How much do young offenders need social work?

The current orthodoxy in social work with young offenders centres on the twin themes of justice and systems management. The first beseeches social work to use mechanisms, such as the 1982 Criminal Justice Act, as a means of improving the juvenile court process. The second seeks to provide a clear alternative to custody by redefining Intermediate Treatment as a strategy aimed primarily at "heavy end" offenders. The recent news that the numbers of those receiving Youth Custody has risen sharply since the implementation of the above Act, only serves to amplify the importance of the debate about what kind of social work young offenders should receive. The current implication for both the courts and social work practice is that justice is not being done and diversion not being achieved. However, should social work respond by concentrating the vast majority of its endeavours in one particular area, then it would clearly have major implications both for practice and for the allocation of resources. It would therefore have an effect on the kind of social work young offenders might receive and hence how much such a service may be required.     

A comparison of digital subtraction angiography and noninvasive testing in the diagnosis of cerebrovascular disease

Among the 1,892 patients who underwent cerebrovascular digital subtraction angiography at our hospital over the past 18 months, there was a subgroup of 34 patients (65 carotid arteries) for whom noninvasive cerebrovascular test results and standard cerebral arteriograms were also available. These patients were reviewed retrospectively and the ability of both methods to detect hemodynamically significant lesions, defined as a greater than 50 percent reduction in the diameter of the carotid artery, was determined using the arteriograms as the "gold standard." Noninvasive cerebrovascular tests had a sensitivity of 81 percent, a specificity of 95 percent, a positive predictive value of 92 percent, a negative prediction value of 88 percent, and an overall accuracy of 89 percent. Digital subtraction angiography had a sensitivity of 84 percent, a specificity of 92 percent, a positive predictive value of 88 percent, a negative predictive value of 89 percent, and an overall accuracy of 89 percent. If the four cases of hemodynamically significant stenosis of the carotid siphon not detected by digital subtraction angiography had been considered as false-negatives, its sensitivity would have been reduced to 72 percent. In patients with hemispheric cerebral ischemia, we found noninvasive cerebrovascular tests neither necessary nor cost-effective. Digital subtraction angiography, on the other hand, often provided definitive diagnostic information in such patients if the intracranial circulation was well defined and the extracranial lesion corresponded to the patients' symptoms. Noninvasive cerebrovascular testing was the safest and most cost-effective technique for screening patients with asymptomatic bruits, atypical, nonhemispheric cerebral symptoms, and those who have undergone carotid endarterectomy. If the noninvasive cerebrovascular test result was positive or equivocal, digital subtraction angiography was performed to localize the responsible lesion and exclude carotid occlusion.     

Which central venous catheter for neonatal use?

Complications in 100 percutaneous central venous catheters used for parenteral nutrition were monitored prospectively in patients on a regional neonatal medical and surgical unit. Infants were randomly allocated to receive either a Vygon Epicutaneous catheter or Dow Corning silastic tubing. The majority of lines -63 - were removed electively when parenteral feeding was no longer required. The most common serious complication was catheter sepsis for which 11 lines were removed; all patients made a complete recovery. Minor mechanical complications were encountered with 17 catheters. There was no difference in performance or complication rate comparing the two types of catheter. Percutaneous central venous catheters provide a suitable and safe means of administration of parenteral nutrition to preterm infants over an extended period of time.     

The stairway to recovery. An emerging worldview uncovers God's wisdom in nature

What is lacking for the renewal of the earth is not so much ethical consensus as political will. The myth of "man" as the self-sufficient and autonomous master of "inanimate" nature has been ingrained for centuries, and it will take a powerful force to dislodge it. However, we are in a unique period of convergence--a time when we might be transformed by the truth if we only seek it. This new spiritual awakening represents a conscious commitment to a common cause that lies beyond individual self-interest. The commitment has been kindled by a perception that we are creatures intimately connected with the rest of creation and to the power that has called us into being. And it is a commitment carried out in action through a disciplined way of life. If we want to heal the earth, we have to get better ourselves, because it is the way we think and live and act that is harming the earth. We have much to learn from participants in Alcoholics Anonymous, who have learned the secret of proclaiming the good news by doing it, one step at a time, by living it, day by day. The first step is acknowledgment that, as a society--indeed, as the human race-we are at the bottom and cannot get back up. Once we admit we have hit the bottom, there is hope for the environment because we have taken the first step to recovery.     

Comparative pharmacokinetics of propofol in Chinese adults and children.

The pharmacokinetics of propofol were studied in 14 healthy young male Chinese adults, aged 18-38 years, undergoing minor orthopedic surgery. All patients who received a single bolus dose of propofol 2.5 mg/kg were paralyzed with atracurium and mechanically ventilated. Anesthesia was maintained with 67% nitrous oxide plus 1-2% isoflurane in oxygen with alfentanil 5 micrograms/kg intravenously as a bolus injection. Blood concentrations of propofol over the subsequent 24 hours were measured using high pressure liquid chromatography with fluorimetric detection. Data were consistently described by a three compartment model but analysis revealed two significantly different blood propofol concentration-time profiles (p less than 0.05). Five patients, designated "fast" metabolizers, demonstrated a mean elimination half-life which was shorter than that described in Chinese children, while their total body clearance was similar. Nine other patients, designated "slow" metabolizers, had a longer mean elimination half-life and slower total body clearance than those in elderly Caucasian patients. This may be suggestive of propofol metabolism at some extra-hepatic site in some patients, while other patients demonstrate marked lipophilicitic constraint of the drug by the deep compartment.     

The protective activity of ICRF-187 against doxorubicin-induced cardiotoxicity in the rat

Summary The protective activity of the bisdioxopiperazine ICRF-187 against the cardiotoxicity of doxorubicin was evaluated in the rat using both functional and histological assays. Animals that had received a single i. v. dose of doxorubicin (4 mg/kg) alone were compared with those that had been pretreated with a single i. v. injection of saline or ICRF-187 (40 or 60 mg/kg). All rats showed a transient reduction in body weight during the first 3 weeks after drug administration. The greatest reduction (16%) was observed in animals that had received a combination of ICRF-187 (40 or 60 mg/kg) and doxorubicin. Deaths related to cardiotoxicity were observed only in rats that had received doxorubicin alone and in those treated with saline; most of the deaths occurred at between 8 and 13 weeks after drug administration. Sequential assessments of heart function showed a persistent depression of cardiac output in animals that had received doxorubicin, with or without pretreatment with ICRF-187. The reduction in cardiac output observed in rats that had been pretreated with ICRF-187 (40 or 60 mg/kg) amounted to 15% and 30% after 12 and 20 weeks, respectively, indicating that cardioprotection was only partial. Nevertheless, this represented a marked improvement as compared with the 35% reduction in cardiac output measured at 12 weeks in animals that had received doxorubicin but without pretreatment with ICRF-187. Histological examination of animals that had died during the course of the study and had received doxorubicin after pretreatment with saline revealed severe myocardial lesions typical of doxorubicin-induced damage. In contrast, animals that had been pretreated with ICRF-187 and survived for up to 20 weeks after treatment showed a marked amelioration of these lesions. The present findings may be interpreted as a true cardioprotection or a delay in the onset of the cardiotoxicity of doxorubicin resulting from pretreatment with the bisdioxopiperazine ICRF-187. Although prior and ongoing clinical trials clearly indicate that ICRF-187 protects patients well against doxorubicin-induced heart damage, further investigations are required beforehigh doses of ICRF-187 can be used as a means of increasing the protective activity of this drug against doxorubicin-induced cardiotoxicity.This work was supported by the Cancer Research Campaign     

Reliability of labial closure force measurements in normal subjects and patients with CNS disorders.

This study determined the reliability of maximal upper and lower lip closing forces measured using a strain-gauged cantilever beam assembly. An intraclass correlation approach was used to explicitly partition the "error free" between-subject variance and measurement error variance across repeated days (2) and across repeated trials (5). Ten healthy adults served as controls and 30 patients with diagnoses of multiple sclerosis, cerebrovascular accident, or Parkinson's disease served as subjects. The intraclass correlation analyses revealed generally high reliability (R greater than .90) for upper and lower lip force measurements, for various combinations of control and/or patient groups, and within each individual patient group. There was moderate correspondence between the quantitative measures of lip force and the clinical assessment of combined upper (r = .67) and lower lip closure force (r = .62) but low correspondence between the quantitative measures of lip force and the presence of motor speech deficit. The lower lip force of patients with Parkinson's disease (M = 3.1 N) on Day 1 was markedly reduced from that of all other patient groups and controls (M = 10.1 N). These results yield helpful information for the design of investigations of oral-motor weakness and for the quantitative assessment of an individual's clinical status.     

Is routine cervical spine radiographic evaluation indicated in patients with mandibular fractures?

Fractures of the mandible are commonly seen in most urban trauma centers. Over the past decade, the authors have seen a rise in these injuries secondary to an increase in drug and alcohol abuse, violent crime, and high-speed motor vehicle accidents. Several reports have described an association between mandibular fractures and cervical spine injuries and recommend routine cervical spine radiographs in all patients with mandibular injuries. These studies have failed to show a "cause and effect" relationship because of concomitant injuries found in these patients. This study reviews mandibular fractures and cervical spine injury retrospectively and prospectively over a 3-year period. The retrospective study included patients with isolated mandibular fractures who came to Cooper Hospital/University Medical Center Emergency Room in 1987. Thirty patients were identified, 18 of whom had cervical spine x rays. No patients had a significant radiologic or clinical cervical spine injury. The prospective study included all patients with mandibular fractures seen in the emergency room during 1988 and 1989. Seventy-three patients were identified, 44 of whom had mandibular and cervical spine radiographs. None had a significant radiologic or clinical cervical spine injury. The authors conclude that routine cervical spine x rays are costly and unnecessary. Also, any patient with a suspicion of concomitant cervical spine injury (i.e., patients with a loss of consciousness, multi-organ system injury, cervical pain or tenderness, or intoxication from alcohol use) should have cervical spine x rays, including anteroposterior, lateral, and open-mouth odontoid views.     

Acquired lobar emphysema (overinflation): clinical and pathological evaluation of infants requiring lobectomy.

Acquired lobar "emphysema" (overinflation) (ALE) is an increasingly recognized complication of advanced bronchopulmonary dysplasia (BPD). To refine current concepts regarding patient management and pathogenesis, we examined clinical and pathological features of six infants with ALE who did not have obstructing intraluminal lesions and who underwent lobectomy after failing nonoperative management. All had severe neonatal respiratory distress and required prolonged ventilatory support (average, 2 months) with peak inspiratory pressures greater than 30 mm Hg and 100% oxygen. ALE developed between 3 weeks and 20 months of age (median, 5 months), with lobar hyperinflation, atelectasis, and mediastinal shift. Selective bronchial intubation provided only transient benefit. Videobronchoscopy demonstrated no intraluminal obstructing lesions in five patients. In one child, ALE became clinically apparent only after laser excision of an endobronchial cicatrix. All infants had bronchomalacia with the involved lobar bronchus being most severely affected. Ventilation-perfusion scans demonstrated severe impairment of both ventilation and perfusion in the involved lobes. The decision to perform lobectomy was based on clinical parameters and failure of non-operative management. After lobectomy, all children dramatically improved. However, only three of six were alive 2 to 3 years later; one infant died of unrelated causes at 6 weeks; and two died of progressive respiratory insufficiency 13 and 24 months postlobectomy. Microscopic evaluation of the lung demonstrated findings of late-stage BPD with peribronchial and interstitial fibrosis, parenchymal overinflation, and alveolar septal disruption.(ABSTRACT TRUNCATED AT 250 WORDS)