This paper reviews briefly the early evolution of the subject of the biomechanics of impacts. Some examples of rule-making of vehicle crash performance are cited to illustrate the need for evaluation of all design changes and regulations in the real world of crashes and injuries. Some background data on the relative frequencies of casualties and types of collisions are given to establish overall priorities. Mechanisms of injuries in frontal collisions for unrestrained and restrained occupants are described to illustrate the relationships between interior localized contacts and injuries to the lower limbs, the chest, and the head. Kinematics of occupants in angled, lateral, and rear collisions are reviewed together with the related injury mechanisms, and rollover crashes with and without seat belt use are mentioned. Motorcyclist and pedestrian kinematics and some of the desirable characteristics of the vehicle exterior are described together with the unfortunate consequences of the current bumper standards. In summary the paper aims to be a general review of crash kinematics and general mechanisms of injury.

Accidents, Traffic↗

PubMedDate not supplied

Evaluation of a nurse-delivered smoking cessation intervention for hospitalized patients with cardiac disease.

OBJECTIVE: To determine the effect of a nurse-delivered smoking cessation intervention for hospitalized smokers on smoking cessation rates and smoking cessation self-efficacy at 6 months after enrollment. DESIGN: A quasi-experimental design was used; specifically, a nonequivalent control group design was implemented. SETTING: A 450-bed major teaching and research tertiary care hospital, serving patients from across the province of British Columbia, Canada. SUBJECTS: Smokers with a cardiac diagnosis (n = 102) who were admitted to 1 of 2 inpatient cardiac units for medical or surgical treatment. OUTCOME MEASURES: Self-reported smoking status and self-reported smoking cessation self-efficacy. INTERVENTION: Two structured, in-hospital contacts, followed by 3 months of telephone support. The interventions focused on problem-solving and reinforcing the patient's self-efficacy. RESULTS: Of the patients enrolled, 86 completed 6-month follow-up questionnaires. When subjects who were lost to follow-up were assumed to be smokers, 46% of the intervention group, compared with 31% of the control group, were nonsmokers. When key variables were controlled, we found that those subjects in the control group were 3 times more likely to relapse and begin smoking than those who received the intervention. There were no significant differences in follow-up smoking cessation self-efficacy scores in the treatment and control groups. When background variables were controlled, self-efficacy related to positive/social situations and habit/addictive situations were noted to be significantly higher in the intervention group. CONCLUSION: The findings of this research are encouraging; they suggest that a nurse-delivered smoking cessation intervention improved the smoking cessation rate in patients with cardiac disease.

Case-Control Studies↗

PubMedDate not supplied

Functional outcome after the L'Episcopo procedure.

A study was undertaken to assess functional outcome in 11 patients undergoing latissimus dorsi and teres major transfer (L'Episcopo procedure) for external rotation deficient shoulders. The mean age was 37 years (range 18 to 48 years). All of the patients had adult-onset brachial plexus injuries. The mean time for injury to operation was 32 months. Patients were evaluated by questionnaire, measurement of the range of motion, strength testing, and an overhead work simulation. Of the patients studied, 10 of the 11 patients were working (8 returned to their preinjury employment). The cumulative postoperative mean activities of daily living score was 20 (maximum possible 33) compared with 14 before surgery. No complications occurred. Ten patients reported confidence in the limb and believed the procedure was worthwhile. Mean active external rotation of the shoulder at 0 degrees and 90 degrees elevation was 28 degrees (range 15 degrees to 55 degrees and 36 degrees (range 0 degrees to 90 degrees), respectively. Postoperative external rotation strength was 0.32 that of the control side with the arm at the side. Seven of the nine patients tested were able to complete the Valpor overhead work simulation. The L'Episcopo muscle-tendon transfer reliably improves functional outcome in the late functional reconstruction of adult-onset brachial plexus lesions.

Adult↗

PubMedDate not supplied

Major surface antigen gene of a human malaria parasite cloned and expressed in bacteria.

The late blood stages of the human malaria parasite, Plasmodium falciparum, carry a major surface antigen, p190, of molecular weight (Mr) 190,000. This antigenically variable protein is actively processed, first as the parasite matures and again when it is released into the blood stream and invades a new erythrocyte to initiate a cycle of growth. It elicits a strong immune response in man; all tested adult sera from endemic areas have antibodies against this protein. Our evidence indicates that purified p190 can alter the course of parasitaemia in monkeys with falciparum malaria. We have also succeeded in cloning part of the gene for p190 and expressing it in Escherichia coli. To this end we have developed a new technique, antibody select, which greatly simplifies final identification of expressing clones.

Animals↗

PubMedDate not supplied

Cerebral sinus venous thrombosis in children.

OBJECTIVE: Cerebral sinus venous thrombosis (cerebral SVT) is rare in children. Information on clinical characteristics, radiological findings and outcome is emerging. METHODS: Cases of cerebral SVT diagnosed between 1995 and 2001 were identified by a computer-assisted search using International Classification of Disease codes. Medical records were reviewed to collect information on clinical presentation, investigations, treatment and outcome. RESULTS: Sixteen cases of cerebral SVT were identified. All cases presented in association with head and neck pathology. The majority of cases presented with symptoms of raised intracranial pressure and focal neurological signs. Magnetic resonance imaging identified all cases of cerebral SVT whilst CT scanning failed to demonstrate the diagnosis in two cases. Management with anticoagulation was associated with radiological resolution of the thrombosis and normal neurological outcome. Long-term follow up demonstrated neurological deficits in greater than 40% of patients. CONCLUSION: Cerebral SVT in children is associated with significant residual neurological morbidity. Prospective studies to identify predictors of outcome and effective management interventions are required.

Adolescent↗