Idiopathic necrotizing dermatitis: Current management

Objectives: To identify and demonstrate necrotizing dermatitis in infancy; an uncommon, puzzling syndrome, in which anecdotal reporting and personal experience indicates that one third of cases may require skin grafting. Much informed discussion about the pathogenesis of this distressing syndrome centres on the role of spider envenomation; and in particular on the speculative role of the Australian White-tailed spider, Lampona cylindrata. Methods: We present here six cases of necrotizing dermatitis treated surgically at the Royal Children's Hospital and Mater Children's Hospital in Brisbane over the period from 1991 to 1999. Clinical history, surgical details and pathological investigations were reviewed in each case. Microbiological investigation of necrotic ulcers included standard aerobic and anaerobic culture. Result: Nocardia and Staphylococcus were cultured in two cases, but no positive bites were witnessed and no spiders were identified by either the children or their parents. All cases were treated with silver sulphadiazine creme. Two of the infants required general anaesthesia, excision debridement and split skin grafting. The White-tailed spider, Lampona cylindrata, does not occur in Queensland, but Lampona murina does; neither species has necrotizing components in its venom. Circumstantial evidence is consistent with this syndrome being due to invertebrate envenomation, possibly following arachnid bites. Conclusion: In our experience there is insufficient evidence to impute a specific genus as the cause, at this stage of scientific knowledge. If the offending creature is a spider, we calculate that the syndrome of necrotizing dermatitis occurs in less than 1 in 5000 spider bites.

The state of history and the empire of metaphysics [Review]

One of the curious things about this challenging book is that its ostensible subject— the Saxon medical and political scientist Hermann Conring (1606–1681)— is not mentioned in the title. Constantin Fasolt argues that we cannot know what Conring really thought or meant in his writings, which means that his topic cannot be Conring as such and must instead be that which occludes our knowledge of him, the titular limits of history. Given that we do in fact learn a good deal about Conring from Fasolt’s book, we can only hope that the decapitation of its subject will be rectified in a subsequent edition, or perhaps by the restorative work of librarians putting together subject headings. And yet Fasolt’s decision is understandable, for Conring is indeed a stalking-horse for a much bigger quarry: historiography and the historical consciousness. By “history” Fasolt understands a way of imposing intelligibility on the world, which is founded on the twin assumptions that the past is gone and unchangeable, and that the meaning of texts can be determined by placing them in their historical contexts (ix). In challenging this mode of intelligibility, Fasolt is not attempting to improve professiona history—it’s already as good as it can be—but to displace it. He regards his work as a declaration of “independence from historical consciousness” (32). At the same time, Fasolt insists that he is not simply jumping from historiography to philosophy, or attempting to preempt history with ontology (37-39). That has been tried by Nietzsche and Heidegger, who have been tainted by Nazism (Fasolt thinks unfairly). It has also been attempted by modern philosophers from Gadamer to Foucault and Charles Taylor who, in failing to address the “violence” that its mode of intelligibility does to the world, have not succeeded in outflanking history. Perhaps, Fasolt wonders, it is only the personal experience of those who have been subject to this violence—the experience of those who have been subject to historical examination—that can break the spell of history. Fasolt’s disclaimer notwithstanding, in the course of these remarks I shall argue that he is indeed jumping from history to philosophy, or attempting to outflank history by subjecting it to a particular metaphysical understanding. I shall do so in part by sketching the recent intellectual history of this move—a historical examination that I hope inflicts as little violence as possible on Fasolt’s argument.

Upper limb recovery after stroke: The stroke survivors' perspective

Purpose. This study investigated stroke survivors' perspective of upper limb recovery after stroke. The aim was to determine factors other than medical diagnosis and co-morbidities that contribute to recovery. The objectives were to explore how stroke survivors define recovery, identify factors they believe influence recovery and determine strategies used to maximize upper limb recovery. Method. A qualitative study consisting of three focus groups and two in-depth interviews was conducted with stroke survivors (n = 19) and spouses ( n = 9) in metropolitan, regional and rural Queensland, Australia. Data were analysed using principles of grounded theory. Results. Stroke survivors maximize upper limb recovery by 'keeping the door open' a process of continuing to hope for and work towards improvement amidst adjusting to life with stroke. They achieve this by 'hanging in there', 'drawing on support from others', 'getting going and keeping going with exercise', and 'finding out how to keep moving ahead'. Conclusions. This study provides valuable insight into the personal experience of upper limb recovery after stroke. It highlights the need to develop training strategies that match the needs and aspirations of stroke survivors and that place no time limits on recovery. It reinforces the benefits of stroke support groups and advocates their incorporation into stroke recovery services. These findings can be used to guide both the development and evaluation of stroke survivor centred upper limb training programmes.

Searching for convergence in phylogenetic Markov chain Monte Carlo

Markov chain Monte Carlo (MCMC) is a methodology that is gaining widespread use in the phylogenetics community and is central to phylogenetic software packages such as MrBayes. An important issue for users of MCMC methods is how to select appropriate values for adjustable parameters such as the length of the Markov chain or chains, the sampling density, the proposal mechanism, and, if Metropolis-coupled MCMC is being used, the number of heated chains and their temperatures. Although some parameter settings have been examined in detail in the literature, others are frequently chosen with more regard to computational time or personal experience with other data sets. Such choices may lead to inadequate sampling of tree space or an inefficient use of computational resources. We performed a detailed study of convergence and mixing for 70 randomly selected, putatively orthologous protein sets with different sizes and taxonomic compositions. Replicated runs from multiple random starting points permit a more rigorous assessment of convergence, and we developed two novel statistics, delta and epsilon, for this purpose. Although likelihood values invariably stabilized quickly, adequate sampling of the posterior distribution of tree topologies took considerably longer. Our results suggest that multimodality is common for data sets with 30 or more taxa and that this results in slow convergence and mixing. However, we also found that the pragmatic approach of combining data from several short, replicated runs into a metachain to estimate bipartition posterior probabilities provided good approximations, and that such estimates were no worse in approximating a reference posterior distribution than those obtained using a single long run of the same length as the metachain. Precision appears to be best when heated Markov chains have low temperatures, whereas chains with high temperatures appear to sample trees with high posterior probabilities only rarely. [Bayesian phylogenetic inference; heating parameter; Markov chain Monte Carlo; replicated chains.]

Destination image, romance and place experience - an application of intimacy theory in tourism

In some forms of tourism, and perhaps particularly in the case of special interest tourism, it can be argued that tourism encounters are service relationships with emotional attachment through the special interest focus and a level of enduring involvement on the part of participants. This involvement is two-fold. First, an interest with the activity; second, a sharing with like-minded people in a social world that extends from home to tourist destination and return. Intimacies in tourism can thus be interpreted through the model of the relationship cycle that comprises the stages A. Aquaintance, B, Buildup, C, Continuation and D, Dissolution. The paper builds upon this concept by utilising ideas of other-centred and self-centredness in personal relationships, and extends the concept of other-centredness to host environments. It also suggests that, in the academic literature about place, location may be secondary in that the quality of experience is primarily determined by the intimacies that exist between people at that place, especially that existing between visitors. © 2004 Published by Elsevier Ltd.

Hurt feelings in couple relationships: Exploring the role of attachment and perceptions of personal injury

This research program focused on perceptions of the appraisals and emotions involved in hurtful events in couple relationships. Study I tested the broad proposition that hurt feelings are elicited by relational transgressions that generally imply relational devaluation and that evoke a sense of personal injury by threatening positive mental models of self and/or others. Participants (N = 224) provided retrospective accounts of an experience of being hurt by a romantic partner. These accounts, together with expert judges' ratings, showed that most hurtful events involved relational transgressions that signal both relational devaluation and threat to positive mental models; however, relational devaluation was relatively unimportant in explaining the hurt associated with partners' distrust. A sense of injury emerged as the dominant theme in open-ended accounts of emotional reactions; however, other negative emotions also featured and were related to the type of event reported. The emotion terms generated in Study I were used as stimuli in a word-sorting task (Study 2). This study confirmed that many of the terms were perceived specifically as injury related, and shed further light on the link between appraisals and emotions. Theoretical and practical implications of the findings are discussed.