Evidence of acute myocardial infarction on CT.

Improvements in CT technology, specifically with respect to the development of multi-row detector CT, have increased the ability to detect acute myocardial ischaemia. This case report details the finding of decreased myocardial enhancement on CT in a patient who complained of acute chest symptomalogy and was diagnosed with acute myocardial infarction, which was subsequently confirmed by cardiac catheterization. Given the variability of the clinical presentation of acute myocardial infarction, greater attention should be paid by radiologists to myocardial enhancement in patients with significant coronary risk factors, as evidence of acute myocardial infarct or ischaemia may be detected.

Developmental sources of crash risk in young drivers.

OBJECTIVE: To outline various sources of crash risk among young drivers that are developmental (age based) factors. METHODS AND RESULTS: First, a distinction is made between adolescence (ages 10-18) and emerging adulthood (ages 18-25) in order to shed light on the reasons for especially high crash rates among 16-17 year old drivers relative to 18-25 year olds. Then various developmental sources of risk in adolescence are described, including the power of friends, the optimistic bias, and adolescent emotionality. The reasons for especially high crash rates among young males are discussed, with an emphasis on how American ideas about manhood promote driving risks. Finally, a cross national comparison between adolescents in the United States and Denmark shows how developmental risks interact with driving policies. CONCLUSIONS: The high crash rates of adolescents relative to emerging adults and of emerging adults relative to older drivers can be explained in part by developmental factors.

Family functioning in subjects with pseudoseizures and epilepsy.

The purpose of this study was to identify differences in family functioning between subjects with pseudoseizures and their families, and control subjects with epilepsy. Thirty-one adult subjects with pseudoseizures and 31 controls with intractable epilepsy, whose diagnoses were confirmed using video-EEG, were recruited from the epilepsy unit of a tertiary care hospital over a 4-year period. Each study participant and their first-degree adult family members completed two standardized questionnaires designed to measure family functioning: the McMaster Family Assessment Device (FAD) and the Beavers Self-Report Family Inventory (SFI). Individuals with pseudoseizures, when compared with epileptic subjects, exhibited significantly elevated scores in three scales of the FAD and in one scale of the SFI, indicating greater psychopathology within the family, as perceived by the individual. Statistically significant differences with the FAD were on measures of affective involvement (p = .044), communication (p = .004), and general functioning (p = .013). The SFI revealed significantly greater difficulty with conflict (p = .050). No differences were noted between subjects with both pseudoseizures and epilepsy and subjects with pseudoseizures alone. In comparison with the families of the epileptic group, the families of subjects with pseudoseizures displayed statistically significant elevations in their responses on the roles scale (p = .003) of the FAD. The responses of the family members did not differ in regard to the role they assumed within the family unit (i.e., spouse, parent). In summary, individuals with pseudoseizures view their families as being more dysfunctional, particularly in the area of communication, whereas their family members perceived difficulties in defining roles. This suggests that family education and interventions focusing on these areas, may be an important aspect of the treatment of patients with pseudoseizures.

Tiagabine versus phenytoin and carbamazepine as add-on therapies: effects on abilities, adjustment, and mood.

The effects of tiagabine (TGB) on abilities and on adjustment and mood are as yet incompletely understood. These effects were compared with those of phenytoin (PHT) and carbamazepine (CBZ) in an add-on study. Patients included in the analysis were adults with uncontrolled partial seizures who at study entry were on CBZ alone (n=153) or on PHT alone (n=124). Of the patients receiving CBZ, 82 were randomized to add-on TGB and 71 were randomized to add-on PHT during the double-blind period. Of the patients receiving PHT, 58 were randomized to add-on TGB and 66 were randomized to add-on CBZ. Eight tests of mental abilities and three of mood and adjustment were given prior to assignment of add-on treatment and after up to 16 weeks of add-on treatment. For the baseline CBZ group, analyses were done to search for differential changes from baseline in the test scores of the add-on TGB and add-on PHT groups, and for the baseline PHT group in the add-on TGB and add-on CBZ groups. In the baseline CBZ group, no differences in test scores were found between PHT and TGB. In the baseline PHT group for the area of abilities, patients treated with TGB had improved verbal fluency, as well as quicker responses on a test of perceptual/motor speed compared with patients treated with CBZ. For the baseline PHT group in the area of adjustment and mood, patients treated with TGB reported less positive mood and more financial concerns compared to patients treated with CBZ. Overall, add-on TGB showed few or no differences in comparison with add-on CBZ and add-on PHT.

Optimistic bias in adolescent and adult smokers and nonsmokers.

Optimistic biases regarding the risks of smoking were examined among 200 adolescents (aged 12-17) and 203 adults (aged 30-50). Strong majorities of adolescent and adult smokers and nonsmokers agreed that smoking is addictive and causes death for "most people" who smoke. However, for themselves personally, adolescent and adult smokers were more likely than nonsmokers to doubt that they would die from smoking even if they smoked for 30 or 40 years. Furthermore, 60% of adolescent and 48% of adult smokers believed that they "could smoke for a few years and then quit" if they wished, figures far higher than for nonsmokers. Thus an optimistic bias regarding smoking risks appears to be held by both adolescent and adult smokers, especially by adolescents and especially regarding addiction. Implications for smoking prevention programs are discussed.

Emerging adulthood. A theory of development from the late teens through the twenties.

Emerging adulthood is proposed as a new conception of development for the period from the late teens through the twenties, with a focus on ages 18-25. A theoretical background is presented. Then evidence is provided to support the idea that emerging adulthood is a distinct period demographically, subjectively, and in terms of identity explorations. How emerging adulthood differs from adolescence and young adulthood is explained. Finally, a cultural context for the idea of emerging adulthood is outlined, and it is specified that emerging adulthood exists only in cultures that allow young people a prolonged period of independent role exploration during the late teens and twenties.

Adolescent storm and stress, reconsidered.

G. S. Hall's (1904) view that adolescence is a period of heightened "storm and stress" is reconsidered in light of contemporary research. The author provides a brief history of the storm-and-stress view and examines 3 key aspects of this view: conflict with parents, mood disruptions, and risk behavior. In all 3 areas, evidence supports a modified storm-and-stress view that takes into account individual differences and cultural variations. Not all adolescents experience storm and stress, but storm and stress is more likely during adolescence than at other ages. Adolescent storm and stress tends to be lower in traditional cultures than in the West but may increase as globalization increases individualism. Similar issues apply to minority cultures in American society. Finally, although the general public is sometimes portrayed by scholars as having a stereotypical view of adolescent storm and stress, both scholars and the general public appear to support a modified storm-and-stress view.

Cognitive abilities and adjustment with gabapentin: results of a multisite study.

The cognitive and quality of life effects of gabapentin are not yet well explored. While preliminary work in the area has provided positive findings, a large double-blinded study has been needed to explore this area more thoroughly. From 24 sites in North America, 201 adults were studied who had uncontrolled complex partial seizures with or without secondary generalization. Attempts were made to convert each patient from one or two marketed antiepileptic drugs (AEDs) taken in baseline to gabapentin monotherapy (600, 1200, or 2400 mg/day). Tests of cognitive abilities and adjustment were administered at the end of the 8-week baseline period and at the end of the 26-week double-blind treatment period. Analyses of baseline to treatment period changes were conducted for each dose group in comparison with a reference group of placebo-treated patients from another study. In the area of cognitive functioning, no changes in any of the gabapentin groups were found in comparison with the reference group. In the area of adjustment and mood, however, improvement with gabapentin administration was noted on several variables pertaining to emotional and interpersonal adjustment. These results are consistent with findings from previous studies.

Winston's "No Additives" campaign: "straight up"? "no bull"?

OBJECTIVE: The author used data from a larger study to examine adolescents' and adults' responses to Winston cigarettes' "No Additives" advertising campaign. METHODS: The author analyzed responses from 400 adolescents ages 12-17 and 203 adults ages 30-50 who were asked what they believed the meaning of the "No Additives" slogan to be. The author also analyzed adolescents' responses to questions about four specific Winston "No Additives" ads. RESULTS: Two-thirds of adolescents and 27% of adults believed that "No Additives" meant one or more of the following: that Winston cigarettes are healthier than other cigarettes, that they are less likely to harm health, or that they are less likely to be addictive. Adolescents perceived the models in three ads to be younger than 25 years old. Among adolescent respondents, smokers were more likely than nonsmokers to like the ads and to believe the ads made smoking more appealing. CONCLUSIONS: The "No Additives" slogan was perceived by a majority of adolescents and about a quarter of adults as implying one or more health claims. The results of this analysis suggest that the Federal Trade Commission's action in requiring a disclaimer on the "No Additives" ads is well founded but the disclaimer should be strengthened.

Adolescents' responses to cigarette advertisements: links between exposure, liking, and the appeal of smoking.

OBJECTIVE: To evaluate adolescents' responses to cigarette advertisements for different brands. DESIGN: Adolescents were shown one print advertisement for each of five cigarette brands (Camel, Marlboro, Kool, Benson & Hedges, and Lucky Strike). They indicated on a structured questionnaire how many times they had seen the advertisement (or one almost like it), how much they liked it, whether or not they thought it made smoking more appealing, and whether or not it made them want to smoke cigarettes of that brand. SETTING: Middle school and high school classrooms, seven schools in four states in the United States (New York, Pennsylvania, Ohio, and Texas). The classrooms were selected randomly within each school. PARTICIPANTS: 534 adolescents in grades 6-12 (ages 11-18 years) from seven schools in four states, 54% female, 76% white. RESULTS: The advertisements for Camel and Marlboro were more likely than the advertisements for the other brands to be seen, to be liked, to be viewed as making smoking appealing, and to influence adolescents to want to smoke cigarettes of that brand. More than 95% of the adolescents had seen an advertisement featuring Joe Camel or the Marlboro Man at least once, and more than 50% had seen these advertisements six or more times. Nearly half believed that the Joe Camel advertisement makes smoking more appealing, and 40% believed that the Marlboro Man advertisement makes smoking more appealing. Adolescent smokers were more likely than nonsmokers to believe that the advertisements for Camel and Marlboro make smoking more appealing. CONCLUSIONS: The advertisements most popular among adolescents are for two of the brands they are most likely to smoke--Marlboro and Camel. The results of the study are consistent with the view that certain cigarette advertisements enhance the appeal of smoking to many adolescents.

Effects of tiagabine monotherapy on abilities, adjustment, and mood.

PURPOSE: We evaluated the dose-related impacts of tiagabine (TGB) on cognition and mood in a monotherapy study. METHODS: Patients were 123 adults with uncontrolled partial seizures, each treated with a single currently available antiepileptic drug (AED) for management of clinical epilepsy. They completed a battery of neuropsychological tests during an 8-week prospective baseline period and once again at the end of the 12-week fixed-dose period (or earlier if they dropped out of the study). Sixty-six patients were randomized to 6 mg/day TGB and 57 were randomized to 36 mg/day TGB. RESULTS: Few changes in either abilities or adjustment and mood were noted when all patients were considered as a single group. However, analysis of both dose and attainment of TGB monotherapy showed that patients receiving TGB monotherapy did best, improving particularly in the areas of adjustment and mood with low-dose TGB and in the area of abilities with high-dose TGB. Patients who did not attain monotherapy showed no change except that the high-dose group did not perform as well on measures of mood and adjustment. Baseline AED and changes in seizure control did not affect the results. CONCLUSIONS: Patients' attainment of TGB monotherapy was associated with their achievement of positive changes of varying degree on psychological tests. Failure to attain TGB monotherapy was associated with no changes on the tests except in patients receiving high-dose TGB where it appeared that some alterations in mood might have been avoided if a slower titration schedule had been used.

Development of an academic productivity scale for departments of physical medicine and rehabilitation.

OBJECTIVE: To determine which factors related to departments of physical medicine and rehabilitation (PM&R) might contribute to the academic productivity of members of the teaching staff of those departments, and to develop an instrument that measures them. DESIGN: Prospective, inception cohort. SETTING: University medical center, academic PM&R departments. PARTICIPANTS: PM&R academic departments. INTERVENTION: Over a 6-year period, seven PM&R departments volunteered to use this instrument to measure academic productivity at 2-year intervals. Rasch analysis was applied to the generated data. MAIN OUTCOME MEASURE: Measurable items that were included in questions of the scale fell into six categories: research funding and/or experience; scholarly productivity; equipment and facilities; quality of the training program for resident physicians; continuing education efforts in research methodologies and professional organizational participation; and departmental leadership. Rasch analysis was applied to evaluate a new outcome instrument to measure academic productivity in PM&R departments. RESULTS: Twenty-eight of the original 42 questions survived the Rasch analysis and were retained. Questions were dropped either because they did not fit the Rasch analysis (4 of 42 questions) or because application of the Rasch analysis demonstrated that they were inappropriately or outstandingly easy (10 of 42 were inappropriately or outstandingly easy). CONCLUSION: This shortened instrument of 28 questions fits the Rasch analysis, has questions that evently range from easy to very difficult, and addresses six measurable categories that are correlates of PM&R departmental influences on the academic productivity of the PM&R teaching staff.

Cognitive and quality of life effects of differing dosages of tiagabine in epilepsy.

Tiagabine blocks the uptake by neurons or glia of synaptically released GABA resulting in prolonged GABAergic activity and decreased likelihood of epileptic seizures. We evaluated the cognitive and quality of life effects of tiagabine in a double-blind, add-on, placebo-controlled, parallel, multicenter, dose-response efficacy study in patients with focal epilepsy whose complex partial seizures were difficult to control. One hundred sixty-two patients provided cognitive and quality of life data for the analyses and received the following treatments: placebo (n = 57), 16 mg/d tiagabine (n = 34), 32 mg/d tiagabine (n = 45), or 56 mg/d tiagabine (n = 26) at a fixed-dose for 12 weeks after a 4-week dose titration period. Eight cognitive tests and three measures of mood and adjustment were administered during the baseline period and again during the double-blind period near the end of treatment (or at the time of dropout). The patient groups were similar at entry into the study. Results showed no clinically important changes with the addition of tiagabine on the test battery. Although this is an encouraging finding, it remains for future investigations to determine the cognitive and behavioral effects of tiagabine either as monotherapy or in relation to other antiepileptic drugs.

Reckless driving in adolescence: 'state' and 'trait' factors.

Reckless driving practices were studied among 139 high school students aged 17-18. A majority of both boys and girls reported driving at high speeds, and a majority of boys reported racing in a car and passing in a no-passing zone. About one-quarter of boys and girls reported driving while intoxicated. Sensation seeking and aggressiveness were found to be related to reckless driving practices. Fifty-nine of the students kept a log of their driving episodes over a 10-day period. Analysis of these data indicated that the participants drove faster when in an angry mood than when in any other mood. Also, they drove faster when alone or with friends than when their parents were present.

Predicting functional independence from neuropsychological tests following traumatic brain injury.

The relationship between impairment, measured by the Halstead-Reitan Neuropsychological Test Battery (HRNTB), and disability, measured by the Functional Independence Measure (FIM), was investigated in 164 subjects completing acute, inpatient rehabilitation following traumatic brain injury. Exploratory factor analysis of the FIM supported a two-factor model of disability, with 13 items loading on a motor disability factor and five items loading on a cognitive disability factor. HRNTB findings and injury-related variables were predictive of motor disability, as five variables accounted for 39-44% of the variance in FIM Motor scores. Contrary to expectations, the relationship with cognitive disability was comparable to, but did not exceed, that for motor disability, as only 29-40% of the variance in FIM Cognitive scores was accounted for. The WAIS-R Comprehension subtest was the single best predictor of cognitive disability, accounting for 20% of variance, and suggesting that the FIM Cognitive subscale is measuring social-cognitive ability, as intended by its authors. Results are discussed in terms of the relationships among impairment and disability, including the need to further scrutinize the operationalization of these constructs as they relate to cognitive functions.

Cognitive deficits after hepatic transplantation: relevance to the rehabilitation potential.

Alteration in central nervous system function is a well-known sequela of liver failure, but has been thought to be transient after transplantation surgery. We present two cases of cerebral pontine myelinosis complicating liver transplantation. Both of these cases presented with specific post-surgical cognitive deficits assessed by neuropsychological testing. These cognitive deficits altered the ability of each patient to become functionally self-sufficient and thus modified the rehabilitation potentials of these two patients significantly.

Publishing characteristics of chairpersons of physical medicine and rehabilitation departments.

Previous studies note that specific factors intrinsic to an academic department of physical medicine and rehabilitation influence the academic productivity of individual faculty members. To determine whether one of these factors is related to the productivity of departmental chairpersons, this issue was studied for the period from 1983 to 1993. The productivity of chairpersons serving 4 or more consecutive years in the same department significantly declined. Moreover, the productivity of long-term chairpersons (greater than 10 years) was significantly below that of the group of high-frequency publishing chairpersons. Departments with long-term chairpersons also had fewer publications than departments with high-frequency publishing chairpersons. The academic productivity of the chairperson is a factor likely to influence the productivity of the department.

Effects of differing dosages of vigabatrin (Sabril) on cognitive abilities and quality of life in epilepsy.

Vigabatrin (VGB) prevents seizures by irreversible inhibition of gamma-aminobutyric acid (GABA) transaminase and a resulting increase in GABA levels. We evaluated the cognitive and quality-of-life (QOL) effects of VGB in a double-blinded, add-on, placebo-controlled, parallel group dose-response study of patients with focal epilepsy whose complex partial seizures (CPS) were difficult to control. In a single investigation, patients were randomly assigned to placebo (n = 40), 1 g VGB (n = 36), 3 g VGB (n = 38), or 6 g VGB (n = 32), treated for 12 weeks after a 6-week dose escalation period, and tested at the end of the baseline period and at the end of the treatment period with eight cognitive measures and three tests of mood and adjustment. The patient groups were highly similar at study entry. Results at the end of the study showed substantial relief from seizures. The Digit Cancellation Test showed decreases in performance with increasing doses of VGB. Performance on no other test showed any decrement with increasing dosage. Relief from seizures was not associated with changes on the psychological tests. VGB is a useful antiepileptic drug (AED) that has little impact on tests of either cognitive abilities or QOL, even at a high dose.

Prolonged poststrike elevation in tongue-flicking rate with rapid onset in gila monster,Heloderma suspectum: Relation to diet and foraging and implications for evolution of chemosensory searching.

Experimental tests showed that poststrike elevation in tongue-flicking rate (PETF) and strike-induced chemosensory searching (SICS) in the gila monster last longer than reported for any other lizard. Based on analysis of numbers of tongue-flicks emitted in 5-min intervals, significant PETF was detected in all intervals up to and including minutes 41-45. Using 10-min intervals, PETF lasted though minutes 46-55. Two of eight individuals continued tongue-flicking throughout the 60 min after biting prey, whereas all individuals ceased tongue-flicking in a control condition after minute 35. The apparent presence of PETF lasting at least an hour in some individuals suggests that there may be important individual differences in duration of PETF. PETF and/or SICS are present in all families of autarchoglossan lizards studied except Cordylidae, the only family lacking linguallly mediated prey chemical discrimination. However, its duration is known to be greater than 2-min only in Helodermatidae and Varanidae, the living representatives of Varanoidea. That prolonged PETF and SICS are typical of snakes provides another character supporting a possible a varanoid ancestry for Serpentes. Analysis of 1-min intervals showed that PETF occurred in the first minute. A review of the literature suggests that a pause in tongue-flicking and delay of searching movements are absent in lizards and the few nonvenomous colubrid snakes tested. The delayed onset of SICS may be a specific adaptation of some viperid snakes to allow potentially dangerous prey to be rendered harmless by venom following voluntary release after envenomation and preceding further physical contact with the prey.