TURN-IT: a novel turning intervention program to improve quality of turning in daily life in people with Parkinson's disease.

BACKGROUND: People with Parkinson's disease (PD) have a high fall rate and many falls are associated with turns. Despite this, there is minimal research on effects of rehabilitation on the quality of turns. Further, quantifying turns in the home may have broader implications since rehabilitation of turns would ideally improve turning in real world mobility. METHODS: Sixty people with PD and a history of falls will be randomized to receive either a novel TURNing InTervention (TURN-IT) or no intervention (control group). The TURN-IT group will be seen for 6 weeks (18 visits) for an individualized, progressive program that is based on the specific constraints of turning in PD. Wearable sensors will be used to measure 7 days of mobility, including turns, before and after intervention or control period. In addition, blinded assessments of gait, mobility and turns will occur before and after intervention for both groups and falls will be monitored for twelve months post intervention with bimonthly email questionnaires. DISCUSSION: This study has the potential to change how we rehabilitate and assess turning in people with PD and falls. There are several novel aspects to our study including a comprehensive turning-focused intervention that is tailored to the underlying constraints that impair turning in people with PD. Further, our outcome measure of turning quality during 7 days of daily life is novel and has implications for determining real-life changes after rehabilitation. The ultimate goal of this rehabilitation intervention is to improve how patients turn in daily life and to reduce falls. TRIALS REGISTRATION: This protocol is registered at clinicaltrials.gov; #NCT04897256; https://clinicaltrials.gov/ct2/show/NCT04897256?term=Horak&cond=Parkinson+Disease&draw=2&rank=4 .

Heat-related deaths during the July 1995 heat wave in Chicago.

BACKGROUND: During a record-setting heat wave in Chicago in July 1995, there were at least 700 excess deaths, most of which were classified as heat-related. We sought to determine who was at greatest risk for heat-related death. METHODS: We conducted a case-control study in Chicago to identify risk factors associated with heat-related death and death from cardiovascular causes from July 14 through July 17, 1995. Beginning on July 21, we interviewed 339 relatives, neighbors, or friends of those who died and 339 controls matched to the case subjects according to neighborhood and age. RESULTS: The risk of heat-related death was increased for people with known medical problems who were confined to bed (odds ratio as compared with those who were not confined to bed, 5.5) or who were unable to care for themselves (odds ratio, 4.1). Also at increased risk were those who did not leave home each day (odds ratio, 6.7), who lived alone (odds ratio, 2.3), or who lived on the top floor of a building (odds ratio, 4.7). Having social contacts such as group activities or friends in the area was protective. In a multivariate analysis, the strongest risk factors for heat-related death were being confined to bed (odds ratio, 8.2) and living alone (odds ratio, 2.3); the risk of death was reduced for people with working air conditioners (odds ratio, 0.3) and those with access to transportation (odds ratio, 0.3). Deaths classified as due to cardiovascular causes had risk factors similar to those for heat-related death. CONCLUSIONS: In this study of the 1995 Chicago heat wave, those at greatest risk of dying from the heat were people with medical illnesses who were socially isolated and did not have access to air conditioning. In future heat emergencies, interventions directed to such persons should reduce deaths related to the heat.

Choroidal malignant melanoma with liver metastasis before enucleation.

A case of a relatively small ocular malignant choroidal spindle B-type melanoma showed evidence of metastasis at the time of diagnosis of the initial primary tumor. We believe that, for two reasons, the true incidence of metastatic disease at the time of initial diagnosis of choroidal malignant melanoma is not known incomplete workup at the time of diagnosis, and the high percentage of false-negative results of common tests for detecting metastasis. We believe that all patients with the diagnosis of malignant melanoma should have at least a complete physical examination, liver function tests, liver--spleen scan, bone scan, and chest roentgenogram. If enucleation is performed, it should be done as atraumatically as possible. Some aspects of treatment are controversial. Unfortunately, not enough data regarding malignant melanoma or its metastasis are known to recommended with confidence the best method for treating either condition.

Localization of suspected intraocular foreign bodies with a modified Delta 2020 scanner.

Metallic foreign bodies were localized in seven patients using a modified Delta 2020 scanner. In six of these seven, we compared the localization obtained by sector CT scan with ultrasound. The two methods were found to be complementary, with the sector CT scan giving more positive and more easily interpreted localizations, and ultrasonography giving more detailed soft tissue diagnosis. The new sector CT scanner greatly raised the level of confidence in the localization of metallic foreign bodies; however, we recommend the combined use of both techniques for a complete evaluation.

Catamenial pneumothorax. Bilateral occurrence while on suppressive therapy.

A case of recurrent bilateral catamenial pneumothorax is presented with pathologic, cytologic, and radiologic documentation. Unlike previously reported cases where the pneumothorax is unilateral and the symptoms relieved while ovulation is suppressed with cyclic oral contraceptives, in the present case the pneumothorax occurred despite oral contraceptive therapy concurrent with anovulatory withdrawal or breakthrough bleeding.