Predicting Difficult Intubation by using Modified Mallampati (MMT) with or without Thyromental Height Test (TMHT)

Failed Tracheal Intubation with Subsequent inability to maintain an open airway and adequate oxygenation is the most frequent cause of brain damage or death during anesthesia. Recognizing before anesthesia the potential for difficult intubation allows time for optimal preparation. Proper Selection of equipment and techniques is needed to avoid unwanted situation. To find out difficulties associated with endotracheal intubation using Modified Mallampati Test (MMT) combined with Thyromental Height Test (TMHT) and MMT without TMHT. This prospective observational study was conducted at the Department of Anesthesia in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from April 2018 to September 2018. Two hundred two patients with different surgical procedures under general anaesthesia in different operation theaters of BSMMU, Dhaka were selected as study population. After taking written consents from each patient or his/her attendant elaborate history of illness, meticulous clinical examinations were performed and relevant laboratory investigations were done. All information was recorded in a preformed data sheet and statistical analysis was done by SPSS-22.0. Mean age ±SD of the study subjects was 42.49±14.29 years in MMT with TMHT group and 43.40±15.39 years in MMT without TMHT group. Females were enrolled more than males in both the groups. BMI was 28.75±3.59kg/m² in MMT with TMHT group and 29.44±8.64kg/m² in MMT without TMHT group. There were no significant differences in age, gender and BMI between the groups. Sensitivity, specificity, PPV, NPV and accuracy were 100.0%, 96.0%, 96.2%, 100.0% and 98.0% respectively of MMT with TMHT in predicting intubation difficulty. Sensitivity, specificity, PPV, NPV and accuracy were 100.0%, 96.0%, 96.2%, 100.0% and 98.0% respectively of MMT only in predicting intubation difficulty. MMT combined with TMHT is a better predictor of intubation difficulty than MMT alone.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Curcumin loading potentiates the chemotherapeutic efficacy of selenium nanoparticles in HCT116 cells and Ehrlich's ascites carcinoma bearing mice

The anticancer properties of selenium (Se) and curcumin nanoparticles in solo formulations as well as in combination with other therapeutic agents have been proved time and again. Exploiting this facet of the two, we clubbed their tumoricidal characteristics and designed curcumin loaded Se nanoparticles (Se-CurNPs) to achieve an enhanced therapeutic effect. We evaluated their therapeutic effects on different cancer cell lines and Ehrlich's ascites carcinoma mouse model. In vitro results showed that Se-CurNPs were most effective on colorectal carcinoma cells (HCT116) compared to the other cancer cell lines used and possessed pleiotropic anticancer effects. The therapeutic effect on HCT116 was primarily attributed to an elevated level of autophagy and apoptosis as evident from significant up-regulation of autophagy associated (LC3B-II) and pro-apoptotic (Bax) proteins, down-regulation of anti-apoptotic (Bcl-2) protein and Cytochrome c (cyt c) release from mitochondria along with reduced NFκB signaling and EMT based machineries marked by downregulation of inflammation (NFκB, phospho-NFκB) and epithelial-mesenchymal transition (CD44, N-cadherin) associated proteins. In vivo studies on Ehrlich's ascites carcinoma (EAC) mice model indicated that Se-CurNPs significantly reduced the tumor load and enhanced the mean survival time (days) of tumor-bearing EAC mice.

Assessment of Difficulties Associated with Endotracheal Intubation using Modified Mallampati and Upper Lip Bite Test

This study was aimed at finding the parameters for prediction of difficulty in endotracheal intubation, that are easy to examine and that could better predict difficulty. The current observational prospective, cross sectional study was conducted in the department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2015 to September 2015 comprising 180 patient of both sexes requiring endotracheal intubation were arranged into two groups, Group A: Modified Mallampati test Group and Group B: Modified Mallampati & upper lip bite test group (combined) Assessment of difficulty in intubation was done by Cormack & Lehane direct Laryngoscopic grading. Outcome was measured as no difficulty or difficulty in intubation. In Group A 33 cases were true positive, 15 false negative, 26 false positive, 16 true negative. In Group B 53 cases were true positive, 1 false positive, 8 false negative, 28 true negative. The validity tests for Group A for evaluation of difficult intubation were indicated by sensitivity 55.9%, Specificity 51.6%, Accuracy 54.41%, Positive predictive value 68.8% and Negative predictive value 38.1%. The values for Group-B were 86.9%, 96.6%, 90.0%, 98.1% and 77.8% respectively. Combined modified Mallampati & Upper Lip Bite Test has definite value in the diagnosis of difficulty in intubation and can be regarded as sensitive & specific test for operative discrimination of the patient.

Optimization of fermentation conditions for green pigment production from Bacillus cereus M¹ 16 (MTCC 5521) and its pharmacological application

Optimal culture conditions for the production of green pigment was investigated. The optimal culture condition for the production of an extracellular green pigment by growing Bacillus cereus M(1) 16 (MTCC 5521) in a complex medium containing (g l(-1) ) Peptone-4.0, Beef Extract-9.0, NaCl-7.0, MgSO4 .7H2 O-1.0 and KH2 PO4 -5.0 was as follows pH-7.0 at 30°C for 72 h in a 5 l fermenter. Aeration rate and agitator speed had no effect on the pigment production. Thin layer chromatogram of the pigment extracted from the fermented broth with chloroform on silica gel GF254 using ethyl acetate and hexane (1 : 1) as solvent showed three fractions. The major fraction (C3 ) was separated out and identified as 9-methyl-1, 4, 5, 8-tetra-azaphenanthrene. Acute toxicity test revealed the nontoxic nature upto a dose of 2000 mg kg(-1) , b.wt., of mice. MTT assay showed the cytotoxic nature in HL60 cells having an IC50 of 2.47 mmol. So, this biopigment may have application in food, textile colorant and pharmaceutical industry.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study demonstrated the optimum production of a biopigment (9-methyl-1, 4, 5, 8-tetra-azaphenanthrene) by fermentation of a complex medium with Bacillus cereus M(1) 16 (MTCC 5521) in submerged fermentation. This is the first investigation of toxicity and cytotoxicity activities of this biopigment. The study showed that the purified pigment had no toxicity to healthy albino mice but a high cytotoxicity activity in HL60 cancer cell line in vitro. The biopigment had further displayed dyeing capability to both solidified agar and cotton cloth. Therefore, it may represent a nontoxic and natural alternative to chemical dyes and pigments.

Are family-centred principles, functional goal setting and transition planning evident in therapy services for children with cerebral palsy?

BACKGROUND

Family-centred service, functional goal setting and co-ordination of a child's move between programmes are important concepts of rehabilitation services for children with cerebral palsy identified in the literature. We examined whether these three concepts could be objectively identified in programmes providing services to children with cerebral palsy in Alberta, Canada.

METHODS

Programme managers (n= 37) and occupational and physical therapists (n= 54) representing 59 programmes participated in individual 1-h semi-structured interviews. Thirty-nine parents participated in eleven focus groups or two individual interviews. Evidence of family-centred values in mission statements and advisory boards was evaluated. Therapists were asked to identify three concepts of family-centred service and to complete the Measures of Process of Care for Service Providers. Therapists also identified therapy goals for children based on clinical case scenarios. The goals were coded using the components of the International Classification of Functioning Disability and Health. Programme managers and therapists discussed the processes in their programmes for goal setting and for preparing children and their families for their transition to other programmes. Parents reflected on their experiences with their child's rehabilitation related to family-centredness, goal setting and co-ordination between programmes.

RESULTS

All respondents expressed commitment to the three concepts, but objective indicators of family-centred processes were lacking in many programmes. In most programmes, the processes to implement the three concepts were informal rather than standardized. Both families and therapists reported limited access to general information regarding community supports.

CONCLUSION

Lack of formal processes for delivery of family-centred service, goal-setting and co-ordination between children's programmes may result in inequitable opportunities for families to participate in their children's rehabilitation despite attending the same programme. Standardized programme processes and policies may provide a starting point to ensure that all families have equitable opportunities to participate in their child's rehabilitation programme.

Double coins at the oesophageal inlet

Multiple foreign bodies lodged in the oesophagus are extremely rare. Here an unusual case of two coins accidentally lodged at the oesophageal inlet of a six-year-old girl is reported. The coins were successfully removed by oesophagoscopy. It is to be noted that apart from the straight x-ray (PA view) of the neck and chest, a lateral view is essential for proper characterisation and identification of the type and number of foreign bodies prior to surgical removal.

217 A NEW APPROACH TO CRYOPRESERVATION OF LARGE EQUINE EMBRYOS BY VITRIFICATION AFTER BLASTOCOEL MICROMANIPULATION

Vitrified large equine embryos >800 �m recovered on Day 8 after ovulation have not been successfully transferred yet. In this study, we examined the effects of reduction of the blastocoelic fluid and microinfusion of a cryopreservative prior to vitrification on pregnancy outcome. In 2006, 33 embryos, recovered at the expanded blastocyst stage, were transferred fresh with an average pregnancy rate of 91% (30/33). However, suitable recipients are not always available. The sizes of embryos used for this vitrification project were 805 �m (embryo #1), 820 �m (#2), 1120 �m (#3), 1286 �m (#4), and 979 �m (#5). They were all morphologically graded excellent (according to IETS guidelines). These embryos were assigned to either no micromanipulation (embryos #1–#3) or microinfusion of VS1 (1.4 M glycerol in PBS; embryos #4 and #5) after additional aspiration of the blastocoelic fluid and before microinfusion for embryo #5. To facilitate aspiration and microinfusion, a laser system (XYclone; Hamilton Thorne Biosciences, Beverly, MA, USA) was applied. Approximately 20% of the total blastocoelic fluid was removed using a standard micromanipulator and microcapillary system (Eppendorf). All embryos were then vitrified as previously described (Eldridge-Panuska et al. 2005 Theriogenology 63, 1308–1319). In brief, embryos were exposed to VS1 and VS2 (1.4 M glycerol + 3.6 M ethylene glycol in PBS) for 5 min, and VS3 (3.4 M glycerol + 6.6 M ethylene glycol in PBS) for 1 min. Embryos in VS3 were then individually loaded into 0.25-mL straws, separated by 2 air bubbles from columns of 0.5 M galactose. Then straws were placed for 1 min into a cooled plastic goblet surrounded by liquid nitrogen. The goblet was finally plunged into liquid nitrogen. Digital images of all embryos were taken prior to and during the vitrification procedure, and also after thawing prior to embryo transfer. All expanded blastocysts initially decreased in size. After transfer to VS2 and VS3, they lost their spherical shape and blastocoels collapsed. Four vitrified embryos were transfered to recipients on Day 8 after ovulation. After thawing in air at room temperature for 5 s and then in water at 30�C for 15 s, straw contents were emptied into a Petri dish and mixed. After 5 min, single embryos were loaded into an AI pipette and nonsurgically transferred to recipients. The blastocoel of only one embryo re-expanded during the 5 min after thawing (#3) and one embryo was split into two halves (#4). One week after transfer of embryos, recipients were examined by ultrasonography. None of the control embryos nor the split embryo in the treatment group led to the formation of an embryonic vesicle. However, the blastocyst, which had undergone both aspiration of blastocoelic fluid and microinfusion of VS1 (#5), had formed an embryonic vesicle at Day 15 after ovulation. During a further exam on Day 28, the uterine tone in the recipient was still increased, but ultrasonography revealed resorption of the embryo, which was probably caused by heat stress. Nevertheless, we will test this protocol for the cryopreservation of large equine embryos on a larger scale during the next breeding season.

105 ALTERING SEMEN EXTENDER AND GLYCEROL CONCENTRATION TO OPTIMIZE RESULTS AFTER CRYOPRESERVATION OF EQUINE SPERMATOZOA

After cryopreservation, spermatozoa from many stallions may have a lower capacity to fertilize an oocyte than fresh or cooled semen. The aim of this study was to evaluate a standard panel of semen extenders and varied concentrations of the cryoprotective agent (glycerol) to optimize sperm survival rates after cryopreservation. Semen was collected from Quarter Horse stallions (n = 3) from March to May 2006 (6 collections per stallion). Semen was filtered immediately after collection, and sample volume and sperm concentration were measured. A drop of raw semen was placed on two prewarmed slides to estimate the percentage of progressively motile sperm. The semen sample was then diluted to 100 � 106 spermatozoa/mL with a dried skim milk glucose extender (EZ Mixin Original Formula; ARS, Chino, CA, USA) or a chemically defined, milk-free diluent (INRA 96; IMV, Maple Grove, MN, USA). After 1 h of slow cooling and equilibration to 4�C, semen samples were centrifuged for 10 min at 400g. A defined volume of supernatant was removed, so that a concentration of 1000 � 106 spermatozoa/mL was obtained after resuspension of the sperm pellet. A 150-�L aliquot of semen was then added to specified quantities of the same semen extender used after semen collection and cryopreservation medium (Cryoguard�; Minitube, Verona, WI, USA) to obtain final glycerol concentrations of 2, 3, and 4%. This also gave a concentration of 100 � 106 spermatozoa/mL. After equilibration for 1 h at 4�C, spermatozoa were loaded into 0.5-mL straws and frozen in liquid nitrogen vapor. After 10 min, straws were plunged into liquid nitrogen. Semen was thawed at 37�C for 30 s and evaluated as prior to cryopreservation. Mean total semen volumes were 56, 11, and 60 mL in the 3 stallions. Their respective mean sperm concentrations were 124 � 106, 505 � 106, and 161 � 106 sperm/mL, respectively. Mean percentages of progressively motile sperm prior to cryopreservation were 64, 89, and 72%, respectively. With the paired Student's t-test, percentages of progressively motile sperm after cryopreservation were evaluated with respect to semen extender and concentration of glycerol used. Mean overall progressive motility of spermatozoa after cryopreservation differed significantly between the two extenders and was 46% for INRA 96 and 35% for EZ Mixin OF (P < 0.001). Using EZ Mixin OF as semen extender, the best mean post-thaw progressive motility was achieved with 4% glycerol (39%) and differed significantly from that with 2% glycerol (32%; P < 0.01). When INRA 96 was used (49% for 4%, and 42% for 2% glycerol), there was no difference. This results provide evidence that, during freezing of equine spermatozoa, there is a significant effect of the semen extender and the concentration of the cryoprotectant on post-thaw sperm motility. We therefore suggest mini-freezing trials prior to freezing large numbers of sperm to find the semen extender and glycerol concentration that provides optimal survival rates.

An unusual foreign body (Big Metallic Nut) in the nasopharynx of an infant

Foreign body in the nasopharynx is an extremely rare conidition; however a big metallic nut in the masopharynx of an infant of eight- months has not been previously reported in literature. We report an unusual case where an eight-month-old child introduced a big metallic nut through the mouth and was lodged in the nasopharynx, with a brief review of literature regarding the diagnosis and management of such case.

The Relationship Between Blood Pressure and Mortality in the Oldest Old

OBJECTIVES

To explore the relationship between systolic and diastolic blood pressure and risk of 6-year, all-cause mortality in men and women age 65 to 84 versus those 85 and older.

DESIGN

A population-based longitudinal study.

SETTING

This study was conducted at four different sites: East Boston, Massachusetts; New Haven, Connecticut; two rural counties in Iowa; and Piedmont, North Carolina.

PARTICIPANTS

12,802 community-dwelling persons age 65 and older.

MEASUREMENTS

Baseline measurements collected include demographics, self-reported chronic medical conditions, blood pressure measurements, medications, health habits, and hospitalizations.

RESULTS

Unadjusted actuarial survival analyses show that men age 65 to 84 years with systolic blood pressure < 130 mmHg have significantly lower mortality compared with those with systolic blood pressure > or = 180 mmHg (P < .0001). In contrast, men 85 and older with systolic blood pressure > or = 180 mmHg have significantly lower mortality compared with those with systolic blood pressure < 130 mmHg (P < .0001). In Cox proportional hazards analyses controlling for other predictors of survival, the hazard of death associated with each 10-mmHg increase in systolic blood pressure is positively associated among men age 65 to 84 years and negatively associated among men age 85 and older (Hazard ratio and 95% confidence interval (CI): 1.04 (1.01, 1.07) for younger men vs 0.92 (0.86, 0.99) for older men). Among women age 65 to 84, the hazard of death significantly increased with increase in systolic blood pressure (P < .0001), while there was no relationship between level of systolic blood pressure and survival in women 85 and older. Both men 65 to 84 years old and those 85 and older showed a negative relationship between diastolic blood pressure and all-cause mortality (Hazard ratio 0.93, 95% CI (0.88-0.97) for men age 65-84 years, and Hazard ratio 0.90, 95% CI 0.80-1.02 for men 85 and older).

CONCLUSION

In men age 85 and older, higher systolic blood pressure is associated with better survival.

Spinal movement and performance of a standing reach task in participants with and without Parkinson disease

BACKGROUND AND PURPOSE

Evidence suggests that individuals with early and mid-stage Parkinson disease (PD) have diminished range of motion (ROM). Spinal ROM influences the ability to function. In this investigation, the authors examined available spinal ROM, segmental excursions (the ROM used) during reaching, and their relationships in community-dwelling adults with and without PD.

SUBJECTS

The subjects were 16 volunteers with PD (modified Hoehn and Yahr stages 1.5-3) and 32 participants without PD who were matched for age, body mass index, and sex.

METHODS

Range of motion of the extremities was measured using a goniometer, and ROM of the spine was measured using the functional axial rotation (FAR) test, a measure of unrestricted cervico-thoracic-lumbar rotation in the seated position. Motion during reaching was determined using 3-dimensional motion analysis. Group differences were determined using multivariable analysis of variance followed by analysis of variance. Contributions to total reaching distance of segmental excursions (eg, thoracic rotation, thoracic lateral flexion) were determined using forward stepwise regression.

RESULTS

Subjects with PD as compared with subjects without PD had less ROM (FAR of 98.2 degrees versus 110.3 degrees, shoulder flexion of 151.9 degrees versus 160.1 degrees) and less forward reaching (29.5 cm versus 34.0 cm). Lateral trunk flexion and total rotation relative to the ground contributed to reaching, with the regression model explaining 36% of the variance.

DISCUSSION AND CONCLUSION

These results contribute to the growing body of evidence demonstrating that spinal ROM is impaired early in PD.

Impact of pain on disability among older Mexican Americans

BACKGROUND

Joint pain is a very common complaint among elderly persons and may lead to functional disability. The purpose of this study is to estimate the prevalence of self-reported pain on weight bearing and its impact on the 2-year incidence of limitation in lower-body activities of daily living (ADL) in initially nondisabled Mexican American elderly subjects.

METHODS

We studied a probability sample of 2167 noninstitutionalized Mexican American men and women aged 65 or older residing in five Southwestern states. Subjects were asked about pain on weight bearing, ADL, depressive symptomatology, and the presence of chronic diseases. The body mass index was computed using measured height and weight. Finally, a three-task (tandem balance, 8-foot walk, and repeated chair stands), performance-based, lower-body function test was performed.

RESULTS

The overall prevalence of pain on weight bearing in the sample was 31.9%, with 37.7% for women versus 24.0% for men (p <.001). The most prevalent sites of pain were knees (14.7%), followed by ankle/feet (12.1%). In a logistic regression analysis, pain was a significant independent predictor of subsequent disability and of the inability to perform tandem balance, 8-foot walk, and repeated chair stands.

CONCLUSIONS

Pain on weight bearing is prevalent among older Mexican Americans and is a major independent risk factor for subsequent disability.

Analysis of the cat eye syndrome critical region in humans and the region of conserved synteny in mice: a search for candidate genes at or near the human chromosome 22 pericentromere

We have sequenced a 1.1-Mb region of human chromosome 22q containing the dosage-sensitive gene(s) responsible for cat eye syndrome (CES) as well as the 450-kb homologous region on mouse chromosome 6. Fourteen putative genes were identified within or adjacent to the human CES critical region (CESCR), including three known genes (IL-17R, ATP6E, and BID) and nine novel genes, based on EST identity. Two putative genes (CECR3 and CECR9) were identified, in the absence of EST hits, by comparing segments of human and mouse genomic sequence around two solitary amplified exons, thus showing the utility of comparative genomic sequence analysis in identifying transcripts. Of the 14 genes, 10 were confirmed to be present in the mouse genomic sequence in the same order and orientation as in human. Absent from the mouse region of conserved synteny are CECR1, a promising CES candidate gene from the center of the contig, neighboring CECR4, and CECR7 and CECR8, which are located in the gene-poor proximal 400 kb of the contig. This latter proximal region, located approximately 1 Mb from the centromere, shows abundant duplicated gene fragments typical of pericentromeric DNA. The margin of this region also delineates the boundary of conserved synteny between the CESCR and mouse chromosome 6. Because the proximal CESCR appears abundant in duplicated segments and, therefore, is likely to be gene poor, we consider the putative genes identified in the distal CESCR to represent the majority of candidate genes for involvement in CES.

Prevalence of arthritis in older Mexican Americans

OBJECTIVE

This study examines the prevalence of self-reported physician-diagnosed arthritis and arthritis symptoms and their relationship to functional limitations in Mexican American elderly.

METHODS

We conducted a cross-sectional study using a probability sample of 2,873 non-institutionalized Mexican American men and women aged 65 or older, residing in the southwestern United States. Measures included self-reported physician-diagnosed arthritis, morning pain or stiffness, pain when standing, global health rating, activities of daily living (ADL), instrumental activities of daily living (IADL), depressive symptoms, presence of chronic diseases (diabetes mellitus, hypertension, heart attack, stroke), and body mass index. The Mantel-Haenszel chi-square statistic was used to test differences by arthritis status, and a logistic regression model was used to predict the odds of having arthritis.

RESULTS

The overall prevalence of self-reported physician-diagnosed arthritis in the sample was 40.8 percent, 50.0 percent among women and 28.8 percent among men (P < 0.001). Morning pain or stiffness was reported by 37.7 percent of respondents and pain when standing or walking by 31.9 percent. All comorbid conditions, and both IADL and ADL limitations, were more prevalent in those with arthritis than in those without arthritis. Female sex and several medical conditions were independently associated with self-reported arthritis.

CONCLUSIONS

Self-reported physician-diagnosed arthritis is common among older Mexican Americans. Functional limitation and disability are more prevalent among subjects with arthritis than among those without arthritis.

Evidence and outcomes: agendas, presuppositions and power

This paper explores philosophical and methodological issues involved in determining 'What counts as making a meaningful difference?'--the fundamental question in health outcomes research and evidence-based practice. Eight diverse stakeholders are identified along with the competing agendas they bring to the debate. The power to define what counts as meaningful change in health status is typically rooted in disciplinary socialization, linguistic traditions and an orthodox consensus that circumscribes acceptable research foci and methods. The various implicit assumptions and sites of definitional authority have consequences both for health researchers and for the public being served. For researchers, their designs may be driven by available instrumentation, short political time lines, and statistical rather than clinical significance. Because methods to capture salient health outcomes are still being developed, failure to capture significant outcomes may be methodological in origin. The public may experience the consequences of subsequent programmatic funding decisions and the exclusionary potential of different categorization schemes. Despite this, the public seldom has a voice in deciding what constitutes a meaningful health outcome. Researchers are urged to involve their target population in designing studies to help rebalance relative stakeholder power, and to consider the consequences of their methodological decisions.

Kinematic characterization of standing reach: comparison of younger vs. older subjects

OBJECTIVE

To characterize typical spinal motions that occur during standing reach and to describe differences in spinal motions and center of pressure displacements during reach between younger and older healthy adults.

DESIGN

Exploratory, cross sectional investigation utilizing video motion and biomechanics force platform analysis.

BACKGROUND

Standing reach provides a means for assessing both arm function and balance control in the context of a common functional activity. The interaction between age-related declines in spinal mobility and the spinal motion occurring during reach is poorly understood. The characterization of spinal motions during task performance for healthy subjects of different age groups is an important first step for understanding the relationship between impairments and physical performance in disabled populations.

METHODS

Thirty-four subjects ages 20-36 and 33 subjects ages 60-76 participated. Video motion and force plate analysis were used to characterize spinal motion and center of pressure displacements during the functional reach test for younger and older subjects.

RESULTS

Spinal motion during standing reach was characterized by forward trunk flexion, lateral trunk flexion, thoracolumbar rotation, and lower body rotation. Younger and older subjects differed (P = 0.05) in the amount of forward trunk flexion and thoracolumbar rotation which occurred but not lower body rotation. Younger subjects displaced their center of pressure further forward (P = 0.0001) and through a greater percentage of their initial base of support (P = 0.0001) than older subjects.

CONCLUSION

This study provides the first multiplanar characterization of spinal motion used during standing reach. Significant differences for a number of variables existed between younger and older subjects.

Exercise to improve spinal flexibility and function for people with Parkinson's disease: a randomized, controlled trial

OBJECTIVES

The effectiveness of an exercise intervention for people in early and midstage Parkinson's disease (stages 2 and 3 of Hoehn and Yahr) in improving spinal flexibility and physical performance in a sample of community-dwelling older people is described.

DESIGN AND SETTING

Fifty-one men and women, aged 55-84 years, identified through advertisement, local support groups, and local neurologists were enrolled into a randomized, controlled trial. Subjects were assigned randomly to an intervention or a usual care arm (i.e., no specific exercise). Of the original 51 participants, 46 completed the randomized, controlled trial. Participants in the exercise arm (n = 23) received individual instruction three times per week for 10 weeks. Participants in the usual care arm (n = 23) were "wait listed" for intervention.

MEASUREMENTS

Changes over 10 weeks in spinal flexibility (i.e., functional axial rotation) and physical performance (i.e., functional reach, timed supine to stand) were the primary outcome measures.

RESULTS

MANOVA conducted for the three primary outcome variables demonstrated significant differences (P < or = .05) between the two groups. Further analysis using ANOVA demonstrated significant differences between groups in functional axial rotation and functional reach for the intervention compared with the control group. There was no significant difference in supine to sit time.

CONCLUSION

Study results demonstrate that improvements in axial mobility and physical performance can be achieved with a 10-week exercise program for people in the early and midstages of PD.

Characteristics of the healthy worker effect: a comparison of male and female occupational cohorts

The healthy worker effect (HWE) poses a serious methodological problem to investigators of occupational cohorts in that it may mask mortality excesses that result from occupational exposures. This problem is further complicated by the fact that the strength of the HWE generally varies according to sociodemographic, employment, and time-related factors. While the HWE has been well documented among numerous cohorts of male workers, little is known about its expression among female occupational workers. Follow-up mortality data on 44,154 employees from the Hanford nuclear facility for the period of 1944-1986 were examined using standardized mortality ratio (SMR) analysis to assess whether modifiers of the HWE were expressed differently in females than in males. Results of this analysis show that while the HWE was modified by race, age at hire, occupational class, and length of follow-up in both male and female cohorts, different patterns of modification emerged across the two subgroups. Learning about how gender differentiates expression of the HWE will help investigators more precisely assess the confounding effect of the HWE in studies of working cohorts. Therefore, this study's findings are relevant for designing and interpreting future occupational cohort studies.

Post-communism: postmodernity or modernity revisited?

Coinciding with the popularity of postmodern theory, the fall of communism appeared to offer further evidence of the exhaustion of modernity. Such analysis is grounded in a view that the Soviet system was the epitome of modernity. An alternative approach regards post-communism as opening new terrains of struggle for modernity. Thus Habermas and others suggest that post-communist societies are rejoining the trajectory of western modernity whose problems they now recapitulate. This alternative view implies that Soviet systems were something other than 'modern', although their nature is not always clearly defined. However, even if post-communist societies do encounter problems of modernity, they do so in new circumstances where modernist notions of social development have become problematic. This article argues that, contrary to those who regard modernization or postmodernization as irresistible trends, core post-communist societies are likely to develop along an alternative path to that of western modernity. This is tentatively described as 'neo-mercantilist'.

Measures of shoulder protraction and thoracolumbar rotation

Physical therapists need objective measures that can be used reliably with a variety of subject groups to document upper quadrant function. Two aspects of upper quadrant motion, shoulder protraction and thoracolumbar rotation, are assessed routinely in clinical practice, but no standard measurement techniques have been reported. We hypothesized that there would be significant differences, by age and state of health, for both shoulder protraction and thoracolumbar rotation. The purposes of this study were: 1) to develop measurement approaches for shoulder protraction and thoracolumbar rotation; 2) to determine if there are significant differences in these motions for four subject groups: healthy young, healthy elders, functionally limited elders, and people with Parkinson's disease; and 3) to describe between-rater and within-rater reliability for these measures. Fifty-five subjects participated in this investigation. All subjects were rated by a physical therapist and two research assistants. Using an analysis of variance followed by Scheffe's post hoc analysis, significant differences were demonstrated between the groups. Between-rater and within-rater reliability ranged from ICCs of 0.54 to 0.95. Clinicians can use these measures to quantify aspects of upper quadrant function treated routinely in physical therapy practice. These measures also have applicability for researchers.

Stenting for occlusion of the subclavian arteries. Technical aspects and follow-up results

We report the results of stenting in 17 patients who underwent treatment for total occlusions in the subclavian arteries between July 1991 and December 1995. Fourteen of the lesions were located in the left side; 15 patients had a subclavian steal syndrome. The indications for treatment were vertebrobasilar insufficiency (n = 7); arm claudication (n = 5); vertebrobasilar insufficiency and upper-limb ischemia (n = 3); protection of a left internal mammary artery coronary bypass (n = 1); and an isolated subclavian steal syndrome (n = 1). A total of 23 stents were implanted in 17 patients; in 1 patient, 2 stents migrated during deployment, resulting in a 94% procedural success rate. One case of axillary thrombosis was successfully treated with local thrombolysis and balloon angioplasty. There were no postprocedural neurologic complications or deaths. Follow-up over a mean duration of 19.4 months (range, 4 to 56 months) revealed 1 asymptomatic restenosis at 5 months in a patient with 3 stents. Life-table analysis showed an 81% cumulative patency rate at 6 months. We conclude that stenting for occlusion of the subclavian arteries appears feasible and safe; however, further evaluation in a larger group of patients is needed to confirm these results.

Isolation and identification of alkaline thermostable lipase producing microorganism and some properties of crude enzyme

A bacterial strain isolated from soil and identified as Enterococcus faecalis was found capable of producing alkaline thermostable lipase. Optimum pH, temperature and time for enzyme substrate reaction were found to be 8.0, 60 degrees C and 10 min respectively. Phosphates and common surfactants have no or very little inhibitory effects on the activity of the enzyme, whereas bile salts are inhibitory to the enzyme activity. Maximum activity of the enzyme obtained so far is 54.6 IU/ml.