Measurement of the generalized polarizabilities of the proton in virtual Compton scattering at Q2=0.92 and 1.76 GeV2

We report a virtual Compton scattering study of the proton at low c.m. energies. We have determined the structure functions P(LL)-P(TT)/epsilon and P(LT), and the electric and magnetic generalized polarizabilities (GPs) alpha(E)(Q2) and beta(M)(Q2) at momentum transfer Q(2)=0.92 and 1.76 GeV2. The electric GP shows a strong falloff with Q2, and its global behavior does not follow a simple dipole form. The magnetic GP shows a rise and then a falloff; this can be interpreted as the dominance of a long-distance diamagnetic pion cloud at low Q2, compensated at higher Q2 by a paramagnetic contribution from piN intermediate states.

Perception and reproduction of force direction in the horizontal plane

In this study, we evaluated the capacity of human beings to perceive and reproduce forces applied to the hand. We tested for perceptive distortions and/or privileged directions in the performance of these two tasks. Subjects resisted a reference force applied by a joystick in a given direction, with instructions to keep the hand at a constant position. In a perception task, subjects subsequently resisted a second such force, the direction of which they could adjust with a potentiometer; the task was to reorient the second force to be in the same perceived direction as the reference. In a reproduction task, subjects were instructed to push against the now elastically constrained joystick with the same force that was required to resist the initially applied reference force. Twenty-four reference force directions in the horizontal plane were tested twice each. We observed systematic distortions in the reproduction of force direction that were not present in the perception task. We further observed that the distortions could be predicted by anisotropy of limb stiffness and could be affected by manipulating the mechanical impedance of the hand-joystick interaction. We conclude that human subjects specify and store forces to be applied by the hand not in terms of a perceived force vector, but rather in terms of the motor activity required to resist or produce the force-i.e., subjects possess a multi-dimensional "sense of effort."

Studies on dental erosion: An in vivo-in vitro model of endogenous dental erosion--its application to testing protection by fluoride gel application

BACKGROUND

The objective in this study was to develop an in vivo-in vitro model of endogenous erosion, with a view to exploring the potential for some degree of its control by the use of topical fluoride gel application to teeth.

METHODS

Six volunteers each wore a small clasp retained palatal acrylic appliance to which six sterilized enamel tiles were bonded. Three tiles on each appliance were coated extra-orally with either 1.23 per cent acidulated phosphate fluoride (APF) or 2.2 per cent sodium fluoride (NaF) neutral gel for four minutes prior to multiple periods of exposure to the simulated gastric acid, cumulating in 16, 36, 80 and 150 minutes of exposure. Impressions of the enamel tiles prior to and following acid exposure permitted dies to be prepared. These were sectioned through the exposed areas and examined under a stereomicroscope to assess maximum depths of erosion.

RESULTS

The depth of erosive demineralization of enamel was found to be greatly reduced with increased frequency of APF gel application. The reduction in enamel loss was less following topical application of NaF gel.

CONCLUSIONS

It was concluded that fluoride gels significantly reduced enamel erosion using this in vivo-in vitro model and therefore, if prescribed appropriately, should help reduce tooth tissue loss from endogenous erosion.

Caries inhibitory effect of fluoridated sugar in a trial in Indonesia

BACKGROUND

In some regional areas of Indonesia, caries prevalence is increasing rapidly. As water, salt or milk fluoridation were not considered suitable for use throughout Indonesia, and fluoridated tooth paste is mostly too expensive, a fluoride co-crystallised sugar containing 10 ppm fluoride was prepared. Its efficacy in inhibiting caries development was tested in a field trial.

METHODS

The field trial was established in Medan, Sumatera. All dietary background data necessary to ensure the safety of a trial were collected. Subjects chosen were 176 children who were residents of two orphanages and a boarding school for children of poor rural families. The trial used a double-blind format. Close monitoring of fluoride consumption was maintained, and fluoride excretion rates were assessed six monthly by urinary fluoride analysis.

RESULTS

Records of total tooth surface caries present initially and after 18 months of sugar supply showed that the children using fluoridated sugar had significantly fewer carious lesions than those who used normal sugar.

CONCLUSION

This result indicates that sugar might be considered as a further vehicle for supplementary dietary fluoride in communities where there is a high caries prevalence or high caries risk and little exposure to fluoride.

Cognitive allocentric representations of visual space shape pointing errors

Subjects reached in three-dimensional space to a set of remembered targets whose position was varied randomly from trial to trial, but always fell along a "virtual" line (line condition). Targets were presented briefly, one-by-one and in an empty visual field. After a short delay, subjects were required to point to the remembered target location. Under these conditions, the target was presented in the complete absence of allocentric visual cues as to its position in space. However, because the subjects were informed prior to the experiment that all targets would fall on a straight line, they could conceivably imagine each point target as belonging to a single rigid object with a particular geometry and orientation in space, although this virtual object was never explicitly shown to the subjects. We compared the responses to repeated measurements of each target with those measured for targets presented in a directionally neutral configuration (sphere condition), and used the variable errors to infer the putative reference frames underlying the corresponding sensorimotor transformation. Performance in the different tasks was compared under two different lighting conditions (dim light or total darkness) and two memory delays (0.5 or 5 s). The pattern of variable errors differed significantly between the sphere condition and the line condition. In the former case, the errors were always accounted for by egocentric reference frames. By contrast the errors in the line condition revealed both egocentric and allocentric components, consistent with the hypothesis that target information can be defined concurrently in both egocentric and allocentric frames of reference, resulting in two independent coexisting representations.

Dental erosion: in vitro model of wine assessor's erosion

BACKGROUND

Wine makers and assessors frequently experience severe dental erosion. The objectives of this study were to develop an in vitro model of dental erosion caused by frequent wine contact with teeth, and to use this model to assess the effectiveness of a variety of methods which might protect against this form of erosion.

METHODS

An initial pilot study found that riesling style wine was more erosive than champagne style, and both more than claret. Wine tasting was simulated by subjecting exposed windows of enamel and root surfaces on 50 intact, extracted human teeth to 1400 one minute exposures to white wine (ph 3.2). A variety of dental materials were applied to the exposed windows on groups of teeth prior to erosive challenge, to assess their protective ability.

RESULTS

Protective resin coatings and fluoride varnishes protected both enamel and roots against wine induced erosion. A high degree of protection was provided by apf gel, with less by naf gel.

CONCLUSIONS

It was concluded that dentists may be able to help minimise erosion resulting from frequent wine-tasting in their patients by the clinical application of one or a combination of these agents at times prior to prolonged assessment periods.

HIV-1 drug resistance and mother-to-child transmission

The use of antiretroviral drug therapies in HIV-1 infected pregnant women and their infants has resulted in significant reductions in the rates of mother-to-child transmission of HIV-1. A number of drugs that target the reverse transcriptase enzyme have been tested either alone or in combination in short-course regimens tailored for use in developing countries. The drug of choice is nevirapine, which is cheap, easy to administer and highly effective even following a single dose to mother and child. However, this regimen is associated with the selection of mutations associated with drug resistance. While these mutations do not compromise the ability of nevirapine to prevent mother-to-child transmission there is some concern that they may compromise future treatment options. Here we review the current data on HIV-1 drug resistance mutations and what they might mean in terms of efficacy of antiretroviral therapies to prevent mother-to-child transmission.

Rice as a vehicle for dietary fluoride uptake

The objective of this study was to analyze aspects of the metabolism and bio-availability of fluoride after consumption of a sample of polished white rice containing 5.6 ppm fluoride ion. Up to 400 g of fluoridated rice was consumed by three volunteer adult subjects over specific time periods on two separate occasions. Saliva concentrations were elevated immediately and remained so 90 minutes following ingestion, among other indications. It was concluded that polished rice has the potential to be a useful vehicle for dietary fluoride transport.

Studies on dental erosion: an in vitro model of root surface erosion

Most research on dental erosion has focused on erosion in enamel. However, the increasing retention of teeth into old age has increased the potential for root surface erosion. The nature and kinetics of root surface erosion have not yet been adequately explored. The objective of this project was to develop an in vitro model of root surface erosion in order to investigate the polarised light microscopy of controlled erosion and the histology and rate of demineralisation of this process in root cementum/dentine. The results demonstrate a process quite different in outcome from that in enamel erosion. Erosion results in loss of volume of enamel. However, it leaves a root surface softened though with little volume loss so long as the demineralised collagen remains hydrated. The polarised light histology was similar to that seen in root surface caries. The rate of erosive demineralisation of tooth roots by selected acids was investigated, with differing rates of demineralisation similar to that seen in enamel erosion observed. The process of erosion showed evidence of significant diffusion control.

Does gravity play an essential role in the asymmetrical visual perception of vertical and horizontal line length?

The eye perceives the length of vertical and horizontal lines with an inherent asymmetry. A vertical line having the same length as a horizontal one is usually perceived to be longer. In this experimental investigation we tested the hypothesis that gravity has a direct role in producing the observed perceptual asymmetry. To this end we performed experiments in weightlessness during long-orbital space flights onboard the MIR station. Subjects performed a psychophysical task in which the length of a visually-presented vertical line was adjusted to match the length of a horizontal reference. On Earth, almost all subjects produce errors in adjusting the length of the vertical line, consistently under-estimating the length of the horizontal reference. The asymmetry of perception of the line lengths persisted in weightlessness. From these results we conclude that the phenomena of asymmetry of perception of the lengths of vertical and horizontal lines is not dependent on gravity, but is instead defined by properties of the system of internal representation. Grant numbers: 99-04-48450.

A 6 D.O.F. opto-inertial tracker for virtual reality experiments in microgravity

Gravity plays a role in many different levels of human motor behavior. It dictates the laws of motion of our body and limbs, as well as of the objects in the external world with which we wish to interact. The dynamic interaction of our body with the world is molded within gravity's constraints. The role played by gravity in the perception of visual stimuli and the elaboration of human movement is an active research theme in the field of Neurophysiology. Conditions of microgravity, coupled with techniques from the world of virtual reality, provide a unique opportunity to address these questions concerning the function of the human sensorimotor system. The ability to measure movements of the head and to update in real time the visual scene presented to the subject based on these measurements is a key element in producing a realistic virtual environment. A variety of head-tracking hardware exists on the market today, but none seem particularly well suited to the constraints of working with a space station environment. Nor can any of the existing commercial systems meet the more stringent requirements for physiological experimentation (high accuracy, high resolution, low jitter, low lag) in a wireless configuration. To this end, we have developed and tested a hybrid opto-inertial 6 degree-of-freedom tracker based on existing inertial technology. To confirm that the inertial components and algorithms will function properly, this system was tested in the microgravity conditions of parabolic flight. Here we present the design goals of this tracker, the system configuration and the results of 0g and 1g testing.

Internal reference frames for representation and storage of visual information: the role of gravity

Experimental studies of visual mechanisms suggests that the CNS represents image information with respect to preferred horizontal and vertical axes, as shown by a phenomenon known as the "oblique effect". In the current study we used this effect to evaluate the influence of gravity on the representation and storage of visual orientation information. Subjects performed a psychophysical task in which a visually-presented stimulus line was aligned with the remembered orientation of a reference stimulus line presented moments before. The experiments were made on 5 cosmonauts during orbital space flight and additionally on 13 subjects in conditions of normal gravity with a tilting chair. Data were analyzed with respect to response variability and timing. On earth, these measurements for this task show a distinct preference for horizontally and vertically oriented stimuli when the body and gravitational axes were aligned. This preference was markedly decreased or disappeared when the body axis was tilted with respect to gravity; this effect was not connected with ocular counter-rolling nor could we find a preference of any other intermediate axis between the gravity and body aligned axes. On the other hand, the preference for vertical and horizontal axes was maintained for tests performed in microgravity over the course of a 6 month flight, starting from flight day 6. We concluded that subjects normally process visual orientation information in a multi-modal reference frame that combines both proprioceptive and gravitational cues when both are available, but that a proprioceptive reference frame is sufficient for this task in the absence of gravity after a short period of adaptation. Some of the results from this study have been previously published in a preliminary report. Grant numbers: 99-04-48450.

Dynamics of the 16O(e, e'p) reaction at high missing energies

We measured the cross section and response functions for the quasielastic 16O(e,e'p) reaction for missing energies 25< or =E(m)< or =120 MeV at missing momenta P(m)< or =340 MeV/c. For 25<E(m)<50 MeV and P(m) approximately 60 MeV/c, the reaction is dominated by a single 1s(1/2) proton knockout. At larger P(m), the single-particle aspects are increasingly masked by more complicated processes. Calculations which include pion exchange currents, isobar currents, and short-range correlations account for the shape and the transversity, but for only half of the magnitude of the measured cross section.

Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears

OBJECTIVE

To describe the MR features of mucoid degeneration of the anterior cruciate ligament (ACL) in a series of patients with MRI findings that were mistaken for tears in the majority of cases but who were found to have an intact ligament at arthroscopy. We will suggest a pathologic entity corresponding to this finding and describe some characteristic features that can be used to identify this entity on MRI.

DESIGN

A retrospective analysis of 10 MRI examinations of the knee was performed after arthroscopic evaluation. Prearthroscopic MRI findings had been interpreted as a tear in six patients prospectively and in the remaining four the diagnosis of mucoid degeneration was suggested and ultimately proven. All patients had an intact ACL by preoperative clinical examination, examination under anesthesia, and at arthroscopy.

RESULTS

MRI examinations demonstrated an ill-defined ACL, greater in girth than the normal ligament and characterized by increased signal on all sequences. The high-signal ligament was oriented in the normal direction of the ACL. The overall appearance of the ligament was retrospectively described as like a celery stalk. Arthroscopy demonstrated mechanically intact ligaments with a normal to expanded external appearance. Probing of three of the ligaments caused a material to be expressed and pathologic evaluation resulted in the diagnosis of cystic, mucoid degeneration.

CONCLUSION

Mucoid degeneration and an intact ACL can be suspected when an apparently thickened and ill-defined ligament with increased signal intensity on all sequences is identified in a patient with a clinically intact ligament.

Measurement of the recoil polarization in the p(e-->, e'p-->)pi(0) reaction at the Delta(1232) resonance

The recoil proton polarization has been measured in the p(e-->,e'p-->)pi(0) reaction in parallel kinematics around W = 1232 MeV, Q2 = 0.121 (GeV/c)2, and epsilon = 0.718 using the polarized cw electron beam of the Mainz Microtron. All three proton polarization components, Px/P(e) = (-11.4+/-1.3+/-1.4)%, P(y) = (-43.1+/-1.3+/-2.2)%, and P(z)/P(e) = (56.2+/-1.5+/-2.6)%, could be measured simultaneously. The Coulomb quadrupole to magnetic dipole ratio, CMR = (-6.4+/-0.7(stat)+/-0.8(syst))%, was determined from Px in the framework of the Mainz Unitary Isobar Model. The consistency among the reduced polarizations and the extraction of the ratio of longitudinal-to-transverse response is discussed.

A staff dialogue on a socially distanced patient: psychosocial issues faced by patients, their families, and caregivers

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The following case of an HIV-positive woman who was diagnosed with cervical cancer during a twin pregnancy was discussed at the May, 1999 Schwartz Center Rounds. The patient was in drug rehabilitation having been dependent on crack cocaine, with a past history of syphilis and gonorrhea. She was single and her other children were in foster care. Initially she was suspicious and non-compliant. A plan was negotiated to biopsy the cervical lesion after cesarean section and with confirmation of malignancy she underwent radical surgery and subsequently radiotherapy. Despite the almost insurmountable social and educational distance between her and her caregivers, they managed to bond and facilitate care. Although there were compromises with which staff were uncomfortable, the relationship was maintained and continues.

Analysis of fluoride levels retained intraorally or ingested following routine clinical applications of topical fluoride products

A variety of topical fluorides is now used clinically for the prevention and control of dental caries. It is essential for the dental profession to be fully aware of the relative retention rates of fluoride in saliva and thus its contact with the teeth. These may vary following the use of the different categories and concentrations of agents available and with different methods of use. It is also important to be aware of the amounts of fluoride ion ingested following use of the more concentrated forms and of the resultant elevation in total blood fluoride levels. These parameters were investigated in a series of experiments involving human volunteer subjects using a variety of topical fluoride materials commercially available in Australia. Fluoride mouthrinses appeared to provide the highest salivary retention rates per dose of all forms of topical fluoride. Ingestion rates from concentrated gels were acceptable when effective evacuation methods were applied. The use of custom-made trays resulted in a reduction in amounts of fluoride ion ingested, though simple self-application by toothbrush of smaller quantities proved to be an effective alternative in terms of amount of fluoride ion retained in saliva per amount applied and ingested. None of the concentrated gels used resulted in elevations in total blood fluoride levels which were of concern in adults. It is acknowledged that salivary retention rates of fluoride ion do not necessarily reflect the caries inhibitory effects of topical fluorides. However, these data provide some indication of possible advantages of some products and methods of application over others.

Unlicensed and off label prescribing of drugs in general practice

AIM

To determine the incidence and nature of unlicensed and off label prescribing of drugs for children in general practice.

METHODS

A retrospective analysis of all prescriptions for one year involving children (aged 12 years or under) from a single suburban general practice in the English Midlands. Prescribed drugs were categorised as licensed, unlicensed (without a product licence), or used in an off label way (outside the terms of their product licence).

RESULTS

During 1997 there were 3347 prescription items involving 1175 children and 160 different drugs. A total of 2828 (84. 5%) prescriptions were for licensed medicines used in a licensed way; 10 (0.3%) were for unlicensed medicines; and 351 (10.5%) were licensed medicines used in an off label way. For 158 (4.7%) the information was insufficient to determine licence status.

CONCLUSION

This is the first study to show that a significant number of drugs prescribed for children by general practitioners are off label and highlights the anomalies and inadequacies of drug information for prescribers.

Analysis of pointing errors reveals properties of data representations and coordinate transformations within the central nervous system

The execution of a simple pointing task invokes a chain of processing that includes visual acquisition of the target, coordination of multimodal proprioceptive signals, and ultimately the generation of a motor command that will drive the finger to the desired target location. These processes in the sensorimotor chain can be described in terms of internal representations of the target or limb positions and coordinate transformations between different internal reference frames. In this article we first describe how different types of error analysis can be used to identify properties of the internal representations and coordinate transformations within the central nervous system. We then describe a series of experiments in which subjects pointed to remembered 3D visual targets under two lighting conditions (dim light and total darkness) and after two different memory delays (0.5 and 5.0 s) and report results in terms of variable error, constant error, and local distortion. Finally, we present a set of simulations to help explain the patterns of errors produced in this pointing task. These analyses and experiments provide insight into the structure of the underlying sensorimotor processes employed by the central nervous system.

The Gardos channel is responsible for CDNB-induced dense sickle cell formation

The red blood cells (RBCs) derived from blood taken from homozygous sickle cell (SS) patients demonstrate densities that are inversely proportional to the intracellular reduced glutathione (GSH) content. Addition of 1 mM 1-chloro-2,4-dinitrobenzene (CDNB) to low-density sickle cells (LDSS), at 4 degrees C, results in a shift of LDSS erythrocytes to high-density sickle cells (HDSS), with corresponding decreases in GSH. We have previously demonstrated that this CDNB effect was due to increased K(+) leakage and that dense cell formation could be inhibited by clotrimazole (specific for the Gardos channel) but not DIOA (specific for the K(+)-Cl(-) co-transport system) at pH 7.4 (Shartava et al. Am. J. Hematol. 1999;62:19-24). Here we demonstrate that clotrimazole (10 microM) inhibits dense cell formation at pH 7.1 and 6.8, while DIOA (1 mM) has no effect. As pH 6.8 is the optimal pH for the K(+)-Cl(-) co-transport system, we can now reasonably conclude that damage to the Gardos channel is responsible for CDNB-induced dense cell formation.

In vitro assessment of the structural integrity of the female condom after multiple wash, dry, and re-lubrication cycles

Since the introduction of the female condom in the early 90s, there have been numerous reports of reuse of the device. In response to these reports, studies were undertaken to evaluate the safety of female condom reuse. If reuse were shown to be safe, then programmatic costs of introduction of the female condom would be reduced allowing it to be more widely available. This article outlines the results of in vitro structural integrity testing of the female condom after multiple wash, dry, and re-lubrication cycles. Devices were tested up to 10 washes using water leakage, burst, and tensile seam testing. All results were compared to the United States Food and Drug Administration (US FDA) standards for an unused female condom. The results of the structural integrity tests for all 6 washing procedures examined in this study were above the FDA minimum standards for seam strength and burst tests. For the water leakage test, 3 of 6 washing procedures tested passed the required FDA minimum standards (no holes detected). From the results of the study, it seems that washing, drying, and re-lubricating the female condom up to 10 times leads to some deterioration in the structural integrity of the device for specified washing procedures. Further studies are currently being conducted to establish the safety of female condom reuse with respect to microbial retention, structural integrity after in vivo use, and viral permeability.

Spatial, not temporal cues drive predictive orienting movements during navigation: a virtual reality study

A fundamental property of the human brain is the ability to make predictions of future sensory and motor events. We have recently found that steering manoeuvres when walking along curvilinear trajectories are controlled by an anticipatory guidance of the direction of head (and eyes). However it is unclear whether a time-related or space-related signal triggers such anticipatory head orienting movements. By simulating navigation along a multi-legged virtual corridor we show that anticipatory orienting movements are triggered (in standing subjects) by reaching specific locations rather than by the time to the approaching corridor's bend. Similar to what happens in car driving, specific spatial features of the route rather than time to collision seem to drive steering.

Viewer-centered and body-centered frames of reference in direct visuomotor transformations

It has been hypothesized that the end-point position of reaching may be specified in an egocentric frame of reference. In most previous studies, however, reaching was toward a memorized target, rather than an actual target. Thus, the role played by sensorimotor transformation could not be disassociated from the role played by storage in short-term memory. In the present study the direct process of sensorimotor transformation was investigated in reaching toward continuously visible targets that need not be stored in memory. A virtual reality system was used to present visual targets in different three-dimensional (3D) locations in two different tasks, one with visual feedback of the hand and arm position (Seen Hand) and the other without such feedback (Unseen Hand). In the Seen Hand task, the axes of maximum variability and of maximum contraction converge toward the mid-point between the eyes. In the Unseen Hand task only the maximum contraction correlates with the sight-line and the axes of maximum variability are not viewer-centered but rotate anti-clockwise around the body and the effector arm during the move from the right to the left workspace. The bulk of findings from these and previous experiments support the hypothesis of a two-stage process, with a gradual transformation from viewer-centered to body-centered and arm-centered coordinates. Retinal, extra-retinal and arm-related signals appear to be progressively combined in superior and inferior parietal areas, giving rise to egocentric representations of the end-point position of reaching.

The practice and prevalence of dry sex among men and women in South Africa: a risk factor for sexually transmitted infections?

OBJECTIVES

To establish the prevalence of "dry sex" practice in a South African periurban population. To investigate the reasons for and factors influencing the practice of dry sex and to evaluate dry sex practice as a risk factor for sexually transmitted disease (STD).

DESIGN

Cross sectional sample survey.

METHODS

A random community sample of men and women aged between 16 and 35 in Gauteng Province, South Africa, were interviewed regarding the practice of dry sex using a structured interviewer administered questionnaire.

RESULTS

Dry sex practices were reported by 60% of men and 46% of women. Among younger individuals dry sex practice is far more common among the less educated, but there was no significant difference between education groups in the older respondents. A higher proportion of men practising dry sex than not practising dry sex reported having a past history of STD infection (56% versus 41%) although this difference was only marginally significant (p = 0.05). There was no difference in reported history of STD between women who practised dry sex and those who did not.

CONCLUSIONS

This study shows that dry sex practice is common in this community. The younger less educated group were the most likely to practise dry sex. Dry sex practice was associated with an increased prevalence of self reported STDs in men but not in women.

Respiratory depression in children receiving diazepam for acute seizures: a prospective study

The aim of this study was to determine the incidence of respiratory depression following the use of diazepam in children presenting with seizures. All children presenting with seizures to a children's A & E department over a period of 9 months were studied prospectively. Respiratory depression was defined as a fall in respiratory rate or oxygen saturation, or apnoea resulting in ventilation or resuscitation with bag-and-mask oxygen. There were 130 patient episodes involving 97 children who received treatment for their seizures before admission and/or in the A & E department. Administration of diazepam resulted in 122 patient episodes. The route of administration was rectal in 91 episodes, intravenous in 12 episodes, and both rectal and intravenous in 19 episodes. Eleven children had respiratory depression in relation to diazepam administration. Eight of these children required ventilation. The overall incidence of respiratory depression following the use of diazepam was 9%. The incidence of respiratory depression following diazepam given intravenously or rectally is high. The use of diazepam as first-line therapy for children with acute seizures needs to be reviewed.

Gravity affects the preferred vertical and horizontal in visual perception of orientation

The aim of this study was to evaluate the influence of gravity on the representation and storage of visual orientation information. On earth, measurements of response time and variability for a task of aligning remembered visual stimuli showed a distinct preference for horizontally and vertically oriented stimuli when the body and gravitational axes were aligned. This preference was markedly decreased or disappeared when the body axis was tilted with respect to gravity but was maintained for tests performed in microgravity. We conclude that subjects acquire and store visual orientation in a multi-modal reference frame that combines proprioceptive and gravitational information when both are available.

Unlicensed and off label drug use in neonates

AIM

To determine the extent of use of drugs that are either not licensed (unlicensed), or are outside the terms of their product licence (off label) in a neonatal intensive care unit.

METHODS

A prospective study was conducted over 13 weeks.

RESULTS

455 prescription episodes were administered to 70 babies. 63 (90%) patients were given a drug that was either unlicensed or used in an off label way. 54.7% prescription episodes were off label, many for more than one reason, and 9.9% (45) were unlicensed; 35.4% (161) prescription episodes were licensed.

CONCLUSION

The use of unlicensed and off label drugs in neonatal intensive care seems to be far greater than other paediatric settings. This highlights the difficulties faced by those trying to ensure safe and effective prescribing for neonates. Urgent action is required to resolve this situation.

Child extrafamilial sexual abuse: predicting parent and child functioning

OBJECTIVE

This study evaluated the emotional and behavioral adjustment of parents and children within 3 months and 1 year after the discovery of child extrafamilial sexual abuse.

METHOD

Ninety-two case parents (63 mothers, 29 fathers) and 56 children were compared to a nonclinical comparison group of 136 parents (74 mothers, 62 fathers) and 75 children. Parent adjustment was assessed using self-report measures while child functioning was assessed using a combination of child-, parent- and teacher-report measures.

RESULTS

Mothers, fathers and sexually abused children experienced clinically significant effects both initially and at 12 months post-disclosure. Children's perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symtomatology at 3 months and 1 year post-disclosure. Child age and gender also significantly contributed to the prediction of many of the child outcome measures. No abuse-related variable was related to any child self-report measure. Mothers' satisfaction in the parenting role, perceived support and intrusive symptoms predicted their initial emotional functioning. Avoidant symptoms, child's internalizing behavior and mothers' initial emotional functioning were significant predictors of longer-term emotional functioning.

CONCLUSIONS

Results emphasize the need to address children's abuse-related attributions and underscore the need to expand our focus beyond the child victims to the traumatized families.

Reference frames and internal models for visuo-manual coordination: what can we learn from microgravity experiments?

Gravity plays a role in many different levels of human motor behavior. It dictates the laws of motion of our body and limbs, as well as of the objects in the external world with which we wish to interact. The dynamic interaction of our body with the world is molded within gravity's constraints. The task of catching a ball that has been thrown toward a human subject typifies the kind of constraints that the nervous system must take into consideration during visuo-manual coordination on earth. By dissecting and examining the components of this task, one can see what kinds of problems must be solved by the central nervous system to generate coordinated motor actions in response to incoming sensory information. In this review, we use the example of a ball catching task to outline various issues in the field of human motor control and to ask the question as to how the microgravity environment of lower earth orbit can be used to probe the functioning of the human motor system.

Short-term memory for reaching to visual targets: psychophysical evidence for body-centered reference frames

Pointing to a remembered visual target involves the transformation of visual information into an appropriate motor output, with a passage through short-term memory storage. In an attempt to identify the reference frames used to represent the target position during the memory period, we measured errors in pointing to remembered three-dimensional (3D) targets. Subjects pointed after a fixed delay to remembered targets distributed within a 22 mm radius volume. Conditions varied in terms of lighting (dim light or total darkness), delay duration (0.5, 5.0, and 8.0 sec), effector hand (left or right), and workspace location. Pointing errors were quantified by 3D constant and variable errors and by a novel measure of local distortion in the mapping from target to endpoint positions. The orientation of variable errors differed significantly between light and dark conditions. Increasing the memory delay in darkness evoked a reorientation of variable errors, whereas in the light, the viewer-centered variability changed only in magnitude. Local distortion measurements revealed an anisotropic contraction of endpoint positions toward an "average" response along an axis that points between the eyes and the effector arm. This local contraction was present in both lighting conditions. The magnitude of the contraction remained constant for the two memory delays in the light but increased significantly for the longer delays in darkness. These data argue for the separate storage of distance and direction information within short-term memory, in a reference frame tied to the eyes and the effector arm.

Arm end-point trajectories under normal and micro-gravity environments

The purpose of the present experiment was to study the way in which the CNS represents gravitational force during vertical arm pointing movements. Movements in upward and downward directions were executed by two cosmonauts in normal-gravity and weightlessness. Analyses focused upon finger kinematics in the sagittal plane. In normal-gravity, downward direction movements showed smaller curvatures and greater relative times to peak velocity (AT/MT) when compared with upward direction movements. Data from the weightlessness experiments showed that whilst downward movements decreased their curvature during space flight, curvatures of upward movements changed slightly. Furthermore, AT/MT was modified during the first days in micro-gravity for both directions, recovering, however, to pre-flight values after 18 days in space. Results from the present study, provide evidence that gravitational force is centrally treated constituting an important component of the motor plan for vertical arm movements.

The Kinelite Project: a new powerful motion analyser for Spacelab and space station

The goal of the Kinelite Project is to develop a space qualified motion analysis system to be used in space by the scientific community, mainly to support neuroscience protocols. The measurement principle of the Kinelite is to determine, by triangulation mean, the 3D position of small, lightweight, reflective markers positioned at the different points of interest. The scene is illuminated by Infra Red flashes and the reflected light is acquired by up to 8 precalibrated and synchronized CCD cameras. The main characteristics of the system are: Camera field of view: 45 degrees; Number of cameras: 2 to 8; Acquisition frequency: 25, 50, 100, or 200 Hz; CCD format: 256 x 256; Number of markers: up to 64; 3D accuracy: 2mm; Main dimensions: 45 cm x 45 cm x 30 cm; Mass: 23 kg; Power consumption: less than 200 W. The Kinelite will first fly aboard the NASA Spacelab; it will be used, during the NEUROLAB mission (4/98), to support the "Frames of References and Internal Models" (Principal Investigator: Pr. A. Berthoz, Co Investigators: J. McIntyre, F. Lacquaniti).

Monitoring utilisation, quality & effectiveness of free antenatal care in an informal settlement in Gauteng

The aim of this study was to monitor utilisation, quality and effectiveness of free antenatal care from a review of clinic records. Starting randomly, 197 clinic records from four clinics were reviewed. Antenatal care was initiated at the end of the second trimester or in the third trimester, in an inadequate quantity (64% had made less than three visits). Teenagers were significantly more likely to attend only once than the older age groups (Chi-square = 12.5, df = 6, p = 0.05). Standard tasks such as age, weight, blood pressure, foetal heart monitoring, estimated gestational age and urine test results were recorded correctly. However, the effectiveness of care was difficult to assess due to incomplete records and the lack of blood test results. It was concluded that the provision of a free antenatal care service does not automatically increase utilisation; timing and quantity of care obtained were inadequate; and improvements in record keeping are essential for assessing the quality and effectiveness of care.

Hand trajectories of vertical arm movements in one-G and zero-G environments. Evidence for a central representation of gravitational force

The purpose of the present experiment was to study the way in which the central nervous system (CNS), represents gravitational force during vertical arm pointing movements. Movements in upward (against gravity) and downward (with gravity) directions, with two different mass loads (hand empty and with a hand-held 0.5-kg weight) were executed by eight subjects in a normal gravitational environment. Movements by two cosmonauts, in the two directions, were also tested in a state of weightlessness. Analyses focused upon finger trajectories in the sagittal plane. Subjects in a normal gravitational environment showed curved paths for both directions and weight conditions. In addition, downward movements showed significantly smaller curvatures than upward movements. Movement times were approximately the same for all the experimental conditions. Curvature differences between upward and downward movements persisted during space flight and immediately postflight. Movement times from both cosmonauts increased slightly during flight, but returned to normal immediately on reentry in a one-G environment. Results from the present study provide evidence that gravity is centrally represented in an anticipatory fashion as a driving force during vertical arm movement planning.

The efficacy of reducing agents or antioxidants in blocking the formation of dense cells and irreversibly sickled cells in vitro

We show that N-acetylcysteine (NAC) has the ability to cause statistically significant diminishment in the in vitro formation of irreversibly sickled cells (ISCs) at concentrations greater than 250 micromol/L. Other antioxidants, approved for human use (cysteamine, succimer, dimercaprol), were not efficacious. NAC had the ability to cause statistically significant conversion of ISCs formed in vivo back to the biconcave shape. NAC was also shown to reduce the formation of dense cells and increase the available thiols in beta-actin. We showed that diminishing reduced glutathione (GSH), by treatment with 1-chloro-2,4-dinitrobenzene, resulted in increased dense cells. We conclude the NAC blocks dense cell formation and ISC formation by targeting channels involved in cellular dehydration and beta-actin, respectively. The efficacy of NAC is probably due to its combined antioxidant activity and ability to increase intracellular GSH.

Ethical holistic thinking and practice for community health workers and nurses

If we take on board the assumption that social realities are perceived through filters of experience, social position, personality and emotion, then we accept that 'facts' can be differently construed or constructed Compassion cannot be taught as a competency, but we can be made aware through reflexive thinking that the closest we can ever get to a shared truth is through listening to and understanding the other. This paper is a modest attempt to provide some tools for community health workers and nurses who are concerned about the quality of their practice and wish to find creative solutions.

Hand trajectory formation during whole body reaching movements in man

End-effector trajectory formation was studied during a reaching movement using the whole body. The movements of various parts of the body were measured with the optoelectronic ELITE system. Wrist reaching movement paths showed noticeable curvatures. The analysis of various marker onset latencies revealed that the wrist was the last to move, always after the head, knee or trunk, suggesting a subordinate role of the focal component with respect to the primary role of the equilibrium component. These results suggest that reaching wrist movements are subjected to whole-body equilibrium constraints in addition to constraints placed upon end-effector kinematics or the dynamic optimization of upper-limb movements.

Technical evolutions of the French multipurpose instruments for Cognitive Neurosciences

Since the first French flight in space in 1982, the CNES has developed a wide range of instruments, especially in the field of Neurosciences. The design of these instruments has considerably evolved from rather simple equipment up to much more sophisticated tools that are being specially tailored for these missions. Four major phases can be identified: -a simple adaptation of an echographe leading to the first neurosciences experiments (the ARAGATZ'88 mission), -the ILLUSIONS and VIMINAL instruments used during the ANTARES'92 and ALTAIR'93 missions, -the COGNILAB instrument developed for the CASSIOPEE'96 mission, to be re-used in 1997 and in 1999, -a preliminary design of the 1999 mission payload, including virtual reality concepts, in a modular design to adapt to the European COF. Aside from the evolution of scientific requirements, the experience gained during the flights led to progressive improvements in the different technical parts, including visual system, body restraint systems, accessories, such as a force feedback joystick, computer and software, etc. This paper describes the technical evolutions in the CNES Neurosciences program.

Viewer-centered frame of reference for pointing to memorized targets in three-dimensional space

Pointing to a remembered visual target involves the transformation of binocular visual information into an appropriate motor output. Errors generated during pointing tasks may indicate the reference frames used by the CNS for the transformation and storage of the target position. Previous studies have proposed eye-, shoulder-, or hand-centered reference frames for various pointing tasks, depending on visual conditions. We asked subjects to perform pointing movements to remembered three-dimensional targets after a fixed memory delay. Pointing movements were executed under dim lighting conditions, allowing vision of the fingertip against a uniform black background. Subjects performed repeated movements to targets distributed uniformly within a small (radius 25 mm) workspace volume. In separate blocks of trials, subjects pointed to different workspace regions that varied in terms of distance and direction from the head and shoulder. Additional blocks were performed that differed in terms of starting position, effector hand, head rotation, and memory delay duration. Final pointing positions were quantified in terms of the constant and variable errors in three dimensions. The orientation of these errors was examined as a function of workspace location to identify the underlying reference frames. Subjects produced anisotropic patterns of variable error, with greater variability for endpoint distances from the body. The major axes of the variable-error tolerance ellipsoids pointed toward the eyes of the subject, independent of workspace region, effector hand (left or right), initial hand position, and head rotations. Constant errors were less consistent across subjects, but also tended to point toward the head and body. Both overshoots and undershoots of the target position were observed. Increasing the duration of the memory delay period increased the size but did not alter the orientation of the variable-error ellipsoids. Variability of the endpoint positions increased equally in all three Cartesian directions as the memory delay increased from 0.5 to 8.0 s. The anisotropy of variable errors indicates a viewer-centered reference frame for pointing to remembered visual targets with vision of the finger. The anisotropy of pointing variability stems from variability in egocentric binocular cues as opposed to reliance on allocentric visual references or to specific approximations in the sensorimotor transformation. Nevertheless, observed increases in variability with longer memory delays indicate that the short-term storage of the target position does not simply mirror the retinal and ocular sensory signals of the visually acquired target location. Thus spatial memory is carried out in an internal representation that is viewer-centered but that may be isotropic with respect to Cartesian space.