Septic arthritis of the temporomandibular joint.
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Adult↗
Biomedical subjects
G Baker
Publications and source records attributed to G Baker.
Biomechanical analysis of materials handling manipulators in short distance transfers of moderate mass objects: joint strength, spine forces and muscular antagonism.
Although often suggested as a control measure to alleviate musculoskeletal stresses, the use of mechanical assistance devices (i.e. manipulators) in load transfers has not been extensively studied. Without data describing the biomechanical effects of such devices, justification for decisions regarding implementation of such tools is difficult. An experimental study of two types of mechanical manipulators (articulated arm and overhead hoist) was conducted to determine whether biomechanical stresses, and hence injury risk, would be alleviated. Short distance transfers of loads with moderate mass were performed both manually and with manipulator assistance under a variety of task conditions. Using analysis and output from new dynamic torso models, strength demands at the shoulders and low back, lumbar spine forces, and lumbar muscle antagonism were determined. Strength requirements decreased significantly at both the shoulders and low back when using either manipulator in comparison with similar transfers performed manually. Peak spine compression and anterior-posterior (a-p) shear forces were reduced by about 40% on average, and these reductions were shown to be primarily caused by decreases in hand forces and resultant spinal moments. Two metrics of muscular antagonism were defined, and analysis showed that torso muscle antagonism was largest overall when using the hoist. The results overall suggest that hoist-assisted transfers, although better in reducing spine compression forces, may impose relatively higher demands on coordination and/or stability at extreme heights or with torso twisting motions. The relatively higher strength requirements and spine compression associated with the articulated arm may be a result of the high inertia of the system. Potential benefits of practice and training are discussed, and conclusions regarding implementation of mechanical manipulators are given.
Adult↗
Low-back stresses when learning to use a materials handling device.
This study examines the potential effect of short-term practice on low-back stresses during manual lifting and lowering of a 15 kg load, and while using two different types of materials handling devices (MHDs) to lift and lower a 40 kg load. The two MHDs used were an articulated balance arm and a pneumatic hoist. The expectation was that low-back dynamic moments, EMG measured torso muscle antagonism, and EMG predicted L4/L5 disc compression forces would rapidly decrease with practice, and that the manual lift-lower activities would be learned faster than the MHD-assisted exertions. Four naïve male college age subjects performed 40 lift and lower exertions, both manually and with the two MHDs for a total of 24 experiments. Non-linear regressions of the peak and average low-back moments, EMGs and disc compression values revealed only small decreases in the values (from 2 to 14%) over the 40 trials, and it was only statistically significant for five of the 48 regressions. This would seem to indicate that if learning is present in these tasks it is going to be very slow learning, and thus future studies will need to include a much larger number of trials. The effects of MHDs on the learning rates when compared to manual lifting learning rates was not statistically significant. It was shown, however, that MHDs had a particularly beneficial effect on reducing L4/L5 compression forces during load lowering activities despite the MHD load being much heavier than the manual load. It also was found that the level of torso muscle co-contraction increased significantly (2-4 times) when MHD handling was involved compared to manual lifting and lowering.
Adult↗
Diabetes risk factors in low-income Mexican-American children.
OBJECTIVE: To learn if Mexican-American children from low income neighborhoods have excess diabetes risk factors. RESEARCH DESIGN AND METHODS: The study involved 173 Mexican-American children aged 9 years. This is the age before type 2 diabetes usually develops in youths and where the disparity in body fat between Mexican-American and non-Hispanic white children is evident. The study also targets poor children because diabetes and being overweight are more common in Mexican-American adults from a lower than from a higher socioeconomic status. The diabetes risk factors measured were percent body fat, dietary fat intake, daily fruit and vegetable intake, and physical fitness. Body fat was measured by bioelectric impedance, dietary intake was measured by three 24-h dietary recalls, and physical fitness was measured by a modified Harvard step test. RESULTS: According to self-reported dietary recalls, Mexican-American children ate higher than recommended fat servings and had higher percent energy from fat and saturated fat. On the other hand, their reported daily fruit and vegetable intake was half of that recommended by national dietary guidelines. A large percentage of these children were at unacceptable physical fitness levels. Percent body fat was higher in these Mexican-American children than that reported for non-Hispanic white children. Finally, 60% of the children had a first- or second-degree relative with diabetes. CONCLUSIONS: Because diabetes is highly prevalent in Mexican-American adults, type 2 diabetes in increasing in Mexican-American youths, and diabetes risk factors are more common in Mexican-American children, a prudent measure would be to explore early-age diabetes risk factor prevention programs in this population.
Adolescent↗
Prenatal exposure to cocaine reduces dopaminergic D1-mediated motor function but spares the enhancement of learning by amphetamine in rabbits.
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Acoustic Stimulation↗
The microlaparoscope should be used routinely for diagnostic laparoscopy.
OBJECTIVE: To describe the experience of changing from the use of the 10-mm standard laparoscope to the use of the 2-mm microlaparoscope (MicroLap, Imagyn Medical Inc., Laguna Niguel, CA) and to compare the amount of postoperative pain and requirement for analgesics after each technique. DESIGN: Prospective study. SETTING: Day surgery unit in an academic reproductive medicine unit. PATIENT(S): One hundred thirty-five women undergoing diagnostic microlaparoscopy. INTERVENTION(S): Diagnostic laparoscopy with a 2-mm instrument. Recording of postoperative pain on an analog scale. MAIN OUTCOME MEASURE(S): Ability to complete the procedure satisfactorily with the microlaparoscope, pain scores, and use of analgesics. RESULT(S): All diagnostic procedures were performed satisfactorily with the use of the MicroLap. Patients who underwent MicroLap procedures had significantly less abdominal pain postoperatively, but there was no difference in shoulder tip (gas-related) pain. Less analgesia was required after the microlaparoscopy. CONCLUSION(S): In most situations, the microlaparoscope is the instrument of choice for initial diagnostic laparoscopy. The 10-mm laparoscope should be used only as a secondary instrument after microlaparoscopy, if indicated.
Abdominal Pain↗
Uptake and costs of care for epilepsy: findings from a U.K. regional study.
PURPOSE: Epilepsy is a common neurological condition, with significant resource implications for the health services, but few studies to date have examined the uptake and costs of care for this condition. As part of a large prevalence study of epilepsy conducted in one U.K. Health Region, we investigated both direct and indirect costs of epilepsy care and measured and valued the direct costs. METHODS: Data about service use were obtained from primary physician records and patient questionnaires. Unit costs for each item of resource use were generated from several sources. RESULTS: The greatest direct health care cost is that of hospital-based care. Pharmaceutical services also represent a significant element of the cost of epilepsy, the financial costs of prescribing newly developed antiepileptic drugs (AEDs) being large relative to those of the older drugs; therefore, the benefits derived from their use must be carefully assessed. The importance of good seizure control is amply illustrated by the findings about the differential costs associated with epilepsy of varying severity. The direct costs of caring for people with poorly controlled epilepsy are significant, with more than half the total cost of epilepsy care accounted for by patients with frequent seizures even though this group represented only a quarter of all patients in the present study. CONCLUSIONS: Our data emphasize the importance of optimizing seizure control as a means of reducing the costs of epilepsy, not only to the person with the condition, but also to society.
Adolescent↗
Learning disability and epilepsy. 2, a review of available outcome measures and position statement on development priorities.
People with epilepsy plus learning disabilities pose a challenge in terms of clinical management and research investigation, and, to date, the measurement of outcomes in this population has been limited. There have been uncertainties concerning both the 'what' and the 'how' of assessment. This paper presents a comprehensive review of available outcome measures across nine domains, i.e. relating to seizures, drugs, cognitive function, behaviour, social functioning, carer functioning, attitudes, motivation and 'quality of life'. This last domain reflects more global measures designed to encompass several assessment strands. The uses and limitations of each scale is discussed and, where data are available, psychometric properties are also presented. The paper concludes with suggestions for the further development of outcome measures in this population.
Epilepsy↗
Cumulative pregnancy rates in couples with anovulatory infertility compared with unexplained infertility in an ovulation induction programme.
Using a retrospective analysis, we compared cumulative pregnancy rates, early pregnancy failure rates and multiple pregnancy rates in couples with polycystic ovarian syndrome (PCOS) (n = 148), hypogonadotrophic or eugonadotrophic hypogonadism (n = 91) and unexplained infertility (n = 117), who were treated in an ovulation induction clinic between January 1991 and December 1995. The women were treated with either human menopausal gonadotrophin (HMG) or purified follicle stimulating hormone (FSH). The cumulative pregnancy rate (derived from life-table analysis) after four ovulatory treatment cycles was 70% in the PCOS group, 74% in the hypogonadism group and 38% in the unexplained infertility group. The cumulative pregnancy rate in the unexplained infertility group was significantly lower than the other groups (P < 0.001) but there was no significant difference between PCOS and hypogonadism using the log rank test. The early pregnancy failure rate was 25% in the PCOS group, 27% in the hypogonadism group and 26% in the unexplained infertility group (chi(2) = 0.132, not significant). The multiple pregnancy rate was 20% in the PCOS group, 30% in the hypogonadism group and 17% in the unexplained infertility group (chi(2) = 2.105, not significant). Treatment of anovulatory infertility using HMG or FSH is effective irrespective of the cause. Couples with unexplained infertility are less successfully treated using HMG: correction of unexplained infertility may involve more than simple correction of possible subtle ovulatory defects.
Adult↗
Relationship between seizure frequency and costs and quality of life of outpatients with partial epilepsy in France, Germany, and the United Kingdom.
PURPOSE: The relationship between seizure frequency and both health care costs and quality of life (QOL) was investigated in a retrospective, cross-sectional, multicenter study in France, Germany, and the United Kingdom. METHODS: Three hundred outpatients with stable partial epilepsy were approximately evenly distributed among five seizure-frequency groups, ranging from seizure-free in the last 3 months (group 1) to daily seizures (group 5). Economic data, obtained through patient interviews and record abstraction, comprised direct medical costs, direct nonmedical costs, and indirect costs for the preceding 3 months. Total societal costs in the three countries were pooled and converted to United States dollar equivalents. QOL was assessed through a self-administered questionnaire, the Functional Status Questionnaire (FSQ). RESULTS: Mean total costs increased from $780 in group 1 to $2,171 in group 5 (p = 0.0001), with significant increases in each cost category as seizure frequency increased. Greater seizure frequency also significantly (p = 0.0270) correlated with lower employment rates, which ranged from 57% in group 1 to 30% in group 5. QOL declined as seizure frequency increased. Particularly affected were basic and intermediate activities of daily living (ADL), mental health, social activity, and feeling about health. CONCLUSIONS: The study results show that higher seizure frequencies are associated with higher direct and indirect costs and with reduced QOL for patients with epilepsy.
Adolescent↗
Improving publicly funded substance abuse treatment: the value of case management.
OBJECTIVES: This study evaluated the impact of case management on client retention in treatment and short-term relapse for clients in the publicly funded substance abuse treatment system. METHODS: A retrospective cohort design was used to study clients discharged from the following four modalities in 1993 and 1994: short-term residential (3112 clients), long-term residential (2888 clients), outpatient (7431 clients), and residential detox (7776 clients). Logistic regression models were used to analyze the impact of case management after controlling for baseline characteristics. RESULTS: The odds that case-managed clients reached a length of stay previously identified as associated with more successful treatment were 1.6 (outpatient programs) to 3.6 (short-term residential programs) times higher than the odds for non-case-managed clients. With the exception of outpatient clients, the odds of case-managed clients' being admitted to detox within 90 days after discharge (suggesting relapse) were about two thirds those of non-case-managed clients. The odds of case-managed detox clients' transitioning to post-detox treatment (a good outcome) were 1.7 times higher than the odds for non-case-managed clients. CONCLUSIONS: Case management is a low-cost enhancement that improves short-term outcomes of substance abuse treatment programs.
Ambulatory Care Facilities↗
Effect of 6-hydroxydopamine lesions of the medial prefrontal cortex on intravenous cocaine self-administration under a progressive ratio schedule of reinforcement.
Rats were trained to self-administer intravenous cocaine under a progressive ratio (PR) schedule of reinforcement. Under this schedule, an increasing number of lever responses had to be made to obtain each subsequent reinforcement (1.5 mg/kg per injection). Once stable responding was achieved with this schedule, bilateral 6-hydroxydopamine (6-OHDA) or vehicle-only injections were delivered into the medial prefrontal cortex (mPFC). Following recovery from surgery, the animals were given access to cocaine under the PR schedule. The effect of the lesion on self-administration behaviour was examined at various doses of cocaine (0.09-1.5 mg/kg per injection). 6-OHDA lesions of the mPFC had no effect on self-administration behaviour at the higher unit doses of cocaine. However, at the lower doses (0.09 and 0.19 mg/kg per injection), the lesion caused a significant increase in break point (BP), the number of responses made to obtain the last reinforcement of a self-administration session. The neurochemical results showed a significant reduction (57%) in mPFC levels of dopamine (DA) and 3,4-dihydroxyphenylacetic acid (DOPAC) (53%), with no changes in noradrenaline or serotonin levels. In contrast, the lesion caused no changes in DA or DOPAC levels in the nucleus accumbens (NACC) or striatum. These results indicate that the DAergic innervation of the mPFC cortex has a role in cocaine self-administration behaviour; however, whether this role is contingent on NACC DA function remains to be elucidated.
3,4-Dihydroxyphenylacetic Acid↗
Standardisation of a self-report questionnaire for use in evaluating cognitive, affective and behavioural side-effects of anti-epileptic drug treatments.
The development and standardisation of an inventory for measuring anti-epileptic drug effects on cognition and affect is described. The Side Effect and Life Satisfaction inventory (SEALS) was derived from symptoms and side-effects reported by a patient population. It was administered to 45 patients on two occasions and test-retest reliability was demonstrated. It was administered to 923 patients with epilepsy. An underlying factor structure was produced by principal components analysis, consisting of five sub-scales which were stable when data from males and females were analysed separately or together. Validity was evaluated by comparing inventory scores of patients undergoing a number of treatment trials to show that the inventory was sensitive to treatment differences when other variables were controlled. Patients taking two or more anti-epileptic drugs had poorer SEALS scores than those taking a single drug. Patients taking vigabatrin and one other AED had poorer scores than those taking lamotrigine (LTG) and one other AED. A comparison of changes from baseline to week 4 of a double blind comparison of carbamazepine (CBZ) and LTG showed significantly greater improvement in SEALS scores for patients taking LTG, and significantly poorer scores in those patients taking CBZ who dropped out of the study, than in those who continued. It is concluded that SEALS is a valid and reliable tool for use in anti-epileptic drug trials.
Adolescent↗
Testicular aspiration of sperm for intracytoplasmic sperm injection: a novel treatment for ejaculatory failure on the day of oocyte retrieval.
OBJECTIVE: To present a successful outcome of an IVF cycle complicated by failure to produce a sperm sample on the morning of oocyte retrieval. DESIGN: Case report. SETTING: Hospital-based IVF clinic. PATIENT: A couple suffering secondary infertility undergoing their first IVF and intracytoplasmic sperm injection (ICSI) cycle. INTERVENTION: Fine-needle testicular biopsy for sperm retrieval. MAIN OUTCOME MEASURES: Sperm retrieval, fertilization, pregnancy. RESULTS: Sufficient spermatozoa were obtained for ICSI. Ten metaphase II oocytes were injected with two embryos being transferred fresh and four cryopreserved. A single fetal heart was confirmed at 6-week sonar. CONCLUSION: Testicular aspiration of sperm for ICSI is a simple, inexpensive, and effective means of rescuing an IVF cycle in which the male partner unexpectedly has been unable to produce a sperm sample on the morning of oocyte collection.
Adult↗
Non-invasive measurement of cardiac oxygenation and haemodynamics during transient episodes of coronary artery occlusion and reperfusion in the pig.
1. The non-invasive method of near-infrared spectroscopy was used to measure myocardial oxygenation and haemodynamics in response to left anterior descending coronary artery occlusion in a porcine model. 2. Near-infrared spectroscopy measures changes in haemoglobin (and myoglobin) oxygenation and blood volume to yield information on tissue perfusion and flow. It also measures the redox state of cytochrome aa3, thus providing information about intracellular oxygen utilization. 3. Left anterior descending coronary artery occlusion was induced to produce periods of ischaemia lasting between 24s and 13.5 min (n = 13). The changes in deoxyhaemoglobin, oxyhaemoglobin and cytochrome aa3 measured during occlusion were all highly significant compared with baseline variation. In all occlusions (n = 13) a rapid decrease in oxyhaemoglobin concentration (-75.83 +/- 3.27 mumol/l, mean +/- SEM) with a simultaneous increase in deoxyhaemoglobin of 9.27 +/- 1.69 mumol/l was measured. The total haemoglobin concentration also fell by -71.3 +/- 5.32 mumol/l. Cytochrome aa3 was also reduced during occlusion (-8.35 +/- 1.044) mumol/l. 4. Over the range 24-60s occlusion, the magnitude of the fall in total haemoglobin and oxyhaemoglobin correlated with the duration of occlusion (P < 0.003 and 0.013 respectively). For total haemoglobin only the magnitude of the fall correlated with the increase upon release of occlusion (r = 0.89, P < 0.003). 5. Release of occlusion (n = 8) resulted in an immediate increase in the concentration of deoxyhaemoglobin at 9.88 +/- 1.06s, then total haemoglobin at 13.62 +/- 1.23s and finally oxyhaemoglobin at 29.75 +/- 5.96s. The difference between the timing of the maxima after reperfusion is significant (P < 0.002 and P < 0.007 respectively). Moreover, the time for the deoxyhaemoglobin signal to reach maximum values was found to correlate with the duration of occlusion (P < 0.04). This could be indicative of the PO2 of the ischaemic tissues and an immediate off-loading of oxygen from oxyhaemoglobin. The results are reliable, reproducible and sensitive enough to detect the kinetics of haemoglobin oxygenation from a beating heart in situ.
Animals↗
The effects of researcher precautions on perceptions of the ethicality of unobtrusive field experiments.
The effects of stating researchers' precautions on perceptions about the ethicality of questionable studies were examined. The studies used were by West, Gunn, and Chernicky (1975) and by Middlemist, Knowles, and Matter (1976). The first study was generally evaluated more favorably than the second study. Women viewed the West et al. study more negatively than did men, regardless of precautionary information. Most important, precautionary information enhanced men's, but not women's evaluations of the Middlemist et al. study. Implications of these results for ethical decision making, publication policy, and the image of the profession are noted.
Adult↗
A general practice records audit of the process of care for people with epilepsy.
BACKGROUND: The appropriateness of epilepsy as a topic for general practice audit activity has been emphasized, but few audits have been undertaken to data and those that have are small scale. Historically, management of epilepsy has been a neglected area, and services for people with epilepsy remain generally poor. AIM: The study was designed to examine the process of care for people with epilepsy through a region-wide audit of general practitioner records. METHOD: General practitioners in 31 randomly selected general practices in one UK health region undertook a notes audit for all patients identified as having active epilepsy (patients who had had seizures in the last 2 years, or were currently seizure-free but on antiepileptic medication). A standard pro forma was used to collect information relating to diagnosis, drug treatment, and primary and secondary care contacts. RESULTS: Recording of information in the notes was generally good, but poor for some key items essential to the effective management of the condition; results suggest that a number of recommendations about provision of care for epilepsy are not being met: in particular, EEG and CT investigations often appear poorly directed; prescribed antiepileptic therapy is not always optimal; significant numbers of patients are being treated in hospital by non-neurologists; there is little evidence of any regular review being undertaken by general practitioners of their patients with epilepsy; and counselling about the non-clinical aspects of epilepsy often appears inadequate. CONCLUSIONS: Despite recommendations in a number of recent reports, gaps and inconsistencies in epilepsy care persist, both at the primary and secondary level. The means by which such shortcomings can be reduced (e.g. by specialist epilepsy nurses working across the primary-secondary care interface) should now be systematically examined. The study has highlighted a need for evidence-based guidelines which span the primary-secondary care interface and clarify the contribution of the various practitioners involved in the provision of care for people with epilepsy.
Adolescent↗
The 19th Annual Meeting of the Canadian College of Neuropsychopharmacology. Toronto, Canada: June 2-5, 1996.
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Neuropsychology↗