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The association of severe dry eye disease with elevated osmolarity in the tear film is a subject of ongoing discussions. As the absolute value of osmolarity in tear film is highly variable, the daily variation in osmolarity (DVO) has recently been proposed to further identify the osmotic stress at the ocular surface. However, the DVO alone does not explain the variations in the available published data or allow their use in diagnostic testing or therapy. We therefore investigated and evaluated further details of osmokinetics and their importance for ocular surface disease on the basis of the available literature. Additionally, osmolarity was measured in the tear samples of volunteers in the morning hours between 8 - 10 a. m., midday noon-2 p. m., and afternoon between 3 - 5 p. m., i.e., during normal office hours. The results were compared with available published data which suggested that within the DVO, the daily maximal amplitude of osmotic variation (M-DVO) and the frequency of osmotic cycles (defined as daily osmolarity cycles, DOC) could be the main factors that further characterize osmokinetics. In addition, a decisive role could be the level of osmolarity at which the variation does occurs (L-DVO). The possible effects of these characteristics on ocular surface pathophysiology are discussed, along with their relationship to topical therapy with hypo-osmolar solutions, and the model of the osmotic roller coaster is introduced.Die Assoziation einer erhöhten Tränenosmolarität mit dem Vorliegen von schweren Erkrankungen des trockenen Auges ist ein aktuelles Thema derzeitiger Diskussionen. Wegen der großen Variabilität der gemessenen absoluten Osmolaritätswerte wurde die Tagesschwankung der Osmolarität (TSO = Daily Variation of Osmolarity, DVO) als Parameter zur Beurteilung des osmotischen Stresses auf der Augenoberfläche vorgeschlagen. Doch auch mit dem TSO lassen sich nicht alle vorliegenden Ergebnisse erklären oder therapeutisch nutzen. Daher wurde die vorliegende Literatur auf weitere Erkenntnisse zu den Eigenschaften der Osmokinetik und ihre mögliche Bedeutung für die Augenoberfläche untersucht. Außerdem wurde das Tagesprofil der Tränenosmolarität an Probandenaugen erstellt (Messungen zwischen 8 und 10 Uhr, 12 und 14 Uhr sowie 15 und 17 Uhr, also während eines normalen Arbeitstags). Beim Vergleich der Resultate mit den Erkenntnissen der Literatur erscheint es möglich, dass die Bedeutung der TSO (DVO) von der maximalen Amplitude der DVO (M-DVO) und der Anzahl von osmotischen Zyklen per Zeiteinheit, nämlich Tageszyklen (DOC), abhängig sein kann. Darüber hinaus ist das Osmolaritätsniveau (Level of DVO = L-DVO), auf dem diese Veränderungen stattfinden, von potenziell entscheidender Bedeutung. Die möglichen Auswirkungen dieser Charakteristika auf die Pathophysiologie der Augenoberfläche werden diskutiert, auch unter dem Aspekt der Topikaltherapie mit hypoosmolaren Augenpräparaten, wobei das Modell der osmolaren Achterbahn vorgestellt wird.

Background: The motherhood myth has been associated with perceptions of idealised motherhood which makes it difficult for women to express related struggles or distress. This is a second follow-up ...

Background Regional differences in ventricular activation sequence and action potential duration and morphology result in dispersion in ventricular repolarization (VR). VR dispersion is a key factor in arrhythmogenesis. We studied the adaptation of global VR dispersion in humans during normal and abnormal ventricular activation, and the relation to the QT adaptation (hysteresis). Methods We measured global VR dispersion as T amplitude, T area, and ventricular gradient (VG), using continuous Frank vectorcardiography, in response to abrupt and sustained atrial (AP) or ventricular pacing (VP) aiming at 120 bpm, in 21 subjects with permanent pacemakers. Results Following pacing start, VR adaptation showed an initially rapid and complex tri-phasic pattern, most pronounced for T amplitude. There were major differences in the patterns of VR dispersion adaptation following abrupt AP vs VP, confirming that the adaptation pattern is activation dependent. In response to AP, an instantaneous decrease in VR dispersion occurred, followed by an increase and then a slow decrease, all at a lower level than baseline. In contrast, following VP there was an immediate increase to ~4× baseline in T amplitude and T area (but not in VG), with a subsequent biphasic adaptation lasting longer during VP than AP. The initial rapid changes occurred within the time for QT adaptation to reach steady-state. Conclusions Our results corroborate and expand data from animal and invasive human studies, showing similarities of the adaptation pattern on different scales. The initial rapidly changing VR adaptation phase presumably reflects a window of increased vulnerability to arrhythmias.

Despite my humble beginnings in rural China, I had the good fortune of advancing my career and joining an international community of photosynthesis researchers to work on the ‘light reactions’ that are a fundamental process in Nature. Along with supervisors, mentors, colleagues, students and lab assistants, I worked on ionic redistributions across the photosynthetic membrane in response to illumination, photophosphorylation, forces that regulate the stacking of photosynthetic membranes, the composition of components of the photosynthetic apparatus during acclimation to the light environment, and the failure of the photosynthetic machinery to acclimate to too much light or even to cope with moderate light due to inevitable photodamage. These fascinating underlying mechanisms were investigated in vitro and in vivo. My career path, with its ups and downs, was never secure, but the reward of knowing a little more of the secret of Nature offset the job uncertainty.

Perimenopause often represents a physiologically challenging phase in women's lives. The clinical presentation of the perimenopause includes infertility, irregular menstrual cycles, menorrhagia, and new onset of or worsening of mood disorders. Unlike menopause, which is characterized by low levels of estradiol and progesterone, the hallmark of perimenopause is highly variable levels of estradiol and progesterone with abrupt increases and decreases that are often described as a hormonal roller coaster. This chapter invites general gynecologists to understand the hormonal basis of the common complaints of perimenopause and offers information about the physiology of these issues and helpful treatment options.

To many of us in the field, working on matrix metalloproteinases (MMPs) has felt like riding a roller coaster, traveling through times of both excitement and despair. I was fortunate to join the ride when it was a mere carousel of three activities thought to target the proteins that comprise the extracellular matrix (ECM). New technologies brought the thrills of discovery as we uncovered specific proteinase genes and defined specialized activities in different cellular processes. The MMPs and the sister families of “a disintegrin and metalloproteinase” (ADAMs), ADAMs with thrombospondin domains (ADAM-TS), and Astacins are now recognized as key signaling “scissors” that drive rapid changes in a plethora of cellular pathways. My many excellent colleagues and collaborators and I were enthused to contribute to the early development of the field and continue to be amazed at its growth and sophistication. In contrast, the hype and failure of early inhibitor discovery have dogged our standing with the pharmaceutical industry and grant-giving bodies. However, the true believers have kept going, and knowledge of particular functions of MMPs and their contributions to disease progression has progressed. Recognition of the strategic importance of proteinase function should inspire more work harnessing new technologies such as imaging, proteomics, and gene editing to generate a more precise understanding of individual situations. New approaches to inhibitor design and assessment are possible, and the consequent ability to precisely abrogate specific MMP activity could contribute to the fight against a number of pathologies with unmet needs. What a ride it could be!

Feeling as though each day is a roller coaster with barely enough time to catch your breath? Kirsty Sturman, training adviser at VDS Training, says there are simple ways you can feel more in control.

Phenomenon: Pimping has become a well-known and distinct form of questioning in medical education, and as a pedagogical method it has both proponents and detractors. Pimping occurs when a teacher (pimper) asks difficult questions of the learner (pimpee), usually in rapid succession. There is a paucity of literature formally studying this technique and its effects on teachers and learners. Our study examines the use of and attitudes toward pimping in a pathology residency program to better understand its perceived value and effectiveness. Approach: Using a qualitative approach, we conducted semistructured interviews with 8 pathology trainees and 9 pathologists. As part of the interview process, we asked participants to draw a rich picture of a pimping encounter. Consistent with this qualitative method, we analyzed data iteratively using constant comparison. Findings: Negative emotions including anxiety and self-doubt dominated among the learners during pimping encounters. For some, these resulted in motivation to study, and for others this was a futile, nonmotivating experience. Most trainees felt that they were being judged during pimping; however, they perceived that the intentions of pimping were not malicious and in their best interests. This was supported by pathologists, who stated that their motivation for pimping was to identify knowledge gaps, thus benefiting the trainee. Insights: Pimping created a dichotomy of emotions within the majority of learners in this study. Negative emotions occurred during pimping encounters; however, following the encounter, pimping was perceived in a more positive light. Recognizing when and how pimping can create negative emotions that may interfere with learning may enable educators to create more consistently meaningful interactions.

Of the multitude of neurologic injuries related to roller-coaster rides, a majority of them are reported about adults. In this case, we present a patient who presented to the pediatric emergency department with new-onset seizure and hemiplegia 2 days after a roller-coaster ride. She was ultimately diagnosed with a subdural hematoma. The acceleration and G forces of roller coasters are hypothesized to cause enough stress and shearing forces that are thought to directly cause subdural hemorrhage.Advances in roller-coaster technology may surpass the passenger's physical capacity for acceleration and rotary forces, and we may see an increased number of medical complications after these rides. We recommend that emergency and pediatric health care providers consider amusement park thrill rides as a possible cause of subdural hematomas in previously healthy patients with new neurologic complaints.

Context: The identification and evaluation of activities capable of dislodging calyceal renal calculi require a patient surrogate or validated functional pyelocalyceal renal model. Objective: To evaluate roller coaster facilitation of calyceal renal calculi passage using a functional pyelocalyceal renal model. Methods: A previously described adult ureteroscopy and renoscopy simulator (Ideal Anatomic) was modified and remolded to function as a patient surrogate. Three renal calculi of different sizes from the patient who provided the original computed tomographic urograph on which the simulator was based were used. The renal calculi were suspended in urine in the model and taken for 20 rides on the Big Thunder Mountain Railroad roller coaster at Walt Disney World in Orlando, Florida. The roller coaster rides were analyzed using variables of renal calculi volume, calyceal location, model position on the roller coaster, and renal calculi passage. Results: Sixty renal calculi rides were analyzed. Independent of renal calculi volume and calyceal location, front seating on the roller coaster resulted in a passage rate of 4 of 24. Independent of renal calculi volume and calyceal location, rear seating on the roller coaster resulted in a passage rate of 23 of 36. Independent of renal calculi volume in rear seating, calyceal location differed in passage rates, with an upper calyceal calculi passage rate of 100%; a middle calyceal passage rate of 55.6%; and a lower calyceal passage rate of 40.0%. Conclusion: The functional pyelocalyceal renal model serves as a functional patient surrogate to evaluate activities that facilitate calyceal renal calculi passage. The rear seating position on the roller coaster led to the most renal calculi passages.

Studies of the classic exteroceptive sensory systems (e.g., vision, touch) consistently demonstrate that vividly imagining a sensory experience of the world—simulating it—is associated with increased activity in the corresponding primary sensory cortex. We hypothesized, analogously, that simulating internal bodily sensations would be associated with increased neural activity in primary interoceptive cortex. An immersive, language-based mental imagery paradigm was used to test this hypothesis (e.g., imagine your heart pounding during a roller coaster ride, your face drenched in sweat during a workout). During two neuroimaging experiments, participants listened to vividly described situations and imagined “being there” in each scenario. In Study 1, we observed significantly heightened activity in primary interoceptive cortex (of dorsal posterior insula) during imagined experiences involving vivid internal sensations. This effect was specific to interoceptive simulation: It was not observed during a separate affect focus condition in Study 1 nor during an independent Study 2 that did not involve detailed simulation of internal sensations (instead involving simulation of other sensory experiences). These findings underscore the large-scale predictive architecture of the brain and reveal that words can be powerful drivers of bodily experiences.

We report the first case report of symptomatic bilateral subdural hematomas (SDH) associated with riding a centrifugal motion simulator ride. A previously healthy 55-year-old male developed new onset daily headaches 1 week after going on the ride that were due to symptomatic bilateral SDH requiring operative intervention with a full recovery. There was no history of other trauma or other systemic or intracranial abnormality to account for the development of the SDH. We review the headaches and other clinical features associated with chronic SDH. Twelve cases of roller coaster headaches due to SDH associated with riding roller coasters have been reported. The pathophysiology is reviewed, which we believe is the same mechanism that may be responsible in this case. Although it is possible that this neurovascular injury is truly rare, it is also possible that this injury is underreported as patients and physicians may not make the association or physicians have not reported additional cases. The risk of this injury likely increases with age, as the size of the subdural space increases, and may support the maxim that "roller coasters and simulators are for kids."

Bowe et al. report an association between low high-density lipoprotein cholesterol concentrations and various incident chronic kidney disease end points in a cohort of almost 2 million US veterans followed for 9 years. These impressive data should be a starting point for further investigations including genetic epidemiologic investigations as well as post hoc analyses of interventional trials that target high-density lipoprotein cholesterol and, finally, studies that focus on the functionality of high-density lipoprotein particles.

With 300,000,000 riders annually, roller coasters are a popular recreational activity. Although the number of roller coaster injuries is relatively low, the precise effect of roller coaster rides on our brains remains unknown. Here we present the quantitative characterization of brain displacements and deformations during roller coaster rides. For two healthy adult male subjects, we recorded head accelerations during three representative rides, and, for comparison, during running and soccer headers. From the recordings, we simulated brain displacements and deformations using rigid body dynamics and finite element analyses. Our findings show that despite having lower linear accelerations than sports head impacts, roller coasters may lead to brain displacements and strains comparable to mild soccer headers. The peak change in angular velocity on the rides was 9.9 rad/sec, which was higher than the 5.6 rad/sec in soccer headers with ball velocities reaching 7 m/sec. Maximum brain surface displacements of 4.0 mm and maximum principal strains of 7.6% were higher than in running and similar to soccer headers, but below the reported average concussion strain. Brain strain rates during roller coaster rides were similar to those in running, and lower than those in soccer headers. Strikingly, on the same ride and at a similar position, the two subjects experienced significantly different head kinematics and brain deformation. These results indicate that head motion and brain deformation during roller coaster rides are highly sensitive to individual subjects. Although our study suggests that roller coaster rides do not present an immediate risk of acute brain injury, their long-term effects require further longitudinal study.

The behavior of biochemical molecules moving around in cells makes me think of a school of whales wandering in the ocean, captured by the Argus system on the artificial satellite. When bringing a whale back into the sea --- with a transmitter on its dorsal fin, every staff member hopes that it will return safely to a school of its species. A transmitter is now minute in size, but it was not this way before. There used to be some concern that a whale fitted with a transmitter could be given the cold shoulder and thus ostracized by other whales for "wearing something annoying." How is whale's wandering related to the tide or a shoal of small fish? What kind of interaction is there among different species of whales? We human beings have attempted to fully understand this fellow creature in the sea both during and since the age of whale fishing.In a live cell imaging experiment, a luminescent probe replaces a transmitter. We put a luminescent probe on a specific region of a biological molecule and bring it back into a cell. We can then visualize how the molecule behaves in response to external stimulation. Since luminescence is a physical phenomenon, we can extract various kinds of information by making full use of its characteristics.Cruising inside cells in a supermicro corps, gliding down in a microtubule like a roller coaster, pushing our ways through a jungle of chromatin while hoisting a flag of nuclear localization signal --- we are reminded to retain a playful and adventurous perspective at all times. What matters is mobilizing all capabilities of science and giving full play to our imagination. We believe that such serendipitous findings can arise out of such a sportive mind, a frame of mind that prevails when enjoying whale-watching.

To explore coping with the perceived psychosocial consequences of a false-positive screening mammography.Mammographic screening has been found effective to decrease breast cancer (BC) mortality, yet there are adverse effects. Psychosocial consequences of false-positive mammographic screening have mainly been investigated from a population-based perspective. A call for qualitative studies to further explore these consequences has thus been postulated. To date, qualitative studies have elucidated women's experiences following their recall breast examinations, but their coping with perceived psychosocial consequences of a false-positive screening mammography has not yet been explored.An explorative qualitative study.Face-to-face interviews were held with a purposive heterogeneous sample of 13 Swedish-speaking women with a false-positive screening mammography. The transcripts were analysed by the use of an inductive content analysis.Coping with the perceived psychosocial consequences of a false-positive screening mammography implied a roller coaster of emotion and sense. Women described how they imagined the worst and were in a state of uncertainty feeling threatened by a fatal disease. Conversely, they felt protected, surrounded by their families and being professionally taken care of, which together with perceived sisterhood and self-empowerment evoked strength and hope. Being aware of family responsibility became a crucial matter. Experiencing false-positive screening raised thoughts of thankfulness and reappraisal of life, although an ounce of BC anxiety remained. Consequently, gained awareness about BC screening and values in life surfaced.Experiencing a false-positive screening mammography triggers agonising experiences evoking a variety of coping strategies. Provision of screening raises the issue of responsibility for an impact on psychosocial well-being among healthy women.Gained knowledge might provide a basis for interventions to prevent psychosocial consequences of false-positive mammographic screening and provide support for women with a potentially compromised ability to overcome such consequences.

The cancer vaccine field is littered with promising products that failed to show clinical efficacy. Could it finally be on the verge of a first US approval?

Evidence-based practice drives nursing procedures and standards of care. Supporting practice with valid research can be a challenge. After identifying a knowledge- and problem-focused trigger, a group of WOC nurses began a research journey. Our purpose was to determine the effectiveness of the rectal trumpet compared to the fecal collector in maintaining skin integrity in patients with fecal incontinence. The methodology included a convenience sample of 100 patients randomized to rectal trumpet or fecal collector versus standard care. Data were collected on signs of increased skin breakdown or healing, stool leakage around device, dislodgement, and discomfort from device. This article will reveal our journey in conducting this clinical research. After many challenges, the study was terminated, but the experiences and lessons learned during our efforts were invaluable. Even well-planned studies can encounter problems that prevent completion. It is important to evaluate these problems so that lessons can be learned and shared. This is our roller coaster ride in the research world.

Mrs. Smith is an 81-year-old woman who has several medical problems. Despite these problems, however, her faith and spirituality strength give her the strength and determination to move forward in life. She stresses that, “My faith helps me cope with my illnesses.” This article describes Mrs. Smith’s roller coaster life and how faith, prayer, and hope have allowed her to continue to press forward. She interprets pain and illnesses as challenges, not obstacles. Her physician who has been treating her for about 20 years indicates that she has continued to have multiple chronic health issues and has maintained an incredibly positive spirit, particularly when traditional medicine has failed to make a difference. Spiritual care is being increasingly documented as an important component of whole person medicine. For some, religiosity and spirituality are important aspects of patient–provider relationship. God, faith, and hope are essential factors to Mrs. Smith who uses spirituality and religion daily to cope with her chronic illnesses.

Objective: To determine the number of fatalities related to roller coasters and examine factors common to multiple incidents. Methods: A case was defined as the death of a person, which was associated with a roller coaster in the United States between 15 May 1994 and 14 May 2004. Cases were identified from four data sources: (1) Consumer Product Safety Commission, (2) Lexis-Nexis, (3) Medline, and (4) Saferparks. Results: Forty people, ranging in age from 7 to 77 years, were killed in 39 separate incidents. Twenty nine (73%) deaths occurred among roller coaster patrons. Eleven fatalities resulted from external causes related to injuries from falls or collisions. Eighteen people died from medical conditions that might have been caused or exacerbated by riding a roller coaster; 15 were the result of intracranial hemorrhages or cardiac problems. Eleven (28%) deaths involved employees; all were caused by injuries. Conclusions: Approximately four deaths annually in the United States are associated with roller coasters. Prevention of roller coaster fatalities is dependent on establishing an effective surveillance system for amusement ride injuries, engineering rides to better protect both patrons and employees, improving training and supervision of employees regarding safety precautions, and posting cautionary notices near roller coasters for people with specified medical conditions. Further research is needed on roller coaster related deaths resulting from intracranial hemorrhages and cardiac problems.

PurposeTo examine the literature on employee morale and to construct a model of this area pertaining to nurses. This framework seeks to present morale in a holistic manner, illustrating the causal factors that influence nursing morale, the changes that occur in morale when these input variables are altered, and the consequences to patient care and individual and group nursing practices.Design/methodology/approachA number of published works on morale, its causal factors and resulting consequences are critiqued. The findings from this literature review are used to develop a framework for nursing morale.FindingsThe paper presents a definition of morale and, from the literature review, concludes that previous models on morale are fragmented; only tending to explore the variables that influence the employees' emotional state. Consequently, a framework of nursing morale is constructed in order to illustrate this topic from a holistic point‐of‐view.Practical implicationsThe paper concludes with a number of management and research implications. The management implications consist of a number of useful suggestions for senior nurses to enhance the morale within their units.Originality/valueThis paper fulfils an identified gap in the literature, namely the lack of a holistic model of nursing morale, and offers practical help to senior nurses so that they can initiate processes within their wards that can improve their subordinates' morale.

Numerous techniques have been reported for the reduction of zygomatic arch fractures. In this article, we aimed to describe a technique we named as "roller coaster maneuver via lateral orbital approach" to closed reduction of the isolated-type zygomatic arch fractures. Surgical outcomes of 14 patients treated with this method were outlined.

The authors investigated the experiences of parents with children/adult children in metropolitan Sydney, Australia who were living with, or had recovered from, an eating disorder. During regular team meetings, the research assistant who conducted the interviews had described her reactions which led the research team to investigate her experience in more depth. The aim of the present paper was to explore the impact on the research assistant who conducted 22 in-depth interviews with the parents. One of the members of the research team interviewed the research assistant to elicit her reactions. The interview was content analyzed and the following themes were identified: (i). appreciation of an egalitarian model of research; (ii). the emotions expressed by the research assistant; (iii). making sense of the inexplicable and (iv). reflections and comparison to her own life role. The research team would like to advance the theory that the adoption of a formal debriefing mechanism be integrated into the qualitative research process.

Historically, cancer drug development has been a roller coaster. Numerous agents have shown exciting activity in preclinical models and yet have had minimal activity clinically. These disappointments have led to reasonable scepticism about the true value of both syngeneic and xenograft rodent tumour models in accurately identifying agents that will have important clinical utility. Whereas the development of newer techniques, including transgenic mouse models of cancer, offers the potential to develop more predictive models, the role of such mice in cancer drug development is not yet validated. To advance in our understanding of predictive model systems it may be wise to analyse both the successes and the failures of conventional models in order to understand some of their limitations and perhaps to avoid making the same mistakes in the future. Here we review the value and limitations of xenograft models, and the role of integrating preclinical pharmacology in developing new treatments for solid tumours of childhood.

Background Roller coasters are probably one of the more popular rides at amusement parks around the world. Despite their relative safety, nontraumatic intracranial injuries have been reported following roller coaster rides. The presence of an intracranial arachnoid cyst may increase the risk of nontraumatic injury in this setting. Case description We describe a 33-year-old female with a left middle fossa arachnoid cyst who presented with increasing headaches from bilateral subdural hygromas after a roller coaster ride. The patient underwent bilateral burr hole drainage of her subdural hygromas with resolution of her symptoms. Conclusion This case demonstrates the potential risks of intracranial injury in patients with an underlying arachnoid cyst who engage in certain types of recreational activity.

This small qualitative study investigated the lived experience of individuals with HIV/AIDS, exploring the uncertainty related to episodes of life-threatening illness followed by recovery, ‘revival’. The themes that emerged related to the unpredictability of when death would occur. The participants described the dilemma of living with a chronic illness with a totally unpredictable disease trajectory. Following periods of being extremely unwell, individuals would then recover and experience periods of relative wellbeing, only to succumb to another infection later. The findings highlighted the uncertainty that pervades all aspects of HIV-positive individuals’ lives as they face death. An awareness of this may be important in those offering palliative care to those with HIV/AIDS.

In-depth interviews with individuals who had experienced marital infidelity revealed a three-stage process following disclosure of an affair. The process starts with an "emotional roller coaster" and moves through a "moratorium" before efforts at trust building are recognized. Implications for the literature on forgiveness and the process of change in couples therapy are discussed as well as implications for future research and for practice.

There has been enormous attention in the general press on the possibility that high G force roller coasters are inducing brain injury in riders. Armed with a handful of anecdotal case reports of brain injuries, the U.S. Congress has recently proposed legislation to regulate the level of G forces of roller coasters. However, high G forces are well tolerated during many activities and, therefore, are a poor measure for the risk of brain injury. Rather, accelerations of the head that can be caused by G forces are the key to producing injury. To determine the extent of head accelerations during roller coaster rides, we acquired G force data from three popular high G roller coasters. We used the highest recorded G forces in a simple mathematical model of head rotational acceleration, with the head rigidly pivoting from the base of the skull at a radius representing typical men and women. With this model, we calculated peak head rotational accelerations in three directions. Even for a conservative worst-case scenario, we found that the highest estimated peak head accelerations induced by roller coasters were far below conventional levels that are predicted for head injuries. Accordingly, our findings do not support the contention that current roller coaster rides produce high enough forces to mechanically deform and injure the brain.

Vascular and trauma surgeons have seen a marked increase in the incidence of traumatic injury of the ECCA. Making the diagnosis is straightforward, but requires a high index of suspicion. This patient's injury is from hyperextension/flexion trauma that occurred from repetitive rides on roller coasters.

Medicine and health care in Venezuela have had a roller coaster evolution in parallel with advances and retreats of democracy and of efforts to modernize. The most prominent of the founding fathers of Venezuelan medicine has a sitting statue in the homonymous hospital. After a blossoming of medicine, health care, and research led by dermatology that lasted for nearly four decades, the system went into a tailspin that mirrors what took place in the governmental institutions and in the economy. The statue of Vargas seems to warn Venezuelans that if the decay goes too far, it may become irreversible.

This is a case presentation of a 39-year-old male who presents with silent sinus syndrome. He was initially diagnosed by a neuroophthalmologist, and at first, the patient's otolaryngologist disagreed. The patient had a significant reduction in his symptoms with surgical and orthoptic intervention.

My first clue about the events to occur should have been when I was suddenly reassigned to ride in the vehicle with the Chaplain, separated from the rest of my medical team. It did not occur to me to be afraid. There were so many other distractions—the darkness, cloudy night sky, 28% illumination, the incredible weight of the body-armor pinching into my left trapezius. “Ready, Sir,” my 18-year-old corpsman smiled as we lumbered toward the convoy. We were assigned to “Vic 24” (Marinespeak for vehicle number 24). The back, already filled with gear, still needed to accommodate four generously sized men in full battle gear. Motrin and Mobic were just beginning to take the edge off my sciatica when the left knee pain started. “Oh God help me” I whispered as I heaved into the back of Vic 24. My knee, shoulder, and nerve rebuffed my prayer and immediately began to protest with throbs, stabs, and numbness. I collapsed into a seat. “Nine hours in here, huh?” I breathed again. My corpsman practically somersaulted into the vehicle. Even in the dark, I could tell he was smiling. I used to be young and pain-free too. The Chaplain boarded followed by the Marine Staff Sergeant . . . . . It had all the makings of a crude joke—a Nurse, a Priest, and a Marine walk into a bar . . . . We positioned our vehicle in the convoy. “They put the chaplain in the last vehicle because it is the one most likely to get hit. It’s usually the most expendable vehicle, Sir,” offered my corpsman. It’s going to be a long night. I closed my eyes to distract myself from the angry knee, the throbbing nerve, and the smiling corpsman holding an uncapped spitter. That is, until the momentum of our vehicle felt uncertain. There were veers to the left and right, tentative decelerations. I shot a look to the Staff Sargeant. He already knew. “Hey, can you still see the convoy?” He shouted to the driver. There was a grunt of affirmation that no one believed. We all already knew the awful answer. A sharp turn hurled me into my corpsman. He smiled as if on a roller coaster. Thirty awkward minutes later, we skulked to the rear of the waiting convoy. My corpsman beamed. Ignorance is bliss. I succumbed to a postadrenaline rush nap that was interrupted when I heard: “alright Chaps, you gotta switch vics.” Rustling of bags. Click. Door closed. Voice trailing off in the distance. “Where are we going Staff Sergeant?” A vain attempt to sound casual. “Got a recovery mission, Sir? There’s a Vic that needs to get hitched.” We were moving in slow motion but no longer part of the convoy. My corpsman was sound asleep. I saw armored vehicles, cammo-painted faces. The sun was just beginning to bake the back of Vic 24. Blinking produced sweat—blink; drip. Blink; drip. “The A/C is out on this Vic, Sir, see,” the Staff Sergeant read my mind. Drip, drip. He felt compelled to prove it by turning the fan switch on. A large sand-filled powder cloud was released into his face. It lingered. We coughed. I dripped. The fan blew. The powder hovered. My corps man choked back a giggle. Then he choked. I rolled my eyes then I choked. Then dripped. “Sorry, Sir.” I gave no reply. Vic 24 continued on until a clearing opened. In the middle of the field was a mud village with an industrial, concrete building in the center. It had ventilation ducts and royal bluecolored doors. It was not simply that it was too early (or too hot) for anyone to be out. It looked deserted. A traditional housing village surrounding an enormous concrete structure with ventilation ducts and royal blue doors that appears to be uninhabited at mid-morning. It was surrounded by sundry ominous exhibits of U.S. power projection. My corpsman’s eyes widened like a child meeting Mickey Mouse. He was salivating. I swallowed hard. My eyes were drawn to a flash from a distant mountain top. Life moved in super-slow motion again. I heard myself breathing. The flash was followed by a boom, followed by a thud then a puff of smoke and rock. Another flash answered by another boom-thud-puff. Someone just had a very bad morning, I thought stating the obvious. “Staff Sergeant, what are WE . . . doing . . . HERE?” “Refueling, Sir.” “Can I get out, Sir” yipped my young corpsman. “Absolutley not! You’re not leaving this Vic without me and I am not leaving unless there is a patient out there. Let me see your med bag.” Another flash. Another boom-thud-puff. Drip. Drip. Blink. Drip. Medical Services, Naval Hospital Bremerton, One Boone Road, Bremerton, WA 98312-1898. doi: 10.7205/MILMED-D-15-00365

The authors conjecture that to understand normal stress regulation, including cortisol stress reactivity, it is important to understand why these biomarkers are released and what they function to accomplish within the individual. This perspective holds that high (or rising) cortisol has advantages and disadvantages that must be understood within a context to understand how individual differences unfold. This perspective is juxtaposed with a popular vantage point of this stress hormone or of stress exposure that emphasizes the deleterious consequences or problems of this hormone. While the costs and benefits of cortisol are emphasized for normal stress regulation, this dynamic context-dependent purpose of stress hormones should extend to the development of psychopathology as well. This functional and dynamic view of cortisol is helpful for interpreting why Tackett and colleagues (2014) appear to observe advantageous cortisol recovery from stress in individuals with elevated personality disorder symptoms.

The onset of alopecia areata creates a roller coaster of emotions. Like the disease, a patient’s emotions are unpredictable. The lack of control over one’s body is both frightening and intimidating. Alopecia areata not only impacts an individual but it also has a halo effect, impacting family and friends, thereby increasing the number of people affected by the disease.

The Publisher's final version can be found by following the DOI link. Objective: to develop an understanding of primiparous women's experiences and challenges of breast feeding in the early postpartum period at two BFI accredited hospitals in the East Midlands in the UK that has lower rates of sustained breast feeding. Design and setting: a hermeneutic or interpretive phenomenology study was conducted across two hospitals in the East Midlands, UK. Data collection: 22 primigravid women completed a daily written diary maintained for six weeks post birth. In addition, interviews were conducted with 13 women, nine who had completed a diary and four who did not return a diary but wanted to be interviewed, providing 26 different women's perspectives on their breast feeding experiences either from a diary or interview. Findings: three main themes emerged from the interviews and written diaries: (1) mothers experience a ‘roller coaster’ of emotions in relation to trying to establish breast feeding, (2) mothers perceive health care professionals as the ‘experts’ on breast feeding and (3) mothers had difficulties in breast feeding their infants in public, including in front of family and family and when away from their homes. Conclusions: women were ill prepared for the realities of breast feeding despite their antenatal intention to breast feed. Mothers had a preconceived idea that breast feeding would be ‘natural’ and without difficulty. When problems occurred, they perceived this to be a breast feeding problem and so choose artificial milk. Mothers require ongoing support to breast feed, especially in the early postpartum period, but more realistic messages about breast feeding need to be included. Implications for practice: there is a clear need for antenatal education to focus on preparing women for the realities of breast feeding, including newborn behaviour, which may affect women's perceptions of breast feeding. Local health care professionals need to draw upon national breast feeding strategies but develop a localised approach in order to address the regional variance.

This is the author's accepted manuscript. The final published article is available from the link below. © 2013 Occupational Therapy Australia. Background/aim - Occupational therapy educators are challenged to provide students with practical experiences which prepare them for ever changing health-care contexts on graduation. Role-emerging placements have been widely used internationally to help meet this challenge, but research into the learning experiences of students during these innovative placements is limited. This research investigated the enablers and barriers to learning from the perspectives of students on such placements from two European universities. Methods - Two separate qualitative studies tracked 10 final year students. Interviews explored their learning experiences prior to, during and after an eight- or 10-week role-emerging placement in a range of settings. Results - Four themes emerged, which were (1) adapting to less doing, more thinking and planning; (2) understanding the complexity of collaboration and making it work; (3) emotional extremes; and (4) realising and using the occupational therapy perspective. Conclusions - These placements presented a ‘roller coaster’ of authentic learning experiences which created the opportunity for students to use occupation in practice and develop skills for collaborative working in an interprofessional environment. Whereas students viewed their role-emerging placement experiences positively, challenges included the emotional responses of students and placement pace. Findings suggest the need for supportive student placement experiences in both established and role-emerging areas to prepare students for a range of opportunities in an uncertain future. Health Research Board Ireland

Gene therapy and cell therapy have followed similar roller coaster paths of rising public expectations and disappointment over the past two decades. There is now reason to believe that momentum in the field has reached the point where the successes will be more frequent. The use of gene-modified cells has opened new avenues for engineering desired cell properties, for the use of cells as vehicles for gene delivery, and for tracking cells and controlling cell persistence after transplantation. Some notable recent clinical developments in cellular engineering by gene transfer offer lessons on how the field has emerged, and hint at additional future clinical applications.

One of therapists' contemporary moral imperatives is to support American service members and their families regardless of personal position on the Global War on Terrorism. One way therapists can respond to this imperative is by seeking to understand Army wives' experiences during their husbands' wartime deployments. Therefore, this study utilized a combination of individual interviews with Army wives and a reflecting team of military wives and civilians to explore military wives' experiences. Two main themes were identified: the wives' experience was an emotional roller coaster and they felt silenced--and could be unsilenced--in their interactions with civilians. Therapists working with Army wives should (a) normalize the roller-coaster experience; (b) encourage wives to recognize negative and positive influencers and explore their idiosyncratic coping skills; (c) support positive civilian-military connections; and (d) as a civilian and as a therapist, seek to be a positive civilian connection by proactively showing support.

Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan Department of Neurosurgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan Department of Nuclear Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan College of Medicine, National Taiwan University, Taipei, Taiwan College of Medicine, Taipei Medical University, Taipei, Taiwan College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan

The risk of traumatic brain injury (TBI) while riding roller coasters has received substantial attention. Case reports of TBI around the time of riding roller coasters have led many medical professionals to assert that the high gravitational forces (G-forces) induced by roller coasters pose a significant TBI risk. Head injury research, however, has shown that G-forces alone cannot predict TBI. Established head injury criterions and procedures were employed to compare the potential of TBI between daily activities and roller coaster riding. Three dimensional head motions were measured during three different roller coaster rides, a pillow fight, and car crash simulations. Data was analyzed and compared to published data using similar analyses of head motions. An 8.05m/s car crash lead to the largest head injury criterion measure (HIC15) of 28.1 and head impact factor (HIP) of 3.41, over six times larger than the roller coaster rides of 4.1 and 0.36. Notably, the linear and rotational components of head acceleration during roller coaster rides were milder than those induced by many common activities. As such, there appears to be an extremely low risk of TBI due to the head motions induced by roller coaster rides.

Roller coaster riding subjects patrons to various gravitational forces (g‐forces) and can cause serious systemic complications not related to direct traumatic injury. Neurological sequelae include ...

The diagnosis of a malignant brain tumor can thrust a patient and family onto an emotional roller coaster. This crisis can be better managed with the help of a sensitive interdisciplinary team comprised of nurses, physicians, clinical social workers and other health care professionals. Healthcare personnel can help to provide information, support and coping strategies. Nursing and family support groups enable all involved to survive the personal and professional losses they experience.