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Biomedical subjects

D B Wexler

Publications and source records attributed to D B Wexler.

At least 19 recordsLinked to original sources
PubMed1999

The broken mirror. A self psychological treatment perspective for relationship violence.

Clinicians face formidable challenges in working with male perpetrators of domestic violence. Many treatment programs use a confrontational approach that emphasizes male entitlement and patriarchal societal attitudes, without honoring the genuine psychological pain of the abusive male. Although some men with strong psychopathic tendencies are almost impossible to treat, the majority of spouse-abusing males respond best to an empathic, client-centered, self psychological approach that also includes education about sociocultural issues and specific skill building. Understanding the deprivations in mirroring selfobject functions from which these men typically suffer facilitates clinical treatment response. While insisting that men take full responsibility for their abusive behavior, treatment approaches can still be most effective by addressing inherent psychological issues. Group leaders who can offer respect for perpetrators' history, their experience of powerlessness, and their emotional injuries in primary relationships are more likely to make an impact.

Cultural Characteristics↗
PubMed1996

Recovery after tonsillectomy: electrodissection vs. sharp dissection techniques.

Previous studies have suggested that electrodissection tonsillectomy is associated with increased pain and delayed healing in comparison with sharp techniques for tonsillectomy. To better define the clinical significance of this difference, a detailed study of the time course of recovery was undertaken in adults and children after tonsillectomy or adenotonsillectomy by the sharp or electrodissection method. For electrodissection tonsillectomy, electrocautery set to 20 W was used for dissection and hemostasis, and after sharp dissection the suction electrocautery was used only selectively at bleeding sites. Daily pain scores were recorded for 2 weeks, and return to normal diet and activities was monitored. In adults the electrodissection tonsillectomy (n = 26) resulted in an average delay of 2 days in recovery from pain (p < 0.05) and a 2-day delay in return to a normal diet (p < 0.05) compared with sharp tonsillectomy (n = 24). In children (aged 2 to 12 years) the electrodissection technique (n = 26) resulted in an average delay trend of 1 to 1.5 days (not significant) compared with the sharp method (n = 24). Electrodissection tonsillectomy results in an average delay in recovery of 2 days for adults and in a lesser delay in pediatric patients.

Adenoidectomy↗
PubMed1994

Fundamental frequency and amplitude perturbation in reconstructed canine vocal folds.

A submucosal fat autograft was implanted within the cover of injured vocal folds of 5 dogs. The implant occurred 6 weeks after unilateral mucosal excision had been performed. Three months postoperatively the larynges of these animals were excised and their phonation was compared to that of normal dog larynges and to other larynges with mucosal excision (but without fat grafting). Radiated acoustic pressure from the artificially driven larynges was recorded and digitized at 20 kHz with 16-bit resolution. Amplitude and fundamental frequency perturbations were extracted from a segment of phonation to assess the stability of the acoustic signals from the 3 groups. It was found that fat augmentation after mucosal excision reduced amplitude and frequency perturbation measures. There was no significant difference between fat-augmented and normal vocal folds. The acoustic measures were also positively correlated with phonation threshold and phonation efficiency measures reported earlier. The results suggest that submucosal fat autograft implantation within an injured vocal fold cover can restore not only the "ease" of phonation, but also the stability of phonation, which is a component of vocal quality.

Adipose Tissue↗
PubMed1994

Nonlinearity of the Jongkees difference equation for vestibular hypofunction.

The Jongkees formulation for vestibular paresis normalizes the difference between total left and right caloric responses to the sum of responses. When studied over the full paresis range of 0% to 100% hypofunction, the Jongkees formula is found to be a nonlinear index that does not accurately indicate the percentage of vestibular paresis. A linear paresis formula is described that more directly conveys the magnitude of relative vestibular hypofunction.

Analysis of Variance↗
PubMed1991

Monothermal differential caloric testing in patients with Menière's disease.

The monothermal differential caloric test allows determination of vestibular recruitment and decruitment, variables which may help discriminate peripheral from central vestibular lesions. Previous reports indicated a strong association between vestibular recruitment and Menière's disease. This study examined patients having unilateral Menière's disease. Nystagmus beat frequency (NBF) and slow-component velocity (SCV) responses were recorded by electronystagmography (ENG). Electronystagmographic findings showing unilateral dysfunction were present in 54% of patients by slow-component velocity and in 31% by nystagmus beat frequency. Unilateral hypofunction was the most frequent lateralizing ENG finding. Absolute vestibular recruitment occurred in less than 10% of patients but relative recruitment was found in nearly 20% of patients. Slow-component velocity had higher sensitivity than nystagmus beat frequency, with excellent clinical concordance. Monothermal caloric testing as described in this study best detects peripheral vestibular disease in Meniere's patients using slow-component velocity to determine unilateral hypofunction and relative vestibular recruitment.

Adolescent↗
PubMed1990

Vestibular schwannoma presenting with sudden facial paralysis.

Facial paralysis is an unusual manifestation of vestibular schwannoma, and generally signifies an advanced stage of tumor growth. We describe a case of eighth-nerve schwannoma that presented initially with rapid-onset complete unilateral facial paralysis. At the time of operation the nerve was found to be electrically intact despite marked compression by tumor. The facial nerve was preserved and facial motion has partially recovered postoperatively. All unexplained persistent facial paralysis should be evaluated by magnetic resonance imaging with paramagnetic contrast enhancement.

Adult↗
PubMed1989

Effect of quinolone antimicrobials on theophylline pharmacokinetics.

The purpose of the research was to ascertain the comparative differences of quinolone antibiotics on theophylline pharmacokinetics. Eight healthy male volunteers were randomly assigned to four treatments. Each was administered norfloxacin (NOR) 800 mg/d, ciprofloxacin (C) 1 g/d, nalidixic acid (NAL) 2 g/d and placebo (P) for 7 days. On the seventh day of each treatment, theophylline (5 mg/kg) iv was administered. The elimination half-life (T 1/2), total body clearance (CL) and volume of distribution at steady state (Vss) of theophylline were calculated using model-independent methods. ANOVA for repeated measures was used for data comparisons. The mean (SD) theophylline results were: CL l/kg/h--NOR .038 (.006), C .033 (.006), NAL .045 (.008), P .044 (.007); T 1/2 h--NOR 9.2 (1.8), C 10.6 (1.8), NAL 8.3 (1.8), P 7.5 (1.4). Theophylline Vss differences by treatment were not significant. NOR and C significantly decreased theophylline's clearance and the clearance change can be of clinical significance.

Adult↗
PubMed1989

Comparison of beliefs about AIDS among urban, suburban, incarcerated, and gay adolescents.

Beliefs about AIDS were surveyed among opportunistic samples of 1572 adolescents to compare four subgroups of youth: urban public high school students; suburban private school students; youth incarcerated in a detention facility; and a group who were contacted through a gay youth organization. The questionnaire items formed four important theoretical constructs derived by an expert group extensively involved with AIDS education. The constructs were: 1) agreement with health guidelines; 2) perceived personal threat of AIDS; 3) a sense of personal efficacy to prevent infection and the spread of AIDS; and 4) perceived norms of safe sex behaviors. In all groups, females were more likely to endorse higher norms for safe sex practices than males. Older adolescents of both sexes tended to perceive less personal threat of AIDS, and also rated lower norms for safe sex practices than did the younger adolescents. The incarcerated group of adolescents demonstrated significantly poorer knowledge and lower agreement with health guidelines (p = 0.0000), lower perceived personal threat of AIDS (p = 0.005), lower personal efficacy to prevent AIDS (p = 0.003), and lower perceived norms of safe sex practices (p = 0.0000), compared to the other groups. The education implications of these findings are discussed, including the necessity of program elements directed toward subculture peer norms and support, a realistic sense of vulnerability about AIDS, and self-confidence building as well as specific skills to prevent the infection and spread of the human immunodeficiency virus among adolescents.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Phonosurgical studies: fat-graft reconstruction of injured canine vocal cords.

Damage to the vocal cords can result in scarring and impaired vibration and can manifest clinically as hoarseness and loss of vocal power. If the vibratory characteristics could be restored in these scarred vocal cords, the vocal intensity and efficiency of phonation also should improve. In an effort to enhance the vibration of damaged vocal cords, we implanted a submucosal fat autograft within the injured vocal cord cover layer of dogs 6 weeks after unilateral mucosal excision had been performed. Three months postoperatively these animals were compared to normal dogs and those with mucosal excision but no fat-grafting. Acoustic and biomechanical measures of phonation were collected from an excised larynx preparation. We found that the fat-augmented vocal cords had lower threshold pressures for phonation, greater vocal intensity, and more efficient acoustic output than injured vocal cords without the fat-grafting. These results provide a foundation for further research on reconstructive surgery of damaged vocal cords.

Adipose Tissue↗
PubMed1989

The caloric test in electronystagmography.

A wealth of information concerning the caloric test has accumulated since the test was introduced more than eight decades ago. Both convective and nongravity-dependent forces on endolymph are believed to underlie the response at the end-organ level. Higher-order influences are equally important and make the test findings highly dependent on specific test conditions. Slow-component eye velocity is the most widely accepted index of vestibular response, although success using nystagmus beat frequency has also been reported. Both bithermal and monothermal calorization sequences have been studied. Standardization of technique and a consensus on methods of interpretation will be necessary for the determination of the optimal clinical caloric test.

Caloric Tests↗
PubMed1988

Reforming the law in action through empirically grounded civil commitment guidelines.

Some assumptions that guided the national task force in developing the Guidelines for Involuntary Civil Commitment are identified and discussed. The task force's multidisciplinary membership is seen as enhancing the credibility of the suggested reforms. The task force developed guidelines instead of a model law, avoiding disputes about the philosophical basis of commitment laws and providing local jurisdictions the liberty to adapt the task force's recommendations to suit local conditions. Both the problems identified and the suggestions offered by the guidelines were based on the empirical experience of local commitment systems. Communication among the components of civil commitment systems was seen as crucial to reform and as achievable through a recommended structural change.

Advisory Committees↗
PubMed1986

Resynchronization of circadian sleep-wake and temperature cycles in the squirrel monkey following phase shifts of the environmental light-dark cycle.

Circadian rhythms in physiological and behavioral functions gradually resynchronize after phase shifts in environmental time cues. In order to characterize the rate of circadian resynchronization in a diurnal primate model, the temperature, locomotor activity, and polygraphically determined sleep-wake states were monitored in squirrel monkeys before and after 8-h phase shifts of an environmental light-dark cycle of 12 h light and 12 h dark (LD 12:12). For the temperature rhythm, resynchronization took 4 d after phase delay shift and 5 d after phase advance shift; for the rest-activity cycle, resynchronization times were 3 d and 6 d, respectively. The activity acrophase shifted more rapidly than the temperature acrophase early in the post-delay shift interval, but this internal desynchronization between rhythms disappeared during the course of resynchronization. Further study of the early resynchronization process requires emphasis on identifying evoked effects and measuring circadian pacemaker function.

Adaptation, Physiological↗
PubMed1985

Sleep-wake stages during the subjective night of the squirrel monkey.

The study of the circadian sleep-wake cycle is beset by unique technical challenges. Continuous polygraphic recordings are necessary to characterize circadian phenomena; however, the traditional method of recording sleep at high (15 mm/sec) chart speed is impractical for continuous animal studies that may last several weeks at a stretch. A system to determine four sleep-wake stages (awake, transitional, non-REM, REM) from low chart speed (1.5 mm/sec) recordings was developed and validated by direct behavioral observation using four adult male squirrel monkeys prepared for chronic recording of EEG, EOG and EMG. The polygraphic stages "transitional," non-REM and REM were highly correlated with behavioral observations of sleep, although individual sleep stages could not be resolved by behavioral parameters alone.

Animals↗
PubMed1985

Circadian sleep-wake cycle organization in squirrel monkeys.

To investigate the relationship between circadian rhythms of body temperature and sleep-wake stages, four squirrel monkeys were prepared for unrestrained monitoring of temperature, locomotor activity, electroencephalogram, electroculogram, and electromyogram. Continuous records for each animal were made for several 12-h light-dark (LD) cycles and then after a few days in constant illumination (LL). All animals maintained consolidated sleep-wake cycles and had a longer circadian period (mean 24.7 h) in LL than in LD (mean 24.1 h). The increased period reflected greater time per circadian cycle spent awake in LL (mean 14.0 h) than in LD (mean 12.8 h). Total night NREM sleep was less in LL (mean 6.5 h) than in LD (mean 8.2 h). Sleep onset occurred at later phases in LL (187 +/- 6 degrees) than in LD (170 +/- 2 degrees). Because the circadian phase measure of NREM sleep was unchanged between LD and LL conditions, the difference in sleep onsets reflected balanced changes in NREM circadian waveforms. Wake-up phases were the same in both conditions (mean 342 degrees). In summary, during free run squirrel monkeys maintain a stable consolidated circadian sleep-wake cycle with a period greater than 24 h, but they exhibit only minimal internal phase restructuring.

Animals↗