The emotional impact of baseless discrediting of knowledge: An empirical investigation of epistemic injustice

According to theoretical work on epistemic injustice, baseless discrediting of the knowledge of people with marginalized social identities is a central driver of prejudice and discrimination. Discrediting of knowledge may sometimes be subtle, but it is pernicious, inducing chronic stress and coping strategies such as emotional avoidance. In this research, we sought to deepen the understanding of epistemic injustice's impact by examining emotional responses to being discredited and assessing if marginalized social group membership predicts these responses. We conducted a novel series of three experiments (Total N = 1690) in which participants (1) shared their factual knowledge about how a game worked or their personal feelings about the game; (2) received discrediting feedback (invalidating remarks), validating feedback (affirming remarks), or insulting feedback (general negative social evaluation); and then (3) reported their affect. In all three studies, on average, affective responses to discrediting feedback were less negative than to insulting feedback, and more negative than to validating feedback. Participants who shared their knowledge reported more negative affect after discrediting feedback than participants who shared their feelings. There were consistent individual differences, including a twice-replicated finding of reduced negative affect after receiving discrediting and insulting feedback for Black men compared to White men and women and Black women. Black men's race-based traumatic symptom scores predicted their affective responses to discrediting and insulting feedback, suggesting that experience with discrimination contributed to the emotional processing of a key aspect of epistemic injustice: remarks conveying baseless discrediting of knowledge.

Broadening the Perspective on Reducing Pharmaceutical Residues in the Environment

The present study reviews options for reducing harm from pharmaceuticals that are known to cause adverse impacts by their presence in the environment. It reviews recent global and European Union policy development, which could go further in recognizing and addressing the issue in a global context. It considers green chemistry, which can help clean up production processes but holds only long-term promise for creating "green" alternatives. It explores the potential of health promotion and disease prevention, which can contribute significantly to a reduction of the disease burden and thus the need for medicines, both for infectious and for noncommunicable disease. Eco-directed sustainable prescribing practices are reviewed, which have been adopted successfully to reduce the use of harmful pharmaceuticals. We note recent developments in medicines optimization and precision medicine, which hold promise for improving patient outcomes, saving costs, and reducing pharmaceutical use, through individually tailored prescribing whereby the patient codecides their therapy. Waste prevention through reuse or redistribution is beginning to find public support and "take-back" waste disposal schemes set up via extended producer responsibility systems have achieved high returns. Finally, the paper summarizes preferred advanced wastewater technologies, including innovative low-cost, low-energy options. In summary, although end-of-pipe options have a role to play, particularly for highly concentrated wastewaters, solutions further up the medicinal chain and disease prevention interventions, informed by a broad view of health and health care, are needed to pursue a much greater potential reduction of pharmaceuticals in the environment than can be achieved by end-of-pipe solutions alone. Environ Toxicol Chem 2024;43:653-663. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Addressing climate change with behavioral science: A global intervention tournament in 63 countries

Effectively reducing climate change requires marked, global behavior change. However, it is unclear which strategies are most likely to motivate people to change their climate beliefs and behaviors. Here, we tested 11 expert-crowdsourced interventions on four climate mitigation outcomes: beliefs, policy support, information sharing intention, and an effortful tree-planting behavioral task. Across 59,440 participants from 63 countries, the interventions' effectiveness was small, largely limited to nonclimate skeptics, and differed across outcomes: Beliefs were strengthened mostly by decreasing psychological distance (by 2.3%), policy support by writing a letter to a future-generation member (2.6%), information sharing by negative emotion induction (12.1%), and no intervention increased the more effortful behavior-several interventions even reduced tree planting. Last, the effects of each intervention differed depending on people's initial climate beliefs. These findings suggest that the impact of behavioral climate interventions varies across audiences and target behaviors.

Who attributes what to whom? Moral values and relational context shape causal attribution to the person or the situation

Eight preregistered studies (total N = 3,758) investigate the role of values and relational context in attributions for moral violations, focusing on the following questions: (1) Do people's values influence their attributions? (2) Do people's relationships with the violator (self, close other, distant other) influence their attributions? (3) Do the principles intrinsic to the violated values (e.g., loyalty to close others) further influence their attributions? We found that participants were more likely to attribute violations by distant others to the person committing the violation, rather than the situation in which the violation occurred, when participants endorsed the violated values themselves. The tendency to make dispositional attributions did not obtain for violations of participants' less highly endorsed moral values or non-moral values. Relationship with the violator also influenced participants' attributions-participants were more likely to attribute their own and close others' moral violations to situational factors, relative to distant others' violations. This relational pattern was pronounced for violations of "binding" moral values, in which protection of personal relationships and groups is primary. Collectively, these results support a relational-values account of causal attribution for moral violations, whereby attributions systematically vary based on (1) the relevance of the violated values to the attributor's moral values, (2) the attributor's personal relationship to the violator, and (3) an interaction between (1) and (2) such that the principles intrinsic to the violated values influence the effects of one's relationship to the violator.

Moral Values Reveal the Causality Implicit in Verb Meaning

Prior work has found that moral values that build and bind groups-that is, the binding values of ingroup loyalty, respect for authority, and preservation of purity-are linked to blaming people who have been harmed. The present research investigated whether people's endorsement of binding values predicts their assignment of the causal locus of harmful events to the victims of the events. We used an implicit causality task from psycholinguistics in which participants read a sentence in the form "SUBJECT verbed OBJECT because…" where male and female proper names occupy the SUBJECT and OBJECT position. The participants were asked to predict the pronoun that follows "because"-the referent to the subject or object-which indicates their intuition about the likely cause of the event. We also collected explicit judgments of causal contributions and measured participants' moral values to investigate the relationship between moral values and the causal interpretation of events. Using two verb sets and two independent replications (N = 459, 249, 788), we found that greater endorsement of binding values was associated with a higher likelihood of selecting the object as the cause for harmful events in the implicit causality task, a result consistent with, and supportive of, previous moral psychological work on victim blaming. Endorsement of binding values also predicted explicit causal attributions to victims. Overall, these findings indicate that moral values that support the group rather than the individual reliably predict that people shift the causal locus of harmful events to those affected by the harms.

It's Not the Flu: Popular Perceptions of the Impact of COVID-19 in the U.S

Messaging from U.S. authorities about COVID-19 has been widely divergent. This research aims to clarify popular perceptions of the COVID-19 threat and its effects on victims. In four studies with over 4,100 U.S. participants, we consistently found that people perceive the threat of COVID-19 to be substantially greater than that of several other causes of death to which it has recently been compared, including the seasonal flu and automobile accidents. Participants were less willing to help COVID-19 victims, who they considered riskier to help, more contaminated, and more responsible for their condition. Additionally, politics and demographic factors predicted attitudes about victims of COVID-19 above and beyond moral values; whereas attitudes about the other kinds of victims were primarily predicted by moral values. The results indicate that people perceive COVID-19 as an exceptionally severe disease threat, and despite prosocial inclinations, do not feel safe offering assistance to COVID-19 sufferers. This research has urgent applied significance: the findings are relevant to public health efforts and related marketing campaigns working to address extended damage to society and the economy from the pandemic. In particular, efforts to educate the public about the health impacts of COVID-19, encourage compliance with testing protocols and contact tracing, and support safe, prosocial decision-making and risk assessment, will all benefit from awareness of these findings. The results also suggest approaches, such as engaging people's stable values rather than their politicized perspectives on COVID-19, that may reduce stigma and promote cooperation in response to pandemic threats.

Linguistic Evidence for the Dissociation Between Impurity and Harm: Differences in the Duration and Scope of Contamination Versus Injury

Previous research has shown that harm and impurity are relevant to a different extent across individuals and transgressions. However, the source of these differences is still unclear. Here, we combine language analysis and social-moral psychology to articulate the core defining features of impurity versus harm. In Study 1 (a–c), we found systematic variation in language use, indicating that people infer that contamination, unlike injury, affects a target completely and irreversibly, rendering them a transmitter of contamination. In Study 2 (a–b), we investigated how evoking intuitions about these core features of contamination—completeness, irreversibility, and transferability—influences judgments of impurity and harm. We found that implying effects on a target were complete and irreversible altered judgments of impurity, but not harm. Overall, our research supports the conclusion that impurity and harm are substantially distinct in cognition and moral judgment; unlike harm, impurity connotes negative effects that spread continually across space and time.

Partisan mathematical processing of political polling statistics: It's the expectations that count

In this research, we investigated voters' mathematical processing of election-related information before and after the 2012 and 2016 U.S. Presidential Elections. We presented voters with mental math problems based on fictional polling results, and asked participants who they intended to vote for and who they expected to win. We found that committed voters (in both 2012 and 2016) demonstrated wishful thinking, with inflated expectations that their preferred candidate would win. When performing mathematical operations on polling information, voters in 2012 and 2016 deflated support for the opponent. Underestimation of the opponent was found to be absent among the participants who did not expect their preferred candidate to win. Identical experiments conducted after the elections revealed that partisan mathematical biases largely disappeared in favor of estimates in alignment with reality. Results indicate that mathematical processing of political polling data is biased by people's voting intentions and wishful thinking, and, crucially, by their expectations about the likely or actual state of the world.

The behavioral and neural signatures of distinct conceptions of fairness

Adhering to standard procedures (impartiality), returning favors (reciprocity) or giving based on individuals' needs (charity) may all be considered moral and/or fair ways to allocate resources. However, these allocation behaviors may be perceived as differently motivated, and their moral evaluation may make different demands on theory of mind (ToM) - the capacity to process information about mental states, including motives. In Studies 1 and 2, we examined participants' moral judgments of allocations based on (1) impartiality, (2) reciprocity, (3) charity and (4) unspecified criteria as depicted in vignettes, as well as participants' perceptions of allocators' motivations. In Study 3, we used functional magnetic resonance imaging to investigate how brain regions for ToM were recruited during moral evaluation of the same vignettes. Reciprocity and charity were processed similarly, in that they recruited ToM regions to the same extent, i.e., precuneus, dorsal and ventral medial prefrontal cortex and left temporoparietal junction (LTPJ). In turn, impartiality and the unspecified condition were processed similarly, recruiting the same ToM regions to a lesser extent. Nevertheless, reciprocity elicited greater activity relative to impartiality and unspecified in the ToM regions of interest. Overall, evaluations of different allocation behaviors depend differently on ToM, with charity and reciprocity eliciting greater attention to individuals' unique states and motivations.

Quantifying a threat: Evidence of a numeric processing bias

Humans prioritize the processing of threats over neutral stimuli; thus, not surprisingly, the presence of threats has been shown to alter performance on both perceptual and cognitive tasks. Yet whether the quantification process is disrupted in the presence of threat is unknown. In three experiments, we examined numerical estimation and discrimination abilities in adults in the context of threatening (spiders) and non-threatening (e.g., flowers) stimuli. Results of the numerical estimation task (Experiment 1) showed that participants underestimated the number of threatening relative to neutral stimuli. Additionally, numerical discrimination data reveal that participants' abilities to discriminate between the number of entities in two arrays were worsened when the arrays consisted of threatening entities versus neutral entities (Experiment 2). However, discrimination abilities were enhanced when threatening content was presented immediately before neutral dot arrays (Experiment 3). Together, these studies suggest that threats impact our processing of visual numerosity via changes in attention to numerical stimuli, and that the nature of the threat (intrinsic or extrinsic to the stimulus) is vital in determining the direction of this impact. Intrinsic threat content in stimuli impedes its own quantification; yet threat that is extrinsic to the sets to be enumerated enhances numerical processing for subsequently presented neutral stimuli.

Materials Science Structure, Corrosion, and Tarnishing of Ag-Pd-Cu Alloys

The structure of Ag-Pd-Cu-Au-Zn alloys can be expected to have an influence on their corrosion and tarnish resistance. Four experimental Ag-based alloys (I-IV) with varying PdlAg ratios were studied by scanning electron microscopy (SEM), microprobe analyses, and x-ray diffraction analyses. Both as-cast and in the annealed state, they contain a Pd-Cu-Zn-enriched compound A and a Ag-rich matrix (compound B) with a fcc structure, α2. X-ray diffraction data indicated that compound A consisted of two fcc phases (α1 and α 2) in addition to a bcc PdCuxZnx-1 phase. The phases of compound A were too small to be distinguishable by SEM. Alloys I-IV could not be solid-solution-annealed to a single phase.

Static anodic polarization testing was carried out in an artificial saliva containing Na2S (pS=5). It was found that an alloy made as a duplicate of the Pd-Cu-Zn-rich compound A for a given potential had current density clearly lower than that of the Ag-rich alloys. Furthermore, cathodic reduction of oxygen took place at a considerably higher rate on this Pd-Cu-Zn-rich duplicate alloy than on the Ag-based alloys. It is suggested that micro-galvanic cells are created between the Pd-Cu-Zn-rich compounds A and the Ag-rich matrix in alloys I-IV. Immersion tests in aqueous Na2S solutions (pS=1.6) showed tarnishing to take place only on the Ag-rich matrix. However, increasing the Pd content of an Ag-rich single-phase alloy increased its tarnish resistance.

When and Why We See Victims as Responsible

Why do victims sometimes receive sympathy for their suffering and at other times scorn and blame? Here we show a powerful role for moral values in attitudes toward victims. We measured moral values associated with unconditionally prohibiting harm (“individualizing values”) versus moral values associated with prohibiting behavior that destabilizes groups and relationships (“binding values”: loyalty, obedience to authority, and purity). Increased endorsement of binding values predicted increased ratings of victims as contaminated (Studies 1-4); increased blame and responsibility attributed to victims, increased perceptions of victims’ (versus perpetrators’) behaviors as contributing to the outcome, and decreased focus on perpetrators (Studies 2-3). Patterns persisted controlling for politics, just world beliefs, and right-wing authoritarianism. Experimentally manipulating linguistic focus off of victims and onto perpetrators reduced victim blame. Both binding values and focus modulated victim blame through victim responsibility attributions. Findings indicate the important role of ideology in attitudes toward victims via effects on responsibility attribution.

Caring across boundaries versus keeping boundaries intact: links between moral values and interpersonal orientations

Prior work has established robust diversity in the extent to which different moral values are endorsed. Some people focus on values related to caring and fairness, whereas others assign additional moral weight to ingroup loyalty, respect for authority and established hierarchies, and purity concerns. Five studies explore associations between endorsement of distinct moral values and a suite of interpersonal orientations: Machiavellianism, prosocial resource distribution, Social Dominance Orientation, and reported likelihood of helping and not helping kin and close friends versus acquaintances and neighbors. We found that Machiavellianism (Studies 1, 3, 4, 5) (e.g., amorality, controlling and status-seeking behaviors) and Social Dominance Orientation (Study 4) were negatively associated with caring values, and positively associated with valuation of authority. Those higher in caring values were more likely to choose prosocial resource distributions (Studies 2, 3, 4) and to report reduced likelihood of failing to help kin/close friends or acquaintances (Study 4). Finally, greater likelihood of helping acquaintances was positively associated with all moral values tested except authority values (Study 4). The current work offers a novel approach to characterizing moral values and reveals a striking divergence between two kinds of moral values in particular: caring values and authority values. Caring values were positively linked with prosociality and negatively associated with Machiavellianism, whereas authority values were positively associated with Machiavellianism and Social Dominance Orientation.

Development process of the Practical Approach to Lung Health in Kyrgyzstan

The Practical Approach to Lung Health (PAL) strategy was adopted by the Ministry of Health of Kyrgyzstan to improve the quality of case management of priority respiratory illnesses, including tuberculosis (TB). The process of development and implementation of the strategy is described in the present study. The World Health Organization stepwise framework was adapted and used to initiate the PAL strategy within the Kyrgyzstan primary health care (PHC) system. The process followed 10 steps which included the government decision to support PAL development, and the establishment of a national working group in charge of adapting guidelines, developing training materials and testing the feasibility and impact of the guidelines. On the basis of the test results, the guidelines and training materials were revised and a national PAL implementation plan was developed. The ongoing health sector reform which focuses, in priority, on strengthening PHC services and the assistance from the government of Finland, generated favourable political, technical and financial circumstances for the development and implementation of the PAL strategy.

Health promotion in the Finnish shipping industry

In autumn 1997 a pilot project was started in Finland to develop methods for promoting the health of sailors. Four Finnish shipping companies, (4 cargo ships and 2 passenger-cruise ferries), with altogether 730 sailors participated in the project. Special attention was paid to individuals with health problems and those who generally did not take care of their own health or fitness. Three-quarters of the respondents saw their health as good and one fifth as fair. Thirty-four persons responded that their working capacity was poor. 154 sailors were selected into further physical fitness evaluations. The main task of the project team was to activate sailors to take care of their own health and well-being. The health-promoting activities were directed especially at those persons who needed it. Information lectures concerning healthier eating habits and meals were given. Anti-smoking and anti-alcohol drinking information was given. On board one cruise ferry a project was started on how to react as early as possible to alcohol abuse among seafarers. Courses on shore for sailors were arranged to improve their physical fitness and to increase their resting benefit between working periods at sea. The intervention time was one year. Information about smoking and alcohol led to reduced alcohol consumption. The sailors had started to exercise more often both on board ship and on shore. Those who had increased their physical exercise during free time more often found their own health and working ability to have improved than those who had not changed their exercise habits. It appeared that health intervention projects are really needed especially by older sailors. The results also showed that positive effects could be achieved in the fitness of sailors. Better fitness was good for their health and also increased the work safety.

Halothane and desflurane requirements in alcohol-tolerant and -nontolerant rats

On the basis of data implicating GABAA receptors in the effects of volatile general anaesthetics, we hypothesized that alcohol-, barbiturate-, and benzodiazepine-sensitive alcohol-nontolerant (ANT) rats would also be more sensitive than alcohol-tolerant (AT) rats to two clinical general anaesthetics with differing potencies, halothane and desflurane. The obtunding effect of halothane and desflurane on mature ANT (n = 17) and AT (n = 16) rats was assessed by the loss-of-righting reflex endpoint. ANT rats were significantly (P < 0.0001) more sensitive to the obtunding effects of both halothane and desflurane (ED50 = 0.45 +/- 0.03% atm for ANT vs 0.95 +/- 0.04% atm for AT and 2.16 +/- 0.17 vs 3.69 +/- 0.13% atm, respectively). The immobilization effect of halothane and desflurane was assessed with the tail clamp/withdrawal endpoint. ANT rats were more sensitive to the effects of halothane (ED50 = 1.10 +/- 0.08% atm for ANT vs 1.72 +/- 0.09% atm for AT; P < 0.0001) but not desflurane (ED50 = 6.25 +/- 0.25% atm for ANT vs 5.85 +/- 0.21% atm for AT). The data presented support the hypothesis that volatile anaesthetics interact with specific neuronal proteins (possibly GABAA receptors) and agree with recent hypotheses that different elements of the anaesthetic state are produced by separate sites or mechanisms.

'Eczema school' to improve compliance in an occupational dermatology clinic

From the beginning of 1990 a trained nurse has been employed at our Department of Dermatology to give information about skin care, allergen avoidance and skin protection to the patients. To find out the possible benefit obtained by this patient education, a questionnaire was sent out to 540 patients who had been diagnosed with an occupational skin disease established at the Department of Dermatology between 1985 and 1992. It is evident that direct comparison in this kind of longitudinal follow-up must be carried out with great criticism, since changes in patients' work exposure and socioeconomical situation during the follow-up time will also affect the prognosis. In this study, 424 patients returned the questionnaire, 252 who had been examined before 1990 and 172 later. According to the answers, it appeared that during the last 12 months, the majority (65%) had suffered from dermatitis, 13% from constant and 52% from periodic symptoms. However, when the diagnosis had been irritant contact dermatitis without allergens found, the prognosis was significantly better (p<0.008) among those who had received "extra education" and none had persistent dermatitis. Patients with contact allergy to metals or synthetic resins had also managed better, as compared to those who had received traditional treatment (p<0.002, p<0.003). Other factors such as personal motivation and possibilities for work reorganization were also important for the prognosis. 60% of patients were not initially aware of the decision given by the insurance companies, although 94% of their skin diseases had been accepted as occupational dermatoses. Generally, the patients were satisfied with the extra information given by the nurse.

A 5-year prospective clinical study of Astra Tech dental implants supporting fixed bridges or overdentures in the edentulous mandible

In a 5-year prospective clinical study, 155 endosseous implants were installed in the mandible anterior to the mental foramina in 33 edentulous patients (13 males and 20 females). Usually 6 implants were installed for fixed prostheses (FP), 13 patients with 77 implants, and 4 implants for overdentures (OD) with a Dolder bar, 20 patients with 78 implants. At the time of abutment connection 1 implant in 2 patients was found to be loose and removed. However, in both these patients overdentures were successfully placed on the remaining 3 implants. Narrow-beam radiography was used for radiological evaluation. The mean (SD) total marginal bone loss in 5 years was 0.48 (0.38) mm (0.36 (0.22) mm in the FP group and 0.56 (0.45) mm in the OD group). Very few complications were reported during the 5 years, most of them being related to the superstructures. The overall cumulative implant survival rate was 98.7% (100% in the FP group and 97.4% in the OD group). The survival rate of the superstructures was 100%. The present study has demonstrated that Astra Tech implants offer reliable and predictable medium-term support for fixed prostheses and overdentures in the edentulous mandible.

Intrathecal infusion of bupivacaine with or without morphine for postoperative analgesia after hip and knee arthroplasty

Postoperative pain after major orthopaedic operations can be controlled by continuous intrathecal administration of opioids or local anaesthetics. Effective intrathecal analgesia can be achieved through synergism of low doses of the two analgesic drugs and, possibly, less drug-related adverse effects. Therefore, we have evaluated the usefulness of a combined low-dose bupivacaine and morphine infusion in patients undergoing hip and knee arthroplasty. Spinal anaesthesia was induced in 55 ASA I-III patients with 0.5% bupivacaine 2 ml via a 28-gauge spinal catheter (L3-4 interspace) and 0.5-ml increments were given if needed. Intrathecal 24-h infusions consisted of bupivacaine 2 mg h-1 alone (n = 18), bupivacaine 1 mg h-1 alone (n = 18) or bupivacaine 1 mg h-1 combined with morphine 8 micrograms h-1 (n = 19). The interview after 3, 6, 12 and 24 h included assessment of pain at rest and on movement (VAS scale), occurrence of sensory and motor block and nausea/vomiting. Bupivacaine 1 mg h-1 combined with an infusion of morphine provided as good postoperative analgesia as bupivacaine 2 mg h-1, but motor block disappeared earlier (P = 0.01). Patients in the bupivacaine 1-mg h-1 group required more supplementary doses of oxycodone i.m. than the other groups (P = 0.04). Time to first oxycodone dose from the start of intrathecal infusion did not differ between groups. The frequency of nausea and vomiting was similar in all groups. In spite of this, antiemetic medication was required more often in the bupivacaine 1-mg h-1 group (possible because of opioid rescue medication). On the ward, one patient in the bupivacaine 2-mg h-1 group experienced a new increase in sensory block with concomitant hypotension. One patient in the same group had minor decubitus on the heel of the operated leg, probably because of prolonged motor block. We conclude that intrathecal infusion of a combination of bupivacaine 1 mg h-1 and morphine 8 micrograms h-1 produced adequate postoperative analgesia. Unfortunately, postoperative nausea and vomiting was a frequent disturbing adverse effect.

Propofol-induced ataxia and hypnosis in rat lines selected for differential alcohol sensitivity

An alcohol-sensitive rat line, selectively bred for high sensitivity to ethanol-induced motor impairment, also exhibits greater sensitivity to gamma-aminobutyric acid type A (GABAA) receptor agonists, such as benzodiazepines and barbiturates, than an alcohol-insensitive rat line. We have investigated whether this difference was also maintained for the most recent intravenous anaesthetic, propofol. Propofol (100 mg/kg, intraperitoneally) induced similar sleep times and produced identical plasma propofol concentrations in alcohol-sensitive and alcohol-insensitive rat lines. At lower doses (50 and 75, but not 25 mg/kg), propofol produced a greater motor impairment in a tilting plane test in alcohol-sensitive than alcohol-insensitive rats shortly after the injection. Binding of a convulsant, [35S]t-butylbicyclophosphorothionate, to cerebellar and cerebrocortical GABAA receptors in the presence of 2 microM GABA was similarly affected by low micromolar propofol concentrations in both rat lines, while in the absence of GABA, propofol was slightly less potent in the alcohol-sensitive than alcohol-insensitive line. These data indicate that alcohol-sensitive rats show transiently enhanced sensitivity to an ataxic, but not to a hypnotic dose of propofol, which cannot be explained by sensitivity differences to propofol in GABAA receptors determined in a binding assay using brain membrane homogenates.

Evaluation of the usefulness of intrathecal bupivacaine infusion for analgesia after hip and knee arthroplasty

Spinal anaesthesia in 47 ASA I-III patients was induced with 0.5% bupivacaine 2 ml via a 28-gauge spinal catheter (L3-4 interspace) and 0.5-ml increments were given if needed before or during hip or knee arthroplasty. Intrathecal 24-h infusions consisted of 0.5% bupivacaine 0.4 ml h-1 (2 mg h-1) (n = 12), 0.5% bupivacaine 0.2 ml h-1 (1 mg h-1) (n = 12) or saline (n = 11) (12 exclusions). Patients received oxycodone 0.1-0.14 mg kg-1 i.m. for rescue analgesia. Infusion of bupivacaine 2 mg h-1 provided significantly better postoperative analgesia (19 oxycodone doses per group in 24 h) compared with bupivacaine 1 mg h-1 (36 doses of oxycodone per group) and saline (52 doses per group) (P < 0.05). Five patients in the bupivacaine 2-mg h-1 group and none in the other groups had measurable sensory block 24 h after the infusion was started. Three patients in the bupivacaine 2-mg h-1 group, two with concomitant arterial hypotension, and one patient in the bupivacaine 1-mg h-1 group experienced an increase in block on the ward. The incidence of nausea and vomiting was similar in all groups. Although an effective analgesic, intrathecal infusion of bupivacaine 2 mg h-1 cannot be recommended for routine pain relief because of the risk of increasing spinal block. Technical problems (19%) also reduced the overall efficacy of the continuous intrathecal analgesic regimen.

Mortality among Finnish sea pilots 1956-85: a retrospective cohort study

The National Board of Navigation in Finland employed 942 sea pilots in 1956-85, during which time 262 of them died (SMR = 77, 95% CI = 68-86). The male population in southwest Finland served as control. The causes of deaths were collected from death certificates. The mortality rate for all cardiovascular diseases and lung cancer was lower among sea pilots than in the comparison population (SMR = 83, 95% = CI 69-97 and SMR = 67, 95% CI = 37-97) while for ischaemic heart diseases, it was similar to that of the population as a whole (SMR = 96, 95% CI = 77-115). Health selection due to ischaemic heart disease was seen in the lower mortality rates among young pilots who started work in 1956-85. Otherwise, the slightly higher rates may indicate a possibility of adverse health effects of sea piloting.

Comparison of parenteral diclofenac and ketoprofen for postoperative pain relief after maxillofacial surgery

Non-steroidal anti-inflammatory drugs (NSAID) effectively reduce the need for opioid analgesia after various types of surgery. The efficacy of diclofenac and ketoprofen to relieve pain after maxillofacial surgery was compared in the present study. In a randomized and double-blind fashion, 90 ASA I-II patients (16-60 yrs) were studied, divided into three groups: Thirty patients received 1.0 mg.kg-1 diclofenac i.v. after general anaesthesia induction, before surgical incision, and four hours later the same dose was given i.m. Thirty patients received ketoprofen 1.35 mg.kg-1 i.v. and i.m., as above, and a third group of 30 patients received a comparable volume of saline i.v. and i.m. The patients received supplemental analgesia using a patient controlled analgesia apparatus; the rescue medication consisted of 0.03 mg.kg-1 oxycodone i.v. (four-hour maximum dose was 0.4 mg.kg-1) during the 24-hour follow-up. The three groups were comparable regarding the type of maxillofacial surgery (osteotomies vs. soft tissue surgery). Overall, there was a lower need for i.v. oxycodone during the 24-hour period in the diclofenac group (269 doses) than in the ketoprofen group and in the saline group (388 doses, each) (P < 0.01). The significantly lower number of oxycodone administrations in the diclofenac group was a result of a distinguishable difference, particularly during the first four hours after surgery. There was no statistically significant difference in the incidence of side effects of the analgesic therapy between the three groups.

Technical problems and side effects associated with continuous intrathecal or epidural post-operative analgesia in patients undergoing hip arthroplasty

Fifty-five patients undergoing hip arthroplasty under spinal anaesthesia (4 ml of 0.5% plain bupivacaine) were randomized to receive post-operative analgesia either using an intrathecal or an epidural catheter. Associated technical problems and side effects were studied. In both groups per-operative analgesia was achieved with intrathecal 0.5% plain bupivacaine, 4 ml. In the intrathecal infusion group a bolus dose of 100 micrograms morphine was injected through a spinal 28 gauge catheter followed by a 24 h infusion of 200 micrograms morphine (8.3 micrograms h-1). In the epidural infusion group a bolus dose of 2 mg of morphine was injected before the epidural 24 h infusion was started (morphine 200 micrograms h-1 + 0.25% bupivacaine 4 ml h-1). There were 10 catheter failures (two could not be inserted) in the intrathecal group and one in the epidural group. Three epidural catheter infusions failed due to other technical problems. The number of side effects was 21 in the remaining spinal group (n = 20) and 18 in the 20 epidural group patients with successful infusions. One patient in the spinal catheter group developed postdural puncture headache. For post-operative pain relief the patients in the epidural group needed less supplementary intramuscular oxycodone (five doses/four patients) than the spinal group (17 doses/nine patients) (P < 0.05).

Effects of intrathecal clonidine on duration of bupivacaine spinal anaesthesia, haemodynamics, and postoperative analgesia in patients undergoing knee arthroscopy

Clonidine, an alpha-2-adrenergic agonist, may have a clinically relevant analgesic action but also a hypotensive action, when administered spinally. In this study, therefore, the analgesic and circulatory effects of intrathecal clonidine were studied in patients undergoing knee arthroscopy under spinal anaesthesia. Forty ASA I-II patients were randomly divided to two groups. One group received clonidine 3 micrograms.kg-1 mixed with 15 mg 0.5% bupivacaine and the other group an identical saline volume mixed with bupivacaine as above, in a double-blind fashion. Sensory analgesia, blood pressure, heart rate and sedation were followed during and after the operation. Oxycodone 0.14 mg.kg-1 i.m. or ketoprofen 100 mg p.o. was administered when needed. The duration of sensory analgesia (until regression of the block to L2) was longer in the clonidine group (mean 217 min) than in the control group (mean 160 min) (P < 0.05). Duration of motor blockade was also longer in the clonidine group (mean 215 min) compared to the control group (161 min) (P < 0.05). Mean arterial pressure and heart rate were significantly lower in the clonidine group compared to the control group. The clonidine patients needed fewer supplemental doses of oxycodone (8 doses) than those in the control group (16 doses) (P < 0.05). More patients in the clonidine group were sedated 3-6 h after the injection (P < 0.05). Addition of clonidine prolonged the bupivacaine spinal block. However, marked haemodynamic changes and sedation may limit the usefulness of intrathecal clonidine.

Intraarticular morphine for pain relief after knee arthroscopy performed under regional anaesthesia

Eighty patients scheduled to undergo knee arthroscopy were studied in random and double blind fashion. Spinal anaesthesia with hyperbaric 0.5% bupivacaine was selected for 40 overnight-in-patients. At the end of arthroscopy, 1 mg morphine or saline was injected intraarticularly. Local anaesthesia with 1% lidocaine plus adrenaline, was selected for another 40 out-patients. At the end of the arthroscopy either 1 mg morphine or saline was injected intraarticularly. As a rescue medication the spinal anaesthesia patients received oxycodone 0.14 mg kg-1 i.m. or ketoprofen 100 mg p.o. and the local anaesthesia patients received ketoprofen 100 mg p.o. The need for additional postoperative analgesic was almost similar in both spinal anaesthesia groups. The patients having local anaesthesia and given intraarticular morphine needed fewer doses of ketoprofen (22 doses) postoperatively than the control group (39 doses) (P < 0.05). Duration of analgesia was slightly longer after morphine than in the control group (ns). There was no difference between the morphine patients and the control patients in the two studies regarding the incidence of side effects. We conclude that postoperative analgesia in patients undergoing knee arthroscopy under local anaesthesia, but not under bupivacaine spinal anaesthesia, can be improved with a single intraarticular injection of 1 mg morphine.

Effect of late posture change on the level of spinal anaesthesia with plain bupivacaine

We studied 40 patients, 18-60 yr, undergoing orthopaedic surgery of the lower limb under spinal anaesthesia. A midline lumbar puncture was performed in the L3-4 interspace using a 27-gauge needle with the patient in the lateral horizontal position. Plain bupivacaine 3 ml at room temperature was injected. The cephalad level of analgesia was assessed by pinprick 60 min after injection of local anaesthetic, at the end of surgery and again after the patient was moved into bed. All patients had a segmental level of the block of L1-T5 at the beginning of the study. The upper half of the patient's body was then tilted to a 30 degrees head-up position. Segmental spread was subsequently assessed by pinprick at 5-min intervals for 30 min. In six of the 40 patients (15%), increased cephalad spread of spinal analgesia occurred. The mean time from induction of spinal anaesthesia was shorter in these six patients (mean 92 min, range 80-115 min) than in the patients whose block did not change or was decreasing during the 30-min test (mean 119 min, range 83-210 min) (P < 0.05). We conclude that the patient should remain in the supine horizontal position until recovery from the spinal block.

Effect of tropisetron, a 5-HT3 receptor antagonist, on analgesia and nausea after intrathecal morphine

We have studied the effect of tropisetron, a 5-HT3-receptor antagonist, on postoperative nausea, vomiting and pain in 54 patients, aged 50-83 yr, after major hip or knee surgery. The patients were given subarachnoid injection of plain 0.5% bupivacaine, mixed with preservative-free morphine 0.3 mg, for surgical and postoperative analgesia. In a double-blind fashion, either tropisetron 5 mg (1 mg ml-1) or saline 5 ml was injected i.v. 30 min after spinal administration of bupivacaine and morphine. The number of patients needing i.m. oxycodone for pain relief, the total number of oxycodone doses or the mean time to the first i.m. oxycodone administration did not differ significantly between the two groups. The number of patients who became nauseated or vomited during the observation period did not differ significantly between groups. Seventeen patients had nausea and 11 vomited in the tropisetron group, compared with 20 and 13, respectively, in the control group during the first 24 h.

Comparison of intrathecal fentanyl infusion with intrathecal morphine infusion or bolus for postoperative pain relief after hip arthroplasty

The purpose of this study was to compare an intrathecal fentanyl infusion with intrathecal morphine infusion or bolus for postoperative pain relief after hip arthroplasty. Sixty patients scheduled to undergo hip joint replacement were studied. A 28-gauge (n = 12) or a 22-gauge (n = 48) spinal catheter was introduced through the L3-4 interspace, 3-4 cm into the subarachnoid space. Spinal anesthesia was induced with 2 mL of plain 0.5% bupivacaine; additional bupivacaine was given in 0.5-mL increments, as required. Patients were given in a random and double-blind fashion either 0.5 mL of saline as a single bolus, followed by an infusion of 120 micrograms of fentanyl in 24 h (Group I, n = 20), 0.5 mL of saline, followed by an infusion of 200 micrograms of morphine in 24 h (Group II, n = 20), or 200 micrograms of morphine as a single bolus, followed by an infusion of 3 mL of saline in 24 h (Group III, n = 20) through the intrathecal catheter. In Group I, supplementary intramuscular (IM) opioid was required more often (46 doses) than in Group II (18 doses) in 24 h (P < 0.01). The number of patients given IM administered opioid was larger in Group I (18 patients) than in Group II (8 patients) (P < 0.01). The IM opioid was requested sooner in Group I (18 patients, mean 480 min) after the intrathecal injection than in Group III (13 patients, mean 786 min) (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Is there need for change of health examinations for sea pilots?

Sea pilots must be capable of carrying out their work in all situations. Thus, they must not have any disease or defect, that could impair their job performance. By periodic medical examinations attempts are made to ensure their working capacity. In most countries these examinations are carried out by a general practitioner and they include only few if any objective laboratory tests. The aim of the present investigation was to study the effectiveness of the periodic medical examinations to find out in the population of pilots examined persons with health risks, especially risks for cardiovascular diseases. All the pilots examined were over 45 years old (n = 135, response rate 88%). Self-evaluation of health was carried out by a questionnaire. Blood analyses were made and chest X-ray as well as exercise-ECC were taken. The most common subjective symptoms concerned musculoskeletal and gastrointestinal systems; sleep disturbances were also quite common. The three most frequent diseases diagnosed earlier by a doctor were musculoskeletal and gastrointestinal diseases, and arterial hypertension. About 24% of pilots had a lower physical working capacity than predicted. The body mass index indicated at least 11% overweight in half of the cases. At exercise-ECG four pilots appeared to have an ischaemic heart disease and additionally eleven pilots had abnormal ECG. Over 80% of pilots had a serum cholesterol value higher than 5 mmol/l, and serum triglyceride values exceeded the normal value of 2.0 mmol/l in every fourth case. Serum glutamyl transaminase was pathological in over 20% of the cases, and serum glucose level in 8%. The findings by routine physical examinations were very few consisting of stiffness in musculoskeletal system, two cases of elevated blood pressure, two heart murmurs, varicose veins etc. In two cases an inguinal hernia was suspected. The current periodic health examinations does not seem to effectively prevent a person with possible health defect from working as a sea pilot. More objective tests must be included in these examinations and more attention should be paid to prevention of overweight, effective treatment of musculoskeletal symptoms, improving physical working capacity and helping pilots to manage their psychic stress.

Tarnishing in vivo of Ag-Pd-Cu-Zn alloys

Pre-polished specimens of four Ag-Pd-Cu-Zn alloys have been tested for tarnishing while embedded in full acrylic dentures for from six to eight months in vivo. The results have been compared with those from previous immersion tests using 2% Na2S solutions. In both types of tests, a multiphase alloy consisting of a Pd-Cu-Zn-rich compound in a Ag-rich matrix displayed less corrosion and tarnish resistance than did alloys with compositions similar to the Pd-Cu-Zn-rich compound or the Ag-rich matrix. It is suggested that the presence of local microgalvanic cells due to chemical inhomogeneities caused the observed susceptibility to tarnishing. Sulfur was detected by a microprobe in the tarnish layer developed in the oral cavity. The discoloration on this multiphase alloy covered the interdendritic areas with short distances between the chemical inhomogeneities. This microstructural location was somewhat different from the many dark spots created predominantly on Ag-rich areas during in vitro testing. This difference is most likely due to dissimilar conditions with regard to sulfide ion concentrations, the presence of protein films, and the length of exposure time.

An electrochemical and multispectroscopic study of corrosion of Ag-Pd-Cu-Au alloys

Corrosion of a multi-phase Ag-Pd-Cu-Au-based commercial dental casting alloy and a Cu-Pd-rich and Ag-rich single-phase alloy was studied by open-circuit potential measurements, atomic absorption spectrometry, and electron spectroscopy. The alloys were immersed in an artificial saliva solution for 24 hr while the open-circuit potentials of the alloys were measured. The potentials were found to stabilize at certain levels after a steep rise during the first hours of the experiment. Cu was found to dissolve considerably from the Cu-Pd-rich alloy, with simultaneous enrichment of Pd in the surface layer of the alloy. Ag dissolved slightly from the Ag-rich alloy, but both Cu and Ag were found to dissolve from the multi-phase alloy. Neither Pd nor Au dissolved from any of the alloys studied.

In vitro cytotoxicity of Ag-Pd-Cu-based casting alloys

The cytotoxicity and its correlation to alloy composition, structure, corrosion, as well as galvanic coupling was studied with 12 Ag-Pd-Cu-type alloys, one conventional type III gold alloy and pure Ag, Cu, and Pd. The agar overlay cell culture technique was used. Single phase binary CuPd alloys were only slightly cytotoxic below a Cu content of 30 wt%. The tested multiphase alloys were all toxic, but no correlation between toxicity and Cu content could be observed. Solid solution annealing increased the cytotoxicity of a multiphase alloy. Exposure of a single phase alloy to an artificial saliva for 1 week prior to the test decreased its cytotoxicity significantly. Galvanic coupling of the alloys through an outer copper wire decreased their cytotoxicity.

The biocompatibility of a dental Ag-Pd-Cu-Au-based casting alloy and its structural components

The biocompatibility of type III casting gold alloy, an Ag-Pd-Cu-Au-based dental casting alloy and its two main structural components, a CuPd-rich and an Ag-rich phase, was studied after subcutaneous implantation for 7 weeks in 20 guinea pigs. The Ag-Pd-Cu-Au alloy was surrounded by a capsule of immature collagen with fibroblasts and an increased vascular supply. The CuPd-rich component induced and maintained an acute inflammation with highly vascularized granulation tissue. The tissue reaction to the Ag-rich component and the Au-based alloy was slight. Ten of the guinea pigs were sensitized to PdCl2 prior to the implantation period, but this caused no enhanced tissue reaction, except for an increase in the number of mast cells around three of the alloys.

Tarnish and corrosion of a commercial dental Ag-Pd-Cu-Au casting alloy

The correlation between microstructure, tarnish, and corrosion behavior of a commercial dental Ag-Pd-Cu-Au casting alloy after various heat treatments was studied. The attacked structural components were identified by comparing SEM micrographs with light optical micrographs taken after exposure of the alloy to a 2% Na2S solution and after dynamic polarization in de-aerated artificial saliva. The characteristic dynamic polarization curves for the alloy after the heat treatments were established. The results were verified by analogous testing of two experimental alloys with compositions similar to those of the analyzed components in the commercial alloy annealed at 600 degrees C for seven wk. The matrix of the commercial alloy was decomposed, according to the heat treatments, into varying proportions of a tarnish- and corrosion-resistant Cu- and Pd-rich component (A) and a nonresistant Ag-rich component (B). The presence of A considerably increased the tarnish rate of B, due to galvanic coupling. Age-hardening of the alloy increased the proportion of the tarnish- and corrosion-prone component B.

The structure of a commercial dental Ag-Pd-Cu-Au casting alloy

The structure of a commercial dental Ag-Pd-Cu-Au casting alloy has been studied by microprobe and X-ray diffraction analyses after various heat treatments. The composition of phases in equilibrium was established. After being annealed at 400 degrees C, 500 degrees C, and 600 degrees C for seven wk, the alloy consisted of three phases: a Cu- and Pd-rich fee phase (alpha 1) with alpha = 0.372nm, a Ag-rich matrix (alpha 2) with alpha = 0.399nm, and an ordered CsCl-type bcc PdCu phase with alpha = 0.296nm. The PdCu phase was not observed above 600 degrees C, and the proportion of the alpha 1 phase decreased sharply above 700 degrees C. After being annealed at 900 degrees C, the alloy matrix was partly decomposed at the Cu-enriched grain boundaries. The decomposed areas grew into the grain interior during subsequent precipitation hardening. No segregation of Au was detected after casting, and the element was evenly distributed throughout the alloy structure after all heat treatments.

Absence of echocardiographic abnormalities of the anterior mitral valve leaflet in rheumatoid arthritis

Thirty-five consecutives patients with classic or definite rheumatoid arthritis underwent echocardiography to evaluate the motion of the anterior mitral valve leaflet. Adequate echocardiograms were obtained in 31 patients. All 31 patients showed normal valve motion and a normal EF slope. If meticulous technique was not observed, a falsely low value for the EF slope was obtained and a normal slope was found when the method was improved. This study shows that echocardiographic abnormalities of the anterior mitral valve leaflet rarely, if ever, occur in patients with rheumatoid arthritis, provided that careful attention to recording method is observed.