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Purpose: Heterotopic ossification (HO) is a benign disorder characterized by ectopic bone formation in soft tissues that can lead to functional loss in patients. We conducted a systematic review of the evidence on the use of radiation therapy (RT) for the prevention or treatment of HO., Methods and Materials: Literature searches were conducted using Medline (via PubMed), Embase, and ClinicalTrials.gov until April 1 , 2023. Medical subject headings and free text terms relevant to HO and RT were used. In brief, eligible study participants were ≥18 years of age with HO and were treated with low-dose external RT. Two reviewers screened relevant abstracts and extracted full-text data for analysis. The review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines., Results: Ten studies evaluating the effect of RT for either the prevention or treatment of HO met the inclusion for evidence synthesis. Nine randomized controlled trials did not clearly report their methods and had a medium risk of bias. The studies were conducted between 1988 and 2008, with follow-up ranging on average from 3 to 59 months posttreatment. A total of 1530 participants were analyzed, and 566 were treated with RT following fracture fixation, total hip arthroplasty, or total hip replacement. In pooled data from 8 randomized controlled trials, there was a nonsignificant but clinically meaningful reduction in the presence of HO at follow-up for patients who received RT versus comparators (pooled odds ratio, 0.47; 95% CI, 0.19, 1.17). There was minimal evidence of adverse events., Conclusions: This systematic review found a clinically, but not statistically, significant benefit of prophylactic RT for HO at follow-up. These findings are tempered by a moderate risk of bias. While practice patterns vary, RT for HO prophylaxis in high-risk patients may have benefits that outweigh the risks., Competing Interests: Disclosures Christine Bang has received support for meeting attendance or travel from the VA National Oncology Program and the Baltimore VA; Eric Jutkowitz, Taylor Rickard, Thomas Trikalinos, Katherine Rieke, and James L. Rudolph were supported by the VA's Evidence Synthesis Program; Tayler Leonard was supported by the Summer Undergraduate Research Fellowship, and then Summer Research Early Identification Program and Brown University; Sherry X. Yan is a member of the Membership Committee of the Massachusetts Society of Clinical Oncologists, and the Government Relations Council for the American Society of Radiation Oncology; James L. Rudolph has received grants or contracts from the VA, NIA, Brown Physicians, Lifespan Health System, and Icosavax; Katherine Rieke was previously employed by the American Academy of Dermatology; Eduardo Caputo, Htun Ja Mai, and Ghid Kanaan have no conflicts to disclose. This report was prepared by the Evidence Synthesis Program Center located at the VA Providence Health Care System, directed by Eric Jutkowitz, PhD and James Rudolph, MD and funded by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents and do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs., (Published by Elsevier Inc.)

The use of seclusion to manage conflict behaviours in psychiatric inpatient settings is increasingly viewed as an intervention of last resort. Many protocols have, thus, been developed to reduce the practice. We conducted a systematic review to determine the effectiveness of protocols to reduce seclusion on process outcomes (e.g., seclusion, restraint), patient outcomes (e.g., injuries, aggressive incidents, satisfaction), and staff outcomes (e.g., injuries, satisfaction). We searched Medline, Embase, the Cochrane Register of Clinical Trials, PsycINFO, CINAHL, cairn.info, and ClinicalTrials.gov for protocols to reduce seclusion practices for adult patients on inpatient mental health units (from inception to September 6, 2022). We summarised and categorised reported elements of the protocols designed to reduce seclusion using the Behaviour Change Wheel Intervention Functions and resources needed to implement the protocol in psychiatric units. We assessed risk of bias and determined certainty of evidence using GRADE. Forty-eight reports addressed five approaches to reduce seclusion: hospital/unit restructuring (N = 4), staff education/training (N = 3), sensory modulation rooms (N = 7), risk assessment and management protocols (N = 7), and comprehensive/mixed interventions (N = 22; N = 6 without empirical data). The relationship between the various protocols and outcomes was mixed. Psychiatric units that implement architecturally positive designs, sensory rooms, the Brøset Violence Checklist, and various multi-component comprehensive interventions may reduce seclusion events, though our certainty in these findings is low due to studies' methodological limitations. Future research and practice may benefit from standardised reporting of process and outcome measures and analyses that account for confounders., (© 2024 John Wiley & Sons Australia, Ltd. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Resilience-based management is essential to protect ecosystems in the Anthropocene. Unlike large-scale climate threats to Great Barrier Reef (GBR) corals, outbreaks of coral-eating crown-of-thorns starfish (COTS; Acanthaster cf. solaris) can be directly managed through targeted culling. Here, we evaluate the outcomes of a decade of strategic COTS management in suppressing outbreaks and protecting corals during the 4th COTS outbreak wave at reef and regional scales (sectors). We compare COTS density and coral cover dynamics during the 3rd and 4th outbreak waves. During the 4th outbreak wave, sectors that received limited to no culling had sustained COTS outbreaks causing significant coral losses. In contrast, in sectors that received timely and sufficient cull effort, coral cover increased substantially, and outbreaks were suppressed with COTS densities up to six-fold lower than in the 3rd outbreak wave. In the Townsville sector for example, despite exposure to comparable disturbance regimes during the 4th outbreak wave, effective outbreak suppression coincided with relative increases in sector-wide coral cover (44%), versus significant coral cover declines (37%) during the 3rd outbreak wave. Importantly, these estimated increases span entire sectors, not just reefs with active COTS control. Outbreaking reefs with higher levels of culling had net increases in coral cover, while the rate of coral loss was more than halved on reefs with lower levels of cull effort. Our results also indicate that outbreak wave progression to adjoining sectors has been delayed, probably via suppression of COTS larval supply. Our findings provide compelling evidence that proactive, targeted, and sustained COTS management can effectively suppress COTS outbreaks and deliver coral growth and recovery benefits at reef and sector-wide scales. The clear coral protection outcomes demonstrate the value of targeted manual culling as both a scalable intervention to mitigate COTS outbreaks, and a potent resilience-based management tool to "buy time" for coral reefs, protecting reef ecosystem functions and biodiversity as the climate changes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Matthews et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The Aid and Attendance (A&A) benefit is a cash entitlement for Veterans who served in the U.S. military to obtain personal care services. Our objective was to identify factors contributing to variation in A&A enrollment across VA Medical Centers (VAMCs). We used VA data to calculate the enrollment rate among older Veterans receiving a VA pension or compensation in 2015, then purposefully sampled social work leaders at 15 VAMCs with the highest ( n  = 7) and lowest ( n  = 8) enrollment rates for interviews. All respondents viewed A&A as an important benefit. Participants at high-enrollment sites indicated strong working relationships with Veterans Benefits Administration (VBA) and Veterans Service Organizations (VSOs) with onsite presence and education about A&A facilitate access. Participants at low-enrollment sites indicated they desired education around A&A eligibility criteria and collaboration with VBA/VSOs. VA and non-VA social workers would benefit from education about VBA's benefits, and this requires collaboration with VBA representatives.

Effectively implementing landscape-scale forest restoration on the ground is particularly challenging. Available decision-support tools particularly lack the ability to comprehensively incorporate biophysical, social and institutional dimensions in a spatially explicit manner from the pixel to the whole landscape. In order to contribute to fulfilling this gap, this paper has two major objectives. The first is to present a spatially explicit decision-support tool for mapping Forest Restoration Vocation (FRV) that includes socio-economic and institutional aspects in forest landscape restoration. The second is to discuss the ways in which the FRV has been applied in the Brazilian decision-making context. The FRV was used to prioritize areas for three different restoration modalities: assisted natural regeneration (passive restoration), forest plantation with native trees to conserve biodiversity and forest plantation for agroforestry systems (active restoration). The FRV is already being adopted as a planning tool to invest R$ 1.2 billion (approx. US$ 300 million) to restore 40,000 ha in the Rio Doce, Brazil-an area corresponding to 0.05% of the area of watershed. Due to the high level of degradation of the basin, there is a need to restore 1.6 Mha via forest plantations in riparian Areas of Permanent Preservation (APPs) while 30% of APPs can be effectively restored using natural regeneration. The FRV can be effective for gauging progress and monitoring forest restoration implementation metrics across the landscape and through time. There are however still problems in effectively assessing if the investment in forest restoration will generate impact in the long term and deliver the ecosystem services society depends on., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

There is evidence in the literature that two retrievals from long-term memory cannot occur in parallel. To date, however, that work has explored only the case of two retrievals from newly acquired episodic memory. These studies demonstrated a retrieval bottleneck even after dual-retrieval practice. That retrieval bottleneck may be a global property of long-term memory retrieval, or it may apply only to the case of two retrievals from episodic memory. In the current experiments, we explored whether that apparent dual-retrieval bottleneck applies to the case of one retrieval from episodic memory and one retrieval from highly overlearned semantic memory. Across three experiments, subjects learned to retrieve a left or right keypress response form a set of 14 unique word cues (e.g., black-right keypress). In addition, they learned a verbal response which involved retrieving the antonym of the presented cue (e.g., black-"white"). In the dual-retrieval condition, subjects had to retrieve both the keypress response and the antonym word. The results suggest that the retrieval bottleneck is superordinate to specific long-term memory systems and holds across different memory components. In addition, the results support the assumption of a cue-level response chunking account of learned retrieval parallelism.

Retrieval of two responses from one visually presented cue occurs sequentially at the outset of dual-retrieval practice. Exclusively for subjects who adopt a mode of grouping (i.e., synchronizing) their response execution, however, reaction times after dual-retrieval practice indicate a shift to learned retrieval parallelism (e.g., Nino & Rickard, in Journal of Experimental Psychology: Learning, Memory, and Cognition, 29, 373-388, 2003). In the present study, we investigated how this learned parallelism is achieved and why it appears to occur only for subjects who group their responses. Two main accounts were considered: a task-level versus a cue-level account. The task-level account assumes that learned retrieval parallelism occurs at the level of the task as a whole and is not limited to practiced cues. Grouping response execution may thus promote a general shift to parallel retrieval following practice. The cue-level account states that learned retrieval parallelism is specific to practiced cues. This type of parallelism may result from cue-specific response chunking that occurs uniquely as a consequence of grouped response execution. The results of two experiments favored the second account and were best interpreted in terms of a structural bottleneck model.

To explore brain areas involved in basic numerical computation, functional magnetic imaging (fMRI) scanning was performed on college students during performance of three tasks; simple arithmetic, numerical magnitude judgment, and a perceptual-motor control task. For the arithmetic relative to the other tasks, results for all eight subjects revealed bilateral activation in Brodmann's area 44, in dorsolateral prefrontal cortex (areas 9 and 10), in inferior and superior parietal areas, and in lingual and fusiform gyri. Activation was stronger on the left for all subjects, but only at Brodmann's area 44 and the parietal cortices. No activation was observed in the arithmetic task in several other areas previously implicated for arithmetic, including the angular and supramarginal gyri and the basal ganglia. In fact, angular and supramarginal gyri were significantly deactivated by the verification task relative to both the magnitude judgment and control tasks for every subject. Areas activated by the magnitude task relative to the control were more variable, but in five subjects included bilateral inferior parietal cortex. These results confirm some existing hypotheses regarding the neural basis of numerical processes, invite revision of others, and suggest productive lines for future investigation.

A configural theory of human amnesia is proposed. The theory predicts that amnesic patients will exhibit selective deficits on tasks that normal subjects perform by learning new configurations of stimulus elements. This prediction is supported by results for four amnesic patients who learned a nonconfigural control task but failed to learn the configural transverse patterning task even after extensive practice. Matched normal subjects easily learned both tasks. The theory provides unique and viable accounts of the central results in the human amnesia literature. Relations between the configural approach and other theories are discussed.

Two experiments tested an identical elements model of the organization of basic arithmetic skills (T. C. Rickard, A. F. Healy, & L. E. Bourne, 1994). This model assumes a distinct abstract representation for each unique combination of the basic elements (i.e., the operands and the required operation) of a problem. Participants practiced multiplication and division problems and were then tested on various altered versions of these problems. Experiment 1 confirmed the prediction of no positive transfer when the presented elements of a test problem do not exactly match those of a practice problem. Experiment 2 confirmed the prediction that there is complete transfer when the elements of the test problem match exactly with those of a practice problem. Experiment 2 also confirmed that there is both perceptually specific and nonspecific speed-up with practice. Implications for number processing and arithmetic are discussed.

Thirteen subjects were extensively trained on nine multiplication problems varying in difficulty. Practice was associated with a reaction time speed up and an attenuation of the problem size effect. The introduction of previously unpracticed problems led to a performance rebound to pretraining levels, indicating practice specificity. The eventrelated potentials were characterized by a late positive complex, followed by a positive slow wave. Offset latency of positive slow wave and preresponse amplitude at parietal electrodes showed practice specificity effects that systematically changed with practice and problem size, indicating an association with the load imposed on working memory. The peak of the late positive complex probably reflects task learning or adaptation effects because it was attenuated by practice predominantly at frontal electrodes, showed no practice specificity, and was not affected by problem size.

Objective: To use the findings from neuropsychological evaluation and functional magnetic resonance imaging (fMRI) to assess interhemispheric reorganization of function after early unilateral brain injury., Design and Methods: The study focused on one case of early brain injury that resulted in both dyscalculia and dyslexia. Brain injury was studied using both structural and fMRI. Intellectual function was evaluated using the Wechsler Intelligence Scale for Children, Third Edition, while visuospatial skills were assessed using the Block Design subtest of the Wechsler Intelligence Scale for Children, Third Edition, and Judgment of Line Orientation subtest. The Selective Reminding Test and the Recurring Figures Test were used to evaluate memory and orientation; language and speech skills were evaluated using the Boston Naming Test, Controlled Oral Word Association, Gates-MacGinitie Reading Test, and color naming. Various methods were used to study arithmetic skills, including the Wide Range Achievement Test-Revised and the Peabody Individual Achievement Test. The control group for fMRI consisted of nine normal subjects., Setting: Neuropsychological laboratory in primary care hospital., Patient: A 17-year-old boy who had sustained a closed head injury associated with a partially depressed, right parietal skull fracture, and right temporal hemorrhage in a motor vehicle crash at age 7 months (November 9, 1977). Subsequent social behavior was normal, but the patient had difficulty throughout school in mathematics and spelling and was characterized as having a "short attention span.", Intervention: None., Main Outcome Measures: Standardized tests of arithmetic and reading supplemented by an assessment of calculation and quantitative skills. While performing calculations, fMRI disclosed predominantly left hemisphere activation involving the frontal and posterior parietal regions, whereas this task produced bilateral activation of the supramarginal gyrus in seven of nine normal subjects., Results: Neuropsychological findings confirmed the presence of dyscalculia and dyslexia despite normal intellectual functioning. Visuospatial skills ranged from the low normal to average level. The fMRI findings were consistent with early interhemispheric transfer of visuospatial skills normally committed to the right parietal area to the left parietal region. The patient's dyscalculia and reading ability raise a question of acquired left parietal dysfunction as a consequence of the competition between verbal and visuospatial functions for left hemisphere representation., Conclusion: Interhemispheric reorganization of function may be bidirectional rather than a feature unique to the left hemisphere substrate for language.

Recent behavioral investigations indicate that the processes underlying mental arithmetic change systematically with practice from deliberate, conscious calculation to automatic, direct retrieval of answers from memory [Bourne, L.E.Jr. and Rickard, T.C., Mental calculation: The development of a cognitive skill, Paper presented at the Interamerican Congress of Psychology, San Jose, Costa Rica, 1991: Psychol. Rev., 95 (1988) 492-527]. Results reviewed by Moscovitch and Winocur [In: The handbook of aging and cognition, Erlbaum, Hillsdale, NJ, 1992, pp. 315-372] suggest that consciously controlled processes are more dependent on frontal lobe function than are automatic processes. It is appropriate, therefore to determine whether transitions in the locus of primary brain activity occur with practice on mental calculation. In this experiment, we examine the relationship between characteristics of event-related brain potentials (ERPs) and mental arithmetic. Single-digit mental multiplication problems varying in difficulty (problem size) were used, and subjects were trained on these problems for four sessions. Problem-size and practice effects were reliably found in behavioral measures (RT). The ERP was characterized by a pronounced late positivity after task presentation followed by a slow wave, and a negativity during response indication. These components responded differentially to the practice and problem-size manipulations. Practice mainly affected topography of the amplitude of positivity and offset latency of slow wave, and problem-size mainly offset latency of slow wave and pre-response negativity. Fronto-central positivity diminished from session to session, and the focus of positivity centered finally at centro-parietal regions.(ABSTRACT TRUNCATED AT 250 WORDS)

Replantation of amputated rat feet utilizing an efferent arteriovenous shunt constructed between the distal posterior tibial artery and the proximal posterior tibial vein, in the absence of all other venous drainage, provides an alternative pathway to the normal venous drainage in a replanted rat foot. However, this substitute venous drainage was insufficient to prevent progressive ischemia and necrosis of some or all of a replanted rat foot. When a cutaneous pedicle flap supplemented the arteriovenous shunt, venous drainage was much improved, tissue hypoxia and edema began to subside on the third day, severe tissue necrosis was prevented, and seven of eight feet replanted by this technique survived. These observations may be useful in replantation in humans when veins in the amputated part are too small to be used or so damaged that they cannot be repaired or reconstructed by a vein graft, but arteries can still provide a means of returning blood from the amputated part. Constructing an alternative pathway to the normal venous drainage pattern may allow severely damaged parts to survive after replantation.

Resectional arthroplasty with interposition of a rolled tendon spacer was used to treat posttraumatic arthritis of the fifth metacarpal-hamate joint in eight patients. The average follow-up was 5 years. All of the patients subjectively rated the functional capability and the cosmetic appearance of their hands as good or excellent. After operation, there was a net increase of 30% in the average grip strength of the study group. The motion preserved at the small finger carpometacarpal joint facilitated power function of the hand.

A case of isolated thenar numbness, with an associated painful palmar wrist mass is presented. At operation, a palmar wrist ganglion compressing the palmar cutaneous branch of the median nerve was encountered. After ganglion excision the numbness in the palm was relieved, and there was no recurrence at 6 years follow-up.

Thirty-six digits with an intra-articular fracture of the dorsal aspect of the distal phalanx that involved one-third or more of the articular surface were treated by open reduction and internal fixation with Kirschner wires. After an average length of follow-up of forty-six months, roentgenograms of the distal joint in twenty-six digits appeared essentially normal. Ten digits had minor roentgenographic changes but, with the exception of one digit, the joint space was congruous and free of significant abnormalities. The average loss of extension of the distal joint was 2 degrees, and the average arc of flexion of the distal joint was 69 degrees. The average strength of pinch in all digits that were operated on was essentially equal to the strength of pinch in the contralateral digit. Exact reduction and internal fixation using the technique described resulted in excellent motion and function.

Growing lambs fed diets containing two concentrations of Co (basal and basal plus 1 ppm) were injected with Factor B (cobinamide) or saline during an 8-wk trial conducted to determine the effects of Factor B on liver B12 levels and on propionate metabolism. At the end of the trial, lambs given Factor B had lower (P less than .05) liver vitamin B12 concentrations and higher (P less than .05) Factor B concentrations than controls fed the high Co diet. The high Co diet did not enhance liver B12 levels in the lambs treated with Factor B. Feed intake and body weight gain were not significantly affected by treatment. Plasma propionate increased (P less than .05) with time on experiment, and concentrations during the final period were negatively correlated (r = -.45; P less than .05) with liver B12 levels. When the lambs were loaded with propionate, a similar correlation (r = -.59; P less than .05) was observed between log plasma level at t = 20 and liver B12 levels. Liver B12 levels (.2 to 1.1 micrograms/g) were all within what is usually considered a normal range. . No significant relationship between plasma propionate and liver Factor B levels were observed.

Of 151 ununited fractures of the scaphoid that were treated with iliac bone grafts and Kirschner-wire fixation through a volar approach, all but four (97 per cent) healed in an average of seventeen weeks, Three of the four failures resulted from obvious technical errors. Neither the preoperative existence of necrosis of the proximal fragment nor the location of the fracture affected the results. When there was mild radiocarpal arthritis preoperatively, it did not progress postoperatively; if there was moderate radiocarpal arthritis preoperatively, progression seldom was seen if a radial styloidectomy was done. Displaced and unstable ununited fractures healed even if the deformity was not corrected completely. The principal benefit of the procedure was relief of pain rather than an increase either in motion of the wrist or in strength of grip.

An ununited scaphoid fracture whose proximal fragment is small, sclerotic, fragmented, or badly deformed is usually not suitable for bone-grafting. We treated twenty-one such patients by excision of the small proximal fragment through a volar incision and the insertion of a hand-carved silicone-rubber spacer. After surgery, twenty patients (95 per cent) were able to return to work and engage in strenuous activities, including sports. Pain was significantly relieved, although wrist motions and grip were only minimally improved. Preoperative and postoperative comparative measurements of carpal collapse and translation showed only insignificant changes after this procedure.

In adults, when flexor tendons cannot be repaired until weeks or months after injury or when tendons have ruptured and part of the tendon is nonviable, it is often inadvisable to suture the tendon ends together. When a primary repair has failed, when there has been a delay in tendon reconstruction to allow skin coverage or joint mobilization, or when repair has been delayed because of infection, continuity of a profundus tendon or flexor pollicis longus tendon can often be restored by using a free graft to bridge the defect. Many patients treated by this procedure will have a satisfactory result providing that the flexor tendon is undamaged within its digital sheath and the muscle is intact and has adequate amplitude. In the study reported here, satisfactory function was restored to 28 of 37 fingers and to eight of ten thumbs treated by this method.

We removed the fracture fragment from fifty-nine patients who had an isolated fracture of the hook of the hamate. Preoperatively, all had complained of pain and tenderness on the ulnar side of the palm or on the dorsal ulnar aspect of the wrist. Most fractures were thought to have occurred while the patient was swinging a racquet, golf club, or baseball bat. Some fractures were caused by striking the palm on a solid object, by falling on the palm, or by a crush injury to the hand. Most of the fractures were diagnosed conclusively on a carpal tunnel roentgenogram or on a special oblique roentgenogram of the wrist supinated. We now believe that computed axial tomography is the best imaging technique for demonstrating this fracture. Except for two patients who had a crush injury, all of the patients returned to their regular occupational and athletic pursuits. There were no surgical complications.

A study of the long-term results after operation on 66 women (83 hands) with Dupuytren's disease showed that women are twice as likely as men to have a postoperative flare reaction. Why a flare reaction develops is uncertain. In this study, patients who had a carpal tunnel release at the time of operation for treatment of Dupuytren's disease or those who had an extensive fasciectomy, as opposed to removal of only the contracted tissue, were more apt to have a flare reaction. In addition, after operation, moderate or severe loss of finger flexion occurred in 35% of hands without a flare reaction and in 76% of those who had a flare reaction. This suggests that women having an operation for treatment of Dupuytren's disease are apt to have a worse result than men.