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PubMed2006

Efficacy of a child-friendly form of constraint-induced movement therapy in hemiplegic cerebral palsy: a randomized control trial.

Constraint-induced (CI) movement therapy is a promising therapy for improving upper limb function in adults after stroke. It involves restraint of the non-involved limb and extensive movement practice with the involved limb. In this study, a single-blinded, randomized, control study was performed to examine the efficacy of CI therapy, modified to be child friendly, in children with hemiplegic cerebral palsy (CP). Twenty-two children (8 females, 14 males; mean age 6 y 8 mo [SD 1 y 4 mo]; range 4-8 y) were randomized to either an intervention group (n=11) or a delayed treatment control group (n=11). Children wore a sling on their non-involved upper limb for 6 hours per day for 10 out of 12 consecutive days and were engaged in play and functional activities. Children in the treatment group demonstrated improved movement efficiency and dexterity of the involved upper extremity, which were sustained through the 6-month evaluation period, as measured by the Jebsen-Taylor Test of Hand Function and fine motor-subtests of the Bruininks-Oseretsky Test of Motor Proficiency (p<0.05 in both cases). Initial severity of hand impairment and testing compliance were strong predictors of improvement. Caregivers reported significant increases in involved limb frequency of use and quality of movement. However, there was no change in strength, sensibility, or muscle tone (p>0.05 in all cases). Results suggest that for a carefully selected subgroup of children with hemiplegic CP, CI therapy modified to be child-friendly, appears to be efficacious in improving movement efficiency of the involved upper extremity.

Analysis of Variance↗

PubMed2006

Health-related quality of life of children with vision impairment or blindness.

The aims of the study were to describe the functional ability, health status, and health-related quality of life (HRQL) of young children with a vision impairment or blindness (VI/BL) and to examine the effect of different types of ophthalmic condition and the presence of other impairments or systemic disorders. A cross-sectional community survey of children aged 3 to 8 years with VI/BL was conducted in four areas of England using the Health Utilities Index Mark 3 system. Seventy-nine children (47 males, 32 females; mean age 6 y 2 mo [SD 1 y 6 mo]) met the selection criteria: 43% had a visual pathway condition, 38% a condition of the eye, and 19% nystagmus alone; and 61% had additional impairments/disorders. Eighty per cent had functional limitations on at least two of the following attributes: vision, hearing, speech, cognition, ambulation, dexterity, emotion, and pain. Forty-four per cent had functional limitations on four or more attributes. Children with nystagmus alone had significantly higher mean HRQL utility scores (0.80 [SD 0.26]) than children with a condition of the eye (0.45 [SD 0.33]), who, in turn, had higher scores than children with a visual pathway condition (0.05 [SD 0.33], p=0.002). Children with an isolated VI/BL had significantly higher mean scores (0.73 [SD 0.21]) than those with additional impairments/disorders (0.09 [SD 0.34], p<0.001). These findings underline the need for a broad assessment of each child with VI/BL and a multidisciplinary approach to care.

Blindness↗

PubMed1999

Relation between clinical measures and fine manipulative control in children with hemiplegic cerebral palsy.

The present investigation examines the relation between various clinical measures and the performance of a functional precision grip-lift task. Fifteen children with hemiplegic cerebral palsy (CP), aged 8 to 14 years, and 15 age-matched control children grasped and lifted an object whose surface texture was varied while their fingertip forces were recorded. The force coordination was compared with tactile sensibility, grip strength, manual dexterity, and spasticity using correlational and regression analyses. The findings highlight the importance of tactile sensibility in this task. However, the manner in which sensibility was related varied for the sensory adaptation of fingertip forces, the anticipatory scaling of the force increase, and the smooth transitions between the temporal phases comprising the grip-lift task. The findings also indicate that spasticity affects some measures of the task, but not others, suggesting that the relation between spasticity and motor performance may not be absolute. The results further suggest that the impairments in grasping in children with hemiplegic CP are largely but not exclusively due to disturbed sensory mechanisms which may have direct implications for therapeutic intervention.

Adolescent↗

PubMed2003

Selection of neurosurgical trainees.

BACKGROUND: Medical students in Canada must make career choices by their final year of medical school. Selection of students for a career in neurosurgery has traditionally been based on marks, reference letters and personal interviews. Studies have shown that marks alone are not accurate predictors of success in medical practice; personal skills and attributes which can best be assessed by letters of reference and interviews may be more important. This study was an attempt to assess the importance of, and ability to teach, personal skills and attitudes necessary for successful completion of a neurosurgical training program. METHODS: A questionnaire was sent to 185 active members of the Canadian Neurosurgical Society, asking them to give a numerical rating of the importance of 22 personal skills and attributes, and their ability to teach those skills and attributes. They were asked to list any additional skills or attributes considered important, and rate their ability to teach them. RESULTS: Sixty-six (36%) questionnaires were returned. Honesty, motivation, willingness to learn, ability to problem solve, and ability to handle stress were the five most important characteristics identified. Neurosurgeons thought they could teach problem solving, willingness to consult informed sources, critical thinking, manual dexterity, and communication skills, but honesty, motivation, willingness to learn and ability to handle stress were difficult or impossible to teach. CONCLUSIONS: Honesty, motivation, willingness to learn, ability to problem solve and handle stress are important for success in a neurosurgical career. This information should be transmitted to medical students at "Career Day" venues. Structuring letters of reference and interviews to assess personal skills and attributes will be important, as those that can't be taught should be present before the start of training.

Attitude of Health Personnel↗

PubMed2000

Speed and memory in WAIS-R-NI Digit Symbol performance among healthy older adults.

Although roles have been proposed for both graphomotor speed and learning in the execution of Digit Symbol, few data have been available concerning performance across the adult lifespan on the Symbol Copy, paired associates, or free recall measures derived from Digit Symbol and recommended in the WAIS-R-NI. We report findings on 177 healthy older adults (ages 50-90), providing normative data by age group, education level, and gender. As previously reported, Digit Symbol scores decline steeply with age (r = -.64). Symbol Copy speed declines almost as steeply (r = -.58). Incidental learning, however, declines only modestly (r = -.26 on both measures). Symbol Copy is a far stronger correlate of Digit Symbol (r = .72) than are paired associates or free recall (r = .26 and r = .28, respectively). The 2 incidental learning measures do, however, offer valuable supplementary information as part of a comprehensive individual assessment. When low Digit Symbol scores are produced by slowing on Symbol Copy, further evaluation of perceptual and motor speed and dexterity are indicated. When low incidental learning scores are obtained, further evaluation of memory is warranted. Qualitative analysis of errors (e.g., rotations) made on the incidental learning procedures may also be valuable.

Adult↗

PubMed2001

Bimolecular electron and energy transfer reactivity of exchange-coupled dinuclear iron(III) complexes.

Bimolecular quenching between photosensitizers and exchange-coupled transition metal complexes has been studied in an effort to experimentally establish a link between Heisenberg spin exchange and chemical reactivity. The acceptors are members of the oxo/hydroxo-biscarboxylato class of dinuclear Fe(III) compounds, where protonation of the oxo bridge provides a means for modulating the magnitude of spin exchange within the cluster. Photoexcitation of solutions containing Ru(II) polypyridyl sensitizers and the Fe(III) complexes results in quenching of emission from the (3)MLCT excited state of the Ru(II) chromophores; nanosecond time-resolved absorption measurements demonstrate that quenching occurs, in part, by electron transfer. Decoupling electron transfer driving force (DeltaG(0)(ET)) from changes in the magnitude of spin exchange was achieved by varying the bridging carboxylate to afford a series of complexes of the form [Fe(2)O(H)(O(2)CR)(2)(Tp)(2)](n)(+) (n = 0, 1, 2). Electrochemical measurements reveal a greater than 500 mV shift in cluster reduction potential across the series (i.e., R = CH(3) to CF(3)), whereas variable-temperature magnetic susceptibility measurements demonstrate a corresponding invariance in spin exchange between the metal centers (J(oxo) = -119 +/- 4 cm(-1) and J(hydroxo) = -18 +/- 2 cm(-1) for H = -2JS(1).S(2)). Structural analyses suggest that reorganization energies (lambda) associated with electron transfer should be identical for all molecules within a given series (i.e., oxo or hydroxo bridged); likewise Deltalambda between the series is expected to be small. A comparison of quenching rates for the two extended series firmly establishes that neither reorganization energy nor electron transfer driving force considerations can account for differences in reactivity between oxo-bridged (large spin exchange) and hydroxo-bridged (small spin exchange) quenchers. Upon consideration of energy transfer contributions, it is determined that reactivity differences between the oxo- and hydroxo-bridged quenchers must lie in the relative rates of Dexter energy transfer and/or electron transfer, with the origin of the latter linked to something other than DeltaG(0)(ET) or lambda. Finally, the extent to which spin exchange within the dinuclear Fe(III) quenchers can be identified as the key variable influencing these reactivity patterns is discussed.

Algorithms↗

PubMed2005

Intramolecular energy transfer involving heisenberg spin-coupled dinuclear iron-oxo complexes.

The synthesis, structure, and physical properties of a series of oxo-bridged dinuclear Fe(III) complexes containing pendant naphthalene groups are described. The compounds [Fe(2)O(O(2)CCH(2)-C(10)H(7))(tren)(2)](BPh(4))(NO(3))(2) (8), [Fe(2)O(O(2)CCH(2)-C(10)H(7))(TPA)(2)](ClO(4))(3) (9), Fe(2)O(O(2)CCH(2)-C(10)H(7))(2)(Tp)(2) (10), and Fe(2)O((O(2)CCH(2)CH(2))(2)-C(10)H(6))(Tp)(2) (11) (where tren is tris(2-aminoethyl)amine, TPA is tris(2-pyridyl)amine, and Tp is hydrotrispyrazolylborate) have been characterized in terms of their structural, spectroscopic, magnetic, and photophysical properties. All four complexes exhibit moderately strong intramolecular antiferromagnetic exchange between the high-spin ferric ions (ca. -130 cm(-)(1) for H = -2JS(1).S(2)). Room-temperature steady-state emission spectra for compounds 8-11 in deoxygenated CH(3)CN solution reveal spectral profiles similar to methyl-2-naphthyl acetate and [Zn(2)(OH)(O(2)CCH(2)-C(10)H(7))(2)(TACN-Me(3))(2)](ClO(4)) (13, where TACN-Me(3) is N,N,N-1,4,7-trimethyltriazacyclononane) but are significantly weaker in intensity relative to these latter two compounds. Time-resolved emission data for the iron complexes following excitation at 280 nm can be fit to simple exponential decay models with tau(obs)(S)()1 = 36 +/- 2, 32 +/- 4, 30 +/- 5, and 39 +/- 3 ns for compounds 8-11, respectively. The decays are assigned to the S(1) --> S(0) fluorescence of naphthalene; all of the lifetimes are less than that of the zinc model complex (tau(obs)(S)()1 = 45 +/- 2 ns), indicating quenching of the S(1) state by the iron-oxo core. Nanosecond time-resolved absorption data on [Zn(2)(OH)(O(2)CCH(2)-C(10)H(7))(2)(TACN-Me(3))(2)](ClO(4)) reveal a feature at lambda(max) = 420 nm that can be assigned as the T(1) --> T(n) absorption of the naphthalene triplet; the rise time of 50 +/- 10 ns corresponds to an intersystem crossing rate of 2 x 10(7) s(-1). A similar feature (though much weaker in intensity) is also observed for compound 8. The order-of-magnitude reduction in the T(1) lifetime of the pendant naphthalene for all of the iron-oxo complexes (tau(obs)(T)1 = 5 +/- 2 micros vs 90 +/- 10 micros for [Zn(2)(OH)(O(2)CCH(2)-C(10)H(7))(2)(TACN-Me(3))(2)](ClO(4))) indicates quenching of the naphthalene triplet with an efficiency of >90%. Neither the naphthalene radical cation nor the reduced Fe(II)Fe(III) species were observed by transient absorption spectroscopy, implying that energy transfer is the most likely origin for the quenching of both the S(1) and T(1) states. Spectral overlap considerations strongly support a Förster (i.e., dipolar) mechanism for energy transfer from the S(1) state, whereas the lack of phosphorescence from either the free naphthyl ester or the Zn model complex suggests Dexter transfer to the diiron(III) core as the principal mechanism of triplet quenching. The notion of whether spin exchange within the diiron(III) core is in part responsible for the unusual ability of the iron-oxo core to engage in energy transfer from both the singlet and triplet manifolds of naphthalene is discussed.

Journal Article↗

PubMed2006

Energy transfer in hybrids based on a thiophene-substituted ethynylbipyridine dimer decorated with Re(I), Ru(II), and Os(II) units.

The preparation, structural features, electrochemical behavior, and optical properties (at room temperature and at 77 K) are reported for a series of thiophene-containing hybrids based on the bent conjugated backbone of a rigid ditopic ligand, the dimeric moiety 3,4-dibutyl-2,5-bis{5'-[(3,4-dibutylthien-2-ylethynyl)-2,2'-bipyridin-5-yl]ethynyl}thiophene (TBTBT). Within the dimer, the diethynyl-2,2'-bipyridine units (bpy, the coordination sites) alternate with three 3,4-dibuthylthiophene units and coordination of the [Re(CO)3Cl], [Ru(bpy)2]2+, and [Os(bpy)2]2+ centers results in the mononuclear species RuTBTBT and OsTBTBT and the binuclear species RuTBTBTRu, OsTBTBTOs, RuTBTBTOs, and ReTBTBTOs. At room temperature, the emitting states obtained by photoexcitation are of 3MLCT nature, and vibronic analysis of the emission spectra indicates that they are largely delocalized over the TBTBT ligand. In the binuclear species, the intermetal separation is ca. 17 A, and for RuTBTBTOs, an efficient Ru --> Os excitation transfer takes place, resulting solely in an Os-based emission. The process is ascribed to double-electron transfer (Dexter), as mediated by the TBTBT ligand; a similar conclusion holds for the case of ReTBTBTOs. For RuTBTBTOs, the process is discussed in some detail also with regard to the possibility of disentangling the constituent hole and electron-transfer events.

Electrochemistry↗

PubMed1996

Energy Transfer in Rigid Ru(II)/Os(II) Dinuclear Complexes with Biscyclometalating Bridging Ligands Containing a Variable Number of Phenylene Units.

We have prepared rodlike cyclometalated Ru(II)/Os(II) dinuclear complexes, (ttp)Ru(dpb-(ph)(n)()-dpb)Os(ttp)(2+), where the biscyclometalating bridging ligands contain dipyridylbenzene fragments, dbp, separated by a variable number, n, of phenylene spacers, and the terminal ligand is a terpyridine derivative [dpbH is di-2-pyridyl-1,3-benzene, ttp is 4'-p-tolyl-2,2':6',2"-terpyridine, and n = 0-2]. The rigid bridging ligands keep the metal centers at a distance r(MM) = 11, 15.5, and 20 Å, depending on n. Photoinduced energy transfer has been investigated by luminescence spectroscopy in nitrile solvents at room temperature and at 77 K (i.e., in frozen medium). According to a classical description of the process, the energy transfer occurs in a nearly activationless regime, is governed by electronic factors, and can be described in terms of the Dexter-type mechanism. The obtained energy transfer rates roughly span 3 orders of magnitude and indicate (i) that the temperature (i.e., the state of the solvent) has a small influence on the process and (ii) that the interposed phenylene spacers are weak attenuators of intercenter electronic coupling, H [H = H(0) exp(-betar(MM)), with beta approximately 0.33 Å(-)(1)].

Journal Article↗

PubMed1999

Rigid Molecular Rods with Cumulene-Bridged Polyphosphines: Synthesis, Electronic Communication, Molecular Photophysics, Mixed-Valence State, and X-ray Photoelectron Spectroscopic Study.

The synthesis, molecular photophysics, redox characteristics, and electronic interactions, as well as an X-ray photoelectron spectroscopic (XPS) study of a series of Ru(II) and Os(II) complexes with a polyphosphine/cumulene spacer, namely, 1,1',4,4'-tetrakis(diphenylphosphino)cumulene (C(4)P(4)), are studied and compared with the corresponding systems containing spacers with shorter sp carbon chain (C(n)()) lengths. Characterizations of all mono-, homo-, and heterobimetallic complexes with PF(6)(-) counteranions are accomplished using (1)H, (13)C, and (31)P{(1)H} NMR, fast atom bombardment (FAB/MS), and matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF/MS) mass spectroscopy and elemental analysis. From the electrochemical study it is observed that the length of the C(n)() bridges has a profound influence on redox potentials and the electronic interaction between the two metal-based termini. XPS studies reveal that a simple change in carbon chain length affects the electron donation of the phosphine spacer to the metal-based termini. As a result, the redox potential of the Ru(II) or Os(II) center is shifted significantly. The comproportionation constant, K(c), is calculated as 1.3 x 10(7) (M = Ru(II)) or 4.5 x 10(10) (M = Os(II)) for homobimetallic [(bpy)(2)M(C(4)P(4))M(bpy)(2)](4+), suggesting a strong electronic communication across the C(4)P(4) spacer. However, the K(c) value is estimated to be ca. 4 for the corresponding complexes [(bpy)(2)M(C(3)P(4))M(bpy)(2)](4+) (M = Ru, Os; C(3)P(4) = 1,1',3,3'-tetrakis(diphenylphosphino)allene), indicative of a system with electronic isolation between the two termini. In heterobimetallic [(bpy)(2)Ru(C(n)()P(4))Os(bpy)(2)](4+) (n = 3, 4), the energy transfer from Ru(II) to Os(II) is found to be very efficient, with rate constants k(en) of ca. 3 x 10(9) s(-)(1) (n = 3) and 1 x 10(11) s(-)(1) (n = 4). The increased value of k(en) upon the change from C(3) to C(4) can be explained by the increase in the electronic communication across spacers. Detailed studies and calculations have revealed a Dexter-type of mechanism for the triplet energy transfer in the system.

Journal Article↗

PubMed2003

Characterization of the triplet state of tris(8-hydroxyquinoline)aluminium(III) in benzene solution.

The lowest triplet state of tris(8-hydroxyquinoline)aluminium(III) (Alq3) has been prepared by pulse radiolysis/energy transfer from appropriate donors in benzene solutions and has an absorption maximum around 510 nm with a lifetime of about 50 mus. It is quenched by molecular oxygen, leading to singlet oxygen formation. From flash photolysis and singlet oxygen formation measurements, a quantum yield of triplet formation of 0.24 was determined for direct photolysis of the complex. A value of 2.10 +/- 0.10 eV was determined for the energy of the lowest triplet state by energy transfer studies and was confirmed by phosphorescence measurements on Alq3, either in the heavy atom solvent ethyl iodide or photosensitized by benzophenone in benzene. Dexter (exchange) energy transfer was observed from triplet Alq3 to platinum(II) octaethylporphyrin.

Journal Article↗

PubMed2005

Temperature-induced switching of the mechanism for intramolecular energy transfer in a 2,2':6',2' '-Terpyridine-based Ru(II)-Os(II) trinuclear array.

The synthesis and photophysical properties of a linear 2,2':6',2' '-terpyridine-based trinuclear Ru(II)-Os(II) nanometer-sized array are described. This array comprises two bis(2,2':6',2' '-terpyridine) ruthenium(II) terminals connected via alkoxy-strapped 4,4'-diethynylated biphenylene units to a central bis(2,2':6',2' '-terpyridine) osmium(II) core. The mixed-metal linear array was prepared using the "synthesis at metal" approach, and the Ru(II)-Ru(II) separation is ca. 50 A. Energy transfer occurs with high efficiency from the Ru(II) units to the Os(II) center at all temperatures. Forster-type energy transfer prevails in a glassy matrix at very low temperature, but this is augmented by Dexter-type electron exchange at higher temperatures. This latter process, which is weakly activated, involves long-range superexchange interactions between the metal centers. In fluid solution, a strongly activated process provides for fast energy transfer. Here, a charge-transfer (CT) state localized on the bridge is populated as an intermediate species. The CT triplet does not undergo direct charge recombination to form the ground state but transfers energy, possibly via a second CT state, to the Os(II)-based acceptor. The short tethering strap constrains the geometry of the linker, especially in a glassy matrix, such that low-temperature electron exchange occurs across a particular torsion angle of 37 degrees . The probability of triplet energy transfer depends on temperature but always exceeds 75%.

Journal Article↗

PubMed2006

Triplet energy back transfer in conjugated polymers with pendant phosphorescent iridium complexes.

The nature of Dexter triplet energy transfer between bonded systems of a red phosphorescent iridium complex 13 and a conjugated polymer, polyfluorene, has been investigated in electrophosphorescent organic light-emitting diodes. Red-emitting phosphorescent iridium complexes based on the [Ir(btp)(2)(acac)] fragment (where btp is 2-(2'-benzo[b]thienyl)pyridinato and acac is acetylacetonate) have been attached either directly (spacerless) or through a -(CH(2))(8)- chain (octamethylene-tethered) at the 9-position of a 9-octylfluorene host. The resulting dibromo-functionalized spacerless (8) or octamethylene-tethered (12) fluorene monomers were chain extended by Suzuki polycondensations using the bis(boronate)-terminated fluorene macromonomers 16 in the presence of end-capping chlorobenzene solvent to produce the statistical spacerless (17) and octamethylene-tethered (18) copolymers containing an even dispersion of the pendant phosphorescent fragments. The spacerless monomer 12 adopts a face-to-face conformation with a separation of only 3.6 A between the iridium complex and fluorenyl group, as shown by X-ray analysis of a single crystal, and this facilitates intramolecular triplet energy transfer in the spacerless copolymers 17. The photo- and electroluminescence efficiencies of the octamethylene-tethered copolymers 18 are double those of the spacerless copolymers 17, and this is consistent with suppression of the back transfer of triplets from the red phosphorescent iridium complex to the polyfluorene backbone in 18. The incorporation of a -(CH(2))(8)- chain between the polymer host and phosphorescent guest is thus an important design principle for achieving higher efficiencies in those electrophosphorescent organic light-emitting diodes for which the triplet energy levels of the host and guest are similar.

Journal Article↗

PubMed2005

Chemically induced dynamic electron spin polarization-detected energy transfer. Substrate size effects and solvent dependence.

Time-resolved electron paramagnetic resonance spectroscopy is used to probe energy transfer from aromatic photoexcited triplet states to azo compounds in liquid solution. The observation of chemically induced dynamic electron spin polarization in the spectra gives precise information regarding the spin physics and mechanism of the energy transfer process. The substrate size is varied by altering the chain length of alkyl chains covalently attached to the azo compounds via ester or amide linkages. The solvent dependence of the energy transfer process is also investigated. The results are discussed in terms of Dexter and Förster mechanisms for energy transfer, the properties of the excited states, and the diffusive properties of the molecules in the solvents of interest. Decomposition rate studies and fluorescence measurements are also reported.

Journal Article↗

PubMed2006

Singlet energy transfer in porphyrin-based donor-bridge-acceptor systems: interaction between bridge length and bridge energy.

Singlet excitation energy transfer is governed by two donor-acceptor interactions, the Coulombic and exchange interactions giving rise to the Förster and Dexter mechanisms, respectively, for singlet energy transfer. In transfer between colliding molecules or between a donor (D) and acceptor (A) connected in donor-bridge-acceptor (D-B-A) system by an inert spacer (B), the distinction between these two mechanisms is quite clear. However, in D-B-A systems connected by a pi-conjugated bridge, the exchange interaction between the donor and acceptor is mediated by the virtual low-lying excited states (unoccupied orbitals) of that bridge and, as a consequence, becomes much more long-range in character. Thus, the clear distinction to the Coulombic mechanism is lost. This so-called superexchange mechanism for singlet energy transfer has been shown to make a significant contribution to the energy transfer rates in several D-B-A systems, and its D-A distance as well as D-B energy gap dependencies have been studied. We here demonstrate that in a series of oligo-p-phenyleneethynylene (OPE) bridged porphyrin-based D-B-A systems with varying D-A distances the Förster and through-bond (superexchange) mechanisms both make considerable contributions to the observed singlet energy transfer rates. The donor is either a zinc porphyrin or a zinc porphyrin with a pyridine ligand, and the acceptor is a free base porphyrin. By comparison to a homologous series where only the D-B energy gaps varies, a separation between the two energy transfer mechanisms was possible and, moreover, an interplay between distance and energy gap dependencies was noted. The distance dependence was shown to be approximately exponential with an attenuation factor beta=0.20 A-1. If the effect of the varying D-B energy gaps in the OPE series was taken into account, a slightly higher beta-value was obtained. Ground-state absorption, steady-state, and time-resolved emission spectroscopy were used. The experimental study is accompanied by time-dependent density functional theory (TD-DFT) calculations of the electronic coupling, and the experimental and theoretical results are in excellent qualitative agreement (same distance dependence).

Journal Article↗

PubMed1998

Clinical use of the FemAssist device in female urinary incontinence.

OBJECTIVE: We sought to determine the safety and effectiveness of a new, simple noninvasive device, "FemAssist" for women suffering from urinary incontinence. METHODS: The "FemAssist" is a dome-shaped medical grade silicon device intended to be worn over the external urethral meatus and held in place by suction and an adhesive gel. Thirty eight women with varying degrees of genuine stress urinary incontinence (GSUI) or mixed incontinence on multichannel urodynamic testing were fitted with one of two sizes of "FemAssist" with regard to their anatomy and dexterity. RESULTS: Thus far, of the 38 women who have completed the study, there have been no reported significant increases in bacteriuria or urinary tract infection rates. Over half of the women reported an improvement in the quality of life including comfort, convenience, and overall satisfaction. The device was worn for a total of 886 days by the group; 82% of these were dry days. CONCLUSION: Our preliminary study suggests that the "FemAssist" device is safe and effective for some women with urinary incontinence.

Adult↗

PubMed1999

A health-related quality of life measure for use in patients with onychomycosis: a validation study.

Onychomycosis is a common nail disorder associated with pain, discomfort and varying degrees of physical impairment and loss of dexterity. Psychological and social limitations result from reactions of others to visible impairment. The goal of this research is to validate a questionnaire to measure the impact of toenail onychomycosis on health-related quality of life (HRQoL). One hundred and fifty onychomycosis patients were enrolled in an observational study at eight sites in the US. Attending physicians reported information on clinical status at enrolment. Patients completed a questionnaire covering HRQoL that included general and disease-specific items measuring the impact of onychomycosis on activities and appearance, plus problems and symptoms associated with toenail infection. The subscales of the instrument showed high internal consistency reliability (range = 0.63-0.95). Construct validity reflected the close association of physical functioning scores with onychomycosis impairment. Test-Retest reliability was good to excellent for all scales (ICC = 0.52-0.89). Discriminant validity was evidenced by persons who are younger and female reporting worse disease-specific HRQoL. Responsiveness to clinical change was noted for all disease-specific scale scores for improved patients. This instrument has demonstrated reliability, validity and responsiveness for use in observational and clinical studies of toenail onychomycosis patients. Data indicate that onychomycosis patients report significant pain and discomfort reflecting the need for HRQoL measurement.

Activities of Daily Living↗

PubMedDate not supplied

Generalized post-tetanic changes in excitatory postsynaptic and acetylcholine-evoked currents in neurons in the common snail.

Changes in excitatory postsynaptic currents (EPSC) and influx currents induced by local iontophoretic application of acetylcholine (ACh currents) to the surfaces of the bodies of identified neurons LPa3 and RPa3 in the common snail after heteroreceptor tetanic stimulation were studied. The effects of rhythmic application of acetylcholine (0.5-1.0 times per sec for 10-40 sec) on the magnitude of EPSC were analyzed, along with the effects of tetanic stimulation of the nerves (n. intestinalis, n. pallialis dexter, n. pallialis sinister; 1-5 Hz for 1-2 min) on the amplitudes of the ACh current and the magnitudes of EPSC evoked by stimulation of another nerve. The following changes in conditioning responses were found over 1-1.5 h after tetanization: rhythmic application of ACh to the dorsal surface of the cell body resulted in potentiation of EPSC, and tetanic orthodromic stimulation potentiated the ACh current and induced heterosynaptic depression of EPSC. These post-tetanic changes were not local--they developed in those chemoreceptor zones of the membrane which were not activated by the preceding conditioning rhythmic stimulation. It is concluded that generalized post-tetanic changes in neuron responses are induced by activation of its subsynaptic and extrasynaptic mediator chemoreceptors.

Acetylcholine↗