A novel method for continuous environmental surveillance for carbon monoxide exposure to protect emergency medical service providers and patients.

BACKGROUND: Carbon monoxide exposure is an important, but frequently undiagnosed, cause for Emergency Medical Services (EMS) response. Its elusive characteristics and non-specific symptoms make detection difficult without monitoring devices. Consequently, both patients and EMS providers are at increased risk of harm from such exposures. CASE SERIES: We report a series of five cases of carbon monoxide encounters, in which carbon monoxide exposure was not suspected, whereby portable (pager-sized) environmental carbon monoxide detectors, that provide continuous surveillance of the ambient air, were utilized. These devices were carried within, or attached to, the first-in medical jump bags, alerting EMS crews to potentially harmful levels of carbon monoxide. CONCLUSION: This case series highlights the importance of environmental surveillance for carbon monoxide by EMS providers, particularly in such cases where its presence is not suspected. This was, in fact, the case in all the encounters presented herein.

Inter- and Intra-rater Reliability of Modified House-Brackmann and Sunnybrook Facial Nerve Grading Systems in Post Parotidectomy Patients.

To compare inter-rater, intra-rater and inter-system reliability of modified House-Brackmann and Sunnybrook grading systems. The study was conducted in a tertiary care hospital with a single cohort of 20 patients and 3 raters. The patients, eligible to be included for the study, were those over 18 years of age planned for nerve sparing parotidectomy. In the postoperative period, patients were video recorded performing specific movements according to the requirements of modified House-Brackmann and Sunnybrook systems. These recordings were used for the grading once recruitment was completed. The inter-rater, intra-rater and inter-system reliability of modified House-Brackmann and Sunnybrook systems were assessed using the intraclass coefficient. The intra-rater reliability was good-to-excellent for both groups with Intra-Class coefficient (ICC) ranging from 0.902 to 0.958 in modified House-Brackmann and in 0.802 to 0.957 Sunnybrook system. The inter-rater reliability was good-to-excellent with ICC ranging from 0.806 to 0.906 in modified House-Brackmann and 0.766 to 0.860 in Sunnybrook system. The inter-system reliability was good-to-excellent with ICC ranging from 0.892 to 0.937. There was no significant difference in the reliability of modified House-Brackmann and Sunnybrook systems. Thus, an interval scale accomplishes the task of grading facial nerve palsy in a reliable way, and the choice of the specific instrument will be based on other factors like expertise involved, ease of administration and generalisability to the incumbent clinical scenario.

Breast reconstruction following mastectomy in Indian women: a neglected entity.

Phyllodes tumour is a rapidly growing neoplasm with a propensity to involve the entire breast tissue. In large tumours, the treatment comprises a wide local excision or a mastectomy. A woman in her 20s from rural India presented with complaints of a recurrent left breast lump. The lump progressed to a large size, limiting her social activities and causing depression. On examination, she had a mass occupying almost the entire left breast, with stretched skin, dilated veins and pressure necrosis. There were no palpable axillary nodes. She was offered a wide local excision and reconstruction with a latissimus dorsi pedicled flap. After much discussion and clarification of some misconceptions around breast reconstruction, she underwent the planned surgery. This was followed by adjuvant radiation therapy as the histopathology was consistent with a complex phyllodes tumour with close margins. She was well at 1-year follow-up and led a good family and social life. Breast conservation and reconstruction are seldom offered as part of cancer treatment in India. All women should be offered surgical options that are oncologically safe while preserving body image, and hence healthcare providers must work towards breaking the barriers that prevent breast reconstruction.

A walk in the park: a case study in research ethics.

Can researchers, interested in novel ways to assess HIV seroprevalence among populations which are otherwise hidden, collect condoms that have been discarded on the ground in a public sex environment and test them for HIV? Researchers, who use other types of abandoned samples, such as discarded syringes, hair or saliva samples, or excess biological samples, confront similar issues. This review evaluates whether such abandoned tissues can be studied based on U.S. Code of Federal Regulations and literature on related issues including: research involving banked tissues, blinded seroprevalence studies, and property claims that individuals might make on the samples. It also addresses broader questions of potential for stigma and risk to individuals and communities. The article concludes that the research should be permitted legally because either it does not involve human subjects, or it satisfies the requirements for waiver of consent; and that the research should also be permitted because the ethical principal of avoiding harm to individuals is fully satisfied based on a careful reading of the lessons of the tissue bank, biological property rights, and blinded seroprevalence study debates, as well as a consideration of other potential harms that might be involved.

Prevention and treatment of diabetic foot ulcers.

The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service. Diabetes and its associated complications are of a growing concern. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients. The complicating factor of underlying peripheral vascular disease renders the majority of diabetic foot ulcers asymptomatic until latter evidence of non-healing ulcers become evident. Therefore, preventative strategies including annual diabetic foot screening and diabetic foot care interventions facilitated through a multidisciplinary team have been implemented to enable early identification of diabetic patients at high risk of diabetic foot complications. The National Diabetes Foot Care Audit reported significant variability and deficiencies of care throughout England and Wales, with emphasis on change in the structure of healthcare provision and commissioning, improvement of patient education and availability of healthcare access, and emphasis on preventative strategies to reduce morbidities and mortality of this debilitating disease. This review article aims to summarise major risk factors contributing to the development of diabetic foot ulcers. It also considers the key evidence-based strategies towards preventing diabetic foot ulcer. We discuss tools used in risk stratification and classifications of foot ulcer.

Age effects in coding tasks: componential analysis and test of the sensory deficit hypothesis.

Multiple forms of a symbol-digit substitution task were used to provide a componential analysis of age differences in coding task performance. The results demonstrated age differences in feature encoding, memory, and visual search. A 2nd experiment was conducted with young adults to investigate a sensory deficit as a locus of age differences. The spatial contrast sensitivity deficit of older adults was simulated on forms by applying a digital filter. Persons in the age-simulated contrast condition performed worse than those in the normal contrast condition. The stimulus degradation effect was linked to visual search speed. The study illustrates the utility of componential analysis and offers direct support for the hypothesis that sensory deficits affect performance on tasks used to assess intelligence.

Sociodemographic and Clinical Predictors of Self-Management among People with Poorly Controlled Type 1 and Type 2 Diabetes: The Role of Illness Perceptions and Self-Efficacy.

Self-management is critical if people with diabetes are to minimise their risk of macrovascular and microvascular complications, yet adherence to self-management recommendations is suboptimal. Understanding the predictors of optimal diabetes self-management in specific populations is needed to inform effective interventions. This study investigated the role of demographic and clinical characteristics, illness perceptions, and self-efficacy in explaining adherence to self-management recommendations among people with poorly controlled diabetes in North West of England. Illness perceptions and self-efficacy data were collected using validated questionnaires and clinical data were obtained from hospital records. Correlations were used to investigate bivariate relationships between independent variables and self-management, and multiple regression techniques were used to determine demographic and psychosocial predictors of self-management. Various demographic and clinical characteristics were associated with adherence to self-management recommendations. In particular, employment status explained 11% of the variation in adherence to foot care whilst diabetes treatment category explained 9% of exercise and 21% of the variations in SMBG recommendations. Also, 22% and 8% of the variations in overall self-management were explained by illness perceptions and self-efficacy beliefs, respectively. Illness perceptions and self-efficacy beliefs of people with poorly controlled diabetes are important predictors of their self-management behaviours and could potentially guide effective interventions.

Preoperative radiotherapy in carcinoma rectum.

The present study was undertaken to address the various concerns that has limited the use of preoperative radiotherapy in rectal cancer in our institution. All patients diagnosed as having carcinoma rectum between August 2005 and July 2007 were included in the study. Group 1 patients consisted of those presenting with T2, T3 and T4 who received preoperative radiation of 25 Gy. Group 2 consisted of those with T4 tumours, who received Long course radiotherapy. Complication of radiation like dermatitis, enteritis and proctitis were noted. Before surgery CT scan and TRUS were repeated. In the postoperative period a record of abdominal, perineal wound complications and other complications were noted. The results were compared with a similar group of patients who did not receive preoperative radiotherapy. There were 21 patients (12males) with a mean age of 48.4 years (Range 18-70) in the radiotherapy group. Sixteen patients received short course (25 Gy) and five patients received long course of preoperative radiotherapy. Fourteen patients underwent definitive surgery in the form of abdominoperineal resection (APR) or anterior resection (AR). In the non-RT group there were 17 patients (8 males) with a mean age of 50.2 year. Fourteen patients underwent definitive surgery like APR (11) and AR (3). In the RT group CT scan and TRUS failed show any significant downsizing or down staging of tumour. In the RT group, incidence of acute skin toxicity was 23.8 % (5/21), all were seen in those who received long course of radiotherapy (Group 2). Grade 2 or 3 lower G I symptoms occurred in 3 (18.6 %) patients of Group 1 and 1(20 %) patient of group 2. There was higher incidence of perineal wound complication in the RT group (19.0 % vs 5.9 %). Preoperative long course of radiotherapy may be associated with high rates of dermatitis and perineal wound infection. Short course may be associated with lower G I toxicity.

Effects of power frequency electromagnetic fields on melatonin and sleep in the rat.

BACKGROUND: Studies investigating the effect of power frequency (50-60 Hz) electromagnetic fields (EMF) on melatonin synthesis in rats have been inconsistent with several showing suppression of melatonin synthesis, others showing no effect and a few actually demonstrating small increases. Scant research has focused on the ensuing sleep patterns of EMF exposed rats. The present study was designed to examine the effects of extremely low power frequency electromagnetic fields (EMF) on the production of melatonin and the subsequent sleep structure in rats. METHODS: Eighteen male Sprague-Dawley rats were exposed to a 1000 milligauss (mG) magnetic field for 1 month. Urine was collected for the final 3 days of the exposure period for analysis of 6-sulphatoxymelatonin, the major catabolic product of melatonin found in urine. Subsequent sleep was analyzed over a 24-hour period. RESULTS: Melatonin production was mildly increased in exposed animals. Although there were no statistically significant changes in sleep structure, exposed animals showed slight decreases in REM (rapid eye movement) sleep as compared to sham (non-exposed) animals. CONCLUSIONS: Power frequency magnetic fields induced a marginally statistically significant increase in melatonin levels in exposed rats compared to control. Subsequent sleep analysis indicated little effect on the sleep architecture of rats, at least not within the first day after 1 month's continuous exposure. Varying results in the literature are discussed and future research suggested.

Effects of diet-induced obesity on protein expression in insulin signaling pathways of skeletal muscle in male Wistar rats.

BACKGROUND: The prevalence of diet-induced obesity is increasing globally, and posing significant health problems for millions of people worldwide. Diet-induced obesity is a major contributor to the global pandemic of type 2 diabetes mellitus. The reduced ability of muscle tissue to regulate glucose homeostasis plays a major role in the development and prognosis of type 2 diabetes. In this study, an animal model of diet-induced obesity was used to elucidate changes in skeletal muscle insulin signaling in obesity-induced diabetes. METHODS: Adult male Wistar rats were randomized and assigned to either a control group or to a test group. Controls were fed a standard laboratory pellet diet (chow-fed), while the test group had free access to a highly palatable diet (diet-fed). After 8 weeks, the diet-fed animals were subdivided into three subgroups and their diets were altered as follows: diet-to-chow, diet-fed with addition of fenofibrate given by oral gavage for a further 7 weeks, or diet-fed with vehicle given by oral gavage for a further 7 weeks, respectively. RESULTS: Untreated diet-fed animals had a significantly higher body weight and metabolic profile than the control chow-fed animals. Intramuscular triacylglyceride levels in the untreated obese animals were significantly higher than those in the control chow-fed group. Expression of protein kinase C beta, phosphatidylinositol 3, Shc, insulin receptor substrate 1, ERK1/2, and endothelial nitric oxide synthase was significantly increased by dietary obesity, while that of insulin receptor beta, insulin receptor substrate 1, and protein kinase B (Akt) were not affected by obesity. CONCLUSION: These data suggest that diet-induced obesity affects insulin signaling mechanisms, leading to insulin resistance in muscle.

Stimulus contrast and word reading speed in Alzheimer's disease.

The oral word reading speed of patients with Alzheimer's disease (AD) and healthy young and older control participants was evaluated across a broad range of stimulus contrast levels in two experiments. The impact of stimulus repetition on reading speed also was examined. It was found that the older adult participants, and particularly the AD patients, were more sensitive to contrast reductions. Each subject group was able to read repeated words more rapidly than novel words but this repetition effect emerged only at lower stimulus contrast levels. It was concluded that AD patients have feature extraction speeds comparable to non-demented older adults but only when the stimuli are presented at a relatively high contrast. These findings suggest that the automatic encoding processes involved in word recognition remain intact in mildly demented AD patients given stimuli of sufficient strength.

Impact of stimulus integrity on age differences in letter matching.

Young and older adults were tested in both a letter-identification and a letter-matching task in which the integrity of the letter stimuli was manipulated through contrast reduction and low-pass spatial frequency filtering. The use of the contrast and filtering manipulations was an attempt to increase encoding difficulty in an effort to examine whether stimulus integrity impacts more than just the initial encoding of the letter pairs in a letter-matching task, namely the comparison process as indexed by fast-same and false-different effects. Of interest in terms of aging is whether a decline in information-processing performance often reported in the aging literature is related to the known encoding deficits of older adults. In the letter-identification task, both contrast reduction and filtering slowed letter-identification speed for both groups, with the effect being larger for the older adults. In the letter-matching task, decreased processing efficiency produced by the contrast-reduction and low-pass-filtering manipulations led to an overall increase in reaction time and errors, but it did not interact with the magnitude of the fast-same effect or false-different effects for either subject group. These findings suggest that the stimulus integrity manipulations only impact the encoding of the letter pairs in the matching task and not the comparison process. The results of the present study support a dual-process model of the matching task consisting of separate encoding and comparison processes. The finding of a larger fast-same effect for older adults suggests that the age effect is occurring at the comparison stage, but it is not impacted by the stimulus integrity manipulations. The findings are described within a generalized slowing framework.