexamic acid during spinal anesthesia. This article reviewed reports of these occurrences, identified contributing factors to the drug errors, and discussed prevention strategies.

An 83-year-old woman receiving long-term prednisolone treatment presented with a right optic neuropathy and right third, fourth, fifth, and sixth cranial nerve palsies secondary to sino-orbital aspergillosis with cavernous sinus involvement. Because the patient refused conventional treatment, she was given a two-year course of oral itraconazole 200 mg/day, leading to a complete imaging resolution of the lesion. Three years after completing treatment, there is no clinical or imaging evidence of disease recurrence. Visual and ocular motor function did not recover, but ptosis and proptosis improved. We believe this to be the first documented case of successful treatment of such a lesion with oral itraconazole monotherapy.

Inflicted head injury to the developing brain frequently results in serious disability. The pathogenesis of the neuraxial and ocular findings in infants believed to have suffered inflicted head injury remains the subject of considerable debate. Recent neuropathology studies of fatal cases of inflicted head injury and of a foetal/perinatal non-traumatic model have led to the proposal that there is a 'unified hypothesis', the essential feature of which is hypoxic brain swelling secondary to cervicomedullary injury. It has been suggested that less than violent forces may be involved and even that some cases may not be due to trauma at all. The purpose of this paper is to provide a critical review of the data upon which these suppositions are based on a background of what is already known. It is submitted that there are serious flaws in the methodology; the conclusions reached cannot logically be drawn from the data; and the 'unified hypothesis' is not supported by the evidence. On the basis of the data presented, it is also difficult to sustain the secondary hypothesis purporting to describe a minority cohort with 'infantile encephalopathy with subdural and retinal bleeding' of non-traumatic causation.

Objective.The association between psammoma bodies on cervical smear (PBCS) and the presence of gynecological malignancy has been documented previously. The aim of this study was to determine the incidence of malignancy where psammoma bodies were detected on smear, to identify features that may be predictive of associated malignancy, and to make recommendations about management.

Children with cerebral palsy (CP) have often been described as passive communicators. Their familiar conversation partners tend to direct and control interaction. Such conversation patterns may have various precursors: children's motor impairment, their intelligibility difficulties, and/ or their level of cognitive development. To test the comparative influence of these factors, measures of motor function, speech, communication, cognitive and language skills were applied in 40 children (18 males, 22 females) with CP who were aged from 2 years 8 months to 10 years. These variables were correlated with measures relating to interaction patterns to investigate whether individual features predicted communication style. In this group, poor speech intelligibility was the main predictor of restrictive communication patterns, such as fewer child-initiated conversation exchanges, more simple child communicative acts such as yes/no answers and acknowledgements of the other partner's messages. Results support the provision of therapy to increase children's intelligibility, whether spoken or augmented, such as the introduction of communication aids and training programmes for parents.

Children with cerebral palsy (CP) have often been described as passive communicators. Their familiar conversation partners tend to direct and control interaction. Such conversation patterns may have various precursors: children's motor impairment, their intelligibility difficulties, and/ or their level of cognitive development. To test the comparative influence of these factors, measures of motor function, speech, communication, cognitive and language skills were applied in 40 children (18 males, 22 females) with CP who were aged from 2 years 8 months to 10 years. These variables were correlated with measures relating to interaction patterns to investigate whether individual features predicted communication style. In this group, poor speech intelligibility was the main predictor of restrictive communication patterns, such as fewer child-initiated conversation exchanges, more simple child communicative acts such as yes/no answers and acknowledgements of the other partner's messages. Results support the provision of therapy to increase children's intelligibility, whether spoken or augmented, such as the introduction of communication aids and training programmes for parents.

The aim of the paper is to propose guidelines for good practice in disclosing the diagnosis of cerebral palsy to parents. The guidelines draw on an interview study with parents of 107 children, average age 24 months, in the South East Thames region. In addition case notes were examined, and mothers completed questionnaires to measure current levels of depression and coping strategies. Dissatisfaction with how the diagnosis had been disclosed was greater where children had been premature and/or low birth weight, where they developed more severe degrees of physical disability, and where the diagnosis had been made later. Dissatisfaction was related to greater degrees of later self reported depression. The guidelines take account of the findings, in particular the need for early close liaison between neonatology and community paediatric services. Suggestions are made for how to ensure implementation and monitoring of good practice.

Magnetic resonance angiography (MRA) is commonly used to follow up patients after endovascular treatment for intracranial aneurysms. Magnetic resonance artefacts from coil constructs may impair image quality and jeopardise the evaluation of the effectiveness of treatment and review of adjacent vasculature. We present here a technical note on the usage of Barricade coils recently introduced at our institution. The MRA artefacts associated with these coils may make it impossible to ascertain aneurysm closure and anatomy. Hence these patients would need to be recalled for digital subtraction angiograms for a complete neuroradiological follow-up.

Spontaneous vertebral artery (VA) dissection may involve the intradural segment of the VA and result in subarachnoid haemorrhage (SAH). These lesions are frequently associated with recurrent SAH, and have a high mortality.Prior to the development of endovascular techniques the majority of these lesions were treated surgically. In cases where the dissection involved the posterior inferior cerebellar artery (PICA) origin surgery was associated with significant complications including recurrent SAH from retrograde VA flow into the dissected segment above the surgical clip. We describe two cases of complete VA dissection in which the entire intradural VA was sacrificed to prevent recurrent SAH. The first case tolerated planned left PICA occlusion without developing a significant neurological deficit. The second case had infarcted the right PICA territory at presentation.

The paper describes the stages in development of an assessment of the adaptive behaviour skills of children in Bangladesh. Item selection and reduction are described, based on an ecological analysis of behaviours expected of children aged between two and nine years of age, living in both urban and rural settings. The IBAS has four major subscales: motor skills, socialisation, communication and daily living skills. Norms have been constructed based on testing a nationally representative sample of 1404 children. Content, construct and discriminant validity are established, and the reliability of the total scale and subscales is high, both between testers and over time. The IBAS can provide a baseline indication of level of skills in a child with intellectual disability, and aid in planning an appropriate curriculum‐based programme in discussion with the child's family.

Children who are severely physically handicapped and non-speaking may be assessed for recommendation of an augmentative communica tion system. A working model of assessment, developed at the Com munication Aids Centre at The Wolfson Centre, London, is presented and illustrated with three case studies. The paper includes discussion of the prerequisite skills for use of a communication aid, and consideration of important factors in the child's environment, such as training opportunities and the expectations of communication partners, which affect the success of the outcome.

For children to progress in their use of augmentative communication systems, in-service training of staff in schools is required. This paper presents preliminary evaluation of a training package entitled ‘My Turn to Speak’. Nineteen participants and 10 comparison staff were filmed before and after a five-session training workshop, interacting in the classroom in naturally occurring situtations with a non-speaking physically disabled child. Significant improvements in the quality of adults' facilitation of the children's communication was discernible at follow-up, four months after completion of the training. However, teachers were found to alter their behaviour more quickly after training than non-teaching staff. The requirements for setting up successful multidisciplinary training are discussed.

The aim of this study was to evaluate the effectiveness of in-service training for adults working with students using augmentative and alternative communication (AAC) systems, given as part of a new training package My Turn to Speak. Teachers, classroom assistants and therapists attended training workshops led by the specialist team who developed the package. For the evaluation, staff attending the workshop were paired with staff who did not attend. All staff were video-taped interacting with target children who used AAC, before and at two points after training. Ratings of adults' interaction with the target children showed significant positive change in the ways in which participants facilitated target children's communication following training, and none for controls. Outcomes for target children, participants and schools are discussed.

The paper describes a scripted elicitation procedure for assessing the communication skills of nonspeaking physically disabled children. Preliminary data are reported for 16 children attending the Communica tion Aids Centre for children, London. Functions of communication, such as requests for clarification and expression of self, were more likely to be used by children during the scripted procedure with an unfamiliar adult than when they were observed in interaction with a parent.

Local anaesthetic drugs are used to reversibly block the transmission of sensory, motor and autonomic nervous impulses. This article is concerned with the basic pharmacology of these drugs.

We describe a previously unreported complication associated with the use of Guglielmi Detachable Coils and Mechanical Detachable Spirals in the endovascular treatment of intracranial aneurysms in which part of a coil migrated into the parent artery after completion of the procedure. Four cases are documented and possible aetiological mechanisms are discussed.

Intravenous regional anaesthesia (IVRA, Bier's block) has a long history and is an accepted part of anaesthetic and emergency-department practice. This review describes a standard technique before explaining its various components and why a basic knowledge of local-anaesthetic pharmacology is essential for any practitioner.

We describe a series of 60 cases of patients with masses arising within the cerebral ventricles. The site and relative frequency is noted for each histological type. The differential diagnosis depends on patient age and sex, site, morphology and number of masses, presence and type of hydrocephalus and the characteristics of the mass on computed tomography (CT) and magnetic resonance (MR) images. A review of the literature has been performed and this information collated with our own experience to give detailed descriptions of the typical features of each intraventricular mass. Attention is drawn to intraventricular neurocytoma, a recently described tumour that may be mistaken histologically for intraventricular oligodendroglioma or ependymoma. A comparison is made of the value of CT and MR in the diagnosis of intraventricular masses.