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Tujuan dari penelitian ini adalah untuk mengantisipasi terjadinya kebakaran yang sangat besar dengan memantau kondisi panel listrik yang ada di kapal. Penelitian ini menggunakan kontrol listrik miniatur berukuran tinggi 35,5 cm, panjang 27cm dan lebar 9. Perancangan fire detector panel listrik berbasis mikrokontroler tipe 328 digunakan untuk memonitor keberadaan benda api dan suhu yang melebihi batas maksimal dengan menggunakan sensor suhu DHT22 dan sensor nyala api yang ada pada panel listrik di kapal. Hasil pembacaan sensor akan diproses menggunakan mikrokontroler Atmega 328 yang ditampilkan dalam aplikasi IDE, dalam bentuk data deteksi kebakaran, pembacaan suhu dan kondisi pada panel. Ketika sensor mendeteksi api dan suhu melebihi batas buzzer maksimum dan LED akan menyala untuk menginformasikan alarm dan ketika sensor sensor tidak mendeteksi objek kebakaran atau suhu melebihi batas, buzzer dan LED akan mati.

Background: Missing data can introduce bias and reduce the power, precision and generalisability of study findings. Guidelines on how to address missing data are limited in scope and detail, and poorly implemented. Aim: To develop guidelines on how best to (i) reduce, (ii) handle and (iii) report missing data in palliative care clinical trials. Design: Modified nominal group technique. Setting/participants: Patient and public research partners, palliative care clinicians, trialists, methodologists and statisticians attended a 1-day workshop, following which a multi-stakeholder development group drafted the guidelines. Results: Seven main recommendations for reducing missing data, nine for handling missing data and twelve for reporting missing data were developed. The top five recommendations were: (i) train all research staff on missing data, (ii) prepare for missing data at the trial design stage, (iii) address missing data in the statistical analysis plan, (iv) collect the reasons for missing data and (v) report descriptive statistics comparing the baseline characteristics of those with missing and observed data. Reducing missing data, preparing for missing data and understanding the reasons for missing data were greater priorities for stakeholders than how to deal with missing data once they had occurred. Conclusion: Comprehensive guidelines on how to address missing data were developed by stakeholders involved in palliative care trials. Implementation of the guidelines will require endorsement of research funders and research journals.

To date, sport-related concussion diagnosis and management is primarily based on subjective clinical tests in the absence of validated biomarkers. A major obstacle to clinical validation and application is a lack of studies exploring potential biomarkers in non-injured populations. This cross-sectional study examined the associations between saliva telomere length (TL) and multiple confounding variables in a healthy university athlete population. One hundred eighty-three (108 male and 75 female) uninjured varsity athletes were recruited to the study and provided saliva samples at either pre- or mid-season, for TL analysis. Multiple linear regression was used to determine the associations between saliva TL and history of concussion, sport contact type, time in season (pre vs. mid-season collection), age, and sex. Results showed no significant associations between TL and history of concussion, age, or sport contact type. However, TL from samples collected mid-season were longer than those collected pre-season [β = 231.4, 95% CI (61.9, 401.0), p = 0.008], and males had longer TL than females [β = 284.8, 95% CI (111.5, 458.2), p = 0.001] when adjusting for all other variables in the model. These findings population suggest that multiple variables may influence TL. Future studies should consider these confounders when evaluating saliva TL as a plausible fluid biomarker for SRC.

To evaluate how an exertional field-test impacts the Sport Concussion Assessment Tool 5 (SCAT5) subcomponents in uninjured athletes.Prospective case-series.Sports medicine setting.A total of 37 rugby and wrestling athletes (76% female) with a median age of 19 years (range: 18-23). Twenty-one (57%) had a history of concussion.The SCAT5 was administered prior-to and following a volitionally fatiguing, field-based 30-15 Intermittent Fitness Test. The primary outcome measures included: total symptom scores and severity, standardized assessment of concussion, neurological screening, and balance errors during the modified balance error scoring system. Wilcoxon signed-rank tests examined differences in ordinal data between pre- and post-exertion with Bonferroni corrections (alpha = 0.006). Data were also stratified into time to SCAT5 administration post-exertion and compared via Cliff's Delta (d).The SCAT5 was administered a median of 20-min (interquartile range: 14-26-min) following exertion. No differences were found pre- and post-exertion across all SCAT5 metrics (p 0.048). Within the post-exertion 0-10-min stratification, total symptoms and severity scores appeared to be elevated with a large effect size (d ≥ 0.64).While SCAT5 metrics were not statistically altered when quantified a median of 20-min following high-intensity exertion; greater symptom reporting may occur 10-min following exertion.

To examine how high-intensity physical exertion affects clinical measures of cervical spine (CSp), vestibular/ocular motor screen (VOMS), and vestibulo-ocular reflex (VOR) function.Case series.Sports Medicine Centre.A total of 37 athletes consented to participate (22 rugby, 15 wrestling; 9 men, 28 women; median age = 19 years [range 17-23 years]).Outcome measures included tests of CSp (cervical flexor endurance, head perturbation test, cervical flexion rotation test and anterolateral strength), VOR (head thrust test and dynamic visual acuity [DVA]), and a quantified version of the VOMS. These metrics were assessed prior to and after completing the 30-15 Intermittent Fitness Test. Bland-Altman plots and Wilcoxon signed-rank tests were utilized to analyze the data using an alpha of p 0.004.Cervical anterolateral strength (kg) was reduced post-exertion on the left (z = 3.87; p 0.001), but not on the right between conditions (z = -1.49; p = 0.14). Athletes reported increased dizziness (z = -3.55; p = 0.004) and had reduced DVA following exertion (z = -2.78; p 0.001). All other metrics were not significantly different following exertion (p 0.011).Reduced performance on DVA, decreased left-anterolateral strength, and increased dizziness occurred following high-intensity exertion in varsity collision and combative athletes, which has implications for sideline screening for sport-related concussion.

Introduction The purpose of this study was to identify the location of the peroneal tendons in relationship to the fibular groove in an asymptomatic population of elite U.S. Military Service members. Materials and Methods The peroneal tendons of 41 active duty U.S. Army Rangers were examined. Subjects were placed in a lateral recumbent position with the ankle in a resting neutral position to visualize the tendon in a retromalleolar short-axis view. Maximum active ankle eversion followed by gravity inversion was facilitated while the ultrasound probe was maintained in its original position. Distance from the fibrous lateral ridge of the retromalleolar groove to the anterior aspect of the peroneal brevis was measured in the short axis in neutral, eversion, and inversion. Results The mean sagittal distance and standard deviation was 0.48 ± 0.9 mm. No subjects demonstrated greater than 1 mm difference between positions, and no dislocations were identified. Side-to-side difference and dominant vs nondominant differences were not statistically significant. Conclusion The study demonstrates that the distance between the peroneal brevis and the lateral fibular ridge is consistent throughout extremes of motion. These results further the understanding of peroneal tendon function under dynamic examination. Our findings also establish side-to-side consistency prompting a bilateral examination to help identify abnormal pathology.

The prevalence of obesity and associated cardiometabolic diseases continues to rise, despite efforts to improve global health. The adipose tissue is now regarded as an endocrine organ since its multitude of secretions, lipids chief among them, regulate systemic functions. The loss of normal adipose tissue phenotypic flexibility, especially related to lipid homeostasis, appears to trigger cardiometabolic pathogenesis. The goal of this manuscript is to review lipid balance maintenance by the lean adipose tissue’s propensity for phenotype switching, obese adipose tissue’s narrower range of phenotype flexibility, and what initial factors account for the waning lipid regulatory capacity. Metabolic, hypoxic, and inflammatory factors contribute to the adipose tissue phenotype being made rigid. A better grasp of normal adipose tissue function provides the necessary context for recognizing the extent of obese adipose tissue dysfunction and gaining insight into how pathogenesis evolves.

Litigation raising climate change issues has increased in the number and types of cases across a growing number of national and international jurisdictions. An emergent trend is litigation that invokes particular legal rights to address climate change issues. Referred to collectively in this article as ‘environmental rights,’ these include rights established under the public trust doctrine, as well as within the realms of constitutional and human rights, including the right to life and right to a quality environment. This article surveys the development of climate change litigation—in various jurisdictions around the world—in which parties have sought to invoke these environmental rights. In addition to examining how climate change litigation has adapted rights-based claims made in earlier, more traditional litigation, this article reviews recent significant cases and examines how this growing body of case law is contributing to an expansion in the content of fundamental rights in the climate change context.

The recently published NCRP Commentary No. 27 evaluated the new information from epidemiologic studies as to their degree of support for applying the linear nonthreshold (LNT) model of carcinogenic effects for radiation protection purposes (NCRP 2018 Implications of Recent Epidemiologic Studies for the Linear Nonthreshold Model and Radiation Protection, Commentary No. 27 (Bethesda, MD: National Council on Radiation Protection and Measurements)). The aim was to determine whether recent epidemiologic studies of low-LET radiation, particularly those at low doses and/or low dose rates (LD/LDR), broadly support the LNT model of carcinogenic risk or, on the contrary, demonstrate sufficient evidence that the LNT model is inappropriate for the purposes of radiation protection. An updated review was needed because a considerable number of reports of radiation epidemiologic studies based on new or updated data have been published since other major reviews were conducted by national and international scientific committees. The Commentary provides a critical review of the LD/LDR studies that are most directly applicable to current occupational, environmental and medical radiation exposure circumstances. This Memorandum summarises several of the more important LD/LDR studies that incorporate radiation dose responses for solid cancer and leukemia that were reviewed in Commentary No. 27. In addition, an overview is provided of radiation studies of breast and thyroid cancers, and cancer after childhood exposures. Non-cancers are briefly touched upon such as ischemic heart disease, cataracts, and heritable genetic effects. To assess the applicability and utility of the LNT model for radiation protection, the Commentary evaluated 29 epidemiologic studies or groups of studies, primarily of total solid cancer, in terms of strengths and weaknesses in their epidemiologic methods, dosimetry approaches, and statistical modelling, and the degree to which they supported a LNT model for continued use in radiation protection. Recommendations for how to make epidemiologic radiation studies more informative are outlined. The NCRP Committee recognises that the risks from LD/LDR exposures are small and uncertain. The Committee judged that the available epidemiologic data were broadly supportive of the LNT model and that at this time no alternative dose-response relationship appears more pragmatic or prudent for radiation protection purposes.

Leadership coaching can be productive in maximizing a leader's development. But to make leadership coaching work effectively for students, as opposed to executives, this chapter offers guidance on key concepts and practices from the Center for Creative Leadership's Coaching Framework.

Aims The present study investigated if treatment with the immunotherapeutic, lacto-N-fucopentaose-III (LNFPIII), resulted in amelioration of acute and persisting deficits in synaptic plasticity and transmission as well as trophic factor expression along the hippocampal dorsoventral axis in a mouse model of Gulf War Illness (GWI). Main methods Mice received either coadministered or delayed LNFPIII treatment throughout or following, respectively, exposure to a 15-day GWI induction paradigm. Subsets of animals were subsequently sacrificed 48 h, seven months, or 11 months post GWI-related (GWIR) exposure for hippocampal qPCR or in vitro electrophysiology experiments. Key findings Progressively worsened impairments in hippocampal synaptic plasticity, as well as a biphasic effect on hippocampal synaptic transmission, were detected in GWIR-exposed animals. Dorsoventral-specific impairments in hippocampal synaptic responses became more pronounced over time, particularly in the dorsal hippocampus. Notably, delayed LNFPIII treatment ameliorated GWI-related aberrations in hippocampal synaptic plasticity and transmission seven and 11 months post-exposure, an effect that was consistent with enhanced hippocampal trophic factor expression and absence of increased interleukin 6 (IL-6) in animals treated with LNFPIII. Significance Approximately a third of Gulf War Veterans have GWI; however, GWI therapeutics are presently limited to targeted and symptomatic treatments. As increasing evidence underscores the substantial role of persisting neuroimmune dysfunction in GWI, efficacious neuroactive immunotherapeutics hold substantial promise in yielding GWI remission. The findings in the present report indicate that LNFPIII may be an efficacious candidate for ameliorating persisting neurological abnormalities presented in GWI.

Extracorporeal membrane oxygenation (ECMO) support for severe acute respiratory failure has been increasing. Evidence suggests that higher volume centers have better outcomes, leading to a need for specialized ECMO transport teams. The inherent nature of the prehospital environment adds an additional layer of complexity; however, the experience of multiple centers has demonstrated that cannulating and transporting a patient on ECMO can be performed safely. The purpose of this review article is to discuss the state of knowledge with respect to ECMO transport with special emphasis given to how to actually undertake such complex transports.

Background The Rotator Cuff Quality of Life Index (RC-QOL) was developed to evaluate quality of life in patients with rotator cuff disorders (RCD). The purpose of this study was to provide additional reliability, validity, and responsiveness testing in accordance with the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. Methods Preliminary patient interviews included 15 patients. Seventy patients (mean age, 58; standard deviation, 9 years) with RCD were evaluated. Methodology testing included internal consistency, test-retest reliability, measurement error, content validity, and construct validity. Responsiveness, interpretability, and generalizability were also analyzed. Results The Cronbach α was 0.96 (95% confidence interval, 0.89-0.99; range, 0.72-0.94). The intraclass correlation coefficient for the RC-QOL was 0.87 (95% confidence interval, 0.79-0.85; range, 0.77-0.88). The standard error of measurement was 8 (range, 7-13). The smallest detectable change was 3 (range, 2-4). Content validity was confirmed through standardized patient interviews. All a priori hypotheses were confirmed. No floor or ceiling effects were present. The minimally clinical important difference ranged between 7 and 14 points. The study met the COSMIN criteria for interpretability and generalizability. Conclusion The RC-QOL is a reliable and valid measure of health-related quality of life in patients with chronic RCD. The results of this study added to the methodologic quality assessment of the RC-QOL, completing 7 of 10 COSMIN criteria.

To engage clinicians in diagnosing patellar tendinopathy in large surveillance studies is often impracticable. The Oslo Sports Trauma Research Centre-patellar tendinopathy (OSTRC-P) questionnaire, a self-report measure adapted from the OSTRC questionnaire, may provide a viable alternative.To evaluate the diagnostic accuracy of the OSTRC-P questionnaire in detecting patellar tendinopathy in youth basketball players when compared to clinical evaluation.Following the STAndards for Reporting of Diagnostic accuracy studies guidelines, the researchers recruited 208 youth basketball players (13-18 years of age) for this prospective diagnostic accuracy validation study. Participants completed the OSTRC-P questionnaire (index test) prior to a clinical evaluation (reference standard) by a physical therapist blinded to OSTRC-P questionnaire results. Sensitivity, specificity, predictive value, likelihood ratio, and posttest probability were calculated. Linear regression was used to examine the association between the OSTRC-P questionnaire severity score and the patellar tendinopathy severity rating during a single-leg decline squat.The final analysis included 169 players. The OSTRC-P questionnaire had a sensitivity of 79% (95% confidence interval [CI]: 65%, 90%), specificity of 98% (95% CI: 94%, 100%), positive predictive value of 95% (95% CI: 83%, 99%), negative predictive value of 92% (95% CI: 86%, 96%), positive likelihood ratio of 48 (95% CI: 12, 191), and negative likelihood ratio of 0.21 (95% CI: 0.12, 0.37). The posttest probabilities were 95% and 8%, given positive and negative results, respectively. A positive association was found between OSTRC-P questionnaire severity score and single-leg decline squat rating (β = 0.08; 95% CI: 0.03, 0.12; P = .001).The OSTRC-P questionnaire is an acceptable alternative to clinical evaluation for self-reporting patellar tendinopathy and grading its severity in settings involving youth basketball players.Diagnosis, level 1b. J Orthop Sports Phys Ther 2018;48(10):758-766. Epub 27 Apr 2018. doi:10.2519/jospt.2018.8088.

Protein degradation plays a critical role in synaptic plasticity, but the molecular mechanisms are not well understood. Previously we showed that proteasome inhibition enhances the early induction part of long-term synaptic plasticity for which protein synthesis is essential. In this study, we tested the effect of proteasome inhibition on protein synthesis using a chemically induced long-lasting synaptic plasticity (cLTP) in the murine hippocampus as a model system. Our metabolic labeling experiments showed that cLTP induction increases protein synthesis and proteasome inhibition enhances the amount of newly synthesized proteins. We then found that amyloid beta (Aβ), a peptide contributing to Alzheimer's pathology and impairment of synaptic plasticity, blocks protein synthesis increased by cLTP. This blockade can be reversed by prior proteasome inhibition. Thus, our work reveals interactions between protein synthesis and protein degradation and suggests a possible way to exploit protein degradation to rescue adverse Aβ effects on long-term synaptic plasticity.

Background The prevalence of Achilles tendon (AT) pathology is common and can result in disability. Understanding normal AT properties can improve our ability to prevent AT injuries. We examined the cross-sectional area of the AT at multiple levels in an asymptomatic population of Army Rangers. Methods This is a prospective cohort study composed of 41 voluntarily recruited United States Army Rangers deployed in a combat theater. All subjects were members of the Ranger Regiment participating in more than 20 h of intense bipedal non-sport weekly training with no history of AT pathology. While standing, each subject had bilateral AT calcaneal tuberosity insertions (0 cm) marked, along with skin markings made at 2 cm, 4 cm, and 6 cm superior to the AT insertion. AT diameter was measured at each level in the coronal and sagittal planes using ultrasound. Results Mean sagittal diameter of the AT was 4.4 mm, 4.3 mm, 4.2 mm, and 3.9 mm at 0 cm, 2 cm, 4 cm, and 6 cm, respectively. Mean coronal diameter of the AT was 19.3 mm, 14.7 mm, 13.8 mm, and 14.5 mm at 0 cm, 2 cm, 4 cm, and 6 cm, respectively. The cross-sectional area was calculated as 0.66 cm2, 0.5 cm2, 0.46 cm2, and 0.44 cm2 at 0 cm, 2 cm, 4 cm, and 6 cm, respectively. Conclusion Our data suggest that increased non-sport activity may not increase the cross-sectional area of the AT. Identifying the normal diameter at multiple levels throughout the most commonly injured area may improve the provider's ability to identify early disease processes and apply targeted interventions to help slow or prevent progression and possible rupture. Level of Evidence Level III-V.

Background: Chronic rotator cuff tears are prevalent and can be disabling. The existing literature is unclear regarding the effectiveness of nonoperative treatment. The purposes of this study were to determine whether the outcome of nonoperative treatment can be predicted on the basis of the presenting clinical characteristics and whether the outcome achieved at three months after treatment can be maintained at two years. Methods: The prospective cohort included ninety-three patients with a documented chronic full-thickness rotator cuff tear. Patients underwent a three-month supervised program of nonoperative treatment and were then evaluated by an orthopaedic surgeon. The treatment outcome was defined as a success if surgical treatment was no longer deemed appropriate by both patient and surgeon because the patient had improved considerably and was predominantly asymptomatic. The outcome was defined as a failure if the patient elected to have surgery after failing to improve and remaining symptomatic. The presenting clinical characteristics that were analyzed included age, sex, smoking status, hand dominance, duration of symptoms, onset (traumatic etiology or insidious onset), shoulder motion, external rotation strength, tear size as documented by ultrasonography or magnetic resonance imaging, and the Rotator Cuff Quality-of-Life Index (RC-QOL). Results: Seventy (75%) of the patients were successfully treated. Logistic regression analysis showed that the baseline RC-QOL score was a significant predictor of outcome (p = 0.017). Eighty-nine percent of patients maintained their three-month outcome at two years of follow-up. Conclusions: The RC-QOL was predictive of the outcome of nonoperative treatment of patients with a chronic full-thickness rotator cuff tear. Patients in whom the nonoperative treatment was deemed successful at the conclusion of three months of treatment had a very high chance of ongoing success at two years after the initiation of treatment. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Direct mechanical ventricular actuation (DMVA) exerts direct cardiac compression/decompression and does not require blood contact. The safety and effects of DMVA support in chronically dysfunctional beating hearts in vivo have not been established. This study evaluated hemodynamics and load-independent systolic/diastolic cardiac function before/after acute support (2 hours) using DMVA in small hearts with induced chronic failure. Chronic heart failure was created in seven small dogs (15 ± 2 kg) via either serial coronary microembolizations or right-ventricular overdrive pacing. Dogs were instrumented to measure cardiac output, hemodynamic pressures, left ventricular volumes for pressure-volume analysis via preload reduction. Temporary cardiac support using a DMVA device was instituted for 2 hours. Hemodynamic and mechanical assessments, including dobutamine dose-responses, were compared both before and after support. Hemodynamic indices were preserved with support. Both left-ventricular systolic and diastolic function were improved postsupport, as the slopes of the preload-recruitable stroke work (+29 ± 7%, p < 0.05) and the end-diastolic pressure-volume relationship (EDPVR: -28 ± 9%, p < 0.05) improved post-DMVA support. Diastolic/systolic myocardial reserve, as assessed by responsiveness to dobutamine challenges, was preserved after DMVA support. Short-term DMVA support can safely and effectively sustain hemodynamics, whereas triggering favorable effects on cardiac function in the setting of chronic heart failure. In particular, DMVA support preserved load-independent diastolic function and reserve.

A combination of helium and oxygen (heliox) can facilitate gas exchange and limit peak inspiratory pressures through reduced resistance to gas flow and decreased turbulent flow. The combination of these gases has been used for a variety of upper and lower airway conditions, including patients who were spontaneously breathing, receiving noninvasive ventilation, as well as during mechanical ventilation. To date, there are no reports regarding the use of heliox in patients with bronchiolitis obliterans syndrome following lung transplantation. We report the use of such a combination of gases in 2 patients with bronchiolitis obliterans syndrome following lung transplantation as a supportive measure to facilitate ventilation during the initial treatment course for acute respiratory failure in the ICU. A heliox mixture was administered with noninvasive ventilation and with mechanical ventilation through the ventilator in a heart-lung transplant recipient and a lung transplant recipient, respectively.

Combined heart-lung transplantation remains as a treatment option for patients with cardiopulmonary failure. There is speculation that lung grafts protect the heart from developing graft vasculopathy after combined heart-lung transplantation. This protective mechanism is more likely, at best, a delay in the onset of coronary artery vasculopathy. We present our experiences in two cases of an aggressive form of cardiac allograft vasculopathy after combined heart-lung transplantation that resulted in the death of both patients.

IntroductionComplex interventions are common in palliative care (PC) but are difficult to evaluate. Complementary therapies (CT) are one type of widely-used complex intervention for which there is inconclusive evidence. No systematic review has been conducted in PC of trials or of qualitative studies of patients’ views of CTs. There are novel approaches with established exemplars of using both types of reviews to help develop more clinically appropriate interventions. These approaches are in their infancy in PC research and have much to offer the specialism.AimsUsing our on-going review on CT we present as an exemplar in PC an approach to draw together the findings of trials and qualitative studies in a data table (matrix) to contrast what patients value and want with how the intervention is tested.MethodsWe sought trials on the effectiveness of CT and qualitative studies on patients’ perspectives about these therapies. Our primary outcomes for trials included anxiety. Eight databases were searched in 2017. Citations and full-text papers were reviewed to identify relevant studies. Meta-analyses pooled trial data where appropriate and a thematic synthesis is being undertaken to understand patient experience. These findings will be combined in a matrix to explore similarities and differences.Results19 trials and five qualitative studies were included. Data analysis and development of the matrix which includes intervention content and patients’ needs is currently underway. We will present the final matrix framework.ConclusionsOur approach demonstrates a potential way in PC to enhance development of practice appropriate complex interventions.

Teaching Jesuit values as an ethical view in business schools is fraught with several practical issues. Our paper addresses a way that Jesuit/Ignatian values can be taught within a discipline-speci...

Prime volume of the cardiopulmonary bypass circuit may lead to significant hemodilution and the potential need for blood products for all patients, but may be more critical in the pediatric and, specifically, the neonatal patient. We report on the first use of the Terumo® CAPIOX® FX05 (Baby-FX™) oxygenator with integral arterial filter, prime volume 43 ml, evaluating performance and air-handling of six Baby-FX™ versus thirteen Baby-RX™ oxygenators. The Terumo Baby-FX™ primes and performs as easily as the Baby-RX™ series. A significant prime component in the neonatal CPB circuit can be the arterial line filter (ALF). Removal of the ALF may lead to significant reduction in prime volume, decreased exposure to foreign surfaces with subsequent reduction in inflammation, and potential elimination or reduction in blood product exposures.

The overdenture is, perhaps, an under-used form of treatment in the primary dental care sector. In this, the final paper in a series of three, the reader will be reminded of the basic concepts concerning overdentures. The author will outline some of the important changes that are likely to influence overdenture provision in the United Kingdom, and describe clinical aspects of this form of treatment.

Preintervention and post-intervention, repeated-measures experimental design.The objective was to investigate the effects of foot orthoses with medial arch support on ankle inversion angle and plantar forces and pressures on the fifth metatarsal during landing for a basketball lay-up and during the stance phase of a shuttle run.Proximal fractures of the fifth metatarsal, specifically the Jones fracture, are common in sports. Wearing foot orthoses with medial arch support could increase the ankle inversion angle and the plantar forces and pressure on the fifth metatarsal that may increase the risk for fifth metatarsal fracture,Three-dimensional (3-D) videographic, force plate, and in-shoe plantar force and pressure data were collected during landing after a basketball lay-up and during the stance phase of a shuttle run with and without foot orthoses with medial arch support for 14 male subjects. Two-way ANOVAs with repeated measures were performed to compare ankle inversion angle, maximum forces, and pressure on the fifth metatarsal head and base between conditions and between tasks.The maximum ankle inversion angle and maximum plantar force and pressure on the base of the fifth metatarsal during both tasks as well as the maximum plantar force and pressure on the head of the fifth metatarsal during the stance of the shuttle run were significantly increased (Por =026) when wearing foot orthoses. No significant differences were found in the maximum vertical ground reaction forces between foot orthotic conditions.Generic use of off-the-shelf foot orthoses with medial arch support causes increased plantar forces and pressures on the fifth metatarsal and may increase the risk for proximal fracture of the fifth metatarsal. Future studies are needed to investigate this risk, acknowledging that the differences noted in our study were small in magnitude and the foot type was not measured.

Background: This case series describes surgical management of nasal aspergillosis refractory to conventional medical management or with evidence of cribriform plate osteolysis in three dogs. Methods: All dogs had surgical debridement of mucosa, nasal turbinates and necrotic debris via dorsal sinusotomy/rhinotomy. Sinuses were packed with iodine cadexomer-impregnated bandages for several weeks and affixed with tie-over bandages. Bandage changes were performed under sedation in 2/3 cases. Once mature granulation tissue covered all exposed bone, the tie-over bandages were removed and the sinusotomy/rhinotomy closed by apposing the skin edges. Conclusion: This technique was well tolerated, effective and afforded a cure in all three patients. It should be considered in cases of cribriform lysis or lack of clinical response to conventional medical management.

Context Researchers have postulated that reduced hip-abductor muscle strength may have a role in the progression of knee osteoarthritis by increasing the external knee-adduction moment. However, the relationship between hip-abductor strength and frontal-plane biomechanics remains unclear. Objective To experimentally reduce hip-abduction strength and observe the subsequent changes in frontal-plane biomechanics. Design Descriptive laboratory study. Setting Research laboratory. Patients or Other Participants Eight healthy, recreationally active men (age = 27 ± 6 years, height = 1.75 ± 0.11 m, mass = 76.1 ± 10.0 kg). Intervention(s) All participants underwent a superior gluteal nerve block injection to reduce the force output of the hip-abductor muscle group. Main Outcome Measure(s) Maximal isometric hip-abduction strength and gait biomechanical data were collected before and after the injections. Gait biomechanical variables collected during walking consisted of knee- and hip-adduction moments and impulses and the peak angles of contralateral pelvic drop, hip adduction, and ipsilateral trunk lean. Results Hip-abduction strength was reduced after the injection (P = .001) and remained lower than baseline values at the completion of the postinjection gait data collection (P = .02). No alterations in hip- or knee-adduction moments (hip: P = .11; knee: P = .52) or impulses (hip: P = .16; knee: P = .41) were found after the nerve block. Similarly, no changes in angular kinematics were observed for contralateral pelvic drop (P = .53), ipsilateral trunk lean (P = .78), or hip adduction (P = .48). Conclusions A short-term reduction in hip-abductor strength was not associated with alterations in the frontal-plane gait biomechanics of young, healthy men. Further research is needed to determine whether a similar relationship is true in older adults with knee osteoarthritis.

We present the successful completion of a video fluoroscopy swallow study and subsequent nutritional plan of a child bridged to lung transplantation with ambulatory venovenous (VV) extracorporeal membrane oxygenation (ECMO). With a limited number of programs bridging pediatric patients to lung transplantation with VV ECMO, a better understanding of nutritional support is needed to provide optimal care to this patient population awaiting organ donation.

Placement of a bicaval dual-lumen (BCDL) catheter demands sophisticated visualization in patients to assure proper positioning in order to administer single-site venovenous extracorporeal membrane oxygenation (VV ECMO). Large animal models are needed and thus appropriate procedures to assure anatomic and functional cannula placement would assist in experimental design and procedures. This report describes the use of agitated blood and saline transthoracic contrast echocardiography to confirm appropriate placement and function of the BCDL catheter in a swine model of VV ECMO. Five consecutive common crossbred piglets had confirmation using this technique with assurances of cannulation while not significantly altering experimental time and procedures. Researchers studying VV ECMO in large animal models may want to consider this method of confirmation of BCDL catheter placement.

Objective: Western Australia has one of the highest published rates of the use of compulsory treatment orders in the English-speaking world. Differences in patient characteristics, legislation and service setting may explain variations in the reported efficacy of compulsory community treatment. Our objective is to investigate predictors of Community Treatment Orders (CTO) placement in the first year of implementation in Western Australia and see if there were any differences in the type of patients placed on these orders compared to other studies.Method: A population–based record linkage study of Mental Health and Offender Databases comparing 265 patients on CTOs with a consecutive control group (CCG) of equal number matched on date of discharge from inpatient care or CTO placement.Results: Previous health service use, after-care placement, mental disorder history including schizophrenic history, a positive forensic history of violence to others as well as patient's marital status were the significant predictors of CTO placement.Conclusions: Studies of compulsory community treatment appear to be of similar populations. In spite of the comparatively high rate of use, psychiatrists in Western Australia do not appear to be applying community treatment orders to different types of patient compared to elsewhere. We need further research to establish the relative contribution of patient characteristics, legislation and service setting toward the use and outcome of compulsory community treatment.

Objective: To determine the clinical correlates of dysmorphic concern in persons seeking cosmetic enhancement from cosmetic physicians.Method: A questionnaire survey of 137 patients attending the practices of two cosmetic physicians.Results: Four subjects (2.9%; 95% CI = 0.8%–7.3%) had a diagnosis of body dysmorphic disorder (BDD), but many more expressed overconcern with physical appearance (‘dysmorphic concern’). Dysmorphic concern accounted for a substantial amount of the variance for mood, social anxiety, and impairment in work and social functioning, while concerns related to how self or others perceive the putative flaw in appearance, impacted significantly on work and leisure activities, but did not apparently influence mood and social anxiety to any significant degree.Conclusions: Dysmorphic concern is a broad dimensional construct that is related to both inter- and intrapsychic distress and disablement associated with people seeking cosmetic enhancement

Objective: We describe a system of outcome evaluation for early psychosis programmes and present preliminary data. The Early Psychosis Outcome Evaluation System (EPOES) was designed for use in a naturalistic, prospective study of a cohort of early-episode psychosis patients. We describe patients in terms of symptoms, substance use, social functioning and family burden, and examine the effectiveness of treatment programmes. Method: Four sites in Perth, Western Australia, participated. Outcome was evaluated from three sources: case manager (CM), patient (P) and family member (FM). Seven clinical outcome measures were used: the Brief Psychiatric Rating Scale (CM), Brief Symptom Inventory (P), Substance Use (CM); Social Functioning Scale (P); Global Assessment Scale (CM); Burden Assessment Scale (FM), and the General Health Questionnaire-12 (FM). Measures were collected at intake (baseline) into a specialist early psychosis service and thereafter every 6 months until discharge from the service. Results: After the first year of data capture, 84 baseline assessments have been completed, and 23 patients have been followed up at 6 months. Clinicians and patients reported significantly less psychopathology at 6 months. Sixty per cent of patients reported marijuana use within 3 months of baseline assessment, and 30% amphetamine, ecstasy or cocaine use. Increased levels of psychopathology were recorded for substance-using patients. Family members (59%) reported psychological distress at baseline; this was reduced at 6 months. Patient social functioning and family burden did not improve measurably. Conclusions: The EPOES is an effective system that provides feedback on the clinical status of early-episode psychosis patients. Both observed and self-rated psychopathology and family psychological distress, is improved after 6 months of intervention. Family burden and patient social functioning did not demonstrate improvement. Patient social functioning is an important area for treatment. Substance use is associated with poorer psychopathology. EPOES provides a feasible system of measuring outcome in early psychosis intervention.

At the request of the membership, and at the direction of the President, Dr. Barbara Uzzell, and the Board of Directors (BoD), the National Academy of Neuropsychology (NAN) Policy and Planning Committee has developed the following 2001 Definition of a Clinical Neuropsychologist, as part of NAN’s White Paper series on Professional Policy and Practice. The entire NAN membership has had an opportunity for input to this definition, and it has been clearly endorsed by our membership and the BoD. We believe that the 2001 NAN Definition incorporates the best aspects of the previous work on Definitions of a Clinical Neuropsychologist, if one keeps in mind that the intent is to provide information to managed care and third party payers regarding general neuropsychological practice and minimal educational, experiential, and licensure requirements. An inclusive, expanded, and updated definition referencing the 1989 and 1984 definition articles, published by Division 40 (Clinical Neuropsychology) of the American Psychological Association (APA) was considered necessary as an internal NAN reference document. This 2001 NAN Definition of a Clinical Neuropsychologist underwent three major Policy and Planning Committee revisions, one full membership review and one membership vote (81% endorsement out of 789 votes), and two NAN BoD comprehensive discussions, resulting in unanimous approval by a formal vote of the Board of Directors on May 5, 2001.

Objectives: To compare the 12-month clinical outcome of patients attending a depot clinic who were changed to oral atypical antipsychotic medication, with those who remained on depot preparations. Method: A systematic review of the case records of all patients aged between 18 and 65 attending the depot clinic at Fremantle Hospital, Western Australia. Results: The records of 72 patients were identified (mean age 43.3 years; duration of illness 8.5 years; 37% female); 71% had schizophrenia. Twenty-five patients were successfully switched to an oral atypical antipsychotic (34%), 34 controls remained on a depot (47%), five were managed on a combination of a depot and an atypical, and eight returned to depot medication after a trial of an oral atypical. At 12 month follow-up, patients on oral atypicals showed significant improvement on the CGI (z = − 2.57, p = 0.01), less akathisia (z = − 2.12, p = 0.03), and reduced use of antiparkinsonian medication (z = − 1.97, p = 0.04); these changes were not mirrored in ...

A pediatric patient requiring venovenous (VV) extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation developed heparin-induced thrombocytopenia. Unfractionated heparin was discontinued, and a bivalirudin infusion was started. During the lung transplant evaluation, he was found to have allosensitization, requiring treatment with plasma exchange along with pulse methylprednisolone, rituximab, bortezomib, and pooled immunoglobulin infusion. We describe our experience with successful plasma exchange for allosensitization during bivalirudin anticoagulation on VV ECMO in a pediatric patient.

Optical spectrophotometric methods are used to detect both plasma-free hemoglobin and antifactor Xa level, so hyperbilirubinemia can interfere with the measurement of both the monitoring laboratory tests for extracorporeal membrane oxygenation (ECMO) due to similar absorbance wavelengths. We present a seven-year-old child with acute respiratory failure on venovenous ECMO who developed an acute increase in plasma-free hemoglobin and undetectable antifactor Xa level due to acute hyperbilirubinemia from hepatic dysfunction related to antifungal therapy.

This multicenter, randomized, double-blind study compared the efficacy and safety of once-daily oral granisetron 2 mg (n = 134) and placebo (n = 126) as prophylaxis for nausea and emesis in patients receiving upper abdominal fractionated radiotherapy. Patients were scheduled to receive 10-30 fractions of radiotherapy; granisetron (two 1-mg tablets) or placebo was administered 1 hr before radiotherapy on each scheduled treatment day. Treatment comparisons were made at 24 hr and at 10 and 20 fractions. Patients treated with granisetron experienced greater emetic control than those treated with placebo as evidenced by median times to first emesis (35 vs. 9 days, p < 0.001) and first nausea (11 vs. 1 day, p < 0.001). Overall endpoint analysis showed that proportionally more granisetron than placebo patients were emesis free (57.5% vs. 42.1%, p = 0.0047) and nausea free (30.6% vs. 16.7%, p = 0.0042). Furthermore, 25% more granisetron-treated than placebo-treated patients were emesis free and 20% more were nausea free on at least 80% of study treatment days. The most commonly reported adverse experiences in granisetron-treated patients were diarrhea, asthenia, and constipation. These findings demonstrate that a once-daily, 2-mg dose of oral granisetron is well tolerated and significantly more effective than placebo in preventing nausea and emesis induced by fractionated radiotherapy to the upper abdomen.

This study examined the interactive effects of pregnancy and aerobic conditioning on maternal cardiac structure and function. Effects of closely monitored cycle ergometer conditioning were studied during the second (TM2) and third trimesters (TM3) in 22 previously sedentary pregnant women (exercised group, EG) and a nonexercising pregnant control group with similar characteristics (CG, n = 19). Subjects were studied in the resting state by two-dimensional echocardiography and during cycle ergometer exercise at three steady-state power outputs at the start of TM2 (ENTRY), at the end of TM2 and TM3 (postconditioning), and 3-4 months postpartum (NPR, nonpregnant reference, CG only). Aerobic conditioning did not increase left ventricular dimensions beyond those attributable to pregnancy itself. In addition, in contrast with previous studies of nonpregnant women, physical conditioning during pregnancy did not reduce heart rate (HR) in the resting state. During exercise, the slope of the HR versus oxygen uptake (Vo2) regression decreased significantly between preconditioning and the end of TM3 in the EG, suggesting that training-induced reductions in HR become more evident with increasing exercise intensity. Also, significant reductions in oxygen pulse (Vo2/HR) were observed at all three work rates in the CG, but not in the EG. These findings support the hypothesis that the cardiovascular effects of aerobic conditioning are obscured by more powerful effects of pregnancy in the resting state but become "unmasked" during strenuous exercise.Key words: human gestation, cycle ergometer exercise, echocardiography, heart rate, stroke volume.

Glenohumeral instability is a common occurrence following anterior dislocation of the shoulder joint, particularly in young men. The bony abnormalities encountered in patients with glenohumeral instability can be difficult to detect with conventional radiography, even with special views. The aim of our study was to evaluate the bony abnormalities associated with glenohumeral instability using CT imaging with 3-D reconstruction images. We scanned 11 patients with glenohumeral instability, one with bilateral symptoms; 10 were male, one female, and their ages ranged from 18-66 years. Contiguous 3 mm axial slices of the glenohumeral joint were taken at 2 mm intervals using a Siemens Somatom CT scanner. In the 12 shoulders imaged, we identified four main abnormalities. A humeral-head defect or Hill-Sachs deformity was seen in 83% cases, fractures of the anterior glenoid rim in 50%, periosteal new bone formation secondary to capsular stripping in 42%, and loose bone fragments in 25%. Manipulation of the 3-D images enabled the abnormalities to be well seen in all cases, giving a graphic visualization of the joint, and only two 3-D images were needed to demonstrate all the necessary information. We feel that CT is the imaging modality most likely to show all the bone abnormalities associated with glenohumeral instability. These bony changes may lead to the correct inference of soft tissue abnormalities making more invasive examinations such as arthrography unnecessary.

The purposes of this review were twofold: to apply modern physicochemical principles to explain changes in acid-base regulation and the control of ventilation in human pregnancy; and to demonstrate the value of pregnancy as a model for the study of endocrine effects on physiological control systems. Application of P.A. Stewart's approach (P.A. Stewart. Can. J. Physiol. Pharmacol. 61: 1444-1461, 1983) shows that lower values of plasma hydrogen ion concentration ([H+]) observed at rest and in association with exercise in pregnancy are the result of lower values for carbon dioxide tension (PCO2) and total weak acid ([Atot]). This effect is partly offset by a lower strong ion difference ([SID]). The ability to predict plasma [H+] at rest and following strenuous exercise in pregnancy (J.G. Kemp, F.A. Greer, and L.A. Wolfe. J. Appl. Physiol. 83: 644-651, 1997) supports the validity of Stewart's approach. Jennings and associates (D.B. Jennings. Can. J. Physiol. Pharmacol. 72: 1499-1512, 1994) have further demonstrated in animal models the involvement of plasma osmolality and circulating levels of angiotensin II (ANG II) and arginine vasopressin (AVP) in the chemical control of ventilation. We hypothesize that pregnancy-induced increases in respiratory sensitivity to carbon dioxide are the combined result of reduced plasma osmolality, reduced cerebrospinal fluid [SID], and augmented circulating levels of progesterone, ANG II, and AVP.Key words: human gestation, hydrogen ion concentration, strong ion difference, osmolality, angiotensin II, arginine vasopressin, progesterone.