Carpe diem, Carpe ampulla: a numerical model as an aid to the design of child-resistant closures.

The population of most developed countries is ageing. Despite continuing medical advances, ageing brings with it a host of issues, not least a loss in strength and dexterity. One major area of concern is the ability of elderly consumers to access packaged goods such as food and medicines. In previous studies, the authors developed a numerical model of a human hand that was used to investigate the effect of physical dimensions and choice of grip on joint stresses to aid the understanding between physical effort, ability and discomfort. This previous work was supported by ethnographic studies and led to recommendations for packaging design. In this paper, a small ethnographic study is undertaken which identifies the grip types used to access to a product that is known to cause particular difficulties for the elderly, the "squeeze and turn" child-resistant closure or CRC, commonly used on medicines and cleaning products. One of the grip types used was chosen to be modelled using the numerical model developed in previous studies by the author. Model geometry and loading were adapted to simulate the "squeeze and turn" nature of the initial opening for closures of this type. A series of studies were then undertaken using different hand geometries; an average male hand, an average female hand and a fifth percentile female hand. The prediction from the model here is that female users with smaller hands will experience more discomfort when accessing squeeze and turn CRC's and that the turn process whilst maintaining the squeeze is problematic.

Ellis-van Creveld syndrome, (chondroectodermal dysplasia syndrome) in a Gurkha family.

The first reported case of Ellis--van Creveld syndrome in a Gurkha child is described, and the implications of the syndrome in this ethnic group are briefly considered.

Trichinosis diagnosed by computed tomography.

Trichinosis is a worldwide disease contained by good husbandry and culinary practice, presenting unexpectedly in individual cases or mini-epidemics. The disease varies greatly in its manifestation and severity although when marked can be recognized by fever with myositis and periorbital oedema. Antibody tests are specific but the appearance on computed tomography of the brain are sufficiently characteristic to allow a confident diagnosis. Two cases where such appearances led to the diagnosis are reported.

A case-comparison study of hypertension and hyperparathyroidism.

The frequency of hypertension in patients with primary hyperparathyroidism has been compared with that found in cases matched for conditions of comparable surgical magnitude, age, race, sex, and days in the hospital. The mean blood pressure of the patients was 143/89 mm Hg, significantly higher than that of controls, which was 130/81 mm Hg (P less than 0.001 for systolic and diastolic pressures). The difference was especially notable in view of the fact that the mean weight of the controls was 169 lb compared to 153.9 lb for the patients. Actual hypertension, defined as a diastolic blood pressure of 90 mm Hg or more and or treatment with hypertensive therapy was much more frequent in the patients (90 of 124; 73%) than in the controls (53 of 124; 43%; P less than 0.001). Serum creatinine was 1.3 mm/dl in patients and 1.1 mm/dl in controls. The blood pressure difference between patients and controls persisted when patients with creatinine levels of 2.0 mm/dl or less were omitted. The blood pressure difference between patients and controls had disappeared by the end of hospitalization. We conclude that primary hyperparathyroidism is associated with modest blood pressure elevation, that renal damage is probably not the mechanism, and that surgical cure perhaps may lower blood pressure. The mean effect of primary hyperparathyroidism is to shift the blood pressure distribution curve to the right by approximately 15/10 mm Hg.