Neuropsychological, psychosocial and vocational correlates of the Glasgow Outcome Scale at 6 months post injury: a study of moderate to severe traumatic brain injury patients

Traumatic brain injury (TBI) subjects at Glasgow Outcome Scale levels 3 (severe disability), 4 (moderate disability), 5 (good recovery), and an other injury control group (OIC) were compared in terms of neuropsychological, psychosocial, and vocational functioning 6 months after injury. Subjects were a sample of 100 patients with a moderate to severe traumatic brain injury (TBI) and a matched sample of 30 other injury control subjects (OIC) enrolled in the UCLA Brain Injury Research Center study of TBI outcome. Overall, the results showed a systematic decrease in mean neuropsychological test performance as a function of increasing GOS severity, as well as an increased prevalence of symptoms of depression and lower ratings on measures assessing employability and capacity for self care. TBI patients in the 'severe' and 'moderate disability' groups were distinctly inferior to the 'good recovery' and 'OIC' groups, who were quite similar to each other in terms of cognitive, psychosocial, and vocational outcomes. The results demonstrate overall support for the predictive and concurrent validity of the GOS 6 months post injury. Despite these results, which strengthen the utility and appeal of the GOS for multicentre studies, concerns still remain regarding GOS category 4 (moderate disability), which was shown to lack sufficient discriminability in this study.     

The role of psychiatry in the public mental health delivery system: An introduction

The papers which follow are revised and expanded versions of presentations made at the Conference on Improving Florida's Services for the Mentally Ill: The Role of Psychiatry, held in Tallahassee, Florida on October 7–8, 1986, and organized by the Florida Mental Health Institute, University of South Florida. The conference was sponsored by the Florida Department of Health and Rehabilitative Services through the Committee on Public Psychiatry. The authors and their organizational affiliations are listed below     

Environmental distribution and long-term dispersion of reactor 14CO2 around two German nuclear power plants

Carbon-14 data on atmospheric CO2 as well as on plant material (tree leaves and wheat) from the vicinity of two German boiling water reactors (Philippsburg and Isar/Ohu) are reported. Atmospheric CO2 samples taken routinely with an integration time of one or two weeks 1.75 km downwind of the Philippsburg reactor (900 MW electrical power) show a maximum 14C excess concentration of delta 14C (excess) = 300 +/- 7%, corresponding to 12.7 mBq m-3 (STP air). The long-term average excess amounts to delta 14C (excess) = 47 +/- 3%, corresponding to 2.0 mBq m-3 (STP air). The concentrations observed with plant material at the same sampling site range between delta 14C (excess) = 0% and 120%, corresponding to 0 and 27 mBq (g carbon)-1. With the meteorological dispersion parameters actually measured at the nuclear power plants, the dispersion factors for the various sampling sites and for the individual periods of sampling were calculated on the basis of a one-dimensional Gaussian plume model. With the observed 14C excess concentrations and the dispersion factor, a "theoretical" (i.e. calculated) reactor 14C source strength is then determined. For the Philippsburg reactor, which is situated in the flat Rhine valley, the "theoretical" and the observed yearly mean 14C emissions compare rather well (within a factor of 2). A significant systematical deviation from the model was found in the concentration decrease with source distance: the decrease predicted between the 1.75-km and 3.25-km distances is steeper than actually observed. The 14C excess concentrations found in tree leaves around the Isar/Ohu reactor (907 MW electrical power) at 1-2 km distance fall into the same range as observed at Philippsburg. In the hilly terrain at this reactor site, the model calculations agree well with the observed values up to a distance of 1 km if the relative elevation of the sampling site is taken into account by introducing a "reduced stack height" in the model calculations. This method fails in predicting the concentrations at distances greater than 1 km from the source.     

Proteus syndrome

The term Proteus syndrome was coined in 1983 to describe a disorder of skeletal, hamartomatous, and other mesodermal malformations. The syndrome was named after the Greek god Proteus, whose name means "the Polymorphous." Clinical features of this new syndrome are currently being defined. Including the case reported herein, we have found 34 patients with Proteus syndrome described in the English literature. Major clinical findings, defined as those findings seen in more than half of the cases, include hemihypertrophy, macrodactyly, exostoses, epidermal nevi, characteristic cerebriform masses involving the plantar or palmar surfaces, a variety of subcutaneous masses, and scoliosis. Histologic examination of subcutaneous masses has identified a variety of lipomatous, hamartomatous, and angiomatous tumors.     

Effect of crossover on the statistical power of randomized studies

Randomized studies involving long-term follow-up are vulnerable to the effects of unplanned crossover. In surgical studies, such crossover usually occurs when control patients become more symptomatic and undergo operation. In several large studies of coronary bypass grafting, crossover ranged from 25% to 38%. The most common way of dealing with this problem is to apply the "intention-to-treat" principle, which analyzes such crossovers with their originally assigned groups. Besides the logical problem of counting a control patient who actually undergoes operation as "nonsurgical," a more subtle problem arises in terms of statistical power. When statistical power is low, a truly effective treatment may be mistakenly labeled as no better than control, causing a potentially valuable form of therapy to be ignored or discarded. This analysis demonstrates that crossover may have a profound effect on the statistical power of randomized studies and presents a method for predicting the effect of such crossover on statistical power.     

Autosensitivity of Pseudomonas aeruginosa to Its Own Pyocin

Sensitivity of smooth and mucoid Pseudomonas aeruginosa strains from the same patient to their own pyocins was found to be greater at 20 than at 35 C.     

Modulation of the chemotactic properties of complement fragments C5a and C3 by the anti-inflammatory agent,SC-41930

Cleavage of the fifth component of complement yields C5a, a potent neutrophil (PMN) and eosinophil chemoattractant, and modulator of microvascular permeability. Similarly, but to a lesser degree, C3 increases vascular permeability and histamine release. SC-41930 (7-[3-(4-acetyl-3-methoxy-2-propylphenoxy)-propoxy]-3,4-dihydro-8-propyl-2H-1-benzopyran-2-carboxylic acid), an orally-active antiinflammatory agent was tested in anin vivo model of dermal PMN chemotaxis induced by r-hu-C5a and hu-C3. Intradermal injection of C5a in the guinea pig resulted in a significant dose-dependent influx of PMNs at 4 hours as assessed by the dermal levels of myeloperoxidase (MPO). SC-41930 (20 mg/kg) given orally to guinea pigs with intradermal injections of 1 μg C5a significantly (p<0.001) reduced dermal MPO content. SC-41930 was less potent against C3, requiring 40 mg/kg to significantly reduce dermal MPO levels. Agents such as SC-41930, which nullify complement's proinflammatory properties, may well have therapeutic potential.