Functional magnetic stimulation of the colon in persons with spinal cord injury.

OBJECTIVE: To evaluate the usefulness of functional magnetic stimulation (FMS) as a noninvasive method to stimulate the colon in individuals with spinal cord injury (SCI). DESIGN: A prospective before-after trial consisting of 2 protocols. SETTING: FMS laboratories of 2 SCI centers. PARTICIPANTS: Two able-bodied men and 13 men with SCI levels ranging from C3 to L1. Protocol 1 consisted of 9 subjects, 2 of whom were excluded from the analysis. Protocol 2 consisted of 4 subjects. INTERVENTION: Commercially available magnetic stimulators with round magnetic coils (MCs) were used. Protocol 1 measured the effects of FMS on rectal pressure by placing the MC on the transabdominal and lumbosacral regions. Protocol 2 consisted of a 5-week stimulation period to investigate the effects of FMS on total and segmental colonic transit times (CTTs). MAIN OUTCOME MEASURE: An increase in rectal pressure and a decrease in CTT by magnetic stimulation. RESULTS: Data were averaged and the standard error of the mean was calculated. Statistically significant changes in rectal pressure and CTT were also measured. Rectal pressures increased from 26.7 +/- 7.44cmH(2)O to 48.0 +/- 9.91cmH(2)O, p =.0037, with lumbosacral stimulation, and from 30.0 +/- 6.35cmH(2)O to 42.7 +/- 7.95cmH(2)O, p =.0015, with transabdominal stimulation. With FMS, the mean CTT decreased from 105.2 to 89.4 hours, p =.02. CONCLUSION: FMS is able to stimulate the colon and reduce CTT. FMS is a noninvasive, technological advancement for managing neurogenic bowel in patients with SCI.

Battered gay men: an exploration of abuse, help seeking, and why they stay.

In comparison to a large body of literature about battered heterosexual women and a growing body about battered lesbians, this is one of the first published studies that investigates the experiences of battered gay and bisexual men. Results indicated that these men suffered patterns, forms, and frequencies of physical, emotional, and sexual abuse similar to what has been documented by research on battered heterosexual and lesbian women. Likewise, the most commonly reported reasons for staying--namely, hope for change and love for partner--appear to be universal to the experience of being battered. Unlike battered heterosexual women, respondents in this study were not likely to report that being financially trapped was a major reason why they had remained. HIV-status, however, appears to significantly influence their decision to remain. Moreover, lack of knowledge about domestic violence and the lack of availability of appropriate resources play a significant role in same-gender domestic violence victims' decisions to remain. Like battered lesbians, battered gay men infrequently sought assistance from battered women's services and perceived these services as not helpful. By contrast, individual counselors and agencies who provided individual counselors were rated as quite helpful.

Perception of dysphonic voice quality by naive listeners.

For clinical assessment as well as student training, there is a need for information pertaining to the perceptual dimensions of dysphonic voice. To this end, 24 naive listeners judged the similarity of 10 female and 10 male vowel samples, selected from within a narrow range of fundamental frequencies. Most of the perceptual variance for both sets of voices was associated with "degree of abnormality" as reflected by perceptual ratings as well as combined acoustic measures, based upon filtered and unfiltered signals. A second perceptual dimension for female voices was associated with high frequency noise as reflected by two acoustic measures: breathiness index (BRI) and a high-frequency power ratio. A second perceptual dimension for male voices was associated with a breathy-overtight continuum as reflected by period deviation (PDdev) and perceptual ratings of breathiness. Results are discussed in terms of perceptual training and the clinical assessment of pathological voices.

Diphthong changes in style shifting from Southern English to Standard American English.

This study was undertaken to identify the acoustic correlates of the diphthongs /aI/ and /contains as a subset I/ in individuals who were trained to "style shift" between Standard American English (SAE) and Southern English (SE). The diphthongs were produced by four individuals from the coastal southern dialect region who were selected from among those who had successfully completed an accent-reduction program. Results showed that diphthongs used in SE were shorter and had less noticeable transitional elements than those in SAE. The difference was more apparent for /aI/ than /contains as a subset I/. There were no instances in which a diphthong was completely replaced by a vowel in SE. Findings indicate that acoustic analysis may be a useful tool in identifying dialectal elements, particularly for those individuals who are learning to style shift.

Child psychiatry practice patterns in Ontario.

OBJECTIVES: To examine the demographics, training, distribution, venues of practice, remuneration patterns, and professional affiliations of child psychiatrists in Ontario. METHOD: In July 1997, questionnaires were sent to 229 Ontario psychiatrists. A second mailing was sent to nonresponders in the fall of 1997. The overall response rate was 66.8%. RESULTS: Compared with other research regarding the ratio of child psychiatrists to children with mental health problems, Ontario fares relatively well (1:6148). Generally, Ontario child psychiatrists report having received formalized training in the speciality. Child psychiatrists are disproportionately concentrated in Toronto and in midsize cities with medical schools compared with rural regions. Out-reach services to smaller communities are provided by 30% of child psychiatrists, but it is not clear whether the services are sufficient and equitably available. Approximately 50% of current psychiatrists will be aged 65 years or older in 15 years, and it is unclear whether sufficient numbers will replace them. The profession appears to be reaching an equitable gender representation. Most child psychiatrists belong to the professional organizations that support the profession; however, they are least likely to belong to the Ontario Psychiatric Association (OPA). CONCLUSIONS: An optimal ratio of child psychiatrists per population served still needs to be determined, with special consideration given to the needs of rural communities. The small ratio of child psychiatrists to the population of children with mental health needs highlights the importance of collaborating with other medical and mental health professionals. Recruiting and retaining child psychiatrists will need to be monitored. Child psychiatrists in Ontario need a unified voice to address these issues.

Methicillin-resistant Staphylococcus aureus in patients with spinal cord injury.

During the past decade, methicillin-resistant Staphylococcus aureus (MRSA) has become a major cause of nosocomial and community-acquired infections in the United States. A retrospective chart review of MRSA-positive cases from January 1990 to December 1994 was done to assess the extent of the problem, the factors associated with MRSA acquisition, and the effectiveness of a Center for Disease Control (CDC) protocol to treat MRSA infection in a population with spinal cord injury (SCI). Seventy-four percent of the patients acquired MRSA during their hospitalization. Urine was the most common site of colonization, and 73 percent of the patients with positive urine cultures managed their bladders with indwelling catheters. Implementation of the CDC protocol in 1991 was associated with a decrease in the MRSA incidence rate in subsequent years. Other simple methods of treatment, such as bladder irrigation, were also effective. To control the spread of MRSA, a continual concerted effort by hospital staff through education and implementation of the MRSA protocol is necessary.

Voice problems and risk factors among aerobics instructors.

Fifty female and four male aerobics instructors completed a questionnaire pertaining to vocal problems and variables that could indicate an increased risk for developing problems. The questions concerned teaching experience, physical data regarding instructional facilities, method of voice projection, music volume, history of illness, allergies, voice loss, hoarseness, smoking habits, and knowledge of vocal hygiene. The results showed that a significant number of instructors experienced partial or complete voice loss (44%) during and after instructing, as well as increased episodes of voice loss, hoarseness, and sore throat unrelated to illness since they began instructing. Significant variables associated with voice problems included sore throat and hoarseness following instruction, and shouting to cue the participants. It was also found that very few instructors in this study had any knowledge of vocal hygiene techniques.

Acoustic correlates of dysphonia: type and severity.

The purpose of this study was to explore the acoustic discrimination and graded severity of three clinical voice types. Listeners classified 102 samples of dysphonic vowels /a/ and /i/ on the basis of voice types: breathy, hoarse, and strained. The vowels were analyzed acoustically with two measures of perturbation and 2 measures of spectral noise. Discriminant analysis showed that apriori, acoustic classifications of voice type were made with 92% accuracy using four acoustic parameters: (a) cepstral peak prominence (CPP), (b) jitter standard deviation (SD-J), (c) fundamental frequency (F0), and (d) standard deviation of signal-to-noise ratio (SD-SNR). Findings suggest that voice type is associated with the interaction of spectral noise, fundamental frequency, and signal irregularity, and that dysphonic severity is associated with similar parameters, regardless of voice type.

Micturition by functional magnetic stimulation.

Effectiveness of functional magnetic stimulation (FMS) technology on bladder contraction and bladder emptying was evaluated in twenty-two spinal cord injured subjects. FMS of the bladder was performed by stimulating the sacral nerves or the suprapubic region using a commercially available magnetic stimulator with a round coli. With sacral stimulation, the mean change in bladder pressure (Pves) was 24.4 +/- 4.88 cm H2O; with suprapubic stimulation, the mean change in Pves was 16.5 +/- 4.44 cm H2O. The change in Pves with sacral stimulation was higher than with suprapubic stimulation (p < .01). Seventeen subjects demonstrated voiding, either with sacral or suprapubic stimulation. Using a water-cooled coli, one subject demonstrated complete bladder emptying. FMS of the bladder has the potential to be a useful non-invasive technology for bladder emptying and bladder training in patients with neurogenic bladders.

Acoustic measures of dysphonic severity across and within voice types.

The purpose of the study was to explore an interaction between pathologic voice type and the acoustic prediction of dysphonic severity. One hundred and two phonatory samples, representing a wide range of laryngeal conditions, were categorized by listeners into three voice types: breathy, rough, and hoarse. A second group of trained listeners rated the severity of the samples on a 7-point scale. Twenty-five frequency- and time-domain measures were used to predict perceptual severity. Multiple regression analyses showed that the most useful measure for the prediction of severity across voice types was noise-to-harmonic ratio (NHR). The severity of individual voice types was predicted with differential results on the basis of both short- and long-term measures of perturbation.

Effects of perceptual training based upon synthesized voice signals.

28 undergraduate students participated in a perceptual voice experiment to assess the effects of training utilizing synthesized voice signals. An instructional strategy based upon synthesized examples of a three-part classification system: "breathy," "rough," and "hoarse," was employed. Training samples were synthesized with varying amounts of jitter (cycle-to-cycle deviation in pitch period) and harmonic-to-noise ratios to represent these qualities. Before training, listeners categorized 60 pathological voices into "breathy," "rough," and "hoarse," largely on the basis of fundamental frequency. After training, categorizations were influenced by harmonic-to-noise ratios as well as fundamental frequency, suggesting that listeners were more aware of spectral differences in pathological voices associated with commonly occurring laryngeal conditions. 40% of the pathological voice samples remained unclassified following training.

Sentence/vowel correlation in the evaluation of dysphonia.

Considering the widespread use of the sustained vowel in the evaluation of voice disorders, our objective was to study the degree to which the vowel is representative of voice in continuous speech. Phonatory samples were recorded from 20 normal subjects and 60 patients representing commonly occurring voice problems (nodules, unilateral paralysis, and functional). The phonatory samples were evaluated by 25 listeners on the basis of 12 bipolar, semantic differential scales. Factor analysis produced two perceptual dimensions with similar loadings for both vowels and sentences. A correlation of 0.78 was obtained between vowels and sentences on factor 1 scores, "vocal severity," and a correlation of 0.77 was obtained between vowels and sentences on factor 2 scores, "pitch/quality." Six of the 80 pairs of sentences and vowels differed by two scale points or more on vocal severity. Results suggest that although a relatively strong relationship exists between the two measures, sustained vowel sounds may not be an adequate clinical index to the dysphonic severity of continuous speech.

Pathologic voice type and the acoustic prediction of severity.

We hypothesized that acoustic measures would predict dysphonic severity with differential results for pathological voice types. An instructional program based upon synthesized voice signals was developed to facilitate an awareness of prototypical voice types. Eighty phonatory samples representing normal subjects as well as patients with unilateral vocal fold paralysis, vocal nodules, and functional dysphonia were analyzed acoustically on the basis of four measures: average fundamental frequency (F0), jitter, shimmer, and harmonic/noise ratio (H/N ratio). Following training, 29 listeners classified 62% of the phonatory samples on the basis of breathy, hoarse, rough, and normal. Dysphonic severity of rough voices was predicted more successfully by H/N ratio (r2 = .73) than by shimmer (r2 = .43). Dysphonic severity of breathy voices was predicted only by the combined features of less jitter, more shimmer, and lower H/N ratio (r2 = .74). No combination of acoustic variables was successful in the prediction of the hoarse voice type.

Asymmetrical visual-spatial attentional performance in ADHD: evidence for a right hemispheric deficit.

This study was designed to confirm the presence of a lateralizing deficit in visual-spatial attention in children with ADHD, to further characterize the nature of this deficit and to specify the likely hemispheric locus of dysfunction. Two versions of the covert orienting of attention procedure which evaluated separately endogenous and exogenous cuing effects were administered to 20 unmedicated children aged 9-12 with ADHD and 20 matched controls. Both groups also underwent thorough psychiatric assessment and testing using the TOVA and the Wisconsin Card Sorting Task (WCST). Children with ADHD showed an asymmetrical performance deficit characterized by a loss of costs on controlled (endogenous) attentional orienting to invalidly cured left visual field targets. The degree of cost asymmetry correlated negatively with the number of categories sorted on the WCST. It was concluded that unmedicated children with ADHD show an asymmetrical performance deficit on the covert orienting procedure characterized by a disruption of right hemispheric attentional mechanisms. This deficit may be related to diminished right hemispheric frontal-striatal catecholamine activity.

A comparison of the restraint and seclusion experiences of patients with schizophrenia or other psychotic disorders.

OBJECTIVE: The purpose of this study was to understand how restrained and secluded patients felt about these interventions, and to compare the perceptions of the two groups. METHODS: Subjects were 25 restrained, and 25 secluded inpatients. A questionnaire was developed to explore patients' feelings and perceptions of the two interventions. Comparisons were made on the clinical data and the answers from both groups. RESULTS: Restrained and secluded patients seemed to view some aspects of their experience differently. Few (40%) of the secluded group reported finding positive aspects, compared to even fewer (20%) of restrained. Most patients in both groups felt negatively about staff involved, and disagreed with staff on the reported intensity of their documented threatening behavior. The interventions seemed to have only a brief modifying effect on patients' behavior following these interventions and did not seem to modify future behavior. CONCLUSIONS: Despite their differences, many patients in both groups reported negative feelings about the interventions and the staff involved. Both groups seemed not to perceive the procedural staff interactions as communication. Our study population seemed to be a subgroup of the admitted patient population who were repeatedly requiring seclusion or restraint. Screening this patient population during the admission process, and planning preventive and alternative interventions could decrease the need for restraint and seclusion.

Acoustic prediction of severity in commonly occurring voice problems.

The relative effectiveness of three acoustic measures (jitter, shimmer, and harmonic/noise ratio) in predicting the dysphonic severity of a diverse clinical population singly and together was investigated. Phonatory samples were recorded from 20 normal subjects and 60 patients representing 3 laryngeal groups (nodules, paralysis, and functional). The phonatory samples were evaluated by 22 listeners using a 7-point equal-appearing interval scale. Shimmer produced a bivariate correlation of 0.54 with dysphonic severity; harmonic/noise ratio correlated -0.32 with dysphonic severity; and jitter produced no significant correlation with severity. The combination of acoustic variables through multiple regression analysis produced a correlation of 0.56, with only shimmer and average F0 contributing to the correlation. For this particular clinical population, therefore, findings indicated that (a) none of the variables was strongly correlated with dysphonia ratings, and (b) a combination of acoustic predictors was no more successful than a single predictor of dysphonic severity, namely, shimmer.

Comparative study of laser versus electrocautery prostatic resection: 18-month followup with complex urodynamic assessment.

A total of 25 patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia was entered into a prospective, randomized trial comparing prostatectomy done with the Urolase right angle firing neodymium:YAG laser fiber and standard transurethral electroresection of the prostate. Efficacy of treatment, as assessed by standardized American Urological Association symptom scores, patient assessment of symptom improvement, peak urinary flow rates, post-void residual urine volumes and complex urodynamic evaluation, including assessment of opening pressure and maximum detrusor voiding pressure, was equivalent for the 2 treatment groups through 1 year. Ultrasonic assessment of prostatic volumes at 1 year showed a mean decrease in total volume of 59% for standard electrocautery resection compared to 28% for laser prostatectomy. Symptom scores and peak urinary flow rates remained equivalent for both groups through 18 months.

Abnormal processing of irrelevant information in attention deficit hyperactivity disorder.

The presence of a selective attention deficit in children with attention deficit hyperactivity disorder (ADHD) was investigated by administering a trial-by-trial version of the Stroop Color-Naming Task to children, aged 9-12, with ADHD (n = 19) and age-matched normal control children (n = 19). Performance was evaluated on both interference and facilitation components of the task. On the standard version of the task, with equal numbers of color words and neutral words, children with ADHD showed increased Stroop interference (prolongation of color-naming times by color-incongruent stimuli) but normal amounts of facilitation (speeding of color naming by color-congruent stimuli). This finding suggests that children with ADHD show increased disruption of color-naming performance by task-irrelevant information, probably secondary to decreased attentional control over the interference process. In contrast to findings of studies in adults, both groups of children failed to use an attentional strategy to reduce interference when they were administered blocks of trials that varied their expectancy for color word trials. This precluded a direct test of the diminished control hypothesis. There were no significant correlations between abnormal Stroop performance and impairment on the Continuous Performance Test or the Wisconsin Card Sorting Test or measures of IQ or reading performance. The implications of these findings for our understanding of information-processing deficits in children with ADHD and of the neurobiological underpinnings of these deficits are discussed.

The effect of intensive case management on hospitalization of patients with schizophrenia.

OBJECTIVE: The study aim was to determine if a community-based psychiatric rehabilitation program with intensive case management was more effective than traditional outpatient services in reducing hospitalization of chronic schizophrenic patients. METHODS: One hundred twelve schizophrenic patients enrolled in the intensive case management program were matched by age, number of previous hospitalizations, and days spent in the hospital with 112 schizophrenic patients who received medication services and minimal case management. The two groups were compared on the amount of services used and the number of hospitalizations and hospital days over a 24-month study period. RESULTS: Patients in the intensive case management program had been enrolled for a mean of 10.96 months, with a range from one to 24 months. They used significantly more mental health services during the study period compared with the patients in the control group. However, no significant differences were found between the two groups in number of hospitalizations and hospital days. Both groups showed an increase in the number of hospitalizations over the study period. CONCLUSIONS: A community-based psychiatric rehabilitation program with intensive case management was no more effective than medication services and minimal case management in reducing hospitalization among chronic schizophrenic patients.

Incidence and management of autonomic dysreflexia and other intraoperative problems encountered in spinal cord injury patients undergoing extracorporeal shock wave lithotripsy without anesthesia on a second generation lithotriptor.

Spinal cord injury patients are at increased risk for urolithiasis and many will require treatment, most commonly with extracorporeal shock wave lithotripsy. New, second generation lithotripsy devices allow treatment without tub immersion, and without general or regional anesthesia for most patients. Spinal cord injury patients, with loss of sensation below the level of injury, would seem to be ideal candidates for such treatment. We present our experience with 20 consecutive spinal cord injury patients treated without anesthesia on the Medstone STS second generation lithotriptor. All patients were awake and experienced no direct sensation from the shock waves. All but 1 patient (T12 level), however, experienced autonomic dysreflexia, with significant elevations in systolic blood pressure (mean increase 44 mm. Hg, maximum 74) and diastolic blood pressure (mean increase 24 mm. Hg, maximum 61), with reflex bradycardia (mean decrease -22 beats per minute). Autonomic dysreflexia was successfully treated in this setting with short-acting sublingual nifedipine. Associated bradycardia was treated with atropine in 6 patients. Preoperative bowel preparation proved to be useful in spinal cord injury patients to maximize stone imaging and may decrease autonomic dysreflexia if this is caused by shock waves impacting on the distended bowel. Other problems included uncontrolled skeletal muscle spasms elicited by shock waves, which proved to be troublesome in maintaining patient position and stone localization. Muscle spasms were decreased with benzodiazepines. Care was also observed in spinal cord injury patients to pad all pressure points on the hard, dry treatment surfaces associated with second generation lithotriptors and, thus, prevent skin breakdown.