The Birmingham Hip Resurfacing: 5-year clinical and radiographic results from a District General Hospital

We prospectively examined the functional and radiographic outcomes of a serial cohort of 104 Birmingham Hip Resurfacings in an independent centre. Final follow-up was to a mean of 61 months, and six cases were lost to follow-up. Excellent results were obtained in 91%, but obese patients had significantly (p < 0.03) poorer post-operative outcomes. Whilst there were no cases of neck fracture neck narrowing of up to 20 mm was noted. Radiolucent lines were present in a single zone in 9.4% (9/96) acetabular and 3.1% (3/96) femoral components. However, no components were definitely loose and there were no revisions for any reason during the period of the study. This independent series confirms that the Birmingham Hip Resurfacing gives excellent early clinical results and little early evidence of radiographic failure. The high rate of neck narrowing gives us cause for concern and we would recommend regular radiographic follow-up.     

The value of cystoscopy and bladder biopsy taken at the time of tension-free vaginal tape insertion.

The primary aim of this study was to determine if a cystoscopy performed at the time of a tension-free vaginal tape (TVT) insertion is useful in finding unexpected pathology. A secondary outcome measure was to assess whether a bladder biopsy and cystoscopy performed during the TVT operation provide useful information about the outcome of surgery. The findings in 100 consecutive women were reviewed. A total of 42 women demonstrated mixed detrusor overactivity (DO) and urodynamic stress incontinence (USI); 32 women had abnormal biopsies. Women with DO were no more likely to have abnormal bladder biopsies than women without DO (p > 0.05). An abnormal bladder biopsy or cystoscopy failed to predict postoperative irritable symptoms (p > 0.05). The presence of preoperative DO correctly predicted postoperative irritable symptoms (p < 0.01). Cystoscopic abnormalities were noted in 14 women including one carcinoma, and one case of dysplasia was discovered on biopsy. In five women, the cystoscopy showed a bladder perforation. Cystoscopy should be performed in all women undergoing continence procedures.     

Training for Direct Support Staff at Group Homes for People with Chronic Mental Illness

For people with chronic mental illness, their support system (including direct support staff at group homes) play a key role in ameliorating exacerbations leading to crisis care. However, little information exists on curriculum or training programs focused on reducing exacerbations while promoting compassionate care. We developed, implemented and evaluated such a program that featured role-playing and animated videos supplemented with limited didactics. During development phase, direct support staff reviewed videos and rated them as depicting realistic situations with high acceptability. During implementation, the 6-week course (at least one staff from six different group homes not involved in the development phase) using a 3-month pre-post design found reductions in total number of incident reports and pre-specified outcomes of recipient right complaints, emergency calls, and psychiatric hospitalizations. The program demonstrated acceptability, improved care and better outcomes on some but not all outcomes. Improved training of direct support staff is possible and has positive outcomes.     

Aromas of rosemary and lavender essential oils differentially affect cognition and mood in healthy adults

This study was designed to assess the olfactory impact of the essential oils of lavender (Lavandula angustifolia) and rosemary (Rosmarlnus officinalis) on cognitive performance and mood in healthy volunteers. One hundred and forty-four participants were randomly assigned to one of three independent groups, and subsequently performed the Cognitive Drug Research (CDR) computerized cognitive assessment battery in a cubicle containing either one of the two odors or no odor (control). Visual analogue mood questionnaires were completed prior to exposure to the odor, and subsequently after completion of the test battery. The participants were deceived as to the genuine aim of the study until the completion of testing to prevent expectancy effects from possibly influencing the data. The outcome variables from the nine tasks that constitute the CDR core battery feed into six factors that represent different aspects of cognitive functioning. Analysis of performance revealed that lavender produced a significant decrement in performance of working memory, and impaired reaction times for both memory and attention based tasks compared to controls. In contrast, rosemary produced a significant enhancement of performance for overall quality of memory and secondary memory factors, but also produced an impairment of speed of memory compared to controls. With regard to mood, comparisons of the change in ratings from baseline to post-test revealed that following the completion of the cognitive assessment battery, both the control and lavender groups were significantly less alert than the rosemary condition; however, the control group was significantly less content than both rosemary and lavender conditions. These findings indicate that the olfactory properties of these essential oils can produce objective effects on cognitive performance, as well as subjective effects on mood.     

Electron microprobe study of calcifications in human brain tumors

Summary Preliminary electron microprobe studies of a small number of meningiomas, oligodendrogliomas, glioblastoma multiformae, craniopharyngiomas, and metastatic epithelioma of the breast suggest that the elemental composition of the deposits associated with these tumors is characteristic for each type of tumor.     

Periventricular astrocytosis and acute necrotizing encephalitis

Summary A group of rats presented with acute necrotizing encephalitis. The histopathological picture was the same in all the animals yet the periventricular regions where no morphologically appreciable signs of necrosis or infection could be found, presented with a florid astrocytic response. This periventricular astrocytosis was undetected with standard morphological methods but well-demonstrated with histoenzymatic techniques. It is presumed that these astrocytes originated in the ependyma with a possible cellular contribution from the choroid plexus.This work was done while in tenure of a Clinical Research Fellowship of the Medical Research Council (England) in the Royal Postgraduate Medical School, Lodon.     

Canonical correlation analysis: potential for environmental health planning.

There is a challenging need to identify the relationships between environmental quality and health status. It may be especially important to be able to isolate key variables which can be consolidated into a few indices of environmental conditions as they are related to health. Such indices might be used to identifying associations among groups of variables, such as specific geographic area. The indices may also provide insights into environmental health relationships which are worthy of further epidemiological investigation. Canonical correlation analysis is a multivariate statistical technique which provides a means of identifying associations among groups of variables, such as health and environmental measures. The technique can produce weighted indices of environmental conditions as they are related to health within a city or region. This paper describes what canonical correlation is, and outlines how it might be used for these purposes. An illustrative application based on data collected for Philadelphia, Pennsylvania is also presented.