Completeness and accuracy of International Classification of Disease (ICD) external cause of injury codes in emergency department electronic data.

The accuracy of external cause of injury codes (E codes) for work-related and non-work-related injuries in Massachusetts emergency department data were evaluated. Medical records were reviewed and coded by a nosologist with expertise in E coding for a stratified random sample of 1000 probable work-related (PWR) and 250 probable non-work-related (PNWR) cases. Cause of injury E codes were present for 98% of reviewed cases and accurate for 65% of PWR cases and 57% of PNWR cases. Place of occurrence E codes were present in less than 30% of cases. Broad cause of injury categories were accurate for about 85% of cases. Non-specific categories (not elsewhere classified, not specified) accounted for 34% of broad category misclassifications. Among specified causes, machinery injuries were misclassified most often (39/60, 65%), predominantly as cut/pierce or struck by/against. E codes reliably identify the broad mechanism of injury, but inaccuracies and incompleteness suggest areas for training of hospital admissions staff, providers, and coders.

Characteristics of work related asthma: results from a population based survey.

OBJECTIVES: Many risk factors for asthma have been investigated, one of which is the workplace. Work related asthma is a frequently reported occupational respiratory disease yet the characteristics which distinguish it from non-work related asthma are not well understood. The purpose of this study was to examine differences between work related and non-work related asthma with respect to healthcare use and asthma control characteristics. METHODS: Data from the Massachusetts Behavioral Risk Factor Surveillance System for 2001 and 2002 were used for this analysis. Work related status of asthma was determined by self-report of ever having been told by a physician that asthma was work related. Healthcare measures evaluated were emergency room visits and physician visits for worsening asthma and for routine care. Characteristics of asthma control evaluated were frequency of asthma symptoms, asthma attacks, difficulty sleeping, and asthma medication usage in the last 30 days and limited activity in the past 12 months. RESULTS: The prevalence of lifetime and current asthma in Massachusetts were 13.0% and 9.2%, respectively. Approximately 6.0% (95% CI 4.8 to 7.3) of lifetime and 6.2% (95% CI 4.7 to 7.8) of current asthma cases were work related. In the past 12 months, individuals with work related current asthma were 4.8 times (95% CI 2.0 to 11.6) as likely to report having an asthma attack, 4.8 times (95% CI 1.8 to 13.1) as likely to visit the emergency room at least once, and 2.5 times (95% CI 1.1 to 6.0) as likely to visit the doctor at least once for worsening asthma compared to individuals with non-work related asthma. CONCLUSIONS: Work related asthma is associated with increased frequency of asthma attacks and use of healthcare services. A better understanding of factors that contribute to differences in healthcare use and asthma control is needed to improve prevention and control strategies for individuals suffering from the disease.

An examination of the spatial working memory deficit following neurotoxic medial dorsal thalamic lesions in rats.

The present study examined the performance of rats with neurotoxic lesions centred in the thalamic nucleus medialis dorsalis on standard and modified versions of the eight arm radial maze test. In Experiment 1, the thalamic lesions produced a borderline deficit in acquisition of the standard task, but subsequently had no effect when a delay was interposed after the first four arms had been entered. The same lesions had no effect on T-maze alternation, but they did impair radial-arm maze performance when intramaze and extramaze cues were set against each other. In Experiment 2, lesions of the dorsomedial thalamus impaired acquisition of the standard radial-arm maze task, but combining the results from Experiments 1 and 2 showed that this acquisition deficit was confined to those animals in which bilateral damage extended into the adjacent anterior thalamic nuclei. In addition, lesions of the dorsomedial thalamus disrupted radial-arm maze performance when the task was modified to compare working memory and reference memory and increased activity and exploration. These changes were not associated with anterior thalamic damage. Finally, the thalamic lesions did not affect performance on a test of spontaneous object recognition. It is concluded that lesions of medialis dorsalis do not disrupt spatial memory but do affect other processes that can interact with task performance. These include a failure of extramaze cues to overshadow intramaze cues, a change in activity and exploration levels and deficits in with-holding spatial responses.

Neurotoxic lesions of the dorsomedial thalamus impair the acquisition but not the performance of delayed matching to place by rats: a deficit in shifting response rules.

This study examined the acquisition of a T-maze matching to place task by rats with neurotoxic lesions of the thalamic nucleus medialis dorsalis. This test of spatial working memory also entails learning a task rule that is contrary to the animals' innate preference. The rats next performed the same matching task over different retention delays. Finally, they were trained on a reversal of the task rule, i.e., to nonmatch to place. Although the lesions produced a clear acquisition impairment on the matching task, there was no evidence of a loss of working memory. A series of control tasks found no appreciable effect on a conditioned cue preference task or on open field activity. The pattern of results shows that medialis dorsalis lesions lead to a selective increase in perseverative behavior that can retard task acquisition. This perseverative deficit closely resembles that observed after prefrontal damage in rats, strongly indicating dysfunction in a common system.

The effects of selective lesions within the anterior thalamic nuclei on spatial memory in the rat.

Groups of rats received cytotoxic lesions centred in either the anterior thalamic nucleus (AM), the anterior ventral and anterior dorsal thalamic nuclei (AV/AD), or all three nuclei combined (ANT.T). These lesions were made by injecting N-methyl-D-aspartate acid (NMDA). These rats, and a group of surgical controls (SHAM), were trained on a rewarded forced-alternation task in a T-maze. While the selective AM and AV/AD lesions produced an initial acquisition impairment, only the animals with combined lesions (ANT.T) showed a persistent deficit throughout the 16 acquisition sessions. Subsequent testing with a cross-maze confirmed that the SHAM, AV/AD, and AM groups were able to use allocentric cues, while the ANT.T group were impaired. In contrast none of the three anterior groups were impaired on a subsequent egocentric discrimination and reversal task run in the same apparatus. A final test using the eight arm radial-maze, revealed marked deficits in the ANT.T group as well as milder deficits in the AV/AD group. The results from these experiments help to confirm the importance of the anterior thalamic nuclei for allocentric tasks, but suggest that no region is pre-eminently important. The findings also help to account for other studies which have reported that anterior thalamic lesions have seemingly mild effects on tests of spatial memory.

Evolution of post and core systems.

Post and core systems have evolved dramatically over the past few years. Some procedures based on the use of resin-composite systems seem destined for failure in the long term. New glass ionomer based systems, employing resin hybrid materials should give rise to fewer complications and prove simpler to use. Nevertheless, intelligent case selection and the application of sound basic design principles are required to make the best use of any system.

A comparison of the effects of anterior thalamic, mamillary body and fornix lesions on reinforced spatial alternation.

The effects of cytotoxic lesions in either the anterior thalamic nuclei or the mamillary bodies were compared with those of fornix lesions on a test of spatial working memory. All three lesions impaired acquisition of a forced alternation task in a T-maze, but the disruptive effects of the mamillary body lesions were significantly less than those following either fornix or anterior thalamic damage. When the alternation task was changed, so as to increase proactive interference, the impairment associated with mamillary body damage became more evident and was now equal in severity to that in the animals with anterior thalamic lesions. The fornix lesion group were the most impaired. In contrast, all three groups performed normally on a test of object recognition. The results add weight to the view that hippocampal--anterior thalamic connections are critical for normal spatial memory and that the relative contribution of the mamillary bodies is task dependent.

The effects of lesions to the fornix and dorsomedial thalamus on concurrent discrimination learning by rats.

Rats with lesions in either the fornix or the thalamic nucleus medialis dorsalis were unimpaired on the acquisition of two object discrimination tasks. The same animals were then tested on a concurrent learning task in which various object discriminations were presented at different rates during the same session. This arrangement was primarily designed to minimise any response bias effects. Animals were able to acquire the various concurrent tasks, even when only one trial per day was given for a particular discrimination. It was found that fornix lesions had little or no effect and only produced a mild impairment when the rate of stimulus presentation resembled that used in typical concurrent tasks. Lesions of medialis dorsalis produced a more general, but again mild, deficit. In a final task, the animals were trained to discriminate between two stimuli composed of common elements arranged in different spatial combinations. Fornix lesions impaired acquisition of this spatial configural discrimination, while lesions of medialis dorsalis had a variable effect. The results indicate that fornix lesions can spare concurrent discrimination learning, and that any deficits may be related to interference effects associated with common elements in the stimuli. Lesions in medialis dorsalis appear to affect the initial learning of reward-based performance rules.

Removal of the hippocampus and transection of the fornix produce comparable deficits on delayed non-matching to position by rats.

Rats with radiofrequency lesions of the fimbria/fornix or with extensive aspiration lesions of the hippocampal region (the hippocampus proper, dentate gyrus, and subicular complex) were tested on their performance of a delayed non-matching to position task which had been learnt before surgery. On a given trial, one of two sample levers was presented in a random manner. Following a response on this lever and a subsequent delay, both levers were presented and reward was now contingent on a response on the lever that was not used as the sample. Both lesions produced equivalent performance deficits on this test of spatial working memory, the pattern of these deficits being consistent with a mnemonic impairment. The lack of difference between these two groups on a variety of performance measures indicates that hippocampal connections passing through the fornix are not only necessary for this test, but that non-fornical hippocampal connections appear unable on their own to maintain accurate responding.

Ovarian follicular response of mares to GnRH agonist (leuprolide acetate) treatment after pituitary suppression.

Follicular growth and ovulation were monitored in 18 horse mares during a control cycle and during a cycle in which the mares received a GnRH agonist, leuprolide acetate (LA; 200 or 400 mug), twice daily until ovulation. Prior to both of these cycles, follicular growth was suppressed using a 10-day estrogen-progesterone treatment regimen, with prostaglandin F-2alpha (10 mg) administered on Day 10. Four of the mares treated with LA remained anovulatory for at least 3 weeks after the end of treatment and were excluded from statistical analysis. The dosage of LA did not affect response. Treatment with LA significantly (P=0.0375) increased the percentage of large follicles per ovulation (i.e., follicles greater than 30 mm in diameter on the day on which the largest follicle reached 35 mm) and also increased (P=0.0539) the diameter of the second largest follicle. However LA did not significantly alter the number of ovulations. Mean daily concentrations of luteinizing hormone (LH) were not significantly different during treatment and control cycles. The LH in blood samples collected repeatedly on Day 19 after the start of estrogen-progesterone treatment did not show a difference in frequency or amplitude of pulses between treatment and control cycles. Mares were artificially inseminated during estrus and the embryos were recovered. Fewer embryos were recovered per ovulation from mares after treatment with LA (26%) than during the control cycle (64%). Results indicate that treatment with LA either suppressed follicular activity or induced multiple follicular growth.

Medial dorsal thalamic lesions and working memory in the rat.

Pigmented rats of the DA strain with either radiofrequency or ibotenic acid lesions of the thalamic nucleus medialis dorsalis were postoperatively given nonspatial and spatial tests of working memory. In the nonspatial task, delayed nonmatching-to-sample, rats with both types of thalamic lesions showed acquisition impairments. The subgroup of rats with nucleus medialis dorsalis lesions that were able to reach the acquisition criterion did, however, perform normally when the retention interval was extended to 60 s. In the spatial task, delayed forced-alternation, rats were tested with differing retention intervals and with both spaced and massed trials. Damage to nucleus medialis dorsalis had no effect on acquisition or on spaced trials, but a slight deficit was found in the animals with radiofrequency lesions under the massed trial condition. Much clearer deficits were, however, present in those animals in which the lesion extended appreciably into the anterior thalamic nuclei. The findings indicate that while cellular damage to nucleus medialis dorsalis may disrupt learning, some impairments in tests of spatial working memory attributed to this nucleus may reflect damage to the adjacent anterior thalamic nuclei.

Pathological changes of the mare endometrium and genotypes for transferrin and ELA.

Histological features of the endometrium, as assessed in biopsy samples, were related to Standardbred mare genotypes for transferrin, esterase (as a control) and equine leucocyte antigens (ELA). Pathological changes were found more frequently in each successively older age group of mares. Among mares aged 6-19 years, there were significant pathologic changes on first examination following an infertile breeding season for 46 of 90 (51%) of transferrin homozygotes and 50 of 146 (34%) of transferrin heterozygotes. The difference between the two groups was significant for the total data (chi 1(2) = 6.56, P = 0.010) and when the data were stratified for mare age at biopsy (chi 1(2) = 7.33, P = 0.0068). The effect of transferrin was similar in both trotters and pacers, especially for frequent genotypes commonly found in horses of both gaits. There was no effect of esterase and, in a smaller set of ELA-typed mares, no significant effect of ELA genotype on uterine biopsy category. Transferrin has a well-established microbiostatic and biocidal effect. Conceivably, heterozygotes for some combinations of transferrin variants could have a slower natural rate of endometrial deterioration than homozygotes.

The effects of mammillary body and combined amygdalar-fornix lesions on tests of delayed non-matching-to-sample in the rat.

A series of experiments compared the effects of mammillary body lesions with those of combined damage to the amygdala and fornix on 2 tests of working memory, both of which used the delayed non-matching-to-sample rule. This comparison was based on evidence of the involvement of these regions in anterograde amnesic syndromes. The mammillary body lesions had no effect on the acquisition or subsequent performance of a non-spatial recognition task and had only a mild effect on the acquisition of a spatial forced-alternation task. Although the animals with combined amygdalar plus fornix lesions were able to master the non-spatial recognition task they were impaired when the levels of proactive interference were increased. The same animals were also severely impaired on the forced-choice alternation task. The overall pattern of results is seen as mirroring those found in primates and points to an underlying similarity in the mnemonic roles of these limbic regions.

Ultrasound as an aid to diagnosis of granulosa cell tumour in the mare.

The ultrasonic appearance of seven cases of granulosa cell tumour is described, and compared with an ovarian haematoma and an ovarian serous cystadenoma. The granulosa cell tumours varied from being uniformly dense to having one or several large fluid filled cysts. Some tumours resembled the haematoma or cystadenoma and also, in some aspects, normal ovarian structures such as corpora haemorrhagica or follicles in early pregnancy. There was no typical ultrasonographic appearance of the granulosa cell tumours which enabled definitive diagnosis. However, ultrasound may be a diagnostic aid when used in conjunction with the history and findings on rectal palpation.

Microconservative restorations for approximal carious lesions.

The availability of new restorative materials such as glass ionomers, which have an anticaries action, prompts a reevaluation of some of the basic principles of restorative dentistry. It seems that conventional methods of treating the approximal carious lesion are too radical and that microconservative techniques offer a simpler, more effective solution when correctly applied.

Cervical hyperplasia with prolapse in a mare.

Cervical hyperplasia with prolapse through the vulvar lips was documented in a mare. Postmortem examination indicated that the mass originated from the cervical wall. The surface of the prolapsed mass had histologic features of normal cervix. Cervical hyperplasia can be considered in a list of differential diagnoses in cases of prolapse of the internal genitalia in mares.

The future of esthetic dentistry.

The materials and techniques of esthetic dentistry are provoking reconsideration of the basic principles of operative dentistry. Cavity preparations can be minimized, demands on retention are altered, and prevention can be practiced. Problems remain, particularly in bonding and sealing to dentin. The newer materials have yet to prove themselves in terms of durability, especially in regard to fracture and wear.