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The purpose of this paper is to illustrate delirium as a possible consequence of the application of symptom-triggered therapy for alcohol withdrawal and to explore alternative treatment modalities. In the management of alcohol withdrawal syndrome, symptom-triggered therapy directs nursing staff to regularly assess patients using standardized instruments, such as the Clinical Institute for Withdrawal Assessment of Alcohol, Revised (CIWA-Ar), and administer benzodiazepines at symptom severity thresholds. Symptom-triggered therapy has been shown to lower total benzodiazepine dosage and treatment duration relative to fixed dosage tapers (Daeppen et al., 2002). However, CIWA-Ar has important limitations. Because of its reliance on patient reporting, it is inappropriate for nonverbal patients, non-English speakers (in the absence of readily available translators) and patients in confusional states including delirium and psychosis. Importantly, it also relies on the appropriate selection of patients and considering alternate etiologies for signs and symptoms also associated with alcohol withdrawal.

The authors report a case of a 47-year-old male admitted for cardiac arrest because of benzodiazepine and alcohol overdose who developed worsening delirium on CIWA-Ar protocol.

While symptom-triggered therapy through instruments such as the CIWA-Ar protocol has shown to lower total benzodiazepine dosage and treatment duration in patients in alcohol withdrawal, over-reliance on such tools may also lead providers to overlook other causes of delirium.

This case illustrates the necessity for providers to consider using other available assessment and treatment options including objective alcohol withdrawal scales, fixed benzodiazepine dosage tapers and even antiepileptic medications in select patients.

According to Clark (1935a, b), if the various studies on the secondary effects of public works expenditures are examined, two main approaches to the analysis of the problem are revealed: “one via successive cycles of income and spending by ultimate recipients of income” – which the Columbia economist termed the “Kahn-Keynes” approach – “the other via the volume of money and its velocity of circulation.” As is well known, in the first approach, business fluctuations are seen primarily as a consequence of fluctuations in current investment. Accordingly, the amount of the secondary effects is determined by: (a) the amount of the net increase in investment; (b) the marginal propensity to consume; and (c) the length of the income propagation period. As it appears from the above, in the “Kahn-Keynes” analysis of the secondary expansion, money plays only a passive role.

When a small schoolboy I became acquainted with the proverb Fames optimum condimentum. Nevertheless, millions of human beings, perhaps because they have little experience of famishment, persist in taking other condimenta with their food two or three times a day. Some of them, having satisfied their hunger, slake their thirst with products of a brewery—most of the commoner condiments not being even remotely associated with brewing. I have spent many years in efforts to secure that foods are called by their proper names. Egg powder, Devonshire hake, tonic cocktails, queer liquors containing isopropyl alcohol or even methyl alcohol, phoney blended whiskey—how would food lawyers have lived if these and other wrongly described goods had never come on the market ? Though a rose by any other name may smell as sweet, a dandelion called a rose does not. And those who administer the food laws have come across many examples of articles labelled on the principle of lucus a non lucendo. How these old tags stick in one's memory.

FOR CATALOGUERS, and librarians generally, 1967 will prove to be a vintage year, the annus mirabilis for the cataloguer, with the publication in January of the American text of the new Anglo‐American Code. The British text is expected to be published in November. The availability in this country of the American text gives some little time for a preview of the British version. The profession has had ample warning; the new code has had a long gestation period. For the Americans, especially, it is the culmination of many years of effort, from their preliminary second edition of the 1908 code in 1941, through the second edition of 1949, the Library of Congress Rules for Descriptive Cataloging of the same year, the Lubetzky Report of 1953, the Draft Code of 1960, to the Paris Principles of 1961. The present code owes very much to its predecessors, particularly the Paris Principles, which were in effect a set of guidelines agreed on internationally to ensure broad international consistency between any future national codes without spelling out the detailed rules. Except for one or two instances the new code follows the Paris Principles closely.

The Public Health (Meat) Regulations, 1924 have at last been replaced. At the time of their making, they were hailed as a great advance towards an adequate meat inspection service; that they have lasted for almost forty years is not an indication, however, of their success in meeting the needs of the situation. They were too much of a compromise with vested interests; the great obstacle was the private slaughterhouse and complete freedom of action by the butcher. Notices and hours of slaughter and removal of carcases were all designed to help the butcher and not the inspector. In districts with many private slaughterhouses, widely scattered, they made the work of an inspector honestly trying to inspect all animals slaughtered very hard indeed. These difficulties made certain that inspection at the time of slaughter or immediately after of all animals slaughtered for food could only be practicable in the larger centres.

Leaders today are continuously seeking models to navigate through the challenges posed by the pandemic times, so as to help the organizations flourish in the volatile business environment. This paper attempts to explore the alignment of insights drawn from the ancient Indian scripture, the Bhagavad Gita, with today’s leadership requirements, towards the betterment of both the leaders and organizations.

A qualitative approach with thematic analysis is used to identify leadership qualities pertinent in difficult times through interviews with 15 employees at leadership positions. It establishes the alignment of the qualities with the sapient advice from the Holy Scripture, maneuvered by today’s leaders to become more purposeful and impactful.

The discernments from the Bhagavad Gita holistically entwine the emotional, intellectual and spiritual aspects of resilient leaders and provide guidance on the leaders’ attitude towards work, behaviour and self management, to help steer through the challenging environment. With turbulent changes during the COVID-19 pandemic, conventional leadership skills would be outmoded, and hence the leaders need to strengthen the critical shifts in their own established sets of attitudes as well as that of their workforce.

Under the changing work environment, while the new leadership narrative of the world beyond takes shape, this study delves both into ancient Indian wisdom and current opinion to identify a template of workable practices that would differentiate extraordinary leaders from the rest.

British Island Airways has appointed Ralph Erskine to the board of directors.

Communications regarding this column should be addressed to Mrs. Cheney, Peabody Library School, Nashville, Tenn. 37203. Mrs. Cheney does not sell the books listed here. They are available through normal trade sources. Mrs. Cheney, being a member of the editorial board of Pierian Press, will not review Pierian Press reference books in this column. Descriptions of Pierian Press reference books will be included elsewhere in this publication.