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Background. Subthalamic deep brain stimulation (STN-DBS) is an effective treatment for selected Parkinson's disease (PD) patients. Gait characteristics are often altered after surgery, but quantitative therapeutic effects are poorly described. Objective. The goal of this study was to systematically investigate modifications in asymmetry and dyscoordination of gait 6 months postoperatively in patients with PD and compare the outcomes with preoperative baseline and to asymptomatic controls without PD. Methods. A convenience sample of thirty-two patients with PD (19 with postural instability and gait disorder (PIGD) type and 13 with tremor dominant disease) and 51 asymptomatic controls participated. Parkinson patients were tested prior to the surgery in both OFF and ON medication states, and 6-months postoperatively in the ON stimulation condition. Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) I to IV and medication were compared to preoperative conditions. Asymmetry ratios, phase coordination index, and walking speed were assessed. Results. MDS-UPDRS I to IV at 6 months improved significantly, and levodopa equivalent daily dosages significantly decreased. STN-DBS increased step time asymmetry (hedges' g effect sizes [95% confidence interval] between pre- and post-surgery: .27 [-.13, .73]) and phase coordination index (.29 [-.08, .67]). These effects were higher in the PIGD subgroup than the tremor dominant (step time asymmetry: .38 [-.06, .90] vs .09 [-.83, 1.0] and phase coordination index: .39 [-.04, .84] vs .13 [-.76, .96]). Conclusions. This study provides objective evidence of how STN-DBS increases asymmetry and dyscoordination of gait in patients with PD and suggests motor subtypes-associated differences in the treatment response., Neurorehabilitation and Neural Repair, 35 (11), ISSN:1545-9683, ISSN:0888-4390, ISSN:1552-6844

Studies of implementation of evidence-based supervision policies and procedures often report minimal to moderate adherence to evidence-based models. The few studies that exist examine the degree to which characteristics of probation officers, individuals on supervision, and supervision processes have an impact on rearrest (outcomes). Using administrative data on 7,326 probationers and surveys from 161 probation officers employed by five agencies, hierarchical linear models were used to identify the features of supervision processes that are most important to reduce recidivism. The findings clarify that no one evidence-based supervision feature (i.e., a validated risk and need assessment tool, case planning, treatment, compliance management, etc.) can achieve recidivism reductions. The best results can be achieved by using all features, although a risk-based case management approach that prioritizes employment and/or reducing the criminogenic needs creates similar outcomes. This article discusses the implications of prioritizing which supervision processes are used to impact positive supervision outcomes.

Background: Social media platforms, like TikTok, have become popular options for the distribution of health care information. Because of the lack of scientific oversight, the quality of health care–related videos has become a focus of the current literature. However, orthopaedic surgery has lagged behind other fields in acknowledging the widespread utilization of TikTok videos for medical information consumption. This study aims to assess the quality and educational benefits of ankle sprain–related TikTok videos. Methods: TikTok was queried using the hashtag “#anklesprainexercises.” One hundred videos were included after applying the exclusion criteria. The number of views, likes, shares, comments, and favorites was recorded. The content was graded using DISCERN (a well-validated informational analysis tool) and ASEES (a self-designed tool for exercise evaluation). We hypothesized that information on TikTok related to ankle sprain exercises would be poor in quality. Results: The total number of views of the 100 videos was 6 483 412, with a median of 5377.5 (IQR = 1074-20 275). The videos collectively received 385 847 likes, 3642 comments, 55 574 favorites, and 14 918 shares with a median of 267.5 (IQR = 41.5-1678.0), 4.0 (IQR = 0.0-23.0), 42.0 (IQR = 4.8-264.5), and 13.0 (IQR = 1.8-67.8), respectively. General users had a higher percentage of their videos graded as “very poor” (61.8%) in comparison to the number of videos uploaded by health care professionals deemed “very poor” (34.4%). Neither general user nor health care professionals had videos graded as “good” or “excellent.” There were significant differences between the 2 groups for DISCERN 1, 3, and ASSES scores. Conclusion: Although TikTok is a powerful tool for information distribution, the educational value of the videos related to ankle sprain injury exercises was poor. With only 2% of videos receiving a grade of “fair,” and no videos reaching a score of “good” or “excellent,” health care professionals should be aware of the low-quality content easily accessible on TikTok. Level of Evidence: Level III, cross-sectional study.

Background: Virtual reality (VR) has been explored to improve baseline and postinjury assessments in sport-related concussion (SRC). Some experience symptoms related to VR, unrelated to concussion. This may deter use of vestibular/ocular motor screening (VOMS) using VR. Baseline VR VOMS symptomatology differentiates baseline from overall symptomatology. Hypothesis: There will be no difference between current clinical manual VOMS (MAN), a clinical prototype (PRO), and VR for symptom provocation change score (SPCS) and near point of convergence (NPC) average score in a healthy population and sex differences among the 3 modes of administration. Study Design: Cohort study. Level of Evidence: Level 3. Methods: A total of 688 National Collegiate Athletic Association Division I student-athletes completed VOMS using 3 methods (MAN, N = 111; female athletes, N = 47; male athletes, N = 64; average age, 21 years; PRO, N = 365; female athletes, N = 154; male athletes, N = 211; average age, 21 years; VR, N = 212; female athletes, N = 78; male athletes, N = 134; average age = 20 years) over a 3-year period (2019-2021) during annual baseline testing. Exclusion criteria were as follows: self-reported motion sickness in the past 6 months, existing or previous neurological insult, attention deficit hyperactivity disorder, learning disabilities, or noncorrected vision impairment. Administration of MAN followed the current clinical protocols, PRO used a novel prototype, and VR used an HTC Vive Pro Eye head mounted display. Symptom provocation was compared using Mann-Whitney U tests across each VOMS subtest with total SPCS and NPC average by each method. Results: MAN had significantly ( P < 0.01) more baseline SPCS (MAN = 0.466 ± 1.165, PRO = 0.163 ± 0.644, VR = 0.161 ± 0.933) and significantly ( P < 0.01) and more SPCS (MAN = 0.396 ± 1.081, PRO = 0.128 ± 0.427, VR = 0.48 ± 0.845) when compared with PRO and VR. NPC average measurements for VR (average, 2.99 ± 0.684 cm) were significantly greater than MAN (average, 2.91 ± 3.35 cm; P < 0.01; Cohen’s d = 0.03) and PRO (average, 2.21 ± 1.81 cm; P < 0.01; Cohen’s d = 0.57). For sex differences, female athletes reported greater SPCS with PRO (female athletes, 0.29 ± 0.87; male athletes, 0.06 ± 0.29; P < 0.01) but not in VR or MAN. Conclusion: Using a VR system to administer the VOMS may not elicit additional symptoms, resulting in fewer false positives and is somewhat stable between sexes. Clinical Relevance: VOMS may allow for standardization among administrators and reduce possible false positives.

The Washington State Institute for Public Policy (WSIPP) uses meta-analyses to help program administrators identify effective programs that reduce recidivism. The results are displayed as summary effect sizes. Yet, many programs are grouped within a category (such as Intensive Supervision or Correctional Education), even though the features of the programs might suggest they may be very different. The following research question was examined: What program features are related to the effect size in the WSIPP program category? Researchers at ACE! at George Mason University reviewed the studies analyzed by WSIPP and their effect sizes. The meta-regression global models showed recidivism decreased with certain program features, while other program features actually increased recidivism. A multivariate meta-regression showed substantial variation across Cognitive-Behavioral Therapy programs. These preliminary findings suggest the need to further research how differing program features contribute to client-level outcomes, and develop a scheme to better classify programs.

Introduction Force measurement wheels are essential instruments for analysing manual wheelchair propulsion. Existing solutions are heavy and bulky, influence propulsion biomechanics, and are limited to confined laboratory environments. In this paper, a novel design for a compact and lightweight measurement wheel is presented and statically validated. Methods Four connectors between the push-rim and wheel-rim doubled as force sensors to allow the calculation of tangential and radial forces as well as the point of force application. For validation, increasing weights were hung on the push-rim at known positions. Resulting values were compared against pre-determined force components. Results The implemented prototype weighed 2.1 kg and was able to transmit signals to a mobile recording device at 140 Hz. Errors in forces at locations of propulsive pushes were in the range up to ±3.1 N but higher at the frontal extreme. Tangential force components were most accurate. Conclusion The principle of instrumenting the joints between push-rim and wheel-rim shows promise for assessing wheelchair propulsion in daily life.

Introduction Therapists’ interpersonal skills are important contributors to client participation. Providing therapists with opportunities to self-reflect on their approach to therapeutic communication can support occupational therapy best practice. The aim of this study was to evaluate the reliability and validity of the observer version of the Pediatric Clinical Assessment of Modes. Method The Pediatric Clinical Assessment of Modes was used to rate therapists’ overall and individual communication mode use according to the Intentional Relationship Model. Successful and unsuccessful attempts were rated separately. Results The observers rated 125 therapist–child interactions. The successful and unsuccessful domains of the Pediatric Clinical Assessment of Modes demonstrated appropriate internal consistency, inter-rater reliability, and structural validity for evaluating the therapist’s overall communication and individual use of the collaborating, empathizing, encouraging, instructing, and problem-solving modes. The empathizing, encouraging, and problem-solving subscales demonstrated greater than expected floor effects and could not effectively separate therapists into high and low performance groups for the unsuccessful domain. The observers reported low frequency of successful and unsuccessful communication attempts for the advocating subscale, raising concerns related to the reliability of this subscale for evaluating therapist–child interactions. Conclusion Study findings support the reliability and validity of the Pediatric Clinical Assessment of Modes for use in pediatric outpatient rehabilitation.

Proliferation of ectopic Schwann cells within the central nervous system (CNS) parenchyma (schwannosis) in early life is most commonly associated with human neurofibromatosis type-2 and has been unrecognized in domestic animals. Three foals and a calf, 5 to 11 weeks old, with progressive neurological signs from birth were studied. Histologically, at multiple levels of the spinal cord, all animals had bilateral plaques of proliferative spindle cells, predominantly affecting the white matter adjacent to dorsal and ventral nerve roots and variably extending into the gray matter. Proliferating cells had strong intracytoplasmic immunoreactivity for the Schwann cell markers myelin protein zero and periaxin, highlighting the formation of peripheral nervous system (PNS) myelin within the spinal cord. In all cases, foci of disorganized neural tissue (glioneuronal hamartomas) were present, which in 2 cases formed a mass effect that resulted in syringohydromyelia. Neonatal presentation suggests a congenital maldevelopment of the nervous system, with spontaneous invasion of PNS-derived Schwann cells into the CNS.

Despite the prevalence of substance dependence in incarcerated populations and the correlation between substance use and crime, only 11% receive substance abuse treatment, even as treatment participation may help reduce institutional misbehavior and postrelease recidivism. The current research examined the influence of individual and program factors on substance abuse treatment participation and prison misconducts in a state prison system. Based on analyses of administrative data from 2012 to 2015 and program data, the findings support previous research documenting participant characteristics as predictors of misconducts. In addition, program training requirements significantly predicted misconducts. Implications and research recommendations are discussed.

Prior research with a sample of male probationers indicates severity levels of one arresting intimate partner violence (IPV) offense are predictive of future frequency of such offenses and treatment completion. This study is an extended analysis looking at severity ratings across two IPV offenses to measure violence stability. The stability of IPV severity levels was analyzed in a sample of offenders in Lake County, Illinois. Offender subtypes of generally violent (GV) men and family only (FO) violent men were incorporated into stability analyses using generalized linear mixed modeling (GLMM) to determine whether certain types of offenders vary in violence levels over time. The purpose was to determine the predictive utility of using a single offense to determine the domestic violence trajectory for male probationers. Reoffense records of 80 men were collected from a larger sample of 352 males, ages 17 to 72 placed on probation in Lake County, Illinois, between 2006 and 2008. Severity of offenses was coded dichotomously based on a behaviorally derived measure. Results demonstrate 64% of reoffenders remained stable in IPV severity. Overall, severity levels decreased across time. This is the first study to use a probationary sample of men to analyze violence stability trends over time. This study confirms the utility of measuring a single offense to predict future violence trajectories for IPV offenders.

Although the suprachiasmatic nucleus (SCN) has long been considered the master circadian clock in mammals, the topology of the connections that synchronize daily rhythms among SCN cells is not well understood. We combined experimental and computational methods to infer the directed interactions that mediate circadian synchrony between regions of the SCN. We analyzed PERIOD2 (PER2) expression from SCN slices during and after treatment with tetrodotoxin, allowing us to map connections as cells resynchronized their daily cycling following blockade and restoration of cell-cell communication. Using automated analyses, we found that cells in the dorsal SCN stabilized their periods slower than those in the ventral SCN. A phase-amplitude computational model of the SCN revealed that, to reproduce the experimental results: (1) the ventral SCN had to be more densely connected than the dorsal SCN and (2) the ventral SCN needed strong connections to the dorsal SCN. Taken together, these results provide direct evidence that the ventral SCN entrains the dorsal SCN in constant conditions.

Objective: To examine the rates of psychiatric comorbidities within a New Zealand sample of adults with ADHD compared with a community control group. Method: We merged six data sets to obtain a sample of 222 adults (158 ADHD, 64 controls). Comorbidities were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders ( 4th ed. text rev. [ DSM-IV-TR]) Axis-I disorders. Results: Both groups were equivalent in IQ, socioeconomic status, gender, education, income levels, and age. Lifetime rates of psychiatric disorders were significantly higher in the ADHD group (83%) versus the control group (52%) with higher rates of major depressive disorder (MDD; 65% vs. 36%), social phobia (31% vs. 11%), substance abuse (26% vs. 8%), and alcohol abuse (32% vs. 14%). Within the ADHD group, other than a group difference in specific phobias, there were no gender differences. Conclusion: The findings are consistent with international research; adults with ADHD in New Zealand have higher rates of psychiatric disorders than the general population.

Introduction In occupational therapy, there has been an increased interest in patients’ occupational participation within forensic settings. This retrospective study involved a longitudinal analysis of occupational participation within six forensic hospitals in England. The aim was to contribute to the understanding of forensic patients’ occupational participation over a two-year period. Methods The Model of Human Occupation Screening Tool (MOHOST) was rated by 78 occupational therapists on 489 patients in low and medium secure units who were receiving occupational therapy over two years. The many-faceted Rasch Model was used to convert their MOHOST scores at each time point into interval scales. Regression analysis was used to examine changes in occupational participation over time. Results Patients’ overall occupational participation improved over time. Specifically, participation improved in five of the six MOHOST subdomains, which included their motivation for occupation, pattern of occupation, communication/interaction skills, process skills, and environment. Patients did not demonstrate significant change in their motor skills, which varied as expected. In addition, patients in low secure units had better occupational participation than those in medium secure settings. Conclusion Our findings indicated improvements in the patients’ occupational participation over the 2-year period. Further investigations are needed to understand factors contributing to change.

Introduction The validity and reliability of the Japanese Interest Checklist for the Elderly were examined. Method 687 participants responded, using the new scale system: ‘currently participate based on interest,’ ‘participate less because of health status’ or ‘no interest.’ The convergent and discriminant validity of the factorial structure were examined using two-stage Confirmatory Factor Analysis approaches. The discriminant validity and reliability of the scale system were examined using two-stage Item Response Theory approaches. Results The first Confirmatory Factor Analysis stage indicated values representing good (factor loadings: 0.99–0.75; Comparative Fit Index: 0.99; Tucker-Lewis Index: 0.98) to adequate (Root Mean Square Error of Approximation: 0.054) fit levels. Both the discriminant validity and convergent validity were identified to be high. The second Confirmatory Factor Analysis stage with a Path analysis and consideration of age and gender indicated values representing a good fit (factor loadings: 0.99–0.78; Comparative Fit Index: 0.99; Tucker-Lewis Index: 0.98; Root Mean Square Error of Approximation: 0.048). The first Item Response Theory stage indicated the values for the discriminant validity in the expected ranges; however, it displayed lower reliability in some activities. The second Item Response Theory state with the latent-class model-based multi-group Item Response Theory confirmed the pattern of invariance. Conclusion The factorial structure was valid across different groups of people. The scale system has to be improved.

Although the number of juvenile drug treatment courts (JDTC) in operation has increased since the first JDTCs were implemented in the 1990s, research continues to lag regarding the effectiveness of the treatment interventions that are provided. The purpose of the present study was to explore how the risk-need-responsivity models’ general responsivity principle could be used to inform the effectiveness of the interventions provided to 1,176 participants in nine JDTCs in the United States. Responsivity adherence was measured using the number of general responsivity-adherent techniques included in each intervention. The results indicated that an increase in general responsivity adherence was associated with an increase in substance-use severity score, which suggests that the effect of the JDTC model on treatment outcomes could vary by the type of interventions provided to participants. In addition, the findings suggest the need to further specify adherence to the general responsivity principle, particularly among substance-involved juvenile offenders.

Phyllodes tumors of the breast display a wide variation in histological appearance and are classified into benign, borderline, and malignant categories based on a combination of histological parameters. These tumors may include a malignant heterologous component that is believed to originate through a process of multidirectional differentiation from a cancer stem cell. In these cases, the tumor is classified as a malignant phyllodes tumor. Among the heterologous elements that have been described in malignant phyllodes tumors are rhabdomyosarcoma, chondrosarcoma, osteosarcoma, liposarcoma and angiosarcoma. We present the first case of a phyllodes tumor with a malignant melanoma component in the breast of a 71-year-old lady, discussing the clinical implications of this diagnosis.

Objective Neurenteric cysts are rare lesions that account for 0.7–1.3% of all spinal cord tumours. We report the first ever case of a neurenteric cyst presenting with stridor and dysphagia. A literature review on the presentation and management of these lesions is also included. Methods A MEDLINE search of articles using the terms ‘neurenteric cyst’, ‘intraspinal cyst’, ‘enterogenous cyst’, ‘intramedullary cyst’ along with diagnosis, presentation and management was performed. Suitable references from these articles were also reviewed. Results All published evidence on neurenteric cysts are either case series or case reports (level IV/V) with the largest case series reporting 23 patients from a single institution. Conclusion Neurenteric cysts are rare spinal cord lesions that usually present with focal neurological signs and managed within neurosurgical units. This is the first reported case of a neurenteric cyst presenting with upper aerodigestive tract symptoms warranting specialist ear, nose and throat input.

Introduction: In England, the Payment by Results reimbursement system was introduced for mental health services. Occupational therapists developed the indicative care packages for identified clusters endorsed by the system. This study sought to systematically gather and document occupational therapists' viewpoints on the appropriateness of a range of therapy aims and, thereby, inform the creation of the occupational therapy indicative care packages. Method: This study is a descriptive, internet-based survey of therapists in six National Health Service trusts in the United Kingdom. Findings: A total of 262 therapists completed the survey for a response rate of 61.07%. Most were female (85.5%) with varying levels of experience (less than 5 years [33%]; between 5 and 20 years [54%]; over 20 years [13%]). Therapists evaluated the most appropriate aims specified for three occupational performance levels of service users and for six occupational areas. Additional aims were reported by therapists, and there was near-consensus for more than half of the aims, with over 75% of therapists agreeing on their appropriateness. Conclusion: Findings from experts' empirical knowledge inform practice by providing evidence for specifying service outcomes that are theory based and occupation focused in guiding the development of recommended occupational therapy objectives. © The College of Occupational Therapists Ltd.

Background Refeeding syndrome (RS) is a potentially fatal condition that can occur following the re-introduction of nutrition after a period of starvation. Hypophosphataemia following the reintroduction of nutrition is often the only reliable biochemical marker of RS. Refeeding index (RI) generated from baseline insulin-like growth factor-1 (IGF-1) and leptin has been proposed as a useful biochemical marker for the identification of patients at risk of developing refeeding hypophosphataemia (RH). Methods A prospective study included 52 patients referred for parenteral nutrition (PN). The sensitivity and specificity of IGF-1 measured using a sensitive assay was compared to the RI in predicting the development of RH (a ≥30% drop in PO4 during the first 36-h of PN administration). Leptin and IGF-1 were analysed on baseline samples using a quantitative enzyme-linked immunoassay. Daily blood samples were collected from all patients for routine biochemistry for the full duration of PN administration. Results High sensitivity IGF-1 measurement alone was comparable with the RI, using receiver–operating characteristic (ROC) curve analysis, with areas under the curve being 0.79 and 0.80, respectively, and superior to leptin alone (0.72) for predicting ≥30% drop in PO4. The cut-off value for IGF-1 that gave best sensitivity (91% [95% CI 75–98%]) and specificity (65% [95% CI 41–85%]) was 63.7 µg/L, with a likelihood ratio of 2.59. Conclusion Baseline IGF-1 is an objective, sensitive and specific biochemical marker in identifying patients who are at high risk of developing RH prior to PN administration and therefore may have a role in clinical practice.

Community-managed landscapes have valuable conservation potential. In particular, indigenous community management has slowed deforestation. However, globalized agriculture is an underlying driver of changes to indigenous community-managed landscapes. Our objective is to explain a hypothesized global-to-local causal pathway that stems from processes of globalized agriculture and changes to indigenous community-managed landscapes. The global-to-local pathway involves a nested hierarchy of political–economic processes, specifically land and natural resource privatization, commodification, and acquisition. At the local landscape level, we focus on changes to land tenure, livelihoods, land use, and land cover. Changes to land tenure involve a shift away from community and toward individual ownership and management. Concurrently, livelihoods shift away from subsistence and toward market-oriented activities. Subsequently, land use shifts away from small-scale extensive and toward large-scale intensive crop cultivation, away from diverse crop cultivation and toward monocropping, and away from crop toward livestock farming. Ultimately, land cover shifts away from diverse agro-forested and toward homogeneous deforested lands. We illustrate our approach using ejidos, a type of community-managed lands, in Yucatán, México as an exploratory example. We use descriptive statistics to initially assess the shift in ejido land tenure, from community to individually parcelized systems, and the shift in a principal subsistence livelihood and land use activity, from maize cultivation to cattle rearing. We highlight that individually parceled areas within ejidos are more deforested than community-managed areas. In all, we urge landscape conservation scientists to more fully consider not just local actions but also impacts stemming from globalized agriculture and to advance the breadth and depth of more extensive studies and analyses.

Background Bile acids (BAs) play an important role in releasing incretin hormones via the enteroendocrine L-cell surface TGR5 receptors. The aim of this study was to investigate the difference in BA concentration at baseline and in response to a meal stimulus between type 2 diabetes mellitus (T2DM) and a matched normoglycaemic group. Materials and methods A cross-sectional study of 12 patients with known T2DM and 12 matched normoglycaemic controls compared BA fractions after an overnight fast and following a standard meal. Results The T2DM group had higher baseline glucose (P Conclusion The post-prandial bile acid response is elevated in obese patients with T2DM compared to matched normoglycaemic individuals.

The authors conducted a systematic literature review of preventive pharmacological treatments for episodic childhood migraines searching several databases through May 20, 2012. Episodic migraine prevention was examined in 24 publications of randomized controlled trials that enrolled 1578 children in 16 nonrandomized studies. Single randomized controlled trials provided low-strength evidence that propranolol would result in complete cessation of migraine attacks in 713 per 1000 children treated (95% confidence interval, 452-974); trazodone and nimodipine decreased migraine days, while topiramate, divalproex, and clonidine were no more effective than placebo in preventing migraines. Migraine prevention with multidisciplinary drug management was not sustained at 6 months. Divalproex resulted in treatment discontinuation due to adverse effects, and topiramate increased the risk of paresthesia, upper respiratory tract infection, and weight loss. Long-term preventive benefits and improvement in disability and quality of life are unknown. No studies examined quality of life or provided evidence for individualized treatment decisions.

Recent work has led to a substantial improvement in the accuracy of predictions of contacts between amino acids using evolutionary information derived from multiple sequence alignments. Where large numbers of diverse sequence relatives are available and can be aligned to the sequence of a protein of unknown structure, it is now possible to generate high-resolution models without recourse to the structure of a template. In this review, we describe these exciting new techniques and critically assess the state of the art in contact prediction in light of them. We discuss areas for immediate research and development as well as potential future developments.

Over the past century, the polypeptide oxytocin has played an important role in medicine with major highlights including the identification of its involvement in parturition and the milk let-down reflex. Oxytocin is now implicated in an extensive range of psychological phenomena including reward and memory processes and has been investigated as a treatment for several psychiatric disorders including addiction, anxiety, autism, and schizophrenia. In this review, we first provide an historical overview of oxytocin and describe key aspects of its physiological activity. We then outline some pharmacological limitations in this field of research before highlighting the role of oxytocin in a wide range of behavioral and neuronal processes. Finally, we review evidence for a modulatory role of oxytocin with regard to psychostimulant effects. Key findings suggest that oxytocin attenuates a broad number of cocaine and methamphetamine induced behaviors and associated neuronal activity in rodents. Evidence also outlines a role for oxytocin in the prosocial effects of 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy) in both rodents and humans. Clinical trials should now investigate the effectiveness of oxytocin as a novel intervention for psychostimulant addiction and should aim to determine its specific role in the therapeutic properties of MDMA that are currently being investigated.

Neoadjuvant chemo-radiation therapy including temozolomide is commonly used for the treatment of gliomas. However, increased lesion size and contrast enhancement are frequently observed following this therapy and this appearance is termed as ‘pseudo-progression’. Since conventional imaging is unable to differentiate pseudo-progression from tumour recurrence, we evaluated the utility of MR spectroscopy (MRS) to differentiate these two pathological entities. Longitudinal MRI and MRS studies prior to and within four months post chemo-radiation therapy including diffusion-weighted imaging and single voxel spectroscopy (short and intermediate echo) were performed in 62 glioblastoma (GBM) patients undergoing chemo-radiation therapy. Clinical follow-up demonstrated four cases of pseudo-progression. In this study, results from these four cases and a known case of tumour recurrence are reported. Metabolite ratios and presence or absence of lipids at 1.3 ppm were used to differentiate between pseudo-progression and tumour recurrence. All four cases of pseudo-progression demonstrated elevated lipid signals on MRS. Additionally, an absence of choline or a low choline/NAA ratio was also observed. In comparison, the patient with tumour recurrence showed lower lipid signals and a high choline/NAA ratio. The presence of elevated lipid signals along with low choline/NAA ratios can aid in differentiation of pseudo-progression from tumour recurrence.

Prolonged jaundice (PJ) in healthy term neonates is common and frequently benign. It can, however, be the earliest manifestation of underlying liver disease. Its management requires a balanced approach, avoiding over-investigation of well babies while ensuring the early identification of those with pathology. Currently marked heterogeneity exists in the assessment of PJ. Over a two-year period we prospectively audited the management of PJ in two Level 3 neonatal units prior to and after the introduction of a rationalized investigation algorithm in keeping with the recently published British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) guidelines (i.e. clinical examination and stool inspection combined with measurement of split bilirubin). In this study we reviewed initial practice and then evaluated the impact of our change in practice. A total of 197 babies, 1.5% of live births, were referred with PJ. Of these, 105 babies were included in the first part of the study and 92 babies were included in the second part. No pathology relating to PJ, such as infection, hepatitis or liver disease, was identified. Following the introduction of our rationalized algorithm, we demonstrated a statistically significant reduction in the number of return appointments (28 versus 7; P < 0.0009) and repeat investigations (37 versus 7; P < 0.0001). This represented a saving of £1575–2625 per year in laboratory costs alone. Contemporaneously, three infants presented with biliary atresia, none of whom were identified by PJ screening and all of whom were over seven weeks old at diagnosis. A rationalized approach to the assessment of PJ reduces workload and is cost-effective; however, the limitations of selective screening, irrespective of how streamlined it is, remain – if babies are not identified and referred, they cannot be screened. Population-based methodologies offer an alternative approach to the identification of cholestatic liver disease and are worthy of further consideration.

In the United Kingdom, payment for mental health services follows a system of payment-by-results. A mental health clustering tool, classifying individuals into clusters based on service needs, was developed as a broad-based means of planning care packages. It is yet unknown whether payment-by-results clusters will be reflective of the occupational needs of service users. To evaluate the relationship between service users' membership in service need clusters and occupational groupings based on outcomes from an independent measure on participation and engagement in self-care, productivity, and leisure (Model of Human Occupation Screening Tool [MOHOST]), retrospective medical record data were gathered from 675 service users with a range of psychiatric disorders from two organizations in England. Using six subscales of the MOHOST, the two-step cluster analysis identified occupational groupings. Then the multivariate analysis of variance was used to examine whether the mean scores of the six MOHOST subscales were significantly different across the occupational groupings. Finally, participants' membership in the payment-by-results clusters was compared to their membership in the occupational groupings. Participants fell into one of three levels: high-, middle-, or low-functioning occupational groups. These groups did not bear direct relationships with the individual payment-by-results clusters. This suggests that the mental health clustering tool and the MOHOST are likely targeting different characteristics in the service users. Copyright © American Occupational Therapy Foundation.

Objective:The purpose of this study was to propose a process for the study of clinical utility and to illustrate its implementation in the development of an assessment.Method:A mixed methods approach was used to understand the clinical utility of an assessment in development. An exploratory qualitative/quantitative (QUAL?QUANT) approach was used to identify perspectives of the clinical utility of the assessment. The design placed equal status on the two methods used: focus groups and surveys.Results:The proposed process for the study of clinical utility resulted in targeted revisions based upon data obtained from 21 practitioners in three focus groups during a systemised examination of clinical utility.Conclusion:A mixed methods process can be used to ensure the clinical utility of assessments during the development process.

Progress in our understanding of heterotypic cellular interaction in the tumor microenvironment, which is recognized to play major roles in cancer progression, has been hampered due to unavailability of an appropriate in vitro co-culture model. The aim of this study was to generate an in vitro 3-dimensional human breast cancer model, which consists of cancer cells and fibroblasts. Breast cancer cells (UACC-893) and fibroblasts at various densities were co-cultured in a rotating suspension culture system to establish co-culture parameters. Subsequently, UACC-893, BT.20, or MDA.MB.453 were co-cultured with fibroblasts for 9 days. Co-cultures resulted in the generation of breast cancer histoid (BCH) with cancer cells showing the invasion of fibroblast spheroids, which were visualized by immunohistochemical (IHC) staining of sections (4 µm thick) of BCH. A reproducible quantitative expression of C-erbB.2 was detected in UACC-893 cancer cells in BCH sections by IHC staining and the Automated Cellular Imaging System. BCH sections also consistently exhibited qualitative expression of pancytokeratins, p53, Ki-67, or E-cadherin in cancer cells and that of vimentin or GSTPi in fibroblasts, fibronectin in the basement membrane and collagen IV in the extracellular matrix. The expression of the protein analytes and cellular architecture of BCH were markedly similar to those of breast cancer tissue.

Liverpool was once the second city of the Empire. In the 1960s it created a sound that the world tapped its foot to and sporting achievements that were the envy of Europe. Following years in the doldrums, Liverpool has, in the last decade, undergone a dramatic renaissance. It looks and feels different. This rediscovered swagger has given Liverpool the confidence to tell a new story of heritage and regeneration and to trade again on its name and fame. It is not easy for small cities to attract positive attention. But this article describes how Liverpool made a bold decision, alone among UK cities including London, to sell itself on the biggest stage of all, the 2010 World Expo, in the most economically dynamic city, Shanghai, in a country whose economy is growing faster than any other, China. It examines the motivation, the challenges, the outcomes and the legacy.

This paper argues that taking communication as a primary focus of theory and research leads to new insights on the nature of organization, as currently displayed in studies of strategy, institutionalization, boundary objects, discourse and materiality. Communicatively, an organization is both a configuring of practices, each with its own interactive modes of exchange, and a corporate legal person whose ‘voice’ becomes, paradoxically, a component of that same discursive geography. The ‘paradox’ dissolves, however, in a communicative theory, which argues that organizational identity, and its personhood, are established in the same way as those of individuals. The article then presents an original vision of organization as an ‘imbrication’ of domains of discourse out of which layers of identity emerge. The primary mechanism responsible for coherence of purpose and identity is authority, in that the persons of both organization and members must be continually “authored” for them to exist. The article concludes with a brief discussion of the implications of taking a communicative approach for future research.

Purpose: Payment by Results (PbR) was recently introduced to mental health care in England. The system allocates service users to one of 20 clusters and will provide funding based on cluster membership, rather than on block contracts. Occupational therapists are challenged to define care packages for each of the clusters. Method: To facilitate their development, this study identified the occupational profiles of service users in each cluster based on measures offered by the Model of Human Occupation. The study used existing data from the clinical records of 625 service users from two organisations, collected through use of the Mental Health Clustering Tool and the Model of Human Occupation Screening Tool. Results: Across the sample, service users showed greatest problems with habituation, followed by volition and process skills. Qualitatively distinct occupational profiles were identified across the clusters. Service users with non-psychotic problems showed the least interference with occupational participation; those in clusters involving psychosis showed moderate levels of interference; and those in clusters involving cognitive impairment demonstrated the most difficulty with occupational participation. Conclusion: These findings provide an important evidence base for thinking about the occupational needs of service users within the various PbR clusters and the corresponding services that might be offered.

The issue of how much to pay government employees to ensure optimum effort level is a complex one. Government employees are generally reported to be less motivated by high wages than their private sector counterparts. There is substantial empirical evidence that many performance-based pay schemes are either meaningless or dysfunctional in the public sector. Yet, it is common knowledge that most people do not seek employment without expecting some sort of remuneration for their effort. Drawing on the efficiency wage theory and public service motivation (PSM) literature, this article constructs a model to examine the relationship of wages and PSM in determining the effort levels of the public sector workforce in 15 countries that include the United States, Great Britain, and Australia.

Objective: The study was carried out to assess the efficacy and tolerability of rizatriptan orally disintegrating tablet (ODT) for treating acute migraine in patients who are non-responders to sumatriptan. Background: Many migraineurs report dissatisfaction with sumatriptan efficacy. It is unclear whether sumatriptan 100 mg non-responders will respond to other triptans. Methods: This was a randomized, placebo-controlled, double-blind study in adults with >1-year history of ICHD-II (International Classification of Headache Disorders, second edition) migraine who reported that they generally do not respond to sumatriptan (≥50% unsatisfactory response). In the baseline phase, participants treated a single moderate/severe migraine attack with open-label generic sumatriptan 100 mg. Those who continued to experience moderate/severe pain at two hours post-dose were eligible to enter the double-blind treatment phase, during which participants treated three migraine attacks in crossover fashion (two with rizatriptan 10-mg ODT, one with placebo) after being randomly assigned to one of three treatment sequences (1 : 1 : 1 ratio). The primary endpoint was two-hour pain relief. Results: A total of 102 (94%) participants treated at least one study migraine. Pain relief at two hours was significantly greater with rizatriptan compared with placebo (51% vs. 20%, p Conclusion: Rizatriptan 10-mg ODT was superior to placebo at providing two-hour pain relief and two-hour pain freedom in the treatment of acute migraine in those who do not respond to sumatriptan 100 mg. Rizatriptan was generally well tolerated in this population.

Background: With a growing increase in the population of older people worldwide, there is an undeniable need for efficient and cost-effective service delivery in occupational therapy. Method: This randomised clinical trial employed a parallel design, with an experimental and a control group and a pre-test and post-test, to evaluate the effectiveness of a wellness programme based on the Model of Human Occupation (MOHO). Participants were 65 years of age or older, community-dwelling Japanese older people. Data were analysed for 30 experimental participants who received a 15-session MOHO programme and 33 controls who received a 15-session standard care, crafts programme. Quality of life and psychological wellbeing were compared between groups using the Japanese versions of the Life Satisfaction Index — Z (LSI-Z) and the World Health Organisation Quality of Life-26 (QOL26), respectively. Results: The LSI-Z score for the experimental group improved an average of 3.4 points whereas the control group's mean score improved by 0.1 point. The mean change for the experimental group (m.chg = 3.4, SD = 5.8) was significantly different (p = 0.01) from that of the control group (m.chg = 0.1, SD = 4.8) and the effect size (Cohen's d) was 0.62 (95% confidence interval = 0.13–1.11). The psychological domain score (QOL26) improved slightly for the experimental group whereas it declined slightly for the control group. The mean change was significantly different (p = 0.02) between the experimental (m.chg = 0.1, SD = 0.5) and control (m.chg = −0.1, SD = 0.3) groups; effect size (Cohen's d) was 0.49 (95% confidence interval = 0.02–0.96). Conclusion: The findings support the conclusion that MOHO-based occupational therapy interventions can promote wellness effectively in older people by having an impact on quality of life and sense of wellbeing.

Although occupational therapy literature emphasizes the importance of therapeutic use of self, there have been few studies of the interpersonal strategies used in response to different client needs. This study sought to explore therapists' use of self according to the Intentional Relationship Model by examining the use of different modes of interacting with clients. A questionnaire was mailed to a random sample of 1,000 practicing occupational therapists. Sixty-four percent responded and 563 met inclusion criteria. Modes used most to least often were: encouraging, collaborating, problem-solving, instructing, and empathizing. Mode use did not differ according to client population. Therapists who experienced more difficult behaviors and emotions reported higher levels of using all modes. Therapists facing difficult behavior in general were more likely to report use of the instructing and problem-solving modes. Therapists with anxious clients reported greater use of the problem-solving mode, whereas therapists with depressed clients reported increased use of problem-solving, collaborating, and empathizing modes. Implications for occupational therapy practice and education are discussed.

Background: Access sites other than the anterior gastric wall may provide improved ergonomics for natural orifice transluminal endoscopic surgery (NOTES). Endoscopic ultrasound (EUS) guidance significantly reduces, but does not eliminate, risk of access through these alternate sites. This study evaluates the utility of hydroperitoneum as an adjunct to EUS-guided access and closure of alternate access sites for NOTES. Methods: Access and closure procedures were initially performed with EUS guidance alone, and subsequently, because of complications resulting from this technique, the procedures were performed with the aid of a transabdominal hydroperitoneum. Results: In this nonrandomized study, 6 access and closure procedures performed with EUS guidance alone resulted in 4 complications. After modifying the technique to incorporate pre-access hydroperitoneum, 7 EUS-guided access and closure procedures were performed without significant complications. Conclusions: Hydroperitoneum appears to be an effective adjunct to ensure the safety of EUS-guided peritoneal entry and closure of alternate access sites for NOTES.

This article examines the language of numbers as it is used in talk within a contemporary organization to provide a better understanding of the ways speech acts, performed during the construction of accounts, contribute to the process of organizing. Based on an in-depth case study of the site budgetary control process in a French construction firm, it shows that the business of doing calculations through talk generates respective obligations and, in turn, plays a central role in the constitution of the organization. Hence, this article shows how accounting, in all of its manifestations, produces the organization and does not simply occur within it.

Circadian clocks drive endogenous oscillations in organisms across the tree of life. The Earth’s daily light/dark cycle entrains these clocks to the environment. Two major theories of light entrainment have been presented in the literature. The discrete theory emphasizes the instantaneous phase-shifting behavior of short pulses of light, and the continuous theory emphasizes changes to the period of oscillations in constant-light conditions. Historically, the primary tool for predicting and understanding discrete entrainment has been the PRC, which measures discrete adjustments to the clock’s phase. The authors present a unified theory, which relies on a velocity response curve (VRC), similar in shape to a PRC, but that describes continuous adjustments to the clock’s speed. The VRC explains data from both discrete and continuous light experiments and is therefore an invaluable tool to understand entrainment. The authors relate VRC features to specific entrainment behaviors, such as seasonal adjustments to the phase of entrainment. Furthermore, they estimate a VRC from PRC data and successfully reproduce additional PRC data. Finally, they entrain a VRC-based model to natural light/dark cycles, demonstrating the unified theory’s ability to predict clock behavior in the face of a fluctuating signal. The results indicate that a VRC-based model not only provides a comprehensive understanding of entrainment but also has excellent predictive capabilities.

Objective: To investigate the effect of a 36-ingredient micronutrient formula consisting mainly of minerals and vitamins in the treatment of adults with both ADHD and severe mood dysregulation (SMD). Method: 14 medication-free adults (9 men, 5 women; 18-55 years) with ADHD and SMD completed an 8-week open-label trial. Results: A minority reported transitory mild side effects. Significant improvements were noted across informants (self, observer, clinician) on measures of inattention and hyperactivity/impulsivity, mood, quality of life, anxiety, and stress all with medium to very large effect sizes (all ps < .01); however, the mean of inattention remained in a clinical range whereas the means on measures of mood and hyperactivity/impulsivity were normalized. Follow-up data showed maintenance of changes or further improvement for those who stayed on the micronutrients. Conclusions: Although this study, as an open trial, does not in itself prove efficacy, it provides preliminary evidence supporting the need for a randomized clinical trial of micronutrients as treatment for the more complex presentations of ADHD.

The emergence of the glucoregulatory hormone, glucagon-like peptide-1, has expanded our understanding of glucose homeostasis. The glucoregulatory actions of glucagon-like peptide-1 include enhancement of glucose-dependent insulin secretion, suppression of inappropriately elevated glucagon secretion, slowing of gastric emptying, and reduction of food intake. Two approaches have been developed to potentiate the effects of glucagon-like peptide-1 in those with type 2 diabetes. The glucagon-like peptide-1 analogs, such as exenatide, and dipeptidyl peptidase-IV inhibitors, such as sitagliptin, are currently available whereas others are in the final stages of development. These agents effectively reduce hemoglobin A1c while providing the other benefits associated with increased glucagon-like peptide-1. They also offer the potential to preserve the β-cell function. The effects on cardiovascular disease, if any, are unknown. Based on the current evidence, these agents represent viable second-and third-line options in the management of type 2 diabetes.

Osteoarthritis is common, has considerable health consequences, and will affect increasing numbers of persons in coming years. Nonpharmacological interventions are of paramount importance in achieving adequate symptom control. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) play a pivotal role in osteoarthritis pharmacotherapy. Acetaminophen, due to its safety profile, should be adequately trialed before resorting to NSAIDs. NSAIDs and celecoxib, a selective inhibitor of cyclooxygenase-2, should be selected thoughtfully so as to balance the likelihood of treatment success with gastrointestinal bleeding and cardiovascular events. Celecoxib may be used when the risk for gastrointestinal bleeding is high and the risk of cardiovascular events low. Otherwise, NSAIDs, usually naproxen, should be paired with a gastroprotective agent. Topical NSAIDs, including a recently approved diclofenac patch and gel, may also be useful when systemic exposure is undesirable. The role of glucosamine and chondroitin is controversial and the data conflicting. Other modalities, such as tramadol, opioids, and viscosupplementation should be tailored to the patient and clinical situation. Appropriate deployment of agents in the osteoarthritis armamentarium can maximize efficacy and safety thereby improving the disease burden for patients.

Acoustic reflectometry has been shown to be an effective technique for detecting defects, such as holes and blockages, in relatively short, single lengths of pipe. This paper discusses briefly the physical basis of the technique and then describes the results of a series of experiments that were designed to evaluate the suitability of using this approach for monitoring the health of natural gas pipelines. Such pipelines will typically be many kilometres long, have diameters of up to 1 m and may form part of a complex network of pipelines. Previous studies have demonstrated that acoustic reflectometry techniques can be used to detect pipeline defects in relatively small bore pipelines with lengths of several hundred meters. The results reported in this paper indicate that even when using fairly crude equipment, the technique can be successfully applied to detect defects in single pipelines and pipeline networks with large diameters and lengths exceeding 5 km. Although the results presented in this paper are not conclusive, they do provide the necessary justification for a second phase of experiments to be conducted to extend the scope of the technique further.

Three-person teams controlling a simulated unmanned aerial vehicle underwent different training regimes in order to assess the effect of process-based and knowledge-based training on team coordination and performance. Coordination and performance were assessed during training and eight to eleven weeks after training. Process training consisted of either enforcing a rigid coordination process or forcing teams to coordinate in different ways through the introduction of perturbations. Knowledge training consisted of cross-training teams on each others roles. Results indicate that process training had a significant effect on team coordination. In addition, the qualitative nature of coordination flexibility changed from training to retention for process versus knowledge trained teams, with process teams behaving flexibly at retention. Perturbation process training led to significantly higher team performance under high workload. Rigid process training lead to significantly lower performance in one of the retention missions.

Following Alvesson and Kärreman's (2000) influential essay on the modes and interpretation of organizational discourse, this article reports on a longitudinal study of naturally occurring interactions that took place before, during, and after a meeting between representatives of Médecins sans Frontières (Doctors without Borders), a well-known humanitarian organization, and representatives of local health centers in a region of the Democratic Republic of Congo. This episode is used to exemplify the fruitfulness of adopting a view that incorporates two dimensions of discourse, that is, what Alvesson and Kärreman identify as its transient (autonomous) and muscular (determining) nature. The longitudinal aspect of our study allows us to show what interactants accomplish in particular settings, while illustrating a crucial aspect of the trans-local dimension of their talk. As shown in this article, a given Discourse must be embodied, materialized or even incarnated in discourses, that is, tokens of text or talk, in order for it to be reproduced, sustained and transported from one point to another, that is, to become what Latour (1987) calls an immutable mobile . A given Discourse can thus maintain its shape across time and space only if a lot of interactive work is done to assure the stability of its associations in the ordinary day-to-day activity of the people who embody it.

Cognitive event-related potential (ERP) studies of memory and language impairments in amnesia and Alzheimer's disease (AD) are reviewed. Well-circumscribed lesions of the medial temporal lobe (MTL) or diencephalon causing an amnestic syndrome, an inability to encode and retrieve episodic memories beyond the brief duration of working memory, appear to produce altered plasticity of the late positive P600 component, but usually spare P300 and N400 components. The neuropathology of AD affects MTL and extends to neocortical association areas, causing deficits of episodic and semantic memory. In AD dementia, the P300, N400, and P600 all commonly show abnormalities. ERP studies of individuals with mild cognitive impairment may reveal neurophysiological changes prior to the emergence of clinical deficits, which could advance the early detection and diagnosis of AD.