Diagnosis by consensus: A case study in the importance of interdisciplinary interpretation of mummified remains

OBJECTIVE

The goal of this study is to demonstrate the need for interdisciplinary consensus and inclusion of mummy radiology specialists in analyses of mummified remains.

MATERIALS

This study uses paleoimaging data for an ancient Egyptian mummy at the Museum of Human Anatomy "Filippo Civinini".

METHODS

This study demonstrates the benefit of evaluation of mummified remains in a multi-disciplinary interpretive team.

RESULTS

The authors propose a diagnosis of DISH, additional signs of undifferentiated spondyloarthropathy, and lumbarisation of S1.

CONCLUSIONS

The process of diagnosis by consensus is essential to the analysis of mummified remains, which are complexly altered through natural and anthropogenic processes in the millennia subsequent to the individual's death.

SIGNIFICANCE

Mummy paleoimaging and paleopathology lacks a unifying set of standards. We present an example of the value to be found in the multi-disciplinary diagnosis by consensus approach.

LIMITATIONS

We discuss numerous challenges to accurate and meaningful interpretation that radiography of mummified remains pose.

SUGGESTIONS FOR FURTHER RESEARCH

While the authors do not seek to impose any single set of standards, we do recommend a larger discussion on the topic of (culture-specific) standardisation in mummy paleoimaging and paleopathology. We further recommend the development of an international, multi-disciplinary panel of paleoimaging interpreters.

Experimental verification of the steric-entropic mode of retention in centrifugal field-flow fractionation using illite clay plates

The commonly used theory to describe the normal Brownian mode of field-flow fractionation (FFF) assumes the particles to be point masses and hence the shape is ignored. Beckett and Giddings extended this theory to include the effect of thin rods and discs being forced very close to the accumulation wall. By including the decrease in the entropy this causes, they derived new expressions for the retention of such nonspherical particles in FFF. The steric-entropic theory predicts that when the sample cloud thickness is less than the major dimension of the rods or discs then particles elute earlier than predicted by the Brownian mode theory. This leads to an underestimation of the buoyant mass and equivalent spherical diameter calculated from FFF data. In this paper we report for the first time experimental data for the retention of thin illite particles in centrifugal FFF that agrees well with these steric-entropic predictions. Not only do the size distributions calculated using the Brownian mode theory shift to lower size when the field is increased but the shift in the retention ratio of the peak maxima of the FFF fractograms could be predicted fairly accurately by the steric-entropic equations.

Timings of major glaciations, inherent selection schemes and the origins of cold hardy animal phyla

　　BACKGROUND: Knowing the origin dates of specific phyla may help in understanding the intricate relationships between environments and their biota. Past extreme environments would have challenged biota and led to the evolution of phyla that were and possibly still are able to withstand extreme conditions.

OBJECTIVE

We test the hypothesis that major glaciation events imposed strong selection schemes, ultimately leading to the origins of cold hardy phyla.

METHODS

We identified dates of past major glaciation events, cold hardy phyla and their origin dates and synthesized these data in a phylogenetic context.

RESULTS

Origin dates of cold hardy phyla do not correspond with major glaciation events, falsifying the hypothesis.

CONCLUSION

An alternative hypothesis is proposed in which varying degrees of cold hardiness evolved at other taxonomic levels within these phyla.

Comparison of centrifugation and filtration techniques for the size fractionation of colloidal material in soil suspensions using sedimentation field-flow fractionation

Sedimentation field-flow fractionation (SdFFF) with UV detection is used to systematically investigate the effect of traditional membrane filtration and centrifugation procedures on the isolation of specific size fractions from soil suspensions. Both procedures were used to isolate the nominal <0.45 and <0.2 microm fractions from a clay soil suspension. Results showed that the membrane filtration approach seriously underestimated the total mass of particulate matter present as compared to the centrifugation approach. This has serious implications forthe interpretation of results for "colloidal" and "soluble" fractions from soil suspensions and other environmental matrices obtained using the standard membrane approach. The results also show that sedimentation FFF has great potential as a robust and relatively mild technology for studying size distributions in the "colloidal" range for soil suspensions and other aquatic matrices.

Determination of Thermal Diffusion Coefficients Using Thermal Field-Flow Fractionation and Mark−Houwink Constants

In this paper, a new approach for determination of thermal diffusion coefficient D(T) values using thermal field-flow fractionation retention data and Mark-Houwink constants is reported. The method utilizes the availability of Mark-Houwink constants from the literature together with thermal field-flow fractionation retention data to calculate D(T) values for both narrowly and broadly dispersed polymeric samples. The proposed method was tested with thermal field-flow fractionation data from a number of published papers. In general, D(T) results obtained from the new approach agree well with those reported from the literature. Since Mark-Houwink constants have been extensively tabulated, the new method can be used to generate a broad database of D(T) values for use in the characterization of polymers and in studies of the thermal diffusion phenomenon.

Characterization of natural organic matter fractions separated by ultrafiltration using flow field-flow fractionation

Natural organic matter (NOM) from two sites in South Australia were separated by Amicon YM and YC ultrafiltration (UF) membranes into five nominal fractions (<0.5, 0.5-3, 3-10, 10-30 and >30 kDa). These nominal fractions were then characterized for size and molecular weight (MW) distributions using flow field-flow fractionation. The results show that separation by UF did not produce fractions with the expected MW and size. Electrophoretic mobility measurements of the NOM fractions adsorbed to colloidal goethite showed no significant difference between the fractions. However solid-state (13)C NMR of the NOM fractions showed that the separation was influenced by molecular structure as well as molecular size. The results suggest that great caution needs to be exercised when interpreting molecular size and speciation results for humic substances obtained by membrane UF.

A low-cost light-scattering detector for the flow-injection nephelometric determination of sulfate

A simple low-cost flow-through light-scattering detector was developed for determining the particle mass concentration in colloidal suspensions. Employing a laser pointer as a light source and a photodiode IC as a light sensor, the detector was shown to have good sensitivity, yet was small and battery operated. The detector was demonstrated to be effective for the flow-injection nephelometric determination of sulfate by precipitation as barium sulfate.

Effect of an Alternating Oxic/Anoxic Regime on a (Freshwater) Yarra River Sediment

The uptake and release of phosphorus, nitrogen, iron, and manganese from Yarra River sediments have been examined using laboratory reactors. Both slurried and static sediments were exposed to an alternating regime of oxic and anoxic conditions. Experiments examined the effect of changing the oxygen status on daily and weekly time frames. In all experiments, after anoxia was re-established, oxidant consumption followed the expected thermo-dynamic order: O2 > MnIV ≈ NOx > FeIII. Contrary to predictions based on the standard iron–phosphorus model, significant phosphorus release was observed under oxic conditions. This was attributed to the mineralization of organic matter. Nitrate was shown to minimize phosphorus release from anoxic sediments by ‘redox buffering’ which prevented iron(III) reduction. The high ambient water column nitrate concentration (40–45 μM) in the Yarra River should effectively limit phosphorus release from the sediments unless long term (multiweek) anoxia occurs. Reduction of nitrate concentration occurred predominantly via denitrification. This work clearly demonstrated that on a time scale of hours to weeks, the iron, manganese, nitrogen, and phosphorus cycles are interacting closely.

Fate and toxicity of endosulfan in Namoi River water and bottom sediment

Endosulfan (6,7,8,9,10,10,-hexachloro-1,5,5a,6,9,9a-hexahydro-6,9-methano-2,4,3-benzodioxathiepine-3-oxide) sorption (standardized to 1% total organic carbon and dry weight) was significantly (P < 0.05) more concentrated on the large (>63 microm) particle fraction compared with smaller size fractions (<5 microm and 5-24 microm) of bottom sediments from the Namoi River, Australia. Following completion of the particle size fractionation (6 to 12 wk) and a sediment toxicity assessment (2 wk), the sediments showed large decreases in concentrations of alpha-endosulfan that coincided with an increase in endosulfan sulfate concentrations and minimal changes in beta-endosulfan concentrations. In the Namoi River, similar patterns were observed in the composition of total endosulfan in monthly measurements of bottom sediments and in passive samplers placed in the water column following runoff from cotton (Gossypium hirsutum L.) fields. The toxicity of endosulfan sulfate in river water indicated by the nymphs of the epibenthic mayfly Jappa kutera, was more persistent than the alpha- and beta-endosulfan parent isomers due to its longer half-life. This suggests that endosulfan sulfate would contribute most to previously observed changes in population densities of aquatic biota. Measured concentrations of total endosulfan in river water of up to 4 microg L(-1) following storm runoff, exceed the range of the 96-h median lethal concentration (LC50) values in river water for both alpha-endosulfan (LC50 = 0.7 microg L(-1); 95% confidence interval [CI] = 0.5 to 1.1) and endosulfan sulfate (LC50 = 1.2 microg L(-1); 95% CI = 0.4 to 3.3). In contrast, the 10-d LC50 value for total endosulfan in the sediment toxicity test (LC50 = 162 microg kg(-1); 95% CI = 120 to 218 microg kg(-1)) was more than threefold higher than the highest measured concentration of total endosulfan in field samples of bottom sediment (48 microg kg(-1)). This suggests that pulse exposures of endosulfan in the water column following storm runoff may be more acutely toxic to riverine biota than in contaminated bottom sediment.

Determination of total and EDTA extractable metal distributions in the colloidal fraction of contaminated soils using SdFFF-ICP-HRMS

Newly developed methods involving an on-line combination of sedimentation field-flow fractionation-inductively coupled plasma-high resolution mass spectrometry (SdFFF-ICP-HRMS) have been used to study the distributions of extractable heavy metals in a soil which had been treated with sewage sludge contaminated with Cu or Pb. The relationship of these metals with other elements in the colloidal fraction was also investigated. The colloidal fraction from the soil was obtained by repeated gravitational sedimentation and extracted with 0.11 M acetic acid, 0.1 M hydroxylamine hydrochloride, 0.05 M ethylenediaminetetraacetic acid disodium salt (EDTA) or aqua regia to assess the potential availability of the metals Cu and Pb. Large proportions of the Cu and Pb were extracted by EDTA, approaching that removed by aqua regia, whereas < 10% of the aqua regia extractable metals were removed by acetic acid and hydroxylamine chloride. The distributions of the heavy metals, the major mineral forming element (Al) and the elements forming sesquioxides (Fe and Mn) within different size classes (0.05-1 microm) of the colloidal fraction were measured using SdFFF-ICP-HRMS before and after extraction with EDTA. This information provides an insight into the composition of the colloids and the distributions of metal contaminants. In the contaminated soil colloids, the concentration of Fe, Mn and Pb is greatest in the smaller particles (<0.2 microm). In contrast, the Cu concentration is constant over the size range studied. Iron oxide surface coatings probably play a significant role in Pb adsorption on soil particles, but may be less important for Cu. The combination of selective chemical extraction, SdFFF and ICP-HRMS provides a means of determining the distribution of potentially available heavy metals within the colloidal fraction of contaminated soils.

The effect of surface coatings on the association of orthophosphate with natural colloids

A new method has been utilised for the characterisation of natural particle surface coatings. The method involves the use of sedimentation field-flow fractionation (SdFFF), radiolabelling and inductively coupled plasma-high resolution mass spectrometry (ICP-HR MS) techniques to study the effect of colloidal surface coatings on the adsorptive behaviour of orthophosphate. Colloidal river sediment and soil samples were chemically treated in an attempt to selectively remove metal hydroxyoxides and natural organic matter. The samples were then radiolabelled with 33PO4(3-) and analysed by SdFFF to determine the surface adsorption density (SAD) of orthophosphate as a function of particle size. The SdFFF unit was directly coupled to an ICP-HR MS to determine the chemical composition of the colloidal samples as a function of particle size. Element concentration/UV detector signal and element atomic molar ratios were plotted against particle size, and the trends used in the interpretation of SAD distribution (SADD) changes for the samples were studied. In general, non-constant trends in the orthophosphate SADDs were found, except for the river sediment treated with hydroxylamine hydrochloride. The results indicated that, in the soil sample studied, the Mn oxide coating was a dominant factor in determining phosphorus adsorption. This method could also be applicable to other industrial or similar samples.

Fractionation and composition of colloidal and suspended particulate materials in rivers

The association of pollutants (nutrients, heavy metals and organic compounds) with colloidal and suspended particle matter (SPM) plays a dominant role in determining their transport, fate, biogeochemistry, bioavailability and toxicity in natural waters. A scheme for the fractionation and composition of colloidal and SPM from river waters has been tested. All four separation methods, i.e. sieving, continuous flow centrifugation, tangential flow filtration, sedimentation field-flow fractionation, were for the first time used to separate five size particulate fractions from river. Significant (gram) amounts of colloidal material (<1 microm) in three size ranges, nominally 1-0.2, 0.2-0.006 and 0.006-0.003 microm were obtained. The separation scheme was able to process large samples (100 l), within reasonable times (1 day) and the apparatus was portable. The aquatic colloid size was also characterized with high resolution by using sedimentation field-flow fractionation technique. The mass-based particle size distribution for the water sample showed a broad size distribution between 0.05 and 0.4 microm with the maximum around 0.14 microm. There was a systematic increase in the content of organic carbon (estimated by loss on ignition), Mg, Ca, Na, Cu and Zn with decreasing particle size, highlighting the importance of the colloidal (<1 microm) fraction. It was concluded that the colloidal Cu and Zn concentrations in rivers might be much higher than those reported before.

An exploration of child sexual abusers' sexual fantasies before and after treatment

Although there is a substantial literature looking at the relationship between deviant sexual fantasies and child sexual abuse, there is scant previous work that focuses upon the actual content of such fantasies. The present study looks at child sexual abusers' deviant fantasies both pre- and postintervention. Using both qualitative and quantitative methodologies, a description of the frequency and content of, and triggers for, child sexual abusers' deviant fantasies is reported both pre- and postintervention. The implications of this information for subsequent intervention programs is explored.

[Psychiatric rehabilitation in a secure treatment setting]

Working with severely mentally ill persons within the locked environment of a secure residential treatment facility presents a provocative challenge in attempting to establish a rehabilitative program. The author describes the mission, goals and methods of one of Oregon's newly organized facilities for "hard to place" former state hospital patients. The value of teaching the residents self-control is emphasized. Clinical vignettes illustrate how the staff involve the residents in real-life tasks, apply natural consequences to problem behaviors, and make attempts at minimizing the potential sources of confrontation.

[Training in preventing assaultive behaviors for psychiatric professionals]

Dangerous behaviors in psychiatric institutions constitute major clinical and administrative problems. Staff competency in dealing with assaultive patients is an important factor in reducing institutional violence. One of the training programs for mental health staff working with dangerous patients is called Professional Assault Response Training (PART). PART is a product of several years of experience accumulated by the group of California authors in their efforts at designing a safe and effective approach in responding to various dangerous behaviors. PART principles guide staff in 1) de-escalating dangerous incidents through verbal crisis interventions; 2) avoiding or minimizing the risk of minor physical injury through evasion; 3) preventing serious bodily harm through the use of manual restraint. The importance of maintaining self-control by staff is reinforced throughout the entire course as a crucial professional skill. Other PART principles include identifying realistic treatment expectations for assaultive patients, proper physical mobility and emotional balance of staff, recognizing warning signals of impeding danger, using reasonable force to match response to the level of dangerousness. The PART training explores various theoretical explanations of violence (legal model, stress model, environmental model, communication model, developmental model, basic needs model and common-sense model). Verbal interventions which are a cornerstone of the PART approach are matching specific motives of threatening behavior--fear, frustration, manipulation and intimidation. Physical interventions taught in the course (evasion and manual restraint) include only techniques which can be used safely and which are not pain inducing. Finally, the PART training also assists staff in properly documenting assaultive incidents.

Long-term follow-up in the Peer Assessment Program for nonspecialist physicians in Ontario, Canada

BACKGROUND

The College of Physicians and Surgeons of Ontario has assessed randomly selected physician office practices since 1972. Each assessment consists of a tour of the premises and a review of a random selection of 20 to 30 medical records to evaluate the system of record keeping and the content of the records and to thereby indicate the quality of the physician's examinations, history taking, diagnosis and management plan. About 12% of nonspecialist physicians who need help to improve their records and/or the care they provide are identified annually, and following an interview with peers and simple educational interventions, more than 75% are successful in improving.

METHODS

A follow-up was conducted to assess physician practices an average of six years after the first intervention. The reviewers were blinded as to whether the physician being reviewed had been reviewed previously. Each revisited physician was matched to three others undergoing their initial assessments in the same year. The matching variables were age, sex, school of graduation (Canadian versus other), rural versus urban practice location, and affiliation status with the College of Family Physicians of Canada. The assessed performance of the two groups was compared.

RESULTS

The performance of the revisit group was significantly better than that of the matched group (p = 0.05).

CONCLUSIONS

The assessment, interview, and educational interventions undertaken by the licensing authority produced an improvement in practice in the short term in the bottom 10%-15% of all physicians reviewed, which was sustained for more than six years.

Entropic Contribution to the Retention of Nonspherical Particles in Field-Flow Fractionation

In this paper the effect of particle shape on the entropy of nonspherical particles adjacent to a plane surface is considered. The subsequent influence on particle retention in field-flow fractionation (FFF) has been estimated. New retention equations for thin rod and disc shaped particles have been derived to cover this steric-entropic region of FFF. As particle size increases relative to the mean cloud thickness, the retention ratio for nonspherical particles is predicted to increase compared to small spherical particles of the same mass. This could result in a significant underestimation of the calculated equivalent spherical diameter (d) by FFF methods. The steric-entropic FFF equations could be used to calculate accurate d values if the large particle dimension is estimated independently (e.g., by microscopy). Alternatively, run conditions could be designed to minimize steric-entropic perturbations to the ideal retention equation.

Steroid injection for carpal tunnel syndrome

We studied the medium- to long-term results of steroid injection into the carpal tunnel of women with the carpal tunnel syndrome (CTS). Of 45 hands, only 11 had lasting relief of symptoms and 22 had no relief whatsoever. There was no correlation of the typical signs and symptoms of CTS with outcome. Other series have offered various predictive factors for the outcome of injection but we found little or no correlation between these factors and outcome.

Variations in the fluorescence intensity of intact DAPI-stained bacteria and their implications for rapid bacterial quantification

As current techniques for the quantification of bacteria are laborious and often imprecise, instrumental approaches such as sedimentation field-flow fractionation (SdFFF) are attractive. In this technique, fluorogenic dyes specific for nucleic acids are used to identify bacterial cells. Bacterial biomass can be quantified directly with SdFFF if the specific fluorescence of bacterial cells is constant. The effect of different growth conditions on the specific fluorescence of one strain each of Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis and Staphylococcus epidermidis stained with 4',6-diamidino-2-phenylindole was examined. Specific fluorescence varied over a 500-fold range, from 0.22 to 103 arbitrary fluorescence units per cell. Specific fluorescence was highest when cells were in log phase, and lowest when cells were in stationary phase. Specific fluorescence decreased when cells harvested in log phase were starved for 7 d in a carbon-free minimal medium, and increased rapidly (within 2 h) after cells were relieved from carbon limitation. Such variations in specific fluorescence must be considered when using gross fluorescence as a direct indicator of bacterial numbers in the SdFFF technique for quantifying bacterial biomass. Moreover, they have serious implications for the application of fluorescence techniques in other instrumental approaches for bacterial enumeration in environmental samples.

Physical Characterization and Quantification of Bacteria by Sedimentation Field-Flow Fractionation

Studies in microbial ecology require accurate measures of cell number and biomass. Although epifluorescence microscopy is an accepted and dependable method for determining cell numbers, current methods of converting biovolume to biomass are error prone, tedious, and labor-intensive. This paper describes a technique with sedimentation field-flow fractionation to enumerate bacteria and determine their density, size, and mass. Using cultured cells of different shapes and sizes, we determined optimum values for separation run parameters and sample-handling procedures. The technique described can separate and detect 4′, 6-diamidino-2-phenylindole-stained cells and generate a fractogram from which cell numbers and their size or mass distribution can be calculated. A direct method for estimating bacterial biomass (dry organic matter content) which offers distinct advantages over present methods for calculating biomass has been developed.

A trial of two cognitive-behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients: I. Outcome

Despite neuroleptic medication, many schizophrenic patients continue to experience residual positive psychotic symptoms. These residual symptoms cause distress and disability. We report a controlled trial of two cognitive-behavioural treatments to alleviate residual hallucinations and delusions. Forty-nine patients were recruited into the trial, of whom 27 entered the trial and completed post-treatment assessment, and 23 were reassessed at six-month follow-up. Patients were randomly allocated to either coping strategy enhancement (CSE) or problem solving (PS). Half the patients were allocated to a high-expectancy positive demand condition and half to a counter-demand condition to evaluate expectation of improvement. Patients receiving either cognitive-behavioural treatment showed significant reductions in psychotic symptoms compared with those in the waiting period, who showed no improvement. There was some evidence, although equivocal, that patients receiving CSE improved more than those receiving PS. There was no evidence that improvements generalised to negative symptoms or social functioning, nor was there evidence that expectancy of treatment benefit contributed to the treatment effect.

A trial of two cognitive behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients. II. Treatment-specific changes in coping and problem-solving skills

Changes in coping skills and problem-solving skills were examined in two groups of schizophrenic patients. The groups received either coping skills enhancement or problem-solving treatments to reduce their drug-resistant residual psychotic symptoms. The coping skills group showed significant increases both in the number of positive coping strategies used and in their efficacy, whereas the problem-solving group showed a decrease in these measures during treatment. Both groups showed significant improvements in problem-solving skills. Changes in coping but not problem solving were significantly related to decreases in psychotic symptoms during treatment. It was concluded that treatment involving the teaching of coping skills had a specific treatment effect.

Morbid jealousy: a review and cognitive-behavioural formulation

Jealousy is a common emotion which can be considered pathological in some circumstances. The term ‘morbid jealousy’ has been used to signify this abnormal or extreme condition. However, the literature on morbid jealousy is sparse and the empirical data fragmentary. The aims of this paper are to briefly review the concept, to define the dimensions of the disorder and to apply a cognitive-behavioural framework to it. Such a summary paper is timely, to draw together the different aspects of the problem and to provide a theoretical base from which to generate further research.