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PubMed1998

A parallelism between human body temperature and performance independent of the endogenous circadian pacemaker.

A battery of performance tests involving manual dexterity, serial search, and verbal reasoning was given about seven times per day to 2 healthy young male subjects (22 and 25 years of age) involved in separate forced desynchrony studies, each involving several months of temporal isolation. In these studies, the period lengths (denoted T) of the imposed day lengths (sleep/wake and light/dark cycles) were 25.8 and 26.0 h for the 2 subjects. For each subject, the endogenous circadian pacemaker (ECP) failed to entrain to a period of T and instead free ran at a period length denoted tau (24.2 and 24.5 h). By educing performance rhythms (and rectal temperature rhythms) separately at tau and at T (after three complete beating cycles for the first subject and two complete beating cycles for the second subject), the hypothesis could be tested as to whether performance and temperature were parallel, both when educed at tau (indicating ECP influence) and when educed at T (indicating sleep/wake cycle influences). The hypothesis was consistently confirmed at tau and mostly confirmed at T. For most variables, when educed at T, both performance speed and body temperature showed an inverted V-shaped function, with a peak about 9 to 12 h after waking.

Adult↗

PubMed1995

Physical performance and physical self-efficacy in the elderly. A pilot study.

This study examined the relationship between physical performance and physical self-efficacy beliefs in older adults. It was hypothesized that subjects who perform better on physical tasks would show more positive beliefs of physical self-efficacy. Information was obtained from 124 subjects (61 men and 63 women) aged 55 to 85 years. Tests of mobility, strength, and dexterity were administered, as well as a self-report questionnaire of physical self-efficacy. Although most physical performance indexes were observed to be at lower levels after 75 years of age, physical self-efficacy beliefs in women did not show this pattern if the drop in physical performance was relatively small. Male subjects in the age group of 75 years and older however, showed substantial lower levels of performance in most of the tests, which was associated with more negative beliefs of physical self-efficacy. This was corroborated by multiple regression analyses, showing that sex was a significant predictor of physical self-efficacy beliefs in most performance tests. This prediction was moderated by age such that older men had more negative beliefs of physical self-efficacy than older women.

Age Factors↗

PubMedDate not supplied

Clinical study of fetal mesencephalic intracerebral transplants for the treatment of Parkinson's disease.

This study reports our findings from 22 patients (ages ranging from 42 to 73 yr; mean = 55.2) with recalcitrant idiopathic Parkinson's disease (PD) who received implants of fetal ventral mesencephalic tissue using an MRI-guided stereotactic procedure and who have been followed for at least 6 mo postoperatively, employing the guidelines established by the Core Assessment Program for Intracerebral Transplantations. Evaluations were videotaped and were performed both on and off levodopa medications. To date, we have seven patients with 24 mo, three with 18 mo, three with 12 mo, and nine with 6 mo post-surgical assessments. Comparing surgical outcomes to levels prior to fetal transplants we found: 1) mean levodopa levels were reduced 46% at 6 mo, 12% at 12 mo, 20% at 18 mo, and 54% at 24 mo; 2) Unified Parkinson's Disease Rating Scale (UPDRS) scores with patients on levodopa were improved by an average of 38% (6 mo), 50.2% (12 mo), 69.3% (18 mo), and 73.9% (24 mo), while off medication scores showed reductions ranging from 24.7% at 6 mo to 55.1% at 24 mo. Other measures, including Hoehn-Yahr staging, Activities of Daily Living, and dyskinesia rating scales, were also significantly improved following fetal transplants. Timed motor tasks (finger dexterity, supination-pronation, foot tapping, and Stand-Walk-Sit) performance also demonstrated highly significant improvements. Patient's self-rating scores indicated that the patients typically perceived substantial improvements in their condition. However, substantial variability in the improvements following surgery still persists and range from nominal improvements in performance to significant changes that can be classified as altering the overall lifestyle of the patients. To date, 4 of the 22 subjects were considered by the physicians to be nonresponders; that is, there were no clinically relevant improvements in these patients' conditions.

Activities of Daily Living↗

PubMed2004

Familial chondrodysplasia in Holstein calves.

After the release of a report from France on the occurrence of malformed calves genetically related to a Holstein sire, a study was performed to characterize the defect. Danish breeders were encouraged to submit defective progeny of the sire for laboratory examination. Four cases were submitted, whereas a fifth case was only reported. Lesions in affected calves were analogous, with disproportionate growth retardation characterized by fascial dysplasia and shortening of the vertebral column and the abaxial skeleton. Endochondral osteogenesis was disturbed with disorganization of epiphyseal plate chondrocytes, a lesion consistent with generalized chondrodysplasia. Based on morphology, the defect was grouped as a "Dexter bulldog type". A genetic etiology was suspected as cases occurred in a familial pattern. Genealogical evaluation revealed several common ancestors belonging to widely used breeding lines of US Holstein, but because of the extensive use of these sires, their presence in the pedigrees of affected calves might be accidental. Further studies are needed to determine the mode of inheritance.

Animals↗

PubMed2004

Robot-assisted neurosurgery.

Technological advances in the modern operating room have pushed neurosurgeons to the limits of their dexterity and stamina. Motion scalers and tremor filters on robots permit unprecedented precision of tool manipulation, upgrading the human hand, and closing the deftness deficit. The evolution of neurosurgical robots from stereotactic systems to hybrid systems capable of both stereotaxy and microsurgery is examined. The future of robot-assisted neurosurgery, including expanded tool sets and the prospect of semi-autonomous surgery, is discussed.

Humans↗

PubMed2004

Robot-assisted general surgery.

With the initiation of laparoscopic techniques in general surgery, we have seen a significant expansion of minimally invasive techniques in the last 16 years. More recently, robotic-assisted laparoscopy has moved into the general surgeon's armamentarium to address some of the shortcomings of laparoscopic surgery. AESOP (Computer Motion, Goleta, CA) addressed the issue of visualization as a robotic camera holder. With the introduction of the ZEUS robotic surgical system (Computer Motion), the ability to remotely operate laparoscopic instruments became a reality. US Food and Drug Administration approval in July 2000 of the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA) further defined the ability of a robotic-assist device to address limitations in laparoscopy. This includes a significant improvement in instrument dexterity, dampening of natural hand tremors, three-dimensional visualization, ergonomics, and camera stability. As experience with robotic technology increased and its applications to advanced laparoscopic procedures have become more understood, more procedures have been performed with robotic assistance. Numerous studies have shown equivalent or improved patient outcomes when robotic-assist devices are used. Initially, robotic-assisted laparoscopic cholecystectomy was deemed safe, and now robotics has been shown to be safe in foregut procedures, including Nissen fundoplication, Heller myotomy, gastric banding procedures, and Roux-en-Y gastric bypass. These techniques have been extrapolated to solid-organ procedures (splenectomy, adrenalectomy, and pancreatic surgery) as well as robotic-assisted laparoscopic colectomy. In this chapter, we review the evolution of robotic technology and its applications in general surgical procedures.

Humans↗

PubMed2006

Cortical networks related to human use of tools.

Greater manual dexterity and greater conceptual knowledge of tool use represent two main features that distinguish humans from other primates. Studies of human brain lesions suggest that the left hemisphere (at least in right-handed people) includes a system for processing manual skills that is specialized for tool use that interacts with another system involved more with conceptualizing, planning, and accessing knowledge associated with tool use. Growing evidence from recent neuroimaging studies supports this organization, and studies have begun to highlight specific brain regions and pathways that may be necessary for tool use. This review compares and summarizes results from 64 paradigms published over the past decade that have examined cortical regions associated with tool use skills and tool knowledge. A meta-analysis revealed cortical networks in both hemispheres, though with a clear left hemisphere bias, which may be organized to optimally represent action knowledge. Portions of this network appear to represent part of a system that is tightly linked with language systems, which is discussed together with the effects that handedness may have on the cortical organization for tool use.

Cerebral Cortex↗

PubMed2001

A new test of memory for multiple sclerosis I: format development and stimuli design.

Memory tests were often developed for healthy populations. The accuracy of these measures is reduced when administered to patients with neurological diseases, who may experience physical and/or cognitive symptoms. Also, methodological factors, for example, spanning the ability spectrum, and content/format artefacts, may contribute to a decline in test precision. The aim of this study was to develop a new test of memory, which addresses these issues. The new memory test comprises assessments of recall, paired association, and recognition, at a Task Familiarisation stage and two difficulty levels, for both the verbal and spatial modalities. It was administered to 85 healthy individuals and 100 patients with multiple sclerosis (MS). All patients were able to attempt each task of the new assessment and there was no influence of visual integrity or manual dexterity on memory test performance, supporting the applicability of the tasks to patients with multiple sclerosis. Both the standardisation and validation samples demonstrated a wide range of scores on each section of the new test suggesting that the measure spanned an acceptably broad range of abilities. It seems probable, therefore, that the new assessment offers a more exact measure of verbal and spatial recall, paired association, and recognition memory.

Adult↗

PubMedDate not supplied

Cognitive impairments in multiple sclerosis: a review.

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS). Cognitive impairment (CI) may develop at any time during the course of the disease in the presence or absence of neurological disability. On the basis of comprehensive neuropsychological studies, there is now a consensus among investigators that 45 percent to 65 percent of MS patients suffer from some degree and form of cognitive difficulty. Features of CI include bradyphrenia; impaired attention, concentration and abstract reasoning; reduced manual speed and dexterity; deficits in memory retrieval; and language deficits in both the relapsing-remitting and progressive forms of MS. Impairments in all cognitive domains may result from the diffuse spread of microscopic pathology, although a preferential lobar distribution of plaques can present with a predominant deficit in the corresponding cognitive function. Nevertheless, the severity of CI best correlates with total microscopic and macroscopic disease burden of the brain as defined by recently developed magnetic resonance imaging (MRI) sequences. A disruption of connecting intercortical and subcortical pathways is likely to be the main cause of metabolic and functional abnormalities in neurons. However a direct toxic effect of soluble inflammatory products may also compromise neuronal function and survival. Early treatment of MS with interferons and copaxone can prevent or delay the onset of both neurological and cognitive disabilities by reducing the inflammatory activity and damage in the CNS. Until more powerful neuroprotective agents become available, simple neuropsychological screening and cognitive rehabilitation for memory and language impairments will remain important components in the care of MS patients.

Brain↗

PubMed2002

Electric toothbrushes--for whom are they designed?

Powered toothbrushes were first introduced on a large scale in the early 1960s. However, because of a clear lack of superiority compared with manual brushes, and problems with mechanical breakdowns, their sales decreased significantly. However, recommendation for their use continued in special populations with dexterity and cognition problems. The 1990s ushered in an era of new technology, and studies began to suggest superiority of some powered brushes, particularly those using oscillating-rotating or counter-rotational actions. Some studies have shown interproximal cleansing abilities superior to those of manual brushes and yielding results similar to those achieved with the use of a manual brush and floss. Both controlled and open-labeled studies have suggested that electric brushes improve gingival health with patients who routinely used manual brushes prior to using these new powered brushes, and safety has been clearly established. In recommending powered toothbrushes, practitioners should familiarize themselves with the products available, with the clinical studies supporting their benefits compared with manual brushes, their safety and ease of use, and the patient's economic status.

Child↗

PubMed2005

Modified constraint-induced therapy in acute stroke: a randomized controlled pilot study.

BACKGROUND AND PURPOSE: To determine modified constraint-induced therapy (mCIT) feasibility and compare its efficacy to traditional rehabilitation (TR) in acute stroke patients exhibiting upper limb hemiparesis. METHOD: Before-after, multiple baseline, randomized controlled pilot study. SETTING: Rehabilitation hospital. PATIENTS: Ten stroke patients < 14 d poststroke and exhibiting upper limb hemiparesis and affected limb nonuse. INTERVENTIONS: Five patients were administered mCIT, consisting of structured therapy emphasizing more affected arm use in valued activities 3 d/week for 10 weeks and less affected arm restraint 5 d/week for 5 h. Five other patients received 1/2 sessions of traditional motor rehabilitation for the affected arm, which included affected limb manual dexterity exercises and stretching, as well as compensatory strategies with the unaffected limb. The TR regimens occurred 3 d/week for 10 weeks. MAIN OUTCOME MEASURES: The Fugl-Meyer Assessment of Motor Recovery (Fugl-Meyer), Action Research Arm Test (ARA), and Motor Activity Log (MAL). RESULTS: Before intervention, all patients exhibited stable motor deficits and more affected arm nonuse. After intervention, mCIT patients displayed increased affected arm use (+ 2.43 on the MAL amount of use scale), uniformly exhibited increases on the Fugl-Meyer and ARA (mean change scores = + 18.7 and + 21.7, respectively), and were able to again perform valued activities. TR patients exhibited nominal change in affected limb use (+ 0.07 on the MAL amount of use scale) and modest changes on the Fugl-Meyer and ARA (+ 4.4 and + 4.8, respectively). Fugl-Meyer and ARA changes were significant for the mCIT group only (P < 0.01). CONCLUSIONS: mCIT is a promising regimen for improving more affected limb use and function in acute cerebrovascular accident. However, larger confirmatory studies need to be performed.

Acute Disease↗

PubMed2005

In vivo robotic laparoscopy.

Laparoscopy reduces patient trauma but limits the surgeon's ability to view or touch the surgical environment directly. The surgeon's ability to visualize and manipulate target organs can be improved using currently available external robotic systems. However, tool tip orientation and optimal camera placement remain limited because the robot instruments and cameras are still constrained by the entry incisions. Placing a robot completely within the abdominal cavity would provide an unconstrained platform that could provide an enhanced field of view from arbitrary angles and dexterous manipulators not constrained by the abdominal wall fulcrum effect. Several in vivo robots have been developed and successfully tested in a porcine model. These in vivo robots have been used to observe trocar and tool insertions and placement, and to provide additional camera angles that improved surgical visualization. Equipped with a grasper, such robots will provide task assistance. These in vivo robots will be much less expensive than the current generation of large external robotic surgical systems and will ultimately allow a surgeon to be a remote first responder irrespective of the location of the patient.

Animals↗

PubMedDate not supplied

Neuropsychological effects of occupational exposures to carbon disulfide and hydrogen sulfide.

In the framework of an extensive health survey of viscose rayon workers in Belgium, 187 workers underwent a neuropsychological examination. Of these, 120 had been exposed for at least a year to carbon disulfide (CS&inf2;) and hydrogen sulfide (H2S), and 67 served as a non-exposed control group. Measurements showed that many of the 17 jobs in the factory involved exposures to CS&inf2; ranging from 3 mg/m(3) (centrifuge operator) to 147 mg/m(3) (spinning cake regulator), far in excess of the threshold limit value (TLV) of 31 mg/m(3); H2S exposures remained below the recommended TLV of 14 mg/m(3). The neuropsychological investigation included subtests of the Wechsler Adult Intelligence Scale, the entire Wechsler Memory Scale, the Bourdon-Wiersma Test, the Santa Ana Dexterity Test, the Gibson Spiral Maze, and the Bimanual Sinusoidal Movement Test. Specific questions were included to account for the effects of age, educational level, eye complaints, alcohol consumption, medication intake, and test motivation. Only the group exposed to values exceeding three times the recommended TLV for CS2; had significant impairments in both the speed and the quality of psychomotor performance. Exposure to CS2; and H2S had no significant effect on memory and attention. Covariance analysis revealed the confounding influences of educational level and eye complaints for explaining observed "differences" in memory and attention tasks found by univariate analysis.

Adult↗

PubMed2004

Neuropsychologic changes from before transplantation to 1 year in patients receiving myeloablative allogeneic hematopoietic cell transplant.

Research indicates that myeloablative hematopoietic cell transplantation (HCT) impairs neurocognitive function. However, prospective studies on long-term effects are lacking. This longitudinal study examined neurocognitive changes over the first year in 142 adult recipients of allogeneic HC transplants who received neuropsychologic testing before transplantation and again after 80 days and 1 year. Age-, sex-, and education-adjusted population-based standardized scores were used for normative comparisons. Performance on all tests declined from before transplantation to 80 days (P < .05) and improved by 1 year (P < .05), returning to pretransplantation levels on all tests except for grip strength and motor dexterity. Although verbal fluency and memory recovered by 1 year, both were below norms at all 3 testing times (P < .01). Logistic regressions indicated that patients without chemotherapy, other than hydroxyurea, previous to HCT and patients not receiving chronic graft-versus-host disease (GVHD) medication at 1 year had lower risk of impaired function (P < .05). In conclusion, HCT was associated with significant generalized decline in neurocognitive performance at 80 days, with subsequent recovery to pretransplantation levels by 1 year for most survivors, except on motor tasks. Results indicate that long-term cognitive decrements, as distinct from motor disabilities, infrequently derive directly from HCT.

Adult↗

PubMed2001

An in vitro model of hematopoietic stem cell homing demonstrates rapid homing and maintenance of engraftable stem cells.

Hematopoietic stem cell (HSC) homing is believed to rely heavily on adhesion interactions between stem cells and stroma. An in vitro assay was developed for adhesion of engraftable HSCs in bone marrow suspensions to pre-established Dexter-type long-term bone marrow culture stromal layers. The cell numbers in the adherent layer and supernatant were examined, along with the engraftment capability of adherent layer cells to indicate the number of HSCs that homed to in vitro stroma. The cell number in the supernatant declined over the 24-hour period. The number of test cells adhering to the stromal layer increased during the first hour and then fell at 6 and 24 hours. The number of test HSCs adhering to the stromal layer was substantial at 20 minutes, increased during the first hour, and then remained constant at 1, 6, and 24 hours of adhesion. These data indicate that adhesion of engraftable HSCs occurs quickly and increases during the first hour of contact with pre-established stroma, that adhesion plateaus within 1 hour of contact, and that HSCs maintain their engraftment capability for at least 24 hours of stromal adhesion. Long-term engraftment from test cells at more than 1 hour of adhesion represents 70.7% of the predicted engraftment from equivalent numbers of unmanipulated marrow cells, indicating that 2 of 3 test engraftable HSCs adhered. These findings demonstrate the usefulness of this model system for studying stem-stromal adhesion, allowing further dissection of the mechanism of HSC homing and exploration of possible manipulations of the process. (Blood. 2001;98:1012-1018)

Animals↗

PubMed2003

Low level methylmercury exposure affects neuropsychological function in adults.

BACKGROUND: The neurotoxic effects of methylmercury (MeHg) have been demonstrated in both human and animal studies. Both adult and fetal brains are susceptible to the effects of MeHg toxicity. However, the specific effects of adult exposures have been less well-documented than those of children with prenatal exposures. This is largely because few studies of MeHg exposures in adults have used sensitive neurological endpoints. The present study reports on the results of neuropsychological testing and hair mercury concentrations in adults (>17 yrs) living in fishing communities of Baixada Cuiabana (Mato Grosso) in the Pantanal region of Brazil. METHODS: A cross-sectional study was conducted in six villages on the Cuiaba River. Participants included 129 men and women older than 17 years of age. They were randomly selected in proportion to the age range and number of inhabitants in each village. Questionnaire information was collected on demographic variables, including education, occupation, and residence history. Mercury exposure was determined by analysis of hair using flameless atomic absorption spectrophotometry. The neurocognitive screening battery included tests from the Wechsler Memory Scale and the Wechsler Adult Intelligence Scale, Concentrated Attention Test of the Toulouse-Pierron Factorial Battery, the Manual Ability Subtests of the Tests of Mechanical Ability, and the Profile of Mood States. RESULTS: Mercury exposures in this population were associated with fish consumption. The hair mercury concentration in the 129 subjects ranged from 0.56 to 13.6 microg/g; the mean concentration was 4.2 +/- 2.4 micrograms/g and the median was 3.7 microg/g. Hair mercury levels were associated with detectable alterations in performance on tests of fine motor speed and dexterity, and concentration. Some aspects of verbal learning and memory were also disrupted by mercury exposure. The magnitude of the effects increased with hair mercury concentration, consistent with a dose-dependent effect. CONCLUSIONS: This study suggests that adults exposed to MeHg may be at risk for deficits in neurocognitive function. The functions disrupted in adults, namely attention, fine-motor function and verbal memory, are similar to some of those previously reported in children with prenatal exposures.

Adult↗

PubMed2005

Use of the femoral vein ('groin injecting') by a sample of needle exchange clients in Bristol, UK.

BACKGROUND: Use of the femoral vein for intravenous access by injecting drug users (IDUs) (commonly called 'groin injecting') is a practice that is often observed but on which little is written in the literature. The purpose of this study was to describe self-reported data from a sample of groin injectors on the natural history and rationale regarding their groin injecting, to inform future research and the development of appropriate harm reduction strategies. METHODS: A convenience sample of groin injectors willing to participate in a semi-structured interview were recruited through the Bristol Drugs Project Harm Reduction Service. The interviews were conducted over the period of one week. Data on transition to groin injecting, rationale for use and incidence of problems were collected. RESULTS: Forty seven IDUs currently injecting in their femoral vein ('groin') were interviewed, 66% (n = 31) male and 34% (n = 16) female. Their mean age was 31 yrs (range 17 to 50 yrs; SD = 7.7). The mean length of time since first injecting episode was 9.6 yrs (range 6 mths to 30 yrs; SD = 7.0). The mean length of time since use of the groin began was 2.6 years (range 1 mth to 15 yrs; SD = 3.3). The mean length of time between first injection and first use of the groin was 7.0 yrs (SD = 7.0). One person had used no other area for venous access prior to using the groin, nine people had used one, nine people had used two, 10 people had used three, five people had used four and 13 people had used more than four areas. The main reason given for starting to inject in the groin was that 'no other sites were left'. However further discussion identified this meant no other convenient sites were accessible. Practises such as the rotation of injecting sites, as advocated in many harm reduction leaflets, were reported to be difficult and unreliable. The risk of missing the vein and subsequently losing the 'hit' was considered high. Use of the non-dominant hand to administer injections was problematic and deterred rotation between arms. The groin site was reported to be convenient, provide quick access, with little mess and less pain than smaller more awkward veins. The formation of sinuses over time facilitated continued use of the groin. Approximately two thirds of participants had experienced difficulty gaining IV access at their groin. Common problem included scar tissue occlusion, swelling and pain. Some reported infections and past history of deep vein thrombosis. CONCLUSION: Use of the groin was perceived to be convenient by the study group. Problems following safer injecting advice were identified, including dexterity difficulties leading to fear of losing the 'hit'. Health problems at the groin site did not deter use. These results suggest further qualitative work is needed to explore the difficulties in following safer injecting advice in more detail and inform the development of more appropriate advice. Further quantitative work is necessary to establish the prevalence of groin injecting amongst IDUs and the incidence of associated problems. There is a need for a longitudinal study to examine the relationship between injecting technique and loss of patency of veins. If protective factors could be identified, evidence-based safer injecting advice could be established to preserve peripheral veins and reduce use of the groin site, which is high risk and associated with serious adverse consequences.

Journal Article↗

PubMed2006

Health-related quality of life of Canadian children and youth prenatally exposed to alcohol.

BACKGROUND: In Canada, the incidence of Fetal Alcohol Spectrum Disorder (FASD) has been estimated to be 1 in 100 live births. Caused by prenatal exposure to alcohol, FASD is the leading cause of neuro-developmental disabilities among Canadian children, and youth. OBJECTIVE: To measure the health-related quality of life (HRQL) of Canadian children and youth diagnosed with FASD. METHODS: A prospective cross-sectional study design was used. One-hundred and twenty-six (126) children and youth diagnosed with FASD, aged 8 to 21 years, living in urban and rural communities throughout Canada participated in the study. Participants completed the Health Utilities Index Mark 3 (HUI3). HUI3 measures eight health attributes: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain. Utilities were used to measure a single cardinal value between 0 and 1.0 (0 = all-worst health state; 1 = perfect health) to reflect the global HRQL for that child. Mean HRQL scores and range of scores of children and youth with FASD were calculated. A one-sample t-test was used to compare mean HRQL scores of children and youth with FASD to those from the Canadian population. RESULTS: Mean HRQL score of children and youth with FASD was 0.47 (95% CI: 0.42 to 0.52) as compared to a mean score of 0.93 (95% CI: 0.92 to 0.94) in those from the general Canadian population (p < 0.001). Children demonstrated moderate to severe dysfunction on the single-attributes of cognition and emotion. CONCLUSION: Children and youth with FASD have significantly lower HRQL than children and youth from the general Canadian population. This finding has significant implications for practice, policy development, and research.

Adolescent↗