SELECTIVE ATTENTION AND INSTRUMENTAL MODIFICATION OF THE GSR

A series of experiments were conducted on instrumental modification of the Galvanic Skin Response (GSR) in a discrimination procedure where preparatory signals indicated which discriminative stimulus was to occur. When shock avoidance was contingent upon the presence of a response the GSR was enhanced; when shock avoidance was contingent upon the inhibition of a response there was a decrement in reactivity. Heart rate acceleration occurred to Respond stimuli while deceleration occurred to Inhibit stimuli. Various types of cognitive strategies were reported by the subjects from attempts to control attention by attending less to stimuli associated with inhibition to attempts to arouse a response by thinking of exciting events and to inhibit by thinking of calming events. Postexperimental recognition of words tended to be negatively related to magnitude of response. When the verbal stimuli served directly as discriminative stimuli, however, these relationships tended to be reversed.     

Feasibility of an interprofessional collaborative osteoporosis screening programme in Malaysia

Background Population screening for osteoporosis using bone mineral density scan is not feasible in Malaysia as this test is costly. Hence, there is a need to develop a more efficient method to screen for osteoporosis.Objectives To determine the feasibility of an interprofessional collaborative osteoporosis screening programme (IPC-OSP). Methods Postmenopausal women aged?≥?50 years, who had not been diagnosed with osteoporosis were recruited from a primary care clinic from June to August 2014. Patients were assessed for their osteoporosis risk and were counselled on prevention methods. Patients at risk were referred to the doctor with a recommendation for a bone mineral density (BMD) scan. Results Fifty out of 55 patients were recruited (response rate?=?90.9%). A total 26/50 (52.0%) went for a bone mineral density scan, none were osteoporotic, 17/50 (34%) were osteopenic, 2/50 (4.0%), were started on osteoporosis medications and 14/50 (28%) modified their lifestyle to improve bone health or started on calcium supplements. Osteoporosis knowledge significantly increased from baseline to month two (46.3?±?21.4 vs. 79.1?±?14.3, p?<?0.001). Patients had a satisfaction score of 89.8?±?12.4. Follow-up rates were 83.9% and 100% at months 1 (BMD appointment) and 2 (phone follow up), respectively. The intervention was successfully coordinated. Data entry was determined to be viable based on the researchers’ experience. Conclusion The interprofessional collaborative osteoporosis screening programme was found to be feasible in Malaysia.

     

Fundamentals and recent progress relating to the fabrication,functionalization and characterization of mesostructured materials using diverse synthetic methodologies

Since 1990 and the invention of the very first generation of ordered mesoporous silica materials, several innovative methodologies have been applied to synthesize, characterize, and modify silica/non-silica mesoporous materials. The growth of the mesoporous materials field has generated significant environmental and economic advantages compared to various other industrial developments. According to the literature, there are several key synthesis approaches and parameters that can affect the structural, textural and morphological characteristics of mesoporous materials. To date, huge attempts have been made to maximize the activities and selectivities of these materials through either the in situ or post-synthesis functionalization of the large interior surface areas and internal mesostructured frameworks in the presence of specific organic/inorganic components. However, the main challenge is to provide good control over the incorporation and distribution of multiple guest components within the mesostructured hosts. Mesostructured materials have received great attention for various applications, such as being used in electronics, medicine, photocatalysis, catalyst supports, catalysis, absorbers, sensors, gas separation, etc. In the current paper, several recent developments have been highlighted and reviewed regarding the fabrication and characterization of siliceous/non-siliceous mesoporous materials via various synthetic approaches. Furthermore, the availability of diverse functionalization methods has been reviewed to provide comprehensive approaches for synthesizing new generations of suitably modified mesoporous materials with superior structural, physicochemical, and textural characteristics.

Since 1990 and the invention of the very first generation of ordered mesoporous silica materials, several innovative methodologies have been applied to synthesize, characterize, and modify silica/non-silica mesoporous materials.     

The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient

Background

Previously active in the mid-1990s, the Canadian Airway Focus Group (CAFG) studied the unanticipated difficult airway and made recommendations on management in a 1998 publication. The CAFG has since reconvened to examine more recent scientific literature on airway management. The Focus Group’s mandate for this article was to arrive at updated practice recommendations for management of the unconscious/induced patient in whom difficult or failed tracheal intubation is encountered.

Methods

Nineteen clinicians with backgrounds in anesthesia, emergency medicine, and intensive care joined this iteration of the CAFG. Each member was assigned topics and conducted reviews of Medline, EMBASE, and Cochrane databases. Results were presented and discussed during multiple teleconferences and two face-to-face meetings. When appropriate, evidence- or consensus-based recommendations were made together with assigned levels of evidence modelled after previously published criteria.

Conclusions

The clinician must be aware of the potential for harm to the patient that can occur with multiple attempts at tracheal intubation. This likelihood can be minimized by moving early from an unsuccessful primary intubation technique to an alternative “Plan B” technique if oxygenation by face mask or ventilation using a supraglottic device is non-problematic. Irrespective of the technique(s) used, failure to achieve successful tracheal intubation in a maximum of three attempts defines failed tracheal intubation and signals the need to engage an exit strategy. Failure to oxygenate by face mask or supraglottic device ventilation occurring in conjunction with failed tracheal intubation defines a failed oxygenation, “cannot intubate, cannot oxygenate” situation. Cricothyrotomy must then be undertaken without delay, although if not already tried, an expedited and concurrent attempt can be made to place a supraglottic device.     

Analysis of the bicipital groove as a landmark for humeral head replacement

Many anthropometric studies of the normal glenohumeral relationship have been performed in an effort to identify reference points for the correct placement of the humeral head prosthesis in shoulder arthroplasty. The bicipital groove offers a useful landmark for placement of the lateral fin of the prosthesis. However, when fracture surgery is performed, only the distal portion of the bicipital groove may be available for reference. We evaluated the course of the bicipital groove as it moves distally along the humerus. Computer-assisted tomography axial images of 21 cadaveric humeri were obtained in order to follow the course of the bicipital groove from proximal to distal on the humerus. With use of the bisector of the transepicondylar axis as a reference point, the relative change in position of the bicipital groove from proximal to distal was measured. The mean change in rotation of the lateral lip from the proximal to the distal groove was 15.9 degrees, with an SD of 6.8 degrees (range, 4 degrees -32 degrees ). The 95% confidence interval range for the change was 12.8 degrees to 19 degrees. Thus, a significant amount of internal rotation occurs along the course of the bicipital groove. This has significant clinical implications when the bicipital groove is used as a landmark for humeral head replacement in fractures of the proximal humerus.     

Social cognition and symptom dimensions

This study used the Picture Arrangement subtest of the Wechsler Adult Intelligence Scale to assess social cognitive functioning of psychotic patients diagnosed with bipolar, schizophrenia, or schizoaffective disorder. All participants were rated on positive and negative symptom rating scales, from which three symptom dimensions were obtained. Symptom dimensions were not significantly related to ratings of symptom severity or mental status examination scores. Disorganized symptoms were correlated with a wide range of impairments on nearly all subscale measures of social cognition. Negative symptoms were correlated with lower ratings of capacity for emotional investment, complexity of representations, and integration of episodes. Psychoticism was associated with negative affect tone. Diagnostic categories were not related to social cognitive impairments independent of estimates of premorbid level of cognitive function. Evidence of syndromal differences suggests that heterogeneity of variance in studies of functioning of schizophrenic patients can be reduced by inclusion of symptom dimensions.     

Culture confirmed multidrug resistant tuberculosis: diagnostic delay, clinical features, and outcome

Aims: To determine the delay in diagnosis of multidrug resistant (MDR) tuberculosis (TB), the correlation between drug susceptibility patterns of adult-child contact pairs, the effectiveness of treatment, and the outcome in these children. Methods: MDR M tuberculosis culture results of children were prospectively collected during a four year period in the Western Cape Province of South Africa, an area with a TB incidence of 589/100 000 population, and a new MDR TB rate of 0.94%. Folder reviews were done to retrieve clinical information. Children not already on treatment at our MDR TB clinic or TB hospital were recalled and appropriate treatment was started. Follow up was done for as long as possible. Results: Thirty nine children, median age 4.5 years at first TB diagnosis and 6.2 years on MDR culture confirmation, were seen. Delay in starting appropriate MDR treatment after TB diagnosis was a median of 2 days if MDR TB source cases were taken into account, but 246 days if the drug susceptibility pattern of the source case was not considered, and 283 days if there was no known tuberculosis source case. Correlation between the drug susceptibility results of the child''s and adult source case''s isolates was 68%. Seventeen children had smear positive tuberculosis, of whom 13 had cavitatory pulmonary disease. Eight children had central nervous system TB. Thirty six children were treated for MDR tuberculosis, of whom four died. Conclusions: Obtaining a detailed contact history is essential as a delay in starting appropriate MDR antituberculosis treatment has potentially serious consequences.