Funding for cerebral palsy research in Australia, 2000-2015: an observational study.

OBJECTIVES: To examine the funding for cerebral palsy (CP) research in Australia, as compared with the National Institutes of Health (NIH). DESIGN: Observational study. SETTING: For Australia, philanthropic funding from Cerebral Palsy Alliance Research Foundation (CPARF) (2005-2015) was compared with National Health and Medical Research Council (NHMRC, 2000-2015) and Australian Research Council (ARC, 2004-2015) and CPARF and NHMRC funding were compared with NIH funding (USA). PARTICIPANTS: Cerebral Palsy researchers funded by CPARF, NHMRC or NIH. RESULTS: Over 10 years, total CPARF philanthropic funding was $21.9 million, including people, infrastructure, strategic and project support. As competitive grants, CPARF funded $11.1 million, NHMRC funded $53.5 million and Australian Research Council funded $1.5 million. CPARF, NHMRC and NIH funding has increased in real terms, but only the NIH statistically significantly increased in real terms (mean annual increase US$4.9 million per year, 95% CI 3.6 to 6.2, p<0.001). The NHMRC budget allocated to CP research remained steady over time at 0.5%. A network analysis indicated the relatively small number of CP researchers in Australia is mostly connected through CPARF or NHMRC funding. CONCLUSIONS: Funding for CP research from the Australian government schemes has stabilised and CP researchers rely on philanthropic funding to fill this gap. In comparison, the NIH is funding a larger number of CP researchers and their funding pattern is consistently increasing.

Preparticipation cardiovascular screening: toward a national standard.

In the absence of a national requirement for cardiovascular screening of competitive high school and college athletes, some physicians have been vulnerable to lawsuits in the wake of sudden cardiac deaths in athletes. The American Heart Association recently recommended routine cardiovascular screening for athletes and a specific screening protocol. To best serve the athletes and their healthcare providers, the author suggests that national sports governing organizations should make cardiovascular screening a national requirement in preparticipation evaluations.

Practice guidelines take center court: how to limit liability.

An unintended result of practice guidelines, meant to codify and streamline high-quality patient care, is their role in the courtroom: to attack or to defend the delivery of medical care to athletes. Researchers predict that patients' attorneys will make greater use of practice guidelines in malpractice claims. The best tactic sports medicine physicians can use to prevent claims is to become familiar with and adopt applicable practice guidelines. Also, physicians need to know when they're deviating from the guidelines and how to defend such decisions.

The effects of feedback on the behavior of depressed inpatients in two structured interactions.

This study examined the responsivity of depressives' behavior to contingent social feedback within the framework of Coyne's and Lewinsohn's models of depression. Subjects included 10 depressed inpatients, 8 nondepressed psychiatric inpatients, and 10 nondepressed individuals. Each subject participated in two structured interactions with an experimenter in baseline phases and phases in which ongoing contingent feedback was provided by a pair of observers. The results revealed that the behavior of all three subject groups was responsive to the feedback in both interactions. The results are consistent with past research demonstrating social skills problems among depressed individuals but do not support the notion of a social skill deficit in depression. The results are consistent with Coyne's model of depression and suggest that the problematic social behavior often associated with depression may be modifiable by immediate veridical feedback from others.

Legal issues in the delivery of worksite health promotion.

Employee health promotion programs typically involve one or more of the following: (1) education programs, (2) cholesterol, blood pressure, diabetes, or other similar screening programs, (3) smoking cessation programs, (4) drug/alcohol testing and counseling programs, (5) exercise facility or activity programs, and (6) recreational activity programs. The authors examine potential legal implications of these activities. This chapter is intended for those attempting to define and establish these programs or to focus and operate them without undue conflict or legal system involvement.

Effectiveness of matched, mismatched, and package treatments of depression.

The three purposes of this study were: (a) to determine if treatment that is matched to a depressed subject's problematic behavioral response class (irrational cognitions, social skills problems, few pleasant events) is more effective in alleviating depression than is mismatched treatment; (b) to determine if a package treatment is as effective as or more effective than a matched treatment and more effective than a mismatched treatment in alleviating depression; and (c) to determine if a specific treatment produces more changes in its logically-related response class than in logically-unrelated response classes. Nine depressed women were assigned to one of three multiple baseline designs across subjects; subjects in each design received, respectively, matched, mismatched, or a package treatment. Results strengthened two hypotheses, that matched treatment and package treatment are both effective in alleviating depression. Specific treatments did not, however, differentially affect their logically-related response classes.

Legal Aspects of Cardiac Rehabilitation Exercise Programs.

In brief: Cardiac rehabilitation as a distinct c health care service is of fairly recent origin, and existing programs are rather broad and nonstandardized. Consequently, the malpractice crisis that has engulfed the medical profession may well affect professionals who practice cardiac rehabilitation. Various legal issues and concerns face cardiac rehabilitation programs, as they do any other health care provider group. The adoption of written program policies and procedures, set in accordance with national standards of practice, can address the legal and practical problems. Obtaining effective informed consent from patients and using various risk management techniques can also assist in the operation of safe and legally defensible cardiac rehabilitation programs.

Blood flow mapping in the human liver by the xenon/CT method.

In the noninvasive, nonradioactive xenon/CT method of blood flow measurement, xenon gas is inhaled, and the temporal changes in radiographic enhancement produced by the inhalation are measured by sequential CT; time-dependent xenon concentration within various tissue segments is then used to derive local blood flow maps. The usefulness of the method in the assessment of local cerebral blood flow has been documented. In this paper we explore its application to blood flow measurement in the human liver. In our preliminary clinical studies, hepatic blood flow ranged from 50 to 120 ml/100 cc/min in normal and adequately supplied tissue, and lower flow values were observed in tissue with abnormal function. The advantages and limitations of the method in such applications are discussed.

Three-dimensional computed tomography of acetabular fractures.

Computer programs that produce 3D surface reformations from sets of contiguous axial CT scans were used in evaluating a variety of acetabular fractures in 20 patients. The 3D images were easily correlated with plain radiographs, and new views were produced that provided a unique perspective not obtainable by conventional radiography. The 3D images were useful in complex displaced fractures in cases in which the interpretation of plain radiographs was difficult. Plain radiographs and conventional CT scans were more sensitive than the 3D images in detecting undisplaced fractures.

Vascularization of tricalcium phosphate, an artificial bone substitute: preliminary observations.

Tricalcium phosphate (TCP), a biodegradable artificial bone substitute, was used to study the following questions: i) can TCP be vascularized; ii) do ectopically placed implants have osteoinductive capacity; and iii) does vascularization affect implant resorption? Implants were placed in dogs in several areas: i) subcutaneous controls; ii) wrapped with latissimus dorsi muscle; iii) wrapped in omentum; iv) saphenous and thoracodorsal av pedicles threaded through implant. Prior to harvest, animals were given tetracycline and implants were harvested at 3, 6, and 9 weeks. Microfil was injected prior to sacrifice and specimens were xeroradiographed. Histology and computerized axial tomography were obtained. From this study, we conclude that 1) TCP can be vascularized; 2) the most effective method of vascularization was by an AV pedicle threaded through the implant; 3) vascularized implants did not have osteoinductive properties per se, and 4) in the time observed no difference in implant resorption was demonstrated between the test groups.

Xenon/CT blood flow mapping of the kidney and liver.

A noninvasive technique for measuring blood flow by xenon-enhanced X-ray transmission CT has been developed and reported quite extensively in recent years. In this method nonradioactive xenon gas is inhaled, and the temporal changes in radiographic enhancement produced by the inhalation are measured by sequential CT. Time-dependent xenon concentration within various tissue segments is used to derive local blood flow maps. The method has been amply discussed in relation to assessment of local cerebral blood flow. Its application to other body organs is explored in this paper, in which results from six preliminary blood flow studies in the liver and kidneys of nonhuman primates are reported. Blood flow in renal cortex ranged from 150 to 280 ml/100 cc/min and hepatic tissue perfusion from 80 to 120 ml/100 cc/min. The advantages and limitations of the method in such applications are discussed.

Pelvic and acetabular fractures: examination by angled CT scanning.

A new technique of direct angled CT scanning of pelvic and acetabular fractures is presented that allows visualization of the entire ring on a single image or two adjacent images.

Pulmonary function in progressive systemic sclerosis. Comparison of CREST syndrome variant with diffuse scleroderma.

The pulmonary function and chest roentgenograms were evaluated in 88 patients with the CREST syndrome variant of progressive systemic sclerosis (PSS or scleroderma). Seventy-two percent of the patients had abnormal pulmonary function. An isolated decrease in diffusing capacity was the most common abnormality noted, followed by restrictive abnormalities and airway obstruction. Chest roentgenograms revealed interstitial infiltrates consistent with pulmonary fibrosis in 33 percent. When compared to a contemporaneous group of 77 patients with PSS and diffuse scleroderma, patients with the CREST syndrome had similar abnormalities on pulmonary function testing and chest roentgenogram. However, patients with the CREST syndrome had a lower mean diffusing capacity despite a higher mean vital capacity; this combination of findings suggests primary pulmonary vascular disease. Calcified granulomata were identified significantly more often in PSS-CREST patients, while superior rib notching occurred exclusively in patients with PSS and diffuse scleroderma. The CREST variant of PSS is associated with frequent roentgenographic and pulmonary function abnormalities similar to those seen in PSS with diffuse scleroderma.

Mapping of human local pulmonary ventilation by xenon enhanced computed tomography.

Functional maps of local pulmonary ventilation are derived from serial computed tomographic images acquired prior to and during a short period of inhalation of subanesthetic xenon/oxygen gas mixtures. Preliminary results from human studies yield quantitative maps of local ventilation rates with excellent anatomic specificity demonstrating nonuniformities in the distribution of ventilation in normal and abnormal human lungs.

Bromocriptine treatment of women with suspected pituitary prolactin-secreting microadenomas.

The present study was designed to investigate the efficacy of bromocriptine in reducing serum prolactin (PRL) levels and in decreasing the size of PRL-secreting microadenomas. Bromocriptine, 5.0 mg, was administered daily for 2 years of 17 women who had galactorrhea, hyperprolactinemia, and hypocycloidal polytomographic evidence suggestive of a pituitary microadenoma. Serum PRL levels were normalized in 16 of 17 women during therapy. Associated with this was resumption of regular menses in 15 of 16 women with menstrual dysfunction and cessation of galactorrhea in 16 of the 17 women. Improvement in the roentgenographic appearance of the sella turcica occurred in two women. No progression in tumor size was found during the course of therapy. Side effects attributed to bromocriptine were minimal, transient, and usually well tolerated. These data suggest that bromocriptine is an appropriate therapeutic modality for PRL-secreting pituitary microadenomas.

Errors associated with single-scan determinations of regional cerebral blood flow by xenon enhanced CT.

Possible errors in the determination of xenon concentrations in arterial blood, and uncertainties in CT tissue enhancements during inhalation of xenon-oxygen mixtures, are used to assess errors in the determination of regional cerebral blood flow by the in vivo autoradiographic (single-scan) technique. The results of this study indicate that errors associated with the determination of xenon concentrations in arterial blood decrease rapidly as the time of scanning after the initiation of xenon inhalation is increased. Analysis of errors caused by statistical uncertainties in image enhancement indicate that time of scanning is optimal between 1.5 and 2.5 min for determination of fast flow, while errors in slow-flow determinations gradually decrease as the time of scanning increases.

Spiculation of antral margin in erosive gastritis.

Because of the low yield, conventional barium studies had been considered an unreliable methods of detecting erosions of the stomach. With the advent of the double contrast examination, the literature is now replete with examples of erosive demonstrated by this technique. As in endoscopy, the erosions are visualized "en face" only. No case, however, has been recorded in which the diagnosis was made on a profile view of the erosions. We present such a case of erosive gastritis with two unusual features in which 1) the diagnosis was made on a conventional single contrast study and 2) the lesions were identified in profile.

Regional pulmonary ventilation measurements by xenon enhanced dynamic computed tomography: an update.

New developments in computed tomographic technology permit rapid, serial images that may yield information concerning tracer kinetics through a large tissue volume. One possible application of these developments is the derivation of local lung ventilation by observing the temporal changes of stable xenon concentrations. Preliminary results from six multilevel ventilation studies in dogs demonstrate that the lung may be repeatedly imaged during reproducible phases of respiration even when interscan table incrementation is employed to survey a number of tissue segments and breathing is permitted between scans. In addition, subanesthetic xenon concentrations provide adequate enhancement for possible quantification.

The wandering broncholith.

In a patient with "stone asthma" the obstructing broncholith moved from one lung to the other and was later spontaneously expectorated.