Effect of the Advanced Trauma Life Support program on medical students'' performance in simulated trauma patient management

The effect of exogenous transforming growth factor beta (TGF-beta) on Mycobacterium bovis BCG-induced tumor necrosis factor alpha (TNF-alpha) production by human mononuclear cells was studied. It was found that TNF-alpha production by human cells stimulated with BCG was significantly inhibited by TGF-beta. The specificity of the observed inhibition was demonstrated, since the addition of an anti-TGF-beta neutralizing monoclonal antibody completely reversed the inhibitory effect. Furthermore, the suppressive effect of TGF-beta on TNF-alpha secretion in this system was not due to a direct cytotoxic effect, since cell viability was comparable in the presence or absence of TGF-beta. Interestingly, our results demonstrated comparative suppressive effects of TGF-beta and interleukin-10 on BCG-induced TNF-alpha secretion. Together, the data demonstrate, for the first time, that TGF-beta inhibits BCG-induced TNF-alpha secretion by human cells.     

Cognitive decline following stroke: a comprehensive study of cognitive decline following stroke

Many patients with Hodgkin's and non-Hodgkin's lymphoma (NHL) can be cured today with combination chemotherapy and/or radiotherapy. However, for patients with suboptimal responses to initial therapy or for patients with refractory or relapsed disease, salvage therapy alone is usually inadequate to achieve long-term survival. High-dose chemotherapy (HDC) with stem cell rescue has emerged as the treatment of choice for such patients as long-term disease-free survival can be obtained in a significant number of these patients. Dose-intensive treatment has been equivocally shown effective for certain patients with Hodgkin's and NHL, whether or not chemosensitivity is shown before transplant. However, HDC has yet to consistently yield durable responses in patients with indolent NHL. Additionally, perhaps the International Prognostic Index can now help identify "high-risk" NHL patients who may benefit from investigative approaches such as frontline HDC.     

Life reflection: A social–cognitive analysis of life review.

Life review and reminiscence are 2 concepts used to describe the phenomenon of people reflecting on their lives. Rather than used synonymously, these 2 concepts need to be distinguished on the basis of a social–cognitive process analysis. For that purpose, life reflection is introduced as a new term. Evidence shows that life reflection is a social–cognitive process that begins in adolescence and continues across the life span. It serves different functions across the life span, but at all ages it contributes to self-insight and a self-critical perspective. Striving for new insights about oneself and about life in general is challenging and taxing. Reflecting together with a trusted person, thus, may facilitate the process. A study testing and supporting some of these propositions is reported. Results are discussed in the context of lifespan theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Older adults' decoding of emotions: Role of dynamic versus static cues and age-related cognitive decline.

Although age-related deficits in emotion recognition have been widely explored, the nature and scope of these deficits remain poorly understood. We conducted two experiments to examine whether these deficits are less pronounced when older adults evaluate dynamic compared with static images, and second, whether age-related cognitive decline exacerbates these deficits. Our results suggest that age-related cognitive decline exacerbates older adults' deficits in detecting anger, but only from static faces. Furthermore, older adults do not show emotion recognition deficits when evaluating global emotions from dynamic images of faces. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Paediatric life support. An advisory statement by the Paediatric Life Support Working Group of the International Liaison Committee on Resuscitation

This document reflects the deliberations of ILCOR. The epidemiology and outcome of paediatric cardiopulmonary arrest and the priorities, techniques and sequence of paediatric resuscitation assessments and interventions differ from those of adults. The working group identified areas of conflict and controversy in current paediatric basic and advanced life support guidelines, outlined solutions considered and made recommendations by consensus. The working group was surprised by the degree of conformity already existing in current guidelines advocated by the American Heart Association (AHA), the Heart and Stroke Foundation of Canada (HSFC), the European Resuscitation Council (ERC), the Australian Resuscitation Council (ARC), and the Resuscitation Council of Southern Africa (RCSA). Differences are currently based upon local and regional preferences, training networks and customs, rather than scientific controversy. Unresolved issues with potential for future universal application are highlighted. This document does not include a complete list of guidelines for which there is no perceived controversy and the algorithm/decision tree figures presented attempt to follow a common flow of assessments and interventions, in coordination with their adult counterparts. Survival following paediatric prehospital cardiopulmonary arrest occurs in only approximately 3-17% and survivors are often neurologically devastated. Most paediatric resuscitation reports have been retrospective in design and plagued with inconsistent resuscitation definitions and patient inclusion criteria. Careful and thoughtful application of uniform guidelines for reporting outcomes of advanced life support interventions using large, randomized, multicenter and multinational clinical trials are clearly needed. Paediatric advisory statements from ILCOR will, by necessity, be vibrant and evolving guidelines fostered by national and international organizations intent on improving the outcome of resuscitation for infants and children worldwide.     

Major renal lacerations with a devitalized fragment following blunt abdominal trauma: a comparison between nonoperative (expectant) versus surgical management

Of 43 patients who sustained blunt trauma resulting in a major renal laceration with a devitalized fragment 27 had coexisting intraperitoneal and renal injuries for which emergency celiotomy and repair of the nonurological trauma were done. Management of the renal injuries consisted of simultaneous renal exploration with 23% urological morbidity in 13 cases or expectant management with 85% urological morbidity in 14 cases. In this latter patient population infected urinomas and perinephric abscesses seeded from coexisting enteric or pancreatic injuries were the most common complication (57%). The remaining 16 of the 43 patients sustained renal lacerations without associated intraperitoneal injuries and all were managed expectantly with 38% urological morbidity. These findings suggest that renal exploration and surgical repair significantly improve the prognosis only in patients with simultaneous intraperitoneal and renal injuries (p < 0.01).     

Development and validation of a brief self-report measure of trauma exposure: The Trauma History Screen.

Although information about individuals' exposure to highly stressful events such as traumatic stressors is often very useful for clinicians and researchers, available measures are too long and complex for use in many settings. The Trauma History Screen (THS) was developed to provide a very brief and easy-to-complete self-report measure of exposure to high magnitude stressor (HMS) events and of events associated with significant and persisting posttraumatic distress (PPD). The measure assesses the frequency of HMS and PPD events, and it provides detailed information about PPD events. Test–retest reliability was studied in four samples, and temporal stability was good to excellent for items and trauma types and excellent for overall HMS and PPD scores. Comprehensibility of items was supported by expert ratings of how well items appeared to be understood by participants with relatively low reading levels. In five samples, construct validity was supported by findings of strong convergent validity with a longer measure of trauma exposure and by correlations of HMS and PPD scores with posttraumatic stress disorder (PTSD) symptoms. The psychometric properties of the THS appear to be comparable or better than longer and more complex measures of trauma exposure. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predictors of age-associated decline in maximal aerobic capacity: a comparison of four statistical models

Studies assessing changes in maximal aerobic capacity (VO2 max) associated with aging have traditionally employed the ratio of VO2 max to body weight. Log-linear, ordinary least-squares, and weighted least-squares models may avoid some of the inherent weaknesses associated with the use of ratios. In this study we used four different methods to examine the age-associated decline in VO2 max in a cross-sectional sample of 276 healthy men, aged 45-80 yr. Sixty-one of the men were aerobically trained athletes, and the remainder were sedentary. The model that accounted for the largest proportion of variance was a weighted least-squares model that included age, fat-free mass, and an indicator variable denoting exercise training status. The model accounted for 66% of the variance in VO2 max and satisfied all the important general linear model assumptions. The other approaches failed to satisfy one or more of these assumptions. The results indicated that VO2 max declines at the same rate in athletic and sedentary men (0.24 l/min or 9%/decade) and that 35% of this decline (0.08 l . min-1 . decade-1) is due to the age-associated loss of fat-free mass.     

Use it or lose it: Engaged lifestyle as a buffer of cognitive decline in aging?

Data from the Victoria Longitudinal Study were used to examine the hypothesis that maintaining intellectual engagement through participation in everyday activities buffers individuals against cognitive decline in later life. The sample consisted of 250 middle-aged and older adults tested 3 times over 6 years. Structural equation modeling techniques were used to examine the relationships among changes in lifestyle variables and an array of cognitive variables. There was a relationship between changes in intellectually related activities and changes in cognitive functioning. These results are consistent with the hypothesis that intellectually engaging activities serve to buffer individuals against decline. However, an alternative model suggested the findings were also consistent with the hypothesis that high-ability individuals lead intellectually active lives until cognitive decline in old age limits their activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of the Trauma Play Scale: Comparison of children manifesting a history of interpersonal trauma with a normative sample.

The purpose of this study was the continuation in the development of the Trauma Play Scale through the addition of a normative sample. The scale is an observation-based assessment designed to be used by raters to detect differences in play therapy behaviors of children who have a history of trauma versus children with no known history of trauma. The scale is used to measure posttraumatic play behaviors (intense play, repetitive play, play disruptions, avoidant play, and negative affect) of children, via video-recorded play therapy sessions, at 5-min intervals. Percentage agreement and correlation estimates of interrater reliability suggested that raters were able to achieve consensus and consistency in their ratings. Statistical analyses indicated the Trauma Play Scale has a high degree of discriminant validity. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Too much of a good thing: Underprovision versus overprovision of partner support.

We examined whether support underprovision (receiving less support than is desired) and support overprovision (receiving more support than is desired) should be examined as qualitatively distinct forms of inadequate support in marriage. Underprovision of partner support, overprovision of partner support, and marital satisfaction were assessed 5 times over the first 5 years of marriage in a sample of newlywed husbands and wives (N = 103 couples), and were analyzed via actor-partner interdependence modeling (APIM) and growth curve analytic techniques. Increases in underprovision and overprovision of support were each uniquely associated with declines in marital satisfaction over the first 5 years of marriage; however, overprovision of support was a greater risk factor for marital decline than underprovision. Further, when examining support from a multidimensional perspective, overprovision was at least as detrimental, if not more detrimental, than underprovision for each of 4 support types (i.e., informational, emotional, esteem, and tangible support). The present study is the first to examine the utility of differentiating between underprovision and overprovision of partner support. Theoretical, empirical, and clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of life following third molar removal: a patient versus professional perspective

We report a case of pleomorphic adenoma with extensive squamous metaplasia in the palate of a 52-year-old Chinese man. The dimensions of the tumor were 15 x 13 x 13 mm. More than 95% of the epithelial element in the tumor was composed of sheets of squamous cells with cyst formation. The pathogenesis, potential diagnostic pitfalls, proliferative activity and cytokeratin expression of this tumor are discussed.     

The effects of stress and trauma on brain and memory: a view from developmental cognitive neuroscience

Many aspects of brain development depend on experience. Because the major macro-morphological events of brain development occur over the first 2-3 years of postnatal life, this time period can be considered both a period of opportunity as well as a period of vulnerability. In this paper we describe how experience with stress early in life can have a negative impact on certain aspects of brain development, and specifically, those neural circuits that underlie memory. We also describe the effects of traumatic events on the development of the neural basis of memory. In support of our argument, we review the literature on brain, stress, and memory in the context of development. Based on this review, we suggest that the developing brain is particularly vulnerable to the harmful physiological effects of stress, which in turn has the potential to lead to impairments in memory. Unfortunately, there are few empirical data that directly address this hypothesis. In this context we offer a number of suggestions for future research.     

Ankle fracture classification: a comparison of reliability of three X-ray views versus two

Our hypothesis was that malleolar ankle fractures could be classified with two radiographic views as reliably as with three views. Four different observers independently evaluated 99 sets of ankle radiographs. The examiners classified the ankle fractures by using both the Lauge-Hansen and Danis-Weber systems. The interobserver and intraobserver variations were analyzed by kappa statistics. With regard to intraexaminer reliability, the examiners demonstrated excellent accord in classifying the fractures in the Danis-Weber system with either three views or two views. The kappa values were comparable. In the Lauge-Hansen system, three examiners demonstrated excellent accord and one examiner demonstrated good accord in classifying the fractures. Similar kappa values were generated when examiners classified fractures with either three views or two views. With regard to interexaminer reliability, good to excellent accord was demonstrated overall among the four examiners when they used the Danis-Weber system with either three views or two views. The examiners were in good agreement when they used the Lauge-Hansen system. Similar kappa values were generated whether the examiners used three views or two views. Three radiographic views are usually ordered for evaluation of an acute ankle injury. Previous studies have shown that only two views are needed for diagnosis of a malleolar ankle fracture. This study demonstrates that malleolar ankle fractures can be classified with two views, lateral or mortise, with a reliability as good as that achieved with three views. The best agreement is achieved with lateral and mortise views.     

Early detection of cognitive decline in higher cognitively functioning older adults: Sensitivity and specificity of a neuropsychological screening battery.

The sensitivity and specificity of a neuropsychological screening battery designed to determine early cognitive decline in the high functioning elderly are presented. The battery is composed of 4 standard neuropsychological tests assessing cognitive domains commonly effected in early stages of CNS disease. Initial validation data were gathered by applying cutoff scores derived from published or submitted normative data to test data on 2 groups of elderly, higher cognitively functioning individuals: a sample of 45 elderly individuals diagnosed with 1 of 5 target disorders, and a sample of 61 independent elderly. Cutoff scores were identified that produce high rates of correct classification and a range of sensitivity and specificity. The suggested neuropsychological test battery classifies Ss as having a high, moderate, or low probability of cognitive impairment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prostaglandin E2 for cervical ripening: a randomized comparison of Cervidil versus Prepidil

OBJECTIVE: Our purpose was to compare the efficacy and safety of two standardized preparations of prostaglandin E2, Prepidil and Cervidil, for ripening of the cervix and initiation of labor. STUDY DESIGN: This was a prospective randomized study. Subjects in whom induction of labor was indicated were randomly assigned to receive either Prepidil (n = 36), an intracervical prostaglandin E2 gel, or Cervidil (n = 37), a controlled-release hydrogel pessary, as a cervical ripening agent. Inclusion criteria included (1) a Bishop score of < or = 7, (2) a cervix < 4 cm dilated, and (3) < or = 2 cm of cervical dilatation if effacement was > 70%. Each agent was administered according to the manufacturer's recommendations. RESULTS: There was no difference in Bishop scores between the two groups at the completion of the ripening process. The following mean times were shorter for the pessary group than for the gel group: (1) insertion of the ripening agent to vaginal delivery (20.6 vs 26.4 hours, p = 0.017), (2) time to achieve cervical ripening (11.1 vs 15.2 hours, p < 0.001), (3) time to achieve active labor (18.3 vs 25.5 hours, p = 0.019), and (4) hospital stay (3.7 vs 4.4 days, p = 0.03). Labor was initiated without the use of oxytocin in 24% of patients in the pessary group versus 3% of those in the gel group (p = 0.014). CONCLUSION: Both prostaglandin E2 agents are effective in achieving cervical ripening; however, the controlled-release pessary achieves ripening over a shorter time period. Furthermore, because time to achieve vaginal delivery and length of stay are shorter, the use of oxytocin is less frequent, and there is no increase in complications, the overall cost is expected to be less with the use of Cervidil as compared with Prepidil.