The use of detergent irrigation for musculoskeletal wounds.

The primary purpose of irrigation is to remove bacterial contaminants from the wound. Surfactants do that by disrupting the bonds of the organism to the surface. The use of this wound care strategy was studied in a series of investigations spanning several years. In vitro experiments revealed that surfactant irrigation was superior to saline or antibiotic solutions for removal of adherent bacteria from metallic surfaces, from bone, and from bovine muscle. An in vivo model of the complex orthopedic wound was developed. The superiority of surfactant irrigation over saline or antibiotic solution was demonstrated in animal wounds containing metal, bone injury, and soft tissue damage. Specificity of different surfactant irrigations for various bacterial species was demonstrated. A sequential surfactant irrigation protocol was developed and shown effective in the polymicrobial wound with established infection.

Energy model for contrast detection: spatial-frequency and orientation selectivity in grating summation.

Models of spatial vision usually assume a "front-end" of spatial-frequency and orientation selective channels. Subthreshold-summation studies have provided some of the strongest support for this notion. We applied a single-channel energy model and a multiple-channels probability-summation model to explore subthreshold-summation phenomena. We measured the contrast thresholds for detection of two superimposed Gabor patches as a function of the spatial-frequency and orientation difference between the components. The stimuli were centred 7.5 deg above the fixation point and were windowed by a Gaussian function with one of two different spatial spreads. We have shown that the spatial-frequency and orientation selectivity in subthreshold summation of Gabor patches is determined by the similarity (cross-correlation) between the stimulus components. A single-channel energy model as well as a multiple-channels probability-summation model could explain the summation data.

Matched filtering in motion detection and discrimination.

When humans detect and discriminate visual motion, some neural mechanism extracts the motion information that is embedded in the noisy spatio-temporal stimulus. We show that an ideal mechanism in a motion discrimination experiment cross-correlates the received waveform with the signals to be discriminated. If the human visual system uses such a cross-correlator mechanism, discrimination performance should depend on the cross-correlation between the two signals. Manipulations of the signals' cross-correlation using differences in the speed and phase of moving gratings produced the predicted changes in the performance of human observers. The cross-correlator's motion performance improves linearly as contrast increases and human performance is similar. The ideal cross-correlator can be implemented by passing the stimulus through linear spatio-temporal filters matched to the signals. We propose that directionally selective simple cells in the striate cortex serve as matched filters during motion detection and discrimination.

Spatial summation of peripheral Gabor patches.

Previous studies have specified the foveal pattern that is seen most efficiently, with the assumption that the waveform of the best pattern matches the impulse response of the most sensitive visual filter. We measured the threshold contrast for circular, collinear, and orthogonal Gabor stimuli of 6 Hz temporal frequency presented 7 deg above the fixation point. We found that the threshold contrast energy is minimal for a class of stimuli whose Fourier-spectra bandwidth is less than approximately 1 octave. These findings suggest that an energy algorithm might underlie spatial summation of peripheral Gabor patches. The different behavior of spatial summation in fovea and periphery might reflect the differences in pattern detectability across space in the central and peripheral visual fields. It is also possible that a coherent (cross-correlation) algorithm is employed in detection of foveal stimuli and that an incoherent (energy) algorithm is employed in detection of peripheral stimuli.

Identification of the eye-brain-hand system with point processes: a new approach to simple reaction time.

By presenting a Poisson process of flashes to observers who hit a button as quickly as possible after each, the authors identified the system involved in simple reaction time (RT). The nonlinear kernels up to 2nd order were measured from the stimulus and response point processes. The 1st-order kernel is analogous to a histogram of simple RTs. The 2nd-order kernel shows complex patterns of nonlinear suppression and facilitation between pairs of flashes. Simple RT measured as the lag of the 1st-order kernel's peak agrees with RT from conventional discrete trial experiments. RTs are shorter and less variable when the flashes are separated by uniform rather than exponential delays, which shows that observers use the stimulus hazard function to become prepared to detect and respond to the flash.

Comparison of castile soap, benzalkonium chloride, and bacitracin as irrigation solutions for complex contaminated orthopaedic wounds.

OBJECTIVE: The purpose of the present study was to determine the effects of cleaning a contaminated orthopaedic wound with different classes of wound irrigation solutions. STUDY DESIGN: Rats with a contaminated orthopaedic wound were randomized into treatment groups: normal saline (NS), castile soap (CS), benzalkonium chloride (BzC), bacitracin (Abx), or sequential irrigation with BzC, CS, and NS. INTERVENTION: Pseudomonas aeruginosa [P. aeruginosa; 1 x 10(6) colony-forming units (CFU)], or Staphylococcus aureus (S. aureus; 1 x 10(6) CFU) were placed into a paravertebral wound (containing a wire implant placed through a spinous process) and allowed to incubate for fifteen minutes. The wound was then irrigated with three liters of either NS, 0.05 percent CS, 0.03 percent BzC, Abx (33,000 units per liter) or underwent a sequential irrigation treatment (one liter each of BzC, CS, NS). MAIN OUTCOME MEASUREMENTS: The animals were observed daily for wound complications for fourteen days and then killed, and cultures of the wound were obtained. RESULTS: Pseudomonas aeruginosa: Both CS and the sequential irrigation treatment significantly lowered the rate of positive wound cultures when compared with NS (p < 0.05). Irrigation with BzC resulted in a higher rate of positive wound cultures and complications. The sequential irrigation treatment prevented the wound complications associated with irrigation with BzC alone. Staphylococcus aureus: Only BzC irrigation significantly lowered the rate of positive wound cultures when compared with NS (p < 0.05). CONCLUSION: The rate of positive wound cultures due to P. aeruginosa is effectively reduced by irrigation with CS alone or by the sequential irrigation treatment. When used alone, the antiseptic BzC results in a higher rate of positive wound cultures and wound complications. The wound complications seen with irrigation with BzC alone are prevented by the sequential irrigation treatment (BzC followed by CS and NS). The rate of positive wound cultures in this model due to S. aureus is not decreased by irrigation with CS; however, the rate of positive wound cultures is safely and effectively decreased with the use of BzC.

Sequential irrigation with common detergents: a promising new method for decontaminating orthopedic wounds.

This investigation sought to determine the capacity of irrigation solutions in decontaminating orthopedic wounds challenged with a polymicrobial inoculum. Rats were divided into two groups, a control group and a treatment group. After creation of a dorsolumbar incision and placement of a wire through the spinous process, rats were inoculated with Staphylococcus aureus and Pseudomonas aeruginosa. Wounds were irrigated with control or treated solutions. At 2 weeks, cultures were obtained. There were statistically significant differences between groups regarding total number of culture positive sites (P < 0.001), culture-positive animals (P = 0.02), and quantitative cultures (P < 0.02). Sequential irrigation with surfactants lowers bacteria counts recovered from polymicrobial wounds.

Is motion processing unitary?

Motion discrimination space is conventionally categorized into motion detection, speed discrimination, and direction discrimination tasks. But an ideal observer uses a unitary motion mechanism that is affected only by the noise level and the difference in speed (or displacement) between two stimuli. We tested whether human performance in the various motion tasks showed the working of a unitary mechanism or the combined outputs of more than one mechanism. We examined the whole motion discrimination space, using random dots that underwent a sudden jump or displacement. The discriminability was measured as a function of the standard and comparison displacements. Both the ideal observer model and a nonideal observer model that contains additive internal noise predict a planar response surface. When the dot motion was noiseless, the planar surface fitted well except for much higher than expected sensitivity for motion detection. This is consistent with a purely temporal mechanism that uses flicker or a purely spatial mechanism that uses the length of time-averaged streaks. It is also consistent with a Weber's law device. When motion noise was added to the displays, the planar response surface again fitted well, although the residuals showed the presence of a speed energy mechanism. We conclude that a unitary motion mechanism exists (nonideal observer model), although its performance may be supplemented by other mechanisms whose main impact is on discrimination of speeds near zero.

Motion detection and directional tuning.

A random dot pattern was presented which made two jumps in various directions with a variable delay between them. The jumps occurred at the frame transitions of a 3-frame apparent motion sequence. The variation in detectability with the directional difference and the temporal separation of the jumps allows us to make inferences about directional tuning and the temporal response of the motion detection mechanism. The detectability of a pair of jumps was highest when the delay between the jumps was short and the difference in the jump directions was small. In all cases the data were well fitted with a vector version of the speed energy model earlier proposed by Simpson. The model supposes that the two input vectors are temporally filtered, squared and integrated. Using the model, the autocorrelation function of the motion system's temporal impulse response can be found. This function shows the filter to be lowpass. According to the model, the shape of the threshold or d' locus as a function of the difference in the directions of the two jumps does not show the tuning of a motion mechanism. A tuned mechanism will respond well to a jump in its preferred direction, but less well to any other jump. Instead we show that the apparent tuning evident in the threshold and d' loci is due to the way in which the two jump vectors, each fully recovered, are combined in a vector sum.

Benzalkonium chloride. A potential disinfecting irrigation solution for orthopaedic wounds.

The efficacy of benzalkonium chloride was evaluated as an irrigating solution for the eradication of Staphylococcus aureus from a contaminated orthopaedic wound. Thirty Sprague Dawley rats were randomized into two groups. A stainless steel wire was placed in a lumbar spinous process, and the wound was inoculated with 10(7) or 10(6) colony forming units of Staphylococcus aureus. The wound was irrigated with 1 L of normal saline or 0.1% benzalkonium chloride solution. The animals were sacrificed, and cultures were obtained. Rats inoculated with 10(7) colony forming units of Staphylococcus aureus and irrigated with benzalkonium chloride had a significant decrease in the total number of positive cultures, deep wound cultures, and stainless steel wire cultures. Rats inoculated with 10(6) colony forming units of Staphylococcus aureus and irrigated with benzalkonium chloride also had a significant decrease in the total number of positive cultures, deep wound cultures, and stainless steel wire cultures. In a parallel noninoculation study, histologic evaluation of tissues did not show toxicity in the rats irrigated with benzalkonium chloride. This study shows that benzalkonium chloride is more effective than normal saline as an irrigating agent for eradicating Staphylococcus aureus from a contaminated orthopaedic wound.

The significance of positive cultures from orthopedic fixation devices in the absence of clinical infection.

Microbiologic samples for culture were obtained from 21 patients during elective removal of fracture-fixation hardware. The hardware was being removed for pain, displacement, nonunion or malunion correction, or patient preference. None of the patients had evidence of infection as determined by medical history, physical examination, white blood count, and sedimentation rate performed on the day of hardware removal. Two sets of culture samples were obtained from each patient: swabs of the wound and of the hardware were obtained and processed by the hospital laboratory. Eleven hardware cultures and nine wound cultures were positive for microbiologic growth. None of the patients was treated with antibiotics, and none developed any problems with wound infection or healing nor any evidence of osteomyelitis. We concluded that positive cultures obtained during hardware removal in the absence of clinical signs of infection are not meaningful.

Benzalkonium chloride: a potential disinfecting irrigation solution.

OBJECTIVE: To determine the disinfecting properties of benzalkonium chloride as an irrigation agent. DESIGN: Comparison was made between irrigation of contaminated muscle strips with benzalkonium chloride and normal saline (control). SUMMARY OF BACKGROUND DATA: Benzalkonium chloride is a cationic disinfectant, which has questionable efficacy in an organic environment. However, no previous study has attempted to use high volumes of this cationic solution to overcome the neutralizing effect of organic tissue and thus maintain this detergent's germicidal properties. METHODS: 2.5 cm x 0.5 cm x 0.5 cm pieces of bovine muscle were aseptically cut from the center of freshly harvested beef muscle and incubated with 1.0 x 10(7) colony forming units of bacteria for 15 minutes. The muscle strips were then irrigated with either 100 mL, 1 L, or 10 L of benzalkonium chloride at a 1:2000 concentration in normal saline. Normal saline was used as the control. The muscle strips were sonicated to remove adherent bacteria; the number of living organisms was determined by quantitatively culturing the sonicate. RESULTS: In vitro, benzalkonium chloride was superior to normal saline at disinfecting bovine muscle (p < or = 0.001). When 10 L of benzalkonium chloride irrigation was used, no living bacteria could be recovered (p < or = 0.012). CONCLUSION: In this experimental setting benzalkonium chloride was an effective disinfection agent, with enhanced activity at large volumes.

Equivalent background speed in recovery from motion adaptation.

We measured, in the same observers, (1) the detectability, d, of a small rotational jump following adaptation to rotational motion and (2) the detectability of the same jump when superimposed on one of several background rotation speeds. Following 90 s of motion adaptation the detectability of the jump was impaired, and sensitivity slowly recovered over the course of 60 s. The detectability of the jump was also impaired by the background speed in a way consistent with a quadratic form of Weber's law. We propose that motion adaptation impairs the detectability of the small jump because it is as if an equivalent background speed has been superimposed on the display. We measured the equivalent background by finding the real background speed that produced the same d' at each instant in the recovery from motion adaptation. The equivalent background started at approximately one to two thirds the speed of the adapting motion, declined rapidly, rose to a small peak at 30 s, then disappeared by 60 s. Since the equivalent background speed corresponds to the speed of the motion aftereffect, we have measured the time course of the motion aftereffect with objective psychophysics.

Disinfecting agents for removing adherent bacteria from orthopaedic hardware.

This investigation seeks to determine whether surfactants or detergents can be used to clean and disinfect orthopaedic wounds with implanted hardware. Thus, a stepwise investigation of biocompatible surfactants and detergents was performed to identify an irrigation agent for disinfecting orthopaedic wounds. Bacterial adhesions assays, irrigation studies, and bactericidal assays determined that benzalkonium chloride showed the greatest efficacy. Testing involved stainless steel screws colonized with a preformed biofilm of Staphylococcus epidermidis, Staphylococcus aureus, or Pseudomonas aeruginosa, which were immersed in benzalkonium chloride solutions for various time intervals under static conditions. After 10 minutes, benzalkonium chloride achieved a minimum 4 log kill (10,000-fold) for all 3 strains of bacteria. Additional studies demonstrated that the high mechanical energy of jet irrigation improved the disinfecting properties of this agent. With jet lavage, both 1:1000 and 1:5000 concentrations of benzalkonium chloride achieved a minimum 2 log kill (100-fold) for all 3 bacteria. The results or this study suggest that at tissue compatible concentrations, benzalkonium chloride has significant disinfection properties for in vitro colonized orthopaedic devices, and these properties may be enhanced via jet lavage.

Pedestal effect in visual motion discrimination.

Many sensory discriminations, including the discrimination of speed, obey Weber's law and thus become more difficult as the stimuli get larger. Using one-jump apparent motion stimuli, we find that the opposite can occur: displacement discrimination improves with larger jumps. This pedestal effect occurs for small jumps near and below the detection threshold. Finding a pedestal effect in motion discrimination confirms a speed energy model developed in previous experiments on the detection of jump pairs, since the pedestal effect will be observed if the visual system detects the energy of the speed waveform. Once the size of the jumps becomes large enough, the discriminability declines, indicating masking. Masking is just the detectability counterpart of Weber's law; it is not predicted from energy detection. The pedestal effect shows the presence of a squaring nonlinearity for small speed signals, and masking indicates linear transduction for large signals. A half-wave rectifier, when presented with Gaussian noise, behaves this way. The speed energy model can be seen as an approximation, valid for small signals, to a model that includes half-wave rectification.

Temporal summation of visual motion.

The sensitivity of the visual system to changes in velocity over time was investigated using the approach that Rashbass [(1970) Journal of Physiology, 210, 165-186] applied to luminance. Pairs of motion impulses (jumps) were presented, and thresholds for discriminating these pairs of impulses from a stationary display were determined. The results were consistent with a model that posits linear filtering of the input velocity, squaring, and integration over some duration. According to the model, the degree of interaction between the impulses reveals the autocorrelation of the impulse response of the motion system. The data were well fit by a three-element cascade of leaky integrators. In the temporal frequency domain, the visual motion system is a lowpass filter. This means that the visual system is quite insensitive to acceleration.

Variable fixation of staphylococcal slime by different histochemical fixatives.

A variety of histochemical fixatives were used to compare the fixation of bacterial films produced by a standard slime-producing strain of Staphylococcus epidermidis on plastic tissue culture plates. Some reagents were completely ineffective in fixing the slime layer, whereas others gave variable results. The best alternative to the fixative of the reference method, the potentially explosive Bouin's reagent, was air drying.

Optic flow and depth perception.

The field of depth recovery from optic flow has recently experienced much growth, both on the theoretical and on the empirical fronts. Unfortunately, the theoretical results are not as widely known to perception workers as they might be. This article gives a simple analysis of the information for depth present in optic flow. It also reviews the psychophysical results for depth recovery from motion. These results are discussed with reference to the theoretical analysis and to relevant computer algorithms for depth recovery.

Depth-coded motion signals in plaid perception and optokinetic nystagmus.

When two sine-wave gratings drift in different directions at the same speed behind a circular window, a single coherent plaid is seen rather than one grating sliding over the other. We find that as the stereo depth separation of the two component gratings increases, the probability of seeing a plaid declines. The gain of the slow phase of vertical optokinetic nystagmus (OKN) also falls as the separation of the components increases. When the two grating components are in the same depth plane, the vertical eye velocity is greater than that of either component. This shows that the OKN is being driven by the plaid, whose vertical speed is roughly twice as fast as the components. We conclude that both perception and OKN are fed by the same motion signal, which arises after binocular combination and after plaid synthesis.