A clinical evaluation of ophthalmic assessment in children with sensori-neural deafness.

BACKGROUND: Since 1991, children with sensori-neural deafness and their families within Southern Derbyshire have been supported by a multiagency approach to their diagnosis and management. RESULTS: One hundred and twenty-two children were seen at the Child Development Centre for an holistic assessment, and 110 of these children have had an ophthalmic assessment, of whom 48 (43.6%) were found to have ophthalmic abnormalities. These included 43 children (39.1%) with refractive errors, ranging from mild to severe. Of 82 children with uncomplicated deafness, 26 (31.7%) had refractive errors. The prevalence of ophthalmic problems was higher than the prevalence in hearing school children in the literature and in local pre-school children. There were six cases of Usher syndrome. Twenty-one children had more than one eye defect. The findings indicate that deaf and hearing impaired children are two to three times more likely to develop ophthalmic abnormalities than their hearing peers, which makes early detection of paramount importance. An important local outcome has been the establishment of guidelines for ophthalmic assessment to include assessment of vision and screening for Usher syndrome by electro-physiological testing at aged 7 years and above. Screening has been completed to date in 78 children with congenital sensori-neural deafness. CONCLUSIONS: Sensitive and efficient ophthalmic assessment and management are essential for all deaf and hearing impaired children and national guidelines need to be established for both assessment of vision and screening for Usher syndrome, based on further evaluated research.

Quantitation of vitamin E and a carotenoid pigment in cataractous human lenses, and the effect of a dietary supplement.

The quantitation of tocopherols and carotenoids in lipid extracts of cataractous human lenses was performed in parallel with those of matched samples of plasma, which was also analysed at the same time. Alpha-tocopherol in cataractous lenses from elderly human subjects was present at 4.4 mumoles/kg wet weight, much less than the mean of 33 mumoles/l in plasma from these subjects. The mean ratio of alpha- and gamma-tocopherols was 3.5 in the lenses, and 11.3 in plasma. Lens extracts contained no detectable alpha- or beta-carotene, lycopene, or beta-cryptoxanthin. However, all the lens extracts contained a pigment with the retention time and spectrum of lutein and zeaxanthin. Using the molar extinction coefficient of lutein this was present at ca. 0.03 microM, compared with 0.2 microM in plasma. Seven patients with bilateral cataracts had one of their cataractous lenses removed and analysed, and were then given either an oral placebo, or an oral supplement of ascorbate, alpha-tocopherol and beta-carotene. Three months later, the second cataractous lens, and a blood sample, were analysed. Three of the seven had received the active supplement, as confirmed by substantially raised blood levels of alpha-tocopherol and beta-carotene, and raised aqueous humour levels of vitamin C. However, lens tocopherol levels remained unchanged, and no beta-carotene could be detected in the lenses after supplementation. This preliminary evidence needs to be confirmed in larger studies.

Schizophrenia, smoking, and smog.

The article outlines the relationships that obtain among schizophrenia, smoking, and smog. An overview of known scientific facts concerning the pathogenesis of schizophrenia is first provided. The relationship this has with nicotine addiction is discussed next, and finally the notion is introduced that heterocyclic amines found in cigarette smoke and petroleum fumes serve as a potent environmental neurotoxin that seriously compromises mental health in biologically susceptible individuals. It is argued that such biologic susceptibility takes the form of cerebral diabetes, which accounts for the serious impairment of glucose metabolism as demonstrated by positron emission tomography. Central to this argument is the view that diabetes can be peripheral, without affecting the central nervous system, or central, without affecting the peripheral system.

In defence of Cartesian dualism and the hermeneutic horizon.

In this paper, the author proposes to consider the intricate interplay between the art and science of nursing. The caring role, intrinsic to the meaning of the word 'nurse' constrains nursing under the rubric of the arts, while nursing that embraces high technology constrains the discipline under the rubric of science. Thus, the traditional dichotomy that obtains between the arts and sciences seriously complicates the notion of nursing. As a science, nursing adopts the materialist theory of the mind that endorses the inseparability of mind and body. However, as an art, nursing is more closely aligned with dualist interactionism which considers the mind and body to be separate, interacting entities. Nursing is a caring profession, the mastery of which rests on the mastery of the therapeutic relationship which, in turn, implies mastery of holistic nursing care. While the concept of holism implies caring for the 'whole' person in body, mind and spirit, such acknowledgement of the mental and spiritual components of personhood, immediately invites the entry of dualism into our theoretical discourse. Thus, rejection of dualism consigns nursing to theoretical impoverishment and therapeutic emasculation. The contentious question is therefore: Is the theoretical destiny of nursing one of theoretical impoverishment, therapeutic emasculation, and permanent consignment to professional ignominy--and all for the sake of an inconvenient soul?

Rapid decompression to 50,000 feet: effect on heart rate response.

Interest in Molecular Sieve Oxygen Generation Systems (MSOGS) for use in military aircraft has demonstrated a need to study physiological effects of MSOGS product gas in the worst case scenario, a rapid decompression (RD). In this paper we report the heart rate (HR) response to positive pressure breathing (PPB) during and after RD from 6,096 to 15,239 m (20,000 to 50,000 ft) in a hypobaric chamber while breathing gas mixtures that simulate the product gas from MSOGS. Interbeat (R-R) intervals were recorded in 10 subjects while they breathed either Aviators' Breathing Oxygen (ABO), that is 99.5% oxygen, or 93% oxygen at two regulator settings: dilution and non-dilution. Additional experimental profiles on six subjects isolated the effects of hypoxia, anxiety, and PPB on HR changes after RD. Anxiety appeared to have the greatest effect. Most of the subjects showed increased HR and reduced HR variability after the onset of pressure breathing (immediately after decompression). As the exposure continued, HR variability increased as the HR began to decline. No consistent change in the HR response could be attributed to the modest increase in hypoxia produced by substitution of 93% oxygen for ABO.

Models, muddles and medicine.

The current prevalent attitude of disapprobation towards the medical model, held by nurse practitioners and educationalists alike, stems from a desire to denounce diagnostic reductionism and proselytize holistic care. It is argued, that the medical model encourages the perception that the patient is "essentially and only their medical diagnosis," and to relate to patients 'as if' they are kidney, a broken leg, a gall stone, or an ulcer, is to dehumanize the person. In order to overcome this predilection, the patient must be seen as a 'whole person' and not simply as some extraneous part of their dysfunctional anatomy. But this all too pervasive tendency, to reduce patients to nothing more than their medical diagnosis, is surely not the responsibility of the medical model? On the contrary, it is the responsibility of the individual medical or nurse practitioner who, on formulating a medical diagnosis, proceeds to convert the patient into an object and from there on regards the patient as "essentially and only their diagnosis of illness."