Limited Restraint Research Articles

Successful Medical Management of Bilateral Pneumothorax Due to Nasogastric Tube Misplacement in a Cat.

A 7 yr old female spayed domestic shorthair was evaluated for suspected lily ingestion and acute vomiting. The cat had vomited suspected lily plant material before presentation, and a nasogastric tube (NGT) was placed to continue to administer activated charcoal. The NGT was passed with sedation and limited restraint. To confirm placement, a single lateral radiograph was taken, which showed that the tube was in the trachea, bronchus, through the pulmonary parenchyma, and extending into the region of the craniodorsal retroperitoneal space. The tube was subsequently removed, resulting in a tension pneumothorax. Bilateral thoracostomy tubes were placed and attached to continuous suction. The pneumothorax resolved after 2 days, the thoracostomy tubes were removed, and the cat was discharged on day 3 after admission. To the authors' knowledge, this is the first described pneumothorax complication with successful medical management secondary to routine nasogastric tube placement in a cat. This case report underscores the importance of preparedness for thoracostomy tube placement before removal of any NGT that has been confirmed to be placed through the pulmonary parenchyma.

Geometrical and Mechanical Characterization of the Abdominal Fold of Obese Post Mortem Human Subjects for Use in Human Body Modelling.

Obese vehicle occupants sustain specific injury patterns in case of accidents in which the interaction between the seat belt and the abdomen may play a role. This study aimed to collect geometrical characteristics and to investigate the mechanical responses of the abdomen of obese subjects. Four Post Mortem Human Subjects (PMHS) with BMI ranging from 31 to 46 kg/m2 were collected. CT-scans performed in the seated position revealed that the antero-posterior depth of the abdominal fold (from the inguinal region to the most anterior point of the abdominal surface) was much greater (170 mm max., 127 mm average) than the thickness of subcutaneous adipose tissues (85 max., 38 mm in average). Each PMHS was subjected to three infra-injurious antero-posterior belt pulls in a seated posture with a lap belt positioned (C1) superior to the umbilicus, (C2) inferior to the umbilicus, (C3) inside the abdominal fold between the abdomen and the thigh. During the C1 and C2 tests, the belt moved cranially, and the abdominal fold opened widely especially in C2. Forces remained below 1800 N, for maximum applied displacements ranging from 89 to 151 mm for C1 and C2, and 37 to 66 mm for C3. Finally, sled tests were conducted on two PMHS seated on a semi-rigid seat and restrained by a three-point belt equipped with pretensioners and a 3.5 kN force limitation at the shoulder. The first PMHS (BMI 39 kg/m2) was tested at 49 km/h (39 g peak) and sustained severe injuries (AIS 4 pelvis dislocation, AIS 3 bilateral femur fractures) attributed to the combined loading of the seat and lap belt force (about 11 kN and 7 kN, respectively). The second PMHS (BMI 46 kg/m2) was subjected to a 29 km/h test (8 g plateau) and sustained no injury. The lap belt slid inside the abdominal fold in the first case and deformed the lower abdomen in the second, providing limited restraint forces during that interaction and leading to a large body excursion for the first test. The results highlight the possible relevance of the abdominal fold at the abdomen thigh junction to model and study the restraint conditions of obese occupants using Human Body Models (HBM).

Bringing Down the U.S. Prison Population

This article discusses how, after about 50 years of displaying an impressively stable incarceration rate, the United States in the late 1970s began a dramatic prison population increase of about 6% annually, leading to the current status of world leader in incarceration rates. Examination of the factors contributing to the prison population growth suggests the trend is a consequence of policy choices imposed on the criminal justice system. A major factor in that growth has been an increase by a factor of 10 in the incarceration of drug offenders. Findings show that though incarceration may have achieved some incapacitative effects, it led to the recruitment of younger replacements whose limited restraint with guns represented a far greater threat to public safety than the individuals they replaced. A recent proposal by Senator Webb for a National Criminal Justice Commission to address these problems represents an important opportunity to restore rationality to the policies and to provide significant cost savings. This will require a commitment by commission members to avoid partisanship and converge to policies that will serve strong interests of both parties.

Reliability and Validity of Child Passenger Safety Restraint Observations by Community Observers

Objective: To compare the accuracy of trained community observers for direct observation of child passenger restraint use to certified child passenger safety technicians who are either professional observers or community-based technicians, and to compare these three groups with a gold standard. Methods: This is a cross-sectional study of interobserver agreement and accuracy in which 75 photos of children depicted in different child passenger restraint systems were rated by 9 observers total, with 3 representing professional observers, 3 representing certified child passenger safety technicians, and 3 representing trained community observers. For each photo, observers indicated type of restraint; the appropriateness of the harness, if applicable; and overall appropriateness of the restraint. A gold standard was established by consensus agreement of 2 certified car seat technician instructors. Results: The sensitivity and specificity for trained community observers in identifying broad groupings of restraint types was good (78–100% sensitivity; 93–99% specificity), but they had low agreement with the gold standard for overall appropriateness of the child passenger restraints (kappa = 0.28). The community observer group was 42 percent less likely to code the photo depiction of appropriate restraint use as appropriate. Conclusion: Community trained observers do show good sensitivity and specificity for identifying the type of restraint but have a trend toward poorer judgment when determining harness appropriateness and overall appropriateness. They may be a cost-effective option for limited restraint identification.

Enforcing the Right to Property Properly

Of all patrimonial rights, the right to property is considered by far the most powerful. The owner is entitled to the exclusive use of the object, the word ‘use’ is understood in a very wide meaning and the owner has a strong position as far as enforcement of his right is concerned. He can reclaim the object from anyone (revindicatio), he is usually entitled to both positive injunctions (removal of objects from his premises) and prohibitory injunctions (in case of trespass). And finally, when the owner has to put up with infringements, he is entitled to damages. There seems, however, to be quite a gap between the position of the owner who is entitled to an injunction and that of the owner who has to bear infringements and is only entitled to damages. In the first situation (injunction), the owner can vindicate his right according to a property rule which allows him to set the price for infringements. In the second case (damages), the owner is left to compensatory standards. In this paper, the consequences of the substantial shift in protection from an injunction to (different levels of) compensation will be illustrated with examples from the modern civil code of The Netherlands. Dutch law offers examples of different regimes of protection of the owner: a rather strong position (injunctive power) in the area of neighbour law, a relatively strong position in case of expropriation (a generous level of compensation), a typical liability rule (compensation according to objective standards) when a pressing societal interest prohibits injunctive relief, and a weak level of protection in case of a limited restraint of the owners capacity in case of a public development plan (only ‘fair’ compensation). These examples, which show a sliding scale of levels of protection, raise the question whether the right to property is vindicated properly when injunctive power is left for some form of compensation in money. They also raise the question according to which standards of compensation the right to property can and should be adequately protected.

Modified method for the performance of glucose insulin clamp studies in conscious rats

A modified method for performance of insulin-glucose clamp studies in rats was developed via catheterization of the tail vessels, after preconditioning of animals to limited restraint. The procedure is performed in conscious animals under local anesthesia and employs a specially designed foam rubber jacket which allows the animal mobility of the limbs and forward vision. In addition, a table utilizing a belt system allows easy positioning of the animal in the left and right lateral and supine positions during surgery. After initial development of the procedure, its use in 123 animals is reported. Line placement was successfully achieved in all cases with insignificant blood loss or morbidity and zero mortality. We note that 11% of animals did not complete the subsequent insulin-glucose clamp study due to either one of the vascular cannulae leaving the vessel (one animal), venous rupture (12 animals), or cannula blockage unrelated to surgical technique (one animal). Studies on Wistar Kyoto, Spontaneously Hypertensive, and Sprague-Dawley rats showed a fall in catecholamines after animals were replaced in cages, with stabilization within 30 min. In comparison to traditional techniques, this method is, therefore, proposed as a less traumatic and rapid way of performing infusion studies in conscious rats with a high success rate and minimization of loss of animal life due to procedural problems.

Physical restraints: has OBRA made a difference?

1. A component of the Omnibus Budget Reconciliation Act of 1987 declared that nursing home residents have the right to be free from physical or chemical restraints that are not required to treat specific "medical symptoms." 2. The literature suggests that the use of restraints has a negative influence on the caregiving process by restricting creativity and individual treatment. 3. Decreased reliance on restraints can be accomplished in nursing homes without an increase in staffing. 4. Transition to limited restraint use requires an organized, planned effort to change attitudes, beliefs, practices, and policies of a facility.

Molecular weight and hydrodynamic properties of apolipoprotein B in guanidine hydrochloride and sodium dodecyl sulfate solutions.

The apolipoprotein B polypeptide of human serum low density lipoprotein exists (after reduction of disulfide bonds) as a random coil with a molecular weight of 250,000 in concentrated solutions of guanidine hydrochloride. With intact disulfide bonds, there is a limited restraint on the polypeptide conformation in this denaturing solvent. In the presence of saturating amounts of bound sodium dodecyl sulfate, the apolipoprotein is dimeric and highly asymmetric. This work substantiates the monomeric molecular weight of 250,000 for apolipoprotein B reported by others (Smith, R., Dawson, J.R., and Tanford, C. (1972) J. Biol. Chem. 247, 3376-3381) and demonstrates that the dimeric state of the polypeptide extant in vivo is maintained in micellar detergent solution.

A Limited Restraint Harness for Use in Long-Term Infusion of Chickens

A limited restraint harness was developed which permits long-term infusion of chickens under near normal conditions. The harness allows the birds to stand, sit, move forward and backward, and turn 180° in either direction without twisting the cannula.

The genetical evolution of social behaviour. I

A genetical mathematical model is described which allows for interactions between relatives on one another's fitness. Making use of Wright's Coefficient of Relationship as the measure of the proportion of replica genes in a relative, a quantity is found which incorporates the maximizing property of Darwinian fitness. This quantity is named “inclusive fitness”. Species following the model should tend to evolve behaviour such that each organism appears to be attempting to maximize its inclusive fitness. This implies a limited restraint on selfish competitive behaviour and possibility of limited self-sacrifices. Special cases of the model are used to show (a) that selection in the social situations newly covered tends to be slower than classical selection, (b) how in populations of rather non-dispersive organisms the model may apply to genes affecting dispersion, and (c) how it may apply approximately to competition between relatives, for example, within sibships. Some artificialities of the model are discussed.