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IntroductionHand opening is reduced by abnormal wrist and finger flexor activity in many individuals with stroke. This flexor activity also limits hand opening produced by functional electrical stimulation (FES) of finger and wrist extensor muscles. Recent advances in electrical nerve block technologies have the potential to mitigate this abnormal flexor behavior, but the actual impact of nerve block on hand opening in stroke has not yet been investigated.MethodsIn this study, we applied the local anesthetic ropivacaine to the median and ulnar nerve to induce a complete motor block in 9 individuals with stroke and observed the impact of this block on hand opening as measured by hand pentagonal area. Volitional hand opening and FES-driven hand opening were measured, both while the arm was fully supported on a haptic table (Unloaded) and while lifting against gravity (Loaded). Linear mixed effect regression (LMER) modeling was used to determine the effect of Block.ResultsThe ropivacaine block allowed increased hand opening, both volitional and FES-driven, and for both unloaded and loaded conditions. Notably, only the FES-driven and Loaded condition’s improvement in hand opening with the block was statistically significant. Hand opening in the FES and Loaded condition improved following nerve block by nearly 20%.ConclusionOur results suggest that many individuals with stroke would see improved hand-opening with wrist and finger flexor activity curtailed by nerve block, especially when FES is used to drive the typically paretic finger and wrist extensor muscles. Such a nerve block (potentially produced by aforementioned emerging electrical nerve block technologies) could thus significantly address prior observed shortcomings of FES interventions for individuals with stroke.

Background: Residual stress spatial mapping has been developed using various measurement methods, one such method comprising a multiplicity of one-dimensional slitting method measurements combined to form a two-dimensional (2D) map. However, an open question is how to best distribute the individual slitting measurements for 2D mapping. Objective: This paper investigates the efficacy of different strategies for laying out the individual slitting measurements when mapping in-plane residual stress in thin stainless steel slices removed from a larger dissimilar metal weld. Methods: Three different measurement layouts are assessed: independent measurements on nominally identical specimens (i.e., one slitting measurement per specimen, with many specimens), repeatedly bisecting a single slice, and making nominally sequential measurements from one side of the specimen towards the other side of the specimen. Additional comparison measurements are made using neutron diffraction. Results: The work shows little difference between the independent and bisecting slitting measurement layouts, and some differences with the sequential measurements. There is good general agreement between neutron diffraction measurement data and the data from the independent and bisecting layouts. Conclusions: This work suggests that when using slitting to create a 2D map of in-plane residual stress, a cutting layout that repeatedly bisects the specimen works well, requires a small number of specimens, and avoids potential errors from geometric asymmetry or measurement sequence.

Study designExpert consensus study.ObjectiveThis expert panel was created to establish best practice guidelines to identify and treat patients with poor bone health prior to elective spinal reconstruction.Summary of background dataCurrently, no guidelines exist for the management of osteoporosis and osteopenia in patients undergoing spinal reconstructive surgery. Untreated osteoporosis in spine reconstruction surgery is associated with higher complications and worse outcomes.MethodsA multidisciplinary panel with 18 experts was assembled including orthopedic and neurological surgeons, endocrinologists, and rheumatologists. Surveys and discussions regarding the current literature were held according to Delphi method until a final set of guidelines was created with over 70% consensus.ResultsPanelists agreed that bone health should be considered in every patient prior to elective spinal reconstruction. All patients above 65 and those under 65 with particular risk factors (chronic glucocorticoid use, high fracture risk or previous fracture, limited mobility, and eight other key factors) should have a formal bone health evaluation prior to undergoing surgery. DXA scans of the hip are preferable due to their wide availability. Opportunistic CT Hounsfield Units of the vertebrae can be useful in identifying poor bone health. In the absence of contraindications, anabolic agents are considered first line therapy due to their bone building properties as compared with antiresorptive medications. Medications should be administered preoperatively for at least 2 months and postoperatively for minimum 8 months.ConclusionBased on the consensus of a multidisciplinary panel of experts, we propose best practice guidelines for assessment and treatment of poor bone health prior to elective spinal reconstructive surgery. Patients above age 65 and those with particular risk factors under 65 should undergo formal bone health evaluation. We also established guidelines on perioperative optimization, utility of various diagnostic modalities, and the optimal medical management of bone health in this population.Level of Evidence: 5.

Abstract Adverse childhood experiences (ACE) have been linked to less prosocial behavior during social exclusion in vulnerable groups. However, little is known about the impact of the timing of ACE and the roles of protective factors. Therefore, this study investigated the association of the behavioral response to experimental partial social exclusion with adverse and adaptive experiences across age groups and resilience in clinical groups with persistent depressive disorder and borderline personality disorder, i.e., groups with high ACE, and in healthy controls (HC) (N = 140). Adverse and adaptive experiences during childhood, youth, and adulthood were assessed with the Traumatic Antecedents Questionnaire, and resilience was measured with the Connor Davidson Resilience Scale. A modified version of the Cyberball paradigm was used to assess the direct behavioral response to partial social exclusion. In patients, adverse events during youth (B = − 0.12, p = 0.016) and adulthood (B = − 0.14, p = 0.013) were negatively associated with prosocial behavior, whereas in the HC sample, adaptive experiences during youth were positively associated with prosocial behavior (B = 0.25, p = 0.041). Resilience did not mediate these effects. The findings indicate that critical events during youth may be particularly relevant for interpersonal dysfunction in adulthood.

Orientation: Employee job satisfaction is a widely studied concept with limited consensus on which factors of job satisfaction are most significant for tourism and hospitality employees. Specific factors of employee job satisfaction are critical to assist managers, practitioners, and academics, to enhance the levels of employee job satisfaction within national parks. Research purpose: To determine and rank the factors of job satisfaction that are most significant towards an overall job satisfaction of tourism and hospitality employees within national parks. Motivation for the study: Significant factors of job satisfaction will enable managers, practitioners, and academics to use specific factors of job satisfaction when addressing the levels of employee job satisfaction. Research approach/design and method: This article adopted a quantitative explanatory research approach using a structured e-questionnaire to collect data. The study had 211 participants. Descriptive statistics and correlation analysis were used to interpret data. Main findings: Key findings reveal that tourism and hospitality respondents within national parks have diverse demographical characteristics, and present work is among the most significant factor of job satisfaction while salary is least significant for these respondents. Practical/managerial implications: Managers and practitioners need to be specific when addressing factors of employee satisfaction. Managers need to pay more attention on employees’ present work than other factors. Contribution/value-add: This study makes a significant contribution towards the tourism employment literature because the tourism employment is associated with negative work characteristics. Managers are further provided with specific factors to measure job satisfaction.

When Jesus meets the Samaritan Woman at Jacob’s well in John 4, it is a meeting between two colonial subjects in the Roman Empire. In this encounter we find the Samaritan Woman as a triply marginalised body, a woman subject to multiple, intersecting forms of oppression within her patriarchal context. Identified as a Samaritan Woman, Jewish rabbis regarded her as unclean, impure, and being menstruous from birth. It can also be deduced that she is an outcast in her own society because she comes to draw from the well at noon, the hottest part of the day when people did not usually fetch water. This Samaritan Woman is nameless, landless and powerless in an imperial, colonial and patriarchal context. The poem of Diana Ferrus, I’ve come to take you home, in memory of Sarah Baartman, highlights how Baartman was dehumanised and treated as a sexual object by European colonisers. Through a postcolonial reading of John 4, I consider the intersections between the Samaritan Woman and the early life of Sara Baartman in their respective colonial contexts and invite the reader, as the poem invites Baartman, to come home to Africa and resist Western European imperial and colonial patterns and tendencies. Contribution: This article has interdisciplinary implications. This is an interdisciplinary study in the sense that it offers a biblical interpretation of John 4 that is informed by the life of Sara Baartman that has been uncovered through anthropology, history and sociology. It is also integrating the field of postcolonial biblical hermeneutics with the theory of intersectionality.

# Introduction Effective rehabilitation strategies for upper extremity injuries in softball pitchers are scarce in current literature, especially among youth athletes. Additionally, there continues to be ambiguity regarding the interpretation and clinical practicality when treating an overhead athlete with scapular dyskinesis. The purpose of this case report is to highlight the examination and treatment of a youth softball pitcher referred to physical therapy with the diagnosis of scapular dyskinesis. # Case Description This case report presents data and outcomes for a 14-year-old female who experienced chronic right shoulder discomfort related to performing the windmill softball pitch (WSP). The subject was clinically diagnosed with scapular dyskinesis by her referring physician and demonstrated abnormal scapular movement when elevating and lowering her upper extremity. Internal and external rotator isokinetic strength testing and the Athletic Shoulder Test (ASH) were used as primary objective measures. Both were performed six days after the initial evaluation and again six weeks later. Initial testing demonstrated decreased peak torque and total work. Initial treatment involved periscapular and shoulder strengthening with progression to overhead loading. Later rehabilitation strategies focused on neuromuscular control, functional training, and sport-specific activities. # Outcomes The subject initially demonstrated improved peak torque and total work of the shoulder with isokinetic strength testing but continued to have symptoms with pitching, even though the Scapular Dyskinesis Test had become negative. After changing the focus to neuromuscular and functional training the subject had fewer symptoms and became comfortable with self-management. # Discussion This case matches previous research that endorses scapular dyskinesis being a normal finding in overhead athletes with and without shoulder pain. Neuromuscular control and functional training after a period of scapular strengthening were beneficial in improving symptoms in this athlete. # Level of Evidence 5

Plant diversity varies immensely over large-scale gradients in temperature, precipitation, and seasonality at global and regional scales. This relationship may be driven in part by climatic variation in the relative importance of abiotic and biotic interactions to the diversity and composition of plant communities. In particular, biotic interactions may become stronger and more host specific with increasing precipitation and temperature, resulting in greater plant species richness in wetter and warmer environments. This hypothesis predicts that the many defensive compounds found in plants’ metabolomes should increase in richness and decrease in interspecific similarity with precipitation, temperature, and plant diversity. To test this prediction, we compared patterns of chemical and morphological trait diversity of 140 woody plant species among seven temperate forests in North America representing 16.2°C variation in mean annual temperature (MAT), 2,115 mm variation in mean annual precipitation (MAP), and from 10 to 68 co-occurring species. We used untargeted metabolomics methods based on data generated with liquid chromatography-tandem mass spectrometry to identify, classify, and compare 13,480 unique foliar metabolites and to quantify the metabolomic similarity of species in each community with respect to the whole metabolome and each of five broad classes of metabolites. In addition, we compiled morphological trait data from existing databases and field surveys for three commonly measured traits (specific leaf area [SLA], wood density, and seed mass) for comparison with foliar metabolomes. We found that chemical defense strategies and growth and allocation strategies reflected by these traits largely represented orthogonal axes of variation. In addition, functional dispersion of SLA increased with MAP, whereas functional richness of wood density and seed mass increased with MAT. In contrast, chemical similarity of co-occurring species decreased with both MAT and MAP, and metabolite richness increased with MAT. Variation in metabolite richness among communities was positively correlated with species richness, but variation in mean chemical similarity was not. Our results are consistent with the hypothesis that plant metabolomes play a more important role in community assembly in wetter and warmer climates, even at temperate latitudes, and suggest that metabolomic traits can provide unique insight to studies of trait-based community assembly.

Federal Educational Institutes (Bundeserziehungsanstalt) represented the avant-garde of state school reform after WWI in Austria. How does the school cinema of the Bundeserziehungsanstalt Vienna-Breitensee inscribe itself in the reform-pedagogy complex of “wholeness” and “naturalness”? And: What does this mean for teaching practice or the pedagogical dispositif of educational films? As the author will argue, the concept of holistic education puts a wrench into the concept of an educational performance dispositif as narrowed by Frank Kessler to the space and time of educational media performance.

Abstract Background To report the technique and outcome of ultrasound-guided percutaneous access to the superior mesenteric vein (SMV) for balloon-assisted portal vein recanalization–transjugular intrahepatic portosystemic shunt (PVR-TIPS) in a patient with chronic portal venous and splenic vein occlusion. Case presentation A 51-year-old, non-cirrhotic patient with severe portal hypertension was admitted for PVR-TIPS. Neither splenic nor hepatic access was feasible due to chronic portal and splenic vein occlusion. Percutaneous ultrasound-guided direct puncture of the SMV was performed to obtain access for balloon-assisted PVR-TIPS. The transmesenteric approach in combination with a balloon puncture technique for PVR-TIPS was successful, and no immediate complications were observed post-procedure. The subsequent follow-up exams showed patent TIPS and SMV without signs of intraabdominal hemorrhage. Conclusion Percutaneous ultrasound-guided superior mesenteric vein access for balloon-assisted PVR-TIPS is a feasible option in cases where hepatic or splenic access is not.

The contribution presents in a first step those pedagogical and aesthetic concepts that have played an essential role in the development of the Kulturfilm (cultural film) as well as in its differentiation from the educational and instructional film. In a second step, from the perspective of educational science, we will examine which meaninggiving parameters also determine the pedagogical dispositive of (moving) images, which modalities of showing enable experience and learning, and which processes the (learning) subject goes through. In recent years, these questions have increasingly been linked to an examination of the term of attention (Neuendank, 2022). After an introduction to the concept of attention, it will be applied to a reading sketch of the Kulturfilm “Die Wunder des Films” which had selected and newly reassembled previously known educational and Kulturfilm material along a teaching of cinematic recording processes.

Adrienne Malik,1 Olga Dewald,2 John Gallien,3 Mark Favot,3 Adam Kasten,5 Brian Reed,6 Robert Wells,5 Robert R Ehrman4 1Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, MO, 66160, USA; 2Department of Emergency Medicine, Sparrow Hospital, Lansing, MI, 48912, USA; 3Department of Emergency Medicine, DMC Detroit Receiving Hospital, Detroit, MI, 48201, USA; 4Department of Emergency Medicine, DMC Sinai Grace Hospital, Detroit, MI, 48235, USA; 5Department of Emergency Medicine, DMC Harper Hospital, Detroit, MI, 48201, USA; 6Department of Emergency Medicine, Wayne State University, Detroit, MI, 48201, USACorrespondence: Adrienne Malik, Department of Emergency Medicine, University of Kansas Medical Center, 4000 Cambridge St, Kansas City, MO, 66160, USA, Email amalik3@kumc.edu; adriennemalikmd@gmail.comBackground: Patients with difficult peripheral intravenous (IV) access are common in emergency departments (EDs). Ultrasound-guided peripheral intravenous catheters (USIVs) are frequently used in this population; however, information regarding the effect of patient and IV characteristics on the dwell time (DT) and survival probability (SP) of USIVs is limited.Objective: Our study aimed to evaluate for associations between patient or IV characteristics and the DT and SP of USIVs.Methods: Retrospective analysis was performed on a database from an ED nurse (RN) USIV training program at an urban, academic hospital. Patients over 18 years with an USIV placed during the study period were included. Subject demographics, history, IV characteristics, insertion, and removal times were collected. Data were analyzed using descriptive statistics and univariable and multivariable Cox regression. USIV survival times for variates of interest were estimated using Kaplan–Meier curves for three censoring points.Results: The final analysis cohort was 388 patients. Mean age was 56.6 years, 66.5% were female, mean BMI was 29.9 kg/m2, and 42.5% were obese (BMI ≥ 30). Median DT was 40.3 hours in admitted patients (N=340). SP for USIVs at 96 hours was 87.8%. A total of 21 of 340 (6.2%) USIVs failed. USIV location conferred a difference on DT in obese patients when dichotomized into upper arm versus antecubital fossa and forearm together (38.6 hours vs 44.6 hours, p=0.03). No factors were associated with a difference in USIV SP.Conclusion: Median USIV DT of 40.3 hours for admitted patients was higher than in previous studies. Only 7% of USIVs in our study failed. Overall, catheters survived longer than expected.Keywords: ultrasound, peripheral IV, retrospective, emergency medicine, vascular access