Update on bereavement risk.
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Adaptation, Psychological↗
Biomedical subjects
G Schneiderman
Publications and source records attributed to G Schneiderman.
Do child and/or parent bereavement programs work?
Bereavement programs for children and parents are becoming popular since there are more and more neonatal intensive care programs, pediatric oncology programs and pediatric intensive care programs offering these services. This paper addresses the following question: Do bereavement programs work? An overview of the literature dating back to 1964 was undertaken. Only papers dealing with treatment were reviewed. Randomized controlled trials were selected as presenting the best evidence for or against program effectiveness. Methodologic features such as description of the sample, comparability of treatment and control groups, description of the intervention, use of objective, valid, reproducible and blinded outcome measures, sample size calculations, thoroughness of follow-up and attention to clinical as well as statistical significance were assessed. Four randomized controlled trials were found in the literature search. Two of the studies showed benefit, two did not. All four suffered significant methodologic flaws. At this time it is unclear as to whether or not bereavement programs help families. Given the high costs of health care, it is important that studies be done to determine which families are likely to benefit from bereavement programs and what type of program is effective.
Adaptation, Psychological↗
The interosseous membrane of the forearm: structure and its role in Galeazzi fractures.
A cadaveric study was performed to anatomically describe and mechanically document the interosseous membrane of the forearm using gross, histologic, scanning electron microscopic, and mechanical testing. The membrane was found to be a complex structure composed of nerves and vessels but mainly of collagen fibers that thicken to form bands coursing from radius to ulna. Strain-gauge studies demonstrated that the load transfer occurs from the radius to the ulna via the membrane and changes with supination or pronation. With specimens under a specific test load, sectioning of the membrane allowed the fractured radius to shorten by 6.25 mm and sectioning of the triangular fibrocartilage complex resulted in shortening of 7.7 mm. Total shortening after osteotomy and sectioning of the complex structure and membrane ranged from 15 to 40 mm. In Galeazzi fractures, the interosseous membrane acts as a constraint to radial shortening. Anatomic reduction with internal fixation is indicated for this fracture-dislocation.
Aged↗
Blunt injuries to the extracranial cerebral vessels associated with spine fractures.
Injury of the extracranial carotid or vertebral artery with associated spine fractures is a rare but documented entity. In this article, four cases are examined in which patients suffered axial fractures after motor vehicle accidents and subsequently were found to have pathology in one or more of the extracranial arteries. Misdiagnosis is a common complication because symptoms from this are often attributable to closed head injury. Early detection and treatment, however, are essential. As many as 40% of the cases reported have permanent neurologic deficit. Although cerebral angiography remains the diagnostic gold standard, other modalities (eg, transcranial doppler and magnetic resonance angiography) continue to be examined. The treatment of these lesions remains controversial. A variety of surgical procedures may be applicable depending on the time between the injury and the onset of symptoms, the location of the vascular injury, and the rapidity of diagnosis. Anticoagulation therapy appears to play a large role in the management of patients with injury of the extracranial carotid or vertebral artery.
Adult↗
Dynamic EMG analysis of torque transfer in professional baseball pitchers.
Fifteen professional baseball pitchers underwent active pitching motion analysis of the abdominal oblique, rectus abdominis, lumbar paraspinous and gluteus maximus muscles bilaterally via surface electrode evaluation. Baseline resting and isometric maximum values were obtained and active data referenced against these for comparison. The muscle activity then was measured during the pitching sequence and analyzed in each of the five pitching phases. The abdominal oblique, lumbar paraspinous and rectus abdominis contralateral to the pitching arm and the ipsilateral gluteus maximus all had increases in activity level of 75 to 100% during the active pitching motion. Using these data indicating specific muscle group patterns with clinical and performance data, we hope to minimize injuries and maximize pitching performance.
Abdominal Muscles↗
Magnetic resonance imaging in the diagnosis of disc degeneration: correlation with discography.
One hundred and one disc levels in 36 patients with low-back pain were studied with magnetic resonance imaging (MRI) (T2-weighted) sagittal images and conventional roentgenographic discography to detect early disc degeneration. Thirty-nine discs also were evaluated after discography with roentgenographic CT MRI findings were compared with discography results. MRI was 99% accurate in predicting normality or abnormality as determined by discography. Changes in disc signal on MRI accurately reflected the presence or absence of degenerative changes seen on discography in patients with low-back pain. Clinically, MRI is a useful technique for detecting early disc degeneration and for assessing the affected disc level and adjacent levels in patients with low-back pain and spondylolithesis.
Adolescent↗
The will as a vehicle of family dynamics.
The will is an instrument of generational transfer and change. In addition to the realistic decision making processes that go into the writing of a will, family dynamics play a role in this deliveration. This paper will describe a family where a surviving parent changed her will since she claimed that two of her three children were not showing her adequate love and respect. In brief family therapy and with legal support, the will was changed to its original form, dividing the estate equally. No changes were facilitated in family atmosphere or style. Several months later her eldest son's child was referred for treatment because of a behaviour problem at school and this family entered into family treatment. The family had to deal with the emotional disengagement of the grandmother. In addition, her oldest son's sadness, disappointment in his mother's behaviour, which was reflected in the grandson's symptomatology were worked through as well as structural changes to help build an organized family with a tradition based on integrity, trust, and respect. Family dynamics and changes in wills will be discussed.
Child Behavior Disorders↗
Fatal metabolic disease and family breakdown.
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Adjustment Disorders↗
Evaluation of a new blood autotransfusion device.
A new autotransfusion device was evaluated in dogs. The device uses citrate phosphate dextrose as the blood anticoagulant and automatically delivers the agent in a ratio approximating that found in banked blood. Bleeding, aspiration, and autotransfusion of approximately 3 estimated blood volumes produced small changes in hematologic and coagulation studies. Blood electrolytes stayed within normal ranges. Activated clotting times stayed within normal range after autotransfusion of 2 blood volumes but increased slightly after 3 blood volume transfusions. No significant histopathologic changes were found in any organ system. Rapid infusion of citrated blood causes myocardial depression, which can be reversed by giving calcium. Overall performance of the device was excellent, suggesting further documentation in a clinical setting and evaluation with human blood.
Animals↗
Rabbit aortic medial thickness under relaxed and specified simulated in vivo conditions.
A method is presented for measuring the thickness of the intima-media layer of the normal rabbit descending thoracic aortic wall under both relaxed (excised) and specified simulated in vivo conditions. The in vivo conditions were simulated by maintaining the aorta in situ at its normal longitudinal extension while perfusing its lumen at the normal mean arterial pressure with a mixture of liquid silicone polymer and a catalyst, thus providing physiological radial distension. After the rubber cured, both relaxed and extended-distended tissue segments were obtained from adjacent sites on the same aorta. These tissue segments were fixed and further processed for measurement of their medial thicknesses by light microscopy. This data was used to estimate the ratio of the medial thickness of the relaxed, excised aorta to that under in vivo conditions, 1.72 +/- 0.15. This information is required for quantitative analysis of data obtained from previous studies of in vivo macromolecular transport across the rabbit thoracic aortic wall.
Animals↗
Tay-Sachs and related lipid storage diseases: family treatment.
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Adolescent↗
Effect of pulsatility on oxygen transport to the human arterial wall.
Oxygen transfer in fully-developed, pulsating, laminar flow in rigid and distensible tubes was simulated as part of a study of vessel-wall hypoxia and atherogenesis. The model used for the computations is based on dimensions and flows in the human thoracic aorta. The pulsatile velocity fields employed are based on those of Womersley with the modification that the radial convection is written relative to the moving wall. Womersley-type pulsatility, superposed on an axial Poiseuille flow, was found to negligibly affect oxygen transport to the wall. Caution should be exercised, however, in extending this conclusion to the complex pulsatility in actual living vessels.
Aorta, Thoracic↗
Mass transport to walls of stenosed arteries: variation with Reynolds number and blood flow separation.
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Arterial Occlusive Diseases↗
Significance of luminal plasma layer resistance in arterial wall oxygen supply.
Previous analyses of the arterial wall oxygen supply system have assumed that a cell-free layer of plasma next to the endothelium is the major transport barrier in the lumen. Using a computer simulation, we have quantitatively tested this assumption. Our results show that oxygen diffusion gradients extend significantly into the flowing blood well beyond any plasma layer and that the major luminal transport resistance lies in the flowing blood and not in the plasma layer. The simulation was also employed to compute the effect of a reported 50% drop in plasma oxygen diffusivity. This rather large reduction did significantly lower oxygen levels within the arterial wall tissue. Whether such large reductions in diffusivity ever actually occur in human plasma is a subject of current controversy.
Aorta, Thoracic↗
Carbon monoxide-induced arterial wall hypoxia and atherosclerosis.
The elevated carbon monoxide level found in tobacco smokers has been suggested as one etiologic factor linking it with atherosclerosis. Unquestionably carbon monoxide does induce some arterial wall hypoxia, which has been established as an atherogenic factor, but without knowing the extent and location of this hypoxia the importance of this mechanism could not previously be assessed. Carbon monoxide acts both by inducing hypoxemia and shifting the oxyhemoglobin equilibrium curve, with these effects acting on the oxygen transport system from both the luminal blood and the vasa vasorum. We have studied this system using a computer simulation of the human arterial wall and found significant, mid-medial hypoxia with blood carbon monoxide levels routinely found in smokers. Because these levels fluctuate, the hypoxia they induce would be expected to be uncompensated by increased vascularization and therefore potentially represent a much more significant factor in atherogenesis than chronic hypoxia alone.
Adult↗
Oxygen electrode design criteria and performance characteristics: recessed cathode.
A computer simulation of the steady-state operation of recessed (Whalen-type) polarographic oxygen electrodes has been developed to give the design factors important for performance optimization. The simulation makes use of a specially formulated three-dimensional orthogonal coordinate system with the geometry identical to the actual recessed cathode and gives the oxygen concentration field induced by it in the surrounding medium. Equations are presented which allow one to calculate, for any recessed cathode, the current sensitivity, maximum stirring artifact, measurement error, and time constant. Comparisons with analytically obtained expressions for the corresponding quantities for idealized, spherosymmetric cathodes demonstrate the unique aspects of recessed-cathode performance. For commonly used electrodes, a recess length-to-cathode diameter ratio of greater than 10 is found to give a negligible stirring artifact, a negligible measurement error, and a rapid response.
Computers↗
Psychosocial aspects of a Tay-Sachs screening clinic.
The authors administered questionnaires to participants in a Tay-Sachs screening clinic. They received 322 responses. Although the majority of the respondents expressed anxiety about the possibility that they might be carriers, most indicated that this anxiety brought them to the clinic. The authors conclude that a well-publicized and well-organized screening clinic can function successfully and deal with the issue of anticipated loss without producing mass fear. An important factor in their clinic was the fact that they were able to offer an alternative to a Tay-Sachs child through amniocentesis.
Adult↗