Wolfe Tone’s death: Suicide or assassination?

The final events of Wolfe Tone’s short and stormy life are fairly common knowledge. He was captured on board the French flagshipHoche when the vessel surrendered to a superior British naval force off Lough Swilly on October 10, 1798. Despite his protests that he was entitled to normal prisoner-of-war treatment, he was brought in irons a month later to Dublin. A court martial was hurriedly convened and he was found guilty of treason on Saturday November 10 and condemned to be hanged two days later. According to the generally accepted version of subsequent events he cut his own throat early on the Monday morning. The assistant surgeon of the 5th Dragoon Guards dressed the wound “ — but only with a view to prolong life until the fatal hour of one o’clock”. This surgeon was Benjamin Lentaigne, a Royalist emigre from France. Despite the pleas of John Philpott Curran, a leading advocate of the day, the military authorities refused to allow any consultation with a civil surgeon. Was this just bloody mindedness or was there an even more sinister reason? Two possibilities come to mind. One was that the wound had been so incompetently treated that a consultant would have been forced to make adverse comments, the other that the throat wound was not due to a cutting injury but, to a bullet fired either deliberately or accidently and a knife or razor was then used to try and camouflage the original trauma. In 1812 Lentaigne published a pamphlet in Latin in which he made reference to an unusual neck would stating that “— the bullet passed through his throat...” There is no direct evidence that the victim was Tone, why did the writer not make this clear? It may be he was reluctant to expose the medico-military inefficiency or callousness or to jeopardise his son’s career. Whatever the true facts, the verdict must remain the Scots one of “Not proven”.     

Cosolvency of Dimethyl Isosorbide for Steroid Solubility

Dimethyl isosorbide (DMI), which is currently under investigation for its potential use as a pharmaceutical vehicle and drug permeation enhancer, is a water-miscible liquid with relatively low viscosity. The solubilization behavior of DMI as a cosolvent for nonpolar drugs was characterized via dielectric constant measurements of binary solvent systems containing DMI and either water, propylene glycol (PG), or polyethylene glycol (PEG). Evidence from the dielectric constant profiles and NMR studies suggest that DMI undergoes complexation with water and PG, but not with PEG, through hydrogen bonding interactions. The solvent complexation exhibited a major effect on the solubilities of prednisone, dexamethasone, and prednisolone in the mixed solvent systems. Maximum solubility of each drug was found to occur near a DMI/water or DMI/PG concentration ratio of 1:2. In the DMI–PEG mixed system, while there is no apparent interaction between DMI and PEG molecules, the solubility of prednisone was found to increase with decreasing dielectric constant.     

Significant efficiency findings while controlling for the frequent confounders of CAI research in the PlanAlyzer project's computer-based,self-paced,case-based programs in anemia and chest pain diagnosis

Richard E. Clark in his widely published comprehensive studies and meta-analyses of the literature on computer assisted instruction (CAI) has decried the lack of carefully controlled research, challenging almost every study which shows the computer-based intervention to result in significant post-test proficiency gains over a non-computer-based intervention. We report on a randomized study in a medical school setting where the usual confounders found by Clark to plague most research, were carefully controlled. PlanAlyzer is a microcomputer-based, self-paced, case-based, event-driven system for medical education which was developed and used in carefully controlled trials in a second year medical school curriculum to test the hypothesis that students with access to the interactive programs could integrate their didactic knowledge more effectively and/or efficiently than with access only to traditional textual “nonintelligent” materials. PlanAlyzer presents cases, elicits and critiques a student's approach to the diagnosis of two common medical disorders: anemias and chest pain. PlanAlyzer uses text, hypertext, images and critiquing theory. Students were randomized, one half becoming the experimental group who received the interactive PlanAlyzer cases in anemia, the other half becoming the controls who received the exact same content material in a text format. Later in each year there was a crossover, the controls becoming the experimentals for a similar intervention with the cardiology PlanAlyzer cases. Preliminary results at the end of the first two full trials shows that the programs have achieved most of the proposed instructional objectives, plus some significant efficiency and economy gains. 96 faculty hours of classroom time were saved by using PlanAlyzer in their place, while maintaining high student achievement. In terms of student proficiency and efficiency, the 328 students in the trials over two years were able to accomplish the project's instructional objectives, and the experimentals accomplished this in 43% less time than the controls, achieving the same level of mastery. However, in spite of these significant efficiency findings, there have been no significant proficiency differences (as measured by current factual and higher order multiple choice post-tests) between the experimental and control groups. Very careful controls were used to avoid what Clark has found to be the most common confounders of CAI research. Accordingly, this research proved Clark's rival hypothesis, that the computer, in itself, does not appear to contribute to proficiency gains, at least as measured by our limited post-testing. Clark's position is that the computer is primarily a vehicle—as is either a pill or a hypodermic needle for delivering a drug. The hypodermic needle can deliver the drug more efficiently than can the pill, (as can the computer deliver the subject matter content more efficiently, as our research indicates), but the same content is delivered. At the same time, we proved our own hypothesis, as far as efficiency gains resulting from the computer are concerned. However, going beyond Clark's research, we may be teaching processes both more effectively and efficiently with the computer (experience in problem-solving or clinical reasoning and pattern recognition) which our current post-tests do not adequately measure. Our on-going research suggests additional inquiry in several areas: better evaluation instruments to measure the clinical reasoning skills PlanAlyzer was designed to teach; the addition of more advanced cases to determine if this might transform efficiency gains of the computer group into proficiency gains; the addition of enhanced graphic decision support tools and other pedagogical enhancements including cognitive feedback to strengthen PlanAlyzer's power to teach complex concepts of medical decision-making.     

Ciliochoroidal effusions after neodymium:YAG posterior capsulotomy: association with pre-existing glaucoma and uveitis

Two patients with a history of glaucoma and a propensity for uveitis developed ciliochoroidal effusions following Nd:YAG laser posterior capsulotomy. Both patients experienced a waxing and waning course with eventual resolution of symptoms after a steroid regimen. The ciliochoroidal effusions were presumed to be secondary to uveitis induced by the YAG laser surgery. The role of glaucoma, previous surgeries, and an open posterior capsule is uncertain but may have predisposed these patients to ciliochoroidal detachment. We advise caution in performing YAG posterior capsulotomy in patients with glaucoma and a known propensity for uveitis.     

Measurement of the residual radioactivity induced in the front foil of a target assembly in a modern medical cyclotron.

The levels of residual radioactivity induced in Havar foils at the entrance of a high-pressure 18O-enriched water target used for the production of 18F- in a medical cyclotron with 16 MeV protons have been determined using high-resolution gamma-ray spectrometry. Whole body and skin dose rates arising from exposure to these foils during their periodic replacement have been estimated. The results indicate that irradiated foils do not represent a significant radiological hazard for the cyclotron operating staff and that no waste disposal difficulties should be encountered after an appropriate 'cooling' period of 2 years.     

Errors in the measurements of T2 using multiple-echo MRI techniques. II. Effects of static field inhomogeneity

The accurate estimation of the spin-spin relaxation time T2 is an important goal in magnetic resonance imaging particularly because it can be used for quantitative tissue characterization. The spin-spin relaxation time T2 may be estimated using multiecho pulse sequences, but the accuracy of the estimate is dependent on the fidelity of the spin-echo amplitudes, which may be severely compromised by rf pulse and static field imperfections. In this paper, the effects of static field inhomogeneities are investigated. The propagation of the errors introduced by off-resonance effects are analyzed through computer simulations and analytical solutions of the Bloch equations. A series of experiments performed on a simple tissue phantom using a whole-body imaging system operating at 6.35 MHz corroborates the simulation and analytical results. For accurate measurements of T2 using a whole-body imaging system it is necessary to correct for these inhomogeneities. A correction scheme which would enable a more accurate estimate of T2 is currently under investigation.     

Synergist Erection System: clinical experience

The Synergist Erection System (SES) was tested over a six-month period in 44 impotent patients with an organic etiology. The device was successfully used by 73 percent. The duration of erection for 75 percent of the patients was as long as they wanted to wear the device. The frequency of use was once a week for 47 percent. The quality of erection was rated satisfactory by 63 percent of the patients and 78 percent of the couples rated satisfactory intercourse. It appears the SES option is a valid one with high success and satisfaction rating at least on a short-term basis. In addition, it offers prophylactic protection.     

Semen analysis in patients operated on for impalpable testes

Semen analysis was performed on 48 men who had undergone orchiopexy, 40 for unilateral impalpable testes and 8 for bilateral impalpable testes. Patients with unilateral impalpable testes had varying sperm analysis; 18 (86%) of the 23 patients with unilateral impalpable canalicular testes had normal sperm analysis. All patients with bilateral impalpable testes were azoospermic. The subsequent quality of the semen is dependent upon the original anatomical positions of the undescended testes.