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This study aimed to assess the prevalence of neuropsychiatric sequelae following traumatic brain injury (TBI) among the Western Asian, South Asian and African regions of the global south. All studies on psychiatric disturbances or cognitive impairment following TBI conducted (until August 2021) in the 83 countries that constitute the aforementioned regions were reviewed; 6 databases were selected for the literature search. After evaluating the articles using the Joanna Briggs Institute guidelines, the random effects model was used to estimate the prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), TBI-related sleep disturbance (TBI-SD), obsessive-compulsive disorder (OCD) and cognitive impairment. Of 56 non-duplicated studies identified in the initial search, 27 were eligible for systematic review and 23 for meta-analysis. The pooled prevalence of depression in 1,882 samples was 35.35%, that of anxiety in 1,211 samples was 28.64%, that of PTSD in 426 samples was 19.94%, that of OCD in 313 samples was 19.48%, that of TBI-SD in 562 samples was 26.67% and that of cognitive impairment in 941 samples was 49.10%. To date, this is the first critical review to examine the spectrum of post-TBI neuropsychiatric sequelae in the specified regions. Although existing studies lack homogeneous data due to variability in the diagnostic tools and outcome measures utilised, the reported prevalence rates are significant and comparable to statistics from the global north., (© Copyright 2024, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Background: Lean methodology helps maximize value by reducing waste, first by defining what value and waste are in a system. In ophthalmology clinics, value is determined by the number of patients flowing through the clinic for a given time. We aimed to increase value using a lean-methodology guided policy change, then assessed its impact on clinic flow using an automated radiofrequency identification (RFID) based real-time locating system (RTLS)., Methods: A total of 6813 clinical visits occurred at a single academic institution's outpatient glaucoma clinic between January 5, 2018 to July 3, 2018. Over that period, 1589 patients comprising 1972 (29%) of visits were enrolled, with 1031 clinical visits occurring before and 941 visits after a policy change. The original policy was to refract all patients that improved with pinhole testing. The policy change was not to refract patients with a visual acuity ≥20/30 unless a specific request was made by the patient. Pre-post analysis of an automated time-motion study was conducted for the data collected 3 months before and 3 months after the policy change occurred on March 30, 2018. Changes to process and wait times were summarized using descriptive statistics and fitted to linear mixed regression models adjusting for appointment type, clinic volume, and daily clinic trends., Results: One thousand nine hundred twenty-three visits with 1588 patients were included in the analysis. Mean [SD] age was 65.9 [14.7] years and 892 [56.2%] were women. After the policy change, technician process time decreased by 2.9 min (p < 0.0001) while daily clinical patient volume increased from 51.9 ± 16.8 patients to 58.4 ± 17.4 patients (p < 0.038). No significant difference was found in total wait time (p = 0.18) or total visit time (p = 0.83)., Conclusions: Real-time locating systems are effective at capturing clinical flow data and assessing clinical practice change initiatives. The refraction policy change was associated with reduced technician process time and overall the clinic was able to care for 7 more patients per day without significantly increasing patient wait time., (© 2022. The Author(s).)

Recent research has shown that the prevalence of stroke incidents and the number of survivors in developing countries surpass those from developed countries. This study aimed to enumerate the prevalence of post-stroke psychiatric and cognitive symptoms among stroke survivors from West and South Asia and Africa through a systematic review and meta-analysis. Data from each country was systematically acquired from five major databases (PsycINFO, Web of Science, Scopus, PubMed/Medline, and Google Scholar (for any missing articles and grey literature)). Meta-analytic techniques were then used to estimate the prevalence of various post-stoke psychiatric and cognitive symptoms. A total of 36 articles were accrued from 11 countries, of which 25 were evaluated as part of the meta-analysis. The pooled prevalence of post-stroke depression as per the Hospital Anxiety and Depression Scale (HADS), Hamilton Depression Rating Scale, Patient Health Questionnaire, Schedules for Clinical Assessment in Neuropsychiatry (SCAN), Geriatric Depression Scale, and the Montgomery-Asberg Depression Rating Scale ranged from 28.00 to 50.24%. Pooled prevalence of post-stroke anxiety based on the HADS and SCAN was 44.19% and 10.96%, respectively. The pooled prevalence of post-stroke cognitive impairment as per the Mini-Mental Status Examination was 16.76%. This present review has suggested that both psychiatric and cognitive symptoms are common among stroke survivors. Concerted efforts are needed to institute robust studies using culturally sensitive measures to contemplate mechanisms that address the unmet needs of this vulnerable population.

A common problem for healthcare providers is accurately tracking patients' adherence to medication and providing real-time feedback on the management of their medication regimen. This is a particular problem for eye drop medications, as the current commercially available monitors focus on measuring adherence to pills, and not to eye drops. This work presents an intelligent bottle sleeve that slides onto a prescription eye drop medication bottle. The intelligent sleeve is capable of detecting eye drop use, measuring fluid level, and sending use information to a healthcare team to facilitate intervention. The electronics embedded into the sleeve measure fluid level, dropper orientation, the state of the dropper top (on/off), and rates of angular motion during an application. The sleeve was tested with ten patients (age ≥65) and successfully identified and timestamped 94% of use events. On-board processing enabled event detection and the measurement of fluid levels at a 0.4 mL resolution. These data were communicated to the healthcare team using Bluetooth and Wi-Fi in real-time, enabling rapid feedback to the subject. The healthcare team can therefore monitor a log of medication use behavior to make informed decisions on treatment or support for the patient.

Background: Obesity is a known factor for the development of abnormal respiratory physiology. However, several studies have found that obesity does not hinder functional recovery in patients hospitalized for postacute care following a stroke or cardiovascular event. This study was designed to determine the effect of overweight and obesity on patients with acute pulmonary disease, hospitalized in an inpatient rehabilitation facility (IRF)., Objective: To investigate the impact of body mass index (BMI) on indices of function, specifically, the functional independence measure (FIM) among patients with pulmonary related debility admitted to a rehabilitation hospital., Design: Retrospective cohort study., Setting: Pulmonary unit in an acute freestanding rehabilitation hospital., Patients: All patients admitted to an IRF with a diagnosis of pulmonary related debility over a 6-year period., Methods: The data used in the study included the patient height and weight (measured on admission) and FIM (scored on admission and discharge)., Main Outcome Measures: The primary study outcome measure was the change in FIM per day by the patients' BMI category., Results: For the 381 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age and sex, the FIM efficiency only slightly differed by BMI, failing to reach statistical significance. However, age did significantly influence the outcome (P = .05)., Conclusion: This study demonstrates that among a large group of patients with a pulmonary related debility, there was no statistically significant correlation between BMI and FIM efficiency. The overweight patients were similar in progression to those who were underweight, normal weight, and obese. However, this study found that increased age adversely affected the outcome of rehabilitation., Level of Evidence: III., (© 2019 American Academy of Physical Medicine and Rehabilitation.)

Background: Road traffic accidents are known to be the main cause of traumatic brain injury (TBI). TBI is also a leading cause of death and disability. This study, by means of the idiographic approach (single-case experimental designs using multiple-baseline designs), has examined whether methylphenidate (MPH - trade name Ritalin) had a differential effect on cognitive measures among patients with TBI with the sequel of acute and chronic post-concussion syndromes. The effect on gender was also explored., Methods: In comparison with healthy controls, patients with TBI (acute and chronic) and accompanying mild cognitive impairment (MCI) were screened for their integrity of executive functioning. Twenty-four patients exhibiting executive dysfunction (ED) were then instituted with the pharmacological intervention methylphenidate (MPH). The methylphenidate was administered using an uncontrolled, open label design., Results: The administration of methylphenidate impacted ED in the TBI group but had no effect on mood. Attenuation of ED was more apparent in the chronic phases of TBI. The effect on gender was not statistically significant with regard to the observed changes., Conclusions: To our knowledge, this is the first feasibility trial from the Arabian Gulf to report the performance of a TBI population with mild cognitive impairment according to the IQCODE Arabic version. This investigation confirms anecdotal observations of methylphenidate having the potential to attenuate cognitive impairment; particularly those functions that are critically involved in the integrity of executive functioning. The present feasibility trial should be followed by nomothetic studies such as those that adhere to the protocol of the randomized controlled trial. This evidence-based research is the foundation for intervention and future resource allocation by policy- or public health decision-makers.

Background: Although many studies have demonstrated that obesity is correlated with an increased risk of chronic disease, some have reported a paradox by which those in the higher weight categories actually recover better during hospitalization. This study was designed to determine whether this obesity paradox is also reflected in the recovery of patients with traumatic brain injury (TBI) undergoing care in a rehabilitation hospital., Objective: To investigate the association between body mass index (BMI) and the functional progress of patients with TBI, admitted to a rehabilitation hospital., Design: Retrospective cohort study., Methods: The study included all patients admitted to the brain injury unit of a rehabilitation hospital over a 6-year period. The data used for this study included patient height and weight (measured on admission) and functional independence measurements (scored on admission and discharge)., Main Outcome Measures: Functional independence measure (FIM) change per day, BMI category., Results: For the 444 patients admitted, the overall FIM efficiency did not differ significantly by BMI (P = .93). After adjusting for age and gender, overweight and obese patients had the lowest FIM efficiency (1.04 for both groups), followed by the underweight and normal weight groups (1.11 and 1.26, respectively)., Conclusion: This study demonstrated that higher BMI was not significantly correlated with the rate of functional recovery among patients admitted to a rehabilitation hospital for TBI., Level of Evidence: III., (© 2019 American Academy of Physical Medicine and Rehabilitation.)

Objective: To investigate the effects of body mass index (BMI) on the rehabilitation process in patients with a recent knee replacement., Design: This retrospective cohort study included all patients admitted to a rehabilitation hospital, with a recent diagnosis of knee replacement and available hospital admission data including height and weight, between 2014 and 2017., Setting: Rehabilitation hospital., Participants: Study participants included patients who had undergone knee replacement surgery (N=742), with available BMI data., Interventions: None., Main Outcome Measures: FIM scores, including FIM change per day (FIM efficiency) by BMI category., Results: The chart review identified 742 patients who had undergone knee replacement surgery, with available BMI data. The identified patients ranged in age from 58 to 85 years, with a mean age of 70 years. Of the patients included in the study, 24 were male, 49 were female, 73 were within the normal weight class, 180 in the overweight class, 189 in the obese class I, 143 in the obese class II, and 157 patients were classified as obese class III. The mean FIM efficiency was highest in the obese class II category (3.96). In a multivariate analysis after controlling for age, obese classes II and III had significantly better FIM efficiency., Conclusion: This study did not demonstrate that obesity adversely affects the rate of recovery during hospitalization after knee replacement surgery., (© 2019 The Authors.)

A micro-plenoptic system was designed to capture the three-dimensional (3D) topography of the anterior iris surface by simple single-shot imaging. Within a depth-of-field of 2.4 mm, depth resolution of 10 µm can be achieved with accuracy (systematic errors) and precision (random errors) below 20%. We demonstrated the application of our micro-plenoptic imaging system on two healthy irides, an iris with naevi, and an iris with melanoma. The ridges and folds, with height differences of 10~80 µm, on the healthy irides can be effectively captured. The front surface on the iris naevi was flat, and the iris melanoma was 50 ± 10 µm higher than the surrounding iris. The micro-plenoptic imaging system has great potential to be utilized for iris disease diagnosis and continuing, simple monitoring.

Topical formulations of diclofenac, a nonsteroidal anti-inflammatory drug commonly prescribed to treat musculoskeletal complaints such as osteoarthritis, low back pain, and myofascial pain, are available in the form of a solution, gel, and patch. The topical application of diclofenac results in substantially lower systemic exposure to diclofenac compared with oral diclofenac, resulting in a more favorable side effect profile. To the authors' knowledge, this is the first case report of a lower gastrointestinal bleed associated with diclofenac topical patch use in a 77 yr-old-woman with a history of colonic mass and atrial fibrillation on antiplatelet therapy.

Background: A preliminary study using the "gravitational wellness" weightlifting technique demonstrated this to be a unique technique for loading the musculoskeletal system with extremely high loads over short arcs. This leads to rapid weekly strength gains using 30-minute weekly training sessions. This study was designed to further assess the benefit-risk ratio of the gravitational wellness weightlifting technique., Purpose: This descriptive/retrospective study examined musculoskeletal and well-being outcomes as well as injuries reported by consecutive participants at one gravitational wellness gym., Materials and Methods: All adults presenting for training at the Atlanta, Georgia, gravitational wellness system facility over a 6-month period were invited to participate. Data were obtained by telephone interview concerning the presenting complaint/objective of training, subjective outcome, weights lifted, and injuries incurred during training., Results: Of the 77 participants contacted via telephone, 92% agreed to participate (male, n=40; female, n=31). The participants ranged in age from 18 years to 69 years, with a mean age of 48.6 years. Of these, 42 (59%) presented to the gym with the objective of improving a defined musculoskeletal issue. The modal of these was chronic low-back pain. The subjects realized improvement on a 5-point Likert scale of 4.2/5 for their presenting complaint, and improved by 4.27/5 in their overall subjective health. There were no injuries., Conclusion: This study of consecutive participants at a gravitational wellness gym found that by lifting large weights over short arcs 3 0 minutes per week, participants significantly increased their strength, reduced their musculoskeletal pain, improve their subjective well-being, and reported a low rate of injury.

Objective: To investigate the association between body mass index (BMI) and the functional progress of patients with stroke, admitted to a rehabilitation hospital., Design: A retrospective cohort study., Setting: A freestanding university rehabilitation hospital stroke unit., Participants: All patients (N=819) admitted to the stroke unit of a rehabilitation hospital during the study., Interventions: Not applicable., Main Outcome Measures: The primary study outcome measure was the FIM efficiency of patients by BMI category., Results: For the 819 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age and sex, the FIM efficiency differed by BMI. The underweight group had the lowest FIM efficiency, followed by the obese and normal-weight subgroups. The overweight group had the highest FIM efficiency (P=.05) when compared with the obese subgroup., Conclusions: Among patients admitted to an acute rehabilitation hospital for stroke rehabilitation, overweight patients had better functional progress than did patients in the other weight categories., (Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Rationale: The mechanism by which viruses cause exacerbations of chronic airway disease and the capacity of patients with cystic fibrosis (CF) to respond to viral infection are not precisely known., Objectives: To determine the antiviral response to infection in patients with CF., Methods: Sputum was collected from patients with CF with respiratory exacerbation. Viruses were detected in multiplex polymerase chain reaction (PCR)-based assays. Gene expression of 84 antiviral response genes was measured, using a focused quantitative PCR gene array., Measurements and Main Results: We examined 36 samples from 23 patients with respiratory exacerbation. Fourteen samples tested virus-positive and 22 virus-negative. When we compared exacerbations associated with rhinovirus (RV, n = 9) and influenza (n = 5) with virus-negative specimens, we found distinct patterns of antiviral gene expression. RV was associated with greater than twofold induction of five genes, including those encoding the monocyte-attracting chemokines CXCL10, CXCL11, and CXCL9. Influenza was associated with overexpression of 20 genes, including those encoding the cytokines tumor necrosis factor and IL-12; the kinases MEK, TBK-1, and STAT-1; the apoptosis proteins caspase-8 and caspase-10; the influenza double-stranded RNA receptor RIG-I and its downstream effector MAVS; and pyrin, an IFN-stimulated protein involved in influenza resistance., Conclusions: We conclude that virus-induced exacerbations of CF are associated with immune responses tailored to specific infections. Influenza induced a more potent response consisting of inflammation, whereas RV infection had a pronounced effect on chemokine expression. As far as we are aware, this study is the first to compare specific responses to different viruses in live patients with chronic airway disease.

We have developed a label-free viscosity-based DNA detection system, using paramagnetic beads as an asynchronous magnetic bead rotation (AMBR) microviscometer. We have demonstrated experimentally that the bead rotation period is linearly proportional to the viscosity of a DNA solution surrounding the paramagnetic bead, as expected theoretically. Simple optical measurement of asynchronous microbead motion determines solution viscosity precisely in microscale volumes, thus allowing an estimate of DNA concentration or average fragment length. The response of the AMBR microviscometer yields reproducible measurement of DNA solutions, enzymatic digestion reactions, and PCR systems at template concentrations across a 5000-fold range. The results demonstrate the feasibility of viscosity-based DNA detection using AMBR in microscale aqueous volumes.

Individuals learn new skills at different rates. Given the involvement of corticostriatal pathways in some types of learning, variations in dopaminergic transmission may contribute to these individual differences. Genetic polymorphisms of the catechol-O-methyltransferase (COMT) enzyme and dopamine receptor D2 (DRD2) genes partially determine cortical and striatal dopamine availability, respectively. Individuals who are homozygous for the COMT methionine (met) allele show reduced cortical COMT enzymatic activity, resulting in increased dopamine levels in the prefrontal cortex as opposed to individuals who are carriers of the valine (val) allele. DRD2 G-allele homozygotes benefit from a higher striatal dopamine level compared with T-allele carriers. We hypothesized that individuals who are homozygous for COMT met and DRD2 G alleles would show higher rates of motor learning. Seventy-two young healthy females (20 ± 1.9 yr) performed a sensorimotor adaptation task and a motor sequence learning task. A nonparametric mixed model ANOVA revealed that the COMT val-val group demonstrated poorer performance in the sequence learning task compared with the met-met group and showed a learning deficit in the visuomotor adaptation task compared with both met-met and val-met groups. The DRD2 TT group showed poorer performance in the sequence learning task compared with the GT group, but there was no difference between DRD2 genotype groups in adaptation rate. Although these results did not entirely come out as one might predict based on the known contribution of corticostriatal pathways to motor sequence learning, they support the role of genetic polymorphisms of COMT val158met (rs4680) and DRD2 G>T (rs 1076560) in explaining individual differences in motor performance and motor learning, dependent on task type.

Nonpharmacological treatment strategies that originate from sociocultural teachings and are beyond the scope of allopathic medicine are commonly used among people with epilepsy (PWE) in many parts of the world. The present study explored the types and sociodemographic correlates of complementary and alternative medicine (CAM) use among PWE in Oman among attendees of a neurological unit at a tertiary care center. Data on the types of CAM were gathered from telephone interviews. The relevant demographic and clinical characteristics of the participants were obtained from electronic medical records. Of the total of 101 participants, 73.3% were CAM users. The majority of these participants have not disclosed their CAM use to their allopathic health-care providers. The most common types of CAM reported were those falling under the 'mind-body' type (incantations and fumigation) and biologically based (herbal concoctions) or a combination of them. Compared to non-CAM users, a significant and greater proportion of CAM users attributed the etiology of their illness to nonbiomedical factors such as 'evil eyes' (P=0.04). The multivariate logistic regression model indicated that the use of CAM was highly associated with age of <30years (OR=3.09; 95% CI: 1.10, 5.46), unemployment (OR=2.04; 95% CI: 1.15, 6.39), having basic school education (OR=2.21; 95% CI: 0.83, 5.18), low family income (OR=1.52; 95% CI: 0.91, 2.11), and the presence of hypersalivation (OR=2.20; 95% CI: 1.01, 4.39). Further studies are needed to harmonize these two healing practices. On the whole, this study indicates that among attendees of tertiary care utilization, CAM is common among PWE in Oman. The most utilized type of CAM falls under the umbrella of mind-body practice., (© 2013 Elsevier Inc. All rights reserved.)

In an age of increasing numbers of lifestyle diseases and plasticity of longevity, exercise and weight training have been increasingly recognized as both preventing and mitigating the severity of many illnesses. This study was designed to determine whether significant weight-lifting gains could be realized through the Anatoly Gravitational System. Specifically, this study sought to determine whether this once-weekly weight-training system could result in significant weekly strength gains during a 10-week training period. A total of 50 participants, ranging in age from 17 to 67 years, completed at least 10 weekly 30-minute training sessions. The results suggest participants could, on average, double their weight-lifting capacity within 10 sessions. This preliminary study, which would require further scrutiny, suggests the Anatoly Gravitational System provides a rather unique opportunity to load the musculoskeletal system with extremely high loads, with rapid weekly weight gains, using only short weekly training sessions. More studies are warranted to scrutinize these findings.

Finding the causative genetic variations that underlie complex adult traits is a significant experimental challenge. The unbiased search strategy of genome-wide association (GWAS) has been used extensively in recent human population studies. These efforts, however, typically find only a minor fraction of the genetic loci that are predicted to affect variation. As an experimental model for the analysis of adult polygenic traits, we measured a mouse population for multiple phenotypes and conducted a genome-wide search for effector loci. Complex adult phenotypes, related to body size and bone structure, were measured as component phenotypes, and each subphenotype was associated with a genomic spectrum of candidate effector loci. The strategy successfully detected several loci for the phenotypes, at genome-wide significance, using a single, modest-sized population (N = 505). The effector loci each explain 2%-10% of the measured trait variation and, taken together, the loci can account for over 25% of a trait's total population variation. A replicate population (N = 378) was used to confirm initially observed loci for one trait (femur length), and, when the two groups were merged, the combined population demonstrated increased power to detect loci. In contrast to human population studies, our mouse genome-wide searches find loci that individually explain a larger fraction of the observed variation. Also, the additive effects of our detected mouse loci more closely match the predicted genetic component of variation. The genetic loci discovered are logical candidates for components of the genetic networks having evolutionary conservation with human biology.

A genetically heterogeneous population of mice was tested for hearing at 8, 18, and 22 months by auditory brainstem response (ABR), and genotyped at 128 markers to identify loci that modulate late life hearing loss. Half of the test mice were exposed to noise for 2 hours at age 20 months. Polymorphisms affecting hearing at 18 months were noted on chromosomes 2, 3, 7, 10, and 15. Most of these loci had effects only on responses to 48 kHz stimuli, but a subset also influenced the auditory brainstem response at lower frequencies. Loci on chromosomes 4, 10, 12, and 14 had significant effects on hearing at 22 months in noise-exposed mice, and loci on chromosomes 10 and 11 had effects on mice not exposed to noise. Outer hair cell loss was modulated by polymorphisms on chromosomes 10, 11, 12, 17, and 19. Resistance to age-related hearing loss is thus modulated by a set of genetic effects, some age-specific, some frequency specific, some dependent on prior exposure to noise, and some of which compromise survival of cochlear hair cells., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: The detection of mood and anxiety disorders is of great clinical importance in patients with chronic disease but data on the occurrence of affective dysfunction is lacking among people with epilepsy (PWE) in non-western populations. Further compounding such situation, the validity of some of the common assessment measures has not been examined., Objective: The study aims to investigate the application of the Hospital Anxiety and Depression Scale (HADS) by identifying patients with comorbid affective dysfunctions in an Omani population. The semi structured interview, Composite International Diagnostic Interview (CIDI) will be used to establish the psychometric property of HADS in the Omani population., Methods: PWE (n=150) were screened with the semi-structured, (CIDI) and the HADS. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the HADS for every possible threshold score., Results: The semi-structured interview revealed the prevalence rate of 27% for depressive disorder and 45% for anxiety disorder. The best compromise using, the cut-off score of 7 or 8, gave a sensitivity of 99% for depression and 83-91% for anxiety and a specificity of 87.5-100% for depression and 85-94% for anxiety., Conclusions: Findings suggest that HADS is a useful screening tool for this particular population. This finding is discussed from the socio-cultural perspective of Omani society., (Copyright © 2011 Elsevier B.V. All rights reserved.)

To test for and characterize heterogeneity in ancestral contributions to individuals among a population of Mexican American (MA) and non-Hispanic white (NHW) stroke/transient ischemic attack (TIA) cases, data from a community-based stroke surveillance study in south Texas were used. Strokes/TIA cases were identified (2004-2006) with a random sample asked to provide blood. Race-ethnicity was self-reported. Thirty-three ancestry informative markers were genotyped and individual genetic admixture estimated using maximum likelihood methods. Three hypotheses were tested for each MA using likelihood ratio tests: (1) H(0) : μi = 0 (100% Native American), (2) H(0) : μi = 1.00 (100% European), (3) H(0) : μi = 0.59 (average European). Among 154 self-identified MAs, estimated European ancestry varied from 0.26 to 0.98, with an average of 0.59 (SE = 0.014). We rejected hypothesis 1 for every MA and rejected hypothesis 2 for all but two MAs. We rejected hypothesis 3 for 40 MAs (20 < 59%, 20 > 59%). Among 84 self-identified NHWs, the estimated fraction of European ancestry ranged from 0.83 to 1.0, with an average of 0.97 (SE = 0.014). Self-identified MAs, and to a lesser extent NHWs, from an established bi-ethnic community were heterogeneous with respect to genetic admixture. Researchers should not use simple race-ethnic categories as proxies for homogeneous genetic populations when conducting gene mapping and disease association studies in multi-ethnic populations., (© 2011 The Authors Annals of Human Genetics © 2011 Blackwell Publishing Ltd/University College London.)

Purpose: To measure the time needed to teach a series of martial arts techniques to proficiency., Methods: Fifteen volunteer subjects without any prior martial arts or self-defense experience were recruited. A panel of martial arts experts selected 21 different techniques including defensive stances, arm blocks, elbow strikes, palm strikes, thumbs to eyes, instep kicks and a carotid neck restraint. The critical elements of each technique were identified by the panel and incorporated into a teaching protocol, and then into a scoring system. Two black belt martial arts instructors directed a total of forty-five 45-minute training sessions. Videotaped proficiency testing was performed weekly. The videotapes were reviewed by the investigators to determine the proficiency levels of each subject for each technique., Results: The techniques were rated by the average number of training sessions needed for an individual to develop proficiency in that technique. The mean number of sessions necessary to train individuals to proficiency ranged from 27 to 38.3. Using this system, the most difficult techniques seemed to be elbow strikes to the rear, striking with thumbs to the eyes and arm blocking., Conclusions: In this study 29 hours of training was necessary to train novice students to be proficient in 21 offensive and defensive martial arts techniques. To our knowledge, this is the first study that attempts to measure the learning curves involved when teaching martial arts techniques.

Background: A previous study suggested that the routine use of drugs intended to improve attention and arousal, such as methylphenidate, tend to have a variable but not significant effect on sleep-wake cycles. As amantadine is a frequently employed drug in brain injury rehabilitation, with known effects on fatigue and motor processing speed, this study examined the effect of amantadine on the sleep-wake behaviour of patients with brain injury undergoing rehabilitation., Method: This was a naturalistic observation using an observationally defined sleep-wake distribution for a total of 43 subjects with brain injury. Identified patients were observed for a full 24 hours a day 2 weeks before and 2 weeks after starting amantadine. Some of these patients (n = 12) had been administered amantadine on clinical grounds and, for this paper, served as the experimental group, while the drug naive (n = 31) served as a control. Three outcome measures were operationalized: hours of sleep in 24 hours, hours of sleep during daytime and hours of sleep during night-time., Result: The average number of hours of sleep during a 24-hour period was not significantly different for the two cohorts. Similarly hours of sleep during daytime and hours of sleep during night-time were on average the same for the two groups. The data suggest that amantadine has no direct bearing on sleep/wake cycles using these parameters., Conclusion: This study fails to demonstrate that the use of amantadine on an inpatient brain injury population will affect sleep/wake quantity.

Enteral feeding by percutaneous endoscopic gastrostomy (PEG) tube has become a commonly used method of supplying nutrition to patients with impaired neurologic function. In this case study we describe a 33-year-old brain-injured patient whose PEG insertion was complicated by inadvertent malpositioning and subsequent infection. After initially being placed through the liver, the PEG tube migrated out several weeks later, resulting in intra-abdominal feed collection, peri-hepatic abscess formation, and peritonitis. Physicians should be aware of the potential for inadvertent positioning through other viscera, and consider optimal methods of intraprocedural monitoring and post placement verification.

Objective: To assess the association of body mass index (BMI) with functional independence measure (FIM) score in patients with deconditioning. We also examined whether the association was different for motor and cognitive subscales of the FIM instrument., Design: A retrospective study of 1077 inpatients admitted to the general medicine service for deconditioning at an acute rehabilitation hospital. Patients were classified into underweight (BMI < 18.5), normal range (BMI = 18.5-24.9), overweight (BMI = 25.0-29.9), obese class I (BMI = 30.0-34.9), obese class II (BMI = 35.0-39.9), and obese class III (BMI > or = 40)., Results: Median gain in FIM scores from admission to discharge was highest in obese class I patients (27 points), followed by obese class II patients (26 points). The most gain in FIM scores was accounted for by the motor subscale. Adjusting for age, gender, and length of in-hospital stay, obese class I patients had a 5.8-point (95% confidence limits = 1.2, 7.0) higher gain in FIM score compared with patients with BMI in the normal range., Conclusions: In an acute rehabilitation setting, obese patients had higher gains in FIM scores as compared with normal-range-BMI patients. Most of the improvements in FIM scores were accounted for by the motor subscale, with little or no improvement on the cognitive scale.

We present our experience with 30 patients on functional outcomes of patients with anoxic brain injury (ABI, n=15) due to cardiac etiologies from freestanding inpatient rehabilitation hospital. A convenience sample of patient with traumatic brain injury (TBI, n=15) with similar demographic characteristic to ABI was used for comparison on indices of activity of daily living, cognition, mobility as well as other indices of functional prognosis such as hospital length of stay, cost and discharge predisposition. No statistical significant differences were found between the two groups on the presently employed outcome measures. This investigation supports the positive impact of inpatient rehabilitation for individuals with hypoxia of cardiac etiology. Future research comparing outcomes of ABI to TBI with larger, controlled trials is warranted.

Objectives: To explore the relationship between serum testosterone levels, age, length of stay, admission, discharge and changes in functional capacity over time among patients with traumatic brain injury treated in a rehabilitation hospital., Design: This study used a nonrandomized chart review of 54 males, consecutively admitted to a brain injury rehabilitation hospital., Methods: The charts of 54 males consecutively admitted to a brain injury rehabilitation unit between the periods of December 2004 and May 2005 were included in this study. Individuals were included in this study if they were 18 years of age or older, had suffered a traumatic brain injury, undergone admission and discharge, functional independence measure (FIM) testing and had received a serum testosterone level check within one to seven days from admission., Main Outcome and Results: The main outcome measure of this study was the FIM changes over time, as compared with admission testosterone levels. Low serum testosterone levels on admission to the in-patient rehabilitation unit were associated with longer lengths of stay, lower average admission FIM scores, less improvement in FIM scores, and a lower FIM efficiency. Although not statistically significant, individuals presenting to our unit with low testosterone levels, on average, stayed 26 days longer than did those with normal levels. Age and the presence of multi-trauma did not appear to be factors associated with serum testosterone levels. Changes in discharge cognitive FIM scores between the two groups approached statistical significance (p = 0.06)., Conclusion: This pilot study suggests that testosterone levels may be important in the recovery of patients with traumatic brain injury, treated at an in-patient rehabilitation hospital.

Background: The rehabilitation of the traumatic brain injury (TBI) patient is especially challenging in non-western populations as the phenotypic indicators as well as the neurobehavioral assessments for the survivors of brain injury are limited., Objective: The study screened for the prevalence of anxiety and depressive states among patients with TBI and examined the validity of the Hospital Anxiety and Depression Scale (HADS) to identify TBI patients with comorbid affective dysfunctions, specifically anxiety and depressive disorders, in an Omani population., Methods: Sixty-eight survivors of TBI were screened with the semi-structured, Composite International Diagnostic Interview (CIDI) and the HADS. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the HADS for every possible threshold score., Results: The semi-structured interview revealed the prevalence rate of 57.4% for depressive disorder and 50% for anxiety disorder. The sensitivity (53.8%) and specificity 75.9%, gave the best compromise using the cut-off score of 4, suggesting HADS is not a useful screening tool for this particular population., Conclusions: Phenotypic indicators as detected by CIDI revealed that prevalence of affective dysfunctionality is common among this TBI population. Although the HADS is the most widely used screening instrument in other clinical populations, it does not appear to be a reliable resource in identifying depression and anxiety in people with traumatic brain injury in Oman.

Post-transcriptional RNA processing is an important regulatory control mechanism for determining the phenotype of eukaryotic cells. The processing of a transcribed RNA species into alternative splice isoforms yields products that can perform different functions. Each type of cell in a multi-cellular organism is presumed to actively control the relative quantities of alternative splice isoforms. In this study, the alternatively spliced isoforms of five mRNA transcription units were examined by quantitative reverse transcription-PCR amplification. We show that interindividual variation in splice-isoform selection is very highly constrained when measured in a large population of genetically diverse mice (i.e., full siblings; N = 150). Remarkably, splice-isoform ratios are among the most invariant phenotypes measured in this population and are confirmed in a second, genetically distinct population. In addition, the patterns of splice-isoform selection show tissue-specific and age-related changes. We propose that splice-isoform selection is exceptionally robust to genetic and environmental variability and may provide a control point for cellular homeostasis. As a consequence, splice-isoform ratios may be useful as a practical quantitative measure of the physiological status of cells and tissues.

The aim of this study was to examine effects of polymorphic genes on vertebral bone morphology and mechanical properties. Genotypes from 525 18-month-old female mice were compared to geometric traits obtained from micro-computed tomography and mechanical properties from compression testing. Genetic markers were associated with traits on at least 13 different chromosomes, demonstrating the complexity of genetic control over vertebral form, function and aging.

Objective: To compare the safety of air insufflation as a contrast medium for percutaneous endoscopic gastrostomy (PEG) tube replacement verification with that of the more traditional method using positive contrast material (gastrograffin) under fluoroscopic guidance., Design: Retrospective case series comparing 2 radiographic procedures used for PEG tube verification at a rehabilitation hospital. The first series reviewed studies of patients over 1 year, during which the method of choice for PEG tube replacement verification was with air insufflation. The second series reviewed studies of patients over the subsequent year, during which the method of choice for PEG tube replacement verification was with gastrograffin., Setting: An inpatient rehabilitation hospital., Participants: Nineteen patients and 29 PEG tube replacements were identified that used air insufflation and 17 patients and 19 PEG tube replacements were identified that used gastrograffin., Interventions: Not applicable., Main Outcome Measures: Medical complications in a 2-week follow-up period as a result of the verification procedures., Results: There were no cases in either of the replacement procedures in which the PEG tube was found to not be in the gastrointestinal system. There was also no evidence at 2-week follow-up that any of the patients' complications were the result of either procedure., Conclusions: The air contrast procedure appears to be a relatively safe alternative procedure for PEG tube replacement verification.

A previous analysis of serum insulin-like growth factor I (IGF-I) levels in a mouse population (n = 961) derived from a cross of (BALB/cJ x C57BL/6J) F1 females and (C3H/HeJ x DBA/2J) F1 males documented quantitative trait loci (QTL) on chromosomes 1, 10, and 17. We employed a newly developed, random walk-based method to search for three- and four-way allelic combinations that might influence IGF-I levels through nonadditive (conditional or epistatic) interactions among 185 genotyped biallelic loci and with significance defined by experiment-wide permutation (P < 0.05). We documented a three-locus combination in which an epistatic interaction between QTL on paternal-derived chromosomes 5 and 18 had an opposite effect on the phenotype based on the allele inherited at a third locus on maternal-derived chromosome 17. The search also revealed three four-locus combinations that influence IGF-I levels through nonadditive genetic interactions. In two cases, the four-allele combinations were associated with animals having high levels of IGF-I, and, in the third case, a four-allele combination was associated with animals having low IGF-I levels. The multiple-locus genome scan algorithm revealed new IGF-I QTL on chromosomes 2, 4, 5, 7, 8, and 12 that had not been detected in the single-locus genome search and showed that levels of this hormone can be regulated by complex, nonadditive interactions among multiple loci. The analysis method can detect multilocus interactions in a genome scan experiment and may provide new ways to explore the genetic architecture of complex physiological phenotypes.

Background: It has been suggested that there exists a close relationship between seizure discharges and functional recovery from brain injury, and that paroxysmal bombardment in late seizures may herald functional recovery or may "kick-start" recovery., Case Report: We report the case of a 52-year-old patient who, following a subarachnoid hemorrhage and multiple surgeries, experienced discernible apallic syndrome of long duration. His hospitalization is well documented. The patient underwent protracted, intense rehabilitation, but he remained in this prolonged state of loss of consciousness and behavioral passivity until he experienced a series of periodic seizures. Widespread improvement in his cognitive and functional abilities coincided closely with the seizure activity. The literature on this topic is reviewed., Conclusion: This case confirms the close relationship between seizure discharges and functional recovery reported in preclinical literature.

Background and Purpose: A number of neuro-stimulants are routinely used as part of post-acute care of hospitalized brain-injured patients. To our knowledge, the effect of these stimulants on the sleep-wake cycles of brain-injured patients undergoing rehabilitation has not been addressed. We examined the effect of one of the most commonly used neuro-stimulants, methylphenidate, on the sleep-wake behavior of brain-injured patients undergoing rehabilitation at a dedicated brain injury clinic., Patients and Method: For this study, records of patients admitted between January and December 1999 were scrutinized retrospectively for the data on observationally defined sleep-wake distribution. A total of 30 patients diagnosed with traumatic brain injury were identified as having been observed for a full 24h a day for at least 10 days. Some of these patients (n=17) were administered methylphenidate on clinical grounds. They served as the experimental group, while the unmedicated patients (n=13) served as controls. For the present analysis, the sleep-wake cycles were arbitrarily designated as nighttime and daytime, respectively. A cumulative sleep-wake quantity in a 24-h period was also observed., Result: The average number of hours of sleep during a 24-h period was not significantly different for the two cohorts. Similar trends emerged for the nighttime and daytime observations. On the whole, methylphenidate appears not to have unfavorable effects on sleep-wake cycles, presently defined as nighttime, daytime and 24-h, in the traumatic brain injury population., Conclusion: This study sought to gain better understanding of the effect of methylphenidate on daytime sleepiness and nighttime sleep, and the data suggest that administration of methylphenidate does not appear to have an adverse effect on sleep-wake quantity.

In this paper, confocal laser scanning microscopy (CLSM) is used to detect and analyze DNA electrophoretic migration in a microchannel filled with in-situ polymerized cross-linked polyacrylamide. DNA distribution at the cross-section of the microchannel is observed to vary only slightly with the tested gel concentrations and the DNA sizes. However, in comparing with DNA electrophoresis using linear polymer solution (LPA), significant differences are observed in the distribution of DNA molecules on the observation plane using a cross-linked matrix (UV-polymerized polyacrylamide). Instead of a uniform signal boost upon the pass of one DNA band in linear polymer matrix, the electrophoretic process with cross-linked polyacrylamide presents a cross-section image with most DNA molecules aggregate near the vertical center of the microchannel during migration. This observation suggests an inhomogeneous nanostructure of in-situ polymerized cross-linked polyacrylamide in a microfabricated glass channel, consistent with SEM results. However, the phenomenon of DNA bands tending to focus in the vertical center along z-axis has not been previously reported. We also conclude from these observations that geometries containing fewer dead corners are desirable to minimize residual DNA in the microchannel.

Fraction collection following electrophoresis is of major importance for a variety of biological analyses. These assays typically need to identify specific fractions in the separated sample for further processing and require extraction of one or a group of fragments. In this paper, we have developed and characterized a technique to generate addressable electric fields for improved extraction during electrophoresis in microfluidic devices. The addressable electric field is achieved by applying a low bias voltage (1-2 V) to microelectrode pairs within the electrophoresis microchannel. Theoretical analysis shows the purity of the extracted sample can be improved as much as 30% over extraction without the shaped electric fields, and nearly 100% predicted yield can be achieved. We also describe the theoretical design of shaped electric fields by characterizing the optimal electrode geometry, field strength, channel configuration, and electrophoretic migration behavior needed for efficient band extraction.

A man in his late twenties with multiple injuries presented to a dedicated brain injury unit. A percutaneous endoscopic gastrostomy (PEG) tube was inserted for enteral feedings and medication delivery. During his inpatient course, the patient's PEG tube was inadvertently removed. House officers quickly replaced the tube by using 300 mL of room air as a contrast medium along with plain film radiography to verify correct placement. To our knowledge, this method has not previously been presented in the literature. The procedure significantly decreases the cost and eliminates the risks associated with endoscopic replacement or radiographic verification by using more common contrast media.

A combination of approaches - gene mapping, biomarker analysis, and studies of signal transduction - has helped to clarify the mechanisms of age-related change in mouse immune status and the implications of immune aging for late-life disease. Mapping studies have documented multiple quantitative trait loci (QTL) that influence the levels of age-sensitive T-cell subsets. Some of these QTL have effects that are demonstrable in young-adult mice (8 months of age) and others demonstrable only in middle-aged mice (18 months). Biomarker studies show that T-cell subset levels measured at 8 or 18 months are significant predictors of lifespan for mice dying of lymphoma, fibrosarcoma, mammary adenocarcinoma, or all causes combined. Mice whose immune systems resemble that of young animals, i.e. with low levels of CD4(+) and CD8(+) memory T cells and relatively high levels of CD4(+) T cells, tend to outlive their siblings with the opposite subset pattern. Biochemical analyses show that T cells from aged mice show defects in the activation process within a few minutes of encountering a stimulus and that the defects precede the recognition by the T-cell receptor of agonist peptides on the antigen-presenting cell. Defective assembly of cytoskeletal fibers and hyperglycosylation of T-cell surface glycoproteins contribute to the immunodeficiency state, and indeed treatment with a sialylglycoprotein endopeptidase can restore full function to CD4(+) T cells from aged donors in vitro.

Objective: To determine whether computer-aided dosing of warfarin is superior to physician dosing to maintain a patient in a rehabilitation hospital within a target international normalized ratio goal., Design: Randomized, double-blinded, clinical trial in an inpatient rehabilitation hospital. A total of 30 consecutive patients admitted receiving warfarin were randomized to either clinician dosing or computer-aided warfarin dosing for the duration of their hospitalization. The main outcome measures included the percentage of days in a therapeutic anticoagulation range and the number of blood draws. Exclusion criteria included short length of stay (n=110, 39%) and a physician declared international normalized ratio target range of <2.0 (n=67, 23%). A total of 73 patients were excluded because of heme-positive stools at admission, recent gastrointestinal bleed, early discharge or consent refusal. Dawn AC software was used to determine warfarin dosage and frequency of blood draws to maintain a target international normalized ratio of 2.0-3.0 for the computer-dosed group (n=14). Several physicians recommended warfarin dosages for the second group (n=16). Two were dropped from the computer model secondary to lost data files for these two patients., Results: Computer-aided dosing of warfarin resulted in 61.7% of days within the therapeutic range (international normalized ratio, 2-3), whereas clinician dosing resulted in only 44.1%. There were no significant differences in the number of blood draws or demographic variables between the two groups., Conclusion: Computers were significantly better at maintaining patients within a therapeutic international normalized ratio range than physicians. There were no significant differences in the number of recommended blood draws.

Biophysical measurements indicative of protein stability and function were performed on crude extracts from liver, muscle, and lens of a genetically heterogeneous mouse population. Genetic information was used to search for quantitative trait loci (QTL) that influenced the biophysical traits, with emphasis on phenotypes that previously have been shown to be altered in aged animals. Spectroscopic and enzymatic assays of crude liver and muscle tissue extracts from approximately 600 18-month-old mice, the progeny of (BALB/cJxC57BL/6J)F1 females and (C3H/HeJxDBA/2J)F1 males, were used to measure the susceptibility of a ubiquitous glycolytic enzyme, glyceraldehyde-3-phosphate dehydrogenase (GAPDH), to thermal denaturation. The rate constant for thermal inactivation of GAPDH correlated with markers on chromosome 5 (D5Mit79 and D5Mit251) for muscle lysates and chromosome 15 (D15Mit63 and D15Mit100) for liver tissue. The degree of variability of inactivation rate constants, a measure of the heterogeneity of muscle GAPDH in tissue extracts, was also associated with markers on chromosome 5 (D5Mit79 and D5Mit205). In addition, spectroscopic characteristics of extracted eye lens proteins were evaluated for their susceptibility to photooxidative stress. Absorbance and fluorescence emission characteristics of the lens proteins were mapped to QTL on chromosomes 5 and 15 (D5Mit25 and D15Mit171) while the degree of heterogeneity in photochemical oxidation kinetics was associated with a marker on the chromosome 8 (D8Mit42). Recent work has shown that GAPDH possesses a number of non-glycolytic functions including DNA/RNA binding and regulation of protein expression. Tissue specific differences in GAPDH stability may have significant consequences to these alternate functions during aging.

We have performed the Taqman beta-actin PCR system in high-surface-to-volume ratio (0.02-0.13 microm(-1)) SiO2 microchannels and observed the reaction yield and uniformity. The concentrations of the enzyme, magnesium chloride, and reaction template were varied in the reaction mix, and PCR amplification was performed in devices of various surface-to-volume ratios. We found that microchannels with higher surface-to-volume ratios required higher enzyme concentrations to achieve the same amplification efficiency. We investigated the possibility that the observed reaction nonuniformity was related to the specific adsorption of magnesium ions to the negatively charged SiO2 surface. The effect of several modifications to the reaction chemistry, the addition of the caged-magnesium dye DM-Nitrophen, the replacement of human DNA template with PCR product, and the coating of the microchannel surface with Teflon were all studied. These modifications resulted in improved reaction uniformity in the microchannels and present opportunities for further studies on enhancing the efficiency and uniformity of PCR in high surface-to-volume ratio SiO2 microchannels.

A genome scan was conducted to seek evidence for polymorphic genes that influence cause of death in mice produced by a cross between CB6F1 females and C3D2F1 males. Loci on chromosomes 1 and 4 were found to modulate risk of lymphoma. A locus on chromosome 4 influenced risk of mammary adenocarcinoma among multiparous female mice, but had no significant effect in virgin females. A chromosome 4 locus was found to modulate risk of death from either hemangiosarcoma or fibrosarcoma. A suggestive linkage was noted (at p =.09) between a marker on chromosome 11 and hepatocellular carcinoma. Lastly, a locus on chromosome 6 was noted to influence the likelihood that pulmonary adenocarcinoma would be present at death. The collection of normal and neoplastic tissues from 1004 terminal necropsies, together with genetic information, provides a valuable resource for further studies of the genetic influences on late-life diseases in mice.

Unlabelled: The goal of this study was to investigate genetic effects on mechanical properties of the mouse femur. We found evidence for QTL on eight chromosomes that affect mechanical traits. Some of these QTL may have primary effects on body weight or femoral geometry, and others seem to affect bone quality directly., Introduction: Previous studies have shown a dependence of fragility-related fracture risk on genetic background. Although many of these studies investigated the effect of genetics on BMD, basic measures of bone geometry and mechanical integrity may provide a more comprehensive characterization of the genetic effects on bone fragility. The purpose of this study was to identify quantitative trait loci (QTL) that affect mechanical and material properties of cortical bone in a genetically heterogeneous mouse population., Materials and Methods: A total of 486 female UM-HET3 mice was used for this study. UM-HET3 mice are produced as the offspring of (BALB/cJ x C57BL/6J) F(1) females and (C3H/HeJ x DBA/2J) F(1) males. Femurs from 18-month-old mice were tested to failure in four-point bending to assess mechanical properties of cortical bone; these properties were compared with genotype data from 185 biallelic loci. A permutation-based test was used to detect significant associations between genetic markers and mechanical traits. This test generates p values that account for the effect of testing multiple hypotheses. Throughout the experiment, p < or = 0.05 was considered statistically significant. Analysis of covariance was used to examine possible effects of body weight and femoral geometry., Results: We found evidence for genes on maternal chromosomes 11 and 13 and paternal chromosomes 2, 4, 7, 10, 11, and 17 that affect mechanical and material properties of femoral bone. The total variance explained by genetic effects on each mechanical trait ranges from 2.9% to 15.4%. Most of the identified polymorphisms influence mechanical traits even after adjustment for body weight. Adjustment for femoral geometry reduces the effects of some of the QTL, but those on chromosomes 2 and 10 do not seem to be influenced by femoral geometry., Conclusions: Many genes and chromosomes are involved in the genetic control over mechanical integrity of cortical bone. QTL on paternal chromosomes 4 and 11 may mediate mechanical properties, at least in part, by modulation of femoral geometry. Other QTL identified here may directly affect bone tissue quality.

The disturbance of motivation and its relationship to depression continues to spark contradictory findings among European and North American populations. Could a cross-cultural study shed some light on the situation? This study aims to detect the prevalence of apathy and to test whether the Apathy Evaluation Scale (AES) can spot the presence or absence of depression in survivors of traumatic brain injury (TBI) in Oman. Eighty subjects who sustained a TBI were given an Arabic version of the AES and were also interviewed with the semistructured Composite International Diagnostic Interview (CIDI). The authors found that the incidence of apathy and depression among Omani people who sustained TBI is similar to that reported elsewhere. The AES has poor discriminatory power in identifying cases of depression. These findings emphasize the importance of developing assessment tools that are culturally sensitive in light of the rising incidence of TBI in developing countries such as Oman.

An active microvalve that uses a meltable piston in place of a conventional solid material to obstruct fluid flow in a microfluidic channel has been developed. This phase change valve is simple to operate and requires no additional fabrication steps. The valve is inherently latched, reusable, and leak-proof (to at least 250 psi) and can be electronically addressed using resistive heaters. The valve has been characterized for a range of operational parameters that will serve as a design guide. For the designs tested, piston displacements of 5 mm or more in 1 s have been achieved. Valves 1.4 mm in length in a 50 microm x 200 microm channel have been integrated on a biochemical reaction device, and successful DNA amplification using PCR has been achieved. The phase change valve can be easily implemented in an array format that can be used to realize complex microfluidic circuits.

Objective: To investigate the focus and extent of the resident physician reading habits, to compare how these change over the years of their training, and to compare these habits with those of physiatrists in practice., Design: A total of 1,076 surveys were sent to 80 physical medicine and rehabilitation residency programs accredited by the Accreditation Council for Graduate Medical Education. The questionnaire contained a list of 36 journals pertinent to the field of Physical Medicine and Rehabilitation. Resident physicians were asked to indicate which journals they read during the past year and how extensively they read them. Respondents were also asked whether they participated in a journal club and if they read as much as they would like., Results: A total of 324 surveys (30.1%) were completed correctly. At least half of the surveyed resident physicians scanned or read six journals:Archives of Physical Medicine and Rehabilitation (85.2%), American Journal of Physical Medicine and Rehabilitation (80.6%), Journal of the American Medical Association (68.8%), New England Journal of Medicine (60.5%), American Journal of Sports Medicine (50.9%), and Rehab in Review (49.7%). Most resident physicians (93.9%) responded that they do not read as much as they would like, and 90.1% of resident physicians participate in some form of journal club., Conclusion: Most resident physicians in the field of physical medicine and rehabilitation tend to scan for important articles within one of six journals, with most of these physicians noting that they do not read as much as they would like. As the resident physicians advance in postgraduate-year level, the number of journals that they scan increases. The reading habits of the resident physicians were quite similar to those noted in our previous study of the reading habits of practicing physiatrists.

Previous studies have shown that T cell subset levels, early life body weight, and levels of leptin and thyroid hormones can each serve, independently, as predictors of life span in populations of genetically heterogeneous mice. New data now confirm, in a replicate cohort, that T cell subset patterns predict longevity, and show that they can do so when measured in mice as young as 8 months of age. Individual T cell subsets, as well as composite indices that combine data from two or more T cell measures at 8 or 18 months, can be combined with 3- and 9-month body weight data to provide better prediction of life span than either immune or weight measures alone. Mice whose immune and weight measures are both in the lowest quartile have mean and maximal life spans that are 18% and 16-25% higher, respectively, than mice in the opposite quartiles for both traits. Thyroxine levels measured at 4 months lead to further improvement over models that combine weight and immune data only. A genome scan provided evidence for loci on chromosomes 2, 12, 13, and 17 that modulate age-sensitive T cell subset patterns at both 8 and 18 months of age. These data show that late-life mortality risks are influenced to a measurable degree by factors that modulate growth trajectory and hormone and immune status in the first third of the life span, and provide clues as to which early life systems deserve further scrutiny as potential mediators of late life disease risk.

Objective: To compare the findings of the Useful Field of View (UFOV) test with those of conventional neuropsychologic tests to determine the utility of the UFOV test as a measure of attention in a population with brain injury., Design: Cohort study., Setting: Freestanding rehabilitation hospital., Participants: Fifteen inpatients with severe brain injury., Interventions: Not applicable., Main Outcome Measures: UFOV test, FIM\T instrument, length of stay (LOS), and standard neuropsychologic testing., Results: The UFOV subtest UF2 correlated strongly with the other 2 subtests, UF1 and UF3. The UF2 subtest correlated most strongly with paper and pencil tests of visual attention. The UF2 predicted 52% of the FIM change and 60% of the LOS variance, second only to admission FIM score, which predicted 75% and 80% of FIM change and LOS variance, respectively., Conclusions: Among the patients in our study, the UFOV test can be used to determine the visual divided attention of patients with acquired brain injury. The results also showed that the UFOV test correlated with LOS and FIM change in patients with acquired brain injury recovering in a rehabilitation facility. Because the UFOV test is much more quickly administered and scored than other measures of attention and divided attention, these results suggest that the UFOV test may provide an easy means to measure a critical variable in the population with head injury.