Positive perceptions held by support staff in community mental retardation services

Existing research on support staff has been focused on variables associated with stress. However, there has been little attention to the possibility that staff may also experience a number of positive outcomes or perceptions. In the present study, 101 support staff working with adults who had mental retardation completed measures of burnout and mental health and a new measure: the Staff Positive Contributions Questionnaire (SPCQ). A range of positive perceptions of their work was endorsed by participants, demonstrating that such perceptions do exist and require theoretical explanation. The SPCQ had promising internal consistency, test-retest reliability, and construct validity. Thus, further research with this instrument is warranted.     

Limited agreement between criteria-based diagnoses of postconcussional syndrome

The objectives of this study were to compare diagnoses of postconcussional syndrome between the International Classification of Diseases, 10th revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV). The patient sample was comprised of 178 adults with mild-moderate traumatic brain injury (TBI). The study design was inception cohort, and the main outcome measure was a structured interview 3 months after injury. The results were that, despite concordance of DSM-IV and ICD-10 symptom criteria (kappa=0.73), agreement between overall DSM-IV and ICD-10 diagnoses was slight (kappa=0.13) because fewer patients met the DSM-IV cognitive deficit and clinical significance criteria. Agreement between DSM-IV postconcussional disorder and ICD-10 postconcussional syndrome appears limited by different prevalences and thresholds.     

The role of technology in task-oriented training in persons with subacute stroke: a randomized controlled trial

This trial compares the effects of task-oriented physical therapy (PT) provided with and without the use of rehabilitation technology on locomotor recovery in 63 persons with subacute stroke. Participants in the experimental (EXP) group used a treadmill, a Kinetron isokinetic exerciser, and a limb-load monitor, whereas those in the control (CTL) group did not while engaging in PT 1 h per day, 5 days per week for 2 months. Locomotor recovery was assessed by clinical (gait speed, Fugl Meyer motor leg and arm subscores, the Balance Scale, the Timed Up and Go, and the Barthel ambulation subscore) and laboratory outcomes (gait kinematics and kinetics) pre- and posttherapy and 3 months later. Within groups, gait speed (P < 0.01) and all secondary measures improved posttherapy (P < 0.01-0.05), and improvements in clinical measures were maintained at follow-up, but there was no difference between groups (P > 0.05). When the groups were pooled, the increase in gait speed was associated (r = 0.52, P = 0.003) with an increase in ankle power generation of the affected leg. The results demonstrate that the efficacy of the task-oriented approach is not dependent on rehabilitation technology.     

Sound attenuation of the indoor/outdoor range E-A-R plug

The sound attenuation provided by the AOSafety Indoor/Outdoor Range E-A-R Plug was examined. This device, currently used in military operations in several countries, is comprised of two plugs that provide conventional ("indoor" plug) and level-dependent sound reduction (the "outdoor" plug), respectively. The effects of the user's gender and repeated fittings were explored. Eight men and eight women were tested on two separate occasions. Unoccluded and protected hearing thresholds were measured for each of nine one-third octave noise bands centered at 0.125 to 8 kHz. Attenuation was calculated as the difference between these two measures. The indoor plug provided 21 to 40 dB of sound reduction across the frequencies tested, closely matching the manufacturer's specification. The outdoor plug provided 5 to 22 dB of conventional attenuation, suggesting that it might serve as a safe means of conventional and level-dependant attenuation in hearing-impaired users. No differences were found in relation to gender or repeated fittings.     

Guidelines for managing pressure ulcers with negative pressure wound therapy

Pressure ulcers are a serious health issue, leading to clinical, financial, and emotional challenges. Numerous treatment modalities are available to promote wound healing, yet clinicians may be unsure how to incorporate these treatment options into an overall plan of care for the patient with a pressure ulcer. A consensus panel of experienced wound care clinicians convened in July 2004 to review the mechanisms of action and research basis for one such treatment modality: negative pressure wound therapy. After answering key questions about this modality, they developed an algorithm to assist the clinician in making decisions about using negative pressure wound therapy appropriately in patients with Stage III and Stage IV pressure ulcers.     

Adult onset leukodystrophy with neuroaxonal spheroids and pigmented glia: report of a family,historical perspective,and review of the literature

We present a two-generation family consisting of a father and two daughters, who had an adult-onset leukodystrophy characterized by widespread destruction of cerebral white matter with neuroaxonal spheroids. The mode of inheritance appears to be autosomal dominant. All three patients presented with a variety of motor and cognitive symptoms, including frontal lobe signs, 4–7 years before death. Each followed a chronic course until death at ages 39, 46, and 51. At autopsy, the white matter loss was widespread but most prominent in the cerebrum with descending corticospinal tract degeneration and relative sparing of subcortical U-fibers. Pigmented glial cells were present, most of which appear to be macrophages, but inconstantly Prussian blue-positive. This disease is consistent with published reports of hereditary diffuse leukoencephalopathy with spheroids (HDLS). However, a review of the literature and a personal review of the neuropathology of the original case of the pigmentary type of orthochromatic leukodystrophy (POLD) reveal overlapping clinical and neuropathologic features between these two previously distinct entities, suggesting a common pathogenetic and perhaps etiological relationship between the two.     

Distribution of hypocretin (orexin) immunoreactivity in the feline pons and medulla

The distribution of hypocretin-1 (hcrt-1) and hypocretin-2 (hcrt-2) immunoreactivities in the cat brainstem was examined using immunohistochemical techniques. Hcrt-1- and hcrt-2-positive fibers with varicosities were detected in almost all brainstem regions. However, no hcrt-1- or hcrt-2-immunoreactive neuronal somata were observed in the cat brainstem. Both hcrt-1- and hcrt-2-labeled fibers exhibited different densities in distinct regions of the brainstem. In most brainstem regions, the intensity of hcrt-1 immunoreactivity was higher than that of hcrt-2 immunoreactivity. The highest densities of hcrt-1- and hcrt-2-positive fibers were found in the nucleus raphe dorsalis (RD), the laterodorsal tegmental nucleus (LDT) and the locus coeruleus (LC), suggesting an important role for these peptides in functions related to sleep-wake behavior.     

Pharmacogenetics of tipifarnib (R115777) transport and metabolism in cancer patients

The purpose of this study was to perform exploratory relationships between the pharmacokinetics of the farnesyl transferase inhibitor, tipifarnib (R115777, Zarnestra) and allelic variants of genes coding for ATP binding-cassette transporters and drug-metabolizing enzymes. Twenty-eight patients with advanced solid tumors were treated with tipifarnib administered orally at a dose of 200 or 300 mg. Blood samples were collected for pharmacokinetics and genotyping of 10 variants in genes encoding P-glycoprotein (ABCB1), cytochrome P450 isozymes CYP3A4 and CYP3A5, and UDP glucuronosyltransferase isozyme UGT1A1. The homozygous T -allele of ABCB1*8 (1236C > T ) was associated with a trend for a higher area under the curve of tipifarnib as compared to patients with only one or no variant alleles [mean (+/-SD), 5,303 +/- 1,620 ng.h/mL vs. 3,619 +/- 1,275 ng.h/mL; P = 0.047). No statistically significant differences were observed with any other genetic variant ( P > 0.15). Overall, this study indicates that ABCB1 genotype might be correlated with tipifarnib pharmacokinetics, although considerable overlap in exposure measures between genotype groups was observed.     

Pharmacokinetic characteristics of ritonavir, zidovudine, lamivudine, and stavudine in children with human immunodeficiency virus infection

STUDY OBJECTIVE: To evaluate and describe the parameters and characteristics of different drug regimens in children infected with human immunodeficiency virus (HIV). DESIGN: Randomized, open-label, multicenter study. SETTING: Pediatric HIV research clinics in the United States and Puerto Rico. PATIENTS: Twenty-one HIV-infected children, aged 3-14 years, who were clinically stable and treated with the same antiretroviral therapy for 16 weeks or longer. INTERVENTION: In step 1, children were randomized to receive one of three treatment regimens: zidovudine plus lamivudine, ritonavir plus zidovudine and lamivudine, or ritonavir plus stavudine. Patients originally assigned to the zidovudine plus lamivudine group in step 1 were eligible to progress to step 2 if their HIV RNA values at week 12, 24, or 36 were 10,000 copies/ml or greater but 100,000 copies/ml or less. In step 2 they received a regimen of ritonavir plus stavudine and nevirapine. MEASUREMENTS AND MAIN RESULTS: Seven children were randomized to each of the three treatment regimens. Concentrations of the agents were quantitated at steady state after observed doses, and the pharmacokinetic parameters were determined. Nevirapine concentrations were not determined. One child was excluded from analysis because pharmacokinetic parameters could not be estimated. Ritonavir oral clearance was slower in the pooled cohort of children who received stavudine compared with zidovudine and lamivudine. Stavudine oral clearance was marginally faster when combined with ritonavir and nevirapine compared with only ritonavir. CONCLUSION: Therapy for HIV is complex, and pharmacodynamic data indicate that relationships exist between systemic concentrations of antiretroviral drugs and virologic response. Careful drug interaction studies have not been conducted for all treatment regimens, and it will not be surprising if unexpected interactions are found. Pharmacokinetic studies to address these considerations should be viewed as a fundamental component of antiretroviral drug development, as they represent a tool to improve pharmacotherapy for HIV-infected children.