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Abstract Background Recovery from knee surgery or injury can be hindered by knee arthrofibrosis, which can lead to motion limitations, pain and delayed recovery. Surgery or prolonged physical therapy are often treatment options for arthrofibrosis, but they can result in increased costs and decreased quality of life. A treatment option that can regain lost motion without surgery would help minimize risks and costs for the patient. The purpose of this study was to determine treatment efficacy of high-intensity home mechanical stretch therapy in patients with knee arthrofibrosis. Methods Records were reviewed for 11,000+ patients who were prescribed a high-intensity stretch device to regain knee flexion. Initial and last recorded knee flexion and days between measurements were available for 9842 patients (Dataset 1). Dataset 2 was a subset of 966 patients from Dataset 1. These 966 patients had separate more rigorous measurements available from physical therapy notes (Dataset 3) in addition to data from the internal database (Dataset 2). Within and between dataset statistics were calculated using t tests for comparison of means and Cohen’s d for determination of effect size. Results All dataset showed significant gains in flexion (p

Food texture preference and product acceptance are hypothesized to be influenced by mouth behavior. Recent work identified four mouth behavior (MB) groups that describe most consumers in the United States: Chewers, Crunchers, Smooshers, and Suckers. While these behavioral preferences are thought to play a significant role in food selection and purchasing decisions, it is unknown how closely they relate to body and oral cavity measures as well as masticatory apparatus performance. Our objectives were twofold: to determine whether MB groups are related to (a) morphological variation in body, head, and oral cavity size and (b) masticatory apparatus performance (i.e., maximum jaw gape, maximum bite forces at the incisors and first molar). Measurements were collected following an online MB assessment (JBMB Mouth Behavior Typing Tool) where participants self-identified as one of the four types of consumers. As expected, univariate associations were observed between masticatory performance and overall body as well as oral cavity size. These relationships did not persist when assessed with multivariate methods. MB groups did not differ by body, head, or oral cavity measurements; maximum gape; or maximum bite force. Because of small sample sizes for Smooshers and Suckers-a reflection of their limited prevalence in the U.S. population-we interpret the results for these groups with caution. We can more confidently conclude based on our sample that Chewers and Crunchers do not differ in size, bite force, or maximum gape, suggesting other factors primarily drive food texture choice and preference in these individuals., (© 2019 Wiley Periodicals, Inc.)

Food texture assessment is difficult because it is constantly being modified as a food is eaten. While texture has generally been statically assessed, methods aimed at measurement over time are becoming more common. However, even when texture is assessed over time, that assessment is based on averages across all individuals. This study shows that individuals with different Mouth Behaviors eat foods differently in an effort to develop a texture that suits their Mouth Behavior. Because of this, their texture assessments differ over the eating experience. Overall liking was driven by whether individuals were able to transform the product texture into one that aligned with their Mouth Behavior and how well they liked the dominant texture attribute., (© 2019 Wiley Periodicals, Inc.)

Background: Trimethoprim-sulfamethoxazole (TMP-SMX) is the drug of choice for anti-Pneumocystis jirovecii pneumonia (PcP) prophylaxis in kidney transplant recipients (KTR). Post-transplant management balances preventing PcP with managing TMP-SMX-related adverse effects. TMP-SMX dose reduction addresses adverse effects but its implications to incident PcP are unclear., Methods: We performed a retrospective review of all patients transplanted between 2011 and 2015 prescribed daily single strength TMP-SMX for twelve months post-transplantation as PcP prophylaxis. Actual TMP-SMX dose and duration, adverse effects, number of dose reductions and reasons, and PcP events were captured. Multivariate logistic regression analyses for risk factors associated with dose reduction were performed., Results: Of 438 KTR, 233 (53%) maintained daily TMP-SMX and 205 (47%) sustained ≥1 dose reduction, with the point prevalence of a reduced dose regimen being between 18 and 25%. Median duration for daily TMP-SMX was 8.45/12 months, contributing 4137 patient-months daily TMP-SMX and 1110 patient-months with a reduced dose. PcP did not occur in any patients. There were 84 documented dose reductions for hyperkalemia and 102 for leukopenia, with 12 and 7 patients requiring TMP-SMX cessation. In multivariate analysis, a living donor transplant protected against hyperkalemia (Odds Ratio 0.46, 95% CI 0.26-0.83, p < 0.01) while acute rejection risked leukopenia (Odds Ratio 3.31, 95% CI 1.39-7.90, p = 0.006)., Conclusions: TMP-SMX dose reduction is frequent in the first post-transplant year but PcP does not occur. To limit the need for TMP-SMX dose reduction due to adverse effects, a clinical trial comparing daily to thrice weekly single strength TMP-SMX in de-novo KTR is justified.

The current paradigm for developing products that will match the marketing messaging is flawed because the drivers of product choice and satisfaction based on texture are misunderstood. Qualitative research across 10 years has led to the thesis explored in this research that individuals have a preferred way to manipulate food in their mouths (i.e., mouth behavior) and that this behavior is a major driver of food choice, satisfaction, and the desire to repurchase. Texture, which is currently thought to be a major driver of product choice, is a secondary factor, and is important only in that it supports the primary driver-mouth behavior. A model for mouth behavior is proposed and the qualitative research supporting the identification of different mouth behaviors is presented. The development of a trademarked typing tool for characterizing mouth behavior is described along with quantitative substantiation of the tool's ability to group individuals by mouth behavior. The use of these four groups to understand textural preferences and the implications for a variety of areas including product design and weight management are explored.

Toluene is a representative member of a class of inhaled solvents that are voluntarily used by adolescents and adults for their euphorigenic effects. Research into the mechanisms of action of inhaled solvents has lagged behind that of other drugs of abuse despite mounting evidence that these compounds exert profound neurobehavioral and neurotoxicological effects. Results from studies carried out by the authors and others suggest that the neural effects of inhalants arise from their interaction with a discrete set of ion channels that regulate brain activity. Of particular interest is how these interactions allow toluene and other solvents to engage portions of an addiction neurocircuitry that includes midbrain and cortical structures. In this review, we focus on the current state of knowledge regarding toluene's action on midbrain dopamine neurons, a key brain region involved in the initial assessment of natural and drug-induced rewards. Findings from recent studies in the authors' laboratory show that brief exposures of adolescent rats to toluene vapor induce profound changes in markers of glutamatergic plasticity in VTA DA neurons. These changes are restricted to VTA DA neurons that project to limbic structures and are prevented by transient activation of the medial prefrontal cortex prior to toluene exposure. Together, these data provide the first evidence linking the voluntary inhalation of solvents to changes in reward -sensitive dopamine neurons.

We introduce a new type of study that combines self-profile of behaviors and attitudes regarding food together with responses to structured, systematically varied concepts about the food. We deal here with the responses of teens, for 28 different foods and beverages. The study creates a database that reveals how a person responds to different types of messaging about the food. We show how to develop the database for many different foods, from which one can compare foods to each other, or compare the performance of messages within a specific food.

Following the September 11 terrorist attacks, the vulnerability of the United States became apparent. It also became evident that there was a need for respiratory protection. The purpose of this study was to determine the prior knowledge and perceptions of emergency medical technicians with respect to bioterrorism and to enhance their current knowledge to better prepare them for possible future events. The study was also designed to create a certified pool of trainers who would be capable of fit-testing all squad members with N-100 respirators. Representatives were recruited from each of the Hunterdon County, New Jersey, rescue squads. Participants attended a train-the-trainer session. Before the session and after, they were tested on knowledge and perceptions about relevant bioterrorism issues and were given an educational presentation on bioterrorism, threatening agents, respiratory health, and proper protection, along with being introduced to the fit-test steps for N-100 respirator masks. The response rate for the training was 94 percent. The authors measured and compared responses on the pre-test and the post-test with respect to knowledge, behaviors, and perceptions, and the results indicated a change following the training. The study thus provided evidence that the train-the-trainer program is an effective method of providing public health preparedness training to members of community organizations and agencies.

Objectives: To assess the correlation and agreement between measurements of PO(2), PCO(2), H(+) and HCO(3)(-) in arterial and capillary blood in patients with acute exacerbations of COPD. To assess the repeatability of capillary measurements., Design: Method comparison study., Setting: Accident and emergency department in a university teaching hospital., Main Outcome Measures: Measurements of PO(2), PCO(2), H(+) and HCO(3)(-) in one arterial and two capillary samples taken from consecutive patients with acute exacerbations of COPD., Results: The agreement between measurements of PCO(2), H(+) and HCO(3)(-) in arterial and capillary blood was good with mean differences of 0.087 kPa, 1.044 nmol/l and 0.513 mmol/l, respectively. The corresponding 95% limits of agreement were narrow. The agreement between measurements of PO(2) was poor with a mean difference of 1.256 kPa and wide 95% limits of agreement. There was good repeatability between capillary samples with mean differences of 0.094 kPa, 0.674 nmol/l and 0.028 mmol/l for measurements of PCO(2), H(+) and HCO(3) respectively and narrow coefficients of repeatability., Conclusions: Capillary blood gas measurements provide an accurate assessment of PCO(2), H(+) and HCO(3)(-) and can be used to reliably measure the ventilatory status of patients. Combined with continuous pulse oximetry they can be used as an alternative to arterial blood gas measurements in patients with acute exacerbations of COPD.

With the advent of highly active antiretroviral therapy, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is becoming a more chronic, manageable disease; nevertheless, the prevalence of neurological complications of AIDS is increasing. In this study, protein levels of tyrosine hydroxylase (TH) and dopamine transporter (DAT) in the substantia nigra of HIV-infected brains and -seronegative controls were determined by immunoblotting. The immunoreactivity of neuronal specific enolase (NSE) was used to assess cell loss. Although there were no changes in levels of immunoreactive DAT or NSE proteins in HIV brains, levels of immunoreactive TH were significantly reduced, relative to controls. These results suggest that decreases in TH, the rate-limiting enzyme of dopamine synthesis, may be a factor in the neurological manifestations of HIV infection.

Disinfection of wastewater solids (waste activated solids [WAS]) by interstitial vapor generation was investigated. In addition to the magnitude of disinfection, the amount of water removed and cost relative to traditional residuals disinfection processes was also examined. The process of interstitial vapor generation occurs as a result of the rapid heating of liquid in the interstices of the solid-liquid array. Intense heating causes boiling of the slurry liquid, resulting in an expanding vapor front that simultaneously dewaters the wastewater solids and contributes to the destruction of viable pathogenic microorganisms. Objectives of the study were threefold: (1) to validate disinfection of WAS using the interstitial vapor technique; (2) establish the degree of possible drying of the residuals using the techniques; and (3) establish the key operating variables for the process. Results showed a significant reduction in the most probable number of total coliforms and Escherichia coli (E. coli). Specifically, greater than four-log unit reductions were produced for both total coliform and E. coli bacteria. In addition to quantifying the reduction in bacteria, the percent solids were increased from an initial amount of 7.6% (mass basis) to a final solids content greater than 90% using optimal processing conditions. Cost comparisons were also conducted and shown to be quite favorable when compared with traditional disinfection methods such as lime addition. Because of the high level of E. coli reduction achieved, the process of interstitial vapor generation is shown to be capable of converting a class B biosolids into a class A pathogen reduced product. For example, an initial most probable number (MPN) of 1.2 x 10(6) E. coli bacteria were reduced to 19 at the extreme conditions of the process, well below the requirement of an MPN of 1000 for fecal coliform bacteria. Given its ability to disinfect and dewater wastewater solids, the interstitial vapor generation process was found to be a robust and beneficial technique to produce an environmental and publicly acceptable recyclable biosolids resource.

This paper reports the results of conjoint analysis of communications about functional foods, run with women aged 40 and above, using messages found on the Internet. Each of 147 women evaluated 60 concepts, comprising 2-4 phrases per concept, with the phrases dealing with an aspect of functional foods. Three respondent segments emerged, based on the pattern of individual utilities, 'health optimists' (no deep interest in functional foods), 'food for life' (food for health), and 'food for cure' (looking to functional foods to help live a normal life). The utilities of the same elements differed far more across these segments than would be expected from conventional classification questionnaires.

A Eulerian-Eulerian multiphase CFD model is employed for the air/water flow. A 3D structure grid is used to incorporate the air nozzle and tank geometry. The fixed frictionless wall boundary approximating the free surface acts as a sink to allow the air bubbles to escape. The air/water volume fraction in the flotation tank is evaluated to determine the effective air/water fluid density. The floc particle is then introduced and is tracked in the air/water fluid using a disperse Lagrangean model. Fate of these flocs depends on their sizes and density. Flocs therefore can either escape through the top water surface, settles in the main tank or breakthrough under the outlet weir. The CFD model is developed for a full scale DAF tank to predict the flow dynamic, particle removal and settled solid profile. The general flow pattern is compared with flow visualisation using the underwater camera. Comparison of average fluid velocities is carried out using acoustic Doppler velocimetry ADV measurement.

To assess the potential risk for other tick-borne diseases, we collected 100 adult Ixodes scapularis in Hunterdon County, a rapidly developing rural county in Lyme disease endemic western New Jersey. We tested the ticks by polymerase chain reaction for Borrelia burgdorferi, Babesia microti, and the rickettsial agent of human granulocytic ehrlichiosis (HGE). Fifty-five ticks were infected with at least one of the three pathogens: 43 with B. burgdorferi, five with B. microti, and 17 with the HGE agent. Ten ticks were coinfected with two of the pathogens. The results suggest that county residents are at considerable risk for infection by a tick-borne pathogen after an I. scapularis bite.