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The term gender cleavage refers to imbalances in same- and cross-gender peer interactions and sociometric peer evaluations, favouring a same-gender (in-group) imbalance. The mechanisms underlying gender cleavage during childhood and adolescence are unclear, with several competing models encapsulating group-level and individual-level processes. In comparison to observational studies, sociometric investigations to date have contributed less substantially to an understanding of the roles of gender, age and maturational factors in gender cleavage, and to theoretical accounts of gender cleavage. On these bases, this thesis examined interlocking theoretical and methodological issues, focusing on middle childhood. Studies 1, 2 and 3 examined method-related and naturally-occurring variations in gender cleavage effects, using sociometric responses &Om a group preference record and three-choice nomination tasks collected by individual interviews with 308 boys and girls in Grades 2 to 6. Results revealed significant gender cleavage effects in both positive and negative peer evaluations from each sociometric method. Nevertheless, the cleavage effect was much less marked in negative peer evaluations, providing evidence that same-gender preference is not necessarily accompanied by cross-gender disliking. In Study 1, the strength of gender cleavage expressed in positive peer evaluations was similar in sociometric measures that encapsulated differing levels of intimacy in peer relationships. Gender cleavage expressed through negative peer evaluations was more pronounced for measures manifesting less intimate peer relationships. In Study 2, sociometric criteria reflecting child-regulated playground interactions produced more extreme expressions of gender cleavage than criteria reflecting adult-regulated situations such as classrooms. In Study 3, significant and strong gender cleavage effects were found in positive peer evaluations for male and female evaluators, and across all grade levels regardless of the sociometric method used. Negative peer evaluations exhibited more complex variations in gender cleavage effects, according to age, gender group and sociometric method. In-group preference evident in same-gender roster-based evaluations was more pronounced in girls than in boys. Out-group (cross-gender) evaluations became more positive and less negative with age in both gender groups. Study 4 investigated the relative applicability of three contrasting theories as models of gender cleavage during middle childhood. Gender stereotyping of peers' behaviour was a stronger predictor of gender cleavage than was behavioural compatibility. This finding confirmed the greater relevance of social-cognitive models than those based on behavioural dissimilarity as explanations for the maintenance of gender cleavage during middle childhood. However, gender cleavage was more strongly and consistently predicted by class-based gender segregation than by either gender stereotyping or behavioural compatibility. Hence, group processes overall appear more important than individual-level processes in the maintenance of gender cleavage during middle childhood. Gender cleavage was found to vary significantly ac-cording to both substantive and method-related factors, and consequently should not be viewed as a static aspect of peer relationships during middle childhood. Instead, gender cleavage should be seen as a dynamic and ever-changing social-developmental phenomenon, that can potentially be modified in school settings by interventions at a group level that involve everyday school practices and policies.

Background: Some studies have reported associations between municipal waste incinerator (MWI) exposures and adverse birth outcomes but there are few studies of modern MWIs operating to current European Union (EU) Industrial Emissions Directive standards. Methods: Associations between modelled ground-level particulate matter ≤10 μm in diameter (PM10) from MWI emissions (as a proxy for MWI emissions) within 10 km of each MWI, and selected birth and infant mortality outcomes were examined for all 22 MWIs operating in Great Britain 2003–10. We also investigated associations with proximity of residence to a MWI. Outcomes used were term birth weight, small for gestational age (SGA) at term, stillbirth, neonatal, post-neonatal and infant mortality, multiple births, sex ratio and preterm delivery sourced from national registration data from the Office for National Statistics. Analyses were adjusted for relevant confounders including year of birth, sex, season of birth, maternal age, deprivation, ethnicity and area characteristics and random effect terms were included in the models to allow for differences in baseline rates between areas and in incinerator feedstock. Results: Analyses included 1,025,064 births and 18,694 infant deaths. There was no excess risk in relation to any of the outcomes investigated during pregnancy or early life of either mean modelled MWI PM10 or proximity to an MWI. Conclusions: We found no evidence that exposure to PM10 from, or living near to, an MWI operating to current EU standards was associated with harm for any of the outcomes investigated. Results should be generalisable to other MWIs operating to similar standards. Keywords: Environment, Birth weight, Stillbirth, Infant mortality, Municipal Waste Incinerator, Epidemiology

Objective To investigate the relation between exposure to both air and noise pollution from road traffic and birth weight outcomes.Design Retrospective population based cohort study.Setting Greater London and surrounding counties up to the M25 motorway (2317 km2), UK, from 2006 to 2010.Participants 540 365 singleton term live births.Main outcome measures Term low birth weight (LBW), small for gestational age (SGA) at term, and term birth weight.Results Average air pollutant exposures across pregnancy were 41 μg/m3 nitrogen dioxide (NO2), 73 μg/m3 nitrogen oxides (NOx), 14 μg/m3 particulate matter with aerodynamic diameter 13.8 μg/m3during pregnancy.Conclusions The findings suggest that air pollution from road traffic in London is adversely affecting fetal growth. The results suggest little evidence for an independent exposure-response effect of traffic related noise on birth weight outcomes.

Elevated urinary albumin excretion is a marker for increased mortality and morbidity in European subjects with non-insulin-dependent diabetes. Urinary albumin excretion was compared in 32 Maoris, 34 Pacific Island Polynesians and 66 subjects of European origin with non-insulin-dependent diabetes attending a diabetes clinic in Wellington, New Zealand. The random urinary albumin to creatinine ratio was used as an estimation of urinary albumin excretion rate. The random urinary albumin to creatinine ratio was significantly higher in Maori and Pacific Island Polynesian subjects, compared to diabetic Europeans (geometric mean urinary albumin to creatinine ratios were 13.13, 12.00 and 2.79 mg/mmol respectively, P less than 0.05). These findings would be consistent with the high mortality and morbidity seen in the Maori and Pacific Island Polynesian diabetic populations. The correlation between hypertension and increased urinary albumin excretion was stronger in the Europeans than in the Maoris and Pacific Island Polynesians studied, suggesting that differences in blood pressure alone are unlikely to account for the observed differences in albumin excretion. Follow-up studies are required to determine whether diabetic Maoris and Pacific Island Polynesians with increased urinary albumin excretion have a similar prognosis to their European counterparts.

A scoring system intended both to assess mortality risk and permit surveillance, evaluation, and comparison of medical care was developed in our surgical ICU. Five simple clinical indices of organ system failure were selected and weighted according to their statistically validated relationship to mortality, resulting in a daily System Outcome Score (SOS). Cluster analysis was used to divide the creation data set of 2,777 patients into suitable groupings of scores to predict mortality; the clustering was confirmed for reproducibility with a validation set of an additional 2,860 patients. Based on this validation of the scoring system, two computer-controlled patient care surveillance techniques were developed. The first involved the definition of three unfavorable SOS patterns evolving during the course of a patient's admission. Detection of one or more of these patterns, described by the acronym SDL, permits review of the care administered to the specific patient generating the pattern. A global assessment of care is achieved with the Outcome Index (OI), which relates overall mortality risk in the ICU to the actual mortality rate over a given time period. Effectiveness of care can then be compared between different time periods within the one unit or between different units with similar patient mix. The overall system offers the potential for a surveillance-based quality assurance system with widespread applicability.

A woven polyester graft is used in chronic anterior cruciate instability. Twenty-five patients were reviewed with an average follow-up period of almost five years. The patients were assessed in terms of function, clinical examination, and residual laxity. The results showed that four could be classified as excellent, 16 good, and four poor. Fifty-two percent of patients returned to their preaccident level of activity, and there did not appear to be any evidence of increasing laxity with time. All patients had a good range of flexion with no extension loss. This prosthesis, along with its unique method of fixation, offers a simple alternative to patellar tendon or soft tissue reconstructions in the chronic anterior cruciate-deficient knee.

A review of patients undergoing aortic aneurysmectomy between 1970 and 1979 at the Emory University Hospital and the Atlanta Veterans Administration Medical Center disclosed six patients with aortovenous fistulas. Four fistulas were aorta to vena cava; one, aorta to left renal vein; and one, aorta to left iliac vein. Four of the arteriovenous fistulas were identified preoperatively. In another patient the symptoms and signs were masked by concomitant retroperitoneal rupture of the aneurysm. The final patient was asymptomatic preoperatively, but had an occluded fistula discovered at operation when laminated thrombus was removed from the wall of the aneurysm. One patient died while being prepared for operation; five were operated upon and survived. Successful management of this problem is contingent upon preoperative recognition, careful manipulation of the aneurysm with endoaneurysmal closure of the fistula, and judicious perioperative fluid management.

The principles of fluidic technology are outlined and applied in the description of a fluidic controlled ventilator. The device is compact, easy to operate and practically fail-safe since it has no moving parts. There is a sensor which prevents any increase in airway pressure above the preset level.

Twenty-one patients underwent serial insulin testing, approximately 1 week, 1 year, 3 years, and 5 years after highly selective vagotomy (HSV) for duodenal ulcer (DU). They were thought to be representative of the much larger number of patients who have undergone HSV for DU in Leeds. The results obtained were compared with the responses to insulin of 40 other DU patients who were tested before HSV. Before operation, all tests were positive in the 1st hr after insulin ("early-positive") by Hollander's criteria and the mean peak acid response to insulin after subtraction of basal acid output (PAO1) was 33 mEq per hr. One week after HSV, all 21 tests were negative and mean PAO1 was 0.05 mEq per hr. One year after HSV, 62% of 21 tests were Hollander-positive and PAO1 had increased significantly (P P > 0.05, compared with PAO1 at 1 year). Five years after HSV, 65% of 20 tests were positive and mean PAO1 was 3.5 mEq per hr, a significant increase (P

A simple technique for assessing inpatient resource requirements is presented. Using this technique the demands on various hospital services, made by different patient groups, can be compared. Two hundred admissions to an acute accident unit were analyzed and we found that domestic injuries made the greatest demands on nursing and institutional care aspects of the service, by virtue of their frequency and severity. Analysis of road accidents identified the motorcyclist as the largest consumer of resources on an individual basis. Finally, a small but peculiarly demanding group has been identified which consists of patients injured while in hospital.

The acute oral toxicity of a series of congeneric fractions prepared from whisky, their synthetic prototypes, furfural, and purified ethyl alcohol has been determined in rats. Of these materials furfural, an found to be the most toxic (LD50 = 0.135 ± 0.015 g/kg) and purified ethyl alcohol the least toxic (LD50 = 10.4 ± 0.75 g/kg). With the exception of the acid fraction, the effects of the other congeners came on more quickly and in surviving animals disappeared more quickly than was the case with ethyl alcohol. The acutely irritating effects of these same materials were studied on the rabbit eye. The acid fractions were found to be by far the most irritating, the other congeners fell in a middle range between this fraction and purified ethyl alcohol, which was the least irritating. The role which the congeners might play in the over-all pharmacologic action of whisky remains largely to be determined. The present state of knowledge would seem to suggest that their concentrations in whisky be kept in general at a minimal level compatible with their satisfactory contribution to its flavor, bouquet, and color.

Fourteen patients with gastric ulcer alone and 5 patients with combined gastric and duodenal ulceration- have been treated by highly selective (parietal-cell) vagotomy without a drainage procedure (H.S.V.) the past 3 years. Before operation no evidence of gastric stasis was found, clinically, radiologically, or during tests of gastric secretion. Spontaneous acid out was low. Acid output in response to a test meal of meat extract was also found to be low. There no evidence that in the patients with gastric ulcer alone the ulcer was due to pyloric channel disease with excessive release of gastrin by the antrum. Each gastric ulcer was proved by frozen-section examination to be benign at the time of operation. Problems with gastric stasis were encontered in early postoperative period. The vagotomy was shown to be complete on insulin testing in each of 17 patients tested. Follow-up ranges from 1 month to 3 years. The clinical progress of the patients has been good, and has symptoms suggestive of recurrent ulceration gastric retention. Barium-meal examination in 11 patients who were follwed up for more than 9 months showed satisfactory gastric emptying, without recurrent ulceration. While the need for much longer follow-up is obvious, these preliminary results are encouraging. Further trial of H.S.V. for gastric ulcer, preferably in the form of a prospective, randomized comparison with Billroth-I gastrectomy, now seems desirable.

The good results of highly selective vagotomy (H.S.V.) in the elective surgical treatment of uncomplicated duodenal ulcer led to its use in the treatment of 30 patients who were suffering from complications of peptic ulcer, over a period of 21 months. In the emergency situation it is vital to select for H.S.V. patients who are fit enough to withstand a 1–2-hour operation. Five out of a total of 9 patients with perforated duodenal ulcer were deemed to be suitable for H.S.V. In contrast, H.S.V. was used in the treatment of all 10 patients with haemorrhage (5 patients with duodenal ulcer and 5 with gastric ulcer), because definitive treatment for the ulcer is essential after haemorrhage has been arrested by direct suture. Pyloric stenosis was diagnosed in 15 of 75 patients who came to elective surgery for duodenal ulcer. The diagnosis was made on clinical and radiological grounds and was confirmed at operation. Seven of the 15 patients had concomitant gastric ulceration. All 15 patients were treated by H.S.V. without a drainage procedure. The stenosis was simply dilated digitally. Seven patients who were followed up for at least a year underwent barium-meal examination, which showed that gastric emptying was normal in each case and that there was no sign of recurrent ulceration. There was no operative mortality. None of the patients with haemorrhage bled again after operation. Only 1 of the 30 patients developed gastric retention, which was transient. Of the 14 patients who were reviewed more than 1 year after H.S.V., 11 had a perfect clinical result, 2 were very good, and 1 was ‘fair’ (Visick grade 3). The long-term prognosis should be the same as that of patients who have undergone elective H.S.V. Granted a modicum of case selection, H.S.V. is a safe operation in the treatment of emergencies such as haemorrhage or perforation. In pyloric stenosis H.S.V. preserves and makes use of the stomach's compensatory mechanisms of hypertrophy and hyperperistalsis, whereas both gastrectomy and vagotomy with drainage destroy them. Vagotomy of the entire stomach makes necessary the addition of a drainage procedure. Vagotomy with drainage impairs the ability of the antrum to ‘mill’ food and to propel chyme onwards, and destroys or by-passes the pyloric sphincter. These surgical insults to normal gastric physiology harm the patient by producing dumping, diarrhoea, bilious vomiting, steatorrhoea, and gross elevation of serum gastrin. The main conclusion of this paper is that such harm can be avoided, because it is shown that even patients with pyloric stenosis can be treated by H.S.V. without a drainage procedure. The routine use of complete gastric vagotomy with a drainage procedure in the elective surgical treatment of duodenal ulcer is no longer justified.

Serial tests of basal acid output (BAO) and maximal acid output (MAO) were performed in patients with chronic duodenal ulceration, before operation, and 1 week, 2 to 3 months, 6 to 12 months, and 12 to 24 months after highly selective vagotomy (HSV) without a drainage procedure. Dose-response studies showed that the dose of pentagastrin used was sufficient to elicit MAO in patients after HSV. The results obtained in Leeds and Copenhagen were very similar. BAO was reduced by a mean of 92% at 1 week, 86% at 2 to 3 months, 87% at 6 to 12 months, and 80% beyond 1 year. BAO increased significantly between 3 months and 12 to 24 months after HSV (P

Ten patients undergoing elective cataract surgery with local anesthesia were evaluated for rebreathing using mass spectrometry and arterial blood gas analysis. Results showed a 10 or 5 1 oxygen-air mixture with an inspired oxygen concentration of 50% (FIO2) administered via a face tent maintained normal blood gases and a satisfactorily low inspired carbon dioxide (FICO2) in conscious patients who were free of lung disease.

The first part of this review describes the pharmacology of cocaine, followed by a short summary of the metabolism, storage, and release of norepinephrine. The remainder discusses possible interactions between cocaine and drugs whose main effector site is the adrenergic neurone. The following medications are mentioned: methyldopa, imipramine, chlorpromazine, monamine oxidase inhibitors, guanethidine, reserpine, phentolamine hydrochloride, propranolol, and epinephrine. The mechanism of drug reactions which may give rise to hypertensive crises and may be responsible for serious complications or death in patients undergoing minor surgery under local anesthesia are described. Knowledge of these interactions will be helpful in preventing serious mishaps.

A persistent problem in caring for patients receiving long-term intravenous chemotherapy for cancer is the maintenance of access to the vascular system. At Emory University Hospital between January 1975 and December 1977, 48 cancer chemotherapy patients had upper-arm bovine arteriovenous fistulas created for vascular access. The heterografts were inserted from the distal brachial artery to the proximal brachial vein under local, regional block, or general anesthesia. Grafts were functioning satisfactorily in 81% of the subjects at the time of death or at termination of treatment. The mean duration of useful graft patency for the entire group was 4.6 months, with a range of 0 to 27 months. Thrombosis of the graft was the most frequently encountered complication; infection and bleeding occurred infrequently. Reoperation was required in 35% of grafts, of which one half were salvaged. No mortality was attributable to the operative procedures or to the presence of a chronic arteriovenous fistula.