Impact of a Pilot Videogame-Based Physical Activity Program on Walking Speed in Adults with Schizophrenia.

The purpose of this report is to describe the impact of a videogame-based physical activity program using the Kinect for Xbox 360 game system (Microsoft, Redmond, WA) on walking speed in adults with schizophrenia. In this randomized controlled trial, 28 participants played either an active videogame for 30 min (intervention group) or played a sedentary videogame for 30 min (control group), once a week for 6 weeks. Walking speed was measured objectively with the Short Physical Performance Battery at enrollment and at the end of the 6-week program. The intervention group (n = 13) showed an average improvement in walking speed of 0.08 m/s and the control group (n = 15) showed an average improvement in walking speed of 0.03 m/s. Although the change in walking speed was not statistically significant, the intervention group had between a small and substantial clinically meaningful change. The results suggest a videogame based physical activity program provides clinically meaningful improvement in walking speed, an important indicator of health status.

Disinfection of human cardiac valve allografts in tissue banking: systematic review report.

Cardiovascular allografts are usually disinfected using antibiotics, but protocols vary significantly between tissue banks. It is likely that different disinfection protocols will not have the same level of efficacy; they may also have varying effects on the structural integrity of the tissue, which could lead to significant differences in terms of clinical outcome in recipients. Ideally, a disinfection protocol should achieve the greatest bioburden reduction with the lowest possible impact on tissue integrity. We conducted a systematic review of methods applied to disinfect cardiovascular tissues. The use of multiple broad spectrum antibiotics in conjunction with an antifungal agent resulted in the greatest reduction in bioburden. Antibiotic incubation periods were limited to less than 24 h, and most protocols incubated tissues at 4 °C, however one study demonstrated a greater reduction of microbial load at 37 °C. None of the reviewed studies looked at the impact of these disinfection protocols on the risk of infection or any other clinical outcome in recipients.

The estimated effect of reducing the maternal smoking rate on neonatal intensive care unit costs in Victorian public hospitals.

This analysis estimates the expected number of Victorian public hospital neonatal intensive care unit cot-days that could be saved annually by reducing the maternal smoking rate. Approximately 106 cot-days could be saved if the maternal smoking rate was reduced from 8.4% to 6.4% (estimated annual cost saving of A$276 000).

Substance use patterns in 9-10 year olds: Baseline findings from the adolescent brain cognitive development (ABCD) study.

BACKGROUND: The Adolescent Brain Cognitive Development ™ Study (ABCD Study®) is an open-science, multi-site, prospective, longitudinal study following over 11,800 9- and 10-year-old youth into early adulthood. The ABCD Study aims to prospectively examine the impact of substance use (SU) on neurocognitive and health outcomes. Although SU initiation typically occurs during teen years, relatively little is known about patterns of SU in children younger than 12. METHODS: This study aims to report the detailed ABCD Study® SU patterns at baseline (n = 11,875) in order to inform the greater scientific community about cohort's early SU. Along with a detailed description of SU, we ran mixed effects regression models to examine the association between early caffeine and alcohol sipping with demographic factors, externalizing symptoms and parental history of alcohol and substance use disorders (AUD/SUD). PRIMARY RESULTS: At baseline, the majority of youth had used caffeine (67.6 %) and 22.5 % reported sipping alcohol (22.5 %). There was little to no reported use of other drug categories (0.2 % full alcohol drink, 0.7 % used nicotine, <0.1 % used any other drug of abuse). Analyses revealed that total caffeine use and early alcohol sipping were associated with demographic variables (p's<.05), externalizing symptoms (caffeine p = 0002; sipping p = .0003), and parental history of AUD (sipping p = .03). CONCLUSIONS: ABCD Study participants aged 9-10 years old reported caffeine use and alcohol sipping experimentation, but very rare other SU. Variables linked with early childhood alcohol sipping and caffeine use should be examined as contributing factors in future longitudinal analyses examining escalating trajectories of SU in the ABCD Study cohort.

Rest-activity and behavioral disruption in a patient with frontotemporal dementia.

The neurological deterioration in dementia is associated with disturbances in circadian rhythms and rest-activity patterns. These disruptions have been documented in Alzheimer's disease (AD) and dementia with Lewy bodies but little is known about rest-activity patterns in patients with frontotemporal dementia (FTD). We report longitudinal (2 year) actigraphy results for a patient who met diagnostic criteria for FTD and his family caregiver. The subject and his family caregiver wore Actiwatches continuously for 2 weeks at 1-year intervals. The findings suggest that with disease progression there is worsening in multiple areas of rest-activity measures for the patient and a negative impact on sleep quality for the family caregiver.

Sensory perception in Parkinson disease.

OBJECTIVE: To determine whether there is a complex sensory disturbance that may be contributing to the motor deficit in patients with Parkinson disease. DESIGN: Comparison of performance by patients and healthy, age- and sex-matched subjects in tests of various sensory functions. SETTING: The Center for Human Performance and Testing at a university hospital and research center. PARTICIPANTS: Ten subjects with Parkinson disease and 10 control subjects matched for age and sex. MAIN OUTCOME MEASURE: Performance on 4 subjects of the Sensory Integration and Praxis Test: finger identification, graphesthesia, localization of tactile stimuli, and kinesthesia. RESULTS: Data were analyzed using paired t tests for ratio data and the paired Wilcoxon test for ordinal data. Patients with Parkinson disease performed significantly worse (P = .001) than the control patients on the test of kinesthesia. There were no significant differences between the 2 groups on the other subtests. CONCLUSIONS: Without visual guidance, patients with Parkinson disease had more difficulty in perceiving the extent of a movement made to a target away from the body, a task requiring reliance on proprioceptive feedback. Parkinsonian patients had no more difficulty than controls in making movements to a target on the surface of the body when they could use tactile sensations. Movement difficulties in patients with Parkinson disease may relate in part to a decrease in proprioception. Activities that enhance kinesthetic awareness may be an important adjunct to the treatment of these patients.

Effect of pallidotomy on postural control and motor function in Parkinson disease.

OBJECTIVE: To investigate the effects of pallidotomy on postural reactions and other motor parkinsonian deficits. DESIGN: Comparison of performance by patients before and after pallidotomy on tests of balance and function. SETTING: A Parkinson disease Center of Excellence and Center for Human Performance Testing at a university hospital and research center. PARTICIPANTS: Twenty-nine patients with Parkinson disease undergoing pallidotomy. MAIN OUTCOME MEASURES: Performance results on the United Parkinson's Disease Rating Scale (UPDRS), activities of daily living and motor subscales (parts II and III). and posturography (sensory organization test), which were collected before and 3 and 6 months after surgery with patients in the practically defined off state (medication withheld for at least 12 hours). RESULTS: Data were analyzed with a paired Wilcoxon and Spearman correlation. There was a significant improvement in mean +/- SD UPDRS motor subscale score after pallidotomy (before surgery, 52.43+/-13.46; after surgery, 43.93+/-15.15; z= 3.63; P=.003). There were no significant changes in the UPDRS activities of daily living subscale or average stability scores when the group was examined as a whole. However, examination of individual data revealed that 9 (56%) of 16 patients who could stand independently before surgery showed improvement in either the number of falls or the average stability score. No patient who was unable to stand independently before surgery was able to stand independently after it. CONCLUSION: Pallidotomy helped improve overall motor function in patients with parkinsonism and, for some patients, also improved postural stability.

Sudden death due to left coronary artery occlusion in infective endocarditis.

A 44-year-old man died suddenly, shortly after admission to the hospital with complaints of abdominal pain. Medical history was significant for chronic alcoholism and homozygous hemoglobin C disease. Autopsy revealed vegetations on the aortic valve, especially on the left coronary cusp. There was anomalous origin of the coronary arteries from the left sinus of Valsalva. The large vegetation on the left coronary cusp had extended into the left main-stem coronary artery and obstructed it. There was evidence of prior embolization to the right coronary artery with mycotic aneurysm formation and myocardial infarction. Other lesions included a cerebral artery mycotic aneurysm and metastatic abscesses within the myocardium and spleen. Although the aortic valve was free of underlying chronic pathology, the causative organism was Streptococcus viridans. This case illustrates several unusual, and, in some instances, unique findings in infective endocarditis.

Spontaneous coronary artery dissection occurs with and without periadventitial inflammation.

Dissection of a coronary artery not associated with aortic dissection or trauma is a rare condition that occurs most frequently in peripartum or postpartum women. It has been suggested that localized periadventitial inflammation, often found adjacent to these lesions, may represent a primary vasculitis which causes dissection. Two cases of spontaneous coronary artery dissection are described, together with a brief review of previously published cases. Based on this review, we conclude that periadventitial inflammation is reactive, rather than primary, in nature.

Dissecting aneurysm of the pulmonary trunk.

Dissecting aneurysms of the pulmonary trunk are a rare cause of sudden death. We report a case in a patient with pulmonary hypertension secondary to a patent ductus arteriosus. A brief review of the condition is also presented.

Simultaneous acute thrombosis of two major coronary arteries following intravenous cocaine use.

Myocardial infarction is now a well-recognized complication of cocaine abuse. This report describes a 38-year-old man who sustained simultaneous acute thrombosis of two major epicardial coronary arteries shortly after intravenous cocaine use. The finding of layers of mural thrombus of varying age, from acute to two to three days, in both coronary arteries represents a previously unreported finding (to our knowledge) in cocaine-associated cardiac death. Potential mechanisms for the association between cocaine use and infarction and the cardiac pathologic findings in cocaine-associated death are discussed.

Determination of sulfide in brain tissue by gas dialysis/ion chromatography: postmortem studies and two case reports.

An analytical method for the determination of sulfide in human and rat brain is described. It utilizes a continuous flow gas dialysis pretreatment and quantitation by ion chromatography with electrochemical detection. Rat brain sulfide levels were reliably measured after fatal intoxication by intraperitoneal injection of NaHS. By expeditious analysis of samples it was possible to demonstrate the presence of endogenous levels of sulfide in both rat and human brain as well as to measure elevated brain levels of sulfide after intoxication. In postmortem rat brain tissue, elevated sulfide levels could still be reliably demonstrated 96 h after death if the bodies had been refrigerated at 4 degrees C. Two case studies of human hydrogen sulfide inhalation fatalities are presented. The described method was able to measure significantly elevated sulfide levels in both cases.

Shotcup petal abrasions in close range .410-caliber shotgun injuries.

Shotcup petal abrasions centered around a shotgun wound of entrance are generally thought to occur at a range of 30 to 90 cm. A suicidal .410-caliber shotgun injury of the right eye is described in which typical petal abrasions were noted around the entrance wound. However, significant soot deposition around the wound suggested that the range of fire was less than 30 cm and perhaps closer to 15 cm. Test-firing of the weapon and ammunition used by the decedent showed some spread of the shotcup petals at a range of 7.5 cm, progressing to maximum spread at 30 to 52.5 cm. Further testing with other .410 ammunition, containing shotcups, confirmed the spread of shotcup petals at ranges less than 30 cm, irrespective of manufacturer, shotshell length, and birdshot size. When a variety of shotguns were tested, it was found that one weapon with a very short barrel and cylinder bore did not exhibit petal spread until a range of 30 cm was reached. The remaining shotguns, with longer barrels and full choke, all demonstrated definite petal spread at a range of 12.5 cm. The long, narrow configuration of .410 shotcup petals may explain their early spread and the production of petal abrasions at ranges of less than 30 cm.

Unexpected death as a result of infective endocarditis.

Thirteen cases of infective endocarditis (IE) diagnosed for the first time at autopsy or, in those patients with a previous diagnosis of IE, not thought to be active at the time of death, are presented. Of the six patients who died within 24 h of the onset of symptoms, two died of obstruction of a valve orifice, two died of sepsis, one died of sepsis and alcoholic cardiomyopathy, and one died of a coronary artery embolus. Of the five patients with symptoms lasting more than 24 h, three died of sepsis and congestive heart failure. One died from sepsis alone and one died from congestive heart failure (CHF). In two patients whose duration of symptoms is unknown, one died of sepsis and CHF, and in the other the mechanism of death is unknown. Predisposing factors present in 11 of 13 patients included alcoholism (three), intravenous (IV) drug abuse (three), prosthetic valves (three), aortic stenosis (two), past rheumatic fever (one), and nonstenotic congenitally bicuspid valves (two). The reasons for no antemortem diagnosis were a missed or incorrect clinical diagnosis in three patients seen by a physician shortly before death, no signs or symptoms or found dead (four), non-specific signs and symptoms (three), refusal of medical treatment (one), and a solitary lifestyle (one); there was insufficient information about one patient. Individuals with needle tracks, generalized petechiae. Osler's nodes, splinter hemorrhages, intravenous catheters, pacemaker wires, and infected aortic-valve (A-V) shunts are at risk of IE. Blood and the vegetations should be cultured. The attending physician should be notified of the diagnosis in such cases.

Radiography of perforating centerfire rifle wounds of the trunk.

All deaths resulting from perforating centerfire rifle wounds of the chest and abdomen, investigated by the Office of the Chief Medical Examiner for the Province of Alberta from 1988 to 1995. were reviewed retrospectively to determine whether the radiographic distribution of bullet fragments in such cases is a useful predictor of bullet trajectory. Study cases were limited to single gunshot wounds without surgical intervention or intermediate targets, and for which adequate radiography was available. Three pathologists individually viewed the radiographs on two separate occasions; wound locations were provided for the second viewing (Group 2). Differences in opinion regarding direction of fire were resolved by consensus review. A trauma radiologist independently made two sets of interpretations in the same way. Comparisons of these groups of interpretations were made with the actual bullet direction determined at autopsy. Of 21 cases included in the study, only three (14.3%) did not require consensus resolution in either group. Accuracy of pathologists' interpretation improved from 38.1% (8/21) to 76.2% (16/21) with provision of wound locations (p = 0.012). The radiologist achieved similar improvement, from 28.6% (6/21) to 47.6% (10/21). The rate of agreement between radiologist and pathologists increased from 42.9% (9/21) to 61.9% (13/21) between Groups 1 and 2. Both the pathologists and radiologist interpreted several cases the same way in both groups; of those cases interpreted differently, the second interpretation was occasionally incorrect after correct interpretation in Group 1. We conclude that bullet direction for perforating centerfire rifle wounds cannot be accurately determined from postmortem radiographs. When wound location is known, the ability to predict bullet direction improves but is still subject to error, including a lack of consistency between observers.

Sleep in older women with Parkinson's disease.

The sleep status of twenty-one women with Parkinson's disease (PD) was compared to that of twenty-two women without PD (controls). Variables measured included the 24-hour sleep-wake cycle, self-reported night-time sleep, mood, functional status and, in PD subjects, levodopa exposure and disease duration. Results indicated that, in general, the women with PD were more sleepy than the controls during the day and less sleepy at night. Both groups exhibited sleepiness rhythms with 12 and 24 hour periodicities and similar nighttime sleep characteristics. Women with PD exhibited more mood disturbance consistent with borderline clinical depression and were significantly more impaired in their ability to carry out the activities of daily living. Early nursing assessment and interventions addressing these potential problems may significantly reduce their incidence and/or severity.

Urinary retention in hospitalized elderly women.

Unrecognized urinary retention may be a factor in the development of recurrent urinary tract infections, urinary incontinence, bladder dysfunction, and upper urinary tract disease. Because urinary retention is often asymptomatic in elderly women, with amounts of up to 1,500 mL retained in the bladder often causing little or no discomfort, nurses need to have a high index of suspicion about its occurrence. A post-void residual is the best way of determining the presence of urinary retention. The goal of treatment for urinary retention is bladder decompression via catheterization followed by voiding trials and determination of residual volumes.

Symptom management of auditory hallucinations in schizophrenia. Results of 1-year follow up.

1. The majority of participants reported that they were still using behavioral strategies to manage their auditory hallucinations throughout the 12-month follow-up period and that they had experienced a decrease in symptom severity. 2. The answers to managing the symptom of auditory hallucinations are as individual as the symptom itself. All of the behavioral management strategies worked for at least one participant, but no strategy worked for everyone. 3. Practicing strategies in a group and at home seemed to promote long-term use of the behavioral strategies.