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This edition’s content has a strong emphasis on medicolegal issues concerning older people. We are particularly grateful to Dr Rai and Dr Abdulla for their article on care of the elderly in the context of the Mental Health Act and Equalities Act, and to Dan Bennett for his article on claims concerning neglect of the elderly. By the time this edition is published, the report from the public inquiry into Mid Staffordshire NHS Foundation Trust should also have been published. AvMA was a core participant in the inquiry and we are confident that the submissions we and others made regarding the care of older people will not be lost on the Chairman, Robert Francis QC. While Stafford was unique as regards the sheer scale of neglect and breakdown of clinical governance, regulation, professionalism and compassion, elements of what went on at Stafford can be found in many of our hospitals. AvMA sees this day in day out in the casework and helpline calls we deal with. A common theme in so many of them involves what can only be called “neglect”, and all too often this is with regard to older people. The Reports by the Care Quality Commission “Dignity and Nutrition for Older People” (October 2011) found that less than half of the hospitals inspected were fully compliant with essential standards. The standard of care that some older patients receive in some of our hospitals has rightly been described as truly shocking and alarming. The question that many of us, not least Robert Francis QC, have been grappling with is “How can things get this bad in a service which, for the most part, can be proud of its excellent care?” and “How can we prevent this?” One of the pieces of evidence to the inquiry which most struck me was that of a young male student nurse. His comments found resonance with the vast majority of the great and good assembled by Robert Francis QC for a workshop on care of the elderly. He decried the way that nurses are recruited based mainly on their academic ability rather than their caring attitude; the inadequate practical experience in training; and the low esteem given to those doing the “basics” of nursing, caring for the elderly. Clearly, it is not just about these issues, but they do seem to be a credible critique of the current situation. Personally, I also think that we should not allow anyone to forget that staffing numbers has a crucial role to play. We must have clear guidelines and minimum requirements regarding staff numbers on wards. However, I am not sure all of this answers the question that perplexes me, as to how anyone who calls themselves a health professional can ignore the calls for help from a sick older person or leave an older patient lying in a soiled bed. It will be interesting to see how far the inquiry report moves us forward.

The reform of health professional regulation has been a hot potato since Dame Janet Smith’s devastating criticisms of the General Medical Council in the Shipman Inquiry report. A host of other high profile scandals and inquiries involving doctors led to a Government White Paper, Trust Assurance and Safety: Health Professional Regulation in the 21sty Century. After that, the Department of Health set in train a mammoth programme of working parties involving a wide range of stakeholders, including AvMA, in coming up with recommendations about how to move forward. It would be wrong to say that nothing has changed since. We have seen the introduction of “Responsible Officers” for example and at least a start on planning the introduction of revalidation for doctors. Oh, and of course the small matter of a change of Government intent on making its own stamp on the subject and injecting yet more cynicism about the role of regulation per se. It published “Enabling Excellence” in 2011. However, it has never been made clear whether that policy statement makes all other work on the subject conducted under the previous Government redundant or not. It is simply silent on the matter. Meanwhile many people including ourselves are wondering what, if anything, is happening with all the recommendations from the working groups, including Tackling Concerns Locally, of which I was a member and which contained some of the most important recommendations for improving regulation in our view. Civil servants simply look askance when you ask them. What for example is happening about the recommendation to fund a specialist independent advice and support service for people considering referring a health professional to a fitness to practice investigation? Or the recommendation to make it a statutory responsibility for employers to have to refer concerns about health professionals to regulators and co-operate with their investigations? Or about the information that should be publicly available about regulators dealings with health professionals? When we heard that the Law Commission had been given the task of reviewing the legislation concerning health professional regulation we were delighted. It is an opportunity to deal with the confusion and huge inconsistency between the regulators. We assumed that they would be doing this in the context of what was happening with all those recommendations which are vital to how effectiveness of health professional regulation. However, that is not the case. This is as much a mystery to them as to the rest of us. They have now published their initial report and recommendations. It is open for consultation until 31 May. The report has some very welcome recommendations but is in danger of being a wasted opportunity to get real consistency and accountability into the system and win back public confidence. It appears to have been written on the basis of making recommendations that are likely to enjoy current political favour, rather than from an objective viewpoint based on the public interest. A consistent theme is allowing the regulators themselves more autonomy and flexibility. A recurring phrase throughout the report is that “Regulators would have broad powers to. . .”. Whilst more flexibility than at present is needed for the regulators to be able to do their jobs appropriately I do not think they have got the balance right. It is not right that every regulator should be able to develop its procedures in the way it sees fit. That would lead to even more inconsistency than at present. Moreover, all of the rules and regulations need to be re-written with patient safety in mind. At present they are developed in ad hoc fashion and on occasions work directly against patient safety. Take for example the GMC ‘five year rule’ which exempts most doctors from investigation if the subject of an allegation is more than five years old. (Other regulators do not have such a provision). Also, the fact that a health professional can be exempted from regulatory action necessary to protect the public simply on the basis of some ‘abuse of process’ on the part of a regulator earlier in the process. From AvMA’s own caseload, we are aware of cases where potentially unfit and dangerous doctors have been deemed to be untouchable by the GMC on these grounds. This makes a mockery of stating that regulators’ overriding aim is to protect the public, even if that were to be clearly stated in the legislation. Whilst we welcome the Commission’s recommendation that each regulator have an internal appeal process for decisions not to investigate a health professional, I can see no logic in there not being any statutory provision for appealing such allegedly wrongful decisions. The principle of needing a safety net for challenging a fitness to practise decision is well established – the CHRE has the power to challenge these. If regulators can get it wrong after a full investigation and Fitness to Practise process, it stands to reason they will get it wrong at earlier stages of the process. The risk and potential consequences are higher here for a dangerous professional slipping through the net. The CHRE could be given the power, in exceptional cases which have already been reviewed internally, to challenge erroneous decisions. At the time of writing the Council for Health Regulatory Excellence (CHRE) has just published its interim report on the review it has been asked by the Government to carry out on one of the largest and most significant regulators – the Nursing and Midwifery Council (NMC). It makes depressing reading. The NMC does not seem to have recovered from its recent dark days and has now gone through two sets of chief executives and chairs leaving in unpleasant circumstances in a handful of years. Health professional regulation is ripe for reform and has been for years. It is a vital part of upholding professional standards and patient safety. We must ensure that the opportunity is taken now to radically overhaul the system to protect patients (as it says “on the tin”) rather than simply tinkering or playing to the political appetite of the day.

Background Objective monitoring of disability progression is critical for any trial of novel agents in the treatment of multiple sclerosis. Currently, Kurtzke9s Expanded Disability Status Scale (EDSS) is the most widely used marker of disease status. However there are significant problems with its use as a trial endpoint. Conventional MRI parameters are compromised by poor correlation with clinical disability and are not a measure of function. The development of a sensitive, objective and quantitative measure of function within the neural networks affected by MS, with detection of subclinical changes in small groups within short timeframes would be highly desirable. Multimodal evoked potential scores fulfil many of these criteria and have been shown to have clear correlation with clinical disability in a range of MS phenotypes. Our study is the first to measure serial global evoked potentials in a substantial PPMS cohort and this is the first interim analysis. Methods A battery of evoked potentials including VEP, SSEP, BSAEP and MEP was recorded at 0, 6, and 12 months and a global evoked potential (GEP) score calculated using a consensus method. Clinical disability was measured using the EDSS and MSFC. Results Twenty patients and three controls have completed the first year of the study. In cross-sectional analysis there was significant correlation between GEP score and EDSS at each time point (baseline [r=0.55; p=0.016], 6 months [r=0.72; p=0.0008], 12 months [r=0.59; p=0.0067]). There was also a correlation between MSFC and GEP on composite data analysis (r=−0.36; p=0.008). In longitudinal analysis there was no progression of the EDSS (Wilcoxon S=34.5; p=0.45) whereas we saw progression of GEP scores that approached statistical significance (S=13.5; p=0.02). Conclusions GEP scoring shows significant promise in the search for accurate, sensitive and objective parameters of disease status in PPMS. Significant cross-sectional correlation with clinical disability and a suggestion of reliable and progressive deterioration with time needs to be expanded upon in the longitudinal analysis to be carried out in the following years of the study.

Smectite genesis is generally considered to require an alkaline environment, for in acid environments it is reportedly unstable. This study shows that smectite is forming in an acid, texture-contrast soil in the Pilliga State Forests in north-western New South Wales. Three modes of smectite genesis in the study soil are presented. The first mode involves direct inheritance from the underlying parent rock. The second and third modes involve precipitation of smectite from solution and its deposition from suspension, respectively. While the bulk of the smectite in the study soil is inherited from the transformation of labile primary minerals and rock fragments in the parent rock, restricted drainage coupled with a parent material capable of supplying the elemental constituents of smectite are also important factors in its genesis.

Over the next few decades, hip fractures will be a major public health concern as the number of elderly, a population at high risk for osteoporosis, increases substantially. The rising incidence of hip fracture is a concern for both afflicted individuals and the health care system because these fractures are associated with significant morbidity, mortality, and costs. This study investigated trends of hip fractures in Canada from 1985 to 2005 through analysis of national databases on hospitalization and morbidity. The primary study outcome measures were age-specific and age-standardized hip fracture rates. The Cochran-Armitage test for linear trend was used to estimate yearly changes in age-specific hip fracture subgroups. Joinpoint regression analysis identified points at which a statistically significant change over time occurred in the linear slope of the trends in hip fracture rates. Over the 21 years of observation, 570,872 cases of hospitalization for hip fractures were identified. A progressive decrease in age-specific hip fracture rates occurred over time among both males (25.0%) and females (31.8%) (P < 0.001 for both): Age-adjusted hip fracture rates among females decreased from 118.6 per 100,000 person-years (95% confidence interval [CI], 115.9-121.4) in 1985 to 80.9 (95% CI, 79.2-82.6) in 2005. Similarly, the age-adjusted hip fracture rates for males decreased from 68.2 per 100,000 person-years (95% CI, 65.6-70.8) to 51.1 (95% CI, 49.4-52.7). Among males and females, joinpoint regression analysis identified a change in the linear slope around 1996. During the early part of the study (1985-1996), the average percentage decrease per year in hip fracture rates was 1.2% (95% CI, 1.0%-1.3%) whereas during the later part of the study (1996-2005), the decrease was 2.4% (95% CI, 2.1%-2.6%) per year from 1996 to 2005 (P < 0.001 for difference in slopes in both time periods). Large changes occurred among both females and males with greater slope reductions after 1996 (P < 0.001 for difference in slopes for both). These findings demonstrate significant progressive decreases in age-standardized rates of hip fracture between 1985 and 2005 and show a more rapid decline in rates in the second half of the study period. The factors contributing to the earlier reduction in hip fracture at a time when there was no widespread diagnostic testing or modern drug therapy are unknown.

Those of you with access to JANET may be interested in exploring the electronic sources of information on serials which are available free over the network. It is possible to "subscribe", through a JANET gateway, to a variety of e-mail based discussion groups or electronic publications on the US BITNET network. It is not necesssary to know anything about how this works, but you do need to know about electronic mail, both to subscribe and to deal with the messages as they arrive.

The design considerations for filaments in energy conserving incandescent lamps are described. Such lamps require compact high emissivity filaments to absorb infrared radiation reflected from heat mirrored focusing envelopes. The relationships between the electrical parameters in the radiation returning environment and in the clear surroundings are developed. Efficiency experiments with filaments of various geometries under conditions of radiation return were performed. A highly compact coiled coil filament seems most promising for development. A calculation is presented of the filament emissivity as a function of spacing of the windings in a coil. Measurements of the emissivity as a function of the pitch of a coiled coil filament agree with the calculation.

A theoretical treatment of the electrical behavior of pulsed discharges in gas‐filled flashlamps is presented. The theory is based on a simple model of the plasma and a balance of electrical power input and radiation output. It is assumed that the plasma radiates as a greybody with an emissivity that depends on the electron density. The principal result is an analytic expression for the arc voltage as a function of current, with initial voltage, arc length and diameter, and atom density as parameters. The expression describes the entire voltage pulse, including the initial fall, the following minimum and the peak when the current peaks. The predicted voltages substantially agree with measurements, including dependences on lamp length and diameter and initial voltage. The theory is an improvement on the empirical V‐I relation commonly used in flashlamp circuit analyses.

Two sets of carriers reveal themselves in amorphous chalcogenide thin films subjected to high electric fields. The application to the samples of short high field pulses, in the range of tens of nanoseconds, shows the same conduction processes present as when applying pulses whose lengths are nearly a million times longer. The coupled carrier equations have been combined with a band model which assigns the carriers respectively to localized hopping or trapping states near the band edge and to extended states near the mobility edge to explain the conduction behaviour. The success of this theory, found earlier with long pulse measurements, continues with short pulse experiments. The theory is substantially free of adjustable parameters and gives numerical and functional agreement in 10 specific cases when applied to 7 experimental phenomena discovered with the short pulse experiments.

In this paper, the technology of an energy-conserving incandescent lamp is described. The lamp has a spherical envelope coated with a multilayer heat mirror of TiO2-Ag-TiO2. The coated envelope focuses the infrared radiation back to a centered compact filament of high emissivity while transmitting the visible wavelengths. The energy savings depend on the emissivity of the filament and the effective reflectance and visible transmittance of the coated envelope. Performance has been evaluated both in a model lamp system and in actual lamps.

The high field, preswitching behaviour of amorphous chalcogenides shows a remarkable unity when pulse data ranging from milliseconds to nanoseconds are compared. These data require the existence of two non-linear current components. The long pulse data have been accurately described earlier by coupled carrier theory. This theory assigns the first carrier to localized, hopping or trapped, states below a band, the second carrier to free states within the band and describes the transient behaviour by a set of coupled carrier equations desirable from the Boltzmann equation. Eleven tests of this theory with short pulse experiments are here given in 4 materials and without the use of adjustable parameters. Substantial agreement is found in both calculated magnitudes and in predicted functional dependences.

In close agreement with theoretical prediction, model energy conserving incandescent lamps have been produced which conserve 55 percent of the energy compared with a clear lamp of the same lumen output at the same filament temperature. This result was obtained with an optically ground and polished envelope internally coated with a multilayer heat mirror. Theoretical predictions employed a computer calculation which included the spectral variation of the filament emissivity and the heat mirror-reflection-induced-shift in the spectral output of the filament.

Infrared emission has been observed during the ON-state of amorphous chalcogenide As 50 Te 50 threshold switching devices. The emission is a line emission of wavelength corresponding to half the band gap of the OFF-state. The intensity of radiation is virtually independent of device area; the radiation output is temperature independent and exhibits thresholds in both its current and thickness dependence; the radiation power increases with the excess device power above the threshold power. The emission has been studied with both metal and semiconductor contacts to the amorphous layer. An analysis of the data indicates that simple spontaneous emission is not present but that stimulated emission could be occurring.

Recently a common normalization of the melting curves of sulfur, selenium, and tellurium is accomplished empirically. This normalization of the pressure–temperature dependence of melting is shown to have a theoretical basis through an extended law of corresponding states. A “hard atomic core” which does not scale in the same manner as the remainder of the intermolecular forces immediately produces an offset both in pressure and volume in the relationship between the phase equilibria of an elemental species and that of a similar element in the same group of the periodic chart. The volume offset can be transformed to a temperature offset provided there exists a parabolic dependence of melting temperature upon pressure. It is shown that linear scaling will then result from which a generalized pressure–temperature phase diagram can be derived, as illustrated by the group-VI-A elements. The physical mechanism for the empirical parabolic melting curve remains an important unresolved problem. Recemment nous avons accompli empiriquement une normalization commune des courbes de fusion pour soufre, selenium et tellure. Cette normalization de la temperature et de la pression est montree d'avoir une base theorique par un loi etendu des etats correspondants. Un centre dur qui ne mesure pas pareillement comme le reste des forces intermoleculaire. produit immediatement une compensation en tante la pression et le volume a la relation entre l'equibre de la phase d'especes elementaire et celui d'element similaire dans le měme groupe de la table periodique. La compensation de volume peut ětre tranforme dans une compensation de temperature pourvu qu'il existe une dependance parabolique de la temperature de fusion sur la pression. Ici, nous montrons qu'une diagramme generalisee de phase qu'on peut faire denver comme resultat d'echelle lineaire pour le groupe VI-A. La mechanismie physique pour la courbe de fusion parabolique reste un probleme important inexplique.

Two types of radiation emission have been detected during the on state of threshold switching events in noncrystalline chalcogenide thin films having a transparent SnO2 (NESA) bottom electrode and a heat conducting top electrode. The common form of the radiation is an emission at about 1.2–1.4 μm which (i) is propagated through a wide solid angle, (ii) is relatively independent of time during the on‐state pulse (iii) has an integrated intensity which is approximately a linear function of on‐state power and a superlinear function of on‐state current, and (iv) requires a minimum on‐state current for initiation. The second type of emission is between 0.75 and 3 μm and is detected rather rarely. This latter emission has a characteristic intensity which is a steeply peaked function of on‐state time and appears to be possibly highly collimated. The peaked emission has been detected in pulsed modes using single set pulses and has also been detected continuously using low‐frequency repetitive threshold set pulses...

The effects of various doses of pentylenetetrazol, clonidine, chlordiazepoxide and diazepam on limb and head movement and behavioral seizure signs were examined in 4-, 8- and 16-day old rats tested at ambient temperatures of either 25 or 35 degrees C. All 4 drugs produced intense behavioral activation at the 2 younger ages but there were marked differences among them in the effects of test temperature on this activation and in the relationship between age and their activating effect. A "paradoxical" and intense behavioral energization was observed after the administration of either of the 2 benzodiazepines at 4, 8 but not 16 days, particularly at the lower test temperature. Clonidine and pentylenetetrazol were activating at all 3 ages but while clonidine had greater effect at the low test temperature, the opposite was the case after pentylenetetrazol. The effects of the benzodiazepines and clonidine were clearly distinct from those of pentylenetetrazol and this was the only drug to substantially elicit seizure signs. It is uncertain whether or not the benzodiazepines cause brain seizures in young animals. If so, then their behavioral manifestation is clearly different from that observed after pentylenetetrazol.

L'auteur etudie la place de la bibliotheque dans la litterature (romans, essais, etc.) et propose ainsi une bibliographie critique sur ce theme

In a study undertaken to evaluate the clinical effectiveness of two behavioral treatments for essential hypertension (biofeedback on arterial pulse-wave velocity and progressive relaxation) 24 hypertensive subjects were randomly assigned to either a relaxation or biofeedback treatment group for 5 weekly sessions. In a second stage of the study 16 of the original subjects received both biofeedback and relaxation treatments during 5 additional weekly sessions. Results indicated that biofeedback and relaxation were equally effective in initial lowering of blood pressure in hypertensives. Although biofeedback training led to superior reductions at the 3-mo. follow-up point, after 1 yr. the blood pressures of both groups were not only equal but well below those presented at the beginning of the study.

The equations which govern the discharge phenomena in neutral gas lasers are cast into simplified form which brings out the dependence of laser properties on the external parameters of importance?gas pressure, tube diameter, and tube current. The well known empirical scaling laws which govern neutral gas laser operation follow quite naturally from this procedure. Specific examples are given to illustrate agreement with experiment.

A short pulse (50–100 nsec) of laser light incident in the z direction causes sequential voltage pulses of opposite polarity in the xy plane of a thin molybdenum film deposited on a polycrystalline aluminum oxide substrate. A laser pulse incident in the z direction to a molybdenum thin film deposited on a transparent glass substrate generates a single voltage pulse in the xy plane whose polarity reverses when the laser beam is introduced from the —z direction. The pulses are interpreted as consequences of a forward and reverse thermal gradient in an anisotropic film, and the data can be quantitatively described using the heat‐diffusion equation.

The Brassington Formation of the southern Pennines comprises a succession of sands, gravels and clays, the youngest beds of which contain Lower Pliocene fossil plants. These strata are generally considered to have foundered into the Carboniferous Limestone through solution subsidence mechanisms. The subsidencc cavities also contain detached marginal blocks of shale, which locally contain Namurian goniatites. Examination of the shale blocks from a number of widely separated localities has revealed that all contain Namurian spore assemblages, datable in some cases as E 2 (Arnsbergian) age. The contact between the shale blocks and oldest sands of the Brassington Formation is unconformable and, characteristically, the latter are seen to rest on zones of lilac-stained weathered shale, representing a pre-subsidence land surface. Evidence is presented which indicates that the Brassington Formation strata are conformable and that the succession represents a single cycle of sedimentation. Because of this conformable relationship it is inferred that this land surface is also of Lower Pliocenc (or Upper Miocene) age. A tacheometric survey of a well-exposed solution subsidence complex at the Bees Nest Pit, Brassington, has enabled structure contour maps to be made of key horizons in the succession. Laboratory tests have been conducted which have attempted to duplicate this structure and so indicate the probable subsidence mcchanisms. Results suggest that subsidence was gradual, with block-by-block removal of the host limestone, and took place in deep, steep-sided pipe-like forms. The depth of subsidence, and hence the elevation of the land surface prior to the deposition of the Brassington Formation, has been determined by estimating the thickness of limestone and Namurian shale which, as suggested by previous research work in the southern Pennines, was once present over the sites of the present subsidence masses. Subsidence can be shown to be of the order of 150–250 m, which implies that the Lower Pliocene land surface of the southern Pennines lay at about 450m O.D. Based on the evidence of the contemporary sea level, the presence of the Lower Pleistocene deposits of se England, and the sub-Neogene surface of the southern Pennines, a graph has been constructed which suggests broadly that Upland Britain has undergone a regular uplift since the main Alpine episode at a rate of about 1 metre in 15,250 years. In this light, the possible age of other well known planation surfaces is discussed.

In recent years, the occasions for design of channels to contain supercritical flow have increased considerably. A need has developed for a method of predicting the physical characteristics of such flow based on theory. Use has been made of the analogy between supersonic gas flow and supercritical fluid flow to apply the method of characteristics, originally developed for gas dynamics, to fluid mechanics. The writers have checked experimentally the validity of the assumptions made by Bagge and Herbich in the analysis of supercritical flow passing through a rectangular expansion. An experimental model was constructed in the laboratory and the resultant surface profiles obtained for different sets of parameters compared to those predicted by the mathematical model. Results indicated that the assumptions of frictionless flow and negligible velocity perpendicular to the bed of the channel were too important to be neglected. Several graphs comparing theoretical profiles with those obtained in an experimental model are presented.

Experimental investigations carried out at Picatinny Arsenal on the electronic and switching behavior of chalcogenide amorphous films are summarized. The I−V off state behavior of the material indicate two distinct processes, A and B, each contributing an exponential type current dependence on voltage. At different temperatures, the off state conduction process A, found at fields below about 3 × 105 V/cm, can be normalized to a single I−V curve displaying an ohmic and exponential region, each a single aspect of one single activated process. The exponential slope is intimately connected with the dielectric properties of the medium. It is found that at the switching threshold the effective shift in activation energy is substantially independent of temperature, of hydrostatic pressure, of thickness and of limited material variations. The conduction by process B at high fields can also be normalized. Both process A and process B have essentially the same activation energy. Analysis of the conduction by process B indicates that an empirical criterion for the onset of switching is that the activation energy for process B be essentially eliminated by the field.

The nascent polypeptide-associated complex (NAC) is a peripheral component of cytoplasmic ribosomes, and interacts with nascent chains as they leave the ribosome. Yeast mutants lacking NAC translate polypeptides normally, but have fewer ribosomes associated with the mitochondrial surface. The mutants lacking NAC suffer mitochondrial defects and have decreased levels of proteins like fumarase, normally targeted to mitochondria co-translationally. NAC might contribute to a ribosomal environment in which amino-terminal, mitochondrial targeting sequences can effectively adopt their appropriate conformation.