Decreasing sound and vibration during ground transport of infants with very low birth weight.

OBJECTIVE: To measure the effectiveness of modifications to reduce sound and vibration during interhospital ground transport of a simulated infant with very low birth weight (VLBW) and a gestational age of 30 weeks, a period of high susceptibility to germinal matrix and intraventricular hemorrhage. STUDY DESIGN: Researchers measured vibration and sound levels during infant transport, and compared levels after modifications to the transport incubator mattresses, addition of vibration isolators under incubator wheels, addition of mass to the incubator mattress and addition of incubator acoustic cover. RESULT: Modifications did not decrease sound levels inside the transport incubator during transport. The combination of a gel mattress over an air chambered mattress was effective in decreasing vibration levels for the 1368 g simulated infant. CONCLUSION: Transport mattress effectiveness in decreasing vibration is influenced by infant weight. Modifications that decrease vibration for infants weighing 2000 g are not effective for infants with VLBW. Sound levels are not affected by incubator covers, suggesting that sound is transmitted into the incubator as a low-frequency vibration through the incubator's contact with the ambulance. Medical transportation can apply industrial methods of vibration and sound control to protect infants with VLBW from excessive physical strain of transport during vulnerable periods of development.

Feasibility studies. The use of NMR spectrometry as a possible substitute of or complement to several analytical tests in pharmacopoeia monographs.

NMR spectrometry has many analytical applications; for instance, the identification of known substances; the structure elucidation of unknown ones; the quantification of APIs, impurities, solvent and water; kinetic studies, stereochemistry determinations, and the analyses of complex mixtures as in metabonomics. NMR spectrometry has the potential to substitute or complement existing analyses that are performed on APIs. In this work, 4 different NMR analyses were done on 2 APIs: fluvastatin sodium and benzalkonium chloride with good results.

Identification and purity test of heparin by NMR - a summary of two years' experience at the Medical Products Agency.

This paper is a review of published and unpublished results on heparin during the last two years. Results and experiences gathered in our laboratory at MPA in Sweden, from the collaborative NMR study on heparin in Europe (coordinated by EDQM), and from the process of drafting heparin Ph. Eur. monograph texts where new ideas and experiments have been performed. Explanations and guidelines are also presented to clarify the NMR identification test introduced in the sodium and calcium heparin monographs. NMR, strong anion exchange-LC (SAX-LC) and capillary electrophoresis (CE) have been compared in the quantification of over-sulphated chondroitin sulphate (OSCS) and dermatan sulphate (DS) in heparin. In this paper, the term heparin will stand for unfractionated porcine heparin sodium. When other heparin types are mentioned, they will be explicitly named.

Determination of Oversulphated Chondroitin Sulphate and Dermatan Sulphate in unfractionated heparin by (1)H-NMR - Collaborative study for quantification and analytical determination of LoD.

Oversulphated Chondroitin Sulphate (OSCS) and Dermatan Sulphate (DS) in unfractionated heparins can be identified by nuclear magnetic resonance spectrometry (NMR). The limit of detection (LoD) of OSCS is 0.1% relative to the heparin content. This LoD is obtained at a signal-to-noise ratio (S/N) of 2000:1 of the heparin methyl signal. Quantification is best obtained by comparing peak heights of the OSCS and heparin methyl signals. Reproducibility of less than 10% relative standard deviation (RSD) has been obtained. The accuracy of quantification was good.

Writing patient-centered functional goals.

Motor learning research, health care policies, reimbursement practices, and the standards of accrediting bodies all support writing patient-centered functional goals of physical therapy. This article defines patient-centered functional goals within the context of the Guide to Physical Therapist Practice and provides a rationale for incorporating functional goals into physical therapy for patients in all areas of practice. The article also describes how physical therapists can collaborate with patients to identify functional goals that are meaningful to them and describes a 5-step process for writing functional goals that are measurable.

Effects of testing context on ball skill performance in 5-year-old children with and without developmental delay.

BACKGROUND AND PURPOSE: Physical therapists often test ball-playing skills of children with disabilities using standardized testing, which may not predict performance of ball skills in games with peers. This type of testing is used by physical therapists to determine whether children have delays in ball-handling skills. The purpose of this study was to compare ball skill performance of children with and without developmental delay in a one-to-one testing situation and in a structured game with peers. SUBJECTS: Five-year-old children with developmental delay (n=20) and 5-year-old children without disabilities (n=20) participated in the study. METHODS: We used the Peabody Developmental Motor Scales receipt and propulsion scale to test children one-to-one with a therapist and during a structured game with peers. RESULTS: Subjects without developmental delay performed better than subjects with developmental delay under both testing conditions. Children with developmental delay performed better in the one-to-one testing condition than in the game with peers. The performance of children without developmental delay did not differ under the 2 conditions. Boys performed better than girls. CONCLUSION AND DISCUSSION: Physical therapists should consider the potential effect of environment on the ball-handling skills of children with disabilities.

Formation of several stable complexes between the minor components of the cyclic tetrapeptide cyclo-(-Pro1-Ala2-D-Phe3-Leu4-) and some specific Boc-amino acids.

The cyclic tetrapeptide cyclo (-Pro1-Ala2-D-Phe3-Leu4-) was modeled and synthesized to be used for molecular interactions and chiral discrimination studies in CDCl3. Total correlation spectroscopy and nuclear Overhauser effect spectroscopy spectra of the cyclic tetrapeptide showed the presence of one dominant stereoisomer-1- and three minor ones--2a, 2b, and 2c--in a relationship of 92:6:1:1. They formed three- to five-hydrogen bond complexes with Boc-D-Ser, Boc-L-Ser and Boc-L-Thr (Boc: t-butyloxylcarbonyl). These three Boc-amino acids interact more strongly with 2a, 2b, and 2c than with 1, altering their relative concentrations to 48:40:6:6. In the complex between the cyclic tetrapeptide and Boc-D-Ser, the stereoisomer 2a exchanged chemically with 1, 2b, and 2c, while 1 did not exchange with either 2b or 2c. This chemical exchange is due to cis-trans isomerization of the peptide bonds. The chiral discrimination of 2a, 2b, and 2c was stronger than that of 1. No complexation occurred with Boc-L-Ala or Boc-L-Trp.

NMR and computer-aided modeling studies of the interactions between a cyclic hexapeptide and the two enantiomers of some Boc- and Fmoc-amino acids.

The cyclic hexapeptide cyclo [-Pro1-Gly2-Glu3 (OBzl)-Pro4-Phe5-Leu6-] (1) was modeled and synthesized to be used for chiral discrimination studies. Total correlated spectroscopy and nuclear Overhauser effect spectroscopy spectra of the cyclic hexapeptide 1 in CDCl3 showed the presence of three stereoisomers: two dominant stereoisomers 1a and 1b that exchanged chemically with each other, and a minor stereoisomer 1c (4%) that exchanged exclusively with the stereoisomer 1b. Of the two dominant stereoisomers, only 1a interacted specifically with t-butyloxycarbonyl (Boc-) and 9-flourenylmethyloxycarbonyl (Fmoc-) amino acids in CDCl3. The interaction site of 1a when complexing with the derivatized amino acids was the chain segment Phe5-Leu6. The Phe5 NH and Leu6 NH protons are contiguous and solvent exposed. Their nmr signals shifted strongly downfield with the addition of Boc- or Fmoc- amino acids to the peptide solution. Thus, both NH protons hydrogen bond to the amino acids, forming a two-point hydrogen-bonding complex. The peptide stereoisomer 1b did not interact specifically with the Boc- and Fmoc-amino acids because of the lack of two contiguous and solvent-exposed peptidic NH protons that seem to be needed for specific interactions of the cyclic hexapeptide 1 with the Boc- and Fmoc-amino acids. A clear difference in the interaction of 1a with D- and L-enantiomers of Boc- Trp and Fmoc-Trp was observed with nmr spectroscopy. Docking models and molecular mechanics calculations together with nmr observations showed that the NH proton of the indole ring of the Boc-L-Trp and the Fmoc-L-Trp hydrogen bonded to the Pro1 carbonyl group. In this three-point hydrogen-bonding complex, the indole ring becomes locked underneath the Leu residue. The nmr signals of all the Leu6 protons (except for Leu NH) shifted strongly upfield owing to the shielding effect of the indole aromatic ring currents. The indole NH of the D-enantiomer did not hydrogen bond to the Pro1 carbonyl group because the formation of such a three-point hydrogen-bonding complex was thermodynamically unfavorable.

Assistive positioning as a control parameter of social-communicative interactions between students with profound multiple disabilities and classroom staff.

This study examined the effects of assistive positioning on social-communicative interactions between 10 students, 6 to 12 years of age, with profound multiple disabilities, and their classroom staff. Interactions were videotaped in the students' classrooms when each student was positioned using a wheelchair, a sidelyer, and a mat on the floor. Data were analyzed by repeated-measures analysis of variance. During unstructured interactions, adults initiated communication at higher rates when students were positioned in their wheelchairs. During structured interactions, when students were given standardized opportunities for interaction, students functioning at lower levels of communication development were more communicative when they were supine on a mat than when in their wheelchairs or a sidelyer. In dynamic systems terms, position served as a control parameter of both adult and student communicative behaviors, which should be considered when recommending use of assistive positioning equipment for students with severe disabilities.

Prescriptions for physical and occupational therapy in school.

Prescriptions for occupational and physical therapy in a metropolitan school district are described. Seven physical therapists and 7 occupational therapists completed close-ended questionnaires on 226 prescriptions. An equivalent of 4.5 fulltime therapists did not participate and accounted for 54 other prescriptions. Each prescription was independently reviewed for its form, content, and relative value to therapy. Of all the prescriptions 119 (52%) involved students with cerebral palsy; 35 (15%), diseases or syndromes of the central nervous system; 12 (5%), myelomeningocele; 8 (4%), head trauma; 7 (3%), neuromuscular disorders; and 30 (13%), developmental delay. Of the 226, 210 (93%) involved students enrolled in special educational programs; 108 (48%) of all prescriptions were written on standardized school forms, half of which contained checklists. In 13 (6%), the content was illegible. References made to technique, anatomic site, neurologic, and general terms varied greatly. Fifty-seven (30%) made open or blanket comments for therapy. The dose or intensity of therapy was stipulated in only 5% of cases. Only 15 prescriptions requested feedback. Prescriptions by physiatrists were rated slightly higher than those written by pediatricians and other specialists. It is suggested that the prescription is necessary but not sufficient to assure communication between the physician and the school staff.

Assessment of the reliability of pediatric screening: a tool for occupational or physical therapists.

This study was conducted to determine interrater and test-retest reliability characteristics of the instrument, Pediatric Screening: A Tool for Occupational and Physical Therapists. This protocol was developed by two public school therapists to be used as a decision-making mechanism for systematically assessing the students' relative need for therapy services. The subjects were 75 children, aged 3 to 16 years, with various types and degrees of disability. Each was scored on the screening tool by three different school therapists within one week to determine interrater reliability. Each of the therapists also tested two or three of the children again several weeks later to determine test-retest reliability. Analysis of interrater reliability using the Spearman-Brown prediction formula showed total scores on the screening tool to be reliable at the .90 level. Test-retest reliability measurements using the Pearson product-moment correlation coefficients showed that total scores were highly correlated (r = .96; p less than .001). These measures indicated that the Pediatric Screening tool is a highly reliable instrument in terms of scoring between therapists and by individual therapists across time.