Hyoid bone position after surgical mandibular advancement

A cephalometric evaluation of the changes in the horizontal and vertical placement of the hyoid bone and of those in the position of the head over the cervical spine after surgical mandibular advancement was undertaken. Seven linear and one angular measurement were investigated in 60 patients, 17 males and 43 females, before and one year after surgical mandibular advancement. The hyoid bone moved forwards horizontally in 78 per cent of the subjects, backwards in 17 per cent, and in 5 per cent of patients it retained its pre-operative position. It moved vertically downwards in 32 per cent of subjects, and in 63 per cent it moved upwards and closer to the body of mandible. The amount of horizontal and vertical change of the hyoid bone was associated with the corresponding change of the mandible after surgery. The vertical change was more distinct in females compared with males. There was variation in the position of the head over the cervical spine; it showed extension in 26.7 per cent of the sample, flexion in 71.7 per cent, and remained the same in only 1.6 per cent after surgery. The results show that with surgical mandibular advancement the hyoid bone follows mainly the advancement of the mandible and moves closer to the body of the mandible. However, there are variations in the changes of hyoid bone and head position that are difficult to predict.

Factors influencing nurses' inferences about patient pain

This study examined the factors that influence nurses' perception of patient pain. Sixteen vignettes were constructed on the basis of interviews with nurses about factors affecting their perception of patient pain and previous published literature. Four variables were systematically varied within a factorial design: diagnosis (surgery vs oncology), level of patient mobility, presence or absence of physical and behavioural signs, and patient gender. Twenty-seven nurses rated each vignette for degree of inferred patient pain and degree of patient psychological distress. Mobility and positive signs of pain had statistically significant effects on nurses' judgments of inferred pain (P < 0.001), but diagnosis had no main effect. Significant interactions showed that: inferred pain in male patients was seen to be greater when immobile while mobility had no effect on the inferred pain of female patients (P < 0.003); oncology patients (compared with surgical patients) had greater inferred pain when displaying positive signs (P < 0.024); and positive signs yielded higher ratings where patients were immobile (P < 0.001). Female patients were perceived to experience higher psychological distress than men (P < 0.037) and oncology patients were perceived to experience higher distress than surgical patients (P < 0.005). Ratings of perceived pain and distress were significantly correlated but did not differ in magnitude. Offered a choice of analgesics to relieve pain for each of the patients depicted, nurses typically chose those with the lowest strength.

Developing the role of the generic healthcare support worker: phase 1 of an action research study

This paper reports on the first phase of an action research practice development project to explore, develop and evaluate the role of the generic healthcare support worker in a high dependency rehabilitation service. The project is being jointly conducted by staff from the University of Southampton, the University of Portsmouth and the Isle of Wight Healthcare NHS Trust and phase 1 is supported by a grant from the NHS Executive (South and West). The aim of phase 1 of the project is to explore the attitudes of staff towards the implementation of the role of the generic healthcare support worker, particularly regarding the practical, professional and ethico-legal problems of the role. Professional and support staff from different parts of the service were interviewed in groups and the interviews were tape recorded, transcribed and subjected to a simple thematic analysis. Four themes emerged from the data relating to the challenge to professional boundaries, being a generic worker, outcomes for service and patients and implementing the role. As an action research project, the aim was not to produce findings that are generalizable beyond the practice areas in which they were generated, but it is nevertheless hoped that the reader might be able to apply some of the conclusions to his or her own setting.

Electrophysiological measures of cognition in biological psychiatry: some cautionary notes

Research into the electrophysiological correlates of mental illness is currently expanding, largely because of the availability of relatively inexpensive and powerful computers. However, improvements in technology do not always lead to enhanced methodological procedures; thus, there are concerns over the proper interpretation of the results of these investigations. Our argument is that electroencephalographic (EEG) research into psychopathology of psychiatric diseases should adopt a cognitivist model of mental dysfunction rather than a neurologist model of brain disease. Cognitive science has significant potential as an integrative framework for theorizing and researching psychiatric disorders and their treatment. Models of human cognitive functioning have rather special and unique features; these will make their impact upon the nature of both the analysis and interpretation of EEG data. The adoption of a sound model of brain function has implications for the methods to be used at different successive stages of the research process. We address a number of methodological requirements pertaining to: the recording and analysis of EEG signals, the laboratory context, the nature of the tasks, and the attribution of obtained effects. However, there are grounds for great caution. Even if the mapping of electrical changes in brain activity leads to a good approximation of the temporal and spatial dynamics of higher brain function, exploitation of such information presupposes a deeper understanding of both human cognition and the physiological basis of the EEG than is often displayed in the literature. To demonstrate this fundamental point, we draw a number of comparisons between traditional neurological approaches to brain assessment and contemporary cognitive psychophysiology.

Will managed care collapse at the hands of the civil justice system? ERISA protection may end

For the first time, instances where HMO strategies to save money collide with the patient's right to receive quality of care have come under the scrutiny of the law.

A psychophysiological inquiry into the nature of the Sokolovian orienting response comparator model: skin conductance and EEG data

The mechanisms which trigger the orienting response (OR) are still the subject of lively debate. Sokolov (1990) proposes the development of a multidimensional model of the physical parameters of stimulation. Recent OR research has shown that the skin conductance OR (SCOR) is related to task demands and controlled processing, although this is not so clear for central physiological indexes of orienting. Seventy-three subjects performed visual discriminations of stimuli within a warning-stimulus paradigm. The physical complexity of stimuli and their task relevance were manipulated within subjects, while the nonspecific effects of workload were controlled with a group factor. SCORs were measured concurrently with 1-s epochs of EEG alpha and theta power from Fz, Cz, Pz, and Oz. Neither index was reliably affected by the physical complexity of stimulation alone. However, both higher task relevance and higher workload significantly increased the magnitude of EEGORs and SCORs. Task averages of central and autonomic activity showed an overall pattern of covariation, but a second-by-second breakdown of EEG spectra suggests that the SCOR may be an aggregate of the activation of diverse brain mechanisms responsible for physiological orienting. The results are consistent with a model of orienting as a continuous dimension of resource allocation to anticipated and current task demands, rather than with the abrupt dichotomy between voluntary and involuntary orienting. Implications for the classical OR Sokolovian model are discussed.

Is sham smoking an adequate control condition for the motoric component of smoking?

This is a study of the similarities and differences between real and sham smoking; 15 participants, all of whom had a smoking history of more than two years, attended on two occasions within a balanced design. They were instructed to either smoke or sham smoke their own brand of cigarette as normally as possible. Real and sham smoking were highly correlated for various measures: frequency of puffs, puff duration, interpuff interval, puff volume, and puff pressure. This showed that the pattern of smoking was common across the two conditions. At the same time, there were differences between the two conditions in the intensity of smoking, such that sham smoking led to significant increases in puff duration, volume, frequency, and decreases in the length of interpuff interval. Sham smoking is often used in smoking experimentation as a control for various aspects of smoking. This is the first study to examine the commonalities between real and sham smoking in a detailed and systematic fashion.

U937 cells can utilize plasminogen activator to regulate human interferon-gamma

Urokinase-type plasminogen activator (uPA) converts the proenzyme plasminogen to plasmin and thereby contributes to processes like cell migration, tissue remodeling, and cytokine processing. We report here that uPA produced by the human U937 promonocytic cell line also initiated the inactivation of recombinant interferon-gamma (rIFN-gamma) by plasmin-mediated proteolysis. When cultured serum-free with plasminogen, U937 promonocytic cells generated measurable levels of plasmin activity and destroyed the antiviral activity of exogenously added rIFN-gamma. This effect was not seen in the absence of plasminogen, was prevented by inhibitors of uPA and plasmin, and was accompanied by changes in the electrophoretic mobility of rIFN-gamma on polyacrylamide gels, consistent with limited proteolysis of the lymphokine. Culturing U937 cells or blood monocytes for 48 h led to an elevated expression of their surface uPA and an increase in their capacity to produce plasmin and inactivate rIFN-gamma. The ability of rIFN-gamma to induce Fc receptors on U937 cells could also be prevented by providing the cells with a source of exogenous plasminogen, indicating that U937 cells could control their own activation in vitro through the action of uPA. The results of these studies support the conclusion that mononuclear phagocytes have the capacity to use uPA to regulate cytokine activity in vitro.

Effects of situational demands on the direction of electrodermal activation during smoking

Task demands (normal smoking; sham smoking; smoking or non-smoking during complex cognitive performance; and, smoking or non-smoking during monotonous vigilance performance) were manipulated in three experiments. Smoking increased electrodermal activity (EDA) arousal from pre-smoking baseline. Sham smoking (as a control for motoric aspects) also increased EDA arousal but to a lesser degree. In contrast the demands of complex cognitive performance were associated with lower EDA arousal during smoking than during non-smoking. Finally, during vigilance performance smoking maintained EDA arousal which during non-smoking decreased. Smoking did not improve performance during complex cognitive processing or vigilance above deprivation performance levels. It was concluded that smoking did have bidirectional effects as a function of task demand. However, there was no evidence that these physiological changes were functional and the smoking behavior data gave no indication as to the cause of these changes.

Motor nerve biopsy in severe Guillain-Barré syndrome

We undertook a biopsy of a terminal branch of the musculocutaneous nerve in a man with severe Guillain-Barré syndrome and very small distally evoked action potentials. The biopsy showed pronounced subperineurial edema, macrophage infiltration, and many axons that had been completely demyelinated, some associated with intratubal macrophages. The biopsy unequivocally identified the pathological process as primary demyelination, not axonal degeneration, and was more informative than previous reports of sural nerve biopsies in patients with Guillain-Barré syndrome.