Evaluation of prognostic factors for return of urinary and defecatory function in cats with sacrocaudal luxation

Objectives The aim of this study was to evaluate outcomes and prognostic factors for cats with sacrocaudal luxation. Methods Medical records and radiographs were reviewed for cats with sacrocaudal luxation. Information obtained from the clinical records included signalment, clinical presentation, concurrent traumatic injuries, treatment details, outcome and survival time. Severity of neurological signs was graded from 1 to 5, based on previous grading systems for cats with sacrocaudal luxation. Degree of vertebral displacement was calculated on survey radiographs. Outcomes were collected from serial neurological examinations and telephone interviews. Cats had to be given a minimum of 30 days to regain urinary function to be included in the study. Results Seventy cats were included. Fifty-five of 61 cats (90%) regained voluntary urinary function. A higher neurological grade was associated with a decreased likelihood ( P = 0.01) and longer duration ( P = 0.0003) of regaining urinary function. No significant associations were found between urinary outcome and age, sex, anal tone, perineal sensation, tail base sensation, degree of craniocaudal or dorsoventral sacrocaudal displacement, concurrent orthopaedic injury, tail amputation, defecatory function at diagnosis and survival. Cats that regained defecatory function had longer survival times than those that did not recover defecatory function ( P = 0.03). Defecatory outcome was not significantly associated with any other variables. Conclusions and relevance In agreement with previous studies, neurological grade is the most important prognostic indicator for cats with sacrocaudal luxation. Determination of the severity of neurological signs can also aid in advising owners the time frame in which urinary function is expected to return. Faecal incontinence may be a more important prognostic factor than previously suspected

Infant Brain Subjected to Oscillatory Loading

This paper describes an experimental investigation of a new earthquake damper for civil structures. It utilizes the energy dissipative capability of plastic shear deformation of thin steel plates welded inside a standard SHS steel section. Its performance is verified by fifteen cyclic and monotonic tests. Experiments showed that this light-weight damper exhibited stable behavior and was capable of dissipating a significant amount of energy. Its performance is influenced by the plate slenderness ratio and by the rigidity of its boundary elements. Slender plates buckled in shear, causing pinching of the hysteresis loop without significant strength degradation. The magnitude of damping offered by the dissipater is quantified. Fabrication, implementation and replacement of the damper proved to be easy and inexpensive. The seismic performance of a structure equipped with shear panel dissipaters is demonstrated using a numerical example

ISSUES IN MEDICINE: Will clinical associates be effective for South Africa?

South Africa has developed an innovative mid-level medical worker model that can contribute substantively to the development of quality district-level health care. These clinical associates entered the South African job market in 2011 and have reportedly been received favourably. The first cohorts performed well on local and national examinations, with pass rates >95%. They have demonstrated confidence and competence in the common procedures and conditions encountered in district hospitals;reportedly fitted in well at most of the sites where they commencedworking; and made a significant contribution to the health team, resulting in a demand for more clinical associates. Universities and provinces involved in producing clinical associates are enthusiastic and committed. However, priorities are to establish sustainable funding sources for training and deployment, provide adequate supervision and support, monitor the initial impact of the new cadre on health services, and manage the sensitivities of the medical and nursing professions around scopes of practice and post levels. Longer-term concerns are national leadership and support, scaling up of training, the development of career pathways, and the improvement of working conditions at district hospitals

Outcomes for family medicine postgraduate training in South Africa

After 1994, the post-apartheid government decided that primary health care and the district health system would be the cornerstone of their new health policy. As a consequence of this, the academic departments of Family Medicine and primary care recognised the need for a nationally agreed set of training outcomes that were more aligned with these new priorities within the public sector. Thus in 2001, the Family Medicine Education Consortium (FaMEC), representing the eight academic departments of family medicine in South Africa, agreed to a set of outcomes for postgraduate family medicine training. At that time, all departments were running Family Medicine Master’s programmes as part-time training courses for doctors in primary health care. Recognition of the need to move towards full-time registrar training already existed, and because of this steps were taken to register Family Medicine as a speciality with the Health Professions Council of South Africa (HPCSA)

The Use of Fab' Enzyme Conjugates for the Measurement of Urinary Growth Hormone

This project was initiated following work performed within this Institute to produce antibodies against human growth hormone for use in a serum immunoradiometric assay (IRMA) and some work to investigate the use of insulin like growth factor I (IGF-I) as a diagnostic and management tool for patients with particular growth disorders. Following initial attempts by other workers within the Institute to measure urinary growth hormone, it was concluded that an IRMA was unlikely to be capable of providing adequate sensitivity for this application. This project was intended to investigate the possibility of using the available antibodies in a fluorimetric assay, using similar methodologies to those of Ishikawa et. al. (1987), (1988), to provide a sensitive assay for measuring urinary growth hormone on a routine basis. The production of a suitable antibody fragment from sheep polyclonal IgG was the first major hurdle in the project and it was not until this problem was successfully traversed, by the use of an alternative method to that of Ishikawa et. al. (1988), that it was possible to progress onto production of a peroxidase conjugate or to develop a working assay. In the resulting assay, microtitration wells were used as an alternative separation system to polystyrene beads, for reasons of practicability. Initially a number of colourimetric peroxidase substrates were used in the optimization of the assay, and later when appropriate measuring equipment became available, fluorimetric and luminometric substrates were used in the hope of achieving enhanced sensitivity. The luminometric substrate,which was only investigated briefly at the last stage of the project, provided an assay with sensitivity in the range necessary for a urine growth hormone assay. A number of problems were encountered when attempting to measure growth hormone in urine due to the presence of matrix effects, and attempts were made to eliminate these as far as possible from the assay. Hence a significant proportion of the work carried out involved investigating these matrix effects and showed that dialysis of the urine samples produced unsatisfactory results. An assay was developed with the sensitivity required to measure growth hormone in urine but the matrix effects of urine samples on the assay could not be overcome adequately. Perhaps the realistic conclusion to be drawn is that a successful assay of this type requires investment in state of the art microtitre plate equipment, detection systems and the best available antibodies and enzyme labels. These are most likely to be provided by a commercial company with an international market for the product and the necessary financial backing

Psychological adjustment of men with prostate cancer: A review of the literature

OBJECTIVE: Prostate cancer (PCA) is the most common malignancy and a major cause of death in men but, importantly, a substantial proportion will live for several years following diagnosis. However, they face the prospect of experiencing symptoms, side-effects of treatment and diminished quality of life. The patient's psychological adjustment is particularly complex, given the potential trajectory of the disease, from the point of diagnosis, with its immediate impact, to the phase of palliative care, with its attendant issue of facing mortality. Since a comprehensive review of the literature on psychological adjustment of men with PCA has not yet been done, we have documented relevant research, integrated findings and drawn conclusions, where possible, in order to map out clinical and research implications. METHOD: We searched 5 databases for the period 1994 - July 2006, during which most of the work in the field has been done. RESULTS: We found few studies of substance among the 60 we examined to draw conclusions about psychological adjustment to prostate cancer and its treatment. This is in marked contrast to the picture in breast cancer. While some patterns have emerged, many gaps remain to be filled. DISCUSSION: Aspects of methodology need attention, particularly longitudinal, prospective designs, incorporation of control groups and the use of valid and reliable measures. There is scope for qualitative studies as a complement to quantitative research

Mechanical versus manual chest compressions in the treatment of in-hospital cardiac arrest patients in a non-shockable rhythm : a randomised controlled feasibility trial (COMPRESS-RCT)

Background Mechanical chest compression devices consistently deliver high-quality chest compressions. Small very low-quality studies suggest mechanical devices may be effective as an alternative to manual chest compressions in the treatment of adult in-hospital cardiac arrest patients. The aim of this feasibility trial is to assess the feasibility of conducting an effectiveness trial in this patient population. Methods COMPRESS-RCT is a multi-centre parallel group feasibility randomised controlled trial, designed to assess the feasibility of undertaking an effectiveness to compare the effect of mechanical chest compressions with manual chest compressions on 30-day survival following in-hospital cardiac arrest. Over approximately two years, 330 adult patients who sustain an in-hospital cardiac arrest and are in a non-shockable rhythm will be randomised in a 3:1 ratio to receive ongoing treatment with a mechanical chest compression device (LUCAS 2/3, Jolife AB/Stryker, Lund, Sweden) or continued manual chest compressions. It is intended that recruitment will occur on a 24/7 basis by the clinical cardiac arrest team. The primary study outcome is the proportion of eligible participants randomised in the study during site operational recruitment hours. Participants will be enrolled using a model of deferred consent, with consent for follow-up sought from patients or their consultee in those that survive the cardiac arrest event. The trial will have an embedded qualitative study, in which we will conduct semi-structured interviews with hospital staff to explore facilitators and barriers to study recruitment. Discussion The findings of COMPRESS-RCT will provide important information about the deliverability of an effectiveness trial to evaluate the effect on 30-day mortality of routine use of mechanical chest compression devices in adult in-hospital cardiac arrest patients

Decreased operative risk of surgical treatment of mitral regurgitation with or without coronary artery disease

AbstractThe consecutive 2 year experience with patients undergoing first-time surgery for mitral regurgitation with and without coronary artery disease was reviewed. From January 1988 to January 1990, 127 patients with pure mitral regurgitation undergoing first-time operation were surgically treated. No other valve lesion, no reoperation and no congenital defects were included. The mean patient age was 62 years with 26% of the patients > 70 years. Twenty-six percent of the entire group was in functional class IV. Seventy-five patients received mitral valve repair and 52 underwent mitral valve replacement with a St. Jude or Hancock valve. In patients undergoing mitral valve repair, there was a higher incidence of those > 70 years old and of coronary artery disease and in patients undergoing mitral valve replacement there was a higher incidence of functional class IV.The operative mortality rate was 2.3% (3 of 127 patients). No patient failed to be discontinued from cardiopulmonary bypass and all three deaths occurred after mitral valve replacement, with one from complications of chronic renal failure and dialysis. There was no significant difference in patients who either did or did not have a concomitant coronary artery bypass graft and there was no difference related to age or functional class. Postoperative complications occurred in five patients in the valve repair group, including recurrent mitral regurgitation in two necessitating reoperation, and in three patients in the valve replacement group.With newer operative and postoperative management techniques, especially preservation of the papillary muscle annular continuity, the risk of mitral valve surgery, particularly of valve repair, is considerably lower than in previous years

Cromwell's Edinburgh press and the development of print culture in Scotland

Alasdair Mann, the noted scholar of book culture in early modern Scotland, has suggested that a significant change had occurred in Scotland's relationship with the printed word by the late seventeenth century. This study sets out to explain how the interregnum served as a ‘watershed’ during which a consumer demand was created for popular print and how this in turn necessitated a significant increase in the production and distribution of printed material. Beginning with the sale of the press and patent of Evan Tyler to the London Stationers’ Company in 1647, the article charts the key factors that transformed Scotland's printing industry from the production of official declarations and works for foreign markets to the production of polemical texts for a Scottish audience. These developments also witnessed publication of the first serial news journal and the growth of a competitive market for up-to-date printed news. More than just an anomaly that flourished during a decade of occupation, these fundamental changes altered Scotland by introducing the large-scale consumption of chapbooks and printed ephemera, thereby initiating the nation's enduring print culture