Computerized assessment of pedophilic sexual interest through self-report and viewing time: reliability, validity, and classification accuracy of the affinity program.

Affinity is a computerized assessment tool that combines viewing time and self-report measures of sexual interest. The present study was designed to assess the diagnostic properties of Affinity with respect to sexual interest in prepubescent children. Reliability of both self-report and viewing time components was estimated to be high. The group profile of a sample of pedophilic adult male child molesters (n = 42, all of whom admitted their offenses) differed from the group profiles of male community controls (n = 95) and male nonsexual offenders (n = 27), respectively. More specifically, both ratings and viewing times for images showing small children or prejuvenile children were significantly higher within the child molester sample than in either of the other two groups, attesting to the validity of the measures. Overall classification accuracy, however, was mediocre: A multivariate classification routine yielded 50% sensitivity for child molester status at the cost of 13% false positives. The implications for forensic use of Affinity are discussed.

Emergency abdominal aortic aneurysm presenting without haemodynamic shock is associated with misdiagnosis and delay in appropriate clinical management.

BACKGROUND: Emergency abdominal aortic aneurysm (EmAAA) represents a spectrum of disease from symptomatic non-ruptured aneurysms to free intraperitoneal rupture, with significantly worse outcomes for patients in a haemodynamically shocked state before surgery. A study was undertaken to see if the preoperative journey and outcome were different in patients who deviated from the classic acutely shocked presentation. METHODS: An observational database compiled from case notes of patients undergoing surgery for EmAAA at Sunderland Royal Hospital between April 2000 and October 2006 was interrogated to examine details of patient preoperative journey, physiological status and 30-day survival. Comparison between groups was performed using chi(2) analysis and the Mann-Whitney U test where appropriate. RESULTS: Records for 98 patients were available for review. Overall 30-day mortality was 49%, and was significantly higher for patients in shock at induction of anaesthesia than in those who were haemodynamically stable (59.6% vs 34.1%, p = 0.01). At presentation, 56 patients were stable and misdiagnosis was significantly more common in these patients than in those who were in shock (58.9% vs 26.2%, p = 0.002), with a significantly increased median time delay from presentation to diagnosis (144 min (IQR 24-366) vs 12 min (IQR 0-42), p<0.0001). Median time from diagnosis to arrival in theatre was significantly longer in patients who were haemodynamically stable at presentation (90 min (IQR 60-150) vs 48 min (IQR 36-90), p = 0.02). Of the 56 patients who were haemodynamically stable at presentation, 19 underwent haemodynamic decompensation before surgery with a significantly increased mortality compared with those who remained stable (73.7% vs 37.8%, p = 0.02). Of these 19 patients, only 5 were correctly diagnosed at presentation. CONCLUSIONS: Diagnosis and treatment of EmAAA in haemodynamically stable patients is often delayed, with the risk of significant rupture and haemodynamic decompensation which is associated with poor outcome. Correct diagnosis and treatment before development of shock has the potential to reduce mortality.

Compensatory head posture and neck problems: is there an association? A cohort study of nystagmus patients.

PURPOSE: The aims of this study were twofold: to investigate if a compensatory head posture due to nystagmus causes long-term neck problems or adversely effects quality of life and to survey ophthalmologists on their opinions and management of these patients. METHODS: A case-controlled study was carried out to assess the range of neck movements in patients with compensatory head posture due to congenital nystagmus. Exclusion criteria included known neck problems, vertebrobasilar insufficiency, and age less than 16 years. Neck movements were assessed using an inclinometer. Quality of life and disability was assessed using the American Academy of Orthopaedic Surgeons' Cervical Spine Questionnaire. One hundred and fifty consultant ophthalmologists throughout the United Kingdom were surveyed via a postal questionnaire. RESULTS: The range of motion in these patients (n=20) was limited when compared to matched controls especially for lateral flexion (P=0.001) and extension (P=0.003). However, despite limited movement, patients did not perceive a disability and there was no adverse effect on quality of life. In all 55% of ophthalmologists believed compensatory head posture due to nystagmus leads to long-term neck problems. About 46% had personal experience of patients with long-term neck problems due to nystagmus. Eighty-four per cent were influenced in their decision to operate by the presence of a head posture. CONCLUSIONS: Significant restriction in neck movements exists in nystagmus patients with compensatory head posture, although this does not appear to adversely affect quality of life.

SOX2 anophthalmia syndrome: 12 new cases demonstrating broader phenotype and high frequency of large gene deletions.

BACKGROUND: Developmental eye anomalies, which include anophthalmia (absent eye) or microphthalmia (small eye) are an important cause of severe visual impairment in infants and young children. Heterozygous mutations in SOX2, a SOX1B-HMG box transcription factor, have been found in up to 10% of individuals with severe microphthalmia or anophthalmia and such mutations could also be associated with a range of non-ocular abnormalities. METHODS: We performed mutation analysis on a new cohort of 120 patients with congenital eye abnormalities, mainly anophthalmia, microphthalmia and coloboma. Multiplex ligation-dependent probe amplification (MLPA) and fluorescence in situ hybridisation (FISH) were used to detect whole gene deletion. RESULTS: We identified four novel intragenic SOX2 mutations (one single base deletion, one single base duplication and two point mutations generating premature translational termination codons) and two further cases with the previously reported c.70del20 mutation. Of 52 patients with severe microphthalmia or anophthalmia analysed by MLPA, 5 were found to be deleted for the whole SOX2 gene and 1 had a partial deletion. In two of these, FISH studies identified sub-microscopic deletions involving a minimum of 328 Kb and 550 Kb. The SOX2 phenotypes include a patient with anophthalmia, oesophageal abnormalities and horseshoe kidney, and a patient with a retinal dystrophy implicating SOX2 in retinal development. CONCLUSION: Our results provide further evidence that SOX2 haploinsufficiency is a common cause of severe developmental ocular malformations and that background genetic variation determines the varying phenotypes. Given the high incidence of whole gene deletion we recommend that all patients with severe microphthalmia or anophthalmia, including unilateral cases be screened by MLPA and FISH for SOX2 deletions.

A prospective, randomised controlled trial comparing the efficacy of pre-oxygenation in the 20 degrees head-up vs supine position.

We investigated whether positioning patients undergoing general anaesthesia for cholecystectomy in a 20 degrees head-up position, as opposed to supine, improved the efficacy of 3 min of standard pre-oxygenation via a circle breathing system. Following pre-oxygenation, patients received a standard induction of anaesthesia and the apnoea time (from administration of rocuronium to the arterial oxygen saturation to fall to 95%) was recorded. Mean (95% CI) apnoea time was 386 (343-429) s in the 20 degrees head-up position (n = 17) vs 283 (243-322) s in the supine position (n = 18; p = 0.002). Pre-oxygenation is significantly more efficacious and by inference more efficient in the 20 degrees head-up position than in the supine position.

A prospective, randomised, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anaesthesia for day case surgery.

Pre-operative anxiety is common and often significant. Ambulatory surgery challenges our pre-operative goal of an anxiety-free patient by requiring people to be 'street ready' within a brief period of time after surgery. Recently, it has been demonstrated that music can be used successfully to relieve patient anxiety before operations, and that audio embedded with tones that create binaural beats within the brain of the listener decreases subjective levels of anxiety in patients with chronic anxiety states. We measured anxiety with the State-Trait Anxiety Inventory questionnaire and compared binaural beat audio (Binaural Group) with an identical soundtrack but without these added tones (Audio Group) and with a third group who received no specific intervention (No Intervention Group). Mean [95% confidence intervals] decreases in anxiety scores were 26.3%[19-33%] in the Binaural Group (p = 0.001 vs. Audio Group, p < 0.0001 vs. No Intervention Group), 11.1%[6-16%] in the Audio Group (p = 0.15 vs. No Intervention Group) and 3.8%[0-7%] in the No Intervention Group. Binaural beat audio has the potential to decrease acute pre-operative anxiety significantly.

Respiratory bronchiolitis associated interstitial lung disease (RB-ILD): a case of an acute presentation.

Respiratory bronchiolitis associated interstitial lung disease (RB-ILD) is a recently described clinicopathological entity that occurs almost exclusively in current heavy cigarette smokers. Few cases have been reported in the literature and no studies have been carried out on the effect of treatment, which currently consists of smoking cessation with or without corticosteroids. We report the first case of an acute presentation of histologically proven RB-ILD in a young cigarette smoker whose diagnosis and management proved to be difficult. Smoking cessation alone was found to be inadequate so management was combined with corticosteroid therapy.

A form for referral of injured patients between maxillofacial and ophthalmology units.

We have designed a form to facilitate referral of injured patients between maxillofacial and ophthalmology units. This form improves communication, gives a written record of referral, and can be used for audit.

Childhood amblyopia treatment: psychosocial implications for patients and primary carers.

PURPOSE: To investigate the psychosocial impact of amblyopia therapy on children and their carers. METHOD: The study was prospective and incorporated a repeated-measures design. A total of 59 carers were classified into occluded (n=31) or nonoccluded group (n=28). A questionnaire consisting of the Perceived Stress Index (PSI) and the Perceived Psychosocial Questionnaire (PPQ) was used to measure carer's perception of stress and psychosocial well-being of the child respectively prior to and following commencement of treatment. Parametric and nonparametric tests were used to analyse the data. RESULTS: No significant difference in carer's stress (P>0.05) and child's psychosocial well-being (P>0.05) was observed between occluded and nonoccluded groups. Within occluded group, carer's stress (P>0.05) and child's psychosocial well-being (P>0.05) did not differ significantly before and following commencement of treatment. Within the occluded group, carers felt more negative towards their child following onset of glasses therapy (P<0.01) and became more positive when occlusion was introduced in the subsequent follow-up (P<0.01). CONCLUSIONS: When compared to carers in the nonoccluded group, those with children undergoing occlusion therapy did not experience significantly more stress or perceived their child as exhibiting less psychosocial well-being. Within the occluded group, carers' stress level and child's psychosocial well-being did not significantly change following onset of occlusion therapy. Carers felt temporarily more negative towards the child following onset of treatment with glasses. In this study, there is no evidence to indicate that occlusion therapy has negative psychosocial impact on carers and children alike.

A brief history of behavioral and cognitive behavioral approaches to sexual offenders: Part 1. Early developments.

This is the first of two papers which briefly outline the development of behavioral and cognitive behavioral treatment of sexual offenders from the mid-1800s to 1969. We first consider the historic role of Sigmund Freud and note that a broad scientific interest in deviant sexual behaviour was well established by 1900. In the early to mid-20th century, two psychologies were prominent in the development of behaviorial approaches, those of John B. Watson and Alfred Kinsey. Behavior therapy for a variety of problems emerged in the 1950s and soon found application to deviant sexuality. The development of penile plethysmography helped to focus interest on deviant sexual preference and behavior. While nonbehavioral approaches to sexual offenders paralleled these developments, a combination of behavioral and cognitive behavioral treatments began to emerge in the late 1960s which ultimately developed into the approaches more commonly seen today.

A brief history of behavioral and cognitive behavioral approaches to sexual offender treatment: Part 2. The modern era.

This paper is the second in our attempt to highlight the major influences, trends, and emerging issues in cognitive behavioral approaches to treating sexual offenders. In this paper the developments from 1970 until the present are covered.

Post-traumatic orbital cellulitis.

Orbital cellulitis is uncommon. It may arise as a sequel to eyelid infection, or from direct spread of infection from the paranasal sinuses; it may be of odontogenic origin and has been reported after meningitis and after nasoorbital fractures with pre-existing sinusitis. Clinically, orbital cellulitis is of great importance, as it is a severe disease with potentially disastrous consequences. It may lead to optic neuritis, optic atrophy, blindness, cavernous sinus thrombosis, superior orbital fissure syndrome, meningitis, subdural empyema, and even death. We report two cases of severe post-traumatic orbital cellulitis with subperiosteal abscesses. These were managed surgically and vision was preserved. We describe the anatomy, a classification of orbital infection, and the importance of multidisciplinary management of these cases.

Olfactory aversion: notes on procedure, with speculations on its mechanism of effect.

The use of a self-administered noxious agent to suppress deviant sexual arousal is the focus of this paper. A recommended procedure for the use of olfactory aversion is described. Data from two publications by the author, wherein different noxious agents had been used, are presented and discussed. Several explanations for the mechanism of effect in olfactory aversion have been offered. Two of these, one using a nausea-producing agent and one using a pain-producing agent are described. The procedure using the pain-producing agent is the simplest to implement, the least ambiguous, and offers the least cumbersome explanation for the behavioral effect observed in olfactory aversion. However, a conditioning explanation is probably too simple. Several examples of cognitive mediation in conditioning procedures are presented and discussed.

An experimental and theoretical investigation of the chemical shielding tensors of (13)C(alpha) of alanine, valine, and leucine residues in solid peptides and in proteins in solution.

We have carried out a solid-state magic-angle sample-spinning (MAS) nuclear magnetic resonance (NMR) spectroscopic investigation of the (13)C(alpha) chemical shielding tensors of alanine, valine, and leucine residues in a series of crystalline peptides of known structure. For alanine and leucine, which are not branched at the beta-carbon, the experimental chemical shift anisotropy (CSA) spans (Omega) are large, about 30 ppm, independent of whether the residues adopt helical or sheet geometries, and are in generally good accord with Omega values calculated by using ab initio Hartree-Fock quantum chemical methods. The experimental Omegas for valine C(alpha) in two peptides (in sheet geometries) are also large and in good agreement with theoretical predictions. In contrast, the "CSAs" (Deltasigma) obtained from solution NMR data for alanine, valine, and leucine residues in proteins show major differences, with helical residues having Deltasigma values of approximately 6 ppm while sheet residues have Deltasigma approximately 27 ppm. The origins of these differences are shown to be due to the different definitions of the CSA. When defined in terms of the solution NMR CSA, the solid-state results also show small helical but large sheet CSA values. These results are of interest since they lead to the idea that only the beta-branched amino acids threonine, valine, and isoleucine can have small (static) tensor spans, Omega (in helical geometries), and that the small helical "CSAs" seen in solution NMR are overwhelmingly dominated by changes in tensor orientation, from sheet to helix. These results have important implications for solid-state NMR structural studies which utilize the CSA span, Omega, to differentiate between helical and sheet residues. Specifically, there will be only a small degree of spectral editing possible in solid proteins since the spans, Omega, for the dominant nonbranched amino acids are quite similar. Editing on the basis of Omega will, however, be very effective for many Thr, Val, and Ileu residues, which frequently have small ( approximately 15-20 ppm) helical CSA (Omega) spans.