Search

Background: Predicting breast tissue motion using biomechanical models can provide navigational guidance during breast cancer treatment procedures. These models typically do not account for changes in posture between procedures. Difference in shoulder position can alter the shape of the pectoral muscles and breast. A greater understanding of the differences in the shoulder orientation between prone and supine could improve the accuracy of breast biomechanical models., Methods: 19 landmarks were placed on the sternum, clavicle, scapula, and humerus of the shoulder girdle in prone and supine breast MRIs (N = 10). These landmarks were used in an optimization framework to fit subject-specific skeletal models and compare joint angles of the shoulder girdle between these positions., Findings: The mean Euclidean distance between joint locations from the fitted skeletal model and the manually identified joint locations was 15.7 mm ± 2.7 mm. Significant differences were observed between prone and supine. Compared to supine position, the shoulder girdle in the prone position had the lateral end of the clavicle in more anterior translation (i.e., scapula more protracted) (P < 0.05), the scapula in more protraction (P < 0.01), the scapula in more upward rotation (associated with humerus elevation) (P < 0.05); and the humerus more elevated (P < 0.05) for both the left and right sides., Interpretation: Shoulder girdle orientation was found to be different between prone and supine. These differences would affect the shape of multiple pectoral muscles, which would affect breast shape and the accuracy of biomechanical models., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Female athletes exhibit greater rates of anterior cruciate ligament injury compared with male athletes. Biomechanical factors are suggested to contribute to sex differences in injury rates. No previous investigation has evaluated the role of breast support on landing biomechanics. This study investigates the effect of breast support on joint negative work and joint contributions to total negative work during landing. Thirty-five female athletes performed 5 landing trials in 3 breast support conditions. Lower-extremity joint negative work and relative joint contributions to total negative work were calculated. Univariate analyses of variance were used to determine the effect of breast support on negative joint work values. Increasing levels of breast support were associated with lower ankle negative work (P < .001) and ankle relative contributions (P < .001) and increases in hip negative work (P = .008) and hip relative contributions (P < .001). No changes were observed in total negative work (P = .759), knee negative work (P = .059), or knee contributions to negative work (P = .094). These data demonstrate that the level of breast support affects lower-extremity biomechanics. The distal-to-proximal shift in negative joint work and relative joint contributions may be indicative of a more protective landing strategy for anterior cruciate ligament injuries.

This paper examines the daily practices of caring for COVID-19 patients in Wuhan, China, in early 2020 and the challenges that nurses faced. The paper shows that the affective contagion, especially among patients, introduced unexpected challenges for nurses in caring for COVID-19-infected patients. Nurses had to contend with the challenges of treating both physical and psychological problems in patients simultaneously. As a result, it was necessary for nurses to adapt to the different rhythm of COVID-19 wards to address these challenges and do so through taking on a range of general and specific nursing tasks and playing a diverse range of roles on the wards, from garbage collector to "psychological counselor." Thus, the paper brings attention to the experiences and demands of providing nursing care in an emergency pandemic context, in particular the necessity of responding to both the physical and the psychological needs of patients. These insights could better prepare health services in China and elsewhere in the world for responding effectively to potential future pandemics., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Polish people are the biggest migrant group in the UK and the scholarship shows that they are attentive to their healthcare needs and seek to fulfil them by using various services both within and outside the British public healthcare system. This article explores the role of junctures within healthcare systems in the connections migrants realize between healthcare systems and sectors. The article argues that in a transnational context, migrants enact these junctures by joining different levels of care within the same sector, between sectors and across national borders. In particular, the article explores how Polish migrants' healthcare seeking practices within and beyond national borders are enacted given the features, availability and relationship between primary and specialist care for how they are articulated between private and public sectors., Methods: This article is based on the second phase of a mixed-methods study on how Polish people in the UK manage their health transnationally. The participants were purposefully sampled from survey respondents (first phase) who identified as having a long-term health condition or caring in a non-professional capacity for someone who is chronically ill. Thirty-two semi-structured audio-call interviews were conducted with Polish migrants living in England between June and August 2020. Transcripts were analysed by applying thematic coding., Results: Key findings include a mix of dissatisfaction and satisfaction with primary care and general satisfaction with specialist care. Coping strategies consisting in reaching specialist private healthcare provided a way to access specialist care at all or additionally, or to partially complement primary care. When Polish private specialists are preferred, this is due to participants' availability of time and financial resources, and to the specialists' capacity to fulfil needs unmet within the public healthcare sector in the UK., Conclusion: Polish migrants join with their practices systems which are not integrated, and their access is limited by the constraints implied in accessing paid services in Poland. This shapes transnational healthcare practices as relating mostly to routine and ad-hoc access to healthcare. These practices impact not only the wellbeing of migrants and the development of the private market but also the public health provision of services., (© 2022. The Author(s).)

Objective: The female breast is a passive tissue with little intrinsic support. Therefore, women rely on external breast support (sports bras) to control breast motion during athletic tasks. Research has demonstrated that lower levels of breast support are associated with altered trunk and pelvis movement patterns during running, a common athletic task. However, no previous study has identified the effect of sports bra support on movement patterns during other athletic tasks including landing. Therefore, the purpose of this study was to examine the effects of breast support on trunk and knee joint biomechanics in female collegiate athletes during a double-leg landing task., Methods: Fourteen female collegiate athletes completed five double-leg landing trials in each of three different sports bra conditions: no support, low support, and high support. A 10-camera motion capture system (250 Hz, Qualisys, Goteburg, Sweden) and two force platforms (1,250 Hz, AMTI, Watertown, MA, USA) were used to collect three-dimensional kinematics and ground reaction forces simultaneously. Visual 3D was used to calculate trunk segment and knee joint angles and moments. Custom software (MATLAB 2021a) was used to determine discrete values of dependent variables including vertical breast displacement, knee joint and trunk segment angles at initial contact and 100 ms post-initial contact, and peak knee joint moments. A repeated measures analysis of covariance with post-hoc paired samples t -tests were used to evaluate the effect of breast support on landing biomechanics., Results: Increasing levels of breast support were associated with reductions in peak knee flexion (Right: p = 0.008; Left: p = 0.029) and peak knee valgus angles (Right: p = 0.011; Left: p = 0.003) as well as reductions in peak knee valgus moments (Right: p = 0.033; Left: p = 0.013). There were no changes in peak knee extension moments (Right: p = 0.216; Left: p = 0.261). Increasing levels of breast support were associated with greater trunk flexion angles at initial contact ( p = 0.024) and greater peak trunk flexion angles ( p = 0.002)., Conclusions: Lower levels of breast support are associated with knee joint and trunk biomechanical profiles suggested to increase ACL injury risk., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Fong, Nelson, Storey, Hinton, Puppa, McGhee, Greenwood and Powell.)

While diagnostic tests are a fundamental component of contemporary medical practice they are seldom considered in studies of transnational healthcare. This article investigates the little-studied role played by diagnostic testing in the healthcare-seeking practices of migrants. It is concerned with the experiences of Polish migrants living in the UK and who access a variety of health services in their host and origin countries across the public and private sectors. We analyse data from semi-structured phone interviews conducted in 2020 with 32 adult Poles living in the UK who identified as having themselves, or non-professionally caring for someone with, a long-term health condition. The article contributes to the literature on migrants' transnational healthcare practices by showing the centrality of diagnostic technology in their health management and sense-making through the creation, modification, and maintenance of 'transnational social fields' (Levitt and Schiller 2004). By emphasizing the role of tests in the patient-doctor relationship the article exposes the therapeutic outcomes of the mobilities of patients and tests as they intersect with physicians in multiple medical encounters., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors. Published by Elsevier Ltd.)

Objective: To determine whether screening tests of upper body, trunk region, and of whole-body function could prospectively identify community AFL players who sustain in-season shoulder/head/neck injuries. Additionally, to present screening test reference values., Design: Prospective cohort; SETTING: Community sport; PARTICIPANTS: 142 male community AFL players (range 15-37 years)., Main Outcome Measures: (i) isometric shoulder external and internal rotation (ER/IR) strength; (ii) upper body combined elevation functional ROM; (iii/iv) whole-body functional jump ROM; (v) static thoracic spine angle; (vi) cervical joint proprioception, and (vii) trunk muscle size and function. Results were compared among players with (n = 21) and without (n = 121) an in-season shoulder, head, or neck injury. ROC analysis and odds ratios were used to determine the predictive values., Results: Two screening tests predicted an in-season shoulder, head, or neck injury; dominant and non-dominant isometric ER strength (AUC 0.629, 95%CI 0.51-0.74; optimal cut point 182 N and AUC 0.619, 95%CI 0.50-0.74; optimal cut point 184 N, respectively). The adjusted odds ratio for the strongest predictor: dominant ER muscle strength was 6.02 (95%CI 1.8-19.9)., Conclusion: Greater ER strength was associated with in-season shoulder/head/neck injuries in community AFL players; however, further research is required to determine the clinical significance of this finding., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

This paper examines the emergence of the role of "moral doctors" who volunteer in what are called "moral clinics" in Huzhou city. In these moral clinics, the characteristics, experiences, and attributes of older women, in particular, are highly valued and viewed as being essential to the role of the moral doctor. These moral doctors act as moral exemplars and conflict mediators in their local communities. Their moral capital and professionalism, combined with their gender, age, familial and neighborhood attributes, contribute to the accumulation of an affective feminized labor which employs the techniques of care, reason, and moral fortitude to govern the self and others. We unpack these ethical virtues exemplified by moral doctors and nurses in order to show how a female-centric "ethic of care" can become a set of techniques in governing others. In this paper, we elaborate on the role that these moral doctors perform to support the aims of the moral clinics in terms of fostering pro-social behavior and moral obligation in local communities. We argue that the performance of this type of "moral work" is both a mechanism of discipline and a process of self-actualization. We contribute to the current literature on "therapeutic governance" in China by showing how the non-expert medicalization of social ills by moral doctors is incorporated into the reproduction of social control., (© 2020 London School of Economics and Political Science.)

This article examines the narrative strategies through which Polish migrants in the UK challenge the formal rights of political membership and attempt to redefine the boundaries of 'citizenship' along notions of deservedness. The analysed qualitative data originate from an online survey conducted in the months before the 2016 EU referendum, and the narratives emerge from the open-text answers to two survey questions concerning attitudes towards the referendum and the exclusion of resident EU nationals from the electoral process. The analysis identifies and describes three narrative strategies in reaction to the public discourses surrounding the EU referendum - namely discursive complicity, intergroup hostility and defensive assertiveness - which attempt to redefine the conditions of membership in Britain's 'ethical community' in respect to welfare practices. Examining these processes simultaneously 'from below' and 'from outside' the national political community, the paper argues, can reveal more of the transformation taking place in conceptions of citizenship at the sociological level, and the article aims to identify the contours of a 'neoliberal communitarian citizenship' as internalized by mobile EU citizens., (© London School of Economics and Political Science 2018.)

Objective: To investigate mechanisms of shoulder girdle injuries and their impact on players from the Australian Football League (AFL)., Design: Retrospective video analysis., Methods: Two experienced sports physiotherapists (>10years) examined video footage of shoulder complex injuries that occurred in the 2015 premiership season. Information obtained from video footage included activity prior to injury; mechanism of injury; arm, head and neck position and point of body contact at the time of injury. Player demographics and injury characteristics were obtained from club and media data., Results: The most common mechanism of injury was lateral contact (34.6%) followed by hyperflexion/ abduction of the shoulder (19.2%). Glenohumeral joint (GHJ) dislocations and subluxations were the most frequent diagnosis for all mechanisms of injury, and occurred in a variety of shoulder positions. Over 80% of injuries occurred with the arm below 100° of shoulder flexion or abduction. The most common activity prior to injury was 'ball in dispute' (34.6%). Lateral contact injuries had the highest overall severity (two-thirds of players missed >3 games) and over 50% of shoulder injuries required surgery. Players missed on average 5.1 season games due to shoulder injury., Conclusion: The lateral contact mechanism was the most common and severe mechanism of shoulder injury. Improved understanding of shoulder girdle injury mechanisms can help guide the use of preventative strategies and injury management programs in elite AFL players., (Copyright © 2019 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: Simple, robust, sensitive and clinically meaningful outcome measures are required for neuroprotective trials in Parkinson's disease (PD). We explored the feasibility of a composite binary outcome measure, 'dead or dependent', in such trials using data from a prospective follow-up study of an incident cohort of PD patients., Methods: Two hundred incident patients had an annual follow-up, including assessment of the Hoehn-Yahr stage (H-Y) and Schwab and England Activities of Daily Living Scale (S&E). Annual scores were converted into binary variables (H-Y <3 vs H-Y ≥3, and S&E ≥80% vs S&E <80%). A new outcome of 'dead or dependent' was also created, with dependence in activities of daily living defined as S&E <80%. Using these data, sample sizes were calculated for a hypothetical three-year randomised trial in which the trial outcome was defined by a binary clinical variable, all-cause mortality, or PD-related mortality., Results: At 3 years, 18.0% of patients were dead and 38.4% were dead or dependent. At 80% power, large sample sizes were required if PD-related mortality (n=1938 per study arm) or all-cause mortality (n=734) were used as the outcome, even for large treatment effects (30% reduction in relative risk). The new outcome of 'death or dependency' required the smallest sample sizes of all the outcome measures (n=277 for 30% reduction in relative risk, 627 for a 20% reduction)., Conclusions: 'Death or dependency' is a feasible and potentially useful outcome measure in PD trials of neuroprotective agents, but further work is required to validate its use and define dependency., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

This study investigated the effect of precision on time to task failure in a repetitive whole-body manual handling task. Twelve participants were required to repetitively lift a box weighing 65% of their single repetition maximum to shoulder height using either precise or unconstrained box placement. Muscle activity, forces exerted at the ground, 2D body kinematics, box acceleration and psychophysical measures of performance were recorded until task failure was reached. With precision, time to task failure for repetitive lifting was reduced by 72%, whereas the duration taken to complete a single lift and anterior deltoid muscle activation increased by 39% and 25%, respectively. Yet, no significant difference was observed in ratings of perceived exertion or heart rate at task failure. In conclusion, our results suggest that when accuracy is a characteristic of a repetitive manual handling task, physical work capacity will decline markedly., Practitioner Summary: The capacity to lift repetitively to shoulder height was reduced by 72% when increased accuracy was required to place a box upon a shelf. Lifting strategy and muscle activity were also modified, confirming practitioners should take into consideration movement precision when evaluating the demands of repetitive manual handling tasks.

Objectives: The purpose of this study was to determine the relationships among passive measures of weight-bearing dorsiflexion range of motion, non-weight-bearing dorsiflexion range of motion and dorsiflexion stiffness, thereby establishing whether they assess similar mechanical characteristics, as each measure has been implicated in injury risk during landings., Design: Cross-sectional study., Methods: Passive weight-bearing dorsiflexion range of motion, non-weight-bearing dorsiflexion range of motion and dorsiflexion stiffness were quantified for 42 males (22.8±5.0 years). The relationship between each data set was calculated using Pearson product-moment correlation coefficients., Results: Although weight-bearing dorsiflexion range of motion and non-weight-bearing dorsiflexion range of motion were significantly correlated, the strength of the relationship was poor (r(2)=0.18; p=0.004). Weight-bearing dorsiflexion range of motion (mean=43.0±5.0°) was significantly greater than non-weight-bearing dorsiflexion range of motion (29.8±5.9°; p<0.001) and weight-bearing dorsiflexion range of motion and non-weight-bearing dorsiflexion range of motion were also poorly correlated with passive dorsiflexion stiffness (1.48±0.55Nm°(-1); r(2)=0.04 and r(2)=0.14, respectively), despite the latter relationship being significant (p=0.017)., Conclusions: Passive dorsiflexion stiffness was not strongly associated with dorsiflexion range of motion, despite the significant correlation in the non-weight-bearing condition. It must be acknowledged that passive dorsiflexion stiffness was weakly associated with dorsiflexion range of motion, although the strength of the association suggests that it may not necessarily determine dorsiflexion range of motion. Furthermore, the functional dorsiflexion limits of the ankle during weight-bearing tasks may be underestimated or misrepresented by non-weight-bearing measures of dorsiflexion range of motion. Therefore, although ankle dorsiflexion range of motion and dorsiflexion stiffness have been implicated in injury risk during weight-bearing tasks such as landings, it may be due to different mechanisms., (Copyright © 2012 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objectives: Vertical landing tasks strain the Achilles tendon and plantar-flexors, increasing acute and overuse strain injury risk. This study aimed to determine how passive ankle dorsiflexion stiffness affected ankle mechanics during single limb drop landings at different vertical descent velocities., Design: Cross-sectional study., Methods: Passive ankle dorsiflexion stiffness and passive weight-bearing dorsiflexion range of motion (DROM) were quantified for 42 men. Participants were then grouped as having low (LPS: 0.94±0.15 Nm°⁻¹; n=16) or high (HPS: 2.05±0.36 Nm°⁻¹; n=16; p<0.001) passive ankle dorsiflexion stiffness. Three-dimensional ankle joint kinematics was quantified while participants performed drop landings onto a force platform at two vertical descent velocities (slow: 2.25±0.16 ms⁻¹; fast: 3.21±0.17 ms⁻¹)., Results: Although affected by landing velocity, there were no significant effects of passive ankle dorsiflexion stiffness, nor any significant ankle dorsiflexion stiffness×vertical descent velocity interactions on any outcome variables characterising ankle mechanics during drop landings. Furthermore, there was no significant difference between the groups for passive weight-bearing DROM (LPS: 43.9±4.1°; HPS: 42.5±5.7°), indicating that the results were not confounded by between-group differences in ankle range of motion., Conclusions: Neither high nor low passive ankle dorsiflexion stiffness was found to influence ankle biomechanics during drop landings at different descent velocities. Landing strategies were moderated more by the demands of the task than by passive ankle dorsiflexion stiffness, indicating that passive ankle dorsiflexion stiffness may not affect plantar-flexor strain during a drop landing., (Copyright © 2012 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

  Many modern foam wound dressings possess a variety of attributes that are designed to create a supportive wound-healing environment. These attributes include absorbing exudate, providing optimum moisture balance at the wound surface, and preventing maceration of surrounding tissue. However, studies suggest that controlling wound bioburden should also be targeted when developing wound therapeutics. Thus, traditional foam dressings may absorb a copious amount of fluid, but may also provide an environment where microbes can grow unchallenged, leading to an increase in wound bioburden. However, antimicrobial foam dressings may prevent or reduce microbial growth, increasing the potential for wound healing. Studies reported herein evaluated the efficacy of 0.5% polyhexamethylene biguanide (PHMB) treated dressings to prevent the growth of methicillin-resistant Staphylococcus aureus (MRSA). An antimicrobial foam (Kendall™ AMD, Covidien, Mansfield, MA), which contains PHMB and a standard foam dressing (Copa™, Covidien, Mansfield, MA), which contains no PHMB (control), were directly inoculated with clinical isolate of MRSA and placed on a growth medium for selected time intervals. The presence or absence of microbial growth was quantified using plate counts and was visually assessed using scanning electron microscopy. At all time points, the antimicrobial foam dressing significantly reduced the MRSA growth compared to the control dressing. Similar results were also obtained in the microscopic evaluations. .

Phialocephala urceolata sp. nov. was isolated from a black film that had developed on a water-soluble proprietary heparin solution (pH 2.5). Morphological and enzymatic characters, along with phylogenetic analyses of rDNA sequence data, indicated that the conidial fungus is closely related to species of Phialocephala known primarily as endophytes in the roots of vascular plants (e.g., Acephala applanata, P. fortinii and P. sphaeroides) or as associates of persistent plant organs such as the stems and needles of woody plants (e.g., P. compacta, P. dimorphospora and P. scopiformis). Phialocephala urceolata is distinctive in having urn-shaped phialides that are sparsely distributed along the conidiophore axis, a slow growth rate in culture and in exhibiting a unique combination of reactions on enzymatic test media (i.e., it acidifies casamino acids medium and is gelatinase negative). Partial sequence data from the small subunit (SSU) rDNA indicated that P. urceolata is among the Helotiales and close to the type species of Phialocephala. Sequence data from the internal transcribed spacer (ITS) region places P. urceolata closest to P. sphaeroides. The source of this contaminant is unknown but its taxonomic relationship with other root endophytic species and its ability to produce polyphenol oxidases suggest that the natural habitat of this species is possibly woody plant tissues or soil enriched with lignocellulose.

Background: Crystal methamphetamine (MA) is a powerful, highly addictive central nervous stimulant that can cause serious health consequences including neurotoxicity, paranoia, psychosis, depression, violence, and death. The objective of this study is to assess the prevalence and characteristics of MA use among two marginalized populations of youth (less than 30 years of age) in British Columbia., Methods: A self-administered questionnaire was administered to a convenience sample of Vancouver street-involved youth (SY) and Lesbian/Gay/Bisexual/Transgender/Questioning (LGBTQ) centre youth in Vancouver and Victoria. Items measured include: participants' demographic characteristics; illicit substance use, including details of MA use; attempts at recovery and treatment; and potential consequences of MA use., Results: One hundred and eighty of the 200 questionnaires distributed were completed. Sixty-seven percent of the SY and 24% of the LGBTQ youth reported ever having used MA. Of these: 43% had used within the last week; 46-57% used multiple times per day in their lifetime; they spent a maximum of 7-9 consecutive days awake; they began use in their middle to late teens; and half had sought help for a substance use disorder. SY who used MA within the last week were more likely to also use marijuana, cigarettes, heroin, ecstasy, and ketamine. Previous use of MA was associated with reports of auditory hallucinations., Conclusion: The current study demonstrates a high prevalence of MA use in two marginalized populations of youth. Use in sexual minorities, resulting psychopathology, and concurrent substance use all have important implications in delivery of service, prevention, and subsequent research.

This paper examines two significant moments in sexual minority citizenship in England and Wales in relation to one of the Marshallian sets of rights, namely, civil or legal rights, focusing specifically on the Sex Offences legislation and policing practices. The first moment that will be examined here is the process whereby homosexual acts were decriminalized in the 1950s and 1960s; here special attention will be paid to the recommendations made by the Wolfenden Committee. The second moment is one we are currently experiencing, which is associated with the inclusive policing of sexual minority communities (especially lesbian, gay, bisexual and transgender communities) under the provisions of the Crime and Disorder Act 1998 and in the review of Sex Offences, especially in the consultation paper (Home Office 2000) and White Paper (Home Office 2002) associated with this review. Privacy and toleration dominate the first moment, at the same time it shall be demonstrated that privacy is also central to the British Sexual Citizenship literatures that have emerged in sociology in the post-Wolfenden context. However, as the title suggests, the second moment under examination points to the emergence of a rather more extensive sexual minority citizenship beyond the boundaries of 'homosexual privacy' (which British Sexual Citizenship Studies is not currently engaging with) and perhaps even beyond the boundaries of toleration through ever more 'inclusive' policing strategies and through the review of sex offences in which many discriminatory laws are being 'de-homosexualized'.

An implicit association test (IAT) measures differential association of 2 target concepts with an attribute. The 2 concepts appear in a 2-choice task (2-choice task (e.g., flower vs. insect names), and the attribute in a 2nd task (e.g., pleasant vs. unpleasant words for an evaluation attribute). When instructions oblige highly associated categories (e.g., flower + pleasant) to share a response key, performance is faster than when less associated categories (e.g., insect & pleasant) share a key. This performance difference implicitly measures differential association of the 2 concepts with the attribute. In 3 experiments, the IAT was sensitive to (a) near-universal evaluative differences (e.g., flower vs. insect), (b) expected individual differences in evaluative associations (Japanese + pleasant vs. Korean + pleasant for Japanese vs. Korean subjects), and (c) consciously disavowed evaluative differences (Black + pleasant vs. White + pleasant for self-described unprejudiced White subjects).

Twenty-eight children took part in a double-blind, placebo-controlled, crossover study of fenfluramine and methylphenidate. Fenfluramine dosage was gradually increased to a standardized dose of 1.5 mg/kg per day, whereas methylphenidate was given in doses of 0.4 mg/kg per day. The children were assessed on laboratory tests of selective and sustained attention, visual matching, and color matching, during which seat activity was monitored automatically. Results showed fenfluramine to be superior to placebo on the memory task, whereas methylphenidate reduced commission errors on a continuous performance test. Methylphenidate caused shorter response times, and fenfluramine caused increases, on two of the tests. Examiner behavior ratings indicated significant improvements with both drugs on the domains of attention, activity level, and mood. These findings, together with those from a companion clinical study, suggest that the drugs may have contrasting mechanisms of action, but both appear to have useful clinical effects in these children.

Each of 28 nonautistic children with attention-deficit hyperactivity disorder and mental retardation received placebo, methylphenidate (0.4 mg/kg/day), and fenfluramine (gradually increased to 1.5 mg/kg/day) for 4 weeks each in a double-blind, crossover design. Teacher ratings indicated significant improvements with both active drugs on subscales designated as Conduct Problem, Hyperactivity, and Irritability, but methylphenidate alone produced improvements on an Inattention subscale. Parent ratings indicated significant improvements with both drugs on subscales labeled Hyperactivity, Motor Excess, and Conduct Problem. Fenfluramine alone caused improved parent ratings on Irritability and Inappropriate Speech, and on Conners' Abbreviated Symptom Questionnaire. Unlike a previous study, subgroup analyses failed to show a significantly better clinical response to methylphenidate for subjects with higher mental ages, although children with higher IQs responded better than those with IQs less than 45. The active drugs had contrasting effects on heart rate and blood pressure. Fenfluramine caused significant weight reductions relative to both placebo and methylphenidate. These findings suggest that both methylphenidate and fenfluramine have useful, but somewhat different, clinical effects in certain children with attention-deficit hyperactivity disorder and mental retardation.

We present an unusual patient with a medical history of a fibrosing pseudotumor of the left orbit that had been stable for 8 years who presented with acute anterior hypophyseal failure. During the next 10-month period, sequential magnetic resonance scans showed a rapid growth of a plaque-like sellar and parasellar mass extending into the right cavernous sinus, right Meckel's cave, along the dural surfaces of the clivus, dens, and body of the second cervical vertebra. A transsphenoidal biopsy revealed sphenoid and intrasellar pseudotumor that invaded the adenohypophysis and had microscopic features identical to those of the previously excised orbital pseudotumor. Rapid growth of the pseudotumor continued despite a course of radiotherapy. Palsies of cranial nerves V and VI and of the sensory root of the cranial nerve VII developed on the right side. Steroid therapy was associated with improvement of the cranial nerve palsies. This is the first report of the sellar fibrosing pseudotumor producing not only anterior hypophyseal failure, but also cranial nerve dysfunction secondary to plaque-like extension into the cavernous sinus, Meckel's cave, and cranial base dura. This intracranial plaque-like extension of a fibrous pseudotumor corresponds to a hypertrophic intracranial pachymeningitis, which is a rare, previously described phenomenon associated to the syndrome of multifocal fibrosclerosis.

Many patients want more information about health and the computer offers tremendous potential for interactive patient education. However, patient education and the provision of information to patients will be most effective if it can be tailored to the individual patient by linkage to the medical record. Furthermore the Data Protection Act requires that patients can have access to explained versions of their computer-held medical record. We have examined the practicality and possible benefits of giving patients on-line access to their medical records in general practice. Seventy patients (20 males; 50 females) took part in the study. Sixty five of these used the computer to obtain information. The section on medical history was most popular, with 52 people accessing it. More than one in four of the problems were not understood until the further explanation screen had been seen. One in four also queried items or thought that something was incorrect. Most patients obviously enjoyed the opportunity to use the computer to see their own medical record and talk to the researcher. Many patients commented that because the General Practitioner (GP) didn't have enough time, the computer would be useful. Sixty one (87%) (95% CI: 79-95%) thought the computer easy to use and 59 (84%) would use it again. This is despite the fact that 43 (61%) thought they obtained enough information from their GP. This small study has shown that patients find this computer interface easy to use, and would use the computer to look at explanations of their medical record if it was routinely available.(ABSTRACT TRUNCATED AT 250 WORDS)