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PubMed2004

Kinetics and mechanism of base-catalysed degradations of substituted aryl-N-hydroxycarbamates, their N-methyl and N-phenyl analogues.

The kinetics and mechanism of the degradation reactions of substituted phenyl N-hydroxycarbamates and their N-methyl and N-phenyl analogues have been studied at pseudo-first-order reaction conditions in aqueous buffers and sodium hydroxide solutions at 20 [degree]C and 60 [degree]C and at I= 1 mol[middle dot]l(-1). The dependence of log k(obs) on pH for phenyl N-hydroxycarbamates at pH < 9 and pH > 13 is linear with the unit slope; at pH 10-12 log k(obs) is pH independent. The Bronsted coefficient [small beta](lg) is about -1 (pH 7-13) and -1.53 (pH > 13) indicating that the degradation reaction of phenyl N-hydroxycarbamates follows an E1cB mechanism giving the corresponding phenol/phenolate and HO-N[double bond, length as m-dash]C[double bond, length as m-dash]O. The latter species undergoes further decomposition to give carbonate, nitrogen and ammonia as final products. In contrast to the phenyl N-hydroxycarbamates the N-methyl derivatives at pH 7-9 undergo degradation to the corresponding phenol/phenolate, carbonate and methylamine via a concerted mechanism ([small beta](lg) is about -0.75). The only exception is 4-nitrophenyl N-hydroxy-N-methylcarbamate in which the predominant break down pathway proceeds via the Smiles rearrangement to give sodium N-methyl-(4-nitrophenoxy)carbamate. At pH > 9 the reaction of N-hydroxy-N-methylcarbamates is kinetically complex: the dependence of absorbance on time is not exponential and it proceeds as a consecutive two-step reaction. N-Hydroxy-N-phenylcarbamate under the same conditions undergoes degradation to phenol, carbonate, aniline and azoxybenzene.

Journal Article↗

PubMed2000

Four impacted permanent canines: an unusual case.

Impacted permanent canines in a child, particularly in the maxilla, pose a functional as well as an esthetic concern for the patient and parents alike. Informing the parties involved that all the permanent canines are impacted is, needless to say, a distressful dilemma for the parents and a unique challenge for the orthodontist. The response to the treatment in this case was quite acceptable. All 4 canines were properly aligned with the aid of orthodontic traction and surgical assistance, and now the patient possesses confidence to smile and has enhanced self-esteem. There is no additional cost or burden of prosthesis for the parents, since all 4 impacted canines were successfully positioned, and all are natural and beautiful teeth. The root resorption that occurred may have been the result of the long treatment time or the result of root movement during incisor uprighting, both of which have been associated with this phenomenon. As in many of these cases, proper gingival contours of one of the orthodontically erupted mandibular canines was a problem and may require the service of a periodontist.

Child↗

PubMed1990

Nonverbal indicants of comprehension monitoring in language-disordered children.

This study investigated normal and language-disordered (LD) children's patterns of nonverbal behavior in response to messages varying in degree of ambiguity. Each LD child was matched to two normally developing children: one for comprehension level (LM) and the other for chronological age (CM). All children participated in a videotaped ambiguity detection task. Nonverbal behaviors that were produced between the time the message was completed and the examiner's acknowledgment of the response were scored for type of behavior exhibited including eye contact, hand behavior, body movement, and smile. Results demonstrated that all subjects increased their nonverbal behavior (e.g. eye contact) from unambiguous to ambiguous message conditions, suggesting awareness of the differences in these message types at a rudimentary level. Most often nonverbal indication was the only signal of ambiguity detection exhibited by the LD children and their LM peers. Only the CM children concurrently indicated awareness through more direct means (i.e., verbalization and pointing to all possible referents) in a consistent and accurate manner. The finding that LD children did differentiate inadequate from adequate messages in a rudimentary manner suggests that clinicians might promote the intentionality of these preintentional nonverbal behaviors as a possible intervention strategy.

Child↗

PubMed1994

Social valence in children with specific language impairment during imitation-based and conversation-based language intervention.

This study investigated the level of social valence and type of social behaviors expressed in 15 children with specific language impairment as they engaged in typical language intervention activities during conversation-based and imitation-based language programs. These programs were both applied to each child over a period of several weeks. Videotapes of treatment sessions were analyzed for the presence of five verbal and 11 nonverbal behaviors selected to measure social valence. In addition, the child's level of social valence was scored on a three-point rating scale. The results showed that although both types of treatments were predominantly associated with positive social valence ratings and a high frequency of smiling, laughing, and engagement in the activities, a significantly higher number of these positive ratings and behaviors were noted within conversation-based treatment. In contrast, although negative social valence ratings and expressions of boredom or dislike were very rare, these were observed more frequently under imitation-based treatment. There was a significantly higher rate of verbal initiations in the conversation-based treatment, and a significantly higher rate of quiet, passive participation in the imitation-based treatment. The findings are discussed in relation to treatment selection and viable strategies for assessing treatment acceptability in children.

Child Language↗

PubMed1998

Infertility and early parent-infant interactions.

Approximately 50% of infertile couples will become parents through pregnancy or adoption, but they experience major difficulties while working towards this goal. Infertility treatments are associated with physical pain and psychological distress, and adoption procedures are prolonged and emotionally stressful. The extent to which these stressors alter the parenting of these couples is not known. The purpose of this study, therefore, was to examine the early parent-infant interactions in infertile couples who become parents through pregnancy or adoption. Two groups of infertile couples (30 who achieved pregnancy and 21 who adopted) and a group of 19 couples without fertility problems were observed interacting with their infants twice, 7 to 21 days after the infant's arrival and a week later, at a time when both parents were at home. Their babies were between 9 days and 5 months of age. Behaviours of the mother, father and infant were recorded every 10 seconds, beginning when the baby was picked up and ending when the baby was put down asleep or 1 1/2 hours had passed. Repeated measures ANOVAs were used to compare the three groups over the observations. There were no differences between fertile and infertile biological parents. Adopted infants showed more alertness, less sleeping, more smiles, and more looking than biological infants. Adoptive mothers spent less time as the sole interactor. Adoptive parents spent more time in playing with their infants and held and touched them less than did biological parents. Infertility, therefore, does not appear to affect early parenting. In general, the amounts of behaviours exhibited by infertile biological parents were very close to those of fertile parents. Differences in the behaviours of adoptive as compared to biological parents can best be explained as responses to the behaviours of their older infants, rather than as evidence of different parenting styles.

Adoption↗

PubMed1998

Loneliness: an epidemic in modern society.

Loneliness is a little discussed concept in today's self-obsessed climate, where it is seen as a negative embarrassing condition. It is unique for every individual, and as such, it is difficult to define. There are other closely related concepts, for example, aloneness and solitude, that further complicate an already complex issue. Loneliness also has various causes and effects that can be one and the same, and so it can be confused with similar but different conditions, for example, depression and self-esteem. But, at the end of the day, if the word loneliness is mentioned in conversation, everybody will understand what it means to them, and how distressing an ordeal it can be. Everyone is lonely to some degree, no matter how much they pretend they are not: it is part of being human. Nursing literature looks at loneliness from a rather basic, superficial perspective, when discussing whether such a traumatic state of being can be solved, but this is not a solution as such. It is such an innate part of the human psyche, that it cannot be solved like a puzzle; it can only be alleviated and made less painful. This can only be achieved by increasing humankind's awareness of this distressing condition that everyone has to endure in some way, shape or form, some time during their lives, about which there is nothing to be embarrassed. If non-lonely individuals could spare a smile or a word for people who might be perceived as being lonely, even if in doing so they selfishly think 'there but for the grace of God go I', such a small gesture might just make their day a little less of an ordeal.

Humans↗

PubMed1999

Ten years on: the abiding presence of R.D. Laing.

The life and work of Ronald David Laing forms the basis for a review of anti-psychiatry from the late 1960s until about the mid 1970s. That the period concerned was not the jamboree of sex, drugs and anarchy by which it is normally portrayed is evidenced by Laing's ambivalence towards anti-psychiatry as well as his yearning for academic and medical respectability. Recent biographies of Laing as well as interviews given shortly before his death were scanned in preparation for this paper. However, some new perspectives are supplied. For example, the curious neglect (by scholars) of the conservative psychiatric forces which paralleled the Laingian critique is briefly examined and especially the attitudes of such forces towards Laingian psychiatry. In addition, some connections are made between Laing's upbringing and his work. Such speculations, always risky, seem valid albeit Laing would probably smile. Lastly, whilst a comparable history of seditious thought in nursing remains unwritten, because hidden, such a history will ultimately depend on psychiatric nursing and especially the career of Annie Altschul who, even earlier than Laing, had sought to define psychiatric care as an interactive and humanizing event.

History, 20th Century↗

PubMed1999

Teaching compassion and respect. Attending physicians' responses to problematic behaviors.

OBJECTIVE: To describe how and why attending physicians respond to learner behaviors that indicate negative attitudes toward patients. SETTING: Inpatient general internal medicine service of a university-affiliated public hospital. PARTICIPANTS: Four ward teams, each including an attending physician, a senior medicine resident, two interns, and up to three medical students. DESIGN: Teams were studied using participant observation of rounds (160 hours); in-depth semistructured interviews (n = 23); a structured task involving thinking aloud (n = 4, attending physicians); and patient chart review. Codes, themes, and hypotheses were identified from transcripts and field notes, and iteratively tested by blinded within-case and cross-case comparisons. MAIN RESULTS: Attending physicians identified three categories of potentially problematic behaviors: showing disrespect for patients, cutting corners, and outright hostility or rudeness. Attending physicians were rarely observed to respond to these problematic behaviors. When they did, they favored passive nonverbal gestures such as rigid posture, failing to smile, or remaining silent. Verbal responses included three techniques that avoided blaming learners: humor, referring to learners' self-interest, and medicalizing interpersonal issues. Attending physicians did not explicitly discuss attitudes, refer to moral or professional norms, "lay down the law," or call attention to their modeling, and rarely gave behavior-specific feedback. Reasons for not responding included lack of opportunity to observe interactions, sympathy for learner stress, and the unpleasantness, perceived ineffectiveness, and lack of professional reward for giving negative feedback. CONCLUSIONS: Because of uncertainty about appropriateness and effectiveness, attending physicians were reluctant to respond to perceived disrespect, uncaring, or hostility toward patients by members of their medical team. They tended to avoid, rationalize, or medicalize these behaviors, and to respond in ways that avoided moral language, did not address underlying attitudes, and left room for face-saving reinterpretations. Although these oblique techniques are sympathetically motivated, learners in stressful clinical environments may misinterpret, undervalue, or entirely fail to notice such subtle feedback.

Adult↗

PubMed2003

House staff nonverbal communication skills and standardized patient satisfaction.

OBJECTIVE: To examine the association of physician nonverbal communication with standardized patient (SP) satisfaction in the context of the "quality" of the interview (i.e., information provided and collected, communication skills). DESIGN: Observational. SETTING: One university-based internal medicine residency program. PARTICIPANTS: Fifty-nine internal medicine residents. INTERVIEWING: The 59 residents were recruited to participate in 3 SP encounters. The scenarios included: 1) a straightforward, primarily "medical" problem (chest pain); 2) a patient with more psychosocial overlay (a depressed patient with a history of sexual abuse); and 3) a counseling encounter (HIV risk factor reduction counseling). Trained SPs rated physician nonverbal behaviors (body lean, open versus closed body posture, eye contact, smiling, tone of voice, nod, facial expressivity) in the 3 encounters. Multiple regression approaches were used to investigate the association of physician nonverbal behavior with patient satisfaction in the context of the "quality" of the interview (SP checklist performance, measures of verbal communication skills), controlling for physician characteristics (gender, postgraduate year). RESULTS: Nonverbal communication skills was an independent predictor of standardized patient satisfaction for all 3 patient stations. The effect sizes were substantial, with nonverbal communication predicting 32% of the variance in patient satisfaction for the chest pain station, 23% of the variance for the depression-sexual abuse station, and 19% of the variance for the HIV counseling station. CONCLUSION: Better nonverbal communication skills are associated with significantly greater patient satisfaction in a variety of different types of clinical encounters with standardized patients. Formal instruction in nonverbal communication may be an important addition to residency.

Female↗

PubMed2003

Cross-cultural comparison of perianesthesia nursing: challenges encountered in the PACU.

Nurses often consider caring for the pediatric patient in the PACU stressful. This stress may be compounded when providing this care in a foreign country. This article compares and contrasts the challenges experienced by one nurse when working in both Russia and China as a PACU nurse for the volunteer group, Operation Smile. Topics discussed in this article include the physical setup of the PACU; safety issues within the PACU; and the importance of communication, pain management, and parents within the PACU. The author elaborates on how to provide safe, competent, and culturally sensitive care to children within the PACU setting.

Adolescent↗

PubMed2000

Nurses' personal opinions about patients' pain and their effect on recorded assessments and titration of opioid doses.

In many clinical settings, nurses have a vital role in pain assessment and titration of opioid doses. Surveys of nurses have revealed knowledge deficits in these areas that are thought to contribute to under-treatment of pain. The present study surveys nurses' decisions about assessment and treatment of pain in 2 patient situations and confirms that nurses continue to undertreat severe pain. As shown in previous studies, nurses may be more influenced by the patient's behavior than the patient's self-report of pain, especially in relation to decisions about opioid titration. Nurses are less likely to increase a previously safe but ineffective dose of opioid for a smiling patient than a grimacing patient. Survey results reveal a tendency for nurses' personal opinions about the patients' pain, rather than their recorded assessments, to influence choice of opioid dose and to contribute to undertreatment of pain.

Analgesics, Opioid↗

PubMed2000

Paralysis of the marginal mandibular branch of the facial nerve: treatment options.

Isolated paralysis of the marginal mandibular branch of the facial nerve results in an asymmetrical smile with elevation of the lower lip on the affected side. We discuss the surgical options for its correction and present a series of 26 patients who underwent either botulinum toxin injection, anterior belly of digastric transfer or free extensor digitorum brevis transfer as treatment. Botulinum toxin injection provided satisfactory results although these were temporary. Anterior belly of digastric transfer was the surgical procedure of choice. It yielded superior cosmetic results, less donor-site morbidity and required a shorter operating time. In more complex congenital facial hypoplastic syndromes, or following extensive surgery in the digastric triangle, the anterior belly of the digastric muscle may be absent or damaged. Extensor digitorum brevis transfer is the preferred option in these cases.

Adolescent↗

PubMed2002

A modified temporalis transfer in facial reanimation.

A modified surgical procedure for temporalis transfer in facial reanimation of five consecutive cases is presented. Instead of the traditional stripping of the temporalis from its origin, its attachment at the coronoid removed, and to its end, the harvested fascia lata graft was sutured to lengthen the muscle's action. These fibres were then passed to the Orbicularis Oculi and Oris to aid in reanimation and to improve their tone. The procedure is less extensive, provides a direct line of pull with good functional results, no muscle atropy since vascularity and innervation is maintained. No complaints of paresthesia, hyposthesia or scar on donor leg was noticed. None of the patients required a revision of surgery for unacceptable contour or asymmetry. This simple procedure has helped reconstruction of natural symmetrical smile with highly successful results.

Adult↗

PubMed2000

Variations on the "baby-sitter" procedure for reconstruction of facial paralysis.

Four cases of fresh facial paralysis were treated using the "baby-sitter" procedure, with fairly satisfactory results obtained. This procedure involves a combination of cross-face nerve grafting and a nerve cross-over technique such as using a hypoglossal-facial nerve or accessory-facial nerve anastomosis. Two stages are required. Nerve cross-over and cross-face nerve grafting using the sural nerve are performed in the first stage. After 1 year nerve anastomosis between the stump of the cross-face nerve graft and that of a buccal branch in the paralyzed cheek is performed during the second stage. The recovery of facial animation through this method is good, with patients able to create a near-natural smile. Electromyography demonstrates double innervation in the paralyzed cheek area.

Accessory Nerve↗

PubMed2006

[Mona Lisa syndrome: idiopathic facial paralysis during pregnancy].

Mona Lisa has been pregnant shortly before the famous painting of Leonardo da Vinci was created (1503-1506). Recently, it has been speculated that Mona Lisa's famous smile is caused by facial muscle contracture and/or synkinesis after Bell's palsy with incomplete nerval regeneration. During pregnancy the incidence of Bell's palsy is increased up to 3.3 times compared to nonpregnant women. The etiology, associated factors as well as various treatment options aiming at the prevention of associated complications and improving recovery of facial nerve function have intensively been evaluated over the past three decades. However, the preferred mode of therapy management, particularly in pregnant women, remains undecided. Corticosteroids may be beneficial if they are applied after the first trimester.

Bell Palsy↗

PubMed1998

Use of the disposable stapler to insure proper fixation of a transferred muscle in treatment of facial paralysis.

The authors introduce the use of a disposable stapler to create a stable muscle end in transferring a free neurovascular muscle segment for the treatment of facial paralysis. This procedure allows the firm fixation of the fragile soft end of a muscle transferred to the nasolabial region of a paralyzed face, and avoids adhesion and tethering of the muscle end to the skin, which may result in inaccurate positioning of a newly-created nasolabial fold and an asymmetrical smile. Transection and hemostasis at both ends of the harvested muscle segment also can be achieved simultaneously. Although the disposable stapler incurs additional cost, it can greatly improve the result of a free neurovascular muscle transfer for the treatment of facial paralysis, as well as simplify harvesting of the muscle segment. No complications and problems have been encountered in stapling the muscle.

Disposable Equipment↗

PubMed1992

Forgotten pioneers in thoracic surgery.

The names of Carrel, Sauerbruch and Blalock are milestones in the early history of thoracic surgery. The recognition of contributions by less renowned contemporaries does not diminish the decisive part played by these founders of prestigious schools of thoracic surgery. Krönlein who in 1883 successfully performed what was probably the first lobectomy is never mentioned. The esophagectomy without thoracotomy publicized by Orringer in 1978 had already been done by Gray-Turner 47 years before, in 1931. McLean who discovered heparin, and Forssmann who introduced cardiac catheterisation by passing an ureteral catheter into his own heart ended up as small-town general surgeons. Horace Smithy of Charleston successfully performed an operation for mitral stenosis four months before Bailey and Harken. Unlike his famous contemporaries, he was unable to publicize his cases at medical meetings because that same year, 1948, he died from an aortic vascular stenosis. Vineberg, who had recommended and successfully performed internal mammary artery implantation since 1946, was smiled at as a utopian until his rehabilitation by Mason Sones' coronarography and until coronary bypass surgery developed into the greatest boom in thoracic surgery. Sir Henry Souttar, who is known to have operated successfully a mitral stenosis a quarter of a century before Bailey, when asked why following his 1925 success he did not persue mitral surgery answered: "Because I could not get another case!" As usual, surgical "break-throughs" met with the resistance of medical men. Before doctors became enthusiastic advocates and referred thousands of cases of pulmonary tuberculosis, and mitral and coronary stenosis, their opposition had to be overcome by successful operation of generally desperate cases.(ABSTRACT TRUNCATED AT 250 WORDS)

History, 19th Century↗

PubMed1997

Neurobiological bases of behavioral development in the first year.

This review summarizes the temporal relations between selected psychological milestones in the first year of the human infant and theoretically relevant developmental neurobiological changes in the brain, supplemented where appropriate, with evidence from the non-human primate. The disappearance of the palmar grasp reflex and the decrease in endogenous smiling and spontaneous crying, which occur at 2-3 months, are correlated to emergent cortical inhibition of brainstem circuits. In addition, the improved ability to recognize an event experienced in the immediate past (recognition memory) is related to growth of the hippocampus and adjacent structures at this age. The behavioral developments at 7-10 months include an enhanced ability to retrieve stored representations of the past and to compare past and present (working memory), along with the emergence of the universal fears of strangers and separation from the caretaker. These milestones are correlated in time with maturational changes in the prefrontal and rhinal cortices and hippocampal formation, the integration of the limbic system and increased responsiveness of the hypothalamus-pituitary-adrenal axis. Knowledge of age-dependent correlations of brain and behavioral maturation is a basis for the investigation of causal relationships between brain development and behavior. A close collaboration of pediatricians, psychologists and neuroscientists is, therefore, necessary.

Age Factors↗