Evidence based guideline for the management of bronchiolitis

Bronchiolitis in infants and children is a common presentation in both the general practice and emergency department settings.

Evidence based guideline for the management of croup

Croup is a common presentation in both the general practice and hospital emergency department setting. The relatively recent introduction of steroid use in the management of croup has resulted in decreased hospital admissions and improved outcomes for children.

Guideline development process for the Health for Kids in the South East project

Health for Kids in the South East (HFK) was a project funded by the Victorian Government Department of Human Services, Hospital Admission Risk Program. The project aimed to improve health outcomes for children in southeast Melbourne (Victoria) by building partnerships between child health clinicians and implementing best practice.

Evidence based guideline for the management of diarrhoea with or without vomiting in children

Acute diarrhoea in children is a common presentation in both the general practice and hospital emergency department settings. Current practice focuses on the prevention and management of dehydration in young children. However, general practitioners may not be aware of recommendations against the use of routine investigation, antidiarrhoeals and antiemetics in children or recommendations regarding dietary advice.

The brain is hyperexcitable in migraine

Migraine is a very common disorder occurring in 20% of women and 6% of men. Central neuronal hyperexcitability is proposed to be the putative basis for the physiological disturbances in migraine. Since there are no consistent structural disturbances in migraine, physiological and psychophysical studies have provided insight into the underlying mechanisms. This is a review of the neurophysiological studies which have provided an insight to migraine pathogenesis supporting the theory of hyperexcitability.

Ocular motor measures in migraine with and without aura

The purpose of this study was to examine basic ocular motor function in individuals with migraine. We used an infrared eye-tracking system to measure horizontal smooth pursuit to a sinusoidal target, saccades to horizontal target displacements of 5-20 degrees , and the stability of fixation in 19 migraine without aura (MoA), 19 migraine with aura (MA) and 19 headache-free control (C) subjects. Eye movement measurements were made at two target displacement rates and against both homogeneous grey and patterned backgrounds. We found no statistically significant differences between migraine and control subjects in any of the eye movement parameters measured, but did find highly significant effects of both target speed and background pattern in all groups. Our results do not provide support for subclinical cerebellar impairment in migraineurs, and do provide evidence that previously described visual abnormalities in migraine are not artefacts of abnormal fixation or eye movements.

Photophysical properties of lumichromes in water

The photophysics of lumichrome, 1-methyllumichrome, and lumiflavin in water solutions have been investigated. Fluorescence lifetimes of 2.7 and 2.2 ns were observed for lumichrome and 1-methyllumichrome, respectively, the corresponding triplet state lifetimes of 17 and 18 micros have been obtained from the transient absorption spectra. Evidence for long lived species with absorption maxima near 450 nm and lifetimes of ca. 400 micros has been found in the transient absorption spectra of both lumichromes. Quantum yields for the sensitised production of singlet oxygen, phi(Delta), are 0.36 and 0.41 for lumichrome and 1-methyllumichrome, respectively, in D(2)O.

An inverse oblique effect in human vision

In the classic oblique effect contrast detection thresholds, orientation discrimination thresholds, and other psychophysical measures are found to be smallest for vertical or horizontal stimuli and significantly higher for stimuli near the +/-45 degrees obliques. Here we report a novel inverse oblique effect in which thresholds for detecting translational structure in random dot patterns [Glass, L. (1969). Moiré effect from random dots. Nature, 223, 578-580] are lowest for obliquely oriented structure and higher for either horizontal or vertical structure. Area summation experiments provide evidence that this results from larger pooling areas for oblique orientations in these patterns. The results can be explained quantitatively by a model for complex cells in which the final filtering stage in a filter-rectify-filter sequence is of significantly larger area for oblique orientations.

Perceived scintillation rate of migraine aura

OBJECTIVE

To measure the perceived rate of flicker (temporal frequency) observed during visual auras.

BACKGROUND

The flickering or scintillating quality of aura elements is a commonly described characteristic of visual migraine auras. Hypotheses about the neural mechanisms involved in aura have rarely taken this feature into account, perhaps because of a lack of quantitative data on this aspect of the aura. While a rate of 10 Hertz had been suggested in the literature, estimates have been speculative due to the difficulty of judging temporal frequencies subjectively.

METHODS

Eleven participants were given portable devices that contained an adjustable light-emitting diode with which to match the flickering of their auras. Observers were asked to make flicker matches at two time points so that rate change during aura progression could be analyzed.

RESULTS

Data were obtained for 36 aura episodes. The mean rate of flicker across individuals was 17.8 Hertz. Rates varied widely between individuals, but were more consistent across multiple episodes in the same observer. Rate of flicker did not appear to relate to aura side or type, or to individual characteristics such as migraine history. When episodes were analyzed for change in flicker rate over time, patterns of increase (n = 7), decrease (n = 4), and no change (n = 22) were all observed.

CONCLUSIONS

When measured with an objective task, aura scintillation rates were found to be somewhat higher than previous anecdotal observations had suggested. These data are discussed in the context of two competing hypotheses concerning the neural mechanism underlying the flicker percept during migraine aura.

An fMRI study of the selective activation of human extrastriate form vision areas by radial and concentric gratings

The ventral form vision pathway of the primate brain comprises a sequence of areas that include V1, V2, V4 and the inferior temporal cortex (IT) [1]. Although contour extraction in the V1 area and responses to complex images, such as faces, in the IT have been studied extensively, much less is known about shape extraction at intermediate cortical levels such as V4. Here, we used functional magnetic resonance imaging (fMRI) to demonstrate that the human V4 is more strongly activated by concentric and radial patterns than by conventional sinusoidal gratings. This is consistent with global pooling of local V1 orientations to extract concentric and radial shape information in V4. Furthermore, concentric patterns were found to be effective in activating the fusiform face area. These findings support recent psychophysical [2,3] and physiological [4,5] data indicating that analysis of concentric and radial structure represents an important aspect of processing at intermediate levels of form vision.

Perception of head orientation

There are two visual components to gaze: head orientation and orientation of the eyes relative to the head. This study explores the accuracy with which subjects can discriminate head orientation when the eyes are centered in the head. Discrimination thresholds averaged 1.9 degrees of head rotation for base head orientations of 0 degree and 15 degrees, but discrimination was markedly poorer around a 30 degrees head orientation. Results were independent of spatial frequency and size over a 4-fold range. Neither negative contrast nor head inversion affected discrimination. Experiments dissociating the internal features from head outline revealed the presence of two main cues to discrimination: deviation of the head profile from bilateral symmetry, and deviation of nose orientation from vertical. Simulations show that model V4 units revealed in previous experiments with Glass patterns can extract the relevant head orientation information. The data are consistent with neurological data indicating a selective loss of face recognition in prosopagnosia with spared gaze discrimination.

Methylene blue based protein solder for vascular anastomoses: an in vitro burst pressure study

BACKGROUND AND OBJECTIVE

Attempts at sutureless anastomoses have used protein-based solders containing chromophores [Oz et al., J Vasc Surg 1990;11:718; Poppas et al., J Urol 1998150:1052] to enhance the strength of laser anastomoses. Reports have described the use of indocyanine green [Oz et al., Surg Forum 1989;316.], fuschin, and fluorescein isothiocyanate as chromophores [Chuck et al. , Lasers Surg Med 1989;9:471; Vance et al., Lasers Med Sci 1988;3:219]. Methylene blue (MB) is a chromophore with absorption peaks in the 600-700 nm region whose use has not been reported in laser-assisted vascular anastomoses. Therefore, we set out to produce and characterise a MB-containing protein solder. The absorption and burst pressure characteristics have been investigated and described as well as a brief review of the chemical and biological properties of MB.

STUDY DESIGN/MATERIALS AND METHODS

The MB and porcine serum albumin (PSA)-based solder was produced and used to form end-to-end anastomoses in porcine splenic arteries. The solder was activated using a laser diode emitting at 670 nm. The burst pressures of the anastomoses were tested, and the results analysed as a function of MB concentration and absorption. In addition, the relationship between MB concentration and absorption was examined.

RESULTS

A dose-response relationship was found between the measured absorption of the solder and the burst pressure of the anastomoses formed. Burst pressures exceeding physiological levels were found. Changes in MB concentration revealed a marked negative deviation from Beer's law at 670 nm, owing to the monomer-dimer-trimer equilibria.

CONCLUSION

PSA with MB solder is able to form high-quality end-to-end anastomoses, with immediate burst pressure profiles similar to those previously described for sutured [Quigley et al., Microsurgery 1985;6:229], lasered [Quigley et al., Microsurgery 1985;6:229], and soldered anastomoses [Small et al., J Clin Laser Med Surg 1997;15:205]. The relationship between burst pressure strength and chromophore absorption is discussed.