Technical Education in the Middle East

Oil and allied industries have brought increasing wealth to the Middle East and a recognition by individual governments of pressing educational requirements. While sharing certain problems, such as overcrowded classes and a lack of specialist teachers, with Europe, other aspects of educational growth in this area are unique.     

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.     

Measurement error in short-term power testing in young people

The aim of this study was to examine the consistency or reproducibility of measuring cycling peak power in children and adults. Twenty-seven pre-pubertal girls and boys and 27 female and male physical education students (age 9.8 +/- 0.5 and 24.4 +/- 4.3 years, respectively; mean +/- s) participated in the study. All participants performed five tests over 15 days and underwent a habituation session before the study. Each test included four sprints against four different braking forces. We found that braking forces of 7.5% of body weight in children and 10% of body weight in adults were too high for most of the participants to elicit maximal cycling power. Unlike the children, the physical education students improved their performance between session 1 and session 2 (1025 +/- 219 vs 1069 +/- 243 W; P < 0.001). Therefore, to obtain reproducible measures of cycling peak power, a habituation session including a complete test protocol (i.e. warm-up plus three sprints) is highly recommended. When the protocol included three sprints in children and at least two sprints in adults, measurement of cycling peak power was found to be highly reliable (test-retest coefficient of variation approximately 3%). Finally, to avoid performance fluctuations, especially over several consecutive evaluations (e.g. longitudinal studies), it is necessary to maintain high motivation in children.     

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.     

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