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Health Canada and the Food and Drug Administration (FDA) in the United States have recently issued warnings pertaining to the use of gadolinium-based magnetic resonance contrast agents in patients with renal insufficiency. A strong temporal relationship between the administration of gadolinium agents and the development of nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis in this patient cohort has been established. This study presents a review of the literature, description of the disease, and discussion of possible contributing co-factors to its development. Best practice recommendations are provided for medical radiation technologists for management of patients with renal insufficiencies that may need to undergo magnetic resonance imaging with a gadolinium-based magnetic resonance contrast agent.

Spinosad is an insect control agent that is derived from a naturally occurring soil bacterium and is effective on several classes of insects, especially Lepidopteran larvae. Spinosad is registered in many countries for use on a variety of crops, including cotton, corn, soybeans, fruits, and vegetables. Residue methods utilizing a magnetic particle-based immunoassay (IA) test kit have been developed and validated for determining spinosad in environmental and food matrices. These methods involve an extraction of the residues from the matrices with appropriate solvents. For some matrices, the sample extracts can be diluted and measured directly by IA without any cleanup. For other matrices, sample extracts are purified using liquid-liquid partitioning and/or solid phase extraction prior to measurement by IA. The methods determine the total residue of spinosad, which includes the active ingredients (spinosyns A and D) and several minor metabolites, including spinosyn B, spinosyn K, and N-demethylspinosyn D. The methods have validated limits of quantitation of 0.0001 microgram/mL in water, 0.05 microgram/g in sediment, and 0.010 microgram/g in crops, crop processed commodities, and animal tissues. This paper briefly summarizes the residue methodology and method validation data for spinosad in 34 food, feed, and environmental matrices.

Objective Understand patients’ experiences with primary care services for congestive heart failure (CHF) and explore the relationship between health services and self-management. Methods We conducted semi-structured interviews with thirty-nine patients with CHF receiving care at one Veterans Affairs Medical Center (VA). We analyzed data using thematic content analysis. Results Participants acknowledged the importance of ongoing engagement in the plan of care for CHF. They attributed success in this effort to be greatly influenced by personal advocates. The advocates included both members of the healthcare team with whom they had a continuity relationship and friends or family members who assisted on a daily basis. Participants also identified psychological symptoms as a major barrier to carrying out self-care. Conclusion Patients identify relationships with health care workers, help from family and friends, and mental health problems as major influences on the ability to manage their CHF. Practice implications Efforts to optimize CHF self-management should attend to health system and psychosocial barriers to care.

Objective To describe the use of the internal mammary vessels (IMVs) in microvascular head and neck reconstruction in a small case series with select donor sites. Design Retrospective medical record review study. Setting Oregon Health and Science University and University of Alabama. Patients Patients for whom IMVs were used for head and neck reconstruction from January 1, 1998, through December 31, 2010. Main Outcome Measures Intraoperative or postoperative complications, flap survival, and morbidity due to the flap. Results Of 2721 free tissue transfers, 55 (2%) (in 48 patients) used IMVs. Use of IMVs was associated with ablative surgery with sternal resection (25 of 55 [45%]), a vessel depleted neck (23 of 55 [42%]), and fistula repair with gross contamination due to prior flap failure or chronic pharyngocutaneous fistula with vessel depleted neck (7 of 55 [13%]). Flaps included radial forearm (33 of 55 [60%]), jejunum (9 of 55 [16]), ulnar (5 of 55 [9%]), and other (8 of 55 [14%]). No vein grafts were used. Pneumothorax developed in 1 patient (2%). Postoperative fistulas were observed in 14 of 48 patients (29%); the fistulas healed conservatively in 7 patients (50%), rotation of flap tissue was required in 2 patients (14%), and the fistulas persisted in 5 patients (36%). The flap survival rate was 98%. Conclusion Internal mammary vessels provide reliable recipient vessels for cervical and sternal microvascular reconstruction.

Functional electrical stimulation (FES) may improve recovery after stroke. We studied its effects in 38 postcerebral infarct patients. Twenty were randomly assigned to receive FES producing ankle dorsiflexion on the affected side and physical therapy. The remaining 18 received physical therapy only. Subjects were evaluated prior to commencing therapy, at its completion after 4 weeks, and again 4 weeks later using functional and electrophysiological measures. Functional deficit in most patients improved (p < 0.01). Although no significant differences were observed when those treated with FES and those not treated were compared at 4 and 8 weeks, there was significant improvement in the rate of recovery using an ambulation score (p < 0.05), and there was a similar trend in the Barthel Index for FES-treated patients (p < 0.1). Our results indicate that FES may confer additional benefit in acute stroke rehabilitation. Further studies are needed to delineate how best to use it.

ROBB K. & EWER-SMITH C. (2010) European Journal of Cancer Care19, 5 The role of therapies in managing cancer-related pain Cancer pain is complex and multi-dimensional and requires a multi-disciplinary team approach. Therapists have an important role in the assessment and management of patients with cancer-related pain, but the challenge remains to practise in an evidence-based way.

The clinical clerkship in Canadian Medical Schools is intended to provide senior medical students with opportunities to gain practical knowledge of clinical medicine, develop technical skills, learn to use judgement and experience first-hand clinical decision making. Assessment of rotations in internal medicine were undertaken in order to understand more fully the nature of medical clerkship experiences. We found that medical clerks in our programme were exposed to a high proportion of undifferentiated problems and an adequate case mix. They performed a wide range of technical procedures. There were, however, certain gaps in the clerks' experiences both in the specialty areas, and in therapeutic and technical procedures. Recognition of these gaps in the clerkship experiences suggests that further deliberation of goals and objectives is required and issues of achievement of competencies need to be addressed.

Event-related fMRI was employed to contrast the neural activity elicited in prefrontal cortex during recognition memory and exclusion tests. The study phases preceding each memory test were identical, involving the presentation of study items (visually presented words) in one of two study contexts. For the recognition test subjects were required to respond positively to all old items regardless of study context, and to respond negatively to new items. For the exclusion task, positive responses were required to old items presented in one of the study contexts only; negative responses were required both to unstudied items and studied items from the alternative context (non-targets). No prefrontal region demonstrated greater activity for new items in the exclusion task. Thus, there was no evidence that retrieval cues were processed differently according to the specificity of the sought-for information. In several regions, most notably bilateral anterior prefrontal cortex, activity was greater for old than for new items regardless of task. Activity in right dorsolateral prefrontal cortex was also greater for old than for new items; these effects however were larger in the exclusion task. The findings are consistent with previous reports that activity in anterior prefrontal cortex elicited by recognition retrieval cues is sensitive to retrieval success, and extend these findings to the exclusion task. The findings for the right dorsolateral cortex add further weight to the proposal that this region supports post-retrieval monitoring of retrieved information.

Spinosad is an insect control agent that is derived from a naturally occurring soil bacterium and has a high level of activity against insects that infest a variety of crops. Dairy and poultry feeding studies were conducted to determine the magnitude of spinosad residues in animal products that would result from the consumption of typical feed commodities containing residues of spinosad. Dairy cows were dosed for 28 days with spinosad at rates equivalent to 0, 1, 3, and 10 μg/g in the diet. Chicken hens were dosed for 42 days with spinosad at rates equivalent to 0, 0.1, 0.3, 1, and 5 μg/g in the diet. Milk, eggs, and tissue samples were analyzed by high-performance liquid chromatography and/or immunoassay methods. Spinosad residues occurred in all of the sample types but were lowest in eggs, skim milk, and lean meat and were highest in the fat. Keywords: Spinosad; spinosyn; residues; beef; chicken; meat; milk; eggs

The alien hand syndrome has been associated with different descriptions of abnormal motor behavior. We report on two patients with transient left hemiparesis who remained with limb apraxia and were particularly impaired by a variety of involuntary skilled movements of their apractic limb. After the report and a review of the literature, we discuss the presence of one type of abnormal movement observed in this syndrome. These movements resemble the mirror movements seen in the normal development of motor control and in some pathologic conditions later. Their appearance in the alien hand syndrome seems to demand both intrahemispheric and interhemispheric motor pathway damage.