Biomedical subjects
Publications and source records attributed to T Armstrong.
A search for antiproton decay has been made at the Fermilab Antiproton Accumulator. Limits are placed on fifteen antiproton decay modes. The results are used to place limits on the characteristic mass scale m(X) that could be associated with CPT violation accompanied by baryon number violation.
OBJECTIVES: To evaluate early results of the intra-ureteric instillation of capsaicin for the treatment of loin pain haematuria syndrome (LPHS). PATIENTS AND METHODS: Ten patients with LPHS were treated using intra-ureteric capsaicin instillation. A solution of capsaicin was infused into the affected ureter through an embolectomy catheter, under anaesthesia. The success of the treatment was assessed using patient questionnaires and the quantitative reduction in the patients' analgesic requirements measured. RESULTS: During a mean follow-up of 6 months, six of the 10 patients had short- to medium-term symptomatic relief after one or more treatments; four had no relief from their symptoms. One patient had a mucosal ulceration in the bladder after extravasation of the capsaicin solution. Two patients subsequently underwent simple nephrectomy for symptomatic nonfunctioning kidneys. CONCLUSION: These results are consistent with other preliminary reports of the efficacy of capsaicin treatment in LPHS and such treatment therefore has a definite therapeutic role in this difficult condition. We are uncertain if the treatment contributed to the deterioration of the excised kidneys. This early experience suggests a need for careful consideration when contemplating this treatment, with attention directed to both the initial diagnosis and possibly the technique of capsaicin/instillation. We include a protocol to follow when preparing patients for capsaicin treatment.
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Although primary brain tumors are relatively uncommon types of adult cancer, their location and resistance to treatment can significantly affect the patient's physical and cognitive function. Consequently, quality of life (QOL) issues are extremely important in the design and evaluation of clinical trials of high-grade glioma treatment. Although a number of studies have examined QOL in patients with primary brain tumors, very little is known about QOL in these patients. These studies often use either poorly validated instruments or tools, such as the Karnofsky performance scale, that do not fully evaluate the effects of the tumor on QOL. Recent attempts to better evaluate QOL in brain tumor patients have led to the development of brain tumor-specific QOL instruments, such as the European Organization for Research and Treatment of Cancer's Quality of Life Questionnaire-Brain Cancer Module and the Functional Assessment of Cancer Therapy-Brain, which offer more insight into the QOL aspects of cancer and its treatment. Instruments such as quality time without symptoms or toxicity (Q-TWiST) provide a means of integrating both quality of time of survival and absence of symptoms or toxicity.
Eighty computer users with musculoskeletal disorders participated in a 6-month, randomized, placebo-controlled trial evaluating the effects of four computer keyboards on clinical findings, pain severity, functional hand status, and comfort. The alternative geometry keyboards tested were: the Apple Adjustable Keyboard [kb1], Comfort Keyboard System [kb2], Microsoft Natural Keyboard [kb3], and placebo. Compared to placebo, kb3 and to a lesser extent kb1 groups demonstrated an improving trend in pain severity and hand function following 6 months of keyboard use. However, there was no corresponding consistent improvement in clinical findings in the alternative geometry keyboard groups compared to the placebo group. Overall, there was a significant correlation between improvement of pain severity and greater satisfaction with the keyboards. These results provide evidence that keyboard users may experience a reduction in hand pain after several months of use of some alternative geometry keyboards.
The aim of this work was to investigate physiological responses to torque reaction forces produced by hand-held power tools used to tighten threaded fasteners. Such tools are used repetitively by workers in many industries and are often associated with upper limb musculoskeletal complaints. The tools considered for stimulation in this study had straight handles and required from 100 to 400 ms to tighten fasteners to a peak torque of 1.0 to 2.5 Nm and from 50 to 150 ms for the torque to decay to zero. A tool stimulator was constructed to apply a programmed torque profile to a handle similar to that of a straight in-line power screwdriver. Wrist flexor and extensor surface EMGs and handle position were recorded as subjects held handles subjected to controlled torque loads that tended to flex the wrist. It was found that: (1) very high EMG values occurred even though torques were of short duration (50 to 600 ms) and the peak torques were low (7-28% of maximum strength); (2) high EMGs in anticipation of torque are directly related to torque build-up rate and peak torque; (3) high peak flexor and extensor EMGs during and following torque onset are related to torque build-up rate and peak torque; (4) minimum time of peak EMGs of 72-87 ms following the onset of torques with 50 ms build-up suggests the contribution of an extensor muscle stretch reflex component; delayed peak for longer build-ups suggests a central control of muscle force in response to torque; (5) angular excursions of handles increase with decreasing torque build-up time and increasing torque magnitude causes increasing eccentric work; (6) the results show that the slow torque build-up times (450 ms) correspond to minimum peak EMGs; and (7) accumulated EMGs increase with increasing torque and torque build-up times. Further studies are needed to evaluate fatigue and musculoskeletal injuries associated with prolonged periods of tool use.
We report a case of total upper airway obstruction occurring immediately after extubation after elective bi-maxillary osteotomy. The obstruction was caused by severe, progressive supraglottic oedema, which totally obscured the laryngeal inlet. No swelling had been present at initial laryngoscopy and intubation. Immediate re-intubation of the patient's trachea was difficult but life saving. Subsequent investigations revealed extensive soft tissue swelling, maximal at the level of the hyoid and extending downwards into the trachea. The cause of such severe oedema in this case is not certain, but may be related to vigorous submental liposuction carried out at the end of operation. We have found no other reports of total airway obstruction occurring immediately after extubation as a result of this cause. We review the appropriate literature, describe the postoperative management and suggest precautions in similar patients.
From a larger study, ratings of satisfaction with disaster relief agencies in the aftermath of Hurricanes Erin and Opal showed high satisfaction from services provided by the American Red Cross/Salvation Army and somewhat lower ratings for the Federal Emergency Management Agency from 167 residents and business owners in the Florida Panhandle.
The anaesthetic management of a child undergoing video-assisted thoracoscopic resection of a large lung cyst is described. In particular, we discuss the prolonged postoperative stay, which resulted from persistent pneumothorax, and his need for substantial analgesia up to the twelfth postoperative day-which seemed no shorter than might have been expected following a thoracotomy. While other workers have claimed advantages with thoracoscopic operations, in terms of reduced pain and morbidity, compared to traditional thoracotomy, we feel that one should be aware of the potential for severe postoperative pain in these patients.
This case-control study assessed whether office workers who report more severe levels of musculoskeletal symptoms of the upper extremities demonstrate higher levels of keyforce in comparison to controls with less severe symptoms. Office workers reporting working on computer keyboards for four hours per day were classified as cases or controls based upon a median split on a Composite Symptom Severity score (cases = 23, controls = 25). Keyboard force and keying rate were measured during a 15-minute keyboarding task. Measures of task-related discomfort, muscular fatigue, pain, upper extremity symptoms, psychological distress and force were collected at baseline, post-keyboard task, and recovery. Ratings of perceived effort and task credibility were also obtained. Measures of work demands, perceived job stress, and upper extremity strength and flexibility were also collected. The results indicated group equivalence on reported work demands and upper extremity strength. Cases were more likely to receive a medical diagnosis of upper extremity cumulative trauma disorder, awaken from sleep due to symptoms, report higher levels of pain during work, experience greater impact of pain on function, and report higher workload pressure and lower support. Cases generated significantly higher keyboarding forces than controls, although both groups produced forces well above that required to operate the keyboard (4-5 times activation force). Cases reported higher levels of upper extremity symptoms and discomfort than controls, and these measures were highest after the keyboarding task for both groups. No significant correlation between keyforce and key rate was observed in either group. Results suggest that generation of excessive force while working on a computer keyboard may contribute to the severity of upper extremity symptoms. Clinically, the findings suggest that evaluating how an individual worker performs keyboarding tasks, or his or her workstyle, may be helpful in the management of these symptoms and disorders.
Hurricanes Erin and Opal struck the same coastal region in the Northwest Florida Panhandle in late summer of 1995. The study examined the stressors that most affected small businesses in the region in the aftermath of the storms. Power outages, telephone disruptions, employees' availability, debris removal, and lack of customers were the major problem areas reported by business owners (N = 57 of 500 potential respondents). The results indicate that most of the stress factors were transitory and the findings are discussed in light of Murphy's 1985 conceptual model of disaster research.
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Work-related musculoskeletal disorders cause chronic pain and functional impairment, impose heavy costs on society, and reduce productivity. In this position paper from the Scientific Committee for Musculoskeletal Disorders of the ICOH, the most important risk factors at work are described. Work-related musculoskeletal disorders have high incidences and prevalences among workers who are exposed to manual handling, repetitive and static work, vibrations, and poor psychological and social conditions. The application of ergonomic principles in the workplace is the best method for prevention. International organizations should develop standards, common classifications, and terminologies. Surveillance systems should be further developed nationally and in workplaces, and more effort should be directed to information dissemination, education, and training.
AIM: To study the frequency of depression in elderly patients admitted to the Internal Medicine Service of an Institutional Hospital. PATIENTS AND METHODS: Patients over 65 years old admitted to the Internal Medicine Service of the Military Hospital at Santiago. Chile were assessed using the CDS-20 depression questionnaire and the FROMAGE score for dementia. RESULTS: One hundred twenty seven patients (71 female), were assessed. According to the FROMAGE score, 30% had moderate and 35% had severe dementia. Ten percent of males and 12% of females were depressive. Moderately demented patients, females, subjects with low educational levels and those living alone had a higher frequency of depression. According to DSM-III the most frequent diagnosis among depressive patients was "adjustment disorder with depressive mood". Attending physicians made the diagnosis in only 11% of patients with depression. CONCLUSIONS: Depression is frequent among hospitalized elders.
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A single keycap on a standard alphanumeric computer keyboard was instrumented with a piezoelectric load cell and the fingertip motion was recorded with a high-speed video motion analysis system. Contact force histories between the fingertip and the keycap were recorded while four subjects typed a standard text for five minutes. Each keystroke force history is characterized by three distinct phases: (I) keyswitch compression, (II) finger impact and (III) fingertip pulp compression and release. Each keystroke force history contained two relative maxima, one in phase II and one in phase III. The subject mean peak forces ranged from 1.6 to 5.3 N and the subject mean peak fingertip velocities ranged from 0.3 to 0.7 m/s. Motion analyses and force measurements suggest a ballistic model of finger motion during typing.
This article reports on the hazard of mortality of aging retired- and disabled-worker men over the decade after they became Social Security beneficiaries. Basic patterns of mortality rates are described using data from the 1982 New Beneficiary Survey linked to administrative records. The article examines the association of increasing age, race, socioeconomic status, private health insurance, and other demographic and health characteristics with the duration of life between the two groups of men, using statistical models. Over the decade, the hazard of death for retired workers significantly increased with aging and with lower socioeconomic status. The hazard of death for the disabled was significantly associated with being black.