‘Why should I be like bloody Rain Man?!’ Navigating the autistic identity

This article explores the views of six higher education students with autism/Asperger syndrome. The research draws upon social identity theory to explore how participants made meaning of their label. There was consensus that information given at the point of diagnosis generally did not reflect their individual experiences. First‐hand accounts tended to be perceived as more personally relevant. The ‘Asperger’ identity was generally framed as fragile and inconsistent, leading some individuals to distance themselves from it. This may be problematic for a group that is already disadvantaged and isolated. However, participants conveyed strong self‐images regardless of how and whether they identified with their diagnosis, which was attributed to their relative privilege in achieving higher education and therefore experiencing success and achievement related to their personal strengths. In this article, Andrea MacLeod, Ann Lewis and Christopher Robertson, from the University of Birmingham, call for researchers and relevant services to involve autistic individuals directly in fostering a constructive ‘autism identity’.     

A Collaborative Workflow for the Digitization of Unique Materials

This paper examines the experience of one institution, the University of Maryland Libraries, as it made organizational efforts to harness existing workflows and to capture digitization done in the course of responding to patron requests. By examining the way this organization adjusted its existing workflows to put in place more systematic methods for digital capture of unique collections, the authors hope to provide insight into the benefits and pitfalls of one model for scaling up digitization.     

The deceit continues: an updated literature review of Munchausen Syndrome by Proxy

OBJECTIVE: This article presents an updated review of the literature of Munchausen Syndrome by Proxy (Factitious Disorder by Proxy, MBP). METHOD: Four hundred fifty-one cases of MBP were analyzed from 154 medical and psychosocial journal articles. RESULTS: Typical victims may be either males or females, usually 4 years of age or under. Victims averaged 21.8 months from onset of symptoms to diagnosis. Six percent of victims were dead, and 7.3% were judged to have suffered long-term or permanent injury. Twenty-five percent of victims' known siblings are dead, and 61.3% of siblings had illnesses similar to those of the victim or which raised suspicions of MBP. Mothers were perpetrators in 76.5% of cases, but as knowledge of MBP grows a wider range of perpetrators is identified. In a small number of cases, MBP was found to co-exist with secondary gain or other inflicted injury. CONCLUSION: Although published cases form a non-random sample, they add to knowledge about MBP and validate claims that it occurs. More knowledge about non-medical aspects of MBP, and more pooling of data, is desirable.     

The influence of a 6.5% carbohydrate-electrolyte solution on performance of prolonged intermittent high-intensity running at 30 degrees C

Nine male student games players consumed either flavoured water (0.1 g carbohydrate, Na+ 6 mmol x l(-1)), a solution containing 6.5% carbohydrate-electrolytes (6.5 g carbohydrate, Na+ 21 mmol x l(-1)) or a taste placebo (Na+ 2 mmol x l(-1)) during an intermittent shuttle test performed on three separate occasions at an ambient temperature of 30 degrees C (dry bulb). The test involved five 15-min sets of repeated cycles of walking and variable speed running, each separated by a 4-min rest (part A of the test), followed by 60 s run/60 s rest until exhaustion (part B of the test). The participants drank 6.5 ml x kg(-1) of fluid as a bolus just before exercise and thereafter 4.5 ml x kg(-1) during every exercise set and rest period (19 min). There was a trial order effect. The total distance completed by the participants was greater in trial 3 (8441 +/- 873 m) than in trial 1 (6839 +/- 512, P < 0.05). This represented a 19% improvement in exercise capacity. However, the trials were performed in a random counterbalanced order and the participants completed 8634 +/- 653 m, 7786 +/- 741 m and 7099 +/- 647 m in the flavoured water (FW), placebo (P) and carbohydrate-electrolyte (CE) trials, respectively (P = 0.08). Sprint performance was not different between the trials but was impaired over time (FW vs P vs CE: set 1, 2.41 +/- 0.02 vs 2.39 +/- 0.03 vs 2.39 +/- 0.03 s; end set, 2.46 +/- 0.03 vs 2.47 +/- 0.03 vs 2.47 +/- 0.02 s; main effect time, P < 0.01). The rate of rise in rectal temperature was greater in the carbohydrate-electrolyte trial (rise in rectal temperature/duration of trial, degrees C x h(-1); FW vs CE, P < 0.05; P vs CE, N.S.). Blood glucose concentrations were higher in the carbohydrate-electrolyte than in the other two trials (FW vs P vs CE:rest, 4.4 +/- 0.1 vs 4.3 +/- 0.1 vs 4.2 +/- 0.1 mmol x l(-1); end of exercise, 5.4 +/- 0.3 vs 6.4 +/- 0.6 vs 7.2 +/- 0.5 mmol x l(-1); main effect trial, P < 0.05; main effect time, P < 0.01). Plasma free fatty acid concentrations at the end of exercise were lower in the carbohydrate-electrolyte trial than in the other two trials (FW vs P vs CE: 0.57 +/- 0.08 vs 0.53 +/- 0.11 vs 0.29 +/- 0.04 mmol x l(-1); interaction, P < 0.01). The correlation between the rate of rise in rectal temperature (degrees C x h(-1)) and the distance completed was -0.91, -0.92 and -0.96 in the flavoured water, placebo and carbohydrate-electrolyte conditions, respectively (P < 0.01). Heart rate, blood pressure, plasma ammonia, blood lactate, plasma volume and rate of perceived exertion were not different between the three fluid trials. Although drinking the carbohydrate-electrolyte solution induced greater metabolic changes than the flavoured water and placebo solutions, it is unlikely that in these unacclimated males carbohydrate availability was a limiting factor in the performance of intermittent running in hot environmental conditions.     

Case studies from morning report: librarians' role in helping residents find evidence-based clinical information

In primary care specialties, Morning Report is a traditional vehicle for expanding medical residents' training in diagnosis and treatment. At one academic medical center, residents and faculty in the Department of Family and Community Medicine use case-based teaching, centered around planning and reviewing patient management, to review intriguing cases from patient encounters in the department's hospital service. Seeking to improve the level of evidence-based information exchanged at Morning Report, department leaders invited reference librarians from the health sciences library to attend weekly Morning Report. The librarians saw this as an opportunity not only to improve residents' information-seeking skills, but also to improve librarians' teaching skills and understanding of the needs of users in clinical settings. This paper describes the evolution of librarians' involvement in Morning Report, examples of the kinds of contributions librarians have made in this setting, and changes made in Morning Report sessions to facilitate this activity.     

Personal digital assistant-based drug information sources: potential to improve medication safety.

OBJECTIVES: This study compared the potential for personal digital assistant (PDA)-based drug information sources to minimize potential medication errors dependent on accurate and complete drug information at the point of care. METHODS: A quality and safety framework for drug information resources was developed to evaluate 11 PDA-based drug information sources. Three drug information sources met the criteria of the framework: Eprocrates Rx Pro, Lexi-Drugs, and mobileMICROMEDEX. Medication error types related to drug information at the point of care were then determined. Forty-seven questions were developed to test the potential of the sources to prevent these error types. Pharmacists and physician experts from Creighton University created these questions based on the most common types of questions asked by primary care providers. Three physicians evaluated the drug information sources, rating the source for each question: 1=no information available, 2=some information available, or 3 = adequate amount of information available. RESULTS: The mean ratings for the drug information sources were: 2.0 (Eprocrates Rx Pro), 2.5 (Lexi-Drugs), and 2.03 (mobileMICROMEDEX). Lexi-Drugs was significantly better (mobileMICROMEDEX t test; P=0.05; Eprocrates Rx Pro t test; P=0.01). CONCLUSION: Lexi-Drugs was found to be the most specific and complete PDA resource available to optimize medication safety by reducing potential errors associated with drug information. No resource was sufficient to address the patient safety information needs for all cases.     

Book reviews

Journal Publishing By Gillian Page, Robert Campbell and Jack Meadows, Cambridge: Cambridge University Press, 1997, 420 pp £35.00, ISBN: 0 521 44137 4 Small Publishers A–Z: The guide to good publishing By Daphne Macara, West Molesey: Pandor House Publications, 1997, 44pp £6.50, ISBN: 1 871248 03 5