Neurosurgical robotics: a review of brain and spine applications

Neurosurgery has traditionally been at the forefront of advancing technologies, adapting new techniques and devices successfully in an effort to increase the safety and efficacy of brain and spine surgery. Among these adaptations are surgical robotics. This paper reviews some of the more promising systems in neurosurgical robotics, including brain and spine applications in use and in development. The purpose of the discussion is twofold—to discuss the most promising models for neurosurgical applications, and to discuss some of the pitfalls of robotic neurosurgery given the unique anatomy of the brain and spine.     

Cow's Milk Exposure and Asthma in a Newborn Cohort: Repeated Ascertainment Indicates Reverse Causation

The effect of cow's milk consumption on childhood asthma has been debated for several years. This study attempts to provide further insight into this association through the use of a longitudinal study design. Newborns from parents with atopic history were recruited from Germany, Austria, and England (n = 696). For five repeated ascertainments, information was collected on cow's milk exposure, incidence of doctor-diagnosed asthma, and confounders. Generalized estimation equations, incorporating different models (concurrent, delayed, combined, and reverse causation), were used to determine this association. No association between cow's milk consumption and childhood asthma was found for the concurrent effects model (OR = 0.81, 95% confidence interval [CI]: 0.55, 1.20). In the delayed effects model, the direction of the association varied with time of follow-up. Thus, we stratified by period, which resulted in a significant protective delayed effect at 36 months (OR = 0.18, 95% CI = 0.06, 0.49). However, reverse causation negated this finding since the presence of asthma in prior months led to a reduction in further exposure to cow's milk (OR = 0.40, 95% CI = 0.16, 0.99). Hence, cow's milk consumption does not protect against childhood asthma. The apparent protection of cow's milk against asthma may result from parents of asthmatic children avoiding cow's milk, rather than actual prophylaxis.     

Asbestos bodies in lung tissue following exposure to crocidolite

A series of 206 necropsies in Western Australia (WA) have had routine counts made of asbestos bodies in samples of lung tissue using conventional light microscopy. Thirty-two cases had worked in the asbestos industry at Wittenoom, WA and (log) counts of asbestos bodies in their lung tissue correlated well with estimates of their (log) cumulative airborne exposure to crocidolite fibers (r = 0.60). There was no association between the number of asbestos bodies and time since exposure to asbestos ceased. In subjects without known exposure to asbestos, there was a weak but nonsignificant increase in number of asbestos bodies with increasing age, with 26% of cases having no asbestos bodies present. It is concluded that the relatively simple technique of light microscopy for counting of asbestos bodies in lung tissue provides a reliable indication of the level of past occupational exposure to crocidolite in subjects whose exposure has been only to crocidolite. This could be extremely useful in follow-up studies of cohorts that lack reliable measures of airborne exposure to crocidolite asbestos.     

An adjusted version of Kohlberg's moral theory: discussion of its validity for research in nursing ethics

Critics of Kohlberg's moral theory today focus on the content of his theory and more specifically on its justice-orientated moral concept. This has led to the well-known 'justice-care debate'. The purpose of this article is to critically examine the validity of Kohlberg's moral theory for research in nursing ethics from a caring perspective (referring to the content) as well as from a cognitive-structural perspective (referring to the basic assumptions of the model). The analysis points to the usefulness and value of the cognitive-structural model to empirically study nurses' ethical behaviour; the content of Kohlberg's model, however, needs to be adapted by adding a caring perspective as well as some personal and situational variables. An adjusted version of Kohlberg's model is proposed and discussed.