Absent, Incapable, and "Normal": Understanding the Inclusiveness of Visually Impaired Students' Experiences in Integrated Physical Education.

The purpose of this study was to examine the inclusiveness of visually impaired youths' experiences in integrated physical education. An experiential qualitative research approach was utilized, and 22 visually impaired youth (age 12-17 years) acted as participants. Data sources included one-on-one Zoom interviews, written responses to long-answer prompts, and reflexive interview notes. Data were analyzed using a reflexive thematic analysis approach, and three themes were constructed: (a) I'm not there, so how could I: The absent person; (b) I can't see, so I can't do it: The incapable person; and (c) It'd be nice to feel like everyone else: The "normal" person. Participants described that feelings of inclusion were unavailable to them and that feeling, and being viewed as, absent, incapable, and (not) "normal" highlighted this unavailability.

Maxillary intraosseous vascular malformation: a case report and literature review.

We present a rare case of maxillary intraosseous vascular malformation and review the nomenclature used by pathologists and clinicians in classifying vascular anomalies. We also discuss the literature and highlight potential management pitfalls.

The effect of decreasing mAs on image quality and patient dose in sinus CT.

The aim of this study was to determine the effect of reducing mAs on the diagnostic quality of images and the radiation dose to the orbits in patients undergoing sinus CT. We studied 40 consecutive patients undergoing paranasal sinus CT for inflammatory disease prior to functional endoscopic sinus surgery (FESS). Four groups of 10 patients were scanned at 200 mAs, 150 mAs, 100 mAs and 50 mAs, respectively. Orbital radiation dose was measured using thermoluminescent dosemeters. Images were reviewed independently by two observers who were unaware of the mAs setting used. Image quality was evaluated using a semi-quantitative scoring system for six anatomical structures. The osteomeatal complex, uncinate process, infundibulum, frontal recess, middle turbinate and optic nerve were assessed as: clearly demonstrated (2 points); demonstrated but not clearly visualized (1 point); or not seen (0 points). No significant difference was shown between any of the four groups in terms of image quality according to the scoring system used in this study. Mean radiation dose to the orbit was reduced by 77%, from 13.5 mGy at 200 mAs to 3.1 mGy at 50 mAs (p<0.05). CT of the sinuses can be performed in patients prior to FESS at greatly reduced mAs without loss of diagnostic quality of the images. This is important in reducing the radiation dose to the lens.

The Middle Years Group: a holistic approach to the management of the menopause in primary care.

OBJECTIVES: The menopause is attaining greater significance as symptoms and long-term sequelae are amenable to hormone replacement treatment. However, hormone replacement treatment is no panacea and all women undergoing the menopause need to make informed decisions about its use. The aim of this study was to assess the effects of a series of group sessions for women aged 45-55 years, dealing with physical, social, emotional and medical aspects of the climacteric. METHODS: All women registered at the Roborough surgery were invited to join a group for four sessions, led by the health visitor and counsellor, with a doctor leading one session on hormone replacement treatment. Women's views on the group were obtained by questionnaire. Prescribing data on hormone replacement treatment and antidepressants were analysed for attenders and a matched group of those invited who did not attend. RESULTS: Twelve percent of invited women attended. All stated that sessions helped an understanding of the physical and emotional changes at this time. No significant differences were found in the use of hormone replacement treatment, antidepressants or in subsequent use of the counsellor's services between the attenders and a matched group of non-attenders. CONCLUSIONS: This group offered all women at risk the opportunity to discuss, share and learn about all aspects of the menopause. It was well received and made no major differences to the uptake of hormone replacement treatment.

High-frequency jet ventilation--a review of its role in laryngology.

High-frequency jet ventilation (HFJV) is a safe, effective anaesthetic technique with a low risk of aspiration which has not yet gained wide acceptance in laryngology. Following anaesthesia and muscular relaxation the patient is intubated with a size 7FG infant feeding catheter and ventilation is achieved by delivering small bursts of anaesthetic gas at high frequency. The mechanisms of gas exchange are thought to be little different from those of conventional ventilation. We have found HFJV to be of value in laryngoscopy, laryngo-tracheal reconstruction, tracheoplasty, bronchoscopy and tonsillectomy. The advantages include: (a) ease of intubation, especially in the presence of a supraglottic mass; (b) improved surgical access compared with a conventional endotracheal tube; and (c) protection of the airway by the inherent 'auto-PEEP' effect. Care must be taken to ensure that conditions allow adequate exhaust of expired gas. Humidification of inspired gas is essential during prolonged procedures.

Hearing loss in chronic renal failure-hearing threshold changes following haemodialysis.

The prevalence of sensorineural hearing loss, measured by pure tone audiometry, was determined in 66 patients with chronic renal failure and threshold changes following haemodialysis were measured in 31 patients. The incidence of hearing loss was 41% in the low, 15% in the middle and 53% in the high frequency ranges respectively. No correlations with weight changes, haematocrit, metabolic bone disease or ototoxic drug history were found. Of 62 ears studied, 38% had a decrease in low frequency threshold after dialysis and 9% had an increase. Threshold in 22/31 ears with pre-existing low frequency loss altered after dialysis with little change in other frequencies and no correlation with weight changes. In conclusion, we find a high incidence of low and high frequency hearing losses in chronic renal failure patients. Fluctuation in low frequencies with dialysis is common. Possible mechanisms include treatment induced changes in fluid and electrolyte composition of endolymph.

Vallecula angioleiomyoma: unusual cause of acute adult airway obstruction.

A 44-year-old man presented with acute airway obstruction. A pedunculated lesion was found arising from the right vallecula. This was confirmed to be an angioleiomyoma, a type of hamartoma rarely found in the oropharynx.

Comparison of three modes of treatment for infertility patients with minimal pelvic endometriosis.

Minimal pelvic endometriosis can be the only pathology found in infertility patients undergoing an infertility work-up. Although the mechanism by which endometriosis causes infertility is not known, it is well established that pregnancy can be attained in many patients when this disease is treated. Three different modes of treatment were used in 167 infertility patients who had minimal pelvic endometriosis without other pelvic pathology. Group I (danazol) achieved 48.9% pregnancy rates (23/47), group II (CO2 laser) had 44.6% pregnancy rates (37/83), and group III (CO2 laser and danazol) achieved 51.4% pregnancy rates (19/37). Although the pregnancy rates in groups I and III were higher, they were not statistically significant when compared with group II.

Excision of Bartholin duct cysts using the CO2 laser.

Many methods have been used to treat cystic enlargement of the duct of the Bartholins gland. Widely used methods have the disadvantage of recurrence, hemorrhage, persistent drainage, or considerable scarring. The carbon dioxide laser offers a simple and effective means of treating cystic Bartholin ducts. Ten patients were treated with the CO2 laser. The cyst was incised with the laser and the cyst wall was vaporized from the inside. In a follow-up period of one to four years, there were only two recurrences, and these responded to a second treatment. Surgery was rapid and uncomplicated in all cases, and healing occurred without scar formation. The CO2 laser offers several advantages over conventional methods for treating cysts of the Bartholin duct.

Multiple purine pathway enzyme activities are encoded at a single genetic locus in Drosophila.

The Drosophila melanogaster Gart locus, known from previous work to encode the enzyme activity phosphoribosylglycinamide formyltransferase (GART), specifies two alternatively processed mRNAs and two proteins. We introduced the entire Gart locus into a Drosophila tissue culture cell line in which the locus is active. The resulting cell clones contained numerous copies of the locus and overproduced both mRNAs and both expected proteins, thus markedly facilitating analysis of these molecules. We assayed extracts of the clones for the activities of 10 enzymes important for de novo purine synthesis and found that, in addition to GART, two other purine pathway activities, phosphoribosylamine-glycine ligase (phosphoribosylglycinamide synthetase, GARS) and phosphoribosylformylglycinamidine cyclo-ligase (phosphoribosylaminoimidazole synthetase, AIRS), are similarly overproduced. All three activities are present together on the larger overproduced protein. A smaller protein appears to possess only GARS activity. Therefore, alternative mRNA processing can allow cells to produce enzyme activities in forms that are either linked or unlinked to other activities.

Gene within a gene: nested Drosophila genes encode unrelated proteins on opposite DNA strands.

A pupal cuticle protein gene has been found within an intron of a Drosophila gene that encodes three purine pathway enzymatic activities. The intronic gene is encoded on the DNA strand opposite the purine pathway gene and is itself interrupted by an intron. Whereas the purine pathway gene is active throughout development, the intronic cuticle protein gene is expressed primarily over a 3 hr period in the abdominal epidermal cells of prepupae that secrete the pupal cuticle. Therefore, a housekeeping gene and a developmentally regulated gene function in a nested arrangement.

Hypothalamic hypopituitarism in a patient with a basal encephalocoele--treatment with luteinizing hormone-releasing hormone.

A 20-year-old patient presented with primary amenorrhoea and growth hormone deficiency caused by a basal encephalocoele. She was found to have developed diabetes insipidus in the 8 years following diagnosis. Gonadotrophin release in response to bolus injection of luteinizing hormone-releasing hormone (LHRH) was normal, as was thyrotrophin and adrenocorticotrophin (ACTH) secretion. Pulsatile administration of LHRH by the subcutaneous route resulted in normal ovulation and subsequent menstruation. The investigation and management of patients with basal encephalocoeles are discussed in the light of these findings.

Patterns of DNA structural polymorphism and their evolutionary implications.

The pattern of sites within purified DNA that are highly susceptible to double-stranded cleavage by micrococcal nuclease has been analyzed in the vicinity of over 20 genes from widely separated loci in Drosophila. These genes have uniformly exhibited a distinctive organization of cleavage sites such that at early times of digestion major sites are observed in the spacer regions surrounding the genes, but not within the protein coding regions themselves. Examples examined include Drosophila genes for heat-shock proteins, cytoplasmic actin, ribosomal protein 49, alcohol dehydrogenase, Sgs 4 glue protein, and other developmentally regulated transcripts, a human beta-globin gene, and mouse alpha 3-globin pseudogene. It seems probable that this gene/spacer pattern will be a general one in the genomes of eucaryotes, but not in the genomes of procaryotes, since neither pBR322 nor phage lambda DNA display such a pattern. One observes a nonrandom spacing of strong cleavage sites in Drosophila DNA, with the most frequent intervals being 195 bp and 411 bp. Such a pattern of variation in DNA structure may have evolved to facilitate the packaging of eucaryotic DNA into chromatin.

Clinical monitoring of the effects of gentamicin by electrocochleography.

Eight patients receiving prolonged treatment with gentamicin for bacterial endocarditis were monitored for possible ototoxicity using transtympanic electrocochleography as an adjunct to pure tone audiometry, vestibular function tests and serum gentamicin levels. An immediate effect of intravenous gentamicin on the cochlea, shown by changes in the whole nerve action potential and/or cochlear microphonic was recorded in seven patients, none of whom had experienced vestibular or auditory symptoms with gentamicin prior to testing. Two patients subsequently developed evidence of vestibular dysfunction, and a high frequency sensorineural hearing loss occurred in a third individual. There have been no previous report of the immediate effects of gentamicin on the human cochlea to date. The significance of these findings in routine clinical monitoring of ototoxicity is discussed in the light of clinical and animal evidence for the possible mode of action of aminoglycosides on the auditory and vestibular apparatus.