Development and preliminary validation of an instrument to assess quality of sitting of children with neuromotor dysfunction

The development of a clinical instrument to assess static and dynamic postural control in sitting in children with neuromotor dysfunction is described. A review of the literature has supported the need for objective assessment tools for measuring various aspects of functioning with this population. In this paper the conceptual basis and preliminary validation study results of a new instrument, the Sitting Assessment for Children with Neuromotor Dysfunction (SACND) are presented. Initial results show the SACND to have good inter-rater reliability, and discriminant validity. Construct validity testing suggest the SACND shows promise for use by clinicians and researchers. Further research is needed to assess the SACND's test-retest reliability, the major underlying test constructs, and the effects of intervention on test scores.     

Pesticide exposure in a farming village in Venezuela--a developing country

This study was designed and performed by the Universidad de Carabobo, Centro de Investigaciones Toxicológicas, Venezuela, and the University of Cincinnati Department of Environmental Health. The authors tested methodology and analyzed preliminary data on demographics, pesticide use, health, environment, and lifestyles in a farming community in Venezuela (population = 386; sample size = 81) to determine if pesticide misuse might have been contributing to public health problems. Questionnaire and geographic information were collected. There were statistically significant incidences of pesticide-related symptoms (p < .01) in farmers versus nonfarmers (odds ratio = 5.7; 95% confidence interval = 2.9, 18.8). In addition, in one area there was a cluster of farmers who experienced symptoms that appeared to be the result of foul air and proximity to farms where there was pesticide use. The results of the study indicated that this public health problem may have been associated with pesticide misuse; however, additional studies are needed to corroborate the findings.     

The views and outcomes of consenting and non-consenting patients receiving ECT

BACKGROUND: Current mental health legislation in the UK makes provision for the use of certain treatments in severely ill patients who are unable, or unwilling, to give informed consent. Under the terms of this legislation, electroconvulsive therapy (ECT) may be used, usually to treat severely depressed patients. A number of organizations have challenged this practice, stating that ECT should only be given with fully informed consent: it has been implied that patients receiving compulsory ECT (given without the patient's consent, under the terms of mental health legislation) find the treatment damaging and unhelpful. METHODS: A series of 150 patients receiving ECT in Aberdeen was studied. A proportion of the series (approximately 7%) received compulsory ECT. The views and treatment outcomes of compulsory patients were compared with those of patients giving informed consent for treatment. RESULTS: More than 80% of patients in both consenting and compulsory groups considered ECT to have helped them. Clinical outcome did not differ between the groups. Patients' views showed marked concordance with independent medical evaluation of outcome. CONCLUSIONS: Outcome following ECT in non-consenting patients is equivalent to that seen in consenting patients whether rated by the patients themselves or by clinicians. Overall outcome is good, with more than 80% of patients benefiting from treatment. A ban on compulsory ECT would deny the access of seriously ill patients to an effective and acceptable treatment.     

A behavioral approach to identifying sources of happiness and unhappiness among individuals with profound multiple disabilities

This investigation evaluated a behavioral means of identifying sources of happiness and unhappiness among individuals with profound multiple disabilities. Indices of happiness and unhappiness were defined, and a corresponding observation system was developed and implemented with five students in an adult education classroom. Each student was observed while participating in two separate classroom activities. Results indicated the definitions and the observation system reliably identified different frequencies of happiness and/or unhappiness indices for each student across separate activities. Results are discussed regarding routine use of the observation system to evaluate classroom activities for effects on student happiness as a measure of quality of life. Future research needs are discussed in terms of determining means to alter certain classroom procedures that are accompanied by indices of student unhappiness.     

The hereditary spastic paraplegias

The hereditary spastic paraplegias are a complex group of neurodegenerative conditions which are characterised by slowly progressive lower limb spasticity. This article describes the main clinical features of pure and complicated hereditary spastic paraplegias and summarises recent advances in our understanding of the molecular genetics of these conditions. Received: 2 June 1999 Accepted: 7 August 1999     

Clonal mixing, clonal restriction, and specification of cell types in the developing rat olfactory bulb

To understand the clonal relationship of various olfactory bulb (OB) cell types, OB progenitor cells were infected at embryonic day (E) 14, E15, and E17 with retroviral libraries encoding alkaline phosphatase or beta-galactosidase. After survival to postnatal day 10-15, sibling relationships were identified by polymerase chain reaction DNA amplification of distinct sequences in the retroviral constructs. Within the OB, clonal progeny dispersed widely in all directions. In sharp contrast, however, clonal dispersion between the OB and neocortex was not observed, although occasional clonal dispersion between the OB and pyriform and hippocampal regions could not be excluded. Most clones (84%) contained a single cell type, especially after E17 injections, suggesting the existence of either restricted precursors, or multipotential progenitors instructed by a restricted cellular environment. Mixed OB clones (16%) contained multiple cell types in the OB, or occasionally glial or neuronal cells outside the OB, demonstrating the existence of multipotential OB progenitors, likely at a stage before formation of the olfactory rostral migratory stream. Surprisingly, OB glial cells were not labeled, suggesting distinct lineages or perhaps distinct migratory paths for glia and neurons into the OB. A hierarchical cell lineage is proposed that involves a multipotential progenitor that gives rise to potentially more limited progenitors.     

Analysis of the symptoms of depression--a neural network approach

The purpose of this study is to determine the individual contribution, or importance number, of the symptoms to an analysis of depression, utilizing a neural network model. In addition, the presence of hopelessness and somatic complaints was examined, to determine their relevance to depression. Using Wave 1 data from Duke University's contribution in the Epidemiological Catchment Area (ECA) study, we created a mathematical model, a neural network, to map the relationship of nine symptoms of major depression, hopelessness and somatic complaints to the presence or absence of the formal diagnosis of depression, and performed a contribution analysis. The contribution analysis using the neural network revealed that the symptoms with the greatest impact on the occurrence of depression, or with the largest importance number for depression, were sadness, loss of interest, tiredness and sleeping trouble, in that order. The most frequently reported symptoms, though, were sadness, sleeping trouble, suicidal ideation, tiredness and poor concentration, in that order. Hopelessness and somatic symptoms were the lowest in their contribution to the diagnosis of depression. The study thus provides the hierarchy of the symptoms of depression and supports the DSM classification of major depression.     

Platinum distribution in malignant glioma following intraoperative intravenous infusion of carboplatin

The objective of this paper was to determine the time course and extent of platinum uptake into human malignant glioma tissue. An intraoperative, intravenous infusion of carboplatin was given to nine patients (seven glioblastoma and two anaplastic glioma) undergoing tumour excision. Carboplatin dosage was calculated individually to achieve a target systemic free carboplatin exposure. Tumour and peritumoural tissue was harvested at timed intervals following carboplatin administration. Plasma and tumour platinum concentrations were measured by graphite furnace flameless atomic absorption spectrophotometry. Histological examination was also performed on a piece of each tissue sample. The mean carboplatin dose administered was 783, SEM 56 mg (range 485-903). Plasma pharmacokinetics showed a typical elimination curve. The mean peak plasma platinum concentration was 44, SEM 5 micrograms/ml (range 27-74). The mean total elemental plasma platinum area under the curve (AUC) was 9.0, SEM 1.4 mg/ml/min. Platinum was detected in 61 tumour samples, the mean peak concentration being 13 SEM 2 micrograms/g (range 5-21). Platinum was also detected in peritumoural brain and necrotic tumour. No correlation was apparent between the degree of necrosis in each tumour specimen and tumour platinum concentration. Platinum concentrations achieved in tumour were similar to levels that would be cytotoxic for glioma cells in vitro. The results of this study have implications for future studies using capillary permeability modifying agents as adjuncts to brain tumour chemotherapy.