British Medical Journal articles from June 2000, page 2

British Medical Journal archives from June 2000

Californian doctors' leaders sue health insurers.(News)(Brief Article)(Statistical Data Included)
June 10, 2000... The California Medical Association (CMA) has fried an antiracketeering lawsuit against the state's three largest for-profit national health insurance companies. The CMA alleges that the health insurers Wellpoint/Blue Cross of California,...

Mosquitoes prefer pregnant women.(News)(Brief Article)(Statistical Data Included)
June 10, 2000... Pregnant women are twice as attractive to malaria canting mosquitoes as non-pregnant women, according to new research. This added attractiveness is thought to be linked to physiological and behavioural changes and places pregnant women at...

UK heroin deaths prompt international alert.(News)(Brief Article)(Statistical Data Included)
June 10, 2000... A new type of infective agent linked to contaminated heroin supplies might have caused the deaths of 22 drug users in Scotland and Ireland. Since the first case was reported on 9 May, some 46 people have been infected by the unidentified...

Surgeons work evenings to cut Spanish waiting lists.(News)(Brief Article)(Statistical Data Included)
June 10, 2000... A comprehensive drive to cut waiting lists has been announced by the Spanish prime minister after a public outcry over the deaths of some patients while waiting for surgery. Jose Maria Aznar told the parliament that extra operating...

Ireland might relax fluoride rules.(News)(Brief Article)(Statistical Data Included)
June 10, 2000... The Republic of Ireland is to consider relaxing taws that require the fluoridation of all drinking water amid mounting controversy over the alleged health risks of the practice. Michael Martin, the Irish health minister, has appointed a...

Japan plans improved monitoring of new drugs.(News)(Brief Article)(Statistical Data Included)
June 10, 2000... The Japanese health ministry will ask pharmaceutical companies to monitor the side effects of new drugs under plans it has submitted to politicians and industry leaders. Under the ministry's plan, companies would be obliged to collect data on...

NEWS.(News)(Brief Article)(Statistical Data Included)
June 10, 2000... The Princess Royal meets a "virtual patient" on a visit to St Bartholomew's Hospital, London, on 25 May. The life sized dummy, which breathes, blinks, moves its arms, and talks, is the centrepiece of the new Barts and the London Medical...

Doctors' strike in Israel may be good for health.(News)(Brief Article)(Statistical Data Included)
June 10, 2000... Industrial action by doctors in Israel seems to be good for their patients' health. Death rates have dropped considerably in most of the country since physicians in public hospitals implemented a programme of sanctions three months ago,...

Waiting time limits proposed for specialist referral.(News)(Brief Article)(Statistical Data Included)
June 10, 2000... Clinical guidelines for managing 11 common conditions, and waiting time limits for referrals from general practitioners to specialists, have been drafted by the National Institute for Clinical Excellence (NICE). It is the first time that...

FDA censures NEJM editor.(News)(Brief Article)(Statistical Data Included)
June 10, 2000... The newly appointed editor of the New England Journal of Medicine has been criticised by the US Food and Drug Administration (FDA) for overpraising a new asthma drug made by a company that he had advised as a paid consultant. Dr Jeffrey...

Blair chairs UK health summit to tackle NHS reform.(News)(Brief Article)(Statistical Data Included)
June 10, 2000... A summit chaired by the prime minister, Tony Blair, has agreed key priorities for modernisation of the NHS amid angry claims from doctors' leaders that their profession has been made a scapegoat for failures in the service. Health...

Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study.(Statistical Data Included)
June 10, 2000... Abstract Objective To determine the prevalence of eating disorders in adolescent females with type 1 diabetes mellitus compared with that in their non-diabetic peers. Design Cross sectional case-control led study. Setting...

Current cost of medical negligence in NHS hospitals: analysis of claims database.(Statistical Data Included)
June 10, 2000... Abstract Objectives To identify trends in the incidence and cost of clinical negligence claims. To determine the current annual cost to the NHS as a whole in terms of cash paid out to patients and their solicitors and the defence costs...

Suicide by patients: questionnaire study of its effect on consultant psychiatrists.
June 10, 2000... Abstract Objective To identify the effect of patients' suicide on consultant psychiatrists in Scotland. Design Confidential coded postal questionnaire survey. Participants Of 315 eligible consultant psychiatrists, 247 (78%)...

Empirical assessment of effect of publication bias on meta-analyses.(Statistical Data Included)
June 10, 2000... Abstract Objective To assess the effect of publication bias on the results and conclusions of systematic reviews and meta-analyses. Design Analysis of published meta-analyses by trim and fill method. Studies 48 reviews in...

Back pain in Britain: comparison of two prevalence surveys at an interval of 10 years.
June 10, 2000... In Britain, as in many other countries, back pain is a major cause of disability, especially in adults of working age. During the decade to 1993, outpatient attendances for back pain rose fivefold, and the number of days of incapacity from...

Socioeconomic variation in hysterectomy up to age 52: national, population based, prospective cohort study.
June 10, 2000... We have previously reported striking inverse social gradients in the risk of hysterectomy in a large national cohort of women born in England, Scotland, or Wales followed since their birth in March 1946 until the age of 43 years.[1] This...

Designing trials of interventions to change professional practice in primary care: lessons from an exploratory study of two change strategies.(Statistical Data Included)
June 10, 2000... Summary points When designing trials of interventions to change professional practice in primary care, choices have to be made about selection of appropriate practices, development and adaptation of interventions, and experimental design...

Use of statins in general practices, 1996-8: cross sectional study.
June 10, 2000... The rationale for prescribing statins is well established.[1] Recently there has been an increase in the rate of prescribing of lipid lowering drugs, although large variations remain between practices.[2] Fewer prescriptions are written in...

Email submissions from outside the United Kingdom.
June 10, 2000... We are now offering an email submission service for authors from outside the UK. The address is papers@bmj.com Ideally our email server would link seamlessly with our manuscript tracking system, but for now it does not, which is why we...

Treating joint damage in young people.(Science, Medicine, and the Future)(Statistical Data Included)
June 10, 2000... Nearly a quarter of all severe ligament or capsular knee injuries that result in a haemarthrosis are associated with cartilage damage.[1 2] Breakdown of the cartilage from trauma or disease results in severe pain and disability and may...

The death of Captain Blifil.
June 10, 2000... "And glad should we be could we inform the reader that both these bodies had been attended with equal success; for those who undertook the care of the lady [Mrs Blifil] succeeded so well that after the fit had continued a decent time she...

Ulcerated lower limb.
June 10, 2000... Ulceration of the lower limb affects 1% of the adult population and 3.6% of people older than 65 years. Leg ulcers are debilitating and painful and greatly reduce patients' quality of life. Ulcer healing has been shown to restore quality of...

How does male circumcision protect against HIV infection?
June 10, 2000... Summary points The majority of men who are HIV positive have been infected through the penis There is conclusive epidemiological evidence to show that uncircumcised men are at a much greater risk of becoming infected with HIV than...

Modernising the NHS Patient care: access.(Statistical Data Included)
June 10, 2000... Summary points Delays plague all healthcare systems, causing discontent, consuming resources, and worsening clinical outcomes Most waiting systems rely on distinguishing between urgent and routine cases and so maintain two queues ...

Do you admit to working within the system?
June 10, 2000... After 11 years as a reconstructive surgeon in Asia, I returned to practise in Britain. While visiting friends for the weekend my 9 year old daughter fell, and when I joined my family later that evening and bent down to give her a kiss I...

Costing in economic evaluation.
June 10, 2000... As argued in previous notes, the perspective of an economic evaluation--societal or confined to some organisation--affects the range of both outcomes and costs that should be included. The case has been made for taking a societal...

On ageing: oh dear!(Brief Article)(Statistical Data Included)
June 10, 2000... Youth is a blunder; manhood a struggle; old age a regret. Coningsby, Benjamin Disraeli, 1804-81 Submitted by Fred Charatan, retired geriatric psychiatrist, Florida

Obituaries.(Statistical Data Included)(Brief Article)
June 10, 2000... Angus Graham Bird Consultant immunologist Leicester (b 1950; q Oxford 1974; FRCP, FRCPath), died from a glioblastoma on 14 January 2000. Graham played a major part in the immunology community, and he gradually rose to international...

Senior medical staffs conference.(Medicopolitical Digest)(Statistical Data Included)(Brief Article)
June 10, 2000... GMC's proposals on revalidation are "untenable" Representatives of the United Kingdom's 32 000 senior hospital doctors believe that the General Medical Council's proposals for revalidation, which are going out for consultation this month...

GMC spells out proposed reforms.(Medicopolitical Digest)(Statistical Data Included)(Brief Article)
June 10, 2000... The General Medical Council has spelt out the decisions it has taken that will impact on how medical services are delivered at local level. In a letter to chief executives of the NHS Executive in the UK, health authorities, NHS trusts,...

Medicine needs doctors from all walks of life.(Medicopolitical Digest)(Statistical Data Included)(Brief Article)
June 10, 2000... Welcoming the inquiry into the admissions procedures of top universities by the House of Commons education subcommittee, the BMA says that the procedures are only the tip of the iceberg when it comes to attracting students into medicine. ...

Public confidence in doctors remains high.(Medicopolitical Digest)(Statistical Data Included)(Brief Article)
June 10, 2000... Public confidence in the medical profession and how doctors do their work remains high, according to a MORI poll conducted for the General Medical Council. The poll, which was carried out in March, shows that the Harold Shipman case does...

Menorrhagia.(Statistical Data Included)(Brief Article)(Review)
June 10, 2000... Menorrhagia Eds Shirish S Sheth, Christopher Sutton Isis Medical Media, 84.95 [pounds sterling], pp 362 ISBN 1 899066 93 4 Rating: *** Menorrhagia is a topic of considerable importance to both women and their gynaecologists. It is a...

Sex, Gender and Health.(Statistical Data Included)(Brief Article)(Review)
June 10, 2000... Sex, Gender and Health Eds Tessa M Pollard, Susan Brin Hyatt Cambridge University Press, 12.95 [pounds sterling], pp 184 ISBN 0 521 59707 2 Rating: ** There has been considerable interest in gender and other inequalities in health over...

Second Opinions--Stories of Intuition and Choice in the Changing World of Medicine.(Statistical Data Included)(Brief Article)(Review)
June 10, 2000... Jerome Groopman Viking, $24.95, pp 243 ISBN 0 670 88801 X Rating: ** Coming on the heels of a recent Institute of Medicine report stating that medical error is the eighth leading cause of death in the United States--with a higher...

A Philosophical Disease: Bioethics, Culture and Identity.(Statistical Data Included)(Brief Article)(Review)
June 10, 2000... A Philosophical Disease: Bioethics, Culture and Identity Cad Elliott Routledge, 12.99 [pounds sterling], pp 256 ISBN 0 415 919401 Rating: *** Bioethics needs philosophers with medical experience, and even more it needs philosophers who...

The Virgin Suicides.(Statistical Data Included)(Brief Article)(Review)
June 10, 2000... The Virgin Suicides Directed by Sofia Coppola, American Zoetrope On general release worldwide Rating: *** Adolescent angst, crazy psychiatrists, blood in the bath, religious repression, flares, and silly haircuts. This beautifully filmed...

Class war.(Statistical Data Included)(Brief Article)
June 10, 2000... "An absolute scandal" was the phrase Gordon Brown used to embroil A the government in a class war with Oxford University (Times 26 May). With the emphatic backing of the Sun (26 May), which enjoyed "his blistering assault on stuck up Oxbridge...

WEBSITE OF THE WEEK.(Statistical Data Included)(Brief Article)
June 10, 2000... Back pain This week two articles in the BMJ suggest that the amount of back pain experienced in Britain has increased, largely as a result of increased reporting of mild to moderate symptoms (pp 1552, 1577). Medicine is unlikely to have the...

Politically correct references.(Statistical Data Included)(Brief Article)
June 10, 2000... In my day we were not stupid enough to suppose that references were the key to getting a hospital consultant job. They were just one more worry. Given a fair wind at interview we knew perfectly well that telephone calls would long ago have...

Meetings.(Statistical Data Included)(Brief Article)
June 10, 2000... If you wanted to become a better doctor, what would you do? We--me and three friends in the hospital--are trying to find the answer to this question through a course we started earlier this year on the doctor and patient relationship at...

Minerva.(Statistical Data Included)(Brief Article)
June 10, 2000... Roman soldiers used urtication, or external stinging, to relieve the pain of arthritis. Since then, many people have tried stinging their aching joints with nettles. The first randomised trial appeared this month in the Journal of the Royal...

Clinton seeks heavy fines for breaching research ethics.(News)(Statistical Data Included)(Brief Article)
June 3, 2000... President Clinton is to ask Congress for authority to levy fines of up to $250 000 (156 000 [pounds sterling]) on medical researchers who violate federal rules on human research, and up to $1m on the universities that employ them. Donna...

Unusable medicines "dumped" on Venezuela.(News)(Statistical Data Included)(Brief Article)
June 3, 2000... Six months after devastating floods and landslides left up to 30 000 people dead or missing and 200 000 homeless, Venezuela is being inundated again-by a flood of unusable medical aid. Harrowing television pictures of the disaster last...

In brief.(News)(Statistical Data Included)(Brief Article)
June 3, 2000... Parliament to inquire into public health: The UK's House of Commons health committee is to examine the coordination between central government, local government, health authorities, and primary care groups in promoting and delivering public...

Asylum seekers in UK receive poor health care.(News)(Statistical Data Included)(Brief Article)
June 3, 2000... Refugees and asylum seekers often receive poor health care in the United Kingdom despite their entitlement to free NHS treatment, according to the Audit Commission. Some general practitioners have closed their lists to asylum seekers because...

Coffee may lower risk of Parkinson's disease.(News)(Statistical Data Included)(Brief Article)
June 3, 2000... Coffee drinkers may have a lower risk of Parkinson's disease than those who don't drink coffee, according to researchers from the Department of Veterans Affairs in Honolulu, Hawaii. Researchers analysed data on 8004 Japanese-American men...

Mouth to mouth ventilation does not improve CPR.(News)(Statistical Data Included)(Brief Article)
June 3, 2000... When performed by a bystander, cardiopulmonary resuscitation (CPR) with chest compression alone provides similar survival to standard CPR with chest compression plus mouth to mouth ventilation in sudden cardiac arrest, according to a new...

Prisoners in England and Wales are at risk of bloodborne viruses.(News)(Statistical Data Included)(Brief Article)
June 3, 2000... A quarter of adult male prisoners have injected drugs, and 6% reject while in prison, according to a national survey of risk behaviours for transmission of bloodborne viruses among prisoners in England and Wales. Three quarters of those who...

Junior doctors accept new pay deal.(News)(Statistical Data Included)(Brief Article)
June 3, 2000... Junior doctors in the United Kingdom have voted overwhelmingly to accept a pay deal that delivers the biggest increases to those working the longest and most antisocial hours. Jobs will fall into one of four bands of pay according to the...

Romanian junior doctors left without salaries.(News)(Statistical Data Included)(Brief Article)
June 3, 2000... Junior doctors in Romania, including specialist registrars, had their pay stopped, as the BMJ went to press, because of a dispute between the health department (Ministerul Sanatatii) and the national health insurance organisation (Casa...

Irish juniors defer their strike.(News)(Statistical Data Included)(Brief Article)
June 3, 2000... A national strike by the Republic of Ireland's junior doctors was deferred last week after an interim agreement on overtime issues was reached the day before planned industrial action. Under this agreement, the country's 3000 doctors will...

BMA demands more responsible media attitude on body image.(News)(Statistical Data Included)(Brief Article)
June 3, 2000... Broadcasters and magazine publishers should "adopt a more responsible editorial attitude towards the depiction of extremely thin women as role models," the BMA's board of science and education said this week. In a report entitled Eating...

SLE is caused by cell debris.(News)(Statistical Data Included)(Brief Article)
June 3, 2000... Good direct evidence that the body's inability to clear up cell debris leads to systemic lupus erythematosus (SLE) has been confined by German scientists. Cell biologists have confirmed that a lack of DNasel, an enzyme that degrades DNA,...

Geographical mobility is predictor of demand on psychiatric services.(News)(Statistical Data Included)(Brief Article)
June 3, 2000... High rates of geographical mobility among psychiatric patients may be one of the main reasons for unexpected high demands on hospital beds and services, according to new research. A study of severely mentally ill patients in London found...

High insulin levels linked to deaths from breast cancer.(News)(Statistical Data Included)(Brief Article)
June 3, 2000... High fasting concentrations of insulin may be an independent risk factor for poor outcomes in women with breast cancer, according to a study presented at the annual meeting of the American Society of Clinical Oncology, in New Orleans,...

Human T cell leukaemia/lymphoma virus infection in pregnant women in the United Kingdom: population study.(Statistical Data Included)
June 3, 2000... Objective To assess the prevalence of human T cell leukaemia/lymphoma virus (HTLV) infection in pregnant women in the United Kingdom. Design Population study. Subjects Guthrie card samples from babies born in 1997-8. Samples were...

Single blind, randomised trial of efficacy and acceptability of oral Picolax versus self administered phosphate enema in bowel preparation for flexible sigmoidoscopy screening.(Statistical Data Included)
June 3, 2000... Abstract Objective To compare the acceptability and efficacy of two methods of self administered bowel preparation for flexible sigmoidoscopy screening: a single phosphate enema and a single sachet of Picolax. Design Single blind,...

A wise physician.(Brief Article)
June 3, 2000... Remedies often make desease worse.... It takes a wise doctor to know when not to prescribe. Baltasar Garcian, 1601-58, The Art of Wordly Wisdom Submitted by T O Cheng, professor of medicine, Washington DC

Commentary: opportunity for patient partnership was lost.(Statistical Data Included)
June 3, 2000... Over the past seven years PASS Direct, a generic advocacy service in Dumfries and Galloway, has helped over 2000 patients in their dealings with the NHS. Many of these people have come to us with the complaint that they were not informed...

Retrospective case note review of acute and inpatient stroke outcomes.(Statistical Data Included)
June 3, 2000... The annual incidence of stroke in the community is about 2 per 1000 population,[1] whereas among hospital inpatients it is 11 per 1000.[3] However, a study that systematically and simultaneously identifies all inpatients experiencing stroke...

Preventing dog bites in children: randomised controlled trial of an educational intervention.(Statistical Data Included)
June 3, 2000... Dog bites are a major cause of injury, particularly in children.[1 2] Guidelines on prevention are generally unevaluated and include controls on high risk breeds, keeping dogs on a leash, animal training, and educating dog owners.[3 4]...

Me, the heartsink patient.(Statistical Data Included)(Brief Article)
June 3, 2000... Going back to work was not just hard. It was ridiculously hard. It was the hardest thing I have ever done. I have never considered not working, but I wanted someone to tell me to stop. As my baby approached 4 months, my days, my waking...

Asthma after childhood pneumonia: six year follow up study.(Statistical Data Included)
June 3, 2000... Abstract Objective To establish the long term cumulative prevalence of asthma in children admitted to hospital with pneumonia and to examine the hypothesis that some children admitted to hospital with pneumonia may be presenting with...

We are interdependent.(Statistical Data Included)(Brief Article)
June 3, 2000... As long as there is poverty in the world I can never be rich, even if I have a billion dollars. As long as diseases are rampant and millions of people in this world cannot expect to live more than 28 or 30 years, I can never be totally...

Systematic review of studies of patient satisfaction with telemedicine.(Statistical Data Included)
June 3, 2000... Abstract Objective To review research into patient satisfaction with teleconsultation, specifically clinical consultations between healthcare providers and patients involving real time interactive video. Design Systematic review of...

Corrections and clarifications.(To: "Further research is needed on why rates of caesarean section are increasing" in April 15, 2000 issue, p 1074)(To: "ABC of arterial and venous disease: acute stroke" in April 1, 2000 issue, pp 920-3)(To: "Guidelines for managing acute bacterial meningitis" in May 13, 2000 issue, p 1290)(Statistical Data Included)(Brief Article)
June 3, 2000... Letter In the issue of 15 April in the first letter on p 1074, headed "Further research is needed on why rates of caesarean section are increasing," we inadvertently omitted the second author's first initial: his name is S W Lindow. ...

Management of lateral neck masses in adults.(Statistical Data Included)
June 3, 2000... One of the most important considerations in an adult presenting with a lump in the neck is that the mass may represent a metastatic deposit from a primary cancer, often but not always in the upper respiratory or alimentary tract (fig 1). This...

Persistent diarrhoea and occult vipomas in children.(Lesson of the Week)(Statistical Data Included)
June 3, 2000... Lesson of the Week Failure to recognise secretory diarrhoea leads to inappropriate gastrointestinal investigations, delayed diagnosis of a vipoma, and avoidable morbidity A wide range of gastrointestinal disorders may cause chronic...

What is humanity?(Statistical Data Included)(Brief Article)
June 3, 2000... Endpiece Humanity is only a mechanical donkey led on by the iron carrot of love, through the pointless treadmill of reproduction. T H White, The Once and Future King. London: Voyager, 1996.

Swollen lower limb--2: Lymphoedema.(ABC of Arterial and Venous Disease)(Statistical Data Included)
June 3, 2000... ABC of arterial and venous disease Lymph conducting pathways may become reduced in number, obliterated, obstructed, or dysfunctional (because of failure of contractility or valve incompetence). A lack of sensitive methods for...

An old friend.(Statistical Data Included)(Brief Article)
June 3, 2000... It was high time I chucked away my old stethoscope. Much was wrong with that battered, grubby Littman: the rubber ring missing from the bell, the warped metal end tube, the left ear piece fallen off. All of which had little to do with the...

Challenges to the health services: the professions.(Modernizing the NHS: Part 4 of 7)(Statistical Data Included)
June 3, 2000... Modernising the NHS This is the fourth in a series of seven articles "There is the challenge for the professions to strip out unnecessary demarcations, introduce more flexible training and working practices and ensure that doctors do...

When I use a word Triage.(Statistical Data Included)(Brief Article)
June 3, 2000... Since my days as an accident and emergency senior house officer I had believed (and perhaps I was taught) erroneously that triage was the process of dividing war or other casualties into three broad groups. These groups, I thought, were the...

Obituaries.(Statistical Data Included)(Brief Article)
June 3, 2000... Dashper James Arkle Former chief medical officer and medical director Fairmile Mental Hospital, Oxfordshire (b 1920; q Oxford/Liverpool 1943; FRCP, FRCPsych; JP), died while watching television on 3 April 2000. After house jobs he joined...

Breast Cancer: Sharing the Decision.(Statistical Data Included)(Brief Article)(Review)
June 3, 2000... Breast Cancer: Sharing the Decision Eds Anna M Maslin, Trevor J Powles Oxford University Press, 24.99 [pounds sterling], pp 263 ISBN 0 19 262967 0 Rating: *** As we enter the new millennium, patients reasonably expect to be involved...

Resuscitation Rules.(Statistical Data Included)(Brief Article)(Review)
June 3, 2000... Resuscitation Rules Tim Hodgetts and Nick Castle BMJ Books, 13.95 [pounds sterling], pp 126 ISBN 0727913719 Rating: *** Cardiopulmonary resuscitation is a procedure that most medical and paramedical professionals are rarely, if ever,...

Peer Review in Health Sciences.(Statistical Data Included)(Brief Article)(Review)
June 3, 2000... Peer Review in Health Sciences Fiona Godlee, Tom Jefferson BMJ Books, 30 [pounds sterling], pp 286 ISBN 0 7279 1181 3 Rating *** Why do we still use a system to select manuscripts for publication and grant applications that is biased...

Defining Features.(Statistical Data Included)(Brief Article)(Review)
June 3, 2000... Scientific and medical portraits 1660-2000 National Portrait Gallery, London, until 17 September There are at least two good reasons to visit the National Portrait Gallery at the moment. One is to ride the escalator to the new...

The sum of my parts.(Statistical Data Included)(Brief Article)
June 3, 2000... Charles Weijer reviews the website www.medicineonline.com, where cosmetic surgeons bid for customers I worry of late that I am not as good looking as I used to be. I stopped exercising about a year ago after a move into the country. The...

WEBSITE OF THE WEEK.(Statistical Data Included)(Brief Article)
June 3, 2000... Gay sex This week the BMJ publishes a short report that shows an increase in the prevalence of high risk sexual behaviours for the transmission of HIV among gay men in London. As I start to look around for the web angle to this theme, my...

NETLINES.(Statistical Data Included)
June 3, 2000... * You can remind yourself about the never ending BSE inquiry at www.ceid. ox.ac.uk/bse. The web page is produced by the Wellcome Trust's Centre for the Epidemiology of Infectious Disease based at Oxford University. It is just a list of simple...

One person's innovation is another's experiment.(Statistical Data Included)(Brief Article)
June 3, 2000... Surgical innovation is necessary, but there is pressure to impose standards on to the innovator normally associated with formal research. Developments in surgery often involve minor refinements and adaptations of well recognised...