Out of the earthquake. Coping with cataclysmic change

Diagnosis of developmental speech and language disorders in accordance with the ICD-10 is to be based on the psychometric assessment of speech and language performance. In the present study the clinical validity of the Heidelberger Sprachentwicklungstest (HSET) for diagnosing expressive language disorders was assessed by comparing HSET subtest results for 92 children aged 4 to 10 years who had various speech and language disorders with the children's scores on another language test, a cognitive test and clinical findings. The HSET scores differed considerably from the clinical ratings of the severity of the language disturbance. The correlations between the HSET scores and the score on the other language test was also low. Although the correlations of the HSET scores with the performance IQ was low, the correlations with the verbal IQ were high. The implications of these findings for the use of the HSET in diagnosing children with language impairments are discussed.     

Enantioselective antiplatelet actions of nipecotamides

This investigation retrospectively examined changes in marital satisfaction following stroke. The relationship between such changes and other pertinent factors were also examined, including severity of aphasia, knowledge of aphasia, number of months after stroke, and length of the marriage. The subjects were 40 spouses of patients with aphasia grouped according to severity of the aphasia (mild, moderate, severe). Spouses completed two different measures of marital satisfaction--the Marital Satisfaction Scale (MSS) and the Marital Comparison Level Index (MCLI). These measures were completed in both a prestroke (retrospective reporting) and a poststroke format to allow for change to be assessed. In addition, a Knowledge of Aphasia questionnaire was completed by the normal spouses to evaluate their understanding of the disorder of aphasia. There was a significant difference between prestroke and poststroke scores on both the MSS and the MCLI, indicating a lower level of satisfaction following the stroke. The amount of change between prestroke and poststroke MSS and MCLI scores was not related to either number of months poststroke or number of years married. Although there was no relationship between changes in prestroke and poststroke scores on the MCLI and Knowledge of Aphasia scores, there was a significant correlation between changes in these scores on the MSS and Knowledge of Aphasia scores. Hence, the more knowledge spouses had regarding aphasia, the less the negative impact the stroke had on marital satisfaction, as measured by the MSS. Results are discussed in terms of the interdisciplinary treatment needs of aphasic patients and the implications for future investigations.     

Effect of preoperative supplementation with alpha-tocopherol and ascorbic acid on myocardial injury in patients undergoing cardiac operations

Augmentation of antioxidant defenses may help protect tissues against ischemia-reperfusion injury associated with operations involving cardiopulmonary bypass. In this study we examined the effect of pretreating patients with alpha-tocopherol (vitamin E) and ascorbic acid (vitamin C) or placebo on injury to the myocardium. Seventy-six subjects undergoing elective coronary artery bypass grafting participated in a prospective, double-blind, placebo-controlled randomized trial, receiving either placebo or both 750 IU dl-alpha-tocopherol per day for 7 to 10 days and 1 gm ascorbic acid 12 hours before the operation. Plasma alpha-tocopherol concentrations, raised fourfold by supplementation, fell by 70% after the operation in the supplemented group and to negligible levels in the placebo group. There were no significant differences between the groups with respect to release of creatine kinase MB isoenzyme over 72 hours, nor in the reduction of the myocardial perfusion defect determined by thallium 201 uptake. Electrocardiography provided no evidence of a benefit from antioxidant supplementation. Thus the supplementation regimen prevented the depletion of the primary lipid soluble antioxidant in plasma, but provided no measurable reduction in myocardial injury after the operation.     

Vasodilation with adenosine or sodium nitroprusside after coronary artery bypass surgery: a comparative study on myocardial blood flow and metabolism

The effects of adenosine and sodium nitroprusside (SNP) on central hemodynamics and myocardial blood flow and metabolism were investigated postoperatively after elective coronary artery bypass (CABG) surgery in ten sedated and mechanically ventilated patients in the intensive care unit. During three consecutive 15-min periods, SNP (0.8 +/- 0.1 micrograms.kg-1 x min-1), adenosine (88.9 +/- 13.3 micrograms.kg-1 x min-1), and then again SNP (0.7 +/- 0.1 micrograms.kg-1 x min-1) were infused to control postoperative hypertension at a mean arterial pressure of approximately 80 mm Hg. Systemic and pulmonary hemodynamics and global (coronary sinus flow, CSF) as well as regional (great cardiac vein flow, GCVF) myocardial blood flow and metabolic variables were measured. During adenosine infusion, in comparison to SNP, heart rate was unchanged, stroke volume index and cardiac index increased (24% and 32%, respectively), and the systemic vascular resistance index decreased (-26%). Mean pulmonary arterial pressure (24%) as well as pulmonary capillary wedge pressure (27%) and central venous pressure (18%) were higher with adenosine compared to SNP. Adenosine also increased CSF and GCVF (108% and 103%, respectively) without altering the CSF/GCVF flow ratio compared to SNP. Furthermore, adenosine increased the coronary oxygen content (51%) and decreased the arterio-great cardiac vein oxygen content difference (-48%) without changing regional myocardial oxygen consumption, indicating a more pronounced hyperkinetic myocardial circulation compared to SNP. In addition, adenosine infusion decreased arterial PO2 (-11%) and increased the intrapulmonary shunt fraction (57%). The PR interval time of the electrocardiogram was prolonged (12%) and the ST segment was more depressed during adenosine infusion compared to SNP.(ABSTRACT TRUNCATED AT 250 WORDS)     

Kinetic Basicities of Aqueous Binary Mixtures: A Surprisingly Good Linear Correlation with the Gas Phase Basicity of the Organic Cosolvent

A remarkably good correlation between the rate of proton transfer from excited protonated 1-aminopyrene and the gas phase basicities of the organic component in water: organic solvent binary mixtures has been found. We suggest that use of anilinium acids minimizes the effect of anion solvation and Coulomb interactions and enables the influence of the organic cosolvent on the proton transfer to be clearly observed. The model proposed is one in which the proton is always transferred to a water molecule and a concerted proton transfer to a water molecule solvated by the organic cosolvent also occurs. The cosolvent influence is then on this latter species via hydrogen bond interactions. The correlation holds in pure water but not in pure organic solvents where, clearly, the proton must be transferred to the organic molecule.     

Transgenic overproduction of islet amyloid polypeptide (amylin) is not sufficient for islet amyloid formation

Islet amyloid polypeptide forms islet amyloid deposits in non-insulin-dependent diabetes mellitus. We have generated transgenic mice which express human islet amyloid polypeptide in their pancreatic beta cells yet do not develop islet amyloid deposits despite producing levels of the amyloidogenic human peptide 2 - 3 fold higher than the native (mouse) peptide. To determine whether marked overproduction of islet amyloid polypeptide is a potential cause of islet amyloid formation, we increased expression of this transgene by producing homozygous transgenic animals and by making heterozygous mice experimentally insulin resistant with nicotinic acid. Pancreatic content of islet amyloid polypeptide-like immunoreactivity in homozygous and nicotinic acid-treated mice was 2-fold (25 +/- 7 fmol/microg; n = 6) and 3.5-fold (47 +/- 20 fmol/microg; n = 3) higher, respectively, than that of untreated heterozygous animals (13+/-2 fmol/microg; n = 11; both p < 0.05). Despite this marked increase in production of islet amyloid polypeptide, neither group of mice developed gross islet amyloid deposits even after 16 months of age. We conclude that overproduction of islet amyloid polypeptide, even as produced by extreme insulin resistance, is not in itself sufficient for islet amyloid formation.     

Comparison of Markov model and fault tree approach in determining initiating event frequency for systems with two train configurations

This study explores the use of Markov models in some areas of systems analysis in which time evolution of the system may be a significant factor in influencing the system reliability or availability. Comparisons are made between the Markov models and the time-averaged fault tree models for determining support system failure initiating event frequency in a nuclear power plant, for both power and shutdown conditions. Factors affecting consistency between the fault tree approach and the Markov model approach are studied for systems with common two train configurations. A correlation is developed to estimate the ratio between initiator frequencies through both approaches for a two parallel component system. Insights are developed as to when time averaged and simplified fault tree models support a good approximation to the more rigorous time-dependent Markov models.     

Adverse environmental conditions in the respiratory and medical ICU settings

Sleep deprivation and fragmentation occurring in the hospital setting may have a negative impact on the respiratory system by decreasing respiratory muscle function and ventilatory response to CO2. Sleep deprivation in a patient with respiratory failure may, therefore, impair recovery and weaning from mechanical ventilation. We postulate that light, sound, and interruption levels in a weaning unit are major factors resulting in sleep disorders and possibly circadian rhythm disruption. As an initial test of this hypothesis, we sampled interruption levels and continuously monitored light and sound levels for a minimum of seven consecutive days in a medical ICU, a multiple bed respiratory care unit (RCU) room, a single-bed RCU room, and a private room. Light levels in all areas maintained a day-night rhythm, with peak levels dependent on window orientation and shading. Peak sound levels were extremely high in all areas representing values significantly higher than those recommended by the Environmental Protection Agency as acceptable for a hospital environment. The number of sound peaks greater than 80 decibels, which may result in sleep arousals, was especially high in the intensive and respiratory care areas, but did show a day-night rhythm in all settings. Patient interruptions tended to be erratic, leaving little time for condensed sleep. We conclude that the potential for environmentally induced sleep disruption is high in all areas, but especially high in the intensive and respiratory care areas where the negative consequences may be the most severe.