Temporal Trends in Traumatic Brain Injury.

Aims Traumatic brain injury (TBI) is a leading cause of preventable mortality and morbidity. Our aim was to examine the demographics, injury characteristics and management of TBI patients treated in an intensive care unit (ICU) in an Irish tertiary-level hospital with a neurosurgical department. Methods A retrospective, longitudinal study of all TBI patients treated in ICU between 2013-2018. Results 77% (n=171) were male and median age was 46 (Q1-Q3: 28-62). The most common mechanism of injury was fall from less than two meters (<2m) followed by road traffic accident (RTA). The proportion of injuries due to RTA increased over the six-year period (p=0.006). 41.4% (n=92) of injuries had reported alcohol involvement. Patients with fall<2m had double the median age and double the rate of alcohol involvement compared to those suffering RTA (p<0.001, p<0.001). The neurosurgical intervention rate was 74% (n=165). The median duration of ICU admission and of intracranial-pressure monitoring, advanced ventilation and inotropic therapy increased over the six-year period (p=0.031, p=0.038, p=0.033, p<0.001). Discussion This study's findings could inform precise and impactful public prevention measures. The increasing duration of ICU admission and of other interventions should be examined further for their effect on patient outcome and resource consumption.

Recent advances in the management of cutaneous malignant melanoma: our case cohort.

Decades of research into the management of cutaneous malignant melanoma have proven it to be a 'tough nut to crack', and its incidence has continued to increase over the last 30 years. Surgery remains a gold standard for early-stage melanoma with five-year survival of 98% for stage I disease, and 90% for stage II. Nonetheless, patients with stage III disease are at a higher risk, resulting in local recurrence as well as distant metastasis. Research regarding the control of metastatic malignant melanoma of the head and neck has evolved. Currently the search is on to understand metastatic malignant melanoma as a heterogeneous disease both at the molecular and clinical level. This paper focuses on the latest systemic therapy for metastatic disease of the head and neck, including cytotoxic chemotherapy, immunotherapy, and target therapy. The new eighth edition of tumour staging, and the sequelae for malignant melanoma, sentinel lymph node biopsy (SLNB), surgical intervention, and its benefits and shortfalls, are discussed. Also, the outcome of our cohort series of patients with metastatic cutaneous malignant melanoma who were treated with systemic combination therapy in Dorset is presented.

Effect of gestational nutrition on vascular integrity in the murine placenta.

Maternal undernutrition is thought to result in smaller offspring and programme disease in later life. It is not known whether gestational nutrition affects development and functioning of placental vessels. The aim of this study was to ascertain if disturbed angiogenesis and junctional integrity were features of the labyrinthine vessels of placenta taken from transgenic Tie2-GFP mice fed either 18% (control) or 9% (low protein; MLP) casein diet. MLP animals showed a significant decrease in fetal weight at E14.5 and in placental and fetal weight at E18.5, however, maternal weight and litter size remained unaffected. Stereological analyses revealed that the fraction of components of the placenta remained similar in both study groups. There was a significant reduction in labyrinthine blood vessel length but not in luminal diameter in the E18.5 MLP group. In both MLP groups, perturbation of vascular endothelial Cadherin and beta-catenin, regulators of junctional integrity, permeability and quiescence, was observed with higher percentage of vessels showing weak or no junctional immunoreactivity. The reduction in length of the labyrinthine vessels and the downregulation of the adhesion molecules suggest that gestational undernutrition causes vascular dysfunction in the murine placenta. This may play a role in the early life programming of disease risk.

Intercomparison of methods of coupling between convection and large-scale circulation: 2. Comparison over nonuniform surface conditions.

As part of an international intercomparison project, the weak temperature gradient (WTG) and damped gravity wave (DGW) methods are used to parameterize large-scale dynamics in a set of cloud-resolving models (CRMs) and single column models (SCMs). The WTG or DGW method is implemented using a configuration that couples a model to a reference state defined with profiles obtained from the same model in radiative-convective equilibrium. We investigated the sensitivity of each model to changes in SST, given a fixed reference state. We performed a systematic comparison of the WTG and DGW methods in different models, and a systematic comparison of the behavior of those models using the WTG method and the DGW method. The sensitivity to the SST depends on both the large-scale parameterization method and the choice of the cloud model. In general, SCMs display a wider range of behaviors than CRMs. All CRMs using either the WTG or DGW method show an increase of precipitation with SST, while SCMs show sensitivities which are not always monotonic. CRMs using either the WTG or DGW method show a similar relationship between mean precipitation rate and column-relative humidity, while SCMs exhibit a much wider range of behaviors. DGW simulations produce large-scale velocity profiles which are smoother and less top-heavy compared to those produced by the WTG simulations. These large-scale parameterization methods provide a useful tool to identify the impact of parameterization differences on model behavior in the presence of two-way feedback between convection and the large-scale circulation.

Intercomparison of methods of coupling between convection and large-scale circulation: 1. Comparison over uniform surface conditions.

As part of an international intercomparison project, a set of single-column models (SCMs) and cloud-resolving models (CRMs) are run under the weak-temperature gradient (WTG) method and the damped gravity wave (DGW) method. For each model, the implementation of the WTG or DGW method involves a simulated column which is coupled to a reference state defined with profiles obtained from the same model in radiative-convective equilibrium. The simulated column has the same surface conditions as the reference state and is initialized with profiles from the reference state. We performed systematic comparison of the behavior of different models under a consistent implementation of the WTG method and the DGW method and systematic comparison of the WTG and DGW methods in models with different physics and numerics. CRMs and SCMs produce a variety of behaviors under both WTG and DGW methods. Some of the models reproduce the reference state while others sustain a large-scale circulation which results in either substantially lower or higher precipitation compared to the value of the reference state. CRMs show a fairly linear relationship between precipitation and circulation strength. SCMs display a wider range of behaviors than CRMs. Some SCMs under the WTG method produce zero precipitation. Within an individual SCM, a DGW simulation and a corresponding WTG simulation can produce different signed circulation. When initialized with a dry troposphere, DGW simulations always result in a precipitating equilibrium state. The greatest sensitivities to the initial moisture conditions occur for multiple stable equilibria in some WTG simulations, corresponding to either a dry equilibrium state when initialized as dry or a precipitating equilibrium state when initialized as moist. Multiple equilibria are seen in more WTG simulations for higher SST. In some models, the existence of multiple equilibria is sensitive to some parameters in the WTG calculations.

Studies on the antagonism by raphe lesions of the antinociceptive action of systemic morphine.

In rats, lesions were placed in the dorsal/median raphe (DMR), in the ventral raphe (VR: raphe magnus), in both the dorsal/median and ventral raphe (DMVR) or in the reticular formation (RF). The effect of the lesions on the antinociception and catalepsy produced by 3 doses of morphine (3, 10 and 30 mg/kg) was examined. The lesions had no significant effect on the catalepsy produced by any of the doses of morphine tested. DMR lesions produced a partial attentuation of the antinociceptive action of both the 3 and 10 mg doses. VR lesions produced a complete blockade of the 3 mg and only a partial attenuation of the 10 mg dose. In contrast, the combined (DMVR) lesions yielded virtually a total blockade of the 3 and 10 mg. Yet, as with the DMR and VR groups, the DMVR lesions failed to produce a significant antagonism on either of the nociceptive tests at the 30 mg dose. These findings suggest that the ascending and descending fiber systems emanating from the dorsal/median and ventral raphe, respectively, facilitate the expression of morphine-induced analgesia but that neither system alone can be regarded as essential for the manifestation of the antinociceptive effects of systematically administered morphine.

A prototype decision support system for differential diagnosis of psychotic, mood, and organic mental disorders.

The authors designed a decision support system to assist mental health professionals to perform differential diagnoses of psychotic, mood, and organic mental disorders in accordance with the American Psychiatric Association's revised third edition of the Diagnostic and Statistical Manual of Mental Disorders. A prototype system arrived at through a rigorous methodology illustrates a style of development that attempts to ensure system maintainability, correctness, and consistency of deduction and promotes high quality in software.

Prototype decision support system for a differential diagnosis of psychotic, mood, and organic mental disorders: Part II.

This paper presents a prototype parallel-processing decision support system, based on the ALICE graph reduction machine, for the differential diagnosis of psychotic, mood, and organic mental disorders in accordance with the American Psychiatric Association's revised third edition of the Diagnostic and Statistical Manual of Mental Disorders. The paper extends the authors' earlier work where the same domain was implemented on an expert-system shell using a rule-based representation.

Analysis of voice changes after thyroplasty using linear predictive coding.

Objective measurement of vocal quality is difficult in patients with severe voice disorders. Improved success has been reported using a modeling technique known as linear predictive coding. This technique uses an inverse filter to estimate a glottic excitation signal. The pitch amplitude is defined as the height of the first peak of the autocorrelation of the glottic excitation signal. In this study linear predictive coding was used to analyze voice disorders in patients with vocal fold immobility. Voice recordings were made in 16 patients undergoing vocal fold medialization and 10 patients who had no surgical procedure between measurements. The voice quality was rated by three speech pathologists. Five acoustic parameters were calculated from the samples. The best agreement with the listeners' perceptual analysis was achieved using the pitch amplitude. Both pitch amplitude and the perceptual ratings of voice quality improved in patients undergoing vocal fold medialization. Therefore the linear model of speech production and inverse filtering are useful in measuring vocal quality in patients with vocal fold immobility.

An experimentally confirmed statistical model on arm movement.

The purpose of this research work was to develop a methodology to model arm movement in normal subjects and neurologically impaired individuals through the application of a statistical modelling method. Thirteen subjects with Parkinson's disease and 29 normal controls were recruited to participate in an arm motor task. An infrared optoelectronic kinematic movement analysis system was employed to record arm movement at 50 times per second. This study identified the modified extended Freundlich model as one that could be used to describe this task. Results showed that this model fit the data well and that it has a good correspondence between the observed and the predicted data. However, verification of the model showed that the residuals contained a sizeable autocorrelation factor. The Cochrane and Orcutt method was applied to remove this factor, which improved the fit of the model. Results showed that Parkinson's disease subjects had a higher autocorrelation coefficient than the normal subjects for this task. A positive correlation (r(s) = 0.72, p < 0.001) was found between the Langton-Hewer stage and the autocorrelation coefficient of PD subjects. This finding suggests that if autocorrelation is positively correlated with disease progression, clinicians in their clinical practice might use the autocorrelation value as a useful indicator to quantify the progression of a subjects' disease. Significant differences in model parameters were seen between normal and Parkinson's disease subjects. The use of such a model to represent and quantify movement patterns provides an important base for future study.

Photodynamic therapy for head and neck cancer xenografts in athymic mice.

This study examines efficacy and optimal treatment variables of photodynamic therapy (PDT) for human head and neck squamous cancer (HNSC) xenografts in athymic mice. Two and four days after injection of hematoporphyrin derivative (HPD), tumors were illuminated with red light from an argon-dye laser. Sixty-three tumors were treated. With HPD dose and light intensity constant at 7.5 mg/kg and 100 mW/cm2, respectively, the extent of tumor necrosis was strongly dependent on duration of light exposure. There was no substantial difference in results for 30- and 60-minute treatment durations between animals injected with HPD 2 and 4 days before treatment. After 30 minutes treatment time, responses were seen in 8 of 10 mice (2 days post-HPD) and 11 of 12 mice (4 days post-HPD). After 60 minutes treatment time, toxicity was high. We conclude that, in this model, PDT is effective in selective killing of HNSC. For future comparison studies in this model, if the indicated HPD dose and light intensity are used we recommend a 2-day delay after HPD injection and a light exposure duration of 30 minutes.

Initial motivations for alcohol treatment: relations with patient characteristics, treatment involvement, and dropout.

This study examines (a) the relation of initial treatment motivations to alcoholics' involvement in outpatient treatment and dropout and (b) the relations among patient characteristics, severity, alcohol expectancies, motivation, and treatment retention. A treatment motivation questionnaire (TMQ) was developed to assess both internalized and external motivations for treatment, as well as confidence in the treatment and orientation towards interpersonal help seeking. In Study 1, the TMQ was administered to 109 outpatients entering an alcoholism clinic. Based on these data the scale was revised and was administered to a subsequent sample of 98 subjects seeking treatment. Information about demographic variables, measures of substance use, alcohol expectancies, and psychiatric severity was also gathered. Eight weeks after intake, outcome was evaluated through attendance records and clinician ratings. Results revealed that internalized motivation was associated with greater patient involvement and retention in treatment. Subjects high in both internalized and external motivation demonstrated the best attendance and treatment retention while those low in internalized motivation showed the poorest treatment retention while those low in internalized motivation showed the poorest treatment response, regardless of the level of external motivation. Problem severity was also related to a greater degree of internalized motivation. The importance of initial motivations in understanding treatment response and dropout is discussed.

Effect of mecoprop drift on some plant species of conservation interest when grown in standardized mixtures in microcosms.

There has been an increasing awareness of potential impacts of herbicide drift on to vegetation in nature reserves and field margin habitats adjacent to treated areas. Previous work using single species bioassays has suggested that the effects of a single drift event are confined close to the sprayer (< 10 m). In the present study eight native dicotyledonous species, with and without a perennial grass (Lolium perenne), were grown in standardized microcosms in order to study (1) the effects of herbicide drift where plants were exposed to competition, and (2) the effects of a second spray application. The microcosms were arranged downwind (0-8 m) of a standard agricultural sprayer applying mecoprop at recommended rates. The effects of the herbicide drift on foliar symptoms of plant damage and end-of-season yield were assessed in each of two years. The main conclusions were that (1) growth of Stachys sylvatica and Lolium perenne (where sown) was enhanced near the sprayer and, (2) six other species (Digitalis purpurea, Galium mollugo, Hypericum hirsutum, Lychnis flos-cuculi, Primula veris and Ranunculus acris) showed some evidence of reduction in either performance (assessed non-destructively after a single exposure) or yield after two exposures. Three species (Lychnis flos-cuculi, Primula veris and Ranunculus acris) showed a reduction in flowering performance. Thus, mecoprop drift affected the aesthetic appearance, possibly the fecundity of some species and the balance between species in these microcosm experiments. The implications of these results for the persistence of attractive plant communities in sensitive areas are discussed.

Effects of herbicide spray drift on selected species of nature conservation interest: the effects of plant age and surrounding vegetation structure.

There has been increasing awareness of the possible impact of herbicide drift on vegetation in nature reserves and field-margin habitats adjacent to treated areas. However, relatively little is known about the impact of such drift on species typical of these habitats. To investigate this problem a series of bioassay experiments simulating spray drift were carried out with five native plant species of different age placed at different distances up to 4 downwind from a sprayer under standardized conditions. These experiments used three herbicides--glyphosate, MCPA and mecoprop--in three types of surrounding vegetation structure--short, medium-height and tall grassland. Many plants showed symptoms of damage after spraying but showed no significant growth reduction at the end of the season even underneath the sprayer. Where a reduction in yield was found, it occurred close to the sprayer. In general, young plants were more often affected than old ones. Yield promotion occurred for some species between 2 and 4 m downwind of the sprayer (curvilinear response) with unknown ecological consequences. The structure of the surrounding vegetation influenced the response for some species, which indicates that deposition patterns can be complex, and thus there may be difficulty in predicting effects in semi-natural communities from simple deposition models.

Assessment of the effects of herbicide spray drift on a range of plant species of conservation interest.

With increasing use of herbicides there has been growing concern that spray drift from treated land will affect vegetation on adjacent nature reserves and other areas of high conservation interest. A preliminary attempt was made to assess this risk by placing a range of native plant species at different distances downwind from standardised drift events and assessing lethal effects and sublethal damage. Five herbicides were tested: asulam, 'Finesse' (chlorsulfuron + metsulfuron-methyl), glyphosate, MCPA and mecoprop. Applications were made at the appropriate time of years for each herbicide (autumn, spring and summer), and at both low and high wind speeds. The maximum safe distance at which no lethal effects were found was 6 m from the sprayer, but for most herbicides the distance was 2 m or less. Generally, damage symptoms were found at greater distances than lethal effects, but in most cases there was rapid recovery by the end of the growing season. These observations are consistent with drift-deposition models, in which the fallout of herbicide droplets has been measured. It is suggested that buffer zones surrounding nature reserves should be in the order of 5-10 m for ground sprayers to minimise the risk of herbicide impacts on these habitats.

Image analysis of benign and malignant neck masses.

Current techniques for differentiating benign and malignant neck masses in computed tomography scans rely on basic features such as size and image density. Advances in digital imaging have led to development of sophisticated computerized image processing tools. Four different image processing algorithms were used to compare 10 patients with neck masses positive for squamous cell carcinoma and 11 patients with benign neck nodes. Statistically significant differences were seen between the malignant and benign masses for edge analysis and Fourier analysis. Significant differences were also seen in several texture parameters, although these results were considered less reliable. There were no differences between the two groups when compared by histogram analysis. It is concluded that both edge analysis and Fourier analysis can provide additional information to distinguish benign and malignant neck masses.

Anatomy and physiology of swallowing in adults and geriatrics.

Key anatomic and physiologic features that play an important role in normal and abnormal swallowing in the adult are described. Highlighted topics include the neurologic afferent and efferent control mechanisms, the effect of stroke on these mechanisms, and the upper and lower esophageal sphincters.

Direct measurement of subglottic pressure and laryngeal resistance in normal subjects and in spasmodic dysphonia.

This study tested the accuracy of indirect methods of measurement of laryngeal airway resistance in normal subjects and in spasmodic dysphonia (SD). The indirect method assumes that subglottic air pressure remains constant during the voiced segment of a syllable. In this study subglottic air pressure was directly measured via puncture of the cricothyroid membrane in seven normal subjects and seven subjects with SD. The true laryngeal airway resistance was calculated and compared with airway resistance measured using indirect techniques based on intraoral air pressure. In five of the seven normal subjects, subglottic air pressure did not remain constant during the voiced segment. As a result, the error produced using indirect method of calculating average laryngeal resistance for the normal subjects varied from -44% to +50%. For SD subjects the error ranged from -49% to +22%. In general, the indirect technique overestimated laryngeal airway resistance in normal subjects and underestimated the resistance in subjects with SD.

The interrelationship of subglottic air pressure, fundamental frequency, and vocal intensity during speech.

In this study we have simultaneously measured subglottic air pressure, airflow, and vocal intensity during speech in nine healthy subjects. Subglottic air pressure was measured directly by puncture of the cricothyroid membrane. The results show that the interaction between these aerodynamic properties is much more complex that previously believed. Certain trends were seen in most individuals, such as an increase in vocal intensity with increased subglottic air pressure. However, there was considerable variability in the overall aerodynamic properties between subjects and at different frequency and intensity ranges. At certain frequencies several subjects were able to generate significantly louder voices without a comparable increase in subglottic air pressure. We hypothesize that these increases in vocal efficiency are due to changes in vocal fold vibration properties. The relationship between fundamental frequency and subglottic pressure was also noted to vary depending on vocal intensity. Possible mechanisms for these behaviors are discussed.

BACUP--the first two years: evaluation of a national cancer information service.

The cancer information service of the British Association of Cancer United Patients (BACUP) was launched in October 1985 as a national service to patients and their relatives, the public, and health professionals. Information is provided by telephone and letter by seven nurses trained in oncology. In the first two years over 30,000 inquiries were received: 23,527 (80%) were from women; 9445 (32%) were from cancer patients 11,574 (39%) from relatives of patients, and 2869 (10%) from health professionals. Inquiries came from all over the United Kingdom and from all sections of society but users were predominantly middle class, aged between 30 and 49, and living in south east England. Information about specific cancer sites, treatment, and how to cope was most commonly sought. Nearly a third of all inquiries were related to breast cancer. Though the service is used more by particular groups focusing on particular diseases, clearly there is a need for a cancer information service in the UK.