Intersection of reality and fiction in art perception: pictorial space, body sway and mental imagery.

BACKGROUND: The thesis of embodied cognition claims that perception of the environment entails a complex set of multisensory processes which forms a basis for the agent's potential and immediate actions. However, in the case of artworks, an agent becomes an observer and action turns into a reaction. This raises questions about the presence of embodied or situated cognition involved in art reception. AIMS: The study aimed to assess the bodily correlates of perceiving fictional pictorial spaces in the absence of a possibility of an actual physical immersion or manipulation of represented forms. METHOD: The subjects were presented with paintings by Vermeer and De Hooch, whilst their body sway and eye movements were recorded. Moreover, test and questionnaires on mental imagery (MRT, VVIQ and OSIQ) were administered. RESULTS: Three major results were obtained: (1) the degree of pictorial depth did not influence body sway; (2) fixations to distant elements in paintings (i.e. backgrounds) were accompanied by an increase in body sway; and (3) mental rotation test scores correlated positively with body sway. CONCLUSIONS: Our results suggest that in certain cases--despite the fictional character of art--observers' reactions resemble reactions to real stimuli. It is proposed that these reactions are mediated by mental imagery (e.g. mental rotation) that contributes to the act of representing alternative to real artistic spaces.

Can airway complications following multilevel anterior cervical surgery be avoided?

OBJECT: The authors conducted a study to determine how to avoid emergency postoperative reintubation and its associated morbidity in patients who have undergone multilevel anterior-posterior cervical spine surgery. METHODS: In a group effort between the departments of anesthesia and neurosurgery, a protocol was developed to avoid having to reintubate patients postoperatively. As a preventative measure, patients remained intubated overnight; on the 1st postoperative day or thereafter, based on direct fiberoptic visualization of reactive tracheal swelling, an anesthesiologist extubated the patients. Fifty-eight patients underwent multilevel anterior corpectomy with fusion (ACF; with 41 receiving plates and 17 not receiving plates), posterior wiring and fusion (PWF), and application of a halo. On average, ACF involved three levels, whereas PWF included 6.5 levels. Surgery typically lasted 10 hours, and an average 2.6 U of blood was required. Forty patients were successfully extubated on the 1st, five on the 2nd, three on the 3rd, two on the 4th, two on the 5th, and three on the 7th postoperative day. Three elective tracheostomies were performed on the 7th postoperative day. Risk factors associated with delayed extubation or tracheostomy in 18 patients included: operative time longer than 10 hours (12 patients), obesity greater than 220 lbs (12 patients), transfusion of more than 4 U of blood (10 patients), ACF reoperations (nine patients), ACF including C-2 (seven patients), four-level ACF (five patients), and asthma (five patients). In the only case in which emergency reintubation was required, three risk factors were present. CONCLUSIONS: Emergency reintubation following anterior-posterior cervical surgery and fusion can be avoided by maintaining intubation overnight and subsequently having an anesthesiologist remove the tube after healing is fiberoptically confirmed. Familiarity with major risk factors contributing to airway compromise, combined with this protocol, should minimize the significant morbidity associated with reintubation following multilevel anterior-posterior cervical fusion.

One model, several results: the paradox of the Hosmer-Lemeshow goodness-of-fit test for the logistic regression model.

BACKGROUND: The Hosmer-Lemeshow test, used extensively to assess the fit of the logistic regression model, is performed by several statistical packages. Recent studies have shown some problems in the use of this test when ties are present. These problems were attributed merely to the test implementation. METHODS: We analysed the order of the observations as an alternative explanation of the problem of ties. Using a data-set of 1393 intensive care unit (ICU) patients we performed the Hosmer-Lemeshow test with all possible subjects dispositions. RESULTS: We obtained about one million different P values, ranging from 0.01 to 0.95. DISCUSSION: It is already known that when the Hosmer-Lemeshow goodness-of-fit test is performed with a number of covariate patterns lower than the number of subjects, its result may be inaccurate. We showed that the extent of this problem could be relevant under particular conditions. We also suggest a strategy for estimating the extent of the problem and subsequent interpretation.

Role of vagus nerve signaling in CNI-1493-mediated suppression of acute inflammation.

CNI-1493 is a potent anti-inflammatory agent, which deactivates macrophages and inhibits the synthesis of proinflammatory mediators. The objective of the present study was to identify the role of the central nervous system (CNS) and efferent vagus nerve signaling in CNI-1493-mediated modulation of acute inflammation in the periphery. CNI-1493 was administered either intracerebroventricularly (i.c.v., 0.1-1,000 ng/kg) or intravenously (i.v., 5 mg/kg) in anesthetized rats subjected to a standard model of acute inflammation (subcutaneous (s.c.) injection of carrageenan). I.c.v. CNI-1493 significantly suppressed carrageenan-induced paw edema, even in doses at least 6-logs lower than those required for a systemic effect. Bilateral cervical vagotomy or atropine blockade (1 mg/kg/h) abrogated the anti-inflammatory effects of CNI-1493 (1 microg/kg, i.c.v. or 5 mg/kg, i.v.), indicating that the intact vagus nerve is required for CNI-1493 activity. Recording of the efferent vagus nerve activity revealed an increase in discharge rate starting at 3-4 min after CNI-1493 administration (5 mg/kg, i.v.) and lasting for 10-14 min (control activity=87+/-5.4 impulses/s versus CNI-1493-induced activity= 229+/-6.7 impulses/s). Modulation of efferent vagus nerve activity by electrical stimulation (5 V, 2 ms, 1 Hz) of the transected peripheral vagus nerve for 20 min (10 min before carrageenan administration and 10 min after) also prevented the development of acute inflammation. Local administration of the vagus nerve neurotransmitter, acetylcholine (4 microg/kg, s.c.), or cholinergic agonists into the site of carrageenan-injection also inhibited acute inflammation. These results now identify a previously unrecognized role of efferent vagus nerve activity in mediating the central action of an anti-inflammatory agent.

A curriculum self-study of writing assignments and reflective practice in nursing education.

Reflective practice is an ongoing process of purposeful thinking about one's clinical practice to develop understanding, insight, and clinical judgment. It can be enhanced through careful use of writing assignments that require reflection, evaluation, and thoughtful analysis. The uses of writing assignments in the undergraduate nursing programs at a midwestern college of nursing were studied over a 2-year period, using survey methodology. A purposive sample of all faculty who taught in baccalaureate or associate of science (ASN) programs (n=21) completed a questionnaire and were interviewed about the number and purpose of writing assignments in courses they taught. Quantification of the results in tabular form allowed the faculty to look at all writing assignments required of students across both programs with regard to the number, length, and nature of those assignments. Results were then recategorized by type of assignments, changes needed, and faculty assessment of the usefulness of these writing assignments. The summary of written assignments was then cross-referenced according to program, semester, and program level. This produced a working document that illustrated the quantity and type of writing assignments that each student, in each program, at a given level and semester must complete. Information was used by faculty teaching across courses to make changes that more effectively linked course writing assignments by association, themes, concepts, or areas of study. This process enables faculty to collaboratively develop writing assignments that facilitate the adult student's linking and associating concepts across courses, as a true exercise in critical thinking.

Parenting education as family support for low-income families of young children.

Parenting education programs can strengthen the family unit as a nurturing center of child development. The Establish Rapport-Offer Information-Promote Attachments-Initiate Outreach guide provides a framework that addresses individual and family needs. Any parenting class should include opportunities for referral and out-reach efforts to help parents who are facing multiple stressors.

Addiction recovery for low-income pregnant and parenting women: a process of becoming.

A naturalistic field study of low-income women (N = 17) in an intensive outpatient addiction recovery program addressed the question: What is the nature of addiction recovery for pregnant and parenting-women in an addiction treatment program? Grounded theory methodology was used to determine the nature of the interpersonal and social processes that define addiction recovery for women in this study. Over 2 years, audiotaped semi-structured interviews, document reviews of medical records, treatment progress and group therapy notes, and participant observation notes were collected and analyzed. The constant comparison method of analysis involved an ongoing process of theoretical sampling, memoing, and open and then axial coding to identify, group, link, and reduce the categories produced. A developmental model of addiction recovery in pregnant and parenting women emerged that consisted of the dimensions of becoming drug and alcohol free, a partner in a relationship, a person, and a parent. These four dimensions parallel and transform each other, yielding different outcomes but similar patterns over time. This model of addiction recovery provides a beginning framework for understanding the transactional nature of addiction recovery for low-income women who are adapting to a drug and alcohol-free lifestyle and the task and role of parenting a newborn.

The importance of statistics in documentation on hip prostheses.

The authors illustrate the possibilities and the limits of instruments that statistics currently make available in the analysis of a medical series involving hip prosthesis surgery. An analysis of the survival rate constitutes one of the most important tools with regard to data in the study of the effectiveness of implants, but its correct application is influenced by the assumption that so-called censored cases have no differences in survival in relation to those that remain under observation even in periods that follow. Simulation reveals the need to process series with a high number of cases, in order to obtain reliable estimates. Finally, only multivaried techniques allow for a correct evaluation of the incidence that single factors have in causing failure of implants.

Intraoperative fractures of the femur in prosthetic hip reimplantations.

A total of 19 cases of intraoperative fractures of the femoral diaphysis occurring during prosthetic hip reimplantation are described. Incidence, predisposing factors, treatment, and influence on long-term results are discussed. The pre-existence of osteolysis or narrowing of the femoral cortex, often associated with primary cemented implantation with a metal-polyethylene combination, constitutes a factor that predisposes the patient to fracture. Fracture consolidation occurs in most cases with minimum treatment, at times without instrumentation; fracture, however, always means a delay in weight-bearing and a slowing down in recovery times. Long-term clinical evaluation shows functional results that are worse for reimplantations complicated by fracture as compared to those where there are no complications. The differences in the radiographic results instead do not reveal statistical significance.

Breaking ground: combining community service, critical thinking, and writing in a mental health clinical course.

This article describes the experience of a team of nursing educators who, over the course of 2 years, redesigned the delivery of an undergraduate nursing clinical course to reflect the changing face of mental health care near the turn of this century. Case studies of student learning experiences show the value of nontraditional clinical settings such as homeless shelters to the professional growth and training of nursing students. Recommendations offer practical advice for combining nontraditional community-based clinical experiences with critical thinking exercises as key components of the mental health clinical course delivery.

Risk factors, attendance, and abstinence patterns of low-income women in perinatal addiction treatment: lessons from a 5-year program.

The purpose of this article is to describe the risk factors, attendance, and abstinence patterns of 40 women who attended a model outpatient perinatal addiction treatment program throughout the 5 years it was funded. Data were regularly collected through use of semistructured interviews, randomly scheduled urine toxicology tests, document reviews, and self-reports, in a descriptive field study design. Mean age of the women was 29 years. They remained in the program an average of 7.89 months. A majority had two or more children, most (90%) were single parents, and 70% were currently in an abusive relationship. Abstinence was positively associated with length of time in the program (r = .4208; p < .01). Attendance was also positively correlated with length of stay (r = .6723; p < .001) as well as abstinence (r = .4454; p < .01). Results suggest that program attendance can be a powerful influence on abstinence, even in the face of the environmental stressors and developmental risk factors that place each woman at increased risk of relapse.

Metal-UHWMPE (Ultra High Molecular Weight Polyethylene) wear: experimental testing.

Testing conducted on a hip joint simulator verified the Charnley hypothesis that the diameter of the prosthetic head is proportional to wear. The study was conducted by pairing heads in Ortinox TM with acetabular cups in polyethylene at high molecular weight (UHMWPE). A comparison between the different sizes of the heads (26 and 30 mm in diameter) showed a different trend in the wear rate; in particular, the head with a smaller diameter behaves better tribologically than the head with a larger diameter.

The use of a multicultural conceptual model in perinatal addiction treatment.

Using a culturally competent approach to address perinatal addiction is essential for promoting a positive response to nursing interventions. Such a health care approach would include sensitivity to cultural values beliefs, and practices specific to the backgrounds of ethnically diverse clients. Clients of Project Hope, a government-funded perinatal addiction treatment program in a midwestern city, are low-income, predominantly African American single parents with a history of substance, family, and/or environmental abuse. A majority had been treated at least once previously for a sexually transmitted disease, placing them in high-risk category for hepatitis and HIV infection. Women remain in the intensive outpatient program an average of 8 months. During that time, the multidisciplinary treatment team use a variety of interventions to address the needs of the clients, which include stable housing, health care, parenting resources, and ongoing social support. The Rooda Conceptual Model of Multicultural Nursing provides a framework for enhancing nurses' understanding of the unique needs of this ethnically diverse population.

Use of the transverse cerebellar diameter/abdominal circumference ratio in pregnancies at risk for intrauterine growth retardation.

A prospective study was conducted to evaluate the ability of the transverse cerebellar diameter/abdominal circumference ratio to identify growth-retarded fetuses. Of the cases analyzed, 48 of 87 (55%) were growth retarded by birth weight. The transverse cerebellar diameter/abdominal circumference ratio identified growth retardation with a sensitivity of 71%, specificity of 77%, positive predictive value of 79%, and negative predictive value of 68%. Fourteen growth-retarded fetuses were missed by the ratio; however, 57% of the missed cases were severely growth retarded. The transverse cerebellar diameter/abdominal circumference ratio can be useful for the assessment of fetal growth retardation; however, the ratio may be normal in cases of severe fetal growth retardation.

Parent-infant interaction during perinatal addiction treatment.

Studies of parent-child interactions during perinatal addiction treatment are needed to offer insights into the nature of child development outcomes for this population. A purposeful sample of 17 women in a drug and alcohol addiction treatment program and their infants was studied over the course of their first year in the program. The purpose of this naturalistic field study was to examine parent-child interactions during addiction treatment. The following research question guided the inquiry: What is the nature of parent-infant interaction during the first year in a perinatal addiction treatment program? This study combined grounded theory methodology with the quantitative methods of descriptive and differential statistics. Open-coding of interviews, field notes, and the treatment records followed grounded theory methodology. A time-sampling procedure was used to examine stability of interactions at the beginning of program participation, again when each infant was 6 months old, and when each infant was 12 months. Results are used to describe parent-child interactions across samples and over time. Chi-square procedures were performed on number of children in each family, length of time in the program, sobriety, and mutual enjoyment of interaction. A significant difference in interaction by length of time in the program (chi 2 = 7.0801, df = 1, p < .00) as well as in interaction by percent sobriety (chi 2 = 4.1538, df = 1, p < .04) was evident. Behaviors of the infants reflected the emotional tone and parenting responses of their mothers. Dyads whose interactions showed a pattern of mutuality were more likely to continue in the treatment program and to maintain sobriety. The ability of a mother to enjoy her infant seemed to be the one factor that made the most difference in child behaviors. Results can be used by clinicians to guide the choice of treatment approaches that support the parent-child relationship during addiction treatment.

[Primary hydatid cyst of the coracobrachial muscle. A clinical case]. / Cisti da echinococco primaria del muscolo coracobrachiale. Caso clinico.

Primary localization of hydatidosis in the musculoskeletal system is a quite rare occurrence. We report a case of a 67 year old man with an infestation of the coracobrachialis muscle. We discuss several instrumental and serologic diagnosis methods and the hypothesis of a primary muscular localization.

[Update on laparoscopic surgery: on the treatment of hydatid cyst of the liver and peritonitis caused by a perforated duodenal ulcer]. / Attualità in tema di chirurgia celioscopica: a proposito del trattamento di una cisti idatidea del fegato e di una peritonite da ulcera duodenale perforata.

Laparoscopic surgery represents a real innovation with respect to the traditional laparotomic way of access, owing to its undeniable advantages, both intraoperative and postoperative. This new technique reduces the complications connected with the surgical wound and with forced allerement. Therefore it allows the patient's fast recovery. Laparoscopic surgery application ground get's wider and wider every day: in fact, the authors report two medical cases, one of elective surgery (treatment of a hidatid cyst of the liver) and the other in emergency surgery (peritonitis due to perforated duodenal ulcer), both obtaining a positive result about the clinical and the postoperative timing of recovery.

Evaluation of intraoperative somatosensory-evoked potential monitoring during 100 cervical operations.

Continuous intraoperative somatosensory-evoked potential monitoring during scoliosis surgery, along with improved instrumentation techniques, has contributed to the reduction of neurologic injury from 4-6.9% to 0-0.7%. To assess whether somatosensory-evoked potential monitoring might play a similar role in cervical surgery, the authors compared the morbidity and mortality rates associated with 218 patients who were not monitored and were operated on between 1985-1989 with those found in 100 consecutive somatosensory-evoked potential monitored procedures done from 1989-1991. The cervical procedures were conducted for disc disease, stenosis, spondylosis, and ossification of the posterior longitudinal ligament. Eight of 218 unmonitored patients became quadriplegic (3.7%) and 1 died (0.5%); no instances of quadriplegia and no deaths were encountered among the 100 monitored patients. The reduction of neurologic deficit was attributed in part to early somatosensory-evoked potential detection of vascular or mechanical compromise of the spinal cord or nerve roots and to the immediate alteration of anesthetic or surgical technique in response to somatosensory-evoked potential changes, i.e., reversal of systemic or "relative" hypotension, adjustment of operative position, release of distraction, and cessation of manipulation. Continuous intraoperative somatosensory-evoked potential monitoring also was a practical tool in monitoring cervical surgery.

Structural characterization of terflavoxate.

Data are reported on the structural characterization of 3-methyl-4-oxo-2-phenyl-4H-1-benzopyran-8-carboxylic acid 1,1-dimethyl-2-(N-piperidinyl)ethyl ester hydrochloride (terflavoxate-HCl, Rec 15/2053, CAS 86433-39-8), a new antispasmodic for the lower urinary tract. UV, IR, NMR and MS spectra fully confirmed the structure. The X-ray crystal structure determination revealed that the molecular structure consists of a rigid platform, formed by the chromone system, with two arms, the phenyl group at C(2) and the ester chain at C(8). The ester chain conformation generates a small hollow where two oxygen atoms face.

New basic esters of 2-phenyl-3-methyl-4-oxo-4H-1-benzopyran-8-carboxylic acid endowed with spasmolytic properties. Synthesis and pharmacological-pharmacokinetic evaluation.

In order to obtain new analogs of flavoxate endowed with higher stability and possibly higher potency, a new series of basic esters of 2-phenyl-3-methyl-4-oxo-4H-1-benzopyran-8-carboxylic acid (MFCA) has been prepared and investigated. Derivatives in which the structure of flavoxate was modified by branching and lengthening of the estereal alkyl chain were synthesized, together with the conformationally restricted N-piperidinyl derivatives. Esters containing in their structure various alicyclic tertiary amines which are present in natural or synthetic drugs endowed with spasmolytic properties, mainly of anticholinergic nature, were also prepared. The stability in aqueous solution, acute toxicity in mouse, and in vitro spasmolytic properties of the new compounds were investigated in comparison with flavoxate. Based on the results obtained from this screening procedure, 3 compounds were selected for further investigation. In this phase, further pharmacological and stability testing as well as preliminary animal pharmacokinetic investigations were carried out. The obtained results suggested the choice of 1,1-dimethyl-2-(1-piperidinyl)ethyl 2-phenyl-3-methyl-4-oxo-4H-1-benzopyran-8-carboxylate HCl (Rec 151 2053, terflavoxate, CAS 86433-39-8) as a candidate for preclinical development. The deeper pharmacological characterization of this compound, carried out mainly in comparison with flavoxate, terodiline, and oxybutynin confirmed its good spasmolytic activity.