State-dependent learning for alcohol-dependent people.
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Biomedical subjects
Publications and source records attributed to R Hodgson.
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This paper describes an incident in which an apparently normal hospital pillow became a ferromagnetic missile when brought into the proximity of a 1.5 T MR system owing to a fine internal spring system within the pillow. Measurements revealed that the 1 kg pillow reached a maximum velocity of 33.7 km h(-1) after undergoing a maximum acceleration of 9.9g. Non-pathological cervical spines should sustain the measured forces and torques without significant injury. However, the effect could be injurious or even fatal to patients suffering from an existing cervical instability, for example due to rheumatoid arthritis. Of more general concern is the fact that the use of a powerful hand-held magnet did not reveal the presence of ferromagnetic components in this instance. Large objects containing sparsely distributed ferromagnetic materials may not be deflected by such a magnet but could still represent a hazard in the MR environment.
The most important variables for measuring performance in team sports such as football are physical condition and technical and tactical performance. However, because of the complexity of the game of football it is difficult to ascertain the relative importance of each of these variables. The aim of the present study was to develop a standardized test battery to evaluate physical performance in football players. The F-MARC test battery was designed to closely relate to the football player's normal activity and comprised a functional, structured training session of approximately 2.5 hours. It included a "quality rating" of the warm-up procedure, tests of flexibility, football skills, power, speed, and endurance. The players finished with a cool-down. A total of 588 football players underwent the F-MARC test battery. Mean values for performance on each test are presented for groups of differing age and skill levels. The test battery proved to be a feasible instrument to assess both physical performance and football skills. This study supports the proposal by Balsom (1994) that analysis of an individual player's physical profile, in relation to mean values for a similar age group and skill level, might be of assistance to the coach in objectively evaluating the effects of a specific training program. It may also be of use to the physician and physical therapist responsible for monitoring progress during rehabilitation after football injuries.
Review of the literature shows that information concerning risk factors for football injuries is incomplete and partly contradictory. The aim of this study was to analyze the influence of medical history, physical findings, football skills, and football performance, as well as psychosocial characteristics on the occurrence and severity of football injuries. The prospective outline of the study was as follows: after a baseline examination was performed to ascertain possible predictors of injury, all players were followed up weekly for 1 year to register subsequent injuries and complaints. Two hundred sixty-four of 398 players (67%) had complete weekly follow-ups over 1 year. A majority of the players (N = 216; 82%) were injured during the observation period. In comparing injured and uninjured players, several differences were observed. To create a multidimensional predictor score for football injuries, 17 risk factors were selected. These risk factors covered a wide spectrum, such as previous injuries, acute complaints, inadequate rehabilitation, poor health awareness, high life-event stress, playing characteristics, poor reaction time, poor endurance, and insufficient preparation for games. By summing up the individual risk factors, a predictive sum was calculated for each player. The more risk factors present at the baseline examination, the higher the probability of that player incurring an injury in the ensuing year. Using two risk factors as the cut-off score, more than 80% of the players were correctly classified as to whether they went on to incur an injury. Based on these findings, knowledge from the literature, and practical experience, possibilities for a prevention program are suggested.
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Susceptibility of bacteria to antimicrobial agents is strongly reduced by the formation of complex biofilms. We investigated whether synthetic histatin analogs with broad-spectrum antibacterial activity in vitro were also active against these complex mixtures of bacteria, as present in saliva and plaque. In a simplified model system for dental plaque, hydroxyapatite discs were placed in a continuous culture system comprised of Streptococcus mutans, S. sanguis, S. salivarius, Actinomyces naeslundii, Veillonella parvula, Fusobacterium nucleatum, and Prevotella intermedia. Ex situ treatment of the biofilms formed on these discs with 100 microg/mL of peptide dhvar4 significantly reduced facultative anaerobic, total anaerobic, and obligate anaerobic Gram-negative counts with 0.8, 0.5, and 0.5 log units, respectively. Ex vivo treatment of salivary bacteria gave reductions of 0.4, 0.7, and 1.5 log units, respectively. For ex vivo treatment of plaque bacteria, reductions of 0.4, 0.4, and 1.4 log units, respectively, were found. In both saliva and plaque samples, obligate anaerobic Gram-negative bacteria were significantly more susceptible to dhvar4 than facultatively anaerobic or anaerobic bacteria as a whole (p=0.013 and p=0.018, for salivary bacteria, and p=0.021 and p=0.020 for plaque bacteria, respectively). Although the oral bacteria are protected by biofilm formation, the synthetic histatin analog caused a significant reduction of viable counts in a model for oral biofilm as well as in isolated oral biofilms.
BACKGROUND: Innovative approaches to the provision of psychiatric care must justify their ability to improve the quality of life within the resource constraints imposed on psychiatry. AIMS: To examine the average costs per patient of the experimental and control group services. METHOD: An individual patient costing methodology that identified, measured and valued all public and private resources. RESULTS: The experimental group was more likely to remain in contact with services over a 12-month period, had fewer acute readmissions and spent less time in acute in-patient units. There were significantly different levels and patterns of resource consumption between the groups and between the two separate catchment areas. CONCLUSION: The cost analysis should be assessed in the context of the previous outcome analysis. It is likely, but not inevitable, that such units will increase the overall costs of care provision; this largely depends on the effectiveness with which such units are integrated into existing care provision.
Suxamethonium in the doses of 1.0, 0.5 and 0.25 mg/kg was compared with mivacurium 0.15 mg/kg in 80 patients requiring nasotracheal intubation for maxillofacial surgery in a double-blind randomized controlled trial. Anaesthesia was induced with thiopentone 5 mg/kg and alfentanil 15 micrograms/kg. Patients were randomly allocated to one of the four relaxant groups. Anaesthesia was maintained with enflurane in 70% nitrous oxide and 30% oxygen and analgesia provided with intravenous pethidine 0.5 to 1.5 mg/kg and rectal indomethacin 100mg. All patients given mivacurium or suxamethonium 1 mg/kg had acceptable intubating conditions. Significantly fewer patients given suxamethonium 0.5 mg or 0.25 mg/kg had acceptable intubating conditions (90% and 70% respectively) (P = 0.003). Poor intubating conditions requiring additional relaxation were seen in two patients given suxamethonium 0.25 mg/kg and two given 0.5 mg/kg, while no patients given suxamethonium 1.0 mg/kg or mivacurium 0.15 mg/kg required additional relaxation (P = 0.004). Only four patients had postoperative myalgia, all of whom were given suxamethonium 0.5 mg/kg or more but no significant difference between groups could be demonstrated.
Assessment of the role of biofilm microstructure in biofilm-specific activities requires non-destructive measurement techniques for parameterization of structural characteristics in parallel with relevant biochemical and physiological data. This paper briefly reviews some current methods for biofilm structural analysis, with emphasis on new developments in optical imaging and mathematical modeling methods. Fluorescence imaging studies of bacterial colonization events occurring on exposed model tooth surfaces indicated that bacterial adhesion to sessile organisms was of central importance to the early colonization process and that this occurred in a non-random manner. Structural studies of mature biofilms by confocal microscopy demonstrated the spatial distribution of individual species using fluorescent antibodies. Biofilms grown under different physiological conditions exhibited differences in structure, and methods were developed for parameterizing the spatial orientations of the bacteria. Diffusive processes within biofilm microstructures were studied using a random walk model in both 2-D and 3-D. Modeling of convective flow within biofilm microstructures was achieved by application of lattice Boltzmann methodology.
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This paper gives an overview of the variety of approaches that have been used in the treatment of alcohol problems. There is good evidence that approaches directed at improving social and marital relationships, self-control and stress management are effective. There is at present little to suggest that aversion therapies, confrontational interventions, educational lectures or films and group psychodynamic therapy are effective, nor is there good evidence yet that use of psychotropic medications is effective. However, it may be that therapies that have not proved effective with the broad range of individuals with alcohol problems might prove effective with selected cases. Future research should place more emphasis on determining the kinds of alcohol problems that are likely to respond to different kinds of treatments directed at different kinds of goals and by different kinds of practitioners. The base of treatment should be broadened to include the large numbers of individuals with alcohol problems but who could not be considered as alcohol-dependent. This would have to involve a wide range of primary care and generic workers and include use of brief interventions.
The cross-cultural validity of the Alcohol Dependence Syndrome was tested on 13 symptoms of alcohol dependence which were assessed as part of a WHO collaborative study of the early detection of harmful drinking. The subjects were drinking patients in health care settings in Australia, Bulgaria, Kenya, Mexico, Norway, and the US. Principal Components Analyses were performed on the symptoms in each centre, and the degree of agreement between the results was assessed by calculating coefficients of congruence between the item loadings on the first principal component. In all six centres the first Principal Component accounted for at least half of the total variance and all symptoms had positive loadings greater than 0.40 on the first Principal Component. The coefficients of congruence were all 0.98 or more, and the 13 symptoms had internal consistency coefficients of 0.94 or more. An alcohol dependence score defined by the sum of positive responses to the 13 alcohol dependence symptoms was positively correlated with self-reported alcohol consumption, alcohol-related problems, serum gamma glutamyltransferase and a clinical examination assessment of alcoholism in all six samples.
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All roadside procedures carried out by doctors of the Royal London Hospital Helicopter Emergency Medical Service were recorded. Of 100 injured patients treated consecutively, 68 patients required 73 treatments or procedures that were beyond the current training of the ambulance paramedic in the United Kingdom. Doctors are therefore an essential part of HEMS operations and allow earlier live-saving medical intervention in the prehospital phase of care.
A patient with polycythaemia rubra vera complicated by severe psychotic depression is described. There have been no previous reports of polycythaemia rubra vera associated with psychiatric morbidity.
One thousand and five women, and 354 of their partners, attending an infertility clinic have been assessed for the presence of Chlamydia trachomatis antibodies in their serum. The overall prevalence in women was 12.4% (125/1,005) but appeared to have increased over a 2-year period. A similar trend was not apparent for men and the prevalence was only 4.2% (15/354). Of the 125 seropositive women 81 had their pelvis examined for the first time by laparoscopy. Fifty seven had tubal disease of varying severity, but only 16 had had an ectopic pregnancy or admitted to a previous history of pelvic inflammatory disease or nonspecific urethritis. These findings suggest that laboratory testing for chlamydial antibodies should be routine in the initial investigation of an infertile couple and that early laparoscopy is indicated in seropositive women.
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Sixty alcoholics (40 males) were assessed for agoraphobia and social phobia, and over half the sample were rated as having either or both these disorders when last drinking. Twenty one subjects had mild phobias and eleven had severe phobias. The more severely phobic males were also found to be the most alcohol dependent and those with no phobias were least alcohol dependent but this effect was not found among the females. All phobic alcoholics reported that alcohol had helped them to cope in feared situations, and almost all had deliberately used it for this purpose. A small sample of out-patients referred for phobias alone were also asked about their use of alcohol. The majority had found it helpful in coping with fears, although more men than women had deliberately used it for this purpose.