Glenoid track measurement using magnetic resonance imaging arthrography is predictive of recurrent instability following arthroscopic shoulder stabilisation.

PURPOSE: The primary aim of this study was to investigate medium-term survivorship following arthroscopic Bankart repair (ABR) for anterior glenohumeral instability. The secondary aim was to determine whether the pre-operative magnetic resonance (MR) arthrography glenoid track measurement predicted recurrent instability following ABR. METHODS: Over a 9-year period (2008-2017), 215 patients underwent ABR. Median age was 26 years (IQR 22-32.5; range 14-77). There were 173 males (81%). 175 patients (81%) had available pre-operative MR arthrography, which was used to determine the presence of "off-track" bone loss. Retrospective analysis was undertaken to determine recurrence of instability at a median follow-up of 76 months (range 21-125 months). Survivorship analysis was undertaken using Kaplan-Meier methodology: the endpoints examined were repeat dislocation, revision stabilisation, and symptomatic instability. RESULTS: 56 patients (26%) presented with further instability, including 29 patients with recurrent dislocation and 15 patients required revision stabilisation. Cumulative incidence of instability was 10% at 1 year, 27% at 5 years and 28% at 7 years. No significant difference in instability was seen between men and women 7 years after stabilisation (19% vs 17%; p = 0.87). Age at time of surgery did not predict recurrence. "Off-track" lesions were identified in 29 patients (16.1%). The incidence of redislocation was significantly higher in these patients (24% vs 3%; p = 0.01; relative risk 7.2; 95% CI 2.45-20.5; p = 0.001). Recurrent instability without frank redislocation was also significantly higher in this group (60% vs 18%; RR 3.33, 95% CI 2.02-5.20; p < 0.0001). CONCLUSIONS: This study has reported a significant rate of recurrent instability in longer-term follow-up after ABR. It has also identified pre-operative MR arthrography as an important predictor of recurrent instability, which may be used to risk stratify patients with anterior instability in a typical UK population. LEVEL OF EVIDENCE: III (cohort study).

Political priorities and public health services in English local authorities: the case of tobacco control and smoking cessation services.

Background: Since 2013, local authorities in England have been responsible for public health including smoking cessation services. Methods: Online surveys of tobacco control leads in English local authorities were conducted in 2014 (76% response rate, n = 116), 2015 (82% response rate, n = 124) and 2016 (85% response rate, n = 129). Results: A high priority for tobacco control was reported in 17% of local authorities in 2014, rising to 27% in 2016. A low priority for tobacco control was reported in 4% of local authorities in 2014, rising to 11% in 2016. Budgets for smoking cessation services were cut in 16% of local authorities in 2014, 39% in 2015 and 59% in 2016. In 2016, budgets were cut in all local authorities where the priority given to tobacco control was perceived to be low and in 40% of the local authorities where it was perceived to be high. Cuts in smoking cessation budgets were principally due to cuts to the public health grant and wider cuts to local authority budgets. Conclusions: At a time of significant cost pressure, political support for tobacco control in English local authorities mitigates but does not remove the risk of cuts to budgets for smoking cessation services.

Different forms of heroin and their relationship to cook-up techniques: data on, and explanation of, use of lemon juice and other acids.

Recent reports of the use of lemon juice in the preparation of heroin for injection have failed to recognize the importance of the different forms of heroin (in the form of the salt or the base) and the impact of this on the chemical manipulation required before injection. One hundred and four opiate addicts in London were interviewed about the forms of heroin (white, brown, etc) and their relationship to cook-up techniques (use of heat and acid). White heroin was typically prepared with water and heat; brown heroin was prepared with acid (citric acid or Vitamin C (ascorbic acid) or lemon juice) and heat; pharmaceutical heroin was prepared with water only (i.e. neither acid nor heat). On the last occasion of heroin use, brown heroin had been the form most commonly used, with over 90% of the sample using citric acid or vitamin C. Lemon juice was rarely used, and heat was almost universally applied in conjunction with lemon juice.

Infants' attention to object structure in early categorization.

Three experiments with object-manipulation tasks examined the effect of object structure on 14-, 18-, and 22-month-olds' categorization. In Experiment 1, categorization of animals and vehicles was tested when object structure was normal and when it was violated by moving parts (legs or wheels) into a novel configuration. In Experiment 2, categorization of animals, vehicles, and furniture was examined when object structure was modified in orientation (e.g., legs inverted) or in configuration (e.g., legs at tangential angles). In Experiment 3, infants' attention to texture in categorization was tested. The results of the studies showed that 14- to 22-month-olds attend to object parts and structural configuration to categorize and that they do not attend to object texture. There is a perceptual basis for early categorization at the superordinate-like level, and infants are constrained in the parts and object structures they recognize in this process.

Hand-mouth coordination, congenital absence of limb, and evidence for innate body schemas.

Studies of phantom limb in cases of congenital (aplasic) absence of limb have provided inadequate evidence concerning the innate neurological substrate responsible for the phantom. In this study we review evidence from ultrasonic and behavioral studies of hand-mouth coordination in utero and in early infancy, neurobiological studies in primates, and studies of neural reorganization following amputation. We suggest two complementary hypotheses to explain aplasic phantoms. First, aplasic phantoms are based on the existence of specific neural circuitry associated with innate motor schemas, such as the neural matrix responsible for early hand-mouth coordination. Second, aplasic phantoms are modified by mechanisms that involve a reorganization of neural representations of the missing limb within a complex network involving both cortical and subcortical structures.

Infants' use of object parts in early categorization.

Two experiments involving object-manipulation tasks were performed to examine whether 1- to 2-year-olds form superordinate-like categories by attending to object parts. In Study 1, 14-, 18-, and 22-month-olds were tested with contrasts of animals, furniture, insects, and vehicles. Fourteen- and 18-month-olds behaved systematically toward categories with different parts (legs or wheels) but not toward categories with matching parts (legs or legs). In Study 2, infants were tested with novel animals and vehicles generated by removing or attaching legs or wheels. In the absence of part differences, all three age groups failed to form superordinate categories. The two younger groups chose to categorize by parts (i.e., legs or wheels) rather than by category membership (animal or vehicle). The results suggest a perceptual basis for categorization whereby infants form dynamic categories, on-line, that are based on the characteristics of the input.

Pointing and social awareness: declaring and requesting in the second year.

The production of pointing and other gestures (e.g. reaching or indicative gestures) by 47 infants aged 1;0 to 1;6 was investigated in two experiments contrasting declarative-referential vs. imperative-instrumental conditions of communication. A further group of seven infants aged 0;10 was examined in order to highlight pre-pointing transitional phenomena. Data analyses concerned gestures and associated vocalizations and visual checking with a social partner. Results show that gestures are produced differentially in the experimental conditions: while reaching is only produced in imperative-instrumental contexts, pointing is characteristic of declarative-referential contexts. The pattern of visual checking with the social partner also differentiates gestures; moreover, it shows developmental changes in the case of pointing. Results suggest that pointing relies on some awareness of 'psychological' processes (e.g. attention and sharing) in the other and the self, and that it is this which may account for the specific relevance of pointing for language development.

Facial aesthetics: babies prefer attractiveness to symmetry.

The visual preferences of human infants for faces that varied in their attractiveness and in their symmetry about the midline were explored. The aim was to establish whether infants' visual preference for attractive faces may be mediated by the vertical symmetry of the face. Chimeric faces, made from photographs of attractive and unattractive female faces, were produced by computer graphics. Babies looked longer at normal and at chimeric attractive faces than at normal and at chimeric unattractive faces. There were no developmental differences between the younger and older infants: all preferred to look at the attractive faces. Infants as young as 4 months showed similarity with adults in the 'aesthetic perception' of attractiveness and this preference was not based on the vertical symmetry of the face.

Origins of the proprioceptive function of vision: visual control of posture in one day old domestic chicks.

Recently hatched domestic chicks control their upright bipedal posture, at least in part, with respect to the flow of visual information at the retina, as do human infants when they first acquire control of the head, of sitting, and of standing. Some implications of the similarity of the proprioceptive function of vision in chicks and in humans for the origins and development of postural control are discussed.

Development of head position preference during early infancy: a longitudinal study in the daily life situation.

We studied developmental changes in supine head position preference in a group of 14 healthy full-term infants from age 3 to 18 weeks. The infants assumed an initial head-right position until 12 weeks. For the maintenance of a head position, a loglinear analysis revealed a developmental trend from an initial head orientation to the right to one with the head in the midline at around 12 weeks. The maintenance of a midline head position was preceded by a marked improvement in postural stabilization, defined as the ability to hold the head upright when seated in an infant chair. The relationship between head position preference and behavioral state changed with age: At 3 weeks all infants maintained the same position regardless of state, but by 18 weeks this situation held for only 64% of those who cried. The implications of these findings for the development of handedness are discussed.

Evaluation of ketorolac, aspirin, and an acetaminophen-codeine combination in postoperative oral surgery pain.

One-hundred twenty-eight outpatients with postoperative pain after the surgical removal of impacted third molars were randomly assigned, on a double-blind basis, to receive oral doses of ketorolac tromethamine 10 mg, aspirin 650 mg, a combination of acetaminophen 600 mg plus codeine 60 mg, or placebo. Using a self-rating record, subjects rated their pain and its relief hourly for 6 hours after medicating. All active medications were significantly superior to placebo. The acetaminophen-codeine combination was significantly superior to aspirin for peak analgesia. Ketorolac was significantly superior to aspirin for every measure of total and peak analgesia, and significantly superior to acetaminophen-codeine for measures of total effect. The analgesic effect of ketorolac was significant by hour 1 and persisted for 6 hours. Repeat-dose data also suggested that ketorolac 10 mg was superior to aspirin 650 mg and acetaminophen-codeine on the day of surgery. Differences among the active medications were trivial for the postoperative days 1-6 analyses. The frequency of adverse effects was over 4 times greater for acetaminophen-codeine than for ketorolac or aspirin.

The young child's representation of depth in drawing: process and product.

Two experiments are reported from a series of studies in which plain blocks of various sizes were presented in various spatial orientations to children aged between 3 and 8 years in an attempt to establish how they represent three-dimensional spatial relations pictorially. The major results were that young children represent depth in the array vertically in the picture plane. Two important findings were that even from an early age drawings contain "view-centered" information and that children differentiate between the relative positions of objects in the array by the temporal order of their drawing. These results show the importance of studying the drawing process as well as its product.

Evaluation of flurbiprofen, acetaminophen, an acetaminophen-codeine combination, and placebo in postoperative oral surgery pain.

Eighty-eight outpatients with postoperative pain after the surgical removal of impacted third molars were randomly assigned, on a double-blind basis, to receive a single, oral dose of flurbiprofen 100 mg, acetaminophen 600 mg, a combination of acetaminophen 600 mg with codeine 60 mg, or placebo. Using a self-rating record, subjects rated their pain and its relief hourly for 12 hours after medicating. Estimates of sum of pain intensity differences, peak pain intensity differences, total relief, peak relief, and hours of 50% relief were derived from these subjective reports. Flurbiprofen and the acetaminophen-codeine combination were significantly superior to placebo for every measure of total and peak analgesia and significantly superior to acetaminophen alone for most measures of efficacy. Based on the 12-hour data, acetaminophen alone did not differ significantly from placebo; however, it was superior to placebo for measures of total effect based on the 4-hour data. Flurbiprofen was significantly superior to the acetaminophen codeine combination with respect to the number of hours until remedication. All medications had manifested an effect by hour 1; analgesia persisted for 12 hours for flurbiprofen, 6 hours for acetaminophen-codeine, and 3 hours for acetaminophen alone. The frequency of adverse effects was similar for the active medications.

Sensorimotor intelligence in severely mentally handicapped children.

The pattern of cognitive development in severely mentally handicapped children was assessed with the Uzgiris-Hunt (1975) Scales of Infant Psychological Development, which measure pre-verbal sensorimotor intelligence. The normative data on which Uzgiris & Hunt constructed the Scales were used for the comparison. The results indicated considerable deficits in the handicapped children, particularly in imitation.

Postural and motor asymmetries in newlyborns.

Twelve full-term newlyborns were examined during wakefulness for head turning and maintenance of head position within the first hour after birth. Ten showed a rightward bias on both these measures. This is the youngest age since birth at which such lateralized functions have been reported. In all infants head position was strongly related to the hand which contacted the mouth but not with contacts to other parts of the face. The reason for this difference is discussed and it is suggested that head position and hand-mouth contacting may form a lateralized synergism which biases the development of handedness.

A 12-hour evaluation of the analgesic efficacy of diflunisal, zomepirac sodium, aspirin, and placebo in postoperative oral surgery pain.

One hundred ninety-nine outpatients with pain following oral surgery were randomly assigned, on a double-blind basis, a single oral dose of diflunisal (500 or 1,000 mg), zomepirac sodium 100 mg, aspirin 650 mg, or placebo. Using a self-rating record, subjects rated their pain and its relief hourly for 12 hours after medication. Measures of total and peak analgesia were derived from these patients' subjective reports. Diflunisal (500 and 1,000 mg) and zomepirac were significantly superior to aspirin and placebo for every measure of total and peak analgesia. Based upon the first 4 hours of observation, aspirin was superior to placebo for every measure of analgesia. Diflunisal 500 and 1,000 mg were comparable to zomepirac in peak analgesia and significantly superior to zomepirac for all measures of total analgesia. The onset of analgesia was comparable for 1,000 mg diflunisal, zomepirac, and aspirin, but more rapid for these treatments than for 500 mg diflunisal. The duration of analgesia was 12 hours for diflunisal, 9 hours for zomepirac, and 3 hours for aspirin.

Neonatal localisation of a sound in visual space.

A tone was played to neonates in one of four conditions: in an unstructured visual field; spatially concordant with a single visual target; spatially discordant with a single visual target; or spatially concordant with one of two identical visual targets at different locations. Auditory-oculomotor spatial coordination, contingent on sound, was enhanced by the presence of a target in the visual field. Audition and vision are mutually supportive in auditory localisation from birth.

Verbal-performance discrepancies: relationship to birth risk and specific reading retardation.

169 unselected children were given the WPPSI at 4 1/2 years and the WISC-R at 8 1/2 years. Retrospective data on perinatal risk factors and neurological disease in childhood were collected. Verbal-performance discrepancies at 4 1/2 years were not related to perinatal risk, childhood neurological disease, left-handedness or subsequent reading ability. A weak relationship was found between WISC-R verbal-performance discrepancies and perinatal history. At 8 1/2 years, VIQ correlated much more strongly with reading ability than did PIQ. Consequently, the relationship between verbal-performance discrepancy and specific reading retardation depends critically on how reading retardation is defined. Logical problems concerning the definition of specific reading retardation are discussed.