BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7559.156 (Published 13 July 2006) Cite this as: BMJ 2006;333:156

Many devices for monitoring patients are fitted with alarms to draw the attention of staff to dangerously low or high readings. The trouble is that the noise they make is loud, shrill, and irritating. What's worse, they often go off when nothing serious has happened. Two psychologists argue that it's time designers of these devices took account of well known principles of auditory cognition. For example, they should use frequencies that make it easy to locate where the alarm is, enrich the sound harmonically, and make the sound intermittent so that it doesn't interfere with speech. It would also help if they could reduce the number of alarms and the rate of false alarms (British Journal of Anaesthesia 2006;97: 12-7).

According to Wikipedia, Tai Chi, the Chinese routine of slow and graceful exercises, translates as “supreme ultimate fist.” Even so, it seems to be a good form of physical activity for elderly women. A pilot study found that aerobic fitness improved more in the group allocated a short form of Tai Chi than in the group randomised to brisk walking (Age and Ageing 2006;35: 388-93).

Many Western countries have seen a gradual decline in levels of civic participation. Younger people especially are less likely to join clubs or engage in voluntary activity. One reason may be that pursuing a career and raising a family leave little time for anything else. But a study from the Netherlands shows that volunteering is not affected by workload or family situation. The authors prefer an explanation in terms of socialisation. Younger people tend to care more about themselves than society as a whole (Acta Sociologica 2006;49: 185-200).

The plight of children in Romanian orphanages wasn't appreciated until that country's communist regime collapsed in 1989. The physical and emotional deprivation that these children endured has had long term effects on their cognition and behaviour and structural changes in the brain too. A recent magnetic resonance imaging study shows that the uncinate fasciculus, the major fibre tract that connects the anterior temporal and inferior frontal cortical regions, is thin and poorly organised in orphans who survive (Pediatrics 2006;117: 2093-100; doi: 10.1542/peds.2005-1727).

Evolution is undeniably a wasteful process, but the answers it comes up with tend to improve survival. So when cardiac pacing is necessary, it would be expected that the closer technology imitates nature's design the better. But a recent meta-analysis, using data amounting to 35 000 patient years of observation found that, compared with ventricular pacing, atrial based pacing is no more effective at reducing cardiac failure or cardiovascular mortality or at increasing survival. Atrial based pacing did, however, reduce the incidence of atrial fibrillation (Circulation 2006;114: 11-7).

Longitudinal epidemiological studies, such as the British birth cohorts, have told us a lot about how social and environmental factors encountered in early life influence health and disease later on. But a commentary in the American Journal of Epidemiology (2006; 164: 122-5) is critical of the way in which they are analysed. The author thinks that multiple linear regression models are not the best way to approach these complex datasets.

Greatly to its credit, Archives of Dermatology (2006;142: 737-40) has just published an independent analysis of the statistical methods used in a year's worth of research papers that it accepted and published. Nearly 40% of the 155 articles that included a statistical analysis contained errors. Most were fairly minor omissions in the presentation of results, but in 14% inappropriate statistical tests had been used.

Minerva loves to tango and was interested to learn that her cerebellar vermis, a part of the brain whose function had previously been a mystery to her, was partly responsible for her allure on the dance floor. In an ingenious experiment, amateur dancers performed cyclic dance steps on an inclined board while lying with their heads in the tunnel of a positron emission tomography scanner. Entrainment of dance steps to music is supported by activity of the anterior vermis, whereas keeping to the beat needs the putamen (Cerebral Cortex 2006;16: 1157-67; doi: 10.1093/cercor/bhj057).

Dutch disease is a condition more familiar to economists than doctors. The term was invented to describe the decline of the manufacturing sector in the Netherlands after the discovery of natural gas in the 1960s. The theory is that a sudden increase in revenues from natural resources raises the exchange rate and makes the manufacturing sector less competitive. But it doesn't have to be the discovery of natural resources; anything that results in a large inflow of foreign currency, including foreign aid and investment, can have the same effect. Under some conditions, foreign aid may have the unintended result of making the poor poorer (World Bank Economic Review 2006;20: 261-90; doi: 10.1093/wber/lhj011). Whereas academics believe that the reports they write on manuscripts sent to them for peer review are invariably courteous and constructive, they often complain that the reports they receive from peer reviewers of their own manuscripts are rude and unhelpful. In an article in Academic Psychiatry (2006; 30: 263-4), a psychiatrist provides insights into this paradox when she describes the uncomfortable experience of finding herself sitting with a group of authors who were revising a paper that she had reviewed critically (and anonymously).

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A 22 year old man presented with rampant dental caries and generalised deposits of calculus. He admitted that he had been snorting or injecting crystal methamphetamine intravenously for two years but denied use of any other drugs. He drank two to three litres of carbonated drinks each day because of a dry mouth. Use of crystal methamphetamine (a crystalline form of amphetamine) is growing rapidly in the US. It is commonly known as “speed,” “meth,” or “chalk.” Crystal methamphetamine causes rampant caries because it is acidic, it often causes dryness of the mouth and cravings for carbonated drinks, and it increases the frequency of tooth grinding.

Kishore Shetty, associate professor, medically complex patient clinic, University of Texas Health Sciences Center, Houston, TX 77030-3402, USA (kishore.shetty{at}uth.tmc.edu

Irukandji syndrome is a painful and unpleasant consequence of being stung by certain jellyfish. The sting itself leaves few local signs, but about 20 minutes later back pain, nausea, abdominal pain, sweating, hypertension, tachycardia, and a fear of impending death develop. The syndrome has been reported in the Caribbean and the Pacific, but until now only two jellyfish (Carukia barnesi and an unnamed species) have been identified. The nature of the venom is unknown, but the recent identification of another five species of cubozoan jellyfish whose sting can cause the syndrome is a step forward (Quarterly Journal of Medicine 2006;99: 425-7).

Guidance at bmj.com/advice

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