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[Mechanical problems in cerebral venous circulation].

Generally speaking, the cerebral circulation is not well known. This lack of knowledge causes problems for the physicians nad here are two examples: 1) resistance of the cerebral circulation. It is an accepted fact that the blood flow in the brain is particularly rapid. Classical anatomical data and recent mechanical notions invalidate this statement. With an average speed in the veins, the blood cannot, in a given time, complete such a long and complex course. What hypothesis could be expressed to find a solution? 2) The physiological role of the spinal fluid. It is an accepted fact that the spinal fluid is only a protecting device of the nerve centers. Recent studies let to believe that it could also have a role in the regulation of the venous flow. There are other mechanical problems: what are the characteristics of the flow in the venous sinus? in the venous junctions? in the venous dilations? Although lesions of the venous cerebral circulation present clinical manifestations to which the vein specialists are not accustomed to, they cannot deny the fact that this is a familiar pathology.

Blood Flow Velocity↗

The prevention of noise-induced hearing loss in the school-aged population: a school educational hearing conservation program.

A questionnaire assessing knowledge of hearing and hearing loss, and planned hearing conservation practices, was collected from 71 high school students before and after an educational hearing conservation program (HCP) consisting of a film, a lecture and a handout. An average increase of 16.7% correct responses from pre- to postexposure to the HCP was found. Moreover, substantial percentages of respondents stated that they now plan to use hearing protection devices and procedures, when appropriate, and about 80% stated they found the HCP helpful to them.

Adolescent↗

A clinical trial of the Braden Scale for Predicting Pressure Sore Risk.

The purpose of this article was to describe the protocol by which predictive instruments can be tested for validity and to evaluate the usefulness of an instrument for predicting pressure sore risk in an AICU. The Braden Scale for Predicting Pressure Sore Risk was described. Methods for measuring predictive validity and for calculating sensitivity, specificity, and per cent predictive value of positive and negative tests were discussed. Sixty consecutively admitted AICU patients who were pressure sore free were rated for pressure sore risk within 24 to 72 hours after admission. The skin condition of each patient was systematically assessed every 2 days. Twenty-four subjects developed pressure sores during the study period. The critical cut-off point at which the patient could be judged to be at risk for pressure sore formation was a Braden Scale score equal to or less than 16. The sensitivity and specificity of the scale at this score were 83 to 64 per cent, respectively. The per cent predictive value of a positive and negative test were 61 and 85 per cent, respectively. The Braden Scale compared favorably with the Norton Scale in respect to sensitivity. The specificity, or the tendency of a scale to overpredict, was greater for the Norton than for the Braden Scale. The Norton Scale overpredicted by 64 per cent, whereas the Braden Scale overpredicted by 36 per cent. This difference may be important clinically if all patients who were judged to be at risk received additional nursing care or protective devices. A greater number of patients may receive unnecessary and expensive treatments using the Norton Scale.

Adult↗

[Noise characteristics of the basic types of housing construction].

The noise regime in houses, depending on the type of buildings - brick, panel and "creeping shuttering" type is considered. Investigations, carried out under natural conditions, showed that the type of building correlates with the noise-isolation capacity of the construction elements, in relation to the stroke noise. Poorest noise-isolation properties are to be expected from the "creeping shuttering" type of buildings. The characteristics of generation and spreading of noise from baths and toilets is discussed. Some tangible technical noise-protecting devices are suggested.

Bulgaria↗

Mechanisms of injury in automobile crashes.

The only way to determine the causes of injury in automobile collisions is through examination of data collected in detailed investigation of crashes. Such data were gathered from a ten-year study of collisions that caused injury to the occupants of the cars. In a comparison of injuries in the newer model automobiles-vehicles equipped with the safety features-with those in older model cars not equipped with the present-day occupant protection devices, significant reduction in injury severity was noted.

Accident Prevention↗

Validation of the CALSPAN gross-motion-simulation code with actually occurring injury patterns in aircraft accidents.

Digital simulation of aircraft-accident kinematics has heretofore been used almost exclusively as a design tool to explore structural load limits, precalculate decelerative forces at various cabin stations, and describe the effect of protective devices in the crash environment. In an effort to determine the value of digital computer simulation of fatal aircraft accidents, a fatality involving an ejection-system failure (out-of-envelope ejection) was modeled, and the injuries actually incurred were compared to those predicted; good agreement was found. The simulation of fatal aircraft accidents is advantageous because of a well-defined endpoint (death), lack of therapeutic intervention, and a static anatomic situation that can be minutely investigated. Such simulation techniques are a useful tool in the study of experimental trauma.

Accidents, Aviation↗

Agility training following anterior cruciate ligament reconstruction.

The treatment program after anterior cruciate ligament (ACL) injury or reconstruction at the United States Military Academy embraces the four cornerstones of rehabilitation--strength, aerobic fitness, coordination, and confidence. It is divided into six phases--presurgery, to prepare the patient for postoperative rehabilitation; postoperative (or postinjury), to allow healing and to prevent thrombosis and muscle atrophy; early healing, to maintain muscle tone and joint motion in a protective device; late healing (water stage), to begin proprioceptive and agility training while regaining joint motion; healed (land stage), to gain greater agility and confidence in controlled situations; competition, to demonstrate if the rehabilitation program has been successful. This paper concentrates on the criteria for advancing from the water phase to the land phase and then to competition. The patient reverts to the preceding phase if pain or swelling is apparent. Full participation in competition is not permitted unless the patient masters all phases and can compete in athletics without fear of reinjury.

Athletic Injuries↗

The biochemical organization of the lens.

The metabolic pathways of the lens are similar to those found in other tissues but with changes of emphasis in keeping with its function. The mode of growth of the lens results in cells and proteins at the centre of the lens persisting throughout adult life. Changes seen in these proteins may be deleterious aging changes or may be adaptations to a developing environment. The blocked alpha-amino groups of two major groups of lens proteins serve to protect the lens against both amino-peptidases and chemical modification. An understanding of the biochemistry of the lens and the chinks in its protective devices leads to the idea that there may be common pathways in cataractogenesis.

Aging↗

Environmental antecedents which affect management and maintenance of programs for self-injurious behavior.

This paper reports the effects of several environmental variables on the management and maintenance of a treatment program for self-injurious behavior (SIB) in residents in a state facility for retarded persons. Fifteen of the clients who participated in a developmental day-care program were compared across the final four months of the program and then at follow-up two years later. Twelve additional clients who were treated in the overall SIB program did not receive the day-care component, but were included in the follow-up study. Regarding program management, the effects of time, staff-initiated interactions, the presence of a newcomer or disruptive client, and medication changes on the behaviors of the 15 clients in the day-care program were assessed from an ecobehavioral approach. Participants in the follow-up study were compared with respect to the type of SIB program they received, the staff-patient ratio in their program, their visual impairment, use of self-protective devices, presence of stimulating material, and time-of-day observed. These issues are discussed in relation to program maintenance.

Adolescent↗

Structural changes in the kidney of freshwater mud eel Amphipnous cuchia (Ham.) subjected to different osmotic conditions.

A histophysiological study was made of the kidney of Amphipnous cuchia subjected to different osmotic conditions (distilled water, 50% and 15% sodium chloride solution). These fish possess typical glomerular kidneys having nephrons composed of a glomerular body, neck segment, proximal convoluted segment (I & II), distal segment, and collecting duct system. When subjected to a hypotonic medium (distilled water) the fish show marked expansion in glomeruli resulting in 'glomerulitis'. A marked shrinkage in glomerular body tissue is found after 50% salt solution treatment and the fish die within one hour of immersion. Many pathological changes occur in the renal capsule and renal segment when the fish are treated with 15% salt solution. The glomerular bodies show shrinkage, degeneration and cyst formation. The glomerular shrinkage is probably due to constriction of arterioles which affects the filtration rate and thus protects against loss of water. Formation of cysts could be a protective device to save the glomeruli from degeneration. The renal tubules show hypertrophy, vacuolization, nuclear degeneration and cyst formation.

Anguilla↗

[The principles and applied aspects concerning the prediction and prevention of noise damage under current regulations].

From a comparison between the present Italian regulations and the main international guidelines regarding the assessment and prevention of effects of industrial noise, three main aspects emerge: firstly, the aims of the regulations (i.e. the characteristics and levels of hearing handicap to be prevented); secondly, the models for evaluating the probability of hearing loss; lastly, the limit values and the preventive measures adopted. The Italian regulations with respect to the ISO, ACGIH, NIOSH guidelines and regulations of other European countries, do not supply any precise indications regarding the aforementioned aspects. As a consequence, measures must be adopted to prevent any type of hearing impairment and the level of the noise has to be reduced to the minimum by acting on the environment, machinery and using individual protective devices.

Europe↗

Organophosphate exposure in pesticide formulation and packaging factories in Harare, Zimbabwe.

A cross sectional study was conducted in September 1989 in order to estimate the prevalence of organophosphate exposure and to identify factors associated with increased organophosphate exposure in pesticide producing factories in Harare, Zimbabwe. Sixty five workers entered the study with 45 of them providing blood specimens. The mean cholinesterase level was 75.3 pc (standard deviation 21.07 pc). Twenty (44.4 pc) workers had cholinesterase levels of less than 75 pc. The workers had adequate knowledge (75 pc+) of the importance of protective devices but had less knowledge of about 50 pc of health effects of pesticides. Smoking (t = 3.49; degrees of freedom (df) = 43; p < 0.01) and eating (t = 2.14; df = 43; p < 0.05) at work place were associated with increased exposure to organophosphate. The number of symptoms was not correlated with cholinesterase levels (Spearman's rank correlation coefficient--0.70; p = 0.12). We conclude that a significant number of workers were exposed to organophosphate. Increased personal hygiene such as washing hands before eating or smoking should reduce the amount of exposure.

Cholinesterases↗

Pressure-reducing effects of heel protectors.

This study examined the pressure-reducing effects of 13 different heel-protecting devices. A group of 40 elderly patients (mean age 82 years, range 71-94) admitted to the Geriatric Department of the University Hospitals in Leuven, Belgium participated in this study. The pressures were registered by means of a sensitive computerized diagnostic system, which measured vertical forces. An ordinary head pillow was shown to be the most effective pressure-reducing device, followed by heel protectors based on siliconized hollow fibers.

Aged↗

An evaluation of cervical orthoses in limiting hyperextension and lateral flexion in football.

Three cervical orthoses often used in football to prophylactically limit motion and prevent the nerve injury known as "burners" were evaluated to determine their performance in limiting both hyperextension and lateral bending of the cervical spine. These orthoses have been used almost entirely on an empiric basis with little objective data to evaluate performance. A rope and pulley mechanism was used to pull the neck into hyperextension and lateral motion, with the only restraint being the various products tested. These trials were videotaped and the restriction provided by the collars was calculated from goniometric analysis of the projected images. These tests were performed to determine which products limit the mechanisms of the "burner" injury and thereby assess which braces might reduce or prevent the occurrence of these injuries. The results of the investigation indicate that all braces studied provided some degree of limitation in one of the mechanisms of injury, hyperextension. One brace performed superiorly in this respect. However, the other mechanism of injury, lateral bending, is inconsistently limited.

Adult↗

Occupational musculoskeletal disorders.

Musculoskeletal disorders of the workplace include the acute, cumulative and chronic injuries or illnesses of the soft tissues which are caused by mechanical stress, strain, sprain, vibration, inflammation, or irritation. The successful management of occupational musculoskeletal disorders must account for workplace conditions (ergonomics and work practices), psychosocial factors, diagnostic uncertainties, and the need for active modalities (exercises and a progressive increase in activities of daily living), rather than passive (bed rest and traction). Although most occupational musculoskeletal disorders respond to conservative measures such as ice or heat, protective devices such as, neutral splints for carpal tunnel syndrome, nonsteroidal anti-inflammatory drugs, and progressive strengthening, resolution may take months. Prevention is often more important than treatment, and may entail workplace revisions and special worker training. Worker selection programs--strength testing, pre-placement radiographs, and inquiries about prior low back pain--have poor predictive value.

Chronic Disease↗

[Occupational environment in veterinary clinics].

In veterinary clinics many drugs and materials are handled, for instance antibiotics, disinfectants and anaesthetic gases. The staff is in close contact with various animal species and performs surgical and obstetrical operations as well as post mortem examinations. X-ray is used widely. Some investigations have indicated, that the working environment has incurred little attention. For example, X-ray equipment has been found defective and air-extraction insufficient in connection with anaesthesias. Consequently the potential for work-related health problems is obvious. The few epidemiologic investigations done indicate an increased frequency of toxic and allergic skin diseases, asthma and certain infections such as ornithosis. As general prophylaxis, better arrangement of the clinics, alterations of drug administration forms and use of gloves and other protective devices are recommended. It is concluded, that the existing knowledge about the working environment in Danish veterinary clinics is scarce, that it may imply health risks, and that further investigation of the question is needed.

Animals↗

Resurgence of tuberculosis: the perspective a dozen years later.

More than a dozen years ago, case rates of tuberculosis (TB) began to increase in the United States, as well as in other industrialized and Third World countries. Our US urban centers were the epicenter of the "new" TB epidemic, with New York City accounting for more than 15% of all TB cases in the United States. Numerous factors were responsible for this dramatic, unexpected explosion in mankind's most prevalent and lethal disease, including (1) an increasing pool of susceptible individuals who, by virtue of human immunodeficiency virus (HIV) infection, were much more likely to rapidly progress to active (contagious) TB after becoming infected with Mycobacterium tuberculosis; (2) a reduction in the resources and sites available for the identification, treatment, and surveillance of patients with tuberculous infection and disease; and (3) the importation of TB cases via immigration. Coupled with the resurgence of tuberculosis, new strains of difficult-to-treat, multiple-drug-resistant M tuberculosis (MDRTB) were isolated with increasing frequency, with New York City again the focal point. More than 60% of the nation's MDRTB cases occurred in New York City, reaching a peak of 441 cases in 1992. Over the past 2 years, epidemiologic data suggest that the epidemic has come under control, with a 38% decrease in new cases (1995) compared with the peak year (1992). A number of factors have been important in regaining control of TB, including enhanced diagnostic modalities, such as the use of some molecular biologic strategies; active case and contact finding by public health workers; tailored therapeutic approaches, such as four-drug initial therapy for non-MDRTB, advanced multidrug management for MDRTB, and expanded use of directly observed therapy; and use of personnel-protective devices and environmental controls to decrease nosocomial transmission of TB. These factors are highlighted in this overview article.

AIDS-Related Opportunistic Infections↗

Corneal response and vision with the Softperm lens in simulated aircraft conditions.

BACKGROUND: Contact lenses are generally more compatible than spectacles with the life-support systems, personal protective devices, and helmet-mounted targeting systems used in modern military aircraft. This study evaluated the Softperm contact lens in a simulated aircraft environment to determine its potential use by USAF aviators. METHODS: Thirteen subjects wearing Softperm lenses were exposed to a simulated aircraft environment for 2 hours. Subjects were evaluated for signs of hypoxic stress by measuring corneal thickness changes and observing changes in corneal staining and conjunctival injection. Changes in visual acuity were also measured. Slit lamp biomicroscopy was used to assess lens movement at the beginning and end of the treatment period to determine if lens fit changed. Over-refractions to determine residual astigmatism were performed to evaluate how well the Softperm lens corrected astigmatic refractive errors. RESULTS: A statistically significant increase in corneal thickness was found after two hours of Softperm wear in the simulated aircraft environment. Several subjects experienced an increase in epithelial staining, which appears to be associated with changes in lens fit (tightening). All subjects experienced conjunctival injection. Residual astigmatism secondary to lens flexure occurred in all but two eyes, but no eyes had greater than 0.75 diopters. CONCLUSIONS: When properly fitted, the Softperm lens can be safely worn in an aircraft environment similar to the one simulated in this study. This lens design may provide an alternative to the lenses presently approved for USAF aviators.

Adult↗