A prospective study of hospital episodes of adults with intellectual disability.

BACKGROUND: Previous research has shown poor hospital experiences and dire outcomes for people with intellectual disability. The main objective of this study was to prospectively track episodes for adults with intellectual disability (ID) in Australian hospitals, with a focus on indications of the quality of care provided. METHODS: A prospective audit of hospital records over 35 months yielded quantitative data about patient characteristics, frequency and length of hospital episodes, diagnostic assessments and outcomes, post-emergency department (ED) destinations and post-discharge recommendations. Fifty participants were recruited largely by identification on hospital ED entry. An audit of patients' hospital records was conducted towards the end of hospital episodes, using a tool developed for the study. RESULTS: Participants were mostly men (70%), aged 42.9 years on average, living mostly with family (46%) or in supported accommodation (44%). Of 157 recorded episodes, 96% started in ED,  85% required urgent or semi-urgent care and 62% were in the first 3 months of study participation. Average time in ED exceeded the 4-h national benchmark, met in 40% of episodes. One or more diagnostic assessments were conducted in 91% episodes and others in short stay units. Almost half (49%) resulted in a ward stay. With an extreme data point removed, <1-35 days were spent in wards. The most frequent diagnosis in 75% of episodes was for digestive problems, followed by nervous system problems then injuries. Median length of bed stays reflected data available for Australian refined diagnosis-related groups. High hospital re-presentations were found: for 67% of episodes in total, 26% (n = 12) of which were within 72 h and 59% (n = 23) within 30 days. CONCLUSIONS: Adults with ID presented frequently to ED and often had lengthy stays. We found no indication of poor care practices in terms of hospital staff willingness to keep patients in ED and conduct of diagnostic assessments. Frequent re-presentations, however, indicated failed hospital care at some level.

Subjective sleep disturbances and quality of life in chronic tetraplegia.

STUDY DESIGN: This is a cross-sectional survey. OBJECTIVES: The objective of this study was to evaluate the subjective sleep disturbances and quality of life in chronic tetraplegia. SETTING: This study was conducted in a community sample from Victoria, Australia. METHODS: People with tetraplegia were mailed a survey battery including the following: demographic questions; Karolinska Sleepiness Scale (KSS); Basic Nordic Sleepiness Questionnaire; Functional Outcomes of Sleep Questionnaire (FOSQ); Multivariate Apnoea Prediction Index and Assessment of Quality of Life (AQoL) Questionnaire. Scores were compared with the best available normative data. RESULTS: A total of 163 of 424 (38%) surveys were returned (77% male; 39% sensory and motor complete; mean age±s.d.=46±14 years; mean years since injury=11±8 years). The AQoL health utility score (0.31±0.29) was significantly lower than published population norms. FOSQ total (17.55±2.57) and KSS (3.93±2.27) scores were no different from the best available population data. People with tetraplegia reported worse sleep habits, symptoms and quality than a normal population, as indicated on 17 of 21 questions on the Basic Nordic Sleep Questionnaire. Multivariate analysis found that greater injury severity (coefficient (95% CI)=0.14 (0.10, 0.18)), increasing age (-0.004 (-0.008, -0.001)) and worse sleep symptoms (-0.005 (-0.009, -0.0003)) were all significantly associated with reduced quality of life. CONCLUSION: People with chronic tetraplegia experience more subjective sleep problems and worse quality of life than their able-bodied counterparts. Quality of life is related to injury severity, age and sleep symptoms. Treating the sleep disorders experienced by people living with tetraplegia has the potential to improve their health and well-being.

Sleep disruption in tetraplegia: a randomised, double-blind, placebo-controlled crossover trial of 3 mg melatonin.

STUDY DESIGN: Randomised, double-blind, placebo-controlled crossover trial of melatonin supplementation to people with complete tetraplegia. OBJECTIVES: To investigate the effect that 3 mg melatonin supplementation has on objective and subjective sleep, quality of life and mood of people living with complete tetraplegia. SETTING: Austin Hospital Sleep Laboratory and participants' homes, Melbourne, Victoria, Australia. METHODS: Two week run-in followed by 3 week nightly administration of 3 mg melatonin or placebo, 2-week washout and further 3 week administration of the opposite treatment. Four testing sessions were conducted; the last nights of the run-in, treatment and washout periods. Testing sessions involved recording full polysomnography, completing a questionnaire battery and collecting urine and blood samples. The questionnaires assessed mood, sleep symptoms and health-related quality of life, and the urine and plasma samples assayed 6-sulphatoxymelatonin (aMT6s) and melatonin levels, respectively. A sleep diary was completed throughout the study. RESULTS: Eight participants (mean (s.d.): age 49.5 years (16), postinjury 16.9 years (7.1)) were recruited in which seven concluded the protocol. Endogenous-circulating melatonin was significantly higher (P < or = 0.01) following melatonin (urine: 152.94 µg h(-1) (74.51), plasma: 43,554.57 pM (33,527.11)) than placebo (urine: 0.86 µg h(-1) (0.40), plasma: 152.06 pM (190.55)). Subjective sleep improved significantly following melatonin specifically for duration of sleep per night and psychological wellbeing. Objective sleep showed a significant increase in light sleep with melatonin, with all other sleep parameters being unchanged. CONCLUSION: These results suggest that increasing melatonin in people with complete tetraplegia is beneficial, especially for subjective sleep. Investigation of the pharmacokinetics of melatonin metabolism in this population is warranted. SPONSORSHIP: This project is proudly supported by the Transport Accident Commission.

Cyclophosphamide, bortezomib and dexamethasone induction for newly diagnosed multiple myeloma: high response rates in a phase II clinical trial.

We have studied a three-drug combination with cyclophosphamide, bortezomib and dexamethasone (CyBorD) on a 28-day cycle in the treatment of newly diagnosed multiple myeloma (MM) patients to assess response and toxicity. The primary endpoint of response was evaluated after four cycles. Thirty-three newly diagnosed, symptomatic patients with MM received bortezomib 1.3 mg/m(2) intravenously on days 1, 4, 8 and 11, cyclophosphamide 300 mg/m(2) orally on days 1, 8, 15 and 22 and dexamethasone 40 mg orally on days 1-4, 9-12 and 17-20 on a 28-day cycle for four cycles. Responses were rapid with a mean 80% decline in the sentinel monoclonal protein at the end of two cycles. The overall intent to treat response rate (>or= partial response) was 88%, with 61% of very good partial response or better (>or=VGPR) and 39% of complete/near complete response (CR/nCR). For the 28 patients who completed all four cycles of therapy, the CR/nCR rate was 46% and VGPR rate was 71%. All patients undergoing stem cell harvest had a successful collection. Twenty-three patients underwent stem cell transplantation (SCT) and are evaluable through day 100 with CR/nCR documented in 70% and >or=VGPR in 74%. In conclusion, CyBorD produces a rapid and profound response in patients with newly diagnosed MM with manageable toxicity.

An examination of the effects of the antioxidant Pycnogenol on cognitive performance, serum lipid profile, endocrinological and oxidative stress biomarkers in an elderly population.

The study examines the effects of the antioxidant flavonoid Pycnogenol on a range of cognitive and biochemical measures in healthy elderly individuals. The study used a double-blind, placebo-controlled, matched-pair design, with 101 elderly participants (60-85 years) consuming a daily dose of 150 mg of Pycnogenol for a three-month treatment period. Participants were assessed at baseline, then at 1, 2, and 3 months of the treatment. The control (placebo) and Pycnogenol groups were matched by age, sex, body mass index, micronutrient intake, and intelligence. The cognitive tasks comprised measures of attention, working memory, episodic memory, and psychomotor performance. The biological measures comprised levels of clinical hepatic enzymes, serum lipid profile, human growth hormone, and lipid peroxidation products. Statistically significant interactions were found for memory-based cognitive variables and lipid peroxidation products, with the Pycnogenol group displaying improved working memory and decreased concentrations of F2-isoprostanes relative to the control group.

The effect of mobile phone electromagnetic fields on the alpha rhythm of human electroencephalogram.

Mobile phones (MP) emit low-level electromagnetic fields that have been reported to affect neural function in humans; however, demonstrations of such effects have not been conclusive. The purpose of the present study was to test one of the strongest findings in the literature; that of increased "alpha" power in response to MP-type radiation. Healthy participants (N = 120) were tested using a double-blind counterbalanced crossover design, with each receiving a 30-min Active and a 30-min Sham Exposure 1 week apart, while electroencephalogram (EEG) data were recorded. Resting alpha power (8-12 Hz) was then derived as a function of time, for periods both during and following exposure. Non-parametric analyses were employed as data could not be normalized. Previous reports of an overall alpha power enhancement during the MP exposure were confirmed (relative to Sham), with this effect larger at ipsilateral than contralateral sites over posterior regions. No overall change to alpha power was observed following exposure cessation; however, there was less alpha power contralateral to the exposure source during this period (relative to ipsilateral). Employing a strong methodology, the current findings support previous research that has reported an effect of MP exposure on EEG alpha power.

The sensitivity of human event-related potentials and reaction time to mobile phone emitted electromagnetic fields.

There is some evidence to suggest that exposure to mobile phones (MPs) can affect neural activity, particularly in response to auditory stimuli. The current investigation (n = 120) aimed to test recent findings in this area, namely that N100 amplitude and latency would decrease, and that P300 latency and reaction time (RT) would increase under active relative to sham exposure during an auditory task. Visual measures were also explored. A double blind, counterbalanced, crossover design was employed where subjects attended two sessions 1 week apart. In both sessions participants (1) performed auditory and visual oddball tasks while electroencephalogram (EEG) was recorded with a MP set to sham exposure mounted over the temporal region, and (2) performed the same tasks while the handset was set to active/sham. When active, the MP transmitted for 30 min at 895 MHz (average power 250 mW, pulse modulated at 217 Hz, average SAR 0.11 W/kg). Paired t-tests compared difference scores from the sham/sham session to those from the sham/active condition. The study was designed to detect differences of 1\4 of a standard deviation with a power of 0.80. There was no significant difference between exposure conditions for any auditory or visual event related potential (ERP) component or RT. As previous positive findings were not replicated, it was concluded that there is currently no evidence that acute MP exposure affects these indices of brain activity.

Extreme-ultraviolet fluorescence from core-excited levels of neutral rubidium.

Strong extreme-ultraviolet fluorescence originating from core-excited autoionizing levels of neutral Rb is observed. Radiative branching ratios approaching unity are inferred from the radiative yields. Long autoionizing lifetimes and fast radiative rates make these levels promising candidates for extreme-ultraviolet laser systems.

Intraventricular hemorrhage. Incidence and outcome in a population of very-low-birth-weight infants.

The incidence, extent, and outcome of germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) were determined with the use of ultrasound and autopsy findings in 100 consecutive infants, with a birth weight of less than 1,500 g. Serial ultrasound examinations once or twice weekly were performed with the use of a portable real-time linear-array scanner. The overall incidence of GMH-IVH was 46%. Twenty infants had grade 1 (GMH), 24 had grade 2 (IVH +/- GMH), and two had grade 3 (IVH +/- GMH with intracerebral hemorrhage) conditions. The mortality in infants with GMH-IVH was 35%, compared with 13% in infants without GMH-IVH. Although 11 (37%) of 30 survivors with GMH-IVH had ventricular dilatation, only two infants required ventriculoperitoneal shunts for progressive hydrocephalus. The incidence of GMH-IVH was increased in outborn infants, in those delivered vaginally, and in those who required mechanical ventilation, bicarbonate therapy, or volume expansion in the first 24 hours. The long-term prognostic significance of the ultrasound findings was unknown and will be determined by follow-up studies.

Kepone: a chemical disaster in Hopewell, Virginia.

One of the most costly chemical disasters in the United States involved a small, single-product manufacturer, ironically named Life Science Products Company, which made the pesticide Kepone for Allied Chemical Corporation. Life Science operated only 16 months in 1974 and 1975, in Hopewell, Virginia, yet managed to poison its workers and pollute the environment, causing millions of dollars of damage. The case dramatically demonstrates the links between hazards inside the factory and those outside the factory, and the confused responses of both administrative and judicial systems to a chemical disaster. In the Kepone case, as in other instances of toxic contamination, the victims confronted problems of care, compensation, and clean-up. The case illustrates two major causes of a chemical disaster: organizational pathologies of public bureaucracies, and irresponsible production by private corporations.