Deep brain stimulation for essential tremor

We examined the effects and safety of deep brain stimulation (DBS) as a treatment for essential tremor (ET). Ten ET patients with disabling medication-refractory tremor underwent stereotactic implantation of a DBS lead in the left Vim thalamic nucleus and completed a 6-month follow-up. The Clinical Tremor Rating Scale and disability assessments were performed at baseline, 1-, 3-, and 6-month follow-up. There were significant improvements in dressing, drinking, eating, bathing, and handwriting as reported by the subjects. Tremor severity, writing, pouring, and spiral and line drawing were significantly improved as rated by the examiner. Improvements persisted through the 6-month follow-up period. Although global disability significantly lessened in the group as a whole, one subject with hand-finger tremor accentuated by writing had no change in disability status. In this 6-month open-label study, DBS was effective and safe in reducing tremor and functional disability in ET.     

Finite element modeling of transient heat transfer and microstructural evolution in welds: Part II. Modeling of grain growth in austenitic stainless steels

During welding, structures are subjected to localized heating and cooling cycles, as described in Part I.[1] A mathematical model is proposed to determine the metallurgical changes that occur in austenitic stainless steel due to the welding thermal cycle. The proposed kinetic model computes the austenite grain growth as a function of time and temperature. It is based on a Zener pinning grain growth model. The results obtained indicate that the model is in good agreement with the experimental data reported in the literature. Furthermore, it was observed that rewriting the kinetic constant in the grain growth equation as a function of the peak temperature led to improved results for the majority of the cases examined.     

Antiretroviral drugs as a public health intervention for pregnant HIV-infected women in rural South Africa: an issue of cost-effectiveness and capacity

OBJECTIVE: To estimate cost-effectiveness and capacity requirements for providing antiretroviral drugs to pregnant HIV-infected women in rural South Africa. SETTING: Hlabisa health district, where HIV prevalence among pregnant women was 26.0% in 1997. METHODS: Calculation of the number of paediatric HIV infections averted under three scenarios, and their cost. No intervention was compared with scenario A (zidovudine delivered within current infrastructure), scenario B (zidovudine delivered through enhanced infrastructure), and scenario C (short-course zidovudine plus lamivudine delivered through enhanced infrastructure). Cost-effectiveness was defined as cost per infection averted and cost per potential life-year gained. Capacity was determined in terms of staff and infrastructure required to effectively implement the scenarios. RESULTS: With no intervention, 657 paediatric HIV infections were projected for 1997. In scenario A this could be reduced by 15% at a cost of US$ 574 825, in scenario B by 42% at US$ 1520770, and in scenario C by 47% at US$ 764901. In scenario C, drugs accounted for 76% of costs, whereas additional staff accounted for 18%. Cost per infection averted was US$ 2492 and cost per potential life-year gained (discounted at 3%) was US$ 88. Cost of scenario C was equivalent to 14% of the 1997 district health budget. At least 12 extra counsellors and nurses and one laboratory technician, together with substantial logistical and managerial support, would be needed to deliver an effective intervention. CONCLUSION: Although antiretrovirals may be relatively cost-effective in this setting, the budget required is currently unaffordable. Developing the capacity required to deliver the intervention would pose both a major challenge, and an opportunity, to improve health services.     

Prostate surgery: a communication challenge

Many patients requiring prostate surgery experience a lack of interest from health-care staff in relation to their views and opinions. Information offered to patients who have undergone prostate surgery is often inadequate as a result of poor communication by health staff. Nurses need to understand the priorities of their patients and use this information to inform the way in which advice is given.     

Hereditary neurocutaneous angiomatosis. Report of four cases

The authors report the coexistence of vascular nevi (hemangiomas and arteriovenous malformations (AVMs) of the skin) with AVMs and venous malformations of the brain in male siblings from two related but nonconsanguineous families of three generations. The proband, his siblings, parents, aunts, uncles, and cousins were examined, underwent magnetic resonance (MR) imaging and MR angiography, and when appropriate, cerebral angiography. A father had vascular nevi and a mother, his sister, had an azygos anterior cerebral artery. No other cutaneous or cerebrovascular malformations were present in the parents. Each of the two families had two boys and one girl, 9 to 18 years of age. All the children had vascular nevi and all of the boys had coexisting cerebrovascular malformations: AVMs in three, and a venous malformation in another. One boy had three cerebral AVMs. Two boys had a cerebral hemorrhage, and one also had focal motor seizures. The skin lesions were not those of the Sturge-Weber-Dimitri, Rendu-Osler-Weber, or Wybum-Mason syndromes. The association of cutaneous and cerebrovascular malformations was seen only in males in these families. but females have also been reported in the literature. The results obtained in these families and three other families reported from Western and Central Europe indicate that the association of cerebral and cutaneous vascular hamartomas constitutes a distinct, hereditary clinicopathological entity with autosomal dominant inheritance and variable penetrance. The clinical manifestations of this syndrome are visible, painful vascular nevi, epilepsy, cerebral hemorrhage, and focal neurological deficits. The preponderance of male patients with the full expression of the syndrome suggests a possible hormonal influence on the expression of the gene.     

X-ray microtomography (microCT) of the progression of sulfate attack of cement paste

High-resolution X-ray computed tomography (i.e., microCT or microtomography) was used to study the sulfate attack of cylinders of Type I cement paste cast with water-cement (w/c) ratios of 0.45, 0.50 and 0.60. Damage levels in samples exposed to a Na₂SO₄ solution with 10,000 ppm sulfate ion concentration were qualitatively rated from 0 (no damage) to 4 (extreme damage) based upon visual examination of the samples' exteriors and microtomography of the samples' interiors. The greater the w/c ratio, the more rapid the onset of sulfate damage. The corners of the cylinders appeared to be particularly susceptible to spalling, and damage may have continued into the cement paste by formation of subsurface cracks.     

The lead dioxide electrode

The recent literature dealing with the redox mechanism of the lead-acid cell positive electrode is reviewed. The basis electrochemistry of lead dioxide in its various polymorphic modifications and states of subdivision is considered in relation to the important aspects of electrode technology of which the major industrial application of the material is the conventional lead-acid cell. The proposed mechanism of the reduction (discharge) of lead dioxide in various acidic solutions are considered in relation to the present state of electrode kinetic theory. The reverse reaction by which lead dioxide is formed and the parasitic intrusion of the self discharge are dealt with as a precursor to the total cyclic process. It is concluded that in a number of respects the mechanisms proposed do not adequately represent the totality of the experimental observations. Such shortcomings are emphasized and extensions to present research are proposed.     

Coupling of dry matter and nitrogen accumulation in ryegrass

The logistic model has proven very useful in relating dry matter production of warm season perennial forage grasses to applied nitrogen. A recent extension of the model coupled dry matter and plant N accumulation through a common response coefficient c. The objective of this analysis was to apply the extended logistic model to cool season Gulf annual ryegrass (Lolium multiflorum Lam.) and to establish a common response coefficient c between accumulation of dry matter and plant N. Analysis of variance established the validity of this hypothesis. The model accurately described response of dry matter, plant N removal, and plant N concentration to applied N, with an overall correlation coefficient of 0.9954. Furthermore, the model closely described the relationship between yield and plant N removal, as well as between plant N concentration and plant N removal. The logistic equation is well-behaved and simple to use on a pocket calculator. It can be used to estimate yields and plant N removal in evaluation of agricultural production and environmental quality.